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1.
Maturitas ; 144: 4-10, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33358207

RESUMO

OBJECTIVE: To assess the impact of confinement due to the coronavirus (Covid-19) pandemic on health-related quality of life (HRQoL) and resilience in peri- and postmenopausal women. MATERIAL AND METHODS: We used an online questionnaire which was sent between April 30th and May 13th, 2020 to women aged 40-70 years who were peri- or postmenopausal according to STRAW criteria. We used the 16-item Cervantes short-form scale (Cervantes-SF) to measure HRQoL, and the 14-item Wagnild and Young Resilience Scale (RS-14) to measure resilience. High scores on the Cervantes-SF indicate low HRQoL and high scores on the RS-14 indicate high levels of resilience. Covid-19 status, sociodemographic descriptors, and lifestyle variables were also evaluated. RESULTS: We included 2430 peri- and postmenopausal women with valid questionnaires. All items of the Cervantes-SF were completed in 2151 cases, whilst the RS-14 was completed in 2413 cases. There was a negative correlation between scores on the Cervantes-SF and RS-14 scales (Rho -0.350; p < 0.0001). Multiple linear regression analysis revealed a statistically significant association between Cervantes-SF scores and living with others (ß-coefficient -10.2; p < 0.001), use of antidepressants (ß 9.3; p < 0.001), physical activity (ß -8.6; p < 0.001) and sexual activity (ß -2.7; p < 0.001). Resilience was associated with the use of antidepressants (ß -5.9; p < 0.001), physical activity (ß 3.2; p < 0.001) and sexual activity (ß 1.7; p = 0.005). According to the multivariate analysis, there were no associations between either Covid-19 or menopausal status and HRQoL or resilience scores. CONCLUSIONS: During the period of mandatory Covid-19 confinement, peri- and postmenopausal women who engaged in physical and sexual activity had higher HRQoL and higher levels of resilience, whilst women who were using antidepressants had lower HRQoL and lower levels of resilience. HRQoL was greater in women who lived with others.


Assuntos
Perimenopausa/psicologia , Pós-Menopausa/psicologia , Qualidade de Vida/psicologia , Quarentena/psicologia , Resiliência Psicológica , Adulto , Idoso , Estudos Transversais , Exercício Físico/psicologia , Feminino , Humanos , Pessoa de Meia-Idade , Inquéritos e Questionários
2.
BMC Womens Health ; 20(1): 277, 2020 12 28.
Artigo em Inglês | MEDLINE | ID: mdl-33371883

RESUMO

OBJECTIVE: To study what women think about menopause treatments and assess their knowledge about them. To analyze adherence to treatment during COVID-19 confinement as a secondary objective. METHODS: A multi-center cross-sectional observational study was conducted using a survey of 2500 women between January and June 2019. This was administered following a non-probability sampling procedure including women between 35 and 75 years. An extension study was conducted during the coronavirus pandemic, between March and June 2020. RESULTS: The responses of 2355 surveyed women were analyzed. Of this sample, 42% knew about menopause hormone therapy (MHT). The most frequently identified indication was the treatment of hot flashes (65.6%). The MHT risks most frequently perceived were weight gain (24.2%) and breast cancer (21.7%); the main reason for rejecting MHT was a lack of information (96.1%). Comparative analyses were conducted according to age, menopausal status, type of menopause, place of residence, type of health care and level of education. During the coronavirus confinement period, 85 women using MHT were located, of which 84.7% continued it. CONCLUSIONS: Women hold certain false beliefs about menopause, and their knowledge of the available treatments is somewhat limited. Adherence to MHT during the COVID-19 confinement in Spain has been high.


Assuntos
Terapia de Reposição de Estrogênios , Conhecimentos, Atitudes e Prática em Saúde , Menopausa , Estudos Transversais , Feminino , Humanos , Adesão à Medicação/estatística & dados numéricos , Espanha
4.
Int J Gynecol Cancer ; 30(10): 1528-1534, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32817200

RESUMO

OBJECTIVE: Risk models in endometrial cancer define prognosis and indicate adjuvant therapy. One of the currently used classifications was designed in 2016 in collaboration with the European Society of Medical Oncology (ESMO), the European Society of Gynecologic Oncology (ESGO), and the European Society of Radiotherapy (ESTRO). A high-intermediate risk group was introduced within the intermediate risk group. The purpose of this study was to evaluate the clinical relevance of this subclassification. METHODS: A multicenter retrospective study was carried out at five international tertiary institutions. Patients diagnosed with intermediate risk endometrial cancer on the basis of definitive pathology findings were included. Patients were stratified into intermediate and high-intermediate risk groups. Incidence of nodal metastases, and disease free and overall survival were compared between the two risk groups in univariate and multivariate analysis. RESULTS: 477 patients were included: 325 (68%) patients were identified as intermediate and 152 (32%) as high-intermediate endometrial cancer patients. Nodal metastases were found in 18 patients (11.8%) in the high-intermediate risk endometrial cancer group and 16 patients (4.9%) in the intermediate risk group. Lymphovascular space invasion was found to be a strong predictive factor of lymph node involvement. High-intermediate risk was found to be an independent factor of disease free survival (hazard ratio (HR) 1.76; 95% confidence interval (CI) 1.00 to 3.08; p=0.050) and overall survival (HR 1.99; 95% CI 1.10 to 3.60; p=0.022) in the multivariate analysis. CONCLUSIONS: The study validates the clinical significance of the intermediate risk endometrial cancer subclassification. Prognosis for high-intermediate risk endometrial cancer was significantly poorer. The prevalence of lymph node metastases was higher in this group of patients.

5.
Maturitas ; 137: 57-62, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32498938

RESUMO

COVID-19 is associated with a systemic inflammatory response with activation of coagulation in symptomatic patients. The possibility of coagulopathies in peri- and postmenopausal women taking estrogen therapies makes it necessary to consider antithrombotic strategies, such as the use of low molecular weight heparins (LMWH) at specific prophylactic or treatment doses for each individual case, depending on the risk factors that each woman presents. For such reasons, a panel of experts from various Spanish scientific societies has met to develop usage recommendations for managing menopausal women taking menopausal hormone therapy (MHT) or combined hormonal contraception (CHC) during the COVID-19 pandemic.


Assuntos
Infecções por Coronavirus , Terapia de Reposição de Estrogênios , Terapia de Reposição Hormonal , Menopausa , Pandemias , Pneumonia Viral , Tromboembolia , Anticoagulantes/uso terapêutico , Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Feminino , Heparina de Baixo Peso Molecular/uso terapêutico , Contracepção Hormonal , Humanos , Pessoa de Meia-Idade , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Fatores de Risco , Tromboembolia/etiologia , Tromboembolia/prevenção & controle
7.
J Gynecol Oncol ; 29(1): e1, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29185259

RESUMO

OBJECTIVE: To assess the impact of lymph node dissection (LND) on morbidity, survival, and cost for intermediate-risk endometrial cancers (IREC). METHODS: A multicenter retrospective cohort of 720 women with IREC (endometrioid histology with myometrial invasion <50% and grade 3; or myometrial invasion ≥50% and grades 1-2; or cervical involvement and grades 1-2) was carried out. All patients underwent hysterectomy and bilateral salpingo-oophorectomy. A matched pair analysis identified 178 pairs (178 with LND and 178 without it) equal in age, body mass index, co-morbidities, American Society of Anesthesiologist score, myometrial invasion, and surgical approach. Demographic data, pathology results, perioperative morbidity, and survival were abstracted from medical records. Disease-free survival (DFS) and overall survival (OS) was analyzed using Kaplan-Meier curves and multivariate Cox regression analysis. Cost analysis was carried out between both groups. RESULTS: Both study groups were homogeneous in demographic data and pathologic results. The mean follow-up in patients free of disease was 61.7 months (range, 12.0-275.5). DFS (hazard ratio [HR]=1.34; 95% confidence interval [CI]=0.79-2.28) and OS (HR=0.72; 95% CI=0.42-1.23) were similar in both groups, independently of nodes count. In LND group, positive nodes were found in 10 cases (5.6%). Operating time and late postoperative complications were higher in LND group (p<0.05). Infection rate was significantly higher in no-LND group (p=0.035). There were no statistical differences between both groups regarding operative morbidity and hospital stay. The global cost was similar for both groups. CONCLUSION: Systematic LND in IREC has no benefit on survival, although it does not show an increase in perioperative morbidity or global cost.


Assuntos
Neoplasias do Endométrio/patologia , Neoplasias do Endométrio/cirurgia , Excisão de Linfonodo , Neoplasias Uterinas/patologia , Neoplasias Uterinas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise Custo-Benefício , Neoplasias do Endométrio/economia , Neoplasias do Endométrio/epidemiologia , Feminino , Humanos , Excisão de Linfonodo/efeitos adversos , Excisão de Linfonodo/economia , Excisão de Linfonodo/estatística & dados numéricos , Metástase Linfática , Análise por Pareamento , Pessoa de Meia-Idade , Morbidade , Estadiamento de Neoplasias , Complicações Pós-Operatórias/economia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Análise de Sobrevida , Resultado do Tratamento , Neoplasias Uterinas/economia , Neoplasias Uterinas/epidemiologia
8.
Maturitas ; 84: 55-62, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26596902

RESUMO

OBJECTIVE: To analyse the psychometric properties of the Cervantes scale short-form (SF) in the peri- and post-menopausal periods. METHODS: Outpatients women 45-65 years with menstrual problems associated with the climacteric syndrome were analysed. Original and SF versions of the Cervantes scale were administered along with the EuroQol-5D (EQ-5D) and work productivity and activity impairment questionnaire (WPAI) scales. Conceptual model, burden of administration, feasibility, reliability, criteria validity and construct validity were assessed. RESULTS: 317 women [55.7±5.3 years (mean±standard deviation)] were recruited: 75.4% were post- and 22.3% were peri-menopausal. The Cervantes-SF was completed in 2.5±1.6min, and 86% answered all items. Cronbach's α was 0.820, and ranged from 0.510 (Aging) to 0.918 (Vasomotor Symptoms) for individual dimensions. The scale structure matched the structure of the original version, χ(2)/(degrees of freedom)=3.6, Comparative Fit Index=0.848, Tucker-Lewis Index=0.850, and root mean square error of approximation=0.099, although differences were found between sexual activity statuses. Criteria validity was good (r=0.890), concurrent validity was congruent with a priori hypothesis using either the EQ-5D or the WPAI scales. The scale discriminated significantly the severity of both vasomotor and genital climacteric associated symptoms. CONCLUSION: The Cervantes-SF has shown good psychometric properties for measuring Health related quality of life in peri- and post-menopausal women who regularly attended gynaecology clinics in Spain.


Assuntos
Perimenopausa , Pós-Menopausa , Qualidade de Vida , Inquéritos e Questionários , Atividades Cotidianas , Eficiência , Feminino , Humanos , Pessoa de Meia-Idade , Perimenopausa/psicologia , Pós-Menopausa/psicologia , Psicometria , Reprodutibilidade dos Testes , Sexualidade , Espanha
9.
Prog. obstet. ginecol. (Ed. impr.) ; 58(8): 381-387, oct. 2015. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-141300

RESUMO

La atrofia vaginal es una enfermedad crónica, a menudo no diagnosticada, que tiene un importante impacto en la salud sexual y la calidad de vida. La atrofia vaginal está causada por los cambios fisiológicos debidos a la disminución de estrógenos y son la base de una serie de síntomas que incluyen sequedad vaginal, dispareunia, prurito e irritación reportados en un 40-60% de las mujeres posmenopáusicas en Europa. El porcentaje de mujeres tratadas es menor del 30% y con un cumplimiento menor del 10% al año. El tratamiento de primera línea para la atrofia vaginal moderada-severa son los estrógenos locales. Recientemente, ha aparecido en España un nuevo tratamiento local de estrógenos, que consiste en un anillo de silicona flexible con un núcleo que contiene 2 mg de hemihidrato de estradiol. El estradiol se libera en cantidades mínimas pero continuas, con una liberación de 6,5 a 9,5 μg/día durante, al menos, 90 días. El anillo vaginal ha demostrado ser efectivo en el alivio de la sintomatología local (vaginal y urológica) y mejorando la mucosa vaginal desde el punto de vista de los hallazgos visuales exploratorios (palidez, turgencia, rugosidad, grosor), así como en cuanto al índice de maduración citológica (mayor proporción de células superficiales y una disminución de células basales, parabasales e intermedias) y pH. El anillo muestra los mismos efectos secundarios que otros tipos de estrógenos locales y es el método más elegido por las pacientes debido a la facilidad de su uso, la comodidad y la satisfacción en general (AU)


Vaginal atrophy is a chronic disease that is often undiagnosed and has a major impact on sexual health and quality of life. Vaginal atrophy is caused by physiological changes due to a decrease of estrogens. These changes are the basis of a number of symptoms including vaginal dryness, dyspareunia, itching and irritation reported in 40-60% of postmenopausal women in Europe. The percentage of treated women is less than 30%, and compliance is less than 10% per year. Local estrogens are the first-line treatment for moderate-to-severe vaginal atrophy. A new local estrogen treatment has recently become available in Spain, consisting of a flexible silicone ring with a core containing 2 mg of estradiol hemihydrate. The amount of estradiol released is minimal but in continuous quantities, with a release of 6.5 to 9.5 mcg/day for at least 90 days. The vaginal ring has been proven to be effective in relieving local symptoms (vaginal and urological), improving the vaginal mucosa based on visual examination (pale color, turgor, roughness, and thickness) and on the rate of cytologic maturation (a greater proportion of surface cells and a decrease in basal, parabasal and intermediate cells) and pH. The ring produces the same side effects as other types of local estrogen and is the most frequently chosen method by patients because of its ease of use and comfort, and the general satisfaction produced (AU)


Assuntos
Feminino , Humanos , Atrofia/tratamento farmacológico , Estradiol/uso terapêutico , Estrogênios/deficiência , Cremes, Espumas e Géis Vaginais/uso terapêutico , Satisfação do Paciente , Qualidade de Vida , Estradiol/farmacocinética , Resultado do Tratamento , Avaliação de Eficácia-Efetividade de Intervenções , Qualidade de Produtos para o Consumidor/normas , Aceitação pelo Paciente de Cuidados de Saúde
10.
Emerg Infect Dis ; 21(3): 456-9, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25695937

RESUMO

In the Peruvian Amazon, paca meat is consumed by humans. To determine human risk for polycystic echinococcosis, we examined wild pacas from 2 villages; 15 (11.7%) of 128 were infected with Echinococcus vogeli tapeworms. High E. vogeli prevalence among pacas indicates potential risk for humans living in E. vogeli-contaminated areas.


Assuntos
Cuniculidae/parasitologia , Equinococose/veterinária , Doenças dos Roedores/epidemiologia , Doenças dos Roedores/parasitologia , Animais , Echinococcus , Feminino , Fígado/parasitologia , Fígado/patologia , Masculino , Peru/epidemiologia , Prevalência , Doenças dos Roedores/diagnóstico
11.
Maturitas ; 78(2): 146-50, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24720907

RESUMO

Vaginal health, defined as the vaginal state in which the physiological condition remains stable, being protected from the onset of symptoms and facilitating a satisfying sex life, is one of the most common and less valued concerns in postmenopausal women. Many of the conditions that affect the vagina are related to its trophism and susceptibility to infection by unusual germs, which are phenomena strongly influenced by estrogen impregnation and the microbiota composition, ultimately affecting sexuality and the quality of life. An expert panel of the Spanish Menopause Society met to establish criteria for diagnosing and treating the processes that affect overall vaginal health and to decide the optimal timing and methods based on the best evidence available.


Assuntos
Pós-Menopausa , Saúde Reprodutiva , Disfunções Sexuais Fisiológicas/terapia , Vagina/patologia , Doenças Vaginais/terapia , Feminino , Humanos , Qualidade de Vida , Doenças Vaginais/diagnóstico , Vaginite/diagnóstico , Vaginite/terapia , Saúde da Mulher
12.
Int J Gynecol Cancer ; 24(4): 703-12, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24651627

RESUMO

OBJECTIVE: The aim of this study is to assess the impact of lymphadenectomy (LND) on morbidity, survival, and cost for high-risk histologic types of endometrial cancer (EC). MATERIALS AND METHODS: We analyzed a multicenter retrospective cohort of 389 women with high-risk histotypes of EC (poor differenced tumors [G3], clear cell, serous papillary, and mixed mesodermal tumors) preoperatively confined to the corpus and diagnosed between 2000 and 2013. All patients underwent hysterectomy and bilateral salpingo-oophorectomy. A matched-pair analysis identified 97 pairs (97 with LDN and 97 without) equal in age, body mass index, comorbidities, International Federation of Gynecology and Obstetrics stage, and adjuvant treatment. Demographic data, pathologic examination results, perioperative morbidity, and survival were abstracted from medical records. Cost was provided by the cost unit of the local hospital. Disease-free and overall survival were analyzed using the Kaplan-Meier curves and Cox multivariable regression analysis. RESULTS: Both study groups were homogeneous in demographic data and pathologic examination results. At a median follow-up of 24.5 months (range, 5.4-146.3), disease-free survival (hazard ratio, 1.09; 95% confidence interval, 0.70-1.90) and overall survival (hazard ratio, 0.86; 95% confidence interval, 0.56-1.33) were similar in both groups regardless of nodal count. Positive nodes were found in 23.7%. Predictor factors of nodal involvement were advanced age (P = 0.024), deep myometrial invasion (P < 0.001), and high CA 125 levels (P = 0.003). In the LDN group, operating time, late postoperative complications, and surgical cost were higher (P < 0.05). There were no statistical differences between both groups relative to surgical morbidity. Early postoperative complications and hospital stay were lower in the LDN group. The global cost was similar for both groups (6027&OV0556; for the LND group and 5772&OV0556; for the no-LND group). CONCLUSIONS: Lymphadenectomy in high-risk histotypes of EC does not increase perioperative morbidity or global cost and has not benefit on survival.


Assuntos
Adenocarcinoma de Células Claras/patologia , Adenocarcinoma Mucinoso/patologia , Carcinoma Papilar/patologia , Carcinoma de Células Escamosas/patologia , Cistadenocarcinoma Seroso/patologia , Neoplasias do Endométrio/patologia , Excisão de Linfonodo , Adenocarcinoma de Células Claras/mortalidade , Adenocarcinoma de Células Claras/cirurgia , Adenocarcinoma Mucinoso/mortalidade , Adenocarcinoma Mucinoso/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Papilar/mortalidade , Carcinoma Papilar/cirurgia , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/cirurgia , Terapia Combinada , Cistadenocarcinoma Seroso/mortalidade , Cistadenocarcinoma Seroso/cirurgia , Neoplasias do Endométrio/mortalidade , Neoplasias do Endométrio/cirurgia , Feminino , Seguimentos , Humanos , Histerectomia , Análise por Pareamento , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Ovariectomia , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida
13.
Am J Clin Dermatol ; 12 Suppl 1: 13-9, 2011 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-21895045

RESUMO

The diagnosis and management of four cases of dermatological disorders, most of which are related to the endocrine disorder of androgen excess, are presented. Combined oral contraceptives (COCs) may be useful when well-tolerated hormonal therapy and/or when contraception is required. A female patient with androgenetic alopecia or female pattern balding, without underlying hyperandrogenism, was treated with ethinylestradiol/chlormadinone acetate (EE/CMA) 0.03 mg/2 mg for 6 months and experienced stabilization of hair loss (case report 1). A patient who had previously received a COC for an irregular menstrual pattern but again experienced irregular menses and also acne after stopping treatment was diagnosed with acne associated with polycystic ovary syndrome (PCOS) [case report 2]. After 6 month's treatment with EE/CMA 0.03 mg/2 mg, this patient had fewer acne lesions and became eumenorrheic. A third patient who had excess hair since childhood was diagnosed with idiopathic hirsutism (no underlying gynecological or endocrinological disorder was found) and was treated with EE/CMA 0.03 mg/2 mg (case report 3). Less hair growth was reported after 6 months' treatment. Case report 4 describes a patient who presented with oligomenorrhea and acne. She was diagnosed with PCOS with acne, seborrhea and mild hirsutism. Treatment with EE/CMA 0.03 mg/2 mg for 6 months resulted in improvements in her facial acne, seborrhea and hirsutism; she also became eumenorrheic. These four cases illustrate that EE/CMA may be a useful and well tolerated treatment option in the management of patients with dermatological disorders with or without hyperandrogenization.


Assuntos
Androgênios/metabolismo , Acetato de Clormadinona/análogos & derivados , Etinilestradiol/análogos & derivados , Dermatopatias/tratamento farmacológico , Adulto , Acetato de Clormadinona/efeitos adversos , Acetato de Clormadinona/uso terapêutico , Anticoncepcionais Orais Combinados/efeitos adversos , Anticoncepcionais Orais Combinados/uso terapêutico , Etinilestradiol/efeitos adversos , Etinilestradiol/uso terapêutico , Feminino , Humanos , Dermatopatias/diagnóstico , Dermatopatias/fisiopatologia , Resultado do Tratamento , Adulto Jovem
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