RESUMO
OBJECTIVE: Obese women with large abdominal volume may present with elevated intra-abdominal and intravesical pressure due to their high body mass index (BMI), which leads to an imbalance in the mechanism responsible for urinary continence. Thus, these women have a 2-fold chance of developing urinary incontinence (UI) than nonobese women. Because increased BMI represents a risk factor for UI development, we hypothesize that its reduction could alleviate or decrease the symptoms of this condition in obese women. Therefore, the aim of this study was to describe the impact of weight loss on the severity of UI symptoms and quality of life (QoL) in women undergoing bariatric surgery. METHODS: This was a combined case-cohort study lasting 1 year, with 26 obese women aged 18 to 59 years who underwent bariatric surgery and presented preoperative UI. The participants' BMI was calculated, their UI was assessed through the International Consultation on Incontinence Questionnaire-Short Form, and QoL by the King's Health Questionnaire. Reassessments were performed at 3, 6, 9, and 12 postoperative months. RESULTS: We found no significant association between BMI reduction and prevalence and severity of UI. However, the 8-point reduction in BMI was sufficient to decrease the severity of UI. Quality of life improved significantly in 7 of the 9 domains evaluated. CONCLUSIONS: According to the results of our study, we can conclude that the reduction in the prevalence and severity of UI together with weight loss induced by bariatric surgery was more evident in the first 3 months postoperatively, impacting positively the QoL of these women.
Assuntos
Cirurgia Bariátrica , Qualidade de Vida , Incontinência Urinária/fisiopatologia , Adulto , Índice de Massa Corporal , Feminino , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/cirurgia , Índice de Gravidade de Doença , Inquéritos e Questionários , Incontinência Urinária/complicações , Incontinência Urinária/psicologiaRESUMO
An influence diagram (ID) is a method of graphical representation of uncertain knowledge, which can be employed to support decisions in health care using probabilistic reasoning. We aimed to describe the development of an ID to support the decision-making process in phase II at Cardiopulmonary and Metabolic Rehabilitation Program (CPMR). The development of the ID was carried out through the identification of relevant variables and their possible values, as well as the identification of details of each variable, in order to find a network structure that appropriately connects the nodes that represent the variables, with arcs linking acyclic graphs, and to build the graph using specialized knowledge and the conditional probability table for each node in the graph. In spite of the complexity of the interactions, the model obtained with the ID seems to contribute in the decision-making process in phase II CPMR, providing a second opinion to the health pratictioner and helping in diagnostic, therapeutic and decision-making processes, since it is useful in situations with non-linear modeling or with absent or uncertain information.