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1.
Gynecol Oncol ; 160(3): 729-734, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33419610

RESUMO

OBJECTIVE: Voiding dysfunctions represent a leading morbidity after radical hysterectomy performed in patients with early-stage cervical cancer. The aim of this study was to perform ad hoc analysis of factors influencing voiding recovery in SENTIX (SENTinel lymph node biopsy in cervIX cancer) trial. METHODS: The SENTIX trial (47 sites, 18 countries) is a prospective study on sentinel lymph node biopsy without pelvic lymphadenectomy in patients with early-stage cervical cancer. Overall, the data of 300 patients were analysed. Voiding recovery was defined as the number of days from surgery to bladder catheter/epicystostomy removal or to post-voiding urine residuum ≤50 mL. RESULTS: The median voiding recovery time was three days (5th-95th percentile: 0-21): 235 (78.3%) patients recovered in <7 days and 293 (97.7%) in <30 days. Only seven (2.3%) patients recovered after >30 days. In the multivariate analysis, only previous pregnancy (p = 0.033) and type of parametrectomy (p < 0.001) significantly influenced voiding recovery >7 days post-surgery. Type-B parametrectomy was associated with a higher risk of delayed voiding recovery than type-C1 (OR = 4.69; p = 0.023 vs. OR = 3.62; p = 0.052, respectively), followed by type-C2 (OR = 5.84; p = 0.011). Both previous pregnancy and type C2 parametrectomy independently prolonged time to voiding recovery by two days. CONCLUSIONS: Time to voiding recovery is significantly related to previous pregnancy and type of parametrectomy but it is not influenced by surgical approach (open vs minimally invasive), age, or BMI. Type B parametrectomy, without direct visualisation of nerves, was associated with longer recovery than nerve-sparing type C1. Importantly, voiding dysfunctions after radical surgery are temporary, and the majority of the patients recover in less than 30 days, including patients after C2 parametrectomy.

2.
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
4.
Cancers (Basel) ; 12(11)2020 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-33207627

RESUMO

This retrospective analysis aimed to assess the risk factors for recurrence in patients diagnosed with early-stage cervical cancer (≤IB1 or IIA1, FIGO 2009) undergoing robot-assisted radical hysterectomy in Spain and Portugal between 2009 and 2018. A second primary objective was to audit the oncological outcomes according to quality indicators (QI) proposed by the European Society of Gynecology Oncology (ESGO). The study population included 239 women. After a median follow-up of 51 months, recurrence occurred in 26 patients (10.9%). Independent factors for recurrence were clinical tumor size > 20 mm (hazard ratio (HR) 2.37), adenocarcinoma as histological type (HR 2.51), positive pelvic lymph nodes (HR 4.83), tumor grade 2 (HR 4.99), tumor grade 3 (HR 8.06), and having not performed sentinel lymph node biopsy (SLNB) (HR 4.08). All 5 QI selected were surpassed by our results. In patients with early-stage cervical cancer undergoing robotic radical hysterectomy, clinicians should be aware that tumor grade 2 and 3, tumor size > 20 mm, adenocarcinoma, positive pelvic nodes, and lack of performance of SLNB are risk factors for recurrence. Fulfillment of QI targets of the ESGO might be considered as an objective oncological outcome indicator supporting the minimally invasive approach for early-stage cervical cancer treatment.

5.
Menopause ; 27(9): 1047-1052, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32852458

RESUMO

OBJECTIVE: The aim of this study is to evaluate the level of knowledge men have about menopause and to analyze whether sociodemographic aspects influence this knowledge. METHODS: A total of 560 consecutive surveys were collected during 2019. Surveys were completed by men anonymously, voluntarily, and without incentives. A maximum score of 45 points was considered for the knowledge analysis. RESULTS: The mean age was 49.13 ±â€Š11.1 years. The most frequent source of information to obtain knowledge about menopause was friends (61.4%). The mean of the questionnaire score was 20.69 ±â€Š6.1 (R: 0-45). The most frequent symptoms associated with menopause were hot flashes and vaginal dryness (93.7%; 48%) and the best-known treatment to improve vaginal health was lubricants at 69.5%. The most common treatment men knew for improving menopause symptoms was menopause hormone treatment; however, 27.9% of men thought there is no treatment for menopause. Differences were found between ages in numbers and grades (P = 0.032). Men with a higher level of education had significantly more knowledge than those with primary school education (P = 0.016). Differences were shown in men who obtained information from healthcare staff with respect to other sources (P < 0.001). CONCLUSIONS: The level of knowledge in men in this sample is limited. Differences were found between ages, level of education, and sources of information. No differences were found between public and private hospitals. Teaching of this knowledge should be carried out by trained personnel, preferably healthcare staff.

6.
Menopause ; 2020 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-32639446

RESUMO

OBJECTIVE: The aim of this study is to evaluate the level of knowledge men have about menopause and to analyze whether sociodemographic aspects influence this knowledge. METHODS: A total of 560 consecutive surveys were collected during 2019. Surveys were completed by men anonymously, voluntarily, and without incentives. A maximum score of 45 points was considered for the knowledge analysis. RESULTS: The mean age was 49.13 ±â€Š11.1 years. The most frequent source of information to obtain knowledge about menopause was friends (61.4%). The mean of the questionnaire score was 20.69 ±â€Š6.1 (R: 0-45). The most frequent symptoms associated with menopause were hot flashes and vaginal dryness (93.7%; 48%) and the best-known treatment to improve vaginal health was lubricants at 69.5%. The most common treatment men knew for improving menopause symptoms was menopause hormone treatment; however, 27.9% of men thought there is no treatment for menopause. Differences were found between ages in numbers and grades (P = 0.032). Men with a higher level of education had significantly more knowledge than those with primary school education (P = 0.016). Differences were shown in men who obtained information from healthcare staff with respect to other sources (P < 0.001). CONCLUSIONS: The level of knowledge in men in this sample is limited. Differences were found between ages, level of education, and sources of information. No differences were found between public and private hospitals. Teaching of this knowledge should be carried out by trained personnel, preferably healthcare staff.

7.
Int J Gynaecol Obstet ; 150(3): 398-405, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32506474

RESUMO

OBJECTIVE: To compare perioperative outcomes and complications in robotically assisted laparoscopy (RAL) and standard laparoscopy (SLP) approaches in the treatment of endometrial cancer by body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters). METHODS: A comparative study was carried out of women treated for endometrial cancer at the Hospital Clinico San Carlos from January 2012 to December 2016: 133 patients were operated by RAL and 101 by SLP. Demographic characteristics of the patients, perioperative outcomes and complications were compared in both approaches. RESULTS: Hospital stay was significantly lower in patients with BMI ≤30 operated with RAL (2 days RAL vs 4 days SLP; P=0.002). Estimated blood loss was significantly lower in the group with BMI<25 (60 mL RAL vs 100 mL SLP; P=0.004) and in the group with BMI ≥30 (87.5 mL RAL vs 180 SLP; P=0.003) operated with RAL. RAL significantly reduced the conversion rate in patients with BMI ≥30 (2 [3.4%] patients RAL vs 6 [27.3%] patients SLP; P=0.004). CONCLUSIONS: RAL has demonstrated advantages in treating obese women with endometrial cancer by reducing blood loss and conversion to laparotomy.

8.
Int J Gynecol Cancer ; 30(9): 1285-1291, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32571891

RESUMO

OBJECTIVE: This study aimed to analyze the prognostic factors for overall and progression-free survival in patients with vulvar cancer. METHODS: This international, multicenter, retrospective study included 2453 patients diagnosed with vulvar cancer at 100 different institutions. Inclusion criteria were institutional review board approval from each collaborating center, pathologic diagnosis of invasive carcinoma of the vulva, and primary treatment performed at the participating center. Patients with intraepithelial neoplasia or primary treatment at non-participating centers were excluded. Global survival analysis and squamous cell histology subanalysis was performed. RESULTS: After excluding patients due to incomplete data entry, 1727 patients treated for vulvar cancer between January 2001 and December 2005 were registered for analysis (1535 squamous, 42 melanomas, 38 Paget's disease and 112 other histologic types). Melanomas had the worse prognosis (p=0.02). In squamous vulvar tumors, independent factors for increase in local recurrence of vulvar cancer were: no prior radiotherapy (p<0.001) or chemotherapy (p=0.006), and for distant recurrence were the number of positive inguinal nodes (p=0.025), and not having undergone lymphadenectomy (p=0.03) or radiotherapy (p<0.001), with a HR of 1.1 (95% CI 1.2 to 1.21), 2.9 (95% CI 1.4 to 6.1), and 3.1 (95% CI 1.7 to 5.7), respectively. Number of positive nodes (p=0.008), FIGO stage (p<0.001), adjuvant chemotherapy (p=0.001), tumor resection margins (p=0.045), and stromal invasion >5 mm (p=0.001) were correlated with poor overall survival, and large case volume (≥9 vs <9 cases per year) correlated with more favorable overall survival (p=0.05). CONCLUSIONS: Advanced patient age, number of positive inguinal lymph nodes, and lack of adjuvant treatment are significantly associated with a higher risk of relapse in patients with squamous cell vulvar cancer. Case volume per treating institution, FIGO stage, and stromal invasion appear to impact overall survival significantly. Future prospective trials are warranted to establish these prognostic factors for vulvar cancer.

9.
Eur J Obstet Gynecol Reprod Biol ; 252: 43-49, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32562940

RESUMO

OBJECTIVES: The aim of the study is to assess whether women who choose to use menopausal hormone therapy (MHT) have lower quality of life (QoL) than those who do not initiate it using Cervantes short form scale (C-SF), and analyze sociodemographic factors associated with lower QoL in women. STUDY DESIGN: A cross-sectional descriptive observational study was made in four hundred and eighty women with climacteric symptoms. RESULTS: Mean age was 51.1 years. Two hundred and sixty-one women (54.3 %) started MHT. The sample´s global mean in C-SF score was 51.3 ± 13.9. Women who choose to use MHT have higher score in C-SF (lower QoL) than women who reject it (58.7 ± 15.9 vs 46.7 ± 12.8; p < 0.001). We found higher score in women with early menopause (53.7 ± 15.9 vs 49.7 ± 13.1; p = 0.037); with no obesity (<30 vs >30 BMI) (52.8 ± 13.5 vs 41.0 ± 8.2; p = 0.002); with previous malignancies (56.2 ± 18.2 vs 50.2 ± 13.5; p = 0.020) and without sexual activity (58.0 ± 25.4 vs 50.4 ± 13.1; p = 0.009. No differences were found in C-SF score with respect to tobacco habits or physical activity. In the multivariate analysis, the variable independently associated to lower QoL by C-SF (high score) was to be a woman who want to initiate MHT (p = 0.004). CONCLUSIONS: Women who choose to use MHT due to menopausal symptoms have lower quality of life measured by C-SF scale. Women with early menopause, with no obesity (<30 BMI), without sexual activity and with previous malignances have lower quality of life measured by C-SF scale. Women with early menopause have more psychic symptoms like nervousness, fatigue and sleep complaints by C-SF scale than women with natural menopause.

10.
Eur J Obstet Gynecol Reprod Biol ; 240: 121-124, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31260857

RESUMO

OBJECTIVE: To study the prevalence and epidemiological characteristics of women with vulvodynia. To assess the risk factors associated to the disease. STUDY DESIGN: A cross-sectional study was made in which questionnaires were anonymously and confidentially distributed to Spanish women over 18 years of age between April 2016 and September 2017. The questionnaires were distributed by e-mail and through social networks, women's associations and specific websites. This type of questionnaire has been validated and used in many studies of this kind. The women answered questions referred to epidemiological aspects, demographic parameters, medical history, the presence of vulvodynia, associated factors, and comorbidities. RESULTS: A total of 684 questionnaires were completed. The prevalence of vulvodynia was 6.6% (45 women). Thirteen percent (95 women) had experienced vulvodynia at some point in life. The factors associated to vulvodynia were prior vaginal deliveries (p = 0.001), vulvovaginal candidiasis (p < 0.001) and urinary tract infections (p < 0.001). Other pain syndromes such as fibromyalgia (p = 0.012), painful bladder syndrome/ interstitial syndrome (p < 0.001), temporomandibular joint pain (p = 0.021), coxofemoral pain (p = 0.001) or headache (p = 0.001) have also been associated to vulvodynia. CONCLUSIONS: The prevalence of vulvodynia in Spain is similar to that found in other countries. Many factors are involved in its development and persistence, particularly the presence of other pain syndromes and recurrent infections that could trigger complex inflammatory reactions.


Assuntos
Vulvodinia/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Espanha/epidemiologia , Vulvodinia/etiologia , Adulto Jovem
11.
Health Econ Rev ; 9(1): 18, 2019 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-31214891

RESUMO

BACKGROUND: The aim of this study is to carry out the economic evaluation, in term of a cost-minimization analysis that considers healthcare costs and indirect costs, of robot-assisted hysterectomy (RAH) compared with conventional laparoscopic hysterectomy (CLH) in female adults scheduled for total laparoscopic hysterectomy for benign conditions. METHODS: Cost-minimization analysis based on an analytic observational study of prospective cohorts with a five-year time horizon. Eligible participants were all female adults scheduled for total laparoscopic hysterectomy for benign conditions at tertiary hospital. The economic evaluation was conducted from a Spanish National Health Service and societal perspective, including healthcare costs and indirect costs. The costs are expressed in Euros from the year 2015. RESULTS: One hundred sixty nine patients were analyzed, 68 in the RAH group and 101 in the CLH group. Average cost for the RAH group was €8982.42 compared to €8015.14 for the CLH group (incremental cost €967.27; p = 0.054). Healthcare cost is the most important component of total cost and represents 86.4% for the RAH group and 82.3% for the CLH group. The difference of €1169 (p = 0.01) in the average healthcare cost is mainly due to the cost of purchasing and maintaining the equipment (difference of €1206.39 in favor of RAH; p < 0.005). With regard to indirect costs, for patients in the RAH group the costs associated with loss of productivity were lower (difference of €203.42; p = 0.17), while the cost of trips to the hospital was higher (difference of €1.98; p = 0.66) in respect to CLH. CONCLUSIONS: Our findings reveal similar effectiveness between RAH and CLH, although CLH is the more efficient option from the point of view of an economic analysis based on cost-minimization.

12.
Maturitas ; 120: 35-39, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30583762

RESUMO

BACKGROUND AND OBJECTIVES: Resilience is a dynamic process that implies positive adaptation to adversity, and it is tested in stressful situations. In this study we compared resilience and menopause-related quality of life in women with and without a history of gynaecological cancer. METHODS: A cross-sectional study was conducted with a total of 293 participants, all of them menopausal women: 80 cancer survivors and 213 without a history of cancer. Participants completed the 14-item Wagnild and Young Resilience Scale (WYRS-14) and the 16-item short form Cervantes (Cervantes-SF-16) questionnaire (on which a lower score indicates a higher menopause-related quality of life), and sociodemographic data were collected. RESULTS: Resilience was significantly higher in the cancer survivors than in the menopausal women without a history of cancer: their total WYRS-14 scores were 86 points [72.25-90.00] and 80 points [69.80-88], respectively. Quality of life for cancer survivors was significantly worse than for women without a history of cancer: their total Cervantes-SF-16 scores were 45.01 [27.19-58.34] and 32.37 [20.00-44.80], respectively. Among the cancer survivors, women with a high resilience score had a better quality of life than those with a low resilience score: the groups' respective scores on the Cervantes-SF-16 total score were 35.98 [25.84-53.00] and 64.59 [51.81-76.68]. CONCLUSIONS: A history of cancer significantly affected women's menopause-related quality of life. Cancer had an impact on resilience. Highly resilient menopausal women with a history of gynaecological cancer had a better menopause-related quality of life than less resilient women with a history of gynaecological cancer.


Assuntos
Neoplasias dos Genitais Femininos/psicologia , Menopausa/psicologia , Qualidade de Vida/psicologia , Resiliência Psicológica , Estresse Psicológico/psicologia , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Inquéritos e Questionários
13.
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
14.
Sex Reprod Healthc ; 11: 97-101, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28159136

RESUMO

OBJECTIVE: To describe behaviors and knowledge related to sexual and reproductive health of Spanish university students and their association with the subject area studied (biomedical or not). METHODS: A descriptive cross-sectional observational study conducted with 2074 students aged 18-24years from the University Complutense of Madrid in the Faculties of Medicine and Law. Simple random stratified sampling without replacement was performed. A self-administered, anonymous and voluntary questionnaire was distributed. It was based on the Youth Risk Health Behavior Survey and assessed behavior and knowledge in three areas: sex, contraceptive methods (CM) and sexually transmitted infections (STIs). RESULTS: In total, 83.5% of respondents had had sexual intercourse, from a mean age of 16.8years and with a mean of 3.4 sexual partners. Compared with the law students (LS), fewer medical students (MS) were sexually active, they had a later age of sexual initiation and they had had fewer sexual partners (p<0.001). High regular use of contraceptive methods was observed (92.8%), with no significant differences between groups, although LS had had more unprotected sex and had more often used emergency contraception than had MS (p<0.001). In total, 81.5% of respondents knew about the vaccine against human papillomavirus, 60.8% its relationship with cancer and 43.2% had been vaccinated, the rates being significantly higher in MS (p<0.001). CONCLUSIONS: The behavior and knowledge of medical students in relation to sexual and reproductive health differed from those of law students.


Assuntos
Anticoncepção , Conhecimentos, Atitudes e Prática em Saúde , Saúde Reprodutiva , Comportamento Sexual , Doenças Sexualmente Transmissíveis , Estudantes de Medicina , Universidades , Adolescente , Adulto , Coito , Comportamento Contraceptivo , Estudos Transversais , Feminino , Humanos , Jurisprudência , Masculino , Vacinas contra Papillomavirus , Assunção de Riscos , Sexo Seguro , Espanha , Estudantes , Inquéritos e Questionários , Sexo sem Proteção , Adulto Jovem
15.
Minerva Ginecol ; 69(2): 160-170, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27973466

RESUMO

Menopausal symptoms include vasomotor symptoms (VMS), vulvar-vaginal atrophy, and loss of bone mass associated with an increased risk of fracture. Treatment of VMS consists of lifestyle changes, hormone treatment (estrogens with and without progestogens, tissue selective estrogens complex or conjugated estrogens and bazedoxifene [CE/BZA], progestogens, and tibolone), and nonhormonal treatments. Genitourinary symptoms due to vulvar-vaginal atrophy are treated with systemic and local hormones, moisturizer creams and gels, CE/BZA, and a selective estrogen receptor modulator (ospemifene). In addition to lifestyle changes, treatments for the risk of fragility fracture include calcium and vitamin D, hormone treatment, selective estrogen receptor modulators (raloxifene, BZA), bisphosphonates, strontium ranelate, denosumab, and teriparatide. This article reviews treatment options and provides treatment algorithms for women with menopausal symptoms.


Assuntos
Densidade Óssea/fisiologia , Menopausa , Sistema Vasomotor/fisiologia , Algoritmos , Feminino , Humanos , Estilo de Vida , Osteoporose Pós-Menopausa/terapia , Fraturas por Osteoporose/prevenção & controle , Doenças Vaginais/etiologia , Doenças Vaginais/terapia , Doenças da Vulva/etiologia , Doenças da Vulva/terapia
16.
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
17.
Eur J Obstet Gynecol Reprod Biol ; 196: 11-6, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26651076

RESUMO

OBJECTIVE: To analyze the value of dynamic spectral imaging (DSI) compared to, and as an adjunct to, conventional colposcopy (CC) in the diagnosis of cervical intraepithelial neoplasia (CIN). STUDY DESIGN: Four hundred seventy-nine women referred for colposcopy after an abnormal Pap-smear (≥ASC-US) to the Low Genital Tract Unit of the San Carlos Clinical Hospital in Madrid, Spain during the years 2012-2014 were examined simultaneously by CC and DSI. Thirty-six cases (8.1%) were excluded because the DSI map was not calculated. The gold standard for comparisons was the final histological diagnosis performed by punch biopsy or LEEP. RESULTS: Out of the 443 cases, 293 were found to be negative for CIN, 109 had CIN1 and 41 were found with CIN2+. The sensitivity of CC to detect those with CIN2+ lesions was 73.2% and the specificity 92.3%. Using the DSI map as an adjunct, led to a statistically significant increase of the sensitivity to 87.8% with a concomitant drop in specificity to 85.6%. The adjunctive use of DSI increased the sensitivity for CIN2+ also in the high-risk group of the 65 cases with an identified HPV16/18 infection; CC had a sensitivity of 88.9%, which increased to 100%. The specificity dropped from 91.1% to 87.5%. CONCLUSIONS: Combining conventional colposcopy with DSI mapping improves the capability to detect cervical lesions.


Assuntos
Neoplasia Intraepitelial Cervical/patologia , Colposcopia/métodos , Diagnóstico por Imagem/métodos , Infecções por Papillomavirus/patologia , Neoplasias do Colo do Útero/patologia , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Teste de Papanicolaou , Estudos Prospectivos , Sensibilidade e Especificidade , Esfregaço Vaginal
18.
Menopause ; 22(3): 325-36, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25203890

RESUMO

OBJECTIVE: The Cervantes Scale is a specific health-related quality of life questionnaire that was originally developed in Spanish to be used in Spain for women through and beyond menopause. It contains 31 items and is time-consuming. The aim of this study was to produce an abridged version with the same dimensional structure and with similar psychometric properties. METHODS: A representative sample of 516 postmenopausal women (mean [SD] age, 57 [4.31] y) seen in outpatient gynecology clinics and extracted from an observational cross-sectional study was used. Item analysis, internal consistency reliability, item-total and item-dimension correlations, and item correlation with the 12-item Medical Outcomes Study Short Form Health Survey Version 2.0 were studied. Dimensional and full-model confirmatory factor analyses were used to check structure stability. A threefold cross-validation method was used to obtain stable estimates by means of multigroup analysis. RESULTS: The scale was reduced to a 16-item version, the Cervantes Short-Form Scale, containing four main dimensions (Menopause and Health, Psychological, Sexuality, and Couple Relations), with the first dimension composed of three subdimensions (Vasomotor Symptoms, Health, and Aging). Goodness-of-fit statistics were better than those of the extended version (χ(2)/df = 2.493; adjusted goodness-of-fit index, 0.802; parsimony comparative fit index, 0.749; root mean standard error of approximation, 0.054). Internal consistency was good (Cronbach's α = 0.880). Correlations between the extended and the reduced dimensions were high and significant in all cases (P < 0.001; r values ranged from 0.90 for Sexuality to 0.969 for Vasomotor Symptoms). CONCLUSIONS: The Cervantes Scale can be reduced to a 16-item abridged version (Cervantes Short-Form Scale) that maintains the original dimensional structure and psychometric properties. At 51% of the original length, this version can be administered faster, making it especially suitable for routine medical practice.


Assuntos
Nível de Saúde , Menopausa/psicologia , Qualidade de Vida , Inquéritos e Questionários , Estudos Transversais , Análise Fatorial , Feminino , Humanos , Pessoa de Meia-Idade , Psicometria , Reprodutibilidade dos Testes , Espanha
19.
Maturitas ; 80(2): 226-33, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25529938

RESUMO

INTRODUCTION: The consequences of vulvar disorders in terms of health, sexuality, and quality of life are usually undervalued, with disparities in the conceptual, diagnosis and treatment criteria. AIM: The objective of this guide will be to analyse the factors associated with the diagnosis and treatment of vulvar disorders and to provide recommendations for the most appropriate diagnostic and therapeutic measures. METHODOLOGY: A panel of experts from various Spanish scientific societies related to sexual health (Spanish Menopause Society [SMS] and the Asociación Española de Patología Cervical y Colposcopia [AEPCC]) met to reach a consensus on these issues and to decide the optimal timing and methods based on the best evidence available. RESULTS: We recommend a biopsy of all vulvar lesions with an uncertain diagnosis, especially with asymmetry, irregular borders, variegated and irregular colour and diameter >6mm. For vulvodynia, we recommend the use of lubricants or topical treatments with lidocaine or bupivacaine, amitriptyline, baclofen or triamcinolone. For vulvar epithelial disorders, we recommend beginning with topical corticosteroids of moderate to high potency. For sexual dysfunction, a multidisciplinary approach is the best management strategy in these patients.


Assuntos
Carcinoma in Situ/terapia , Carcinoma de Células Escamosas/terapia , Pós-Menopausa , Qualidade de Vida , Saúde Reprodutiva , Vulva/patologia , Doenças da Vulva/terapia , Neoplasias Vulvares/terapia , Atrofia , Carcinoma in Situ/diagnóstico , Carcinoma de Células Escamosas/diagnóstico , Consenso , Feminino , Humanos , Sociedades Médicas , Espanha , Doenças da Vulva/diagnóstico , Neoplasias Vulvares/diagnóstico , Vulvodinia/diagnóstico , Vulvodinia/terapia
20.
Gynecol Obstet Invest ; 78(4): 224-9, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25402750

RESUMO

BACKGROUND/AIMS: To assess the performance of colposcopists and correlate it with their experience when diagnosing cervical pathology by reviewing conventional colposcopy (CC) digital images and the Dynamic Spectral Imaging System (DySIS) cervical map. METHODS: Images from 50 women with normal and abnormal cervix collected during CC and the corresponding DySIS maps were projected consecutively to 63 participating colposcopists. Participants were asked for their diagnosis (normal, abnormal findings or cancer). The clinical experience of the participants was divided into low (n = 27), medium (n = 18) and high (n = 18), considering the number of colposcopies each one performed routinely. RESULTS: The mean of overall correct diagnoses was significantly higher with DySIS than CC for the low and medium experience group (20.4 vs. 24.4, and 21.9 vs. 26.0, respectively; p < 0.001), but not in the high experience group. The correct diagnosis was significantly higher with DySIS than CC for all experience groups in cases with a normal cervix and cervical intraepithelial neoplasia 2+ (CIN2+), but not for those with CIN1. All groups agreed that DySIS guides biopsies better, offers more information and allows performing colposcopy even without extensive experience. CONCLUSIONS: The results of evaluating projected colposcopy images were more successful with DySIS than with CC in the diagnosis of cervical pathology, especially among less experienced colposcopists.


Assuntos
Competência Clínica , Colposcopia/instrumentação , Colposcopia/normas , Ginecologia , Doenças do Colo do Útero/patologia , Neoplasias do Colo do Útero/patologia , Ácido Acético , Biópsia , Neoplasia Intraepitelial Cervical/patologia , Colposcopia/métodos , Feminino , Humanos , Satisfação do Paciente , Sensibilidade e Especificidade
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