Efficacy of pelvic floor physiotherapy intervention for stress urinary incontinence in postmenopausal women: systematic review.

INTRODUCTION AND HYPOTHESIS: Our objective was to evaluate the effectiveness of pelvic floor physiotherapy interventions for stress urinary incontinence (SUI) in postmenopausal women. METHODS: Searches were performed in MEDLINE/PubMed, PEDro, Cochrane Library Registry and LILACS databases until October 2021. Only randomized controlled trials (RCTs) which had physiotherapy interventions as primary outcome were included. There were no restrictions on the year of publication or language. Qualitative methodology was evaluated using the PEDro scale. RESULTS: After applying inclusion/exclusion criteria and quality control, 6 randomized controlled trials were included in this systematic review. Methodological quality of trials varied from 5 to 8 (out of 10 possible points in PEDro scale score). Sample consisted of 715 subjects; mean age was between 51.6 and 66.3 years; SUI severity scale ranged from small to severe. Interventions were pelvic floor muscle training (PFMT); vaginal cone (VC); biofeedback (BF); electrical muscle stimulation (EMS); radiofrequency (RF) and electroacupuncture (EA). Pelvic floor physiotherapy was effective in all studies, however, meta-analysis was considered irrelevant due to the heterogeneity of the reported interventions. CONCLUSION: There is not a literature consensus about the most effective pelvic floor physiotherapy intervention applied to stress urinary incontinence in postmenopausal women. It seems appropriate to state that further randomized controlled clinical trials should be done, due to the limited number of studies and heterogeneity of physiotherapeutic interventions applied to date. TRIAL REGISTRATION: This systematic review is registered in PROSPERO in the trial registration CRD42021255062.

Epidemiological Profile of Patients with Crohn's Disease and Ulcerative Colitis in the Last 6 Years / Perfil Epidemiológico de Pacientes com Doença de Crohn e Colite Ulcerativa nos Últimos 6 Anos

Abstract Inflammatory bowel diseases, Crohn's Disease and Ulcerative Colitis, are two relevant changes in the intestinal microbiota of individuals who are subject to environmental and genetic changes. With the social development and, mainly, the spread of industrialization, the increase in gastrointestinal diseases was observed on a large scale. Therefore, the study permeated to relate and obtain its results according to ethnicity, sex, phenotypic alterations of PID and gender, which are risk factors for these diseases. To characterize the epidemiological profile of patients with Crohn's Disease and Ulcerative Colitis in Brazil in the last 6 years. This is a time series epidemiological study with the objective of collecting data from patients who were diagnosed with Crohn's Disease and Ulcerative Colitis, in all Brazilian regions from 2014 to 2019. Data will be collected in the System of SUS Hospital Information (SIH/SUS), within a period of 6 years and for the analysis of these data, sociodemographic variables will be used, namely: ethnicity, sex, region, age group and admissions number, being accessed on 09/22/2020. The panorama presented shows high rates of hospitalization in the Southeast and Northeast regions, the diagnosis for the two diseases predominate in the South region, females, ethnicity/white race and age group between 20 and 29 years highlighted. Thus, the intervention of public policies that improve the population's health condition is of paramount importance. (AU)

Resumo As doenças inflamatórias intestinais, Doença de Crohn e a Colite Ulcerativa, são duas alterações pertinentes na microbiota intestinal de indivíduos que estão sujeitos a mudanças do ambiente e genéticas. Com o desenvolvimento social e, principalmente, alastramento da industrialização o aumento das doenças gastrintestinais foi observado em larga escala. Sendo assim, o estudo permeou em relacionar e obter os seus resultados de acordo a etnia, sexo, alterações fenotípicas de IDP e gênero, que são fatores de riscos para essas doenças. O objetivo desse estudo foi caracterizar o perfil epidemiológico de pacientes com doença de Crohn e colite ulcerativa, no Brasil, nos últimos 6 anos. Trata-se de um estudo epidemiológico de serie temporal com o objetivo de coletar dados de pacientes que foram diagnosticados com doença de Crohn e colite ulcerativas, em todas as regiões brasileiras no período de 2014 até 2019. Os dados serão coletados no Sistema de Informações Hospitalares do SUS (SIH/SUS), dentro do período de 6 anos e para a análise desses dados, serão utilizadas as variáveis sociodemográficas, que são: etnia, sexo, região, faixa etária e números de internações, sendo acessado no dia 22/09/2020. O panorama apresentado demostra altas taxas de internação nas regiões sudeste e nordeste, o diagnóstico para as duas doenças predominam na região sul, o sexo feminino, etnia/raça branca e faixa etária entre 20 e 29 anos em destaque. Desta forma, é de suma importância a intervenção de políticas públicas que melhorem a condição de saúde da população. (AU)

Perfil clínico de mulheres com incontinência urinária de esforço em centro de referência / Clinical profile of women with stress urinary incontinence in a reference center

INTRODUÇÃO: A incontinência urinária é definida como qualquer perda involuntária de urina. É um sério problema de saúde pública e as mulheres são as mais afetadas e apresentam como fatores de risco o envelhecimento, mais de duas gestações, parto vaginal com episiotomia, entre outros. Embora a IU não seja uma condição de vida ameaçadora, pode levar a situações com repercussões a nível social e pessoal, com influência na qualidade de vida. OBJETIVO: Descrever a frequência da IUE em um centro especializado na cidade de Salvador, assim como apontar as características clínicas, fatores de risco e comorbidades associadas à IUE feminina. MATERIAIS E MÉTODOS: Estudo transversal descritivo, a partir da análise de dados de prontuários de mulheres portadoras de incontinência urinária de esforço, incluídos dados sociodemográgicos, fatores de risco, comorbidades associadas, queixas clínicas e dados objetivos de Pad Test e Diário Miccional. RESULTADOS: Foram incluídas 28 mulheres com idade média de 48,9 anos (±7,7), de raça parda (46,2%), com ensino médio completo (40%), casadas (52%), trabalhadoras do lar (32,2%), IMC médio 26,2 (±4,9). A comorbidade associada mais predominante foi obesidade (28,6%), o fator de risco dominante foi o consumo de café (70%). A queixa clínica mais prevalente foi perda ao tossir (96,3%). Quando analisado Pad test, notado maior prevalência de perda leve (57,14%), seguido por (39,29%) de perda moderada e perda grave (3,57%). CONCLUSÃO: Mulheres de meia idade, pardas, menopausadas, obesas, hipertensas, multíparas, que realizaram parto vaginal com episiotomia, constipadas e que ingerem cafeína são mais propensas a desenvolver a incontinência urinária de esforço. Houve uma maior prevalência de incontinência urinária leve.

INTRODUCTION: Urinary incontinence is defined as any involuntary loss of urine. It is a serious public health problem, and women are the most affected and present aging as risk factors, more than two pregnancies, vaginal delivery with episiotomy, among others. Although UI is not a threatening life condition, it can lead to social and personal repercussions, influencing the quality of life. OBJECTIVE: Describe the frequency of SUI in a specialized center in the city of Salvador, as well as point out the clinical characteristics, risk factors, and comorbidities associated with female SUI. MATERIALS AND METHODS: Descriptive cross-sectional study, based on data analysis of medical records of women with stress urinary incontinence, including sociodemographic data, risk factors, associated comorbidities, clinical complaints, and objective data from Pad Test and Diary Diary. RESULTS: Twenty-eight women with an average age of 48.9 years (± 7.7), brown race (46.2%), complete high school (40%), married (52%), housewives (32.2%), mean BMI 26.2 (± 4.9). The most prevalent associated comorbidity was obesity (28.6%); the dominant risk factor was coffee consumption (70%). The most prevalent clinical complaint was cough loss (96.3%). When analyzed Pad test noted a higher prevalence of mild loss (57.14%), followed by (39.29%) moderate loss and severe loss (3.57%). CONCLUSION: Middle-aged, mulatto, menopausal, obese, hypertensive, multiparous women who had a vaginal delivery with episiotomy, constipation, and caffeine intake are more likely to develop stress urinary incontinence. There was a higher prevalence of mild urinary incontinence.

Female genital image: is there a relationship with body image?

OBJECTIVE: Dissatisfaction with body image may extend to the genital region, and the most dissatisfied with their bodies are women. To analyze the relation between body image and genital image in female, and to verify demographic and/or clinical factors related to body image and genital image. MATERIALS AND METHODS: This is a cross-sectional study in 421 women. The Body Shape Questionnaire-34 (BSQ-34) was used to evaluate body image perception; scores ≤110 indicate no dissatisfaction. Also, the female genital self-image scale-7 (FGSIS-7) was used to evaluate genital self-image; scores range between 7 and 28, with higher values considered to indicate a more positive genital self-image. The relation between body image and genital image was determined using the Pearson Correlation test, as well as the relation of these with body mass index (BMI) and age. The relation between these data and genital image was determined by using the ANOVA test or the independent t-test (statistical difference was accepted as p<0.05). In order to verify predictors of dissatisfaction with body image, variables with p<0.10 were inserted into the logistic regression model and checked if they remained significant (p<0.05). RESULTS: Three hundred eighty-nine women were analyzed. The mean age was 34.7±10.2 years. The mean BMI was 24.1±3.6 kg/m², 49% were single, and the mean BSQ-34 and FGSIS scores were 83.2±30.8 and 23.8±3.4, respectively. The correlation (r=-0.24) was found between body image and genital image (p<0.001). A total of 315 women indicated to be satisfied with their body and presented an FGSIS-7 score of 24±3.3. Participants who were dissatisfied with their body had an average FGSIS-7 score of 22.6±3.3. CONCLUSION: Genital image, age, and BMI influence body image. Change in the perception of body image seems to have low correlation with genital self-image in women.

The pilates method in the function of pelvic floor muscles: Systematic review and meta-analysis.

BACKGROUND: Many Pilates instructors believe that the method can produce significant improvement in the resistance of pelvic floor muscles, but it is known that about 49% of women who can contract this muscle do not perform an adequate contraction and cannot increase urethral closure pressure. OBJECTIVES: To evaluate the response of the Pilates method in the function of the pelvic floor muscles, compared to the control group, in healthy women. SEARCH METHODS: The following databases were searched from October to December 2016: PUBMED, SCIELO, LILACS, MEDLINE, WEB OF SCIENCE and CINAHL via PERIÓDICOS CAPES, without restriction of language and year of publication. SELECTION CRITERIA: Randomized (RCTs), quasi-randomized, and non-randomized clinical trials assessing the effectiveness of the Pilates method for the fuction of pelvic floor muscles in healthy women were included. DATA COLLECTION AND ANALYSIS: Two reviewers independently selected the studies, assessed the risk of bias and performed the data extraction. Primary outcomes were the method of evaluation of strength, function, coordination, and symmetry of contraction of the pelvic floor muscles. RESULTS: 4434 articles were identified and 2 articles were selected to compose this review and the meta-analysis. No between-group difference was demonstrated for the pelvic floor muscle function as measured by perineometry (p = 0.32). CONCLUSIONS: No evidence showed a modification of the function of pelvic floor muscles in healthy women practicing the Pilates method.

Estilo de vida após sete anos do evento coronariano isquêmico: estudo transversal / Lifestyle after seven years of post ischemic coronary event: cross-sectional study

FUNDAMENTOS: O envelhecimento acelerado da população e a não aderência de hábitos de vida saudável implica no aparecimento de comorbidades, levando assim à perda da capacidade funcional, limitando o indivíduo nas atividades laborais e sociais. A magnitude do problema leva a refletir sobre a importância dos programas multidisciplinares, despertando para a mudança de hábitos de vida, principalmente em indivíduos que sofreram um evento isquêmico a longo prazo. OBJETIVO: Comparar o estilo de vida de indivíduos após sete anos do evento coronariano isquêmico. MÉTODO: Trata-se de um estudo de coorte retrospectivo, composto por indivíduos portadores de Síndrome Coronariana Isquêmica. Critérios de inclusão: participantes de um estudo prévio, no período compreendido entre abril de 2006 a janeiro de 2007. Após o consentimento, foi realizada uma breve entrevista por contato telefônico, com as seguintes questões: dados sociodemográficos; comorbidades; estilo de vida; número de internações por problemas cardíacos; presença de dor torácica. As variáveis categóricas apresentadas em termos de frequência absoluta, enquanto os dados numéricos, em termos de média e desvio-padrão (XD ± DP). O teste de McNemar para comparação das variáveis categóricas pareadas e teste qui-quadrado para comparação das variáveis categóricas, p≤ 0,0 5. CAAE: 05874112.9.0000.5544. RESULTADOS: Destacam-se as comorbidades mais prevalentes a Hipertensão Arterial Sistêmica 24 (80%), Dislipidemia 21 (70%), Diabete Mellitus 14 (46,6%). Após sete anos do evento, houve um aumento de hipertensos (p=0,01) em contrapartida redução de tabagistas (p=0,02). CONCLUSÃO: Apesar dos indivíduos terem modificado dois estilos de vida relevantes e significantes como a hipertensão e o tabagismo, a população estudada mantém elevadas taxas de fatores de risco cardiovasculares, necessitando de uma intervenção da equipe multidisciplinar.

BACKGROUND: The population's accelerated aging process and unhealthy lifestyle imply in the appearance of comorbidities, thus leading to the loss of functional capacity, limiting the individual in labor, recreational and social activities. The magnitude of the problem reflects on the importance of multidisciplinary programs, awakening the need to change lifestyle, especially in individuals who have suffered a long-term ischemic event. OBJECTIVE: To compare the lifestyle of individuals after seven years of ischemic coronary event. METHOD: This is a retrospective cohort composed of individuals with Ischemic Coronary Syndrome (ICS). Inclusion criteria: participants from a previous study, in the period from April 2006 to January 2007. After the consent, a brief interview was performed by telephone contact, with the following questions: sociodemographic data; comorbidities; Lifestyle; number of hospitalizations due to cardiac problems; presence of chest pain. The categorical variables presented in terms of absolute frequency, while the numerical data, in terms of mean and standard deviation (XD ± SD). The McNemar test for comparison of the categorical variables paired and chi-square test for comparison of the categorical variables, p≤ 0.05. CAAE: 05874112.9.0000.5544. RESULTS: We highlight the most prevalent comorbidities, Hypertension 24 (80%), Dyslipidemia 21 (70%), Diabetes 14 (46.6%). After seven years event, there was an increase in hypertensive patients (p = 0.01) in contrast smokers reduction (p = 0.02). CONCLUSION: Although the individuals have modified two significant lifestyles such as the relevant, hypertension and smoking, the studied population maintains high rates of cardiovascular risk factors, necessitating an intervention by the multidisciplinary team.

Radiofrequency in female external genital cosmetics and sexual function: a randomized clinical trial.

INTRODUCTION AND HYPOTHESIS: Female sexual behavior goes through cultural changes constantly, and recently, some women have shown the desire the ideal genitalia. In this study, we aimed to evaluate clinical responses to nonablative radiofrequency (RF) in terms of its cosmetic outcome in the female external genitalia and its effect on sexual function. METHODS: A single-masking randomized controlled trial was conducted in 43 women (29 sexually active) who were unsatisfied with the appearance of their external genitalia. The women were divided into an RF group (n = 21, 14 sexually active) and a control group (n = 22, 15 sexually active). Eight sessions of RF were performed once a week. Photographs (taken before the first session and 8 days after the last session) were evaluated by the women and three blinded health professionals by using two 3-point Likert scales (unsatisfied, unchanged, and satisfied; and worst, unchanged, and improved). Sexual function was evaluated using the Female Sexual Function Index (FSFI) and analyzed using the Student t test. Women's satisfaction and health professional evaluation were analyzed using the chi-square test and inter- and intragroup binomial comparisons. RESULTS: Satisfaction response rates were 76 and 27 % for the RF and control groups, respectively (p = 0.001). All professionals found a clinical improvement association in the treated group with RF in comparison with the control group (p < 0.01). The overall FSFI sexual function score increased by 3.51 points in the RF group vs 0.1 points in the control group (p = 0.003). CONCLUSIONS: RF is an alternative for attaining a cosmetic outcome for the female external genitalia, with positives changes in patients' satisfaction and FSFI scores.

Quality of life of patients after an acute coronary event: hospital discharge.

BACKGROUND: The acute coronary syndrome (ACS) has a high morbi-mortality rate, including physical deficiencies and functional limitations with impact on quality of life. Cardiovascular rehabilitation 1 (CVR1) should begin as early as possible, to enable improvement in functional capacity and quality of life. Previous studies have shown association of cardiovascular diseases with quality of life, in which depression and anxiety are the domains most altered. The aim of the study is to verify the impact of an acute coronary event on quality of life at the moment of hospital discharge. METHODOLOGY: This was a cross-sectional study, with ACS patients hospitalized in ICU of a private hospital in the city of Salvador, Brazil, submitted to CVR1. The quality of life questionnaire Euroqol-5D was applied on discharge from hospital. Patients included in the study were those with ACV, who had medical permission to walk, had not been submitted to acute surgical treatment, were time and space oriented, and over the age of 18 years. Patients excluded from the study were those with cognitive, orthopedic and neurological problems, who used orthesis on a lower limb, and were in any condition of risk at the time of beginning with CVR1. Data were collected by a previously trained ICU team. RESULTS: Data were collected of 63 patients who revealed compromise in the domains of pain/feeling ill (20.63%) and anxiety/depression (38.09%). Statistical significance was observed in the association between sex and pain/feeling ill (P < 0.01), sex and anxiety/depression (P < 0.01), diabetes and mobility (P < 0.01), hereditary factors and anxiety/depression (p < 0.01), BMI and pain/feeling ill (P < 0.01). CONCLUSION: In this sample of patients, on discharge from hospital after ACS, the pain/feeling ill and anxiety/depression domains were shown to be compromised.