Low rate of complications in nipple-sparing mastectomy for patients with BRCA1 and BRCA2 mutation.

Background: To describe the indications and outcomes of BRCA mutation carriers undergoing nipple-sparing mastectomy (NSM). Methods: In this retrospective study, 76 BRCA mutation carriers with no cancer who opted to undergo risk reduction NSM or diagnosed with breast cancer (BC) who opted to undergo therapeutic NSM were included. Results: Indications for NSM: cancer treatment (n = 33), bilateral risk reduction (n = 39) and contralateral prophylactic NSM (n = 4). In a mean follow-up of 45 months (median: 30 months), one patient (2.5%) undergoing risk-reducing NSM developed a new BC. One (3%) local, one (3%) ipsilateral axillary and one (3%) distant recurrence were observed in BC patients. No partial or total nipple necrosis occurred. Conclusion: NSM is safe for reducing the risk of BC development in BRCA mutation carriers and for treating cancer.

Radiotherapy for Brain Metastases Near the End of Life: Characterizing Patients and Tumor Features.

PURPOSE: Patients with brain metastases are often referred for brain radiotherapy (BrRT) when exclusive palliative management would be more appropriate. To assess the indication of BrRT during end-of-life (EOL) care and evaluate the characteristics of the patients who underwent the treatment. METHODS: This retrospective study comprised patients from four independent oncology centers who had undergone BrRT for metastases. The variables included were Karnofsky performance status (KPS), primary tumor site, metastatic status, neurologic symptomatic status, the number and size of metastases, posterior fossa or meningeal involvement, type of BrRT, having undergone brain metastasectomy, and the availability of systemic therapies after BrRT. Patients were allocated into three subgroups with ≤30, 31-60, and 61-90 days of survival, and a control group of patients who survived >90 days. RESULTS: A total of 546 patients were included in the study. A KPS of <70 (P = .021), the number of brain metastases (P = .001), the lack of brain metastasectomy (P = .006), and the lack of systemic therapies after BrRT (P = .047) were significantly associated with the EOL subgroups. Multivariate analysis showed that a KPS of <70 (P < .001), the lack of brain metastasectomy (P = .015), and the lack of systemic therapies after BrRT (P = .027) were significantly associated with worse survival. In all, 241 (44.1%) patients died within 90 days-120 (22.0%) within 30 days, 75 (13.7%) within 31-60 days, and 46 (8.4%) within 61-90 days of BrRT. Patients with colorectal cancer were significantly more likely to die within 90 days of BrRT than >90 days. CONCLUSION: Considering patients' performance status and whether they are candidates for brain metastasectomy or systemic therapies after BrRT is critical to improving BrRT benefits in scenarios of EOL.

Nipple-sparing Mastectomy with Immediate Implant-based Reconstruction for Patients with Pure Ductal Carcinoma in Situ.

OBJECTIVE: The presence of an extensive intraductal component is associated to an increasing risk of relapse in the nipple-areola complex. The aim of the present study was to evaluate the outcomes of patients diagnosed with ductal carcinoma in situ (DCIS) who underwent nipple-sparing mastectomy (NSM) with immediate breast reconstruction using silicone implants. METHODS: We retrospectively analyzed the postoperative complications and oncological safety of 67 breast cancer patients diagnosed with pure DCIS who underwent NSM with immediate breast reconstruction using silicone implants between 2004 and 2018. RESULTS: Among the 127 NSM procedures performed, 2 hematomas (1.5%) and 1 partial nipple necrosis (0.7%) were observed. After a mean follow-up of 60 months, the local recurrence rate was of 8.9%, the disease-free survival rate was of 90%, and 1 of the patients died. CONCLUSION: Despite the local recurrence rate, we showed that NSM with immediate breast reconstruction using silicone implants is a feasible surgical approach, with a low rate of complications and high survival rates for patients with a diagnosis of pure DCIS when breast-conserving surgery is not an option.

OBJETIVO: A presença de componente intraductal extenso é associada ao risco aumentado de recorrência no complexo aréolo-mamilar. O objetivo deste estudo foi avaliar os resultados de pacientes diagnosticados com carcinoma ductal in situ (CDIS) submetidas a adenomastectomia (nipple-sparing mastectomy, NSM, em inglês) com reconstrução mamária imediata utilizando prótese de silicone. MéTODOS: Restrospectivamente, foram analisadas as complicações pós-operatórias e a segurança oncológica de 67 pacientes com câncer de mama diagnosticadas com CDIS puro, e submetidas a NSM com reconstrução mamária imediata utilizando prótese de silicone, entre 2004 e 2018. RESULTADOS: Entre os 127 procedimentos realizados, 2 hematomas (1,5%) e 1 necrose parcial de mamilo (0,7%) foram observados. Após um período médio de 60 meses de seguimento, a taxa de recorrência local foi de 8,9%, a sobrevida livre de doença, de 90%, e apenas 1 paciente foi a óbito. CONCLUSãO: Apesar da taxa de recorrência local, demostrou-se que NSM com reconstrução mamária imediata com prótese de silicone é um procedimento viável, com baixa taxa de complicação e alta sobrevida para pacientes com diagnóstico de CDIS puro quando a cirurgia conservadora da mama não é uma opção.

Salvage Nipple-sparing Mastectomy for Patients with Breast Cancer Recurrence: A Case Series of Brazilian Patients / Mastectomia preservadora de mamilo para pacientes com recidiva de câncer de mama: Uma série de casos de pacientes brasileiras

Abstract Objective Few studies analyzed the safety of salvage nipple-sparing mastectomy (NSM) for local relapse treatment. We evaluated the outcomes of patients with indications for mastectomy who chose to undergo NSM for ipsilateral breast tumor recurrence (IBTR). Methods Between January 2001 and December 2018, we evaluated 24 women who underwent NSM for local relapse after conservative surgery. Results Thepatientswere followedupfor amean time of132months since thefirst surgery. After the NSM, 5 (20.8%) patients were diagnosed with local recurrence and only 1 (4.2%) patient died. The patients presented 4.8% (2) of partial and 2.4% (1) of total nipple necrosis. Conclusion In this long-term follow-up since the first surgery, we observed low rates of complication and good survival, although associated with high local recurrence in patients diagnosed with IBTR undergoing NSM as salvage surgery.We demonstrated that NSMmay be considered after IBTR for patients who did not want to undergo total mastectomy.

Resumo Objetivo Há poucos estudos sobre a segurança de se realizar adenomastectomia (nipple-sparing mastectomy, NSM, em inglês) para tratamento de recidiva local. O objetivo deste estudo foi avaliar os resultados de pacientes com indicação para mastectomia que optaram por se submeter a NSM para o tratamento de recorrência local. Métodos Foram analisadas 24 pacientes submetidas a NSM para tratamento de recidiva local após tratamento conservador entre janeiro de 2001 e dezembro de 2018. Resultados As pacientes foramacompanhadas por um períodomédio de 132meses a partir da primeira cirurgia. Após a NSM, 5 (20,8%) pacientes foram diagnosticadas com recorrência local, e apenas 1 paciente foi a óbito. As pacientes apresentaram 4,8% de necrose parcial e 2,4% de necrose total do mamilo. Conclusão Em um longo período de acompanhamento desde a primeira cirurgia, foram observadas baixas taxas de complicação pós-operatória e boa sobrevida, porém, associadas comuma alta taxa de recorrência local em pacientes submetidas a NSM para tratamento de recidiva local após cirurgia conservadora. Neste estudo, demonstrou-se que a NSM pode ser considerada uma opção cirúrgica para pacientes que não querem se submeter a mastectomia total.

Nipple-sparing Mastectomy with Immediate Implant-based Reconstruction for Patients with Pure Ductal Carcinoma in Situ / Mastectomia preservadora demamilo com reconstrução imediata baseada em implante para pacientes com carcinoma ductal puro in situ

Abstract Objective The presence of an extensive intraductal component is associated to an increasing risk of relapse in the nipple-areola complex. The aim of the present study was to evaluate the outcomes of patients diagnosed with ductal carcinoma in situ (DCIS) who underwent nipple-sparing mastectomy (NSM) with immediate breast reconstruction using silicone implants. Methods We retrospectively analyzed the postoperative complications and oncological safety of 67 breast cancer patients diagnosed with pure DCIS who underwent NSM with immediate breast reconstruction using silicone implants between 2004 and 2018. Results Among the 127 NSM procedures performed, 2 hematomas (1.5%) and 1 partial nipple necrosis (0.7%) were observed. After a mean follow-up of 60months, the local recurrence rate was of 8.9%, the disease-free survival rate was of 90%, and 1 of the patients died. Conclusion Despite the local recurrence rate, we showed that NSM with immediate breast reconstruction using silicone implants is a feasible surgical approach, with a low rate of complications and high survival rates for patients with a diagnosis of pure DCIS when breast-conserving surgery is not an option.

Resumo Objetivo A presença de componente intraductal extenso é associada ao risco aumentado de recorrência no complexo aréolo-mamilar. O objetivo deste estudo foi avaliar os resultados de pacientes diagnosticados com carcinoma ductal in situ (CDIS)submetidas a adenomastectomia (nipple-sparing mastectomy, NSM, em inglês) com reconstrução mamária imediata utilizando prótese de silicone. Métodos Restrospectivamente, foramanalisadas as complicações pós-operatórias e a segurança oncológica de 67 pacientes com câncer de mama diagnosticadas com CDIS puro, e submetidas a NSM com reconstrução mamária imediata utilizando prótese de silicone, entre 2004 e 2018. Resultados Entre os 127 procedimentos realizados, 2 hematomas (1,5%) e 1 necrose parcial de mamilo (0,7%) foram observados. Após um período médio de 60 meses de seguimento, a taxa de recorrência local foi de 8,9%, a sobrevida livre de doença, de 90%, e apenas 1 paciente foi a óbito. Conclusão Apesar da taxa de recorrência local, demostrou-se que NSM com reconstrução mamária imediata comprótese de silicone é umprocedimento viável, combaixa taxa de complicação e alta sobrevida para pacientes com diagnóstico de CDIS puro quando a cirurgia conservadora da mama não é uma opção.

Salvage Nipple-sparing Mastectomy for Patients with Breast Cancer Recurrence: A Case Series of Brazilian Patients.

OBJECTIVE: Few studies analyzed the safety of salvage nipple-sparing mastectomy (NSM) for local relapse treatment. We evaluated the outcomes of patients with indications for mastectomy who chose to undergo NSM for ipsilateral breast tumor recurrence (IBTR). METHODS: Between January 2001 and December 2018, we evaluated 24 women who underwent NSM for local relapse after conservative surgery. RESULTS: The patients were followed up for a mean time of 132 months since the first surgery. After the NSM, 5 (20.8%) patients were diagnosed with local recurrence and only 1 (4.2%) patient died. The patients presented 4.8% (2) of partial and 2.4% (1) of total nipple necrosis. CONCLUSION: In this long-term follow-up since the first surgery, we observed low rates of complication and good survival, although associated with high local recurrence in patients diagnosed with IBTR undergoing NSM as salvage surgery. We demonstrated that NSM may be considered after IBTR for patients who did not want to undergo total mastectomy.

OBJETIVO: Há poucos estudos sobre a segurança de se realizar adenomastectomia (nipple-sparing mastectomy, NSM, em inglês) para tratamento de recidiva local. O objetivo deste estudo foi avaliar os resultados de pacientes com indicação para mastectomia que optaram por se submeter a NSM para o tratamento de recorrência local. MéTODOS: Foram analisadas 24 pacientes submetidas a NSM para tratamento de recidiva local após tratamento conservador entre janeiro de 2001 e dezembro de 2018. RESULTADOS: As pacientes foram acompanhadas por um período médio de 132 meses a partir da primeira cirurgia. Após a NSM, 5 (20,8%) pacientes foram diagnosticadas com recorrência local, e apenas 1 paciente foi a óbito. As pacientes apresentaram 4,8% de necrose parcial e 2,4% de necrose total do mamilo. CONCLUSãO: Em um longo período de acompanhamento desde a primeira cirurgia, foram observadas baixas taxas de complicação pós-operatória e boa sobrevida, porém, associadas com uma alta taxa de recorrência local em pacientes submetidas a NSM para tratamento de recidiva local após cirurgia conservadora. Neste estudo, demonstrou-se que a NSM pode ser considerada uma opção cirúrgica para pacientes que não querem se submeter a mastectomia total.

Experiência em oficinas terapêuticas para portadores de dependência química: percepção do profissional de saúde / Experience in therapeutic workshops to person with chemical dependency: perception of the health professional

Objetivo: identificar a percepção do profissional de saúde quanto à experiência em oficinas terapêuticas para dependentes químicos. Método: estudo descritivo, transversal, qualitativo, realizado com sete profissionais de saúde em três instituições as quais acompanham dependentes químicos em sofrimento psíquico. Utilizou-se uma entrevista semiestruturada cujo tratamento dos dados se deu por meio de Análise de Conteúdo. Resultados: a prática das oficinas terapêuticas é vista como um instrumento de suma importância para o tratamento do dependente químico, bem como para o portador de transtorno mental, pois proporciona aos pacientes um caminho de interação social propício para realizarem a ressignificação da sua condição de saúde. Percebe-se a existência de preconceito social latente, até mesmo por profissionais de saúde ao abordar a questão do uso de álcool e drogas nas oficinas terapêuticas. Considerações finais: a dependência química protagoniza uma das causas de estigma e preconceito em meio à sociedade e ao profissional de saúde.(AU)

Objective: identify the perception of the health professional regarding the experience in therapeutic workshops for chemical dependents. Method: descriptive, transversal, qualitative study, carried out with seven health professionals in three institutions that accompany chemical dependents in psychic suffering. A semi-structured interview was used, whose data treatment was done through Content Analysis. Results: the practice of therapeutic workshops is seen as an instrument of utmost importance for the treatment of the chemical dependent, as well as for the mentally disturbed, because it provides patients with a path of social interaction propitious to perform the resignification of their health condition. The existence of latent social prejudice is perceived, even by health professionals when addressing the issue of alcohol and drug use in therapeutic workshops. Final considerations: chemical dependence is one of the causes of stigma and prejudice among society and health professionals. (AU)

Objetivo: identificar la percepción del profesional de la salud sobre la experiencia en talleres terapéuticos para dependientes químicos. Método: estudio descriptivo, transversal y cualitativo, realizado con siete profesionales de la salud de tres instituciones que acompañan a dependientes químicos en sufrimiento psíquico. Se utilizó una entrevista semiestructurada cuyo tratamiento de datos se realizó mediante el Análisis de Contenido. Resultados: la práctica de talleres terapéuticos es vista como un instrumento de suma importancia para el tratamiento del dependiente químico, así como para el perturbado mental, porque proporciona a los pacientes una vía de interacción social propicia para realizar la resignificación de su condición de salud. Se percibe la existencia de un prejuicio social latente, incluso por parte de los profesionales de la salud cuando se aborda el tema del consumo de alcohol y drogas en los talleres terapéuticos. Consideraciones finales: la dependencia química es una de las causas de estigmatización y prejuicios en el seno de la sociedad y de profesionales de la salud.(AU)

Axillary management for patients with breast cancer after neoadjuvant chemotherapy: Results of a survey among Brazilian breast surgeons.

BACKGROUND: Currently, there are broadly differing patterns in the management of the axilla after neoadjuvant chemotherapy (NAC) and no consensus with clinically strong evidence on the subject. A survey was performed to assess the current axillary management after NAC among Brazilian breast cancer surgeons. METHODS: The Brazilian Society of Mastology members were invited by email to complete an anonymous online survey and a total of 426 responses were collected. RESULTS: The majority of responders (67%) indicated performing routine axillary staging by physical exam, ultrasound, and fine needle biopsy in case of a suspicious node before NAC. Among breast surgeons working in the Brazilian Public Unified Health System, 11.3% answered that sentinel lymph node biopsy (SLNB) is not reasonable after NAC in their services. Seventy-seven responders (18.2%) reported performing SLNB instead of axillary lymph node dissection (ALND) only in patients who are clinically node-negative before NAC. Axillary complete pathologic response is necessary to omit ALND for 42.8% of responders. The molecular profile of a breast tumor is not considered when choosing axillary management after NAC for 73.7% of responders. CONCLUSIONS: Our survey highlighted the trend towards de-escalation of axillary surgery and observed high heterogeneity in axillary management after chemotherapy in a group of brazilian breast surgeons.

Quality of Life and Graduation in Medicine / Qualidade de Vida e Graduação em Medicina

Abstract: Introduction: In recent years, the quality of life of medical students has been questioned, given the context in which they are inserted. Stress as a result of the number of long hours, difficulty in reconciling academic and personal life, exposure to situations of pain and suffering, have been shown to be the main factors for the decrease in quality of life of these students. The aim of this study was to assess the quality of life of medical students and its associated factors. Method: Cross-sectional study with 419 medical students from a public institution in Goiás. The study was carried out with students over 18 years old and enrolled in the second to the eighth semester of medical school, between 2017 and 2018. Sociodemographic and lifestyle questionnaires and the World Health Organization Questionnaire for Quality of Life - Brief Form (WHOQOL-BREF) were used. Results: The factors related to low quality of life were: female gender, the use of stimulants, thinking about giving up medical school and having comorbidities. Those related to a better quality of life were consuming fruits and vegetables, practicing physical activity, more sleeping time and stress management. Conclusion: This study found a set of factors capable of interfering with the quality of life of these students, suggesting the need for interventions aimed at pedagogical and psychological support.

Resumo: Introdução: Nos últimos anos, tem-se questionado sobre a qualidade de vida dos estudantes de Medicina dado o contexto em que estão inseridos. O estresse como resultado do somatório de carga horária extensa, dificuldade de conciliar a vida acadêmica com a pessoal e exposição a situações de dor e sofrimento tem-se mostrado como o principal fator para a queda da qualidade de vida desses acadêmicos. O objetivo deste estudo foi avaliar a qualidade de vida de acadêmicos de Medicina e seus fatores associados. Método: Trata-se de um estudo transversal realizado com 419 acadêmicos do curso de Medicina de uma fundação pública de Goiás. Foram incluídos alunos a partir de 18 anos e matriculados no curso do segundo ao oitavo período, de 2017 a 2018. Utilizaram-se os questionários sociodemográfico e de hábitos de vida e o World Health Organization Questionnaire for Quality of Life - Brief Form (WHOQOL-bref). Resultados: Os fatores relacionados com a baixa qualidade de vida foram: sexo feminino, utilizar estimulantes, pensar em desistir do curso e possuir comorbidade. Os relacionados com melhor qualidade de vida foram consumir frutas e hortaliças, praticar atividade física, mais tempo de sono e gestão do estresse. Conclusão: Este estudo encontrou um conjunto de fatores capazes de interferir na qualidade de vida desses estudantes, sugerindo a necessidade de intervenções direcionadas ao apoio pedagógico e psicológico.

Repeated Measures Models Applied to Cancer Patients Treated with Exergames

Objective: The objective of this study was to define an appropriate linear model to analyse data on muscular fatigue in cancer patients over time through repeated measures techniques. Methods: Using the split plot in time system and linear mixed models, three groups of individuals were compared as to the methods used to reduce muscle fatigue. Group Cancer consisted of individuals who had already been treated; group Control consisted of healthy individuals and group Chemo / radio-therapy consisted of individuals diagnosed with cancer undergoing chemo and radiation therapy. Sessions were tested with exergames. A series of muscle strength data for each of the six muscles studied, in the pre-treatment, mid-treatment and final sessions. Result: The structure that best fit the covariance matrix was ARMA (1,1), according to AIC and BIC. There were significant differences and tendencies in the data series, especially for the left tibial muscle, in which the interactions between group and session and between group and time were significant, showing that exergames treatment increased muscle strength in debilitated patients and, with 20 sessions, the groups equalled in muscle strength. Conclusion: The linear mixed model proved to be efficient in modelling plots subdivided in time. Identifying the best structure of the covariance matrix allowed us to better estimate the effects, using tests appropriately to verify differences between factors that were not detected when using the median frequency of strength.

Systematic Review of Oral Therapy for the Treatment of Symptoms of Bladder Pain Syndrome: The Brazilian Guidelines.

Interstitial cystitis (IC), including bladder pain syndrome (BPS), is a chronic and debilitating disease that mainly affects women. It is characterized by pelvic pain associated with urinary urgency, frequency, nocturia and negative urine culture, with normal cytology. In 2009, the Society for Urodynamics and Female Urology (SUFU) defined the term IC/BPS as "an unpleasant sensation (pain, pressure, and discomfort) perceived to be related to the urinary bladder, associated with lower urinary tract symptoms for more than 6 weeks duration, in the absence of infection or other identifiable causes." This is the definition used by the American Urological Association (AUA) in the most recent guidelines on IC/BPS. Interstitial cystitis may be sufficiently severe to have a devastating effect on the quality of life, but it may also be associated with moderate symptoms whose effects are less debilitating. Although there are several clinical trials to assess oral and intravesical therapies, the treatment for IC remains far from ideal. This systematic assessment evaluates published randomized clinical trials on oral medications used to treat symptoms of BPS. This study was performed according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) method. Two independent reviewers screened the studies to determine their inclusion or exclusion and to perform the methodological analysis. The inclusion criteria included randomized studies published between April of 1988 and April of 2016 that used oral medications to treat symptoms of BPS or IC. According to the systematic review performed, we should consider pentosan polysulfate as one of the best options of oral drugs for the treatment of BPS symptoms. However, this drug is not an available option in Brazil. Orally administered amitriptyline is an efficacious medical treatment for BPS, and it should be the first treatment offered.

Cistite intersticial (IC), incluindo a síndrome da bexiga dolorosa (SBD), é uma doença crônica e debilitante que afeta principalmente mulheres. É caracterizada por dor pélvica associada à urgência miccional, frequência urinária, noctúria e exame cultural de urina negativo, com citologia normal. A cistite intersticial pode ser suficientemente severa para ter um efeito devastador na qualidade de vida, mas também pode estar associada a sintomas moderados e menos debilitantes. Embora existam vários ensaios clínicos para avaliar terapias orais e intravesicais, o tratamento para IC permanece longe do ideal. Esta revisão sistemática avaliou ensaios clínicos randomizados publicados sobre medicamentos orais usados para tratar sintomas de SBD. Este estudo foi realizado de acordo com o método preferred reporting items for systematic reviews and meta-analyses (PRISMA). Dois revisores independentes examinaram os estudos para determinar sua inclusão ou exclusão e para realizar a análise metodológica. Os critérios de inclusão foram: ensaios clínicos randomizados publicados entre abril de 1988 e abril de 2016 que usaram medicações orais no tratamento dos sintomas da SBD ou CI. De acordo com a revisão sistemática realizada, a melhor opção de medicação oral para o tratamento dos SBD é o pentosano polissulfato sódico. No entanto, esta droga não está disponível no Brasil. A amitriptilina administrada por via oral é um tratamento eficaz para SBD e deve ser oferecida como primeira escolha.

Physical activity in climacteric women: comparison between self-reporting and pedometer.

OBJECTIVE: To compare two methods of assessing physical activity in pre-, peri- and postmenopausal women. METHODS: Cross-sectional study nested in a cohort of pre-, peri- and postmenopausal women in a city in Southern Brazil. The participants completed a questionnaire that included sociodemographic and clinical data. Physical activity was assessed using a digital pedometer and the International Physical Activity Questionnaire, short version. The participants were classified into strata of physical activity according to the instrument used. For statistical analysis, the Spearman correlation test, Kappa index, concordance coefficient and Bland-Altman plots were used. RESULTS: The concordance (k = 0110; p = 0.007) and the correlation (rho = 0.136, p = 0.02) between the International Physical Activity Questionnaire, short version, and pedometer were weak. In Bland-Altman plots, it was observed that differences deviate from zero value whether the physical activity is minimal or more intense. Comparing the two methods, the frequency of inactive women is higher when assessed by pedometer than by the International Physical Activity Questionnaire--short version, and the opposite occurs in active women. CONCLUSIONS: Agreement between the methods was weak. Although easy to use, Physical Activity Questionnaire--short version overestimates physical activity compared with assessment by pedometer.

Atividade física de mulheres no climatério: comparação entre auto-relato e pedômetro / Physical activity in climacteric women: comparison between self-reporting and pedometer

OBJETIVO Comparar dois métodos de avaliação de atividade física entre mulheres na pré, transição e pós-menopausa. MÉTODOS Estudo transversal aninhado à coorte de mulheres na pré, peri e pós-menopausa em uma cidade do sul do Brasil. As participantes responderam a um questionário com dados sociodemográficos e clínicos. A atividade física foi avaliada utilizando-se o Questionário Internacional de Atividade Física – versão curta e a contagem do número de passos com o uso de pedômetro. As participantes foram classificadas em estratos de atividade física de acordo com o instrumento utilizado. Para análise estatística foram realizados os testes de correlação de Spearman, índice de Kappa, coeficiente de concordância e análise das medidas contínuas de Bland-Altman. RESULTADOS A concordância (k = 0,110; p = 0,007) e a correlação (rho = 0,136; p = 0,02) entre o Questionário Internacional de Atividade Física – versão curta e o pedômetro foram fracas. No gráfico de Bland-Altman, observou-se que as diferenças se afastam do valor zero tanto quanto a atividade física é mínima ou mais intensa. Comparando-se os dois métodos, a frequência de mulheres inativas é maior quando avaliadas pelo pedômetro do que pelo Questionário Internacional de Atividade Física. O oposto ocorre entre as ativas. CONCLUSÕES A concordância entre os métodos foi fraca. Embora de fácil aplicação, o Questionário Internacional de Atividade Física superestima a atividade física em relação à avaliação por pedômetro. .

OBJECTIVE To compare two methods of assessing physical activity in pre-, peri- and postmenopausal women. METHODS Cross-sectional study nested in a cohort of pre-, peri- and postmenopausal women in a city in Southern Brazil. The participants completed a questionnaire that included sociodemographic and clinical data. Physical activity was assessed using a digital pedometer and the International Physical Activity Questionnaire, short version. The participants were classified into strata of physical activity according to the instrument used. For statistical analysis, the Spearman correlation test, Kappa index, concordance coefficient and Bland-Altman plots were used. RESULTS The concordance (k = 0110; p = 0.007) and the correlation (rho = 0.136, p = 0.02) between the International Physical Activity Questionnaire, short version, and pedometer were weak. In Bland-Altman plots, it was observed that differences deviate from zero value whether the physical activity is minimal or more intense. Comparing the two methods, the frequency of inactive women is higher when assessed by pedometer than by the International Physical Activity Questionnaire - short version, and the opposite occurs in active women. CONCLUSIONS Agreement between the methods was weak. Although easy to use, Physical Activity Questionnaire - short version overestimates physical activity compared with assessment by pedometer. .

Maturação auditiva periférica: análise das amplitudes das emissões otoacústicas produto de distorção em neonatos pré-termo e a termo / Peripheral auditory maturation: analysis of the amplitudes of the distortion product otoacoustic emissions in preterm and term neonates

Objetivo : Comparar neonatos prematuros e a termo quanto à presença e amplitude das Emissões Otoacústicas Produto de Distorção (EOAPD), bem como caracterizá-los em relação aos indicadores de risco para perda auditiva. Métodos : Estudo realizado por análise das EOAPD (frequências de 2000, 3000, 4000, 6000 e 8000 Hz) e dos indicadores de risco para perda auditiva. Os neonatos foram agrupados segundo a idade gestacional. Os resultados foram analisados empregando-se testes ANOVA, Kruskal-Wallis e Qui-quadrado (5%). Resultados : A amostra constituiu-se de 109 neonatos (218 orelhas), com distribuição homogênea quanto ao gênero e a classificação a termo/pré-termo. Foi observado alto risco para perda auditiva em 40,4% dos lactentes. Dos indicadores de risco para deficiência auditiva, os mais frequentes foram a permanência em incubadora e internação em UTI superiores a cinco dias. As EOAPD mostraram-se presentes em 209 orelhas (95,9%). A ausência de respostas às EOAPD foi significativamente mais recorrente nos grupos com menor idade gestacional. Verificou-se aumento das amplitudes das EOAPD de acordo com o aumento da idade gestacional, exceto para a frequência de 8000 Hz na orelha esquerda. Não foi observada diferença entre orelhas e gêneros quanto à presença e amplitude das EOAPD. Conclusão : Há diferença entre os grupos pré-termo e a termo, quanto à presença e amplitude das EOAPD: maior probabilidade de falha nos grupos com menor idade gestacional e aumento (não linear) das amplitudes, conforme a idade gestacional torna-se maior. Os achados sugerem o fenômeno de maturação do sistema auditivo periférico. .

Purpose : To compare preterm and term neonates in relation to the presence and amplitude of Distortion Product Otoacoustic Emissions (DPOAEs), as well as to characterize them regarding risk indicators for hearing loss. Methods : Study realized by the analysis of the DPOAEs (frequencies of 2000, 3000, 4000, 6000 and 8000 Hz) and risk indicators for hearing loss. The neonates were grouped according to the gestational age. The results were analyzed by ANOVA, Kruskal-Wallis and Chi-square tests (5%). Results : The sample consisted of 109 neonates (218 ears) in homogenous distribution related to gender and preterm/term classification. A high risk for hearing loss was observed in 40.4% of the infants. From the risk indicators for hearing loss, the most common were the duration of the stay in incubators and intensive care units (ICU) longer than five days. The DPOAEs were present in 209 ears (95.9%). The absence of responses to DPOEAs was significantly more frequent in groups with lower gestational age. It was observed an increase of the amplitudes of the DPOEAs with the increase of the gestational age, except for the frequency of 8000 Hz in the left ear. There were no differences between ears and genders regarding the presence and amplitude of the DPOAEs. Conclusion : There are differences between preterm and term groups in relation to the presence and amplitude of the DPOAEs: higher probability of failure in the groups with lower gestational age and (nonlinear) increase of the amplitudes with the increase of the gestational age. The findings suggest the phenomenon of maturation of the peripheral auditory system. .