The Obesity and the Risk of Breast Cancer among Pre and Postmenopausal Women

Background: Breast cancer is the most common cancer among women worldwide and the obesity is one of the factors related to the risk of breast cancer mainly in postmenopausal women. This study investigated the association between obesity in pre- and postmenopausal women with the development of breast cancer and the expression of estrogen, progesterone, HeR-2 and triple-negative (TN) receptors. Methods: A case-control study was conducted on 100 patients with recently diagnosed breast cancer and 400 age-matched controls. The women were divided into pre- and post-menopausal groups. Results: The multivariate analysis showed that postmenopausal women with a BMI ≥ 30 kg/m2 at pre-diagnosis and at the most recent measurement were 1.50 (95% CI 1.06-2.13) and 1.56 (95% CI 1.11-2.21) times more likely to develop breast cancer, respectively. These women had a prevalence of obesity of 27.7% when considering pre-diagnosis BMI and 29.4% when analyzing the indicator of recent BMI. When only the cases regarding the presence of obesity with clinicopathological variables were analyzed, a total of 95.2% of the postmenopausal women with pre-diagnostic obesity according to BMI presented the positive estrogen receptor (ER) subtype. Conclusions: In Brazilian women, there is an association between obesity and the risk of breast cancer postmenopause; moreover, there is an association between the occurrence of the positive ER subtype in postmenopausal women and pre-diagnostic obesity according to BMI.

Delay in Diagnosis and Treatment of Breast Cancer among Women Attending a Reference Service in Brazil

Background: Cancer is a major public health problem. Early diagnosis and treatment are essential for reducing mortality. This study aimed to analyze factors associated with delay in breast cancer diagnosis and treatment among women attending a reference cancer service. Methods: This retrospective, cross-sectional study was performed with data collected from medical records and interviews conducted with women diagnosed with breast cancer and treated from October 2013 to October 2014 at a cancer reference hospital in Paraná, Southern Brazil. Results: A total of 82 participants were enrolled during the study period; their average age was 58.2 ± 11.5 years. The average time taken for final diagnosis of breast cancer was 102.5 ± 165.5 days. Treatment onset was delayed in the majority of cases, and the average time elapsing from diagnostic biopsy to onset of primary treatment was 72.3 ± 54.0 days. The odds of treatment delay were higher among the women with a low educational level. Conclusions: The results underline the need for proposals aimed at early detection, identification of risk factors and timely provision of treatment by health managers that focus on this group.

Screening Cervical Cancer by the Pap Test ­ Relevance of Age Ranges Recommended by the Brazilian Programme for Prevention and Control

Objective: To evaluate screening by the Papanicolaou smear (Pap) and the frequency of cervical abnormalities in the age range recommended by the Brazilian programme for prevention and control of cervical cancer (CC) in the years 2012 and 2013 in a high prevalence city. Methods: This retrospective study covered results of Pap examinations performed on women aged ≥12 years residing in urban areas of the city of Maringá, Paraná in Brazil. The examinations were performed in the years 2012 and 2013 for the System of Public Health (SPH) which maintains a city database. The age ranges were grouped as recommended into <15-24, 25-64, and >64 years. Results: A total 40,866 women were screened, 19,606 in 2012 and 21,260 in 2013. The Pap exams performed for the age range 25-64 years accounted for 80.7% of the total in 2012 and 80.3% in 2013 (p=0.13), while those for <15 to 24 years accounted for 11.7% and 11.3%, respectively. There were more tests performed in the >64 years age group in 2013 (8.46%) than in 2012 (7.52%) (p<0.001). A total of 1,354 (3.31%) women presented with abnormal test results, with atypical squamous cells of undetermined significance (ASC-US) as the most prevalent finding (2.12%) in 2012, while in 2013 it was LSIL (1.56%) (p<0.001 for both). Women with ASC-US showed a lower mean age than did those with other lesions in both years. Conclusions: This study detected a significant expansion of women screened for CC in age ranges not recommended by the Brazilian government.

High risk pregnancies and factors associated with neonatal death.

OBJECTIVE: To identify the factors associated with intra-hospital neonatal mortality based on the individual characteristics of at-risk pregnant mothers, delivery and newborns. METHOD: This was a cross-sectional epidemiological study of live newborns delivered by women attended at the high-risk outpatient unit of a philanthropic hospital in Maringá, Paraná, Brazil between September 2012 and September 2013. RESULTS: Six hundred and eighty-eight women participated in the study. The neonatal mortality coefficient found was 17.7/1,000 live births, most in the early neonatal phase. Premature labor, fetal malformation and multiple gestations were associated with neonatal death. Premature, very low birth weight newborns and those with an Apgar score of less than seven, five minutes after birth were at high risk of death. CONCLUSION: Identifying risk factors can help plan actions to consolidate the perinatal network. Specific programs should be incentivized in other countries, in the search for significant perinatal results such as reducing neonatal mortality. OBJETIVO: Identificar os fatores associados à mortalidade neonatal intra-hospitalar com base nas características individuais de gestantes de risco, do parto e do recém-nascido. MÉTODO: Estudo epidemiológico do tipo transversal, realizado com crianças nascidas vivas de partos hospitalares de mulheres acompanhadas pelo ambulatório de alto risco de um hospital filantrópico de Maringá, Paraná, Brasil, no período de setembro de 2012 a setembro de 2013.RESULTADOS Fizeram parte da pesquisa 688 mulheres. O coeficiente de mortalidade neonatal foi de 17,7 óbitos/1.000 nascidos vivos, sendo sua maioria no período neonatal precoce. Trabalho de parto prematuro, malformação fetal e gestação múltipla foram as intercorrências associadas ao óbito neonatal. Recém-nascidos prematuros, com muito baixo peso ao nascer e Índice de Apgar menor que sete no quinto minuto de vida apresentaram risco elevado de morte. CONCLUSÃO: A identificação de fatores de risco pode auxiliar no planejamento de ações para consolidação da rede perinatal. Programas específicos devem ser incentivados em outros países, na busca de resultados perinatais expressivos, como a redução da mortalidade neonatal.

Prevalence of metabolic syndrome in pre- and postmenopausal women

ABSTRACT Objective The objective of this study was to determine the prevalence of metabolic syndrome (MS) and its components among pre- and postmenopausal women, as well as the association between menopausal status and MS. Materials and methods A retrospective study was conducted at a reference cardiology outpatient clinic in a city located in Northwestern Paraná State, Brazil. A total of 958 medical records of symptomatic climacteric women evaluated between 2010 and 2014 were analyzed. The study consisted of two groups: pre- and post-menopausal women. MS was characterized according to the criteria of the National Cholesterol Education Program’s Adult Treatment Panel III – NCEP-ATP III-2005. Results MS was observed in 18.5% of the total study population; 9.4% of the premenopausal women and 22.2% of the postmenopausal women displayed MS, corresponding to a relative risk of 2.75. In addition, the frequency of MS increased with age. Regarding the components of MS, postmenopausal women were more likely to have high density lipoprotein (HDL-C) levels < 50 mg/dL; systolic blood pressure (SBP) values ≥ 130 mmHg or diastolic blood pressure (DBP) values ≥ 85 mmHg; and fasting glucose levels ≥ 100 mg/dL. Conclusion MS was more prevalent among postmenopausal women than among premenopausal women.

Prevalence of metabolic syndrome in pre- and postmenopausal women.

OBJECTIVE: The objective of this study was to determine the prevalence of metabolic syndrome (MS) and its components among pre- and postmenopausal women, as well as the association between menopausal status and MS. MATERIALS AND METHODS: A retrospective study was conducted at a reference cardiology outpatient clinic in a city located in Northwestern Paraná State, Brazil. A total of 958 medical records of symptomatic climacteric women evaluated between 2010 and 2014 were analyzed. The study consisted of two groups: pre- and post-menopausal women. MS was characterized according to the criteria of the National Cholesterol Education Program's Adult Treatment Panel III - NCEP-ATP III-2005. RESULTS: MS was observed in 18.5% of the total study population; 9.4% of the premenopausal women and 22.2% of the postmenopausal women displayed MS, corresponding to a relative risk of 2.75. In addition, the frequency of MS increased with age. Regarding the components of MS, postmenopausal women were more likely to have high density lipoprotein (HDL-C) levels < 50 mg/dL; systolic blood pressure (SBP) values ≥ 130 mmHg or diastolic blood pressure (DBP) values ≥ 85 mmHg; and fasting glucose levels ≥ 100 mg/dL. CONCLUSION: MS was more prevalent among postmenopausal women than among premenopausal women.

The Rise in Mortality from Breast Cancer in Young Women: Trend Analysis in Brazil.

INTRODUCTION: Breast cancer is the most common cause of cancer death among women. OBJECTIVE: The objective of this study was to analyze time trends in overall mortality from breast cancer in Brazil, Brazilian regions and States. METHODS: This is an exploratory study, of the time series of deaths from breast cancer contained in the Mortality Information System (SIM), of women living in Brazil, Brazilian regions and States, from 1996 to 2013. For the trend analysis, the polynomial regression model was used, and a significant trend was considered when the estimated model obtained a p value <0.05. RESULTS: There was a tendency of increased mortality from breast cancer in Brazilian women (average increase of 0.18 per year; p <0.001), with regional differences, particularly in the age group 20-49 years (0.07 per year; p <0.001). The age group 50-69 years remained constant but had high average rates (37.14). CONCLUSION: More effective planning is needed to focus on the different scenarios of the Brazilian regions. Screening strategies for the incidence and mortality from breast cancer must also be rethought according to age group in the country.

High risk pregnancies and factors associated with neonatal death / Gestación de alto riesgo y factores asociados con la defunción neonatal / Gestação de alto risco e fatores associados ao óbito neonatal

Abstract OBJECTIVE To identify the factors associated with intra-hospital neonatal mortality based on the individual characteristics of at-risk pregnant mothers, delivery and newborns. METHOD This was a cross-sectional epidemiological study of live newborns delivered by women attended at the high-risk outpatient unit of a philanthropic hospital in Maringá, Paraná, Brazil between September 2012 and September 2013. RESULTS Six hundred and eighty-eight women participated in the study. The neonatal mortality coefficient found was 17.7/1,000 live births, most in the early neonatal phase. Premature labor, fetal malformation and multiple gestations were associated with neonatal death. Premature, very low birth weight newborns and those with an Apgar score of less than seven, five minutes after birth were at high risk of death. CONCLUSION Identifying risk factors can help plan actions to consolidate the perinatal network. Specific programs should be incentivized in other countries, in the search for significant perinatal results such as reducing neonatal mortality.

Resumen OBJETIVO Identificar los factores asociados con la mortalidad neonatal intrahospitalaria con base en las características individuales de gestantes de riesgo, del parto y del recién nacido. MÉTODO Estudio epidemiológico del tipo transversal, realizado con niños nacidos vivos de partos hospitalarios de mujeres seguidas en el ambulatorio de alto riesgo de un hospital filantrópico de Maringá, Paraná, Brasil, en el período de septiembre de 2012 a septiembre de 2013. RESULTADOS Hicieron parte de la investigación 688 mujeres. El coeficiente de mortalidad neonatal fue de 7,7 defunciones/1.000 nacidos vivos, siendo su mayoría en el período neonatal precoz. Trabajo de parto prematuro, malformación fetal y gestación múltiple fueron los sucesos asociados con la defunción neonatal. Recién nacidos prematuros, con muy bajo peso al nacer e Índice de Apgar menor que siete el quinto minuto de vida presentaron riesgo elevado de muerte. CONCLUSIÓN La identificación de factores de riesgo puede auxiliar la planificación de acciones para consolidación de la red perinatal. Se deben incentivar programas específicos en otros países, en la búsqueda por resultados perinatales considerables, como la reducción de la mortalidad neonatal.

RESUMO OBJETIVO Identificar os fatores associados à mortalidade neonatal intra-hospitalar com base nas características individuais de gestantes de risco, do parto e do recém-nascido. MÉTODO Estudo epidemiológico do tipo transversal, realizado com crianças nascidas vivas de partos hospitalares de mulheres acompanhadas pelo ambulatório de alto risco de um hospital filantrópico de Maringá, Paraná, Brasil, no período de setembro de 2012 a setembro de 2013. RESULTADOS Fizeram parte da pesquisa 688 mulheres. O coeficiente de mortalidade neonatal foi de 17,7 óbitos/1.000 nascidos vivos, sendo sua maioria no período neonatal precoce. Trabalho de parto prematuro, malformação fetal e gestação múltipla foram as intercorrências associadas ao óbito neonatal. Recém-nascidos prematuros, com muito baixo peso ao nascer e Índice de Apgar menor que sete no quinto minuto de vida apresentaram risco elevado de morte. CONCLUSÃO A identificação de fatores de risco pode auxiliar no planejamento de ações para consolidação da rede perinatal. Programas específicos devem ser incentivados em outros países, na busca de resultados perinatais expressivos, como a redução da mortalidade neonatal.

Síndrome hipertensiva e resultados perinatais em gestação de alto risco / Hypertensive syndrome and perinatal outcomes in high-risk pregnancies / Síndrome hipertensivo y resultados perinatales en embarazos de alto riesgo

Esta pesquisa teve como objetivo analisar os resultados perinatais de gestantes de alto risco com síndrome hipertensiva. Estudo transversal, de base documental, com 920 prontuários de gestantes de um ambulatório de alto risco. A variável independente foi a síndrome hipertensiva, considerando a hipertensão arterial como condições preexistentes, pré-eclâmpsia como antecedente obstétrico e doença hipertensiva específica da gestação (DHEG) como intercorrência clínica. As variáveis dependentes foram prematuridade, baixo peso ao nascer, Apgar inferior a sete no 1° e 5° minutos, morte fetal, morte infantil, parto normal e parto cesáreo. Para analisar a associação entre as variáveis, utilizou-se o teste qui-quadrado e comparou-se o risco relativo no intervalo de confiança (IC) a 95%. Da amostra estudada, 25,32% apresentaram síndrome hipertensiva; 14,36% foram classificadas com hipertensão arterial (grupo 1), 6,73% com pré-eclâmpsia (grupo 2); 4,02% apresentaram DHEG (grupo 3); e 30,65% eram normotensas (grupo 4). No grupo 1 constatou-se risco elevado para morte fetal e o parto normal foi fator de proteção. No grupo 2 verificou-se risco elevado para parto cesáreo. No grupo 3, constituiu risco elevado para prematuridade e baixo peso ao nascer. Os três grupos apresentaram risco elevado para Apgar baixo no 1º e 5º minuto. As síndromes hipertensivas na gestação relacionaram-se a resultados perinatais desfavoráveis, evidenciando a necessidade de cuidados especializados à gestante, por meio de um pré-natal especializado e de qualidade.

This study aimed to analyze the perinatal outcomes of high risk pregnancies of women with hypertensive syndrome. It was a cross-sectional study,with a documental basis, with 920 records of pregnant women from a high-risk outpatient clinic. The independent variable was hypertensivesyndrome, considering arterial hypertension as pre-existing conditions, pre-eclampsia as obstetric antecedents and heart disease of pregnancy(HDP) as clinical complications. The dependent variables were prematurity, low birth weight, Apgar score below than seven in the 1st and 5thminutes of life, fetal death, infant death, normal delivery and cesarean delivery. To analyze the association between the variables, the Chi-squaretest was used and Relative Risk was compared in the 95% confidence interval (CI). Of the sample studied, 25.32% presented hypertensive syndrome;14.36% were classified with arterial hypertension (group 1), 6.73% with preeclampsia (group 2); 4.02% presented DHEG (group 3) and a total of30.65% normotensive (group 4). In group 1, there was a high risk for fetal death and normal delivery was a protective factor. In group 2, there was ahigh risk for cesarean section. In group 3, it was a high risk for prematurity and low birth weight. The three groups were at high risk for low Apgarat the 1st and 5th minute. Hypertensive syndromes during pregnancy were associated with unfavorable perinatal outcomes, evidencing the needfor specialized care to the pregnant woman through a specialized prenatal and quality.

En esta investigación se busca analizar los resultados perinatales de embarazadas de alto riesgo con síndrome hipertensivo. Estudio transversal,de base documental con 920 registros de embarazadas de una clínica ambulatoria de alto riesgo. La variable independiente fue el síndrome hipertensivo, considerando la hipertensión arterial como condición preexistente, la preeclampsia como antecedente obstétrico y la enfermedad hipertensiva específica del embarazo (DHEG) como intercurrencia clínica. Las variables dependientes fueron prematuridad, bajo peso al nacer,Apgar inferior a siete en el 1 ° y 5 ° minutos, muerte fetal, muerte infantil, parto normal y cesárea. Para analizar la asociación entre las variables seutilizó la prueba Chi-cuadrado y se comparó el riesgo relativo en el intervalo de confianza (IC) al 95%. De la muestra estudiada, 25,32% presentaron síndrome hipertensivo; 14,36% se clasificaron con hipertensión arterial (grupo 1), 6,73% con preeclampsia (grupo 2); 4,02% presentaron DHEG(grupo 3) y un total de 30,65% normotensas (grupo 4). En el grupo 1 se constató riesgo elevado para la muerte fetal y el parto normal fue unfactor de protección. En el grupo 2 se observó riesgo elevado para la cesárea. En el grupo 3, riesgo elevado para la prematuridad y el bajo peso alnacer. Los tres grupos presentaron riesgo elevado para Apgar bajo el primero y quinto minutos. Los síndromes hipertensivos en el embarazo serelacionaron con resultados perinatales desfavorables, evidenciando la necesidad de cuidados especializados a la embarazada, por medio de un prenatal especializado y de calidad.

Rastreamento de casos de sífi lis na gestação no sul do Brasil / Syphilis case tracking in pregnancy in southern Brazil

Objetiva-se descrever os casos de sífi lis em gestantes notifi cados no período de 2012 a 2014. Trata-se de um estudo descritivo, transversal e retrospectivo, utilizando fonte secundária de dados da fi cha de notifi cação dos casos de sífi lis em gestantes do Sistema de Informação de Agravos de Notifi cação da Secretaria Municipal de Saúde. Dos 95 casos notifi cados durante o período, notou-se um aumento da notifi cação ano a ano. 66,3% das gestantes tinham idade entre 20 e 34 anos, em 56,8% a cor da pele prevalente foi branca, 48,4% dos casos foram diagnosticados no primeiro trimestre. 63,2% das gestantes encontravam-se na fase primária da doença e 63,2% dos parceiros não foram tratados. Concluí-se que os resultados encontrados apontam um longo caminho a ser percorrido rumo a eliminação deste agravo

The aim is to describe the cases of syphilis in pregnant women reported in the period from 2012 to 2014. A descriptive, cross-sectional retrospective study using secondary source notifi cation form data of syphilis cases in Grievances Information System Pregnant Notifi cation Municipal Health. In the 95 reported cases during the period, it was noted an increase in the reporting year to year. 66.3 % of pregnant women were aged between 20 and 34 years, 56.8% in the prevalent skin color was white, 48.4 % of cases were diagnosed in the fi rst quarter. 63.2 % of women were in the early stage of the disease and 63.2 % of partners were not treated. It concludes that he results indicate a long way to go towards the elimination of this disease

Risk Factors for Breast Cancer in Postmenopausal Women in Brazil.

PURPOSE: To analyze risk factors for postmenopausal breast cancer. METHODS: The present casecontrol study included 600 women treated at a cancer center reference hospital in a municipality in the South of Brazil. RESULTS: Totals of 100 patients and 500 control subjects were evaluated. The mean age of the women was 52.5 ± 11.9 years; the average was 57.4 ± 11.8 years, and the average age of the control subjects was 51.5 ± 11.7 years. The risk factors for breast cancer that were considered included an age ≥ 40 years, postmenopausal status, a body mass index (BMI) ≥ 30 kg/m2, and reduced physical activity. Variables like postmenopausal status and an obese BMI were associated with cases of breast cancer. Women who were postmenopausal or obese were 3.80 or 1.80 times more likely to develop breast cancer, respectively, and physically inactive women were 1.72 times more likely to develop breast cancer. CONCLUSIONS: Obesity and postmenopausal status are associated with the occurrence of breast cancer in this population. Being over 40 years of age was also a statistically significant factor for postmenopausal women.

Treatment and Follow-up of Human Papillomavirus Infected Women in a Municipality in Southern Brazil.

BACKGROUND: This study aimed toanalyze the risk behavior for cervical cancer (CC) and the human papillomavirus (HPV) prevalence and resolution among women who received care through the private healthcare network of a municipality in southern Brazil. MATERIALS AND METHODS: This descriptive and retrospective study was conducted with 25 women aged 20 to 59 years who received care through the private healthcare network and were treated at a specialty clinic in the period from January to December 2012 in a municipality in Northwest Parana, Southern Brazil. Data from medical records with cytological and HPV results were used. Following treatment, these women were followed-up and reassessed after 6 months. Data were statistically analyzed using the t-test and chi-squared test at a 5% significance level. RESULTS: The mean age of the studied women was 27.8±7.75 years old, and the majority were married, with paid employment and were non-smokers. The mean age at menarche was 13.0±0.50 years old, and the mean age at first intercourse was 17.5±1.78 years, with only 8.0% (2) initiating sexual activity at an age ≤15 years old. The majority had 1 to 2 children (60.0%), while 88.0% reported having had one sexual partner in their lifetime, and all the women were sexually active. A total of 68.0% used a hormonal contraceptive method. All the women had leukorrhea and pain and were infected by a single HPV type. Regarding the lesion grade, 80.0% showed high risk and 20.0% low risk. The most prevalent high-risk HPV strain was 16. CONCLUSIONS: These findings provide relevant information on HPV risk factors and infection, as well as the treatment and 6-month follow-up results, in economically and socially advantaged women with no traditional risk factors, corroborating previous reports that different risk factors may be described in different populations. Thus, this study reinforces the fact that even women without the traditional risk factors should undergo HPVmonitoring and assessment to determine the persistence of infection, promoting early diagnosis of the lesions presented and appropriate treatment to thus prevent the occurrence of CC.

Prevalência e fatores associados à realização de mamografia e exame citopatológico / Prevalence and factors associated with the performance of mammography and pap smear test

Estimar a prevalência e os fatores associados à realização de mamografia e examecitopatológico em mulheres da cidade de Maringá, Paraná. Métodos: Estudo transversal,de base populacional, feito com 345 mulheres com idade superior a 20 anos, no período demarço de 2011 a abril de 2012. Realizou-se entrevista por meio de um questionário propostopelo Ministério da Saúde, o qual abordava aspectos sociodemográficos, fatores de risco paradoenças crônicas não transmissíveis e questões relacionadas ao rastreamento mamográficoe citopatológico. Os dados foram analisados mediante análise bivariada, análise brutamediante Odds Ratio (OR) e qui-quadrado por meio do programa Epi Info 3.5.1, e análisemultivariada por meio da regressão logística, realizada com o programa Statistica 7.1, comnível de significância de 5% e intervalo de confiança de 95%. Resultados: A média deidade das mulheres foi de 52,19 (±5,27) anos. A maioria (56,5%) apresentou de 0 a 8 anosde estudo. Além disso, 84,6% (n=266) das mulheres realizaram o exame de Papanicolaue 74.3% (n=169), a mamografia. Foram associadas à menor realização de Papanicolau asmulheres com escolaridade entre 9 e 11 anos de estudo (p=0,01), e quanto à mamografia,tiveram menor adesão as mulheres sem plano de saúde privado (p<0,01). Conclusão: Acobertura da mamografia e do Papanicolau foi satisfatória entre as mulheres da cidade deMaringá, Paraná. A baixa escolaridade e as mulheres que dependiam da rede pública de saúdetiveram menor adesão à realização da mamografia...

Variables that affect the satisfaction of Brazilian women with external breast prostheses after mastectomy.

BACKGROUND: : In 2012, the breast cancer estimate worldwide stood at 1.67 million new cases, these accounting for 25% of all types of cancer diagnosed in women. For 2014, 57,120 new cases are expected, with a risk estimated at 56.1 cases for every 100,000 women. The objective of this study was to analyze the satisfaction regarding the use of external breast prostheses by women undergoing mastectomy. MATERIALS AND METHODS: This cross-sectional study was conducted with 76 women who used an external breast prosthesis (EBP), registered in the services of the Cuiaba Center for Comprehensive Rehabilitation, Mato Grosso, Brazil, from 2009 to 2012. Data were collected from the records of women who had requested the opening of a process of external breast prosthesis concession. RESULTS: Satisfaction with the EBP was identified in 56.6% of the women. Those satisfied with the EBP reported that its weight was not annoying (p<0.01). Although the women felt body sensations of stitches, pains, pulling, dormancy and phantom limb, they are satisfied with the EBP. The variable related to the displacement of the breast prosthesis during activity of everyday life has demonstrated that even though the women have reported the possibility of displacements, they are satisfied with the EBP. The satisfaction with the use of external breast prosthesis did not affect the sexuality of the women with mastectomy. CONCLUSIONS: Learning the specificities of the EBP, taking into consideration the satisfaction of its use, allows the rehabilitation team, by listening to their clientele more attentively, following up this woman throughout her life journey, supporting and guiding the best way of use, with an eye to her personal, emotional and social life, as well as to her self-esteem.

Avaliação dos exames citológicos de papanicolau em usuárias do sistema único de saúde / Evaluaciónde frootis de papanicoLaou en los usuarios del sistema único de salud / Evaluation f papp smears in users of the unified health system

Mundialmente, entre todos os tipos de câncer, na população feminina, o câncer de colo uterino é um dos mais frequentes, ocupando o segundo lugar em incidência. O objetivo do presente trabalho é estimar a prevalência de exames colpocitológicos realizados no município de Maringá, Paraná, e sua distribuição segundo a faixa etária das mulheres e os resultados dos exames. Trata-se de um estudo descritivo, retrospectivo, de coorte, constando da análise de todos os exames colpocitológicos realizados em 24 Unidades Básicas de Saúde (UBS) do município de Maringá, no período de 2006 a 2010. Foram estudados 41.197 exames, a média de idade foi de 41,66±14,18 anos, variando de 12 a 93 anos. Cerca de 75,4% das mulheres (12.579) estavam na faixa etária dos 25 aos 59 anos; 12,7% (2.129) tinham entre 12 e 24 anos e as demais, 11,9% (1.993), possuíam acima de 60 anos de idade. Foi observado que 48,4% dos exames estavam normais; 22,7% apresentavam alterações celulares benignas e 26,7%, atipias celulares. Em 498 mulheres, o laudo citopatológico foi positivo para neoplasia. Uma melhor qualidade de informação poderá permitir avaliações de cobertura, áreas de maior acometimento, de forma a possibilitar a implementação de medidas, visando a prevenção de neoplasias intraepiteliais cervicais.

Entre todos los tipos de cáncer en mujeres en todo el mundo, el cáncer de cuello uterino es el más frecuente, ocupando el segundo lugar en incidencia. El objetivo del estudio fue estimar la prevalencia de citología cervical realizado en Maringá, Paraná, Brasil. Se trata de una cohorte descriptivo, retrospectivo, que consiste en el análisis de toda la citología cervical realizado en 24 Unidades Básicas de Salud (UBS) de Maringá, de 2006 a 2010. Hubo 41.197 pruebas, la edad promedio fue de 41,66±14,18 años, de 12 a 93 años. Aproximadamente el 75,4% de las mujeres (12.579) tenían entre 25 a 59 años, 12,7% (2.129) tenían entre 12 y 24 años y el restante, 11,9% (1.993), tenían más de 60 años de edad. El 48,4% de los exámenes fueron normales, el 22,7% tenían cambios celulares benignos y 26,7%, células atípicas. En 498 mujeres, el informe citología fue positivo para malignidad. Una mejor calidad de información puede permitir evaluaciones de la cobertura, las zonas más afectadas, con el fin de permitir la aplicación de medidas destinadas a la prevención de la neoplasia intraepitelial cervical.

Among all types of cancer in women, around the world, cervical cancer is the most frequent, ranking second in incidence. The objective of the study was toestimate the prevalence of cervical cytology performed in Maringá, Paraná, Brazil. This is a descriptive, retrospective cohort, consisting of analysis of all cervical cytology performed on 24 Basic Health Units (BHU) of Maringá, from 2006 to 2010. There were 41,197 tests, the average age was 41.66±14.18 years, ranging from 12 to 93 years. Approximately 75.4% of women (12,579) were aged 25 to 59 years; 12.7% (2,129) were between 12 to and 24 years and the remaining 11.9% (1,993) were over 60 years of age. Were observed that 48.4% of the exams were normal, 22.7% had with benign cellular changes and 26.7% showed, atypical cells. In 498 women, the report cytology was positive for malignancy. A better quality of information may permit assessments of coverage, areas most affected, in order to enable the implementation of measures aimed at preventing cervical intraepithelial neoplasm.

Mulheres em idade fértil: causas de internação em unidade de terapia intensiva e resultados / Women of childbearing age: causes of hospitalization in intensive care unit and results

INTRODUÇÃO: Pacientes obstétricas representam uma fração significativa das admissões em unidades de cuidado intensivo e consistem em um desafio para a equipe. OBJETIVO: Analisar as principais causas de internação e morte materna de mulheres em idade fértil ocorridas em unidades de terapia intensiva de hospitais de um município do Noroeste do Paraná, Sul do Brasil. MÉTODOS: Estudo exploratório, descritivo, retrospectivo, realizado com mulheres em idade fértil (10 a 49 anos) internadas em três unidades de terapia intensiva existentes em um município do Noroeste do Paraná, por causas obstétricas e não obstétricas, no período de janeiro de 2005 a dezembro de 2009. RESULTADOS: Foram encontradas 775 internações de mulheres em idade fértil, com uma média de idade de 33,7±10,3 anos, com duração média de internação de 5,0±8,4 dias. A maior parte das mulheres era do município estudado (67,2%), com baixa escolaridade (nível primário, 68,2%). Entre as causas obstétricas de internação, a pré-eclâmpsia grave e a eclâmpsia se constituíram na principal causa (71,3%); a pielonefrite se destacou sob outras condições no período gestacional (53%). Não foi encontrada associação estatística entre internações por causas obstétricas em unidade de terapia intensiva e óbito. CONCLUSÃO: As causas não obstétricas representaram a maioria das internações de mulheres em idade fértil nas unidades de terapia intensiva do município, no período estudado e, entre as causas obstétricas, a pré-eclâmpsia grave e a eclâmpsia constituíram a principal causa.

INTRODUCTION: Obstetric patients represent a significant fraction of admissions to intensive care units and consist of a challenge to the team. Objective: To analyze the main causes of maternal death and hospitalization of women of childbearing age occurring in intensive care units of hospitals in a city in Northwestern Paraná, Southern Brazil. METHODS: Exploratory, descriptive and retrospective study, conducted with women of childbearing age (10-49 years) admitted in three intensive care units existing in a city of Northwest Paraná, for obstetric and non-obstetric causes, from January 2005 to December 2009. RESULTS: There were 775 admissions of women of childbearing age, with a mean age of 33.7±10.3 years; the mean duration of hospitalization was 5.0±8.4 days. Most of the women were from the municipality (67.2%), with low education level (primary level, 68.2%). Among the obstetric causes of hospitalization, pre-eclampsia and eclampsia constituted the main cause (71.3%); pyelonephritis stood out other conditions during pregnancy (53%). There was no statistical association betweenhospital admissions for obstetric causes in intensive care unit and death. CONCLUSION: Non-obstetric causes accounted for the majority of hospitalizations of women of childbearing age in the intensive care unit of this municipality during the study period; among obstetric causes, pre-eclampsia and eclampsia were the main causes.

Years of potential life lost due to breast and cervical cancer: a challenge for Brazilian public policy.

BACKGROUND: The purpose of the article was to analyze the years of potential life lost (YPLL) of women who died from breast and cervical cancer in the State of Parana, Southern Brazil. This was a temporal trend study (2000 to 2010) about the coefficients of mortality and the years of potential life lost in women aged 20 to 70 years. MATERIALS AND METHODS: Data were obtained through the database of the Department of the Unified Health System (DATASUS) and the National Mortality Information System. RESULTS: There was a loss of 125.075 YPLL due to breast cancer, with an average of 11.370 YPLL. Regarding cervical cancer, the figure obtained was 91.625 YPLL from 2000 to 2010, with an average of 8.329 YPLL. Increased risk of death from breast cancer was observed for women aged 50 to 59 years, with a significant increase among those in the age group from 40 to 49 years. There was an increased rate of cervical cancer among women 40 to 69 years. CONCLUSIONS: The risk of death grows with increasing age, being higher from 40 years. Prevention is paramount for both cancers. Thus, preventive measures are required and a reassessment of political strategies should be adopted.

Características sociodemográficas e aspectos clínicos de pacientes com doença renal policística do adulto submetidos à hemodiálise / Sociodemographic characteristics and clinical features of patients withadult polycystic kidney disease undergoing hemodialysis

Objetivos: Analisar as características sociodemográficas e clínicas de pacientes portadores da doença renal policística do adulto admitidos nos serviços de hemodiálise no noroeste do estado do Paraná.Métodos: Trata-se de um estudo observacional, descritivo e retrospectivo. Foram revisados os prontuários de pacientes com rins policísticos admitidos para hemodiálise entre 1995 e 2012, em quatro centros que atendem pacientes da área de abrangência da 15ª Regional de Saúde do Paraná.Resultados: Observou-se que 10,3% dos pacientes em hemodiálise tinham rins policísticos como principal causa de doença renal crônica estágio 5. A idade média dos pacientes foi de 54,9±9,4 anos (variando entre 27 e 74 anos), com distribuição igual entre os sexos e predominância caucasiana (72,9%). A idade média de ingresso na hemodiálise foi de 50±10,2 anos. A manifestação clínica associada mais comum foi a hipertensão arterial sistêmica (66,7%). Cisto hepático foi a principal manifestação extrarrenal (10,4%). Vinte e cinco por cento dos pacientes evoluíram para transplante renal e 22,9% foram submetidos à nefrectomia. As classes de drogas anti-hipertensivas mais amplamente usadas foram os ?-bloqueadores (41,7%) e as drogas que diminuem a atividade do sistema renina-angiotensina (31,3%), enquanto 56,3% dos pacientes fizeram uso de eritropoetina humana recombinante.Conclusões: Este estudo epidemiológico foi pioneiro na região noroeste do Paraná. Encontrou-se, na população estudada, um perfil sociodemográfico e clínico da doença renal policística do adulto semelhante ao da América do Norte e Europa, provavelmente pela constituição étnica da amostragem ser predominantemente de euro-descendentes.

Aims: To analyze the socio-demographic and clinical characteristics of patients with adult polycystic kidney disease admitted to hemodialysis services in Northwestern Paraná state, Brazil. Methods: This was an observational, descriptive and retrospective longitudinal study. Medical records of patients with polycystic kidneys who initiated hemodialysis between 1995 and 2012, in four centers that treat patients of the coverage area of the 15th Regional Health Region of Paraná stat e where analyzed. Results: We found that 10.3% of hemodialysis patients had polycystic kidney disease as a leading cause of stage 5 of chronic kidney disease. The mean age of patients was 54.9±9.4 years (ranging between 27 and 74 years), with equal gender distribution and Caucasian predominance (72.9%). The average age of dialysis initiation was 50±10.2 years. The most common comorbidity was systemic hypertension (66.7%). Liver cyst was the main extra-renal manifestation (10.4%). Twenty-five percent of the patients required renal transplantation, and (22.9%) undergone nephrectomy. The most widely used classes of antihypertensive drugs were β -blockers (41.7%) and drugs that act on the renin-angiotensin system (31.3%), while 56.3% of patients were treated with recombinant human erythropoietin. Conclusions: This is a pioneering epidemiological study in Northwestern Paraná state. We found in this population a sociodemographic and clinical profile of adult polycystic kidney disease similar to that of North America and Europe, probably because the ethnic constitution of the sample was predominantly of Euro-descendants.

[Climacteric symptoms and nutritional status of women in post-menopause users and non-users of hormone therapy]. / Sintomas climatéricos e estado nutricional de mulheres na pós-menopausa usuárias e não usuárias de terapia hormonal.

PURPOSE: To analyze the climacteric symptoms, nutritional status and distribution of abdominal fat in postmenopausal women using or not hormone therapy. METHODS: exploratory analytical study of the population survey type in the urban area of Maringa, Parana, conducted on 456 postmenopausal women aged 45 to 69 years. Data collection was based on the urbanized census sector (368) of the municipality, according to the Brazilian Demographic Census. A simple random sample proportional to women residing in each census sector was used, and a questionnaire was applied during a home visit, when anthropometric measurements were performed and blood pressure was determined. The Blatt and Kupperman Menopausal Index was used for the evaluation of climacteric symptoms. The outcome variable was the use of hormone therapy. RESULTS: Mean subject age was 58.7 years. Overweight was present in 72.6% of the women and abdominal obesity in 81.4% of them. Mild climacteric symptoms were observed in 69.5% of the women. Only 18.4% of the women studied were using hormone therapy and they were white, non-smokers, had no comorbidities, and had a partner. Users of hormone therapy had a lower frequency of overweight and obesity and had a lower prevalence of severe climacteric symptoms. CONCLUSION: Overweight and obesity were prevalent in this sample. Although fewer in number, the hormone therapy users had a lower frequency of overweight and mild and severe menopausal symptoms during the postmenopausal period.

Sintomas climatéricos e estado nutricional de mulheres na pós-menopausa usuárias e não usuárias de terapia hormonal / Climacteric symptoms and nutritional status of women in post-menopause users and non-users of hormone therapy

OBJETIVO: Analisar os sintomas climatéricos e estado nutricional em mulheres na pós-menopausa, usuárias e não usuárias de terapia hormonal (TH). MÉTODOS: Estudo analítico, exploratório, tipo inquérito populacional domiciliar, realizado na área urbana do município de Maringá, Paraná, incluindo 456 mulheres com idade entre 45 e 69 anos, no período pós-menopausa. A coleta teve como base de referência os setores censitários urbanizados (368) do município, de acordo com o Censo Demográfico Brasileiro. Foi utilizada amostra aleatória simples proporcional às mulheres residentes em cada setor censitário e, por meio de visita domiciliar, aplicou-se um questionário e verificaram-se as medidas antropométricas e pressão arterial. Para avaliação dos sintomas climatéricos, foi utilizado o Índice Menopausal de Blatt e Kupperman. A variável desfecho foi o uso de TH. RESULTADOS: A média de idade foi de 58,7 anos. O excesso de peso esteve presente em 72,6% das mulheres e a obesidade abdominal em 81,4% delas. Sintomas climatéricos de intensidade leve foram evidenciados em 69,5% das mulheres. Apenas 18,4% das mulheres faziam uso de TH e eram, na sua maioria, brancas, não fumantes, sem comorbidades e sem companheiro. Usuárias de TH apresentaram menor frequência de excesso de peso e obesidade abdominal e tiveram menor prevalência de sintomas climatéricos de intensidade severa. CONCLUSÃO: O excesso de peso e a obesidade abdominal foram prevalentes na amostra estudada. Embora em menor número, as usuárias de TH apresentaram uma frequência menor de excesso de peso e sintomas climatéricos leves e intensos na pós-menopausa.

PURPOSE: To analyze the climacteric symptoms, nutritional status and distribution of abdominal fat in postmenopausal women using or not hormone therapy. METHODS: exploratory analytical study of the population survey type in the urban area of Maringa, Parana, conducted on 456 postmenopausal women aged 45 to 69 years. Data collection was based on the urbanized census sector (368) of the municipality, according to the Brazilian Demographic Census. A simple random sample proportional to women residing in each census sector was used, and a questionnaire was applied during a home visit, when anthropometric measurements were performed and blood pressure was determined. The Blatt and Kupperman Menopausal Index was used for the evaluation of climacteric symptoms. The outcome variable was the use of hormone therapy. RESULTS: Mean subject age was 58.7 years. Overweight was present in 72.6% of the women and abdominal obesity in 81.4% of them. Mild climacteric symptoms were observed in 69.5% of the women. Only 18.4% of the women studied were using hormone therapy and they were white, non-smokers, had no comorbidities, and had a partner. Users of hormone therapy had a lower frequency of overweight and obesity and had a lower prevalence of severe climacteric symptoms. CONCLUSION: Overweight and obesity were prevalent in this sample. Although fewer in number, the hormone therapy users had a lower frequency of overweight and mild and severe menopausal symptoms during the postmenopausal period.