Relationship Involving Sexual Function, Distress Symptoms of Pelvic Floor Dysfunction, and Female Genital Self-Image.

OBJECTIVE: To assess the relationship involving sexual function (SF), the distress symptoms caused by pelvic floor dysfunction (PFD), and female genital self-image (GSI). MATERIALS AND METHODS: We assessed the GSI, SF and PFD distress symptoms by the Female Genital Self-Image Scale (FGSIS), the Female Sexual Function Index (FSFI), and the Pelvic Floor Distress Inventory (PFDI-20) respectively. Data were analyzed by multiple linear regression. RESULTS: Among the 216 women (age: 50.92 ± 16.31 years) who participated in the study, 114 were sexually active in the previous 4 weeks. In the total sample (p < 0.001; adjusted R2 = 0.097) and among sexually active women (p = 0.010; adjusted R2 = 0.162), the distress symptoms caused by pelvic organ prolapse (POP) were related to the GSI. Among sexually active women, sexual desire also was related to the GSI (p < 0.001; adjusted R2 = 0.126). CONCLUSION: The findings of the present study provide additional knowledge about female GSI and suggest that SF and POP distress symptoms should be investigated together with the GSI in the clinical practice.

OBJETIVO: Avaliar a relação entre a função sexual (FS), o incômodo provocado pelos sintomas de disfunção do assoalho pélvico (DAP) e a autoimagem genital (AIG) feminina. MATERIAIS E MéTODOS: A AIG, a FS e incômodo causado pelos sintomas de DAP foram avaliados pela Genital Self-Image Scale (FGSIS), pelo Female Sexual Function Index (FSFI) e pelo Pelvic Floor Distress Inventory (PFDI-20), respectivamente. Os dados foram analisados por regressão linear múltipla. RESULTADOS: Das 216 mulheres (idade: 50,92 ± 16,31 anos) que participaram do estudo, 114 eram sexualmente ativas nas últimas 4 semanas. Na amostra total (p < 0,001; R2 ajustado = 0,097) e entre as mulheres sexualmente ativas (p = 0,010; R2 ajustado = 0,162), o incômodo provocado pelos sintomas de prolapso de órgãos pélvicos (POP) relacionou-se à AIG. Entre as mulheres sexualmente ativas, o desejo sexual também se relacionou à AIG (p < 0,001; R2 ajustado = 0,126). CONCLUSãO: Os achados deste estudo fornecem conhecimento adicional sobre a AIG feminina e sugerem que a FS e o incômodo causado pelos sintomas de POP devem ser investigados juntamente com a AIG na prática clínica.

Relationship Involving Sexual Function, Distress Symptoms of Pelvic Floor Dysfunction, and Female Genital Self-Image / Relação entre função sexual, incômodo dos sintomas de disfunção do assoalho pélvico e autoimagem genital feminina

Abstract Objective To assess the relationship involving sexual function (SF), the distress symptoms caused by pelvic floor dysfunction (PFD), and female genital self-image (GSI). Materials and Methods We assessed the GSI, SF and PFD distress symptoms by the Female Genital Self-Image Scale (FGSIS), the Female Sexual Function Index (FSFI), and the Pelvic Floor Distress Inventory (PFDI-20) respectively. Data were analyzed by multiple linear regression. Results Among the 216 women (age: 50.92 ± 16.31 years) who participated in the study, 114 were sexually active in the previous 4 weeks. In the total sample (p < 0.001; adjusted R2 = 0.097) and among sexually active women (p = 0.010; adjusted R2 = 0.162), the distress symptoms caused by pelvic organ prolapse (POP) were related to the GSI. Among sexually active women, sexual desire also was related to the GSI (p < 0.001; adjusted R2 = 0.126). Conclusion The findings of the present study provide additional knowledge about female GSI and suggest that SF and POP distress symptoms should be investigated together with the GSI in the clinical practice.

Resumo Objetivo Avaliar a relação entre a função sexual (FS), o incômodo provocado pelos sintomas de disfunção do assoalho pélvico (DAP) e a autoimagem genital (AIG) feminina. Materiais e Métodos A AIG, a FS e incômodo causado pelos sintomas de DAP foram avaliados pela Genital Self-Image Scale (FGSIS), pelo Female Sexual Function Index (FSFI) e pelo Pelvic Floor Distress Inventory (PFDI-20), respectivamente. Os dados foram analisados por regressão linear múltipla. Resultados Das 216 mulheres (idade: 50,92 ± 16,31 anos) que participaram do estudo, 114 eram sexualmente ativas nas últimas 4 semanas. Na amostra total (p < 0,001; R2 ajustado = 0,097) e entre as mulheres sexualmente ativas (p = 0,010; R2 ajustado = 0,162), o incômodo provocado pelos sintomas de prolapso de órgãos pélvicos (POP) relacionou-se à AIG. Entre as mulheres sexualmente ativas, o desejo sexual também se relacionou à AIG (p < 0,001; R2 ajustado = 0,126). Conclusão Os achados deste estudo fornecem conhecimento adicional sobre a AIG feminina e sugerem que a FS e o incômodo causado pelos sintomas de POP devem ser investigados juntamente com a AIG na prática clínica.

Internal structure and classification of pelvic floor dysfunction distress by PFDI-20 total score.

PURPOSE: To evaluate the internal structure (structural validity and internal consistency) and propose a classification for the distress caused by the presence of pelvic floor dysfunction (PFD) symptoms based on the total score of the Pelvic Floor Distress Inventory (PFDI-20). METHODS: Cross-sectional study conducted with Brazilian women over 18 years of age. Exploratory and confirmatory factor analysis were performed with Parallel Analysis and to test three models to compare them with the Root Mean Square Error of Approximation (RMSEA) and Comparative Fit Index (CFI). Internal consistency was calculated using Cronbach's alpha. Partial credit model (PCM) was performed to classify the total score of the PFDI-20. RESULTS: Data from 237 women (49.62 ± 16.95 years) were analyzed. The one-dimensional structure had 43.74% of the explained variance with α = 0.929. The one-dimensional model was the most appropriate (CFI = 0.987 and RMSEA = 0.022). The total PFDI-20 score was classified as the absence of symptoms (score zero), symptoms with mild distress (1 to 15 points), symptoms with moderate distress (16 to 34 points), and symptoms with severe distress (35 to 40 points). CONCLUSION: The PFDI-20 has an one-dimensional structure and the distress caused by the presence of PFD symptoms can be classified as mild, moderate and severe. Health professionals and future studies can use our classification to facilitate the understanding of the patient's health status and to obtain other analyses on the severity of the distress of the symptoms of PFD.

There are limitations regarding the meaning of the total score of the Pelvic Floor Distress Inventory (PFDI-20) in clinical practice and scientific research. Thus, the aims of this study were to evaluate the internal structure (structural validity and internal consistency) and propose a classification for the distress caused by the presence of pelvic floor dysfunction (PFD) symptoms from the total score of PFDI-20. Cross-sectional study conducted with Brazilian women over 18 years of age. Data from 237 women (49.62 ± 16.95 years) were analyzed. The PFDI-20 has one-dimensional structure and the distress caused by the presence of PFD symptoms can be classified as mild, moderate and severe.

Factors associated with urinary incontinence in volleyball athletes: a cross-sectional study

The article has the purpose of identify the factors associated with the occurrence of urinary incontinence (UI) among volleyball athletes. This is a cross-sectional study conducted with female athletes of court volleyball. An interview was conducted to identify the factors associated with UI. The presence of urinary loss was identified using the Urinary Distress Inventory 6 (UDI-6). The associated factors found were divided into those related to sociodemographic (education and marital status), behavioral (constipation occurrence), obstetric (previous pregnancies), hereditary (skin color), and sports practice variables (sports level, volleyball position, time of sports practice in years, physical and tactical training routine, and daily water intake). The Chi-square test or Fisher's exact test, Mann-Whitney U test, and binary logistic regression model were used. This study included 83 volleyball athletes with a mean age of 26.6 (± 7.2) years. It was found that 25.3% of the volleyball athletes presented UI and those that reported symptoms of constipation were 10 times more likely to develop UIthan those without constipation.Women who practice high-impact sports in a professional manner, such as volleyball, should be aware of the symptoms of pelvic floor dysfunction, since they will be predisposed to urine leakage. The finding that a considerable number of athletes report UI and that long-term sports practice exposes athletes to a higher risk of UI indicates that pelvic exercises should be proposed in order to reduce these symptoms.

Pelvic floor distress inventory (PFDI)-systematic review of measurement properties.

INTRODUCTION AND HYPOTHESIS: The Pelvic Floor Distress Inventory (PFDI) and PFDI-20 have been translated and validated into several languages ​​with different measurement property values ​​and are recommended by the International Consultation on Incontinence (ICI) as grade A for assessing pelvic floor dysfunction. Thus, the aim of the current study was to investigate the measurement properties of the PFDI and PFDI-20. METHODS: Systematic review conducted in August 2020 through a search performed in PubMed, SCOPUS, WoS, ScienceDirect, CINAHL, and Google Scholar for studies that evaluated the measurement properties of the PFDI and PFDI-20. The data were analyzed according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). RESULTS: Initially, 2857 studies were found, and 7 studies on PFDI and 25 on PFDI-20 were analyzed. The PFDI presented high quality of evidence for hypothesis testing, moderate for test-retest reliability and responsiveness, and very low quality of evidence for content validity. The PFDI-20 presented high quality of evidence for criterion validity, hypothesis testing, and responsiveness, moderate quality for test-retest reliability and measurement errors, and very low quality of evidence for content validity. It was not possible to rate the quality of evidence of the internal consistency of the PFDI and PFDI-20. No studies assessed the cross-cultural validity. CONCLUSION: Only the hypothesis testing presented high quality of evidence for the PFDI. Criterion validity, hypothesis testing, and responsiveness presented a high quality of evidence for the PFDI-20. Due to the high degree of recommendation of the PFDI and PFDI-20 given by the ICI, further studies are needed to reevaluate all the measurement properties of these instruments.

Urine Loss during a Volleyball Competition: Comparison between Amateur and Professional Athletes.

BACKGROUND: High-impact sports can cause dysfunction to the female pelvic floor that leads to the occurrence of stress urinary incontinence. OBJECTIVE: To identify and compare the presence of urine loss between professional and amateur female volleyball athletes during a competition. METHODS: A cross-sectional and comparative study was conducted on 75 volleyball athletes, including 30 amateurs and 45 professional athletes. Female athletes 18 years of age or older were included. Urine loss during the competition was evaluated by self-report and measured by a pad test (in grams). Day-to-day urinary incontinence was identified using the Urinary Distress Inventory 6 (UDI-6). Before the beginning of the game, the instruments were applied by individual interview for data collection and the pad was positioned. After the game, the pad was removed and weighed again. Descriptive and inferential statistics were used, with a significance level of 5%. RESULTS: Half of the professional (50.0%) and amateur (55.6%) athletes have symptoms of urine loss during a competition. Objective urine loss was higher among professional athletes (4.5 ± 1.4 g) compared to amateur athletes (3.8 ± 1.4 g). There was a significant difference (P < .001) in objective urine loss between symptomatic (mean = 5.41, standard deviation [SD] = 0.8) and asymptomatic professional athletes (mean = 3.40, SD = 1.3). CONCLUSION: Self-report of urinary incontinence during the competition was common among professional and amateur athletes. However, objective urine loss was significantly higher among professional athletes.

Treinamento dos músculos do assoalho pélvico em mulheres com dispareunia: um ensaio clínico randomizado / Pelvic floor muscles training in women with dyspareunia: randomized clinical trial

Introdução: A dispareunia afeta a função sexual feminina, bem como a qualidade de vida. Deste modo, o treinamento do assoalho pélvico gera consciência da região vaginal, bem como melhora da função sexual. Objetivo: Analisar o efeito do treinamento dos músculos do assoalho pélvico (TMAP) na qualidade de vida de mulheres com dispareunia. Métodos: Trata-se de um ensaio clínico randomizado em mulheres sexualmente ativas com sintomas de dispareunia que foram aleatoriamente distribuídas em Grupo Intervenção (GI; n = 6) e Grupo Controle (GC; n = 7). A função sexual foi verificada através do Female Sexual Function Index (FSFI). A interferência da dispareunia na qualidade de vida foi verificada por uma escala visual analógica (0= nenhuma interferência; 10= máxima interferência). O GI foi submetido ao TMAP por oito semanas, sendo dois encontros semanais com e duração de 40 minutos, e o GC não recebeu nenhum treinamento. Para análise dos dados, utilizou-se estatística descritiva e inferencial, com nível de significância de 5%. Resultados: Observou-se que os domínios desejo, excitação, lubrificação, orgasmo e satisfação não apresentaram diferença significativa em ambos os grupos. No entanto, houve diminuição dos valores encontrados no domínio dor (p = 0,043; d = 1,24) no GI. Quanto à interferência da dispareunia na qualidade de vida, os valores foram significativamente melhores no GI (p = 0,022; d = 1,95). Conclusão: Após intervenção fisioterapêutica de treino dos músculos do assoalho pélvico, há melhora da dor em mulheres. (AU)

Introduction: Dyspareunia affects female sexual function as well as quality of life. In this mode, pelvic floor training generates awareness of the vaginal region as well as enhances sexual function. Aim: To analyze the effect of pelvic floor muscle training (PFMT) on the quality of life of women with dyspareunia. Methods: This was a randomized clinical trial in sexually active women with symptoms of dyspareunia that were randomly assigned to Intervention Group (GI; n = 6) and Control Group (CG; n = 7). Sexual function was verified through the Female Sexual Function Index (FSFI). Dyspareunia interference on quality of life was verified by a visual analog scale (0 = no interference; 10 = maximum interference). The GI was submitted to the PFMT for eight weeks, two weekly meetings lasting 40 minutes, and the CG received no training. For data analysis, descriptive and inferential statistics were used, with a significance level of 5%. Results: The domains desire, arousal, lubrication, orgasm and satisfaction did not present significant difference in both groups. However, there was a decrease in the values found in the pain domain (p = 0.043; d = 1.24) in the GI. Regarding the interference of dyspareunia in quality of life, values were significantly better in GI (p = 0.022; d = 1.95). Conclusion: After physical therapy intervention of pelvic floor muscles training there is pain improvement in women. (AU)

Incontinência urinária e funcionalidade do assoalho pélvico de idosas fisicamente ativas: uma comparação entre diferentes estratos etários / Urinary incontinence and pelvic floor function in physically active older women: comparison between different age groups / Incontinencia urinaria y funcionalidad del suelo pélvico de mujeres ancianas físicamente activas: una comparación entre diferentes grupos de edad

O estudo teve como objetivo analisar a funcionalidade do assoalho pélvico de mulheres idosas fisicamente ativas, com e sem Incontinência Urinária (IU), de acordo com o estrato etário. Através de uma pesquisa descritiva, com 61 idosas (30 com IU e 31 sem IU), com idade entre 60 e 71 anos, ativas fisicamente, do município de Santa Maria, estado do Rio Grande do Sul, Brasil. As idosas com IU do grupo mais longevo apresentaram pior funcionalidade do assoalho pélvico, nos itens força (p=0,049) e repetições mantidas (p=0,023), sendo o envelhecimento um fator influenciador para a gênese da IU.

The study aimed to analyze the pelvic floor functionality of physically active elderly women with and without Urinary Incontinence, according to the age group. Through a descriptive research, with 61 elderly women (30 with UI and 31 without UI) aged between 60 and 71 years, physically active in the municipality of Santa Maria, state of Rio Grande do Sul, Brazil. The elderly women with UI in the longest-lived group had worse pelvic floor functionality, in the items strength (p = 0.049) and maintained repetitions (p = 0.023), with aging being an influencing factor for UI genesis.

El estúdio tuvo como objetivo analizar la funcionalidade del piso pélvico de mujeres ancianas fisicamente activas con y sin incontinencia urinaria (IU), según el grupo de edad. Por una investigación descriptiva, con 61 mujeres de edad avanzada (30 con IU y 31 sin IU) com edades entre 60 y 71 años, fisicamente activas em el municipio de Santa Maria, estado de Rio Grande do Sul, Brasil. Las mujeres de edad avanzada con IU em el grupo de vida más larga tenían una peor funcionalidade del piso pélvico, em los artículos de la fuerza (p = 0.049) y repeticions mantenidas (p = 0.023), siendo el envejecimiento um fator influyente para la génesis de la IU.

Funcionalidade dos músculos do assoalho pélvico de idosas fisicamente ativas / Pelvic floor muscle functionality of physically active elderly women

Introdução: As atividades físicas leves ou moderadas e as vigorosas podem impactar nos distúrbios do assoalho pélvico de maneira bidirecional, uma vez que podem exercer papel protetor para perdas urinárias, bem como constituir-se em fator desencadeador. Estudos voltados à funcionalidade do assoalho pélvico e ao nível de atividade física de mulheres idosas ainda são escassos. Objetivo: Analisar a funcionalidade dos músculos do assoalho pélvico (MAP) de idosas ativas fisicamente. Métodos: Pesquisa descritiva com 51 idosas (67,8 ± 5,2 anos) praticantes de atividade física. Inicialmente as idosas responderam a questões de uma ficha diagnóstica. Para avaliação funcional dos MAP foi utilizado o Esquema PERFECT. A avaliação do nível de atividade física foi realizada através do acelerômetro. As variáveis estudadas neste estudo foram analisadas descritivamente por meio de medidas de tendência central (média e desvio padrão ou mediana, conforme a natureza dos dados), frequência simples e porcentagem. Para comparar a funcionalidade do assoalho pélvico com a atividade física das idosas foi utilizado o teste ANOVA one-way. O nível de significância adotado foi de 5%. Resultados: As idosas praticam atividade física em média há 10 ± 9,24 anos, 2 vezes na semana. As medianas dos componentes do assoalho pélvico foram: 3 para força, 2 segundos para resistência, 3 para repetição e 4 para fibras rápidas. Conclusão: Apesar de a força dos MAP ser considerada boa, não há relação entre atividade física e a funcionalidade do assoalho pélvico. (AU)

Introduction: Mild or moderate and vigorous physical activities can affect pelvic floor disorders in a bidirectional way, since they may play a protective role for urinary losses, as well as being a triggering factor. Studies on the functionality of the pelvic floor and the level of physical activity of elderly women are still scarce. Objective: To analyze the functionality of the pelvic floor muscles (MAP) of physically active elderly women. Methods: Descriptive research with 51 elderly women (67.8 ± 5.2 years) practicing physical activity. Initially, the elderly answered questions on a diagnostic record. For functional evaluation of the MAP, the PERFECT Scheme was used. The assessment of the level of physical activity was performed through the accelerometer. The variables studied in this study were descriptively analyzed using central tendency measures (mean and standard deviation or median, according to the nature of the data), simple frequency and percentage. One-way ANOVA test was used to compare pelvic floor functionality with physical activity in the elderly. The level of significance was 5%. Results: The elderly practiced physical activity on average 10 ± 9.24 years, 2 times in the week. The medians of the pelvic floor components were: 3 for strength, 2 seconds for resistance, 3 for repetition and 4 for fast fibers. Conclusion: Although the MAP strength is considered good, there is no relationship between physical activity and pelvic floor functionality. (AU)

Disfunções dos músculos do assoalho pélvico em mulheres que realizam o exame preventivo de câncer de colo de útero / Pelvic floor dysfunctions in women undergoing cervical cancer screening

Introdução: As disfunções dos músculos do assoalho pélvico (DMAP) ocorrem devido a alterações das estruturas da região pélvica. A identificação de sintomas no exame preventivo de câncer de colo de útero é importante para aprimorar políticas públicas de atenção à saúde da mulher. Objetivo: Analisar a prevalência de DMAP em mulheres que realizam exame preventivo de câncer de colo de útero. Métodos: Tratou-se de um estudo transversal cuja população foi composta por 64 mulheres adultas. Os instrumentos de pesquisa utilizados foram ficha de identificação de DMAP e ficha de identificação de fatores associados as DMAP. Resultados: Constipação (40,6%), incontinência urinária (IU) (39,1%) e dispareunia (23,4%) foram as mais prevalentes, com 39,1% das mulheres apresentando sintomas de uma única disfunção, 21,9% duas disfunções e 9,4% associação de três disfunções, 44% das mulheres com IU também apresentam constipação e 28% com IU apresentavam dispareunia. Nenhum fator demonstrou associação à constipação, IU demonstrou uma tendência à associação ao consumo de cafeína e dispareunia ao uso de medicamentos Inibidores da Enzima Conversora de Angiotensina. Conclusão: Observou-se maior prevalência de constipação, IU e dispareunia destacando-se a sobreposição de sintomas, enfatizando a importância da detecção precoce das DMAP ainda na atenção primária. (AU)

Introduction: Pelvic floor dysfunctions (PFD) occur due to changes in the structures of the pelvic region. The identification of symptoms in the cervical cancer screening is important to improve public health care for women. Objective: To analyze the prevalence of PFD in women who undergo cervical cancer screening test. Methods: This was a cross-sectional study whose population was composed of 64 adult women. The research instruments used were a PFD identification form and a PFD identification card. Results: Constipation (40.6%), Urinary Incontinence (UI) (39.1%) and dyspareunia (23.4%) were the most prevalent, with 39.1% of the women presenting with a single dysfunction, 21.9% two dysfunctions and a 9.4% association of three dysfunctions, 44% of women with UI also presented constipation and 28% with UI had dyspareunia. No factor was associated with constipation, UI showed a trend to association with caffeine consumption and dyspareunia with the use of ACE inhibitors. Conclusion: A higher prevalence of constipation, UI and dyspareunia was observed, with overlapping of symptoms, emphasizing the importance of the early detection of PFD still in the primary care, for the prevention and treatment of these symptoms. (AU)

Effect of Weight Training with Pelvic Floor Muscle Training in Elderly Women with Urinary Incontinence.

PURPOSE: To determine if weight training combined with pelvic floor muscle training is more efficient than pelvic floor muscle training alone for the treatment of urinary incontinence (UI) symptoms in elderly women. METHOD: This was a two-arm, parallel, randomized controlled trial. Twenty-six women with stress UI participated in the study. The intervention group (IG) underwent training with moderate intensity weights combined with pelvic floor muscle training, whereas the control group (CG) only underwent pelvic floor muscle training. Intervention occurred twice a week over 12 weeks. The International Consultation on Incontinence Questionnaire-Short Form was used as the main measure. Scores of zero defined the absence of symptoms. The absence of symptoms was evaluated at 4 weeks, 12 weeks, and 1 month after the end of treatment. Moreover, activities related to UI and the use and change of daily protection were investigated. RESULTS: The rate of absence of symptoms was significantly higher in IG after 4 weeks (58.3%) compared to CG (14.8%). The relative risk was 4.1 (95% confidence interval [CI] [1.08, 16.06]). Although no intention-to-treat analysis was performed, there was no difference in the evaluations after the interventions. CONCLUSION: Compared to pelvic floor muscle training alone, the combination of weight training and pelvic floor muscle training provided earlier improvement of UI in elderly women.

Perfil das idosas participantes de um grupo de convivência / Profile of the elderly participants of a coexistence group

Objetivo: Descrever o perfil dos idosos inseridos em um centro de convivência. Métodos: Estudo quantitativo de abordagem descritiva. A amostra foi composta por 51 idosas participantes de um programa de extensão universitária de uma universidade pública do sul do Brasil, com média de 67,8 (±5,2) anos. Foi utilizada uma ficha diagnóstica. As variáveis estudadas nessa pesquisa foram analisadas descritivamente por meio de medidas de tendência central e frequência simples e porcentagem. Resultados: Destaca-se nas idosas o estado civil de viúvas (43,1%), vivendo com os familiares (43,1%), com a escolaridade de 5 a 8 anos de estudos (43,1%), da religião católica (78,4%), aposentadas (33,3%) e com a renda familiar entre 1 e 2 salários mínimos (43,1%). As idosas praticam atividade física em média há 10 (± 9,24) anos, 2 (duas) vezes na semana. Conclusão: As idosas que participam deste grupo de convivência são jovens, católicas, viúvas e aposentadas. Os grupos de convivência de idosos podem ser importantes veículos de educação em saúde para idosos, a fim de instrumentalizá-los para o autocuidado, promover sua saúde e prevenir doenças e agravos. (AU)

Objective: To describe the profile of elderly people living in a cohabitation center. Methods: Quantitative study of a descriptive approach. The sample consisted of 51 elderly women 67.8 (± 5.2) years old, enrolled in a university extension program of a public university in the south of Brazil. A diagnostic form was used. The variables studied in this research were descriptively analyzed through measures of central tendency and simple frequency and percentage. Results: We highlighted the marital status of widows (43.1%), living with their families (43.1%), schooling of 5 to 8 years of education (43.1%), (78.4%), retired (33.3%) and the family income between 1 and 2 minimum wages (43.1%). The elderly practiced physical activity on average 10 (± 9,24) years, 2 times in the week. Conclusion: The elderly women who participate in this coexistence group are young, catholic, widowed and retired. Elderly care groups can be important vehicles for health education for the elderly, in order to equip them for self-care, to promote their health and to prevent diseases and injuries. (AU)

Pelvic, anorectal and urinary symptoms according to the nutritional status of adult women: A cross-sectional study / Sintomas pélvicos, anorretais e urinários de acordo com o estado nutricional de mulheres adultas: um estudo transversal

ABSTRACT To review the occurrence of pelvic, anorectal and urinary symptoms according to the nutritional status of adultwomen. Methods This is a cross-sectional study with 54 women, aged 18 to 35 years, divided into normal weight (<25kg/m2), overweight (25kg/m2 to 29.99kg/m2) and obesity (≥30kg/m2) according to the body mass index. The presence of pelvic floor muscle dysfunction symptoms was assessed by the Pelvic Floor Distress Inventory and the impact of these symptoms by the Pelvic Floor Impact Questionnaire. Descriptive and inferential statistics were used, with a significance level of 5%. Results Pelvic Floor Distress Inventory total score was 22.95 (SD=26.11) in the eutrophic group and 59.67 (SD=47.80) in the obesity group (p=0.01). Considering the scales, urinary symptoms were higher in obese women than in the eutrophic group (p=0.01). In the assessment of patients with each symptom, a difference (p<0.01) was observed in incomplete bowel emptying, in which the highest frequency occurred in overweight women (47.4%) compared to eutrophic and obese women (both 26.3%). Urinary incontinence symptoms (18.2% in eutrophic women, 27.3% overweight and 54.5% obese), stress urinary incontinence (8.3% eutrophic, 41.7% overweight and 50.0%, obese) and difficulty in emptying the bladder (0.0% eutrophic, 33.3% overweight and 66.7% obese) exhibited higher frequencies (p=0.03; p<0,01 and p=0.02, respectively) in obese women. Conclusion Symptoms of pelvic floor muscles dysfunction, especially urinary tract muscles, occur more frequently in obese adult women when compared to eutrophic women.

RESUMO Objetivo Analisar a presença dos sintomas pélvicos, anorretais e urinários de acordo com o estado nutricional de mulheres adultas. Métodos Trata-se de um estudo transversal com 54 mulheres, com idade entre 18 e 35 anos, divididas nas seguintes categorias: eutróficas (<25kg/m2), com sobrepeso (25kg/m2 a 29,99kg/m2) e com obesidade (≥30kg/m2), de acordo com o índice de massa corporal. A presença dos sintomas das disfunções dos músculos do assoalho pélvico foi avaliada por meio do Pelvic Floor Distress Inventory, e o impacto desses sintomas pelo Pelvic Floor Impact Questionnaire. Utilizou-se estatística descritiva e inferencial com nível de significância de 5%. Resultados O escore total do Pelvic Floor Distress Inventory apresentou média de 22,95 (DP=26,11) no grupo eutrófico e 59,67 (DP=47,80) no grupo obesidade (p=0,01). Entre as escalas, os sintomas urinários apresentaram valores maiores nas mulheres com obesidade em relação ao grupo eutrófico (p=0,01). Na associação entre cada sintoma, encontrou-se diferença (p<0,01) no esvaziamento incompleto do intestino, cuja maior frequência ocorreu nas mulheres com sobrepeso (47,4%) em comparação às eutróficas e com obesidade (ambas 26,3%). Nos sintomas de incontinência urinária de urgência (18,2% nas mulheres eutróficas, 27,3% nas mulheres com sobrepeso e 54,5% nas mulheres obesas), de incontinência urinária de esforço (8,3% nas mulheres eutróficas, 41,7% nas mulheres sobrepeso e 50,0% nas obesas) e de dificuldade em esvaziar a bexiga (0,0% nas eutróficas, 33,3% nas mulheres com sobrepeso e 66,7% nas mulheres obesas), foram verificadas frequências maiores (p=0,03; p<0,01 e p=0,02, respectivamente) nas mulheres com obesidade. Conclusão Os sintomas de disfunções dos músculos do assoalho pélvico, sobretudo os urinários, ocorrem mais em mulheres adultas obesas em comparação às mulheres adultas eutróficas.

Efeitos do treinamento muscular do assoalho pélvico associado à musculação na perda urinária e nos aspectos psicológicos em mulheres idosas: ensaio clínico randomizado / Effects of pelvic floor muscle training associated with resistance training on urinary loss and psychological aspects in older women: a randomized clinical trial

Objetivo: Comparar os efeitos do treinamento muscular do assoalho pélvico (TMAP), associado ou não à musculação, na perda urinária, estado de humor e autoeficácia do tratamento em mulheres idosas com incontinência urinária (IU). Métodos: Ensaio clínico randomizado, cego, realizado com mulheres idosas (≥60 anos), residentes na Grande Florianópolis/SC. Os critérios de inclusão foram: autorrelato positivo de IU de esforço e mista; força muscular do assoalho pélvico (Oxford ≥2); e função cognitiva preservada. Foram selecionadas 31 idosas para distribuição randomizada cega entre Grupo Experimental (GE) (n = 14) e Grupo Controle (GC) (n = 17), 26 idosas concluíram o tratamento (GE = 12 e GC = 14). Foram coletados dados socioeconômicos e de fatores de risco, além de medidas antropométricas (IMC e circunferência da cintura) e satisfação com o tratamento. Os desfechos principais foram: International Consultation on Incontinence Questionnaire ­ Short Form (ICIQ-SF); Escala de Humor de Brunel (BRUMS); Escala de Autoeficácia para Prática de Exercícios do Assoalho Pélvico (EAPEAP). Todas as idosas realizaram o TMAP e, no GE, foi acrescentada a musculação, durante 12 semanas em ambos os grupos. Resultados: A idade média foi de 64,8 (± 4,7) anos no GE e 66,5 (± 5,6) anos. Os principais fatores de risco ginecológicos, obstétricos, histórico familiar e perfil antropométrico foram semelhantes nos dois grupos. A comorbidade prevalente em ambos os grupos foi a hipertensão arterial (GE = 50,0% e GC = 64,3%). A perda urinária apresentou diferença significativa na comparação intragrupos e entre grupos na pré-intervenção, sem variação significativa no estado de humor e na autoeficácia com o tratamento. Conclusão: O TMAP, associado ou não com musculação no tratamento da IU, foi efetivo para redução da perda urinária, mas não teve melhora significativa no estado de humor e na autoeficácia com o tratamento.

Objective: To compare the effects of pelvic floor muscle training (TMAP), associated or not to bodybuilding, on urinary loss, mood and self-efficacy of treatment in elderly women with urinary incontinence (UI). Methods: Randomized, blinded clinical trial of elderly women (≥60 years old) living in Florianópolis/SC. The inclusion criteria were: self-report of stress and mixed UI; muscle strength of the pelvic floor (Oxford ≥2); and preserved cognitive function. Thirty-one elderly women were selected for randomized blinded distribution between the Experimental Group (SG) (n = 14) and the Control Group (CG) (n = 17) 26 elderly women completed treatment (SG = 12 and GC = 14). Socioeconomic data and risk factors were collected, as well as anthropometric measures (BMI and waist circumference) and treatment satisfaction. The main outcomes were: International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF); Brunel Humor Scale (BRUMS); Self-efficacy Scale for Exercise of the Pelvic Floor (EAPEAP). All the elderly women underwent TMAP and, in GE, bodybuilding was added for 12 weeks in both groups. Results: The mean age was 64.8 (± 4.7) years in GE and 66.5 (± 5.6) years. The main gynecological, obstetric, family history and anthropometric risk factors were similar in both groups. The prevalent comorbidities were arterial hypertension (GE = 50.0% and GC = 64.3%). Urinary loss showed a significant difference in the intragroup and pre-intervention groups, with no significant variation in mood and self-efficacy with the treatment. Conclusion: TMAP, associated or not with bodybuilding in the treatment of UI, was effective in reducing urinary loss, but there was no significant improvement in mood and self-efficacy with treatment.

Fatores de risco para infecção do sítio cirúrgico em cirurgias potencialmente contaminadas / Factores de riesgo para la infección del sitio quirúrgico en cirugias potencialmente contaminadas / Risk factors for surgical site infections in potentially contaminated surgeries

RESUMO Objetivo: associar os fatores de risco do período pós-operatório de cirurgias potencialmente contaminadas, com a ocorrência da infecção do sítio cirúrgico no período pós-operatório hospitalar e domiciliar. Método: período de coleta de dados foi de fevereiro a junho de 2015, com 84 pacientes acompanhados nos três primeiros dias de pós-operatório e sete dias após a alta hospitalar, através de questionários elaborados para avaliação do sítio cirúrgico, das condições clínicas do paciente e da análise de prontuário. Para verificação dos fatores de risco influenciáveis e classificação das infecções do sítio cirúrgico, utilizou-se um questionário com variáveis que foram analisadas de forma descritiva através da frequência simples, porcentagem e medidas de posição e dispersão. Para a associação e nível de significância dos fatores de risco foram realizados testes estatísticos. Resultados: nenhum dos pacientes entrevistados desenvolveu infecção profunda do sítio cirúrgico ou de órgão/espaço, sendo que sete desenvolveram infecção do sítio cirúrgico superficial no pós-operatório hospitalar e 41 em domicílio. Os fatores de risco analisados não foram significativos para o desenvolvimento das infecções. Conclusões: recomenda-se que as instituições implantem um serviço de vigilância e acompanhamento pós-alta, a fim de que se melhore a confiabilidade das taxas de incidência das infecções do sítio cirúrgico; melhorar a qualidade dos cuidados com os pacientes; compreensão epidemiológica e identificação dos fatores de risco. Além disso, propõe-se facilitar o processo de referência e contra referência através de capacitações da Estratégia de Saúde da Família para identificação destes fatores de risco, atuando em rede.

RESUMEN Objetivo: asociar los factores de riesgo del período postoperatorio de cirugías potencialmente contaminadas, con la ocurrencia de la infección del sitio quirúrgico en el período postoperatorio hospitalario y domiciliar. Método: período de recolección de datos fue de febrero a junio de 2015, con 84 pacientes acompañados en los tres primeros días de postoperatorio y siete días después del alta hospitalaria, a través de cuestionarios elaborados para evaluación del sitio quirúrgico, de las condiciones clínicas del paciente y del análisis de prontuario. Para la verificación de los factores de riesgo influenciables y clasificación de las infecciones del sitio quirúrgico, se utilizó un cuestionario con variables que fueron analizadas de forma descriptiva a través de la frecuencia simple, porcentaje y medidas de posición y dispersión. Para la asociación y el nivel de significancia de los factores de riesgo se realizaron pruebas estadísticas. Resultados: ninguno de los pacientes entrevistados desarrolló una infección profunda del sitio quirúrgico o de órgano/espacio, siendo que siete desarrollaron infección del sitio quirúrgico superficial en el postoperatorio hospitalario y 41 en domicilio. Los factores de riesgo analizados no fueron significativos para el desarrollo de las infecciones. Conclusiones: se recomienda que las instituciones implantes un servicio de vigilancia y seguimiento post-alta, a fin de que se mejore la confiabilidad de las tasas de incidencia de las infecciones del sitio quirúrgico; mejorar la calidad del cuidado de los pacientes; la comprensión epidemiológica y la identificación de los factores de riesgo. Además, se propone facilitar el proceso de referencia y contra referencia a través de capacitaciones de la Estrategia de Salud de la Familia para identificar estos factores de riesgo, actuando en red.

ABSTRACT Objective: to associate the risk factors of the postoperative period of potentially contaminated surgeries, with the occurrence of surgical site infections in the postoperative period in the hospital and home setting. Method: the data collection period was from February to June 2015, 84 patients were followed up on the first three post-operative days and seven days after hospital discharge, the collection was performed through questionnaires designed to evaluate the surgical site, the clinical conditions of the patient and chart analysis. In order to verify the influencing risk factors and classifications of surgical site infections, a questionnaire was used with variables that were analyzed in a descriptive manner through simple frequency, percentage, and position and dispersion measurements. Statistical tests were performed for the association and significance level of the risk factors. Results: none of the patients interviewed developed a deep infection of the surgical or organ / space site, seven developed superficial surgical site infections in the post-operative period in hospital and 41 developed a surgical site infection at home. The analyzed risk factors were not significant for the development of infections. Conclusions: it is recommended that institutions implement a post discharge monitoring and follow-up service in order to improve the reliability of the incidence rates of surgical site infections; improving the quality of patient care; epidemiological understanding and identification of risk factors. In addition, it proposes to facilitate the referral and counter referral process through training in the Family Health Strategy in order to identify these risk factors, and by acting in a network.

Association between sitting time and major diseases in Brazilian octogenarians / Associação entre tempo sentado e as principais doenças em octogenários Brasileiros

The aim of this study was to associate sitting time with major diseases affecting octogenarians. This observational crosssectional study involved 351 octogenarians, being 323 women and 28 men, with a mean age of 84.1 (SD = 3.9). Sociodemographic data,health conditions and responses to Section 5 of the International Physical Activity Questionnaire (IPAQ) were entered into a diagnostic program in order to determine the weekly time spent sitting down. Descriptive (single frequency, percentage, mean, and standard deviation) and inferential statistics (Mann-Whitney U test and binary logistic regression) were used. The data were examined at a 5% significance level. The most frequent diseases in the octogenarians were high blood pressure (60.1%), heart diseases (26.5%), diabetes (21.9%), dyslipidemia (21.7%), osteoporosis (18.5%), and osteoarthritis (14.5%). The longer they spent sitting down, the greater the risk of developing diabetes (OR = 4.5, 95% CI 2.5 to 8.2) and dyslipidemia (OR = 2.9, 95% CI 1.6 to 5.0). A sitting time of more than 1,710 minutes per week can predict the occurrence of diabetes (p = 0.002), while sitting for more than 1,380 minutes per week can predict the occurrence of dyslipidemia (p = 0.002). Sitting time was found to be a risk factor for the occurrence of diabetes and dyslipidemia in the studied octogenarians. Chronic diseases were associated with sedentary behavior.

O objetivo deste estudo foi associar o tempo sentado com as principais doenças que afetam as pessoas octogenárias. Este estudo observacional e transversal foi composto de 351 pessoas octogenárias, 323 mulheres e 28 homens. Associou-se dados sociodemográficos, condições de saúde e o domínio 5 do Questionário Internacional de Atividade Física (IPAQ) para determinar o tempo despendido por semana na posição sentada. Foram utilizadas estatísticas descritivas (frequência única, percentagens, média e desvio padrão) e estatística inferencial (teste de Mann-Whitney e regressão logística binária). Os dados foram examinados em um nível de significância de 5%. As doenças mais frequentes nas pessoas octogenárias foram hipertensão arterial (60,1%), doenças do coração (26,5%), diabetes (21,9%), dislipidemia (21,7%), osteoporose (18,5%) e osteoartrite (14,5%). Quanto maior o tempo gasto na posição sentada, maior as chances de desenvolver diabetes (OR = 4,5, IC 95% 2,5-8,2) e dislipidemia (OR = 2,9, IC 95% 1,6-5,0). O tempo sentado maior que 1710 minutos por semana pode predizer a ocorrência de diabetes (p = 0,002), sentar-se por mais de 1380 minutos por semana pode predizer a ocorrência de dislipidemia (p = 0,002). Verificou-se que o tempo sentado é um fator de risco para a ocorrência de diabetes e dislipidemia nos octogenários. As doenças crônicas mostraram associação com o comportamento sedentário.

Pré-operatório de cirurgias potencialmente contaminadas: fatores de risco para infecção do sítio cirúrgico / Preoperative period of potentially contaminated surgeries: risk factors for surgical site infection

Resumo Objetivo Associar fatores de risco do período pré-operatório, de cirurgias potencialmente contaminadas, realizadas em hospital escola da região Sul do Brasil, com a ocorrência da infecção do sítio cirúrgico no período pós-operatório hospitalar e em domicílio. Métodos Estudo transversal descritivo quantitativo realizado de fevereiro a junho de 2015 com 90 participantes mediante a coleta de dados realizada sob a forma de entrevista individual e observação, desde o período pré-operatório, pós-operatório imediato e mediato até sete dias após alta hospitalar. Para análise de dados utilizou-se o Statistical Package for Social Sciences, sendo as variáveis categóricas analisadas descritivamente através da frequência simples e porcentagens e as numéricas pelas medidas de posição e dispersão. Resultados A infecção do sítio cirúrgico no período pós-operatório hospitalar ocorreu em (10%) e no pós-operatório domiciliar em 46,7%. Fatores de risco: sexo, idade, doenças de base, medicações, etilismo e tabagismo foram significativos para o desenvolvimento destas infecções. Conclusão Recomenda-se a realização de histórico de enfermagem e acompanhamento dos pacientes cirúrgicos, durante o período pré-operatório e recuperação operatória, para reduzir a infecção do sítio cirúrgico.

Abstract Objective To associate risk factors of the preoperative period of potentially contaminated surgeries performed in a teaching hospital in the southern region of Brazil with the occurrence of surgical site infection in the postoperative period in the hospital and at home. Methods A quantitative descriptive cross-sectional study conducted from February to June 2015 with 90 participants by means of individual data collection and observation, from the preoperative period, immediate postoperative period and up to seven days after discharge. The Statistical Package for Social Sciences was used for data analysis. Categorical variables were analyzed descriptively by simple frequency and percentages, and numerical variables by position and dispersion measurements. Results The surgical site infection in the postoperative period in the hospital occurred in 10% of participants, and in the postoperative period at home in 46.7%. Risk factors gender, age, underlying diseases, medications, alcoholism and smoking habits were significant for the development of these infections. Conclusion Checking the health history and performing follow-up of surgical patients during the preoperative period and surgical recovery to reduce surgical site infection are recommended.

Treinamento resistido para manutenção da continência urinária após tratamento fisioterapêutico em mulheres na terceira idade: um estudo-piloto / Resistance training to maintain urinary continence after physical therapy in older women: a pilot study / Entrenamiento de resistencia para mantener la continencia urinaria después de la terapia física en mujeres mayores: un studio-piloto

Objetiva-se analisar o treinamento resistido para manutenção dos resultados obtidos na fisioterapia em idosas com incontinência urinária. Como método, utilizou-se ficha diagnóstica, Pad Test, Bateria de Testes de Aptidão Física para Idosos, avaliação antropométrica e avaliação do assoalho pélvico (PERFECT). Os resultados mostram: manutenção da continência, manutenção ou melhora nos itens do PERFECT, melhora das aptidões físicas e das dimensões corporais. Como conclusão: o treinamento resistido pode minimizar a recidiva da incontinência após a reabilitação.

Aim: analyze the resistance training for maintenance of the results with physical therapy in older women with urinary incontinence. Method: used to a diagnostic record, Pad Test, Test Battery Physical Fitness for the Elderly, anthropometric and evaluation of the pelvic floor (PERFECT). Results: maintenance of continence, maintenance or improvement in PERFECT items, improved physical fitness and body dimensions. Conclusion: resistance training can minimize the recurrence of incontinence after rehabilitation.

Objetivo: analizar el entrenamiento de resistencia para el mantenimiento de los resultados con fisioterapia en mujeres mayores con incontinencia urinaria. Método: se utilizó ficha diagnóstica, Pad Test, Batería de Pruebas de Aptitud Física para Ancianos, evaluación antropométrica y evaluación del piso pélvico. Resultados: mantenimiento de la continencia, mantenimiento o mejora de los elementos PERFECT, mejora de la condición física y dimensiones del cuerpo. Conclusión: el entrenamiento resistido puede minimizar la recurrencia de la incontinencia después de la rehabilitación.

Diagnostic Accuracy of Anthropometric Indicators in the Prediction of Urinary Incontinence in Physically Active Older Women.

Purpose To determine the diagnostic accuracy and the cutoff point of the variables conicity index, waist to height ratio and fat percentage to detect urinary incontinence in physically active older women. Method A total of 152 women were analyzed. The instruments used were the International Physical Activity Questionnaire (IPAQ [Area 4]) to check the level of physical activity, and the Diagnostic Form to obtain sociodemographic data and presence of urinary incontinence. To calculate the conicity index, waist to height ratio and fat percentage, body mass, height and waist circumference were measured. Descriptive and inferential statistics were used. Cutoff points, sensitivity (S) and specificity (SP) were determined by receiver operating characteristic (ROC) curves. A 5% significance level was adopted. Results The prevalence of urinary incontinence was of 32.2%. The cutoff point with better sensitivity and specificity for the conicity index was 1.23 (S = 87.8; SP = 35.9); for the waist to height ratio, it was 0.57 (S = 79.6; SP = 45.6); and for the fat percentage, it was 39.71 (S = 89.8; SP = 42.7). The area under the ROC curve was 0.666 for the conicity index, 0.653 for the waist to height ratio, and 0.660 for the fat percentage. Conclusions The cutoff points for the anthropometric measurements conicity index, waist to height ratio and fat percentage indicate that these measures can be used to predict urinary incontinence in physically active older women. Furthermore, fat percentage seemed to be the best measure for this population.

Diagnostic Accuracy of Anthropometric Indicators in the Prediction of Urinary Incontinence in Physically Active Older Women / Acurácia diagnóstica de indicadores antropométricos na predição de incontinência urinária em idosas fisicamente ativas

Abstract Purpose To determine the diagnostic accuracy and the cutoff point of the variables conicity index, waist to height ratio and fat percentage to detect urinary incontinence in physically active older women. Method A total of 152 women were analyzed. The instruments used were the International Physical Activity Questionnaire (IPAQ [Area 4]) to check the level of physical activity, and the Diagnostic Form to obtain sociodemographic data and presence of urinary incontinence. To calculate the conicity index, waist to height ratio and fat percentage, body mass, height and waist circumference were measured. Descriptive and inferential statistics were used. Cutoff points, sensitivity (S) and specificity (SP) were determined by receiver operating characteristic (ROC) curves. A 5% significance level was adopted. Results The prevalence of urinary incontinence was of 32.2%. The cutoff point with better sensitivity and specificity for the conicity index was 1.23 (S =87.8; SP =35.9); for the waist to height ratio, it was 0.57 (S =79.6; SP =45.6); and for the fat percentage, it was 39.71 (S =89.8; SP =42.7). The area under the ROC curve was 0.666 for the conicity index, 0.653 for the waist to height ratio, and 0.660 for the fat percentage. Conclusions The cutoff points for the anthropometric measurements conicity index, waist to height ratio and fat percentage indicate that these measures can be used to predict urinary incontinence in physically active older women. Furthermore, fat percentage seemed to be the best measure for this population.

Objetivo Verificar a acurácia diagnóstica e o ponto de corte das variáveis índice de conicidade, razão cintura/estatura e percentual de gordura para detectar a incontinência urinária em idosas fisicamente ativas. Métodos Foram avaliadas 152 idosas. Os instrumentos utilizados foram o Questionário Internacional de Atividade Física (IPAQ [Domínio 4]), para verificar o nível de atividade física, e a Ficha Diagnóstica, para obter dados sociodemográficos e da presença de incontinência urinária. Para os cálculos de índice de conicidade, razão cintura/estatura e percentual de gordura, mensuraram-se a massa corporal, estatura e perímetro da cintura. Utilizou-se estatística descritiva e inferencial. Os pontos de corte, sensibilidade (S) e especificidade (E) foram determinados por meio das curvas receiver operating characteristic (ROC). Adotou-se um nível de significância de 5%. Resultados A prevalência de incontinência urinária foi de 32,2%. O ponto de corte com melhor sensibilidade e especificidade do índice de conicidade foi de 1,23 (S = 87,8; E = 35,9), da razão cintura/estatura, de 0,57 (S = 79,6; E = 45,6), e, para percentual de gordura, de 39,71 (S = 89,8; E = 42,7). A área sob a curva ROC foi de 0,666 para o índice de conicidade, 0,653 para a razão cintura/estatura, e 0,660 para o percentual de gordura. Conclusões Os pontos de corte das medidas antropométricas índice de conicidade, razão cintura/estatura e percentual de gordura indicam que essas medidas podem ser utilizadas para predizer incontinência urinária em mulheres idosas fisicamente ativas. Além disso, o percentual de gordura demonstrou ser a melhor medida para esta população.