Translation and validation of the techno-stress questionnaire in Brazil.

OBJECTIVE: The aim of this study was to translate the techno-stress questionnaire proposed by Ragu Nathan et al into Brazilian Portuguese and to culturally adapt and validate it. For this, 4 of the 11 original questionnaires' domains were used. METHODS: The questionnaires' domains translated and adapted were as follows: techno-overload, techno-invasion, techno-complexity, and job satisfaction. Initially, the techno-stress questionnaire was translated into Brazilian Portuguese language according to international standards, followed by cultural adaptations. Validation for feasibility and psychometric properties of translated questionnaire was performed on 138 gynecologists and obstetricians who use message applications to communicate with patients. The physicians were divided into groups according to the weekly messaging application usage time for communication with patients: <2 h (GI, n=89), 2-5 h (GII, n=29), and >5 h (GIII, n=23). The questionnaire was applied to all participants twice on the same day, overseen by two different interviewers, at a 15-min interval. After 15 days, it was readministered. The discriminant validity and reliability were calculated to validate the instrument. RESULTS: Techno-stress subscales showed statistically significant differences between the groups. The Cronbach's alpha coefficient for the techno-stress questionnaire was >0.80, showing good internal consistency. No differences were observed in the test-retest comparison of the techno-stress questionnaire, and the intraclass correlation coefficient results showed excellent reproducibility (³0.75). CONCLUSION: The techno-stress questionnaire was adequately translated into Brazilian Portuguese, with good discriminant validity, good internal consistency, and adequate test-retest results.

Message applications in the doctor-patient relationship as a stressor.

OBJECTIVE: The aim of this study was to assess the use of smartphones' messaging apps as a stressor affecting the well-being of gynecologists who use this tool to communicate with patients. METHODS: A cross-sectional study was conducted with gynecologists who use message applications to communicate with patients. Participants answered the WhatsApp Stress Scale, Oldenburg Burnout Inventory, and the techno-stress questionnaire. The population sample consisted of gynecologists and obstetricians selected by convenience. RESULTS: Physicians who spent more time using WhatsApp to communicate with patients had higher levels of stress (p=0.010), Burnout (p<0.001), and techno-invasion score (p<0.05). CONCLUSIONS: A positive association was found between the high frequency of WhatsApp usage for communication with patients and doctor's Burnout and stress, negatively influencing professional's well-being.

Message applications in the doctor-patient relationship as a stressor

SUMMARY OBJECTIVE: The aim of this study was to assess the use of smartphones' messaging apps as a stressor affecting the well-being of gynecologists who use this tool to communicate with patients. METHODS: A cross-sectional study was conducted with gynecologists who use message applications to communicate with patients. Participants answered the WhatsApp Stress Scale, Oldenburg Burnout Inventory, and the techno-stress questionnaire. The population sample consisted of gynecologists and obstetricians selected by convenience. RESULTS: Physicians who spent more time using WhatsApp to communicate with patients had higher levels of stress (p=0.010), Burnout (p<0.001), and techno-invasion score (p<0.05). CONCLUSIONS: A positive association was found between the high frequency of WhatsApp usage for communication with patients and doctor's Burnout and stress, negatively influencing professional's well-being.

Translation and validation of the techno-stress questionnaire in Brazil

SUMMARY OBJECTIVE: The aim of this study was to translate the techno-stress questionnaire proposed by Ragu Nathan et al into Brazilian Portuguese and to culturally adapt and validate it. For this, 4 of the 11 original questionnaires' domains were used. METHODS: The questionnaires' domains translated and adapted were as follows: techno-overload, techno-invasion, techno-complexity, and job satisfaction. Initially, the techno-stress questionnaire was translated into Brazilian Portuguese language according to international standards, followed by cultural adaptations. Validation for feasibility and psychometric properties of translated questionnaire was performed on 138 gynecologists and obstetricians who use message applications to communicate with patients. The physicians were divided into groups according to the weekly messaging application usage time for communication with patients: <2 h (GI, n=89), 2-5 h (GII, n=29), and >5 h (GIII, n=23). The questionnaire was applied to all participants twice on the same day, overseen by two different interviewers, at a 15-min interval. After 15 days, it was readministered. The discriminant validity and reliability were calculated to validate the instrument. RESULTS: Techno-stress subscales showed statistically significant differences between the groups. The Cronbach's alpha coefficient for the techno-stress questionnaire was >0.80, showing good internal consistency. No differences were observed in the test-retest comparison of the techno-stress questionnaire, and the intraclass correlation coefficient results showed excellent reproducibility (³0.75). CONCLUSION: The techno-stress questionnaire was adequately translated into Brazilian Portuguese, with good discriminant validity, good internal consistency, and adequate test-retest results.

Evaluation of the fibulin 5 gene polymorphism as a factor related to the occurrence of pelvic organ prolapse.

OBJECTIVE Pelvic organ prolapse (POP) is a very frequent situation in our population that may lead to a significant decrease in patients' quality of life. Currently, we are looking for predictive factors for the development of POPs; thus, this study seeks to evaluate whether the Fibulin 5 polymorphism (FBLN5) is associated with the occurrence of POP. METHODS This is a cohort study with postmenopausal women who were divided into groups by POP stage: POP stages 0 and I (control group) and POP stages III and IV (case group). Subsequently, analyses of genetic polymorphisms of FBLN5 were performed using the Restriction Fragment Length Polymorphism (RFLP) technique. RESULTS A total of 292 women were included in the study. Pregnancy, parity and vaginal delivery in the patients, as well as in data described in the literature, were related to the occurrence of POP in the univariate analysis. However, after binary logistic regression, home birth and age remained independent risk factors for POP. We found no association between the FBLN5 polymorphism and the occurrence of POP (p = 0.371). CONCLUSION There was no association between the FBLN5 polymorphism and the occurrence of POP in Brazilian women.

Evaluation of the fibulin 5 gene polymorphism as a factor related to the occurrence of pelvic organ prolapse

SUMMARY OBJECTIVE Pelvic organ prolapse (POP) is a very frequent situation in our population that may lead to a significant decrease in patients' quality of life. Currently, we are looking for predictive factors for the development of POPs; thus, this study seeks to evaluate whether the Fibulin 5 polymorphism (FBLN5) is associated with the occurrence of POP. METHODS This is a cohort study with postmenopausal women who were divided into groups by POP stage: POP stages 0 and I (control group) and POP stages III and IV (case group). Subsequently, analyses of genetic polymorphisms of FBLN5 were performed using the Restriction Fragment Length Polymorphism (RFLP) technique. RESULTS A total of 292 women were included in the study. Pregnancy, parity and vaginal delivery in the patients, as well as in data described in the literature, were related to the occurrence of POP in the univariate analysis. However, after binary logistic regression, home birth and age remained independent risk factors for POP. We found no association between the FBLN5 polymorphism and the occurrence of POP (p = 0.371). CONCLUSION There was no association between the FBLN5 polymorphism and the occurrence of POP in Brazilian women.

RESUMO OBJETIVOS O prolapso de órgãos pélvicos (POP) é uma situação muito frequente em nossa população que pode levar a uma diminuição significativa da qualidade de vida dos pacientes. Atualmente, buscam-se fatores preditivos para o desenvolvimento de POPs e, assim, este estudo correlaciona um polimorfismo de Fibulina 5 (FBLN5) com a ocorrência da doença. MÉTODOS Estudo de coorte com mulheres na pós-menopausa, divididas por grupos pelos estádios 0 e I do POP (grupo controle) e POP III e IV (grupo caso). Posteriormente, análises do polimorfismo genético de FBLN5 foram realizadas utilizando a técnica de Polimorfismo de Comprimento de Fragmentos de Restrição (RFLP). RESULTADOS Um total de 292 mulheres foi incluído no estudo. Gestação, paridade e parto vaginal, como bem descritos na literatura, foram relacionados à ocorrência de POPs na análise univariada. No entanto, após a regressão logística binária, o parto domiciliar e a idade permaneceram como fatores de risco independentes para os POPs. Não encontramos associação deste polimorfismo FBLN5 com a ocorrência de POP (p=0,371). CONCLUSÃO Não houve associação deste polimorfismo FBLN5 com a ocorrência de POPs em mulheres brasileiras.

Association between col1a2 Polymorphism and the Occurrence of Pelvic Organ Prolapse in Brazilian Women.

OBJECTIVE: To evaluate the rs42524 polymorphism of the procollagen type I alpha (α) 2 (COL1A2) gene as a factor related to the development of pelvic organ prolapse (POP) in Brazilian women. METHODS: The present study involved 112 women with POP stages III and IV (case group) and 180 women with POP stages zero and I (control group). Other clinical data were obtained by interviewing the patients about their medical history, and blood was also collected from the volunteers for the extraction of genomic DNA. The promoter region of the COL1A2 gene containing the rs42524 polymorphism was amplified, and the discrimination between the G and C variants was performed by digestion of the polymerase chain reaction (PCR) products with the MspA1I enzyme followed by agarose gel electrophoresis analysis. RESULTS: A total of 292 women were analyzed. In the case group, 71 had the G/G genotype, 33 had the G/C genotype, and 7 had the C/C genotype. In turn, the ratio in the control group was 117 G/G, 51 G/C, and 11 C/C. There were no significant differences between the groups. CONCLUSION: Our data did not show an association between the COL1A2 polymorphism and the occurrence of POP.

OBJETIVO: Avaliar o polimorfismo rs42524 do gene pró-colágeno tipo I alfa (α) 2 (COL1A2) como fator relacionado ao desenvolvimento de prolapso de órgãos pélvicos (POP) em mulheres brasileiras. MéTODOS: O estudo envolveu 112 mulheres com POP nos estádios III e IV (grupo caso) e 180 mulheres com POP nos estádios zero e I (grupo controle). Outros dados clínicos foram obtidos por meio de entrevistas com as pacientes sobre seu histórico médico, e o sangue das voluntárias também foi coletado para extração de DNA genômico. A região promotora do gene COL1A2 contendo o polimorfismo rs42524 foi amplificada, e a discriminação entre as variantes G e C foi realizada por digestão dos produtos de reação em cadeia da polimerase (RCP) com a enzima MspA1I, seguida de análise por eletroforese em gel de agarose. RESULTADOS: Foram analisadas 292 mulheres. No grupo caso, 71 tinham o genótipo G/G, 33 tinham o genótipo G/C, e 7 tinham o genótipo C/C. Por sua vez, a relação no grupo controle foi de 117 G/G, 51 G/C e 11 C/C. Não houve diferenças significativas entre os grupos. CONCLUSãO: Nossos dados não mostraram associação do polimorfismo do gene COL1A2 com a ocorrência de POP.

Association between col1a2 polymorphism and the occurrence of pelvic organ prolapse in Brazilian women / Associação entre polimorfismo do gene col1a2 e a ocorrência do prolapso de órgãos pélvicos em mulheres brasileiras

Abstract Objective To evaluate the rs42524 polymorphism of the procollagen type I alpha (α) 2 (COL1A2) gene as a factor related to the development of pelvic organ prolapse (POP) in Brazilian women. Methods The present study involved 112 women with POP stages III and IV (case group) and 180 women with POP stages zero and I (control group). Other clinical data were obtained by interviewing the patients about their medical history, and blood was also collected from the volunteers for the extraction of genomic DNA. The promoter region of the COL1A2 gene containing the rs42524 polymorphism was amplified, and the discrimination between the G and C variants was performed by digestion of the polymerase chain reaction (PCR) products with the MspA1I enzyme followed by agarose gel electrophoresis analysis. Results A total of 292 women were analyzed. In the case group, 71 had the G/G genotype, 33 had the G/C genotype, and 7 had the C/C genotype. In turn, the ratio in the control group was 117 G/G, 51 G/C, and 11 C/C. There were no significant differences between the groups. Conclusion Our data did not show an association between the COL1A2 polymorphism and the occurrence of POP.

Resumo Objetivo Avaliar o polimorfismo rs42524 do gene pró-colágeno tipo I alfa (α) 2 (COL1A2) como fator relacionado ao desenvolvimento de prolapso de órgãos pélvicos (POP) em mulheres brasileiras. Métodos O estudo envolveu 112 mulheres com POP nos estádios III e IV (grupo caso) e 180 mulheres com POP nos estádios zero e I (grupo controle). Outros dados clínicos foramobtidos pormeio de entrevistas comas pacientes sobre seu históricomédico, e o sangue das voluntárias também foi coletado para extração de DNA genômico. A região promotora do gene COL1A2 contendo o polimorfismo rs42524 foi amplificada, e a discriminação entre as variantes G e C foi realizada por digestão dos produtos de reação em cadeia da polimerase (RCP) com a enzima MspA1I, seguida de análise por eletroforese em gel de agarose. Resultados Foram analisadas 292 mulheres. No grupo caso, 71 tinham o genótipo G/G, 33 tinham o genótipo G/C, e 7 tinham o genótipo C/C. Por sua vez, a relação no grupo controle foi de 117 G/G, 51 G/C e 11 C/C. Não houve diferenças significativas entre os grupos. Conclusão Nossos dados não mostraram associação do polimorfismo do gene COL1A2 com a ocorrência de POP.

Evaluation of quality of sleep in women with stress urinary incontinence before and after surgical correction.

OBJECTIVE: To evaluate the quality of sleep in women with urinary incontinence before and after sling surgery. METHODS: A prospective study of case series of women with urodynamic diagnosis of stress urinary incontinence. To evaluate the subjective quality of sleep, two specific questionnaires were used and validated for the Portuguese Language: Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index. The questionnaires were applied before and 6 months after surgical repair. RESULTS: When analyzing the Epworth Sleepiness Scale, there was an improvement in sleep quality (p=0.0401). For the Pittsburgh Sleep Quality Index, only for sleep disorder there was improvement in quality of sleep after surgery (p=0.0127). CONCLUSION: Women with urinary incontinence, submitted to surgery with sling, showed improvement in both quality of sleep and sleep disorder.

Evaluation of quality of sleep in women with stress urinary incontinence before and after surgical correction / Avaliação da qualidade do sono em mulheres com incontinência urinária antes e depois da correção cirúrgica

ABSTRACT Objective: To evaluate the quality of sleep in women with urinary incontinence before and after sling surgery. Methods: A prospective study of case series of women with urodynamic diagnosis of stress urinary incontinence. To evaluate the subjective quality of sleep, two specific questionnaires were used and validated for the Portuguese Language: Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index. The questionnaires were applied before and 6 months after surgical repair. Results: When analyzing the Epworth Sleepiness Scale, there was an improvement in sleep quality (p=0.0401). For the Pittsburgh Sleep Quality Index, only for sleep disorder there was improvement in quality of sleep after surgery (p=0.0127). Conclusion: Women with urinary incontinence, submitted to surgery with sling, showed improvement in both quality of sleep and sleep disorder.

RESUMO Objetivo: Avaliar a qualidade do sono em mulheres com incontinência urinária antes e após correção cirúrgica do tipo sling. Métodos: Estudo prospectivo do tipo série de casos de mulheres com diagnóstico urodinâmico de incontinência urinária de esforço. Para avaliar a qualidade subjetiva do sono, utilizaram-se dois questionários específicos e validados para a língua portuguesa: Escala de Sonolência de Epworth e Índice de Qualidade do Sono de Pittsburgh. Os questionários foram aplicados antes e 6 meses após a correção cirúrgica. Resultados: Ao analisar a Escala de Sonolência de Epworth, houve melhora da qualidade do sono (p=0,0401). Para o Índice de Qualidade do Sono de Pittsburgh, apenas para o transtorno do sono, houve melhora da qualidade do sono após a cirurgia (p=0,0127). Conclusão: Mulheres com incontinência urinária, submetidas à correção cirúrgica por meio de sling, apresentaram melhora tanto na qualidade do sono como no transtorno do sono.

Description and evaluation of experimental models for uterine transplantation in pigs.

OBJECTIVE: To evaluate the technique of uterine transplantation and the use of drugs used in the process of immunosuppression. METHODS: We included 12 sows, and immunosuppression was performed with minimal doses of cyclosporine, and cross-match was done to exclude the possibility of blood incompatibility. Hysterectomy was performed in the donor under general anesthesia, with the removal of the aorta and inferior vena cava in monobloc, and anastomosis of these vessels was made in the recipient. RESULTS: Six experiments were performed, and on the immediate postoperative period, five animals had good reperfusion. However, on the seventh postoperative day, histological analysis showed rejection in five animals. CONCLUSION: The experimental model of uterine transplantation is feasible, but monitoring doses of immunosuppressants is pivotal to prevent rejection episodes.

Description and evaluation of experimental models for uterine transplantation in pigs / Descrição e avaliação de modelos experimentais para transplante uterino em suínos

ABSTRACT Objective: To evaluate the technique of uterine transplantation and the use of drugs used in the process of immunosuppression. Methods: We included 12 sows, and immunosuppression was performed with minimal doses of cyclosporine, and cross-match was done to exclude the possibility of blood incompatibility. Hysterectomy was performed in the donor under general anesthesia, with the removal of the aorta and inferior vena cava in monobloc, and anastomosis of these vessels was made in the recipient. Results: Six experiments were performed, and on the immediate postoperative period, five animals had good reperfusion. However, on the seventh postoperative day, histological analysis showed rejection in five animals. Conclusion: The experimental model of uterine transplantation is feasible, but monitoring doses of immunosuppressants is pivotal to prevent rejection episodes.

RESUMO Objetivo: Avaliar a técnica de transplante uterino e o uso de drogas no processo de imunossupressão. Métodos: Foram incluídas 12 porcas, sendo realizada imunossupressão com doses mínimas de ciclosporina, e prova cruzada para afastar a possibilidade de incompatibilidade sanguínea. Realizou-se, na doadora, histerectomia sob anestesia geral, com a retirada, em monobloco, da aorta e da veia cava inferior, de tal forma que, na receptora, fosse possível realizar a anastomose com estes vasos. Resultados: Foram realizados seis experimentos e, no pós-operatório imediato, houve boa reperfusão em cinco animais. Entretanto, no sétimo dia de pós-operatório, as análises histológicas demonstraram rejeição em cinco deles. Conclusão: O modelo experimental de transplante uterino é factível, mas a monitorização das doses de imunossupressores é importante, a fim de impedir os episódios de rejeição.

Histomorphometric analysis of a rat bladder after electrical stimulation.

OBJECTIVE: We sought to analyze the effects of electrical stimulation (ES) of the pelvic floor on the bladder of rats. METHODS: Forty rats were studied and divided into the following groups: GI (control group) - did not receive ES, GII (placebo) - did not receive ES but had an electrode inserted into the vagina; GIII - underwent six sessions of ES of the pelvic floor and GIV - rats that underwent 12 sessions of ES. Subsequently, the bladder was removed and the epithelium, muscle and blood vessels were analyzed. RESULTS: The muscle wall in GIV had increased thickness when compared to other groups. Further, the number of blood vessels was similar in GIII and GIV, which was higher than that found in GI and GII. Finally, there was an increase in the relative percentage of muscle fibers in relation to collagen for GIV compared to GI. CONCLUSION: After 12 sessions of ES in rats the muscle layer, the number of blood vessels and the relative percentage of muscle fibers were increased.

Histomorphometric analysis of a rat bladder after electrical stimulation / Análise histomorfométrica da bexiga de ratos após eletroestimulação

OBJECTIVE: We sought to analyze the effects of electrical stimulation (ES) of the pelvic floor on the bladder of rats. METHODS: Forty rats were studied and divided into the following groups: GI (control group) - did not receive ES, GII (placebo) - did not receive ES but had an electrode inserted into the vagina; GIII - underwent six sessions of ES of the pelvic floor and GIV - rats that underwent 12 sessions of ES. Subsequently, the bladder was removed and the epithelium, muscle and blood vessels were analyzed. RESULTS: The muscle wall in GIV had increased thickness when compared to other groups. Further, the number of blood vessels was similar in GIII and GIV, which was higher than that found in GI and GII. Finally, there was an increase in the relative percentage of muscle fibers in relation to collagen for GIV compared to GI. CONCLUSION: After 12 sessions of ES in rats the muscle layer, the number of blood vessels and the relative percentage of muscle fibers were increased.

OBJETIVO: Analisar os efeitos da eletroestimulação (ES) de assoalho pélvico na bexiga de ratas. MÉTODOS: 40 ratas foram estudadas e divididas nos seguintes grupos: GI (Grupo controle) - não receberam ES GII (placebo) - não foram submetidas a ES mas possuíam um eletrodo introduzido dentro da vagina; GIII - submetidas a seis sessões de ES do assoalho pélvico e GIV - ratas que receberam 12 sessões de ES. Posteriormente, a bexiga foi removida e analisou-se o seu epitélio, musculatura e os vasos sanguíneos. RESULTADOS: Observou-se aumento na espessura da parede muscular em GIV em relação aos demais grupos. Encontramos, ainda, que o número de vasos sanguíneos foi similar em GIII e GIV, sendo maior ao observado em GI e GII. Por fim, houve aumento na porcentagem relativa de fibras musculares em relação ao colágeno em GIV quando comparada à GI. CONCLUSÃO: Após 12 sessões de ES em ratas houve aumento da camada muscular, número de vasos e da porcentagem relativa de fibras musculares.

Prolapso genital e reabilitação do assoalho pélvico / Pelvic floor rehabilitation and genital prolapse

O prolapso genital é condição comum e importante indicação de cirurgia ginecológica nos dias atuais. A quantificação do prolapso é realizada por meio do POP-Q, uma classificação internacionalmente reconhecida e preconizada pela Sociedade Internacional de Continência (ICS). O suporte dos órgãos pélvicos se dá por um sistema de suspensão, constituído de ligamentos, e outro de sustentação, constituído por fáscias e músculos, especialmente o levantador do ânus, que deve estar íntegro para que possa manter perfeito suporte dos órgãos e o hiato genital fechado. A fraqueza ou defeitos nesse músculo podem levar ao aparecimento de prolapso genital. O tratamento conservador tem ganhado espaço, especialmente em estágios menos avançados do prolapso. Consiste em mudanças nos hábitos de vida diária, tais como redução de peso, diminuição das atividades que aumentam a pressão abdominal, tratamento da constipação intestinal, e intervenções físicas, como o fortalecimento da musculatura do assoalho pélvico. Este estudo constitui um levantamento das evidências científicas acerca do tratamento conservador do prolapso genital, visando proporcionar uma visão mais atual do problema

The pelvic organ prolapse is a common condition and the main cause of gynecologic surgery nowadays. The quantification of genital prolapse is performed by means of POP-Q, an international classification recognized and indicated by the International Continence Society (ICS). The support of the pelvic organs relies on a suspension system, made of ligaments, and a sustentation system, made of fascies or muscles, especially the levator ani, that should be intact in order to give a perfect support for the organs and for close genital gap. The weakness or damages in this muscle can cause genital prolapse. The nonsurgical treatment has been used more frequently, especially in early stages of the prolapse. It consists of changing daily habits, such as reducing weight, decreasing activities that raise abdominal pressure, treating intestinal constipation, and other physical interventions, such as the strengthening of the pelvic floor musculature. This study is a bibliographic evidence-based research about the conservative treatment of the genital prolapse

[Association between mode of delivery and maternal complications in a public hospital in Greater Metropolitan São Paulo, Brazil]. / Associação entre via de parto e complicações maternas em hospital público da Grande São Paulo, Brasil.

The purpose of this study was to assess the relationship between mode of delivery and maternal complications, based on a retrospective cohort of all births at a public hospital in 2003. Complications included: infection, hemorrhage, hysterectomy, uterine rupture, lesions in adjacent organs, deep venous thrombosis, and pulmonary embolism. The analysis used odds ratio (OR), chi-squared test, and Fisher's exact test, besides logistic regression. Fifteen complications were identified. Taking vaginal delivery as the reference, an association was found between cesarean section and overall complications. Analysis of confounding showed an association between hypertension, HIV, placenta previa, and abruptio placentae. After controlling for these variables, an association remained between overall complications and cesarean section (OR = 9.7; p = 0.04). Another analysis comparing elective cesareans and vaginal deliveries also showed an increased risk for cesarean (OR = 4.7; p = 0.02). Finally, comparing elective cesareans with trial of labor, we found an increased proportion of complications in elective cesareans, with borderline significance (OR = 3; p = 0.058). We concluded that cesarean section is associated with maternal morbidity, even after controlling for confounders.

Associação entre via de parto e complicações maternas em hospital público da Grande São Paulo, Brasil / Association between mode of delivery and maternal complications in a public hospital in Greater Metropolitan São Paulo, Brazil

O estudo objetivou avaliar associação entre via de parto e complicações maternas. Realizou-se coorte retrospectiva com partos ocorridos durante o ano de 2003, em um hospital público. As complicações avaliadas foram: infecção, hemorragia, histerectomia, rotura uterina, lesão de órgão contíguo, trombose venosa profunda e embolia pulmonar. Utilizou-se a odds ratio (OR) e os testes de qui-quadrado de Pearson e de Fisher, além da regressão logística. Estabeleceu-se o nível de 0,05 como significante. Foram encontradas 15 complicações. Tomando-se o parto vaginal como referência, encontrou-se associação entre cesárea e as complicações tomadas em conjunto. Analisando-se variáveis confundidoras, encontrou-se associação das complicações com hipertensão, soropositividade para HIV, placenta prévia e descolamento prematuro de placenta. Após controle para estas quatro variáveis, manteve-se a associação entre cesárea e complicações (OR = 9,7; p = 0,04). Encontrou-se também associação entre complicações e cesárea eletiva comparada ao parto vaginal (OR = 4,7; p = 0,02), e maior proporção de complicações, no limite da significância estatística, nas cesáreas eletivas comparadas à "tentativa de parto vaginal" (OR = 3; p = 0,058). Conclui-se que a cesárea associa-se a complicações maternas, mesmo após a realização de vários ajustes.

The purpose of this study was to assess the relationship between mode of delivery and maternal complications, based on a retrospective cohort of all births at a public hospital in 2003. Complications included: infection, hemorrhage, hysterectomy, uterine rupture, lesions in adjacent organs, deep venous thrombosis, and pulmonary embolism. The analysis used odds ratio (OR), chi-squared test, and Fisher's exact test, besides logistic regression. Fifteen complications were identified. Taking vaginal delivery as the reference, an association was found between cesarean section and overall complications. Analysis of confounding showed an association between hypertension, HIV, placenta previa, and abruptio placentae. After controlling for these variables, an association remained between overall complications and cesarean section (OR = 9.7; p = 0.04). Another analysis comparing elective cesareans and vaginal deliveries also showed an increased risk for cesarean (OR = 4.7; p = 0.02). Finally, comparing elective cesareans with trial of labor, we found an increased proportion of complications in elective cesareans, with borderline significance (OR = 3; p = 0.058). We concluded that cesarean section is associated with maternal morbidity, even after controlling for confounders.

Fisioterapia e incontinência urinária de esforço: revisão e análise crítica / Physiotherapy and stress urinary incontinence: review and critical analysis

A incontinência urinária de esforço é enfermidade com alta prevalência e que afeta milhões de pessoas no mundo. Os autores fazem ampla revisão da literatura, mostrando que as técnicas fisioterápicas tais como os exercícios perineais, a eletroestimulação e a terapia com cones são efetivas no tratamento de mulheres com essa afecção, porém, ressaltam a necessidade de estudos prospectivos, com seguimento em longo prazo para determinar por quanto tempo o sucesso terapêutico permanece adequado.

Stress urinary incontinence is a highly prevalent condition that affects millions of people worldwide. This paper presents an important review of the literature on the matter and concludes that physiotherapic techniques such as pelvic floor exercise, electrical estimulation and vaginal cones are effective in the treatment of women with this disease. It is nevertheless necessary to conduct prospective trails with long term follow-up in order to determine the adequacy of such therapeutic intervention.

Incontinência urinária de esforço: relação familiar e predisposição genética / Stress urinary incontinence: familial relatioship and genetic predisposition

A origem multifatorial da incontinência urinária de esforço (IUE) abrange: idade, sexo, paridade, índice de massa corpórea (IMC), hipoestrogenismo e constipação intestinal, entre os mais conhecidos. Também há relatos sobre possível predisposição familiar à IUE, além de sua associação com doenças do colágeno. Baseados nesses relatos e sabendo da importância do colágeno na constituição da musculatura lisa e dos tecidos fasciais de sustentação pélvica, pode-se supor que haja predisposição genética à doença, relacionada principalmente ao metabolismo do colágeno. Alterações desse metabolismo poderiam estar envolvidas na suscetibilidade e na gênese da IUE. Os autores discutem, neste artigo, os principais trabalhos que destacam essa hipótese, o papel do colágeno e a sua relação com IUE, além das pesquisas que podem trazer aplicações práticas na prevenção e tratamento dessa doença.

The multifactorial origins of stress urinary incontinence (SUI) includes: age, sex, parity, body mass index (BMI), hipoestrogenism and intestinal constipation, among the most known factors. There are also reports about a possible familial predisposition to SUI and its association to collagen diseases. Based on these reports, and also on the collagen importance for the smooth muscles and fascial tissues constitution for pelvic organs support, it is reasonable to assume that there is a genetic predisposition to the disease, mostly related to the collagen metabolism. Changes in collagen metabolism might be involved in the susceptibility and origins of SUI. In this article, the authors discuss the main publications that may justify this hypothesis, the collagen function and its relation to SUI. The researches that may lead to practical applications for prevention and treatment of this disease are highlighted.

[Uroflowmetry and flow pressure study parameters in urogynecology patients]. / Parâmetros da urofluxometria e do estudo fluxo/pressão em pacientes uroginecológicas.

OBJECTIVE: The purpose was to evaluate urine flow rates in an urodynamic study (US) of patients with symptoms of lower urinary tract dysfunction and to record effects of final urodynamic diagnosis and age on these variables. METHODS: Retrospective analysis of 205 women who had undergone urogynecological investigation. Patients were divided into three age groups: A (< 45 years); B (45 - 60 years) and C (> 60 years). Comportment of urine flow rates and opening detrusor pressure with increasing age were studied and resulting charts recorded. Comparison of maximum and average urine flow rates, opening detrusor pressure and detrusor pressure at the maximal flow according to final urodynamic diagnostic were also made. RESULTS: There was a decline of urine flow rates with increase of age, which was more significant between groups A X C and B X C. There was also a decline in opening detrusor pressure with aging, which was significant between groups A X C. When analyzing opening detrusor pressure according to final urodynamic diagnosis, a significant decline of this variable was observed in patients with urinary stress incontinence and intrinsic sphincter deficiency in relation to those who were asymptomatic. CONCLUSION: Urine flow rates decreased with age. Women with urinary stress incontinence and intrinsic sphincter deficiency void at a lower detrusor pressure.