Prevalence of primary dysmenorrhea and associated factors in adult women.

OBJECTIVE: This study aimed to assess the prevalence and factors associated with primary dysmenorrhea in a sample of adult women. METHODS: A cross-sectional study was carried out with women aged between 19 and 49 years from a city of northeastern Brazil. Sociodemographic, gynecological, and obstetric variables were assessed by questionnaires and interviews. Dysmenorrhea was measured by self-report, and the Numerical Pain Rating Scale measured the intensity of pain. Statistical analyses included χ2 test, ANOVA, and logistic regression. RESULTS: The average age was 33.2±9.1 years and the prevalence of primary dysmenorrhea was 56% for the whole sample. The average duration of symptoms was 2.7±1.8 days and the mean intensity was 6.1±2.6. The previous cesarean section was associated with a higher rate of primary dysmenorrhea (PR=2.33; 95%CI 1.11-4.90) when considering the whole sample. Women who aged 25-39 years and are insufficiently active had higher rates of primary dysmenorrhea (PR=5.24; 95%CI 1.08-27.31). CONCLUSION: Primary dysmenorrhea has a high prevalence in young adults, adults, and middle-aged women. Cesarean section and being physically inactive was associated with increased rates of dysmenorrhea among adult women.

Prevalence of primary dysmenorrhea and associated factors in adult women

SUMMARY OBJECTIVE: This study aimed to assess the prevalence and factors associated with primary dysmenorrhea in a sample of adult women. METHODS: A cross-sectional study was carried out with women aged between 19 and 49 years from a city of northeastern Brazil. Sociodemographic, gynecological, and obstetric variables were assessed by questionnaires and interviews. Dysmenorrhea was measured by self-report, and the Numerical Pain Rating Scale measured the intensity of pain. Statistical analyses included χ2 test, ANOVA, and logistic regression. RESULTS: The average age was 33.2±9.1 years and the prevalence of primary dysmenorrhea was 56% for the whole sample. The average duration of symptoms was 2.7±1.8 days and the mean intensity was 6.1±2.6. The previous cesarean section was associated with a higher rate of primary dysmenorrhea (PR=2.33; 95%CI 1.11-4.90) when considering the whole sample. Women who aged 25-39 years and are insufficiently active had higher rates of primary dysmenorrhea (PR=5.24; 95%CI 1.08-27.31). CONCLUSION: Primary dysmenorrhea has a high prevalence in young adults, adults, and middle-aged women. Cesarean section and being physically inactive was associated with increased rates of dysmenorrhea among adult women.

Construction and validation of a logical model for specialized Rehabilitation Centers.

OBJECTIVE: To build and validate a logical model for health care in Specialized Rehabilitation Centers (CER) by analyzing the work process and organizational issues of centers in Rio Grande do Norte. METHODS: This is a methodological study developed in three stages: 1) documentary research of legislation and ordinances concerning the healthcare service and the Disability Care Network (RCPD); 2) focus groups with a Census study of the CER in Rio Grande do Norte to understand and assess the daily activities of the service; and 3) systematization of the information collected and, finally, proposition and validation of the evaluative logical model. RESULTS: The model encompassed five central categories of the work and organizational process: "demands", "resources" (inputs, financial and workforce), "processes", "products and results" and "mission, values and external factors". CONCLUSION: The logical model built was suitable for graphical representation of the work process and organizational issues of the SRC. The study showed that the functioning of the services is in line with the regulations. However, there are still organizational gaps that need to be addressed to improve the resolution capacity of the service and the articulation with other points of the network.

Functioning of women in the postpartum period: an International Classification of Functioning, Disability and Health-based consensus of physical therapists.

BACKGROUND: Physical therapists provide treatment for pain and other common complaints for women in the postpartum period, thereby contributing to the improvement of their functioning. However, before applying any interventions, physical therapists should assess their patients to identify the desired therapeutic goals. In this context, the International Classification of Functioning, Disability and Health (ICF) may be a useful tool for documenting functioning data and operationalizing collaborative goal setting. OBJECTIVE: To identify ICF categories and the respective domains that should be considered in the evaluation of women postpartum. METHODS: A consensus-building, three-round e-mail survey was conducted using the Delphi method. The sample included Brazilian physical therapists with expertise in women's health. Meaningful content was analyzed in accordance to the ICF linking rules. The kappa coefficient and content validity index (CVI) were calculated. RESULTS: The panel consisted of 45 participants with a median age of 33 years and more than 10 years of experience in women's health. A total of 1261 meaningful contents were identified from the responses in the first round. After consensus was achieved, a final list of 62 items was prepared, including 53 categories (11 were on structures; 15 on body functions; 12 on activities and participation; 15 on environmental factors) and nine personal factors (CVI=0.89). CONCLUSION: From the perception of physical therapists, an ICF-based postpartum assessment to describe functioning and disability must comprise 53 ICF categories and nine personal factors.

Estratégias de humanização da assistência no ambiente hospitalar: revisão integrativa / Strategies for humanizing assistance in the hospital environment: an integrative review / Estrategias para humanizar la asistencia en el entorno hospitalario: unarevisión integrativa

Introdução:Este artigo apresenta uma revisão integrativada literatura referente às estratégias de humanização no ambiente hospitalar. Objetivo:Identificar e analisar a produção de conhecimento acerca das estratégias que as instituições e profissionais de saúde têmimplementado para humanizar a assistência nesse ambiente.Metodologia:O levantamento de artigos foi realizado via Lilacs, MedLine, Portal de Periódicos da Capes e SciELOorientado pela questão norteadora: quais as estratégias de humanização da assistência que têm sido implementadas no ambiente hospitalar? Foram incluídos artigos originais de pesquisa observacional; publicados em português, inglês ou espanhol; sem limites quanto ao ano de publicação.Resultados:No total, 19artigos compuseram o corpo de análise da revisão e sintetiza exemplos de estratégias implementadas em diversos serviços hospitalares:práticas lúdicas no cuidado através de brinquedos, projetos como Biblioteca Viva, terapias através de palhaços e animais,músicas, e a leitura mediada. Conclusões:As estratégiasde humanizaçãoencontradas oferecem subsídios para que profissionais e gestores possam multiplicar tais estratégias de humanização de modo aampliare melhorara sua realidade.Porém, cabe observar que ao criá-lasdeve-se conhecer e respeitar a particularidade das instituições em que está se operando, para que seja possível comparar e avaliar se a utilização resultará em benefícios e eficácia (AU).

Introduction:This article presents an integrative literature review regarding humanization strategies in the hospital environment. Objective:To identify and analyze the production of knowledge about the strategies that institutions and health professionals have implemented to humanize care in this environment.Methodology:The survey of articles was carried out through Lilacs, MedLine, Portal de Periódicos da Capes and SciELO guided by the guiding question: what strategies of humanization of care have been implemented in the hospital environment? Original articles of observational research were included; published in Portuguese, English or Spanish; without limits as to the year of publication.Results:In total, 19 articles comprised the content of the review analysis and summarizes examples of strategies implemented in various hospital services: playful practices in care through toys, projects such as Biblioteca Viva, therapies through clowns and animals, music, and reading mediated.Conclusions:The humanization strategies found offer subsidies so that professionals and managers can multiply such humanization strategies in order to expand and improve their reality. However, it should be noted that when creating them, one must know and respect the particularity of the institutions in which they are operating, so that it is possible to compare and evaluate whether the use will result in benefits and effectiveness (AU).

Introducción:Este artículo presenta una revisión integradora de la literatura sobre estrategias de humanización en el ámbito hospitalario.Objetivo:Identificar yanalizar la producción de conocimiento sobre las estrategias que las instituciones y los profesionales de la salud han implementado para humanizar el cuidado en este entorno.Metodología:La encuesta de artículos se realizó a través de Lilacs, MedLine, Portal de Periódicos da Capes y SciELO guiada por la pregunta orientadora: ¿qué estrategias de humanización del cuidado se han implementado en el ámbito hospitalario? Se incluyeron artículos originales de investigación observacional; publicado en portugués, inglés o español; sin límites en cuanto al año de publicación.Resultados:En total, 19 artículos cubren el contenido del análisis de la revisión y sintetizan ejemplos de estrategias implementadas en diferentes servicios hospitalarios: prácticas lúdicas enel cuidado a través de juguetes, proyectos como Biblioteca Viva, terapias a través de payasos y animales, música y lectura mediado.Conclusiones:Las estrategias de humanización encontradas ofrecen subvenciones para que los profesionales y directivos puedan multiplicar dichas estrategias de humanización con el fin de ampliar y mejorar su realidad. Sin embargo, cabe señalar que al crearlos se debe conocer y respetar la particularidad de las instituciones en las que se encuentran operando, de manera que sea posible comparar y evaluar si el uso redundará en beneficios y efectividad (AU).

Construction and validation of a logical model for specialized Rehabilitation Centers / Construção e validação de modelo lógico para Centros Especializados em Reabilitação

ABSTRACT OBJECTIVE To build and validate a logical model for health care in Specialized Rehabilitation Centers (CER) by analyzing the work process and organizational issues of centers in Rio Grande do Norte. METHODS This is a methodological study developed in three stages: 1) documentary research of legislation and ordinances concerning the healthcare service and the Disability Care Network (RCPD); 2) focus groups with a Census study of the CER in Rio Grande do Norte to understand and assess the daily activities of the service; and 3) systematization of the information collected and, finally, proposition and validation of the evaluative logical model. RESULTS The model encompassed five central categories of the work and organizational process: "demands", "resources" (inputs, financial and workforce), "processes", "products and results" and "mission, values and external factors". CONCLUSION The logical model built was suitable for graphical representation of the work process and organizational issues of the SRC. The study showed that the functioning of the services is in line with the regulations. However, there are still organizational gaps that need to be addressed to improve the resolution capacity of the service and the articulation with other points of the network.

RESUMO OBJETIVO Construir e validar um modelo lógico para a atenção nos Centros Especializados em Reabilitação (CER) a partir da análise do processo de trabalho e de questões organizativas de centros do Rio Grande do Norte. MÉTODOS Estudo metodológico desenvolvido em três etapas: 1) estudo documental de legislações e portarias relacionadas ao serviço de saúde e à Rede de Cuidados à Pessoa com Deficiência (RCPD); 2) realização de grupos focais, com estudo censitário dos CER do Rio Grande do Norte, para compreender e avaliar o cotidiano do serviço; e 3) sistematização das informações coletadas e, por fim, proposição e validação do modelo lógico avaliativo. RESULTADOS O modelo englobou cinco categorias centrais do processo de trabalho e organizacional: "demandas", "recursos" (insumos, financeiros e força de trabalho), "processos", "produtos e resultados" e "missão, valores e fatores externos". CONCLUSÃO O modelo lógico construído foi adequado para representação gráfica do processo de trabalho e questões organizativas dos CER. Evidenciou-se que o funcionamento dos serviços está alinhado com as normativas. Contudo, ainda há lacunas organizacionais que precisam ser abordadas a fim de melhorar a resolutividade do serviço e a articulação com outros pontos da rede.

Is Constipation Associated with Worse Functioning in Adult Women? A Cross-Sectional Study.

OBJECTIVE: The aim of this study is to analyze the relationship between intestinal constipation and functioning in adult women living in a municipality in the interior of northeast Brazil. MATERIALS AND METHODS: This is a cross-sectional study conducted with 195 adult women in the city of Santa Cruz-RN. Constipation was diagnosed using the Rome III criteria. Functioning was measured through WHODAS 2.0. Social conditions, habits and lifestyle were also investigated. Inferential analysis was performed using the chi-squared test and the Mann-Whitney U-test, and the effect size was determined by eta squared (η2). Multivariate analysis was performed using multiple linear regression to analyze the relationship between the WHODAS total score and constipation, being adjusted by covariates with p≤0.20 in the bivariate. A statistical significance level of p<0.05 was considered. RESULTS: Most of the participants in this study were aged 19 to 39 years (69.7%) and had an income of up to 1 minimum monthly salary (79.5%). WHODAS scores showed that women with constipation had more disability in the cognitive (p <0.001), mobility (p <0.002), self-care (p <0.001), and participation (p <0.001) domains, as well as the total score (p <0.001). After multiple linear regression analysis, the total WHODAS score remained associated with constipation (p <0.001), in which this condition increases the score by nine points. CONCLUSION: The results of this study show that there is a reduction in functioning associated with the presence of constipation in adult women, mainly affecting the cognition, mobility, self-care and participation domains, in addition to the total score.

Sexual function and functioning of women in reproductive age / Função sexual e funcionalidade de mulheres em idade reprodutiva / Función sexual y funcionalidad de las mujeres en edad reproductiva

Abstract Introduction: Sexual function (SF) is an important issue in women's health from the beginning of sexual life. SF can be modified by several factors, and the presence of sexual dysfunction may negatively affect the quality of life of these women. Objective: This study aimed to investigate the sexual function, its associated factors and the association with the functioning in women in reproductive age. Method: A cross-sectional observational study with 172 women that attended 6 Family Health Facilities in the northeast region of Brazil. The evaluation tool consisted of (i) sociodemographic, obstetrical and gynecological issues, and questions about habits and health conditions, (ii) female sexual quotient (FSQ), and (iii) World Health Organization Assessment Schedule 2.0 (WHODAS 2.0). Prevalence of sexual dysfunction was calculated, and bivariate analysis was used to estimate the association of independent variables with the outcome of sexual dysfunction. Results: The prevalence of sexual dysfunction was 37.2%, and 39.5% of the sample considered their sexual health as fair to good. In total, 26.2% of women never think of sex spontaneously, they do not remember or imagine themselves during sexual intercourse, and 38.4% think about it sometimes. No association was found between the investigated variables and sexual dysfunction; however, the latter showed an association on interpersonal relationships of women (p = 0.016). Conclusions: There is a considerable prevalence of sexual dysfunction between women in reproductive age. Thus, results emphasize the relevance of investigations about female sexual function among women in reproductive age that are not in the pregnancy and postpartum period.

Resumo Introdução: A função sexual (FS) é uma questão importante na saúde das mulheres a partir do início da vida sexual. A FS pode ser modificada por vários fatores e na presença de disfunção sexual poderá afetar negativamente a qualidade de vida dessas mulheres. Objetivo: investigar a prevalência da disfunção sexual, os fatores associados em mulheres em idade fértil e o impacto dessa disfunção na funcionalidade. Método: Trata-se de um estudo observacional transversal com 172 mulheres atendidas em seis Unidades de Saúde da Família no nordeste do Brasil. A ferramenta de avaliação consistiu em (i) questões sociodemográficas, obstétricas e ginecológicas e perguntas sobre hábitos e condições de saúde, (ii) quociente sexual feminino (QSF) e (iii) World Health Organization Assessment Schedule 2.0 (WHODAS 2.0). A prevalência de disfunção sexual foi calculada e a análise bivariada foi utilizada para estimar a associação de variáveis independentes com o desfecho disfunção sexual. Resultados: A prevalência de disfunção sexual foi de 37,2%, e 39,5% da amostra considerou sua saúde sexual como regular ou boa. Desse total, 26,2% das mulheres nunca costumam pensar espontaneamente em sexo, nem se lembram ou se imaginam durante a relação sexual e 38,4% pensam apenas às vezes. Não foi encontrada associação entre as variáveis estudadas e a disfunção sexual, porém esta mostrou impacto nas relações interpessoais das mulheres (p = 0,016). Conclusão: Há considerável prevalência de disfunção sexual entre as mulheres com idade reprodutiva. Destaca-se a relevância de investigações acerca da função sexual feminina entre mulheres em idade reprodutiva e que não estejam no ciclo gravídico-puerperal..

Resumen Introducción: La función sexual (FS) es un tema importante para la salud de las mujeres desde el comienzo de su vida sexual. La FS puede ser modificada por varios factores, y en presencia de disfunción sexual puede afectar negativamente la calidad de vida de estas mujeres. Objetivo: Investigar la prevalencia de la disfunción sexual, los factores asociados en las mujeres en edad reproductiva y el impacto de esta disfunción en el funcionamiento. Método: Estudio observacional transversal con 172 mujeres que recibían atención en seis Unidades de Salud de la Familia en la región Nordeste de Brasil. La evaluación consistió en: (i) cuestiones sociodemográficas, obstétricas y ginecológicas, preguntas sobre hábitos y condiciones de salud; (ii) cociente sexual femenino; y (iii) WHODAS 2.0. Se calculó la prevalencia de la disfunción sexual y se utilizó el análisis bivariado para estimar la asociación de variables independientes con el resultado de la disfunción sexual. Resultados: La prevalencia de disfunción sexual fue del 37,2%, y el 39,5% de la muestra consideró su salud sexual como regular o buena. El 26,2% de las mujeres nunca suelen pensar espontáneamente en el sexo, ni se acuerdan o se imaginan durante la relación sexual y el 38,4% piensan apenas a veces. No se encontró asociación entre las variables estudiadas y la disfunción sexual, pero ésta mostró impacto en las relaciones interpersonales de las mujeres (p = 0,016). Conclusión: Hay una considerable prevalencia de disfunción sexual entre mujeres en edad reproductiva. Se destaca la relevancia de investigaciones acerca de la función sexual femenina entre mujeres en edad reproductiva y que no estén en el ciclo gravídico-puerperal.

Linking of assessment scales for women with urinary incontinence and the International Classification of Functioning, Disability and Health.

PURPOSE: This study aimed to link the content of four most used questionnaires to assess the quality of life of women with urinary incontinence (International Consultation on Incontinence Questionnaire; King's Health Questionnaire; Incontinence Quality of Life Questionnaire and Bristol Female Urinary Tract Symptoms Questionnaire) with the International Classification of Functioning, Disability and Health (ICF). METHODS: Linking the questionnaires content and the ICF was performed by two independent reviewers, with an excellent concordance level (k = 0.941), using the method described by Cieza et al. RESULTS: A total of 94 items were analyzed, in which 154 meaningful concepts were identified and linked to 48 ICF categories, of which 49% were from activities and participation component (d) and 36.8% from body functions (b). CONCLUSIONS: The scales are linked with the classification at different levels. The International Consultation on Incontinence Questionnaire was the most limited instrument. Bristol Female Urinary Tract Symptoms Questionnaire and Incontinence Quality of Life Questionnaire presented greater agreement with the ICF, but the concepts in their items are mostly linked to body functions, denoting a biomedical vision. King's Health Questionnaire demonstrated greater affinity with the ICF, and most concepts were related to the activities and participation categories, approaching more effectively the biopsychosocial model. Implications for Rehabilitation Choosing the right instrument to assess the quality of life of women with urinary incontinence can be a difficult task, since the instruments have different approaches. The use of International Classification of Functioning, Disability and Health as a reference among health professionals involved in rehabilitation of women with urinary incontinence will promote unification of the language about this group functioning. The comparison among instruments presented here will help the professional to choose the one that provides the greatest amount of information in a consistent way, aiding the clinical decision-making process.

Identificação de Conceitos da Classificação Internacional de Funcionalidade, Incapacidade e Saúde em Medidas de Qualidade de Vida para o Câncer do Colo do Útero / Identification of Concepts of the International Classification of Functioning, Disability and Health in Measures of Quality of Life for Cervical Cancer / Identificación de Conceptos de la Clasificación Internacional de Funcionamiento, Discapacidad y Salud en Medidas de Calidad de Vida para Cáncer del Cuello Uterino

Introdução: O câncer do colo do útero apresenta elevada incidência em países de baixa e média rendas e provoca repercussões negativas sobre a funcionalidade das mulheres. O interesse na mensuração de medidas terapêuticas, que não se restrinjam às medidas do modelo biomédico, vem assumindo destaque no campo da oncologia. A Classificação Internacional de Funcionalidade (CIF) aparece no cenário mundial como ferramenta de orientação para construção da avaliação biopsicossocial. Objetivo: Exemplificar a metodologia para identificação dos componentes da funcionalidade em escalas específicas utilizadas no cuidado oncológico para mulheres com câncer do colo do útero. Método: Estudo realizado em três etapas: análise de revisões sistemáticas para identificação dos instrumentos específicos para avaliação de câncer do colo do útero; extração das medidas de avaliação; e ligação dos conceitos contidos nas medidas de desfecho com as categorias correspondentes da CIF por dois revisores independentes. Resultados: Na análise do Functional Assessment of Cancer Therapy-Cervix e da European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire Cervical Cancer Module, identificaram-se 72 conteúdos principais ligados a 35 categorias da CIF. Destas, 23 referiam-se às funções corporais, oito às atividades e participação, três aos fatores ambientais e uma à estrutura corporal. Conclusão: Os dois instrumentos possuem ligação com a CIF, no entanto, exploram de forma insuficiente os fatores contextuais, o que demonstra a necessidade de orientação biopsicossocial nas avaliações em saúde para mulheres com câncer do colo do útero de maneira a contemplar, de forma equânime, os componentes da funcionalidade na aferição dos desfechos terapêuticos.

Introduction: Cervical cancer is highly prevalent in low- and middle-income countries and has a negative impact on women's functioning. The interest in the measurement of therapeutic measures that are not restricted to the biomedical model has been assuming prominence in the field of Oncology. The International Classification of Functioning (ICF) appears on the world stage as a guiding tool for the construction of the biopsychosocial evaluation. Objective: To exemplify methodology for identifying the components of functioning in documents used in oncology care in cervical cancer. Method: Three-step study - Analysis of systematic reviews to identify the specific instruments for cervical cancer; extraction of evaluation measures; and linking the concepts contained in the outcome measures with the corresponding categories of ICF by two independent reviewers. Results: In the analysis of the Functional Assessment of Cancer Therapy-Cervix and the European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire Cervical Cancer Module, we identified 72 main contents, related to 35 categories of ICF. Of these, 23 referred to bodily functions, eight to activities and participation, tree to environmental factors and an to a body structure. Conclusion: The two instruments have a link with the ICF; however, they exploit insufficiently the contextual factors, which demonstrates the need for biopsychosocial guidance in health assessments for women with cervical cancer, to contemplate the components of functioning in the measurement of therapeutic outcomes equitably.

Introducción: El cáncer de cuello de útero es altamente incidente en los países de baja y media renta y repercute negativamente en la funcionalidad de las mujeres. El interés en la medición de medidas terapéuticas que no se restrinjan a las medidas del modelo biomédico viene asumiendo destaque en el campo de la Oncología. La Clasificación Internacional de Funcionalidad (CIF) aparece en el escenario mundial como herramienta de orientación para la construcción de la evaluación biopsicosocial. Objetivo: Ejemplificar metodología para identificar los componentes de la funcionalidad en documentos utilizados en el cuidado oncológico en el cáncer del cuello del útero. Método: Estudio realizado en tres etapas: Análisis de revisiones sistemáticas para la identificación de los instrumentos específicos para el cáncer de cuello de útero; extracción de las medidas de evaluación; y conexión de los conceptos contenidos en las medidas de desenlace con las categorías correspondientes de la CIF por dos revisores independientes. Resultados: En el análisis del Functional Assessment del Cáncer Terapia-Cervix y de la European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire Cervical Cancer Module se identificaron 72 contenidos principales, vinculados a 35 categorías de la CIF. De estas, 23 se referían a las funciones corporales, ocho a las actividades y participación, tres a los factores ambientales y una a la estructura corporal. Conclusión: Los dos instrumentos poseen conexión con la CIF, sin embargo, explotan de forma insuficiente los factores contextuales, lo que demuestra la necesidad de orientación biopsicosocial en las evaluaciones en salud para mujeres con cáncer del cuello del útero, para contemplar de forma ecuánime los componentes de la funcionalidad en la comparación de los resultados terapéuticos .