Background: Although the efficacy of pelvic floor muscle training (PFMT) and bladder training are well established, there is a paucity of patient centered models using these interventions to treat women with UI at primary level of health assistance in Brazil. Objective: To investigate the effectiveness of a physical therapy intervention to treat women with UI in primary health centers. Methods: Pragmatic non-randomized controlled trial in which women with UI from the community participated in a supervised physical therapy program consisting of bladder training plus 12 weeks of PFMT, performed either at home or in the health center. Outcome measures were amount and frequency of urine loss measured by the 24-h pad-test and the 24-h voiding diary; secondary outcome was the impact of UI on quality of life measured by the ICIQ-SF. Outcomes were measured at baseline, at the 6th and 12th weeks of the intervention and 1 month after discharge. Results: Interventions reduced the amount (pad-test, p = 0.004; d = 0.13, 95% CI = −0.23 to 0.49) and frequency of urine loss (voiding diary, p = 0.003; d = 0.51, 95%CI = 0.14 to 0.87), and the impact of UI on quality of life (ICIQ-SF, p < 0.001; d = 1.26, 95%CI = 0.87 to 1.66) over time, with positive effects from the 6th week up to 1 month for both intervention setting (home and health center), and no differences between them.

| Urinary incontinence (UI) is considered a public health problem that should be firstly approached in the primary care units (PCU). Educational programs target to professionals who work in these units are a key component in the management of this condition. The aim of this study was to report the experience of the "Caring for Who Cares", a project developed in a PCU aimed at educating employees about UI. The educational program was carried out as a dynamic, with theoretical and practical character, lasting 2 hours. The 28 participants were divided into 2 groups. Each group participated in the program on different days so that the usual activities of the PCU could be maintained. Issues such as types of UI, risk factors, preventive and therapeutic measures, especially urinary and bowel habits and pelvic floor muscle (PFM) training, were discussed. The participants reported being more attentive to their urinary habits after the educational program; some of them had incorporated exercises for the PFM. There were also an increasing number of users referred to the physiotherapy care service. Therefore, the project successfully educated the employees of the PCU for their own care and allowed the implementation of UI preventative and treatment programs in this unit. This experience may be helpful to other professionals when implementing the physical therapy assistance for women with UI in PCU.Keywords | urinary incontinence; primary health care; physical therapy. RESUMO | A incontinência urinária (IU) é um problema de saúde pública, devendo ser abordada em centros de saúde (CS). A educação dos profissionais é necessária para que saibam prestar assistência às usuárias. O objetivo deste estudo foi relatar a experiência do projeto "Cuidar de Quem Cuida", desenvolvido em CS para educar funcionárias acerca da IU. O programa foi realizado na forma de uma dinâmica teórico-prática com duração de 2 horas, sendo que as 28 participantes foram divididas em 2 grupos. Cada grupo participou do programa em dias diferentes de forma que as atividades usuais do CS puderam ser mantidas. Foram discutidos os tipos de IU, fatores de risco, possibilidades terapêuticas e medidas preventivas, destacando-se o cuidado com os hábitos urinários e intestinais e o treinamento dos mús-culos do assoalho pélvico (MAP). Após sua realização, as participantes relataram que passaram a desenvolver hábitos urinários saudáveis e realizar exercícios para os MAP. Observou-se aumento do número de usuárias referenciadas para a Fisioterapia. Assim, o programa instrumentalizou as funcionárias a desenvolver o autocuidado e identificar necessidade de assistência às usuárias. Esta abordagem poderá ser efetiva em outros serviços como um primeiro passo na implantação de assistência fisioterapêutica a mulheres com IU nos CS. Descritores

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The value of the 24-h pad test established by the ICS was not valid for the investigated sample. Environmental conditions, menopausal status, and use of hormone therapy can interfere with the values of the pad test.

Background Considering the lack of studies that examine built environmental factors associated with life satisfaction among old people in developing countries, particularly those focused on Brazil, the aim of this study was to estimate the prevalence of life satisfaction among old adults residents in a Brazilian urban center and to investigate its association with individual characteristics and objective measures of the built environment. Methods A household survey ( N = 832) in Belo Horizonte, Minas Gerais, Brazil (2008–2009) and a Systematic Social Observation (SSO) was used in this study. Life satisfaction was assessed through Self-Anchoring Ladder Scale, developed by Cantril, in 1965. Participants’ answers were categorized as satisfied (rungs 6–10) and dissatisfied (rungs 0–5). A Multilevel Poisson regression analysis with robust variance was performed. Results The prevalence of satisfaction with life was approximately 82%. Higher prevalence of life satisfaction was significantly associated with old people who reported higher incomes, higher religious participation, who practice physical activity and who perceive their health as good and very good. In contextual level, results showed that when the contextual features were adjusted separately by the individual characteristics they were no longer significant. The results also showed a lower prevalence of life satisfaction among those living in neighborhoods with higher physical disorder, even after adjusting for individual and other contextual characteristics. Conclusions The present findings suggest that life satisfaction should be assessed whenever evaluating urban redevelopment programs designed to improve neighborhood characteristics, reducing physical disorder, especially among old adults.

Introduction Low-level lasers have been suggested as a complement to lymphedema treatment. However, this therapy’s mechanism of action and its effects are poorly understood up to the present. Objective To conduct a systematic literature review to analyze the effects of low-level laser in the treatment of upper-limb lymphedema in women submitted to breast cancer surgery. Material and methods Randomized clinical trials were included, in Portuguese, English and Spanish, from January 1990 to July 2013. The article search was carried out in the Pubmed, Lilacs and PEDro electronic databases, with the following descriptors:Terapia a Laser de Baixa Intensidade, Linfedema, Câncer de Mama, Low-level laser therapy, Lymphedema, Breast Neoplasms and also through a manual search. Results and discussion Low-level lasers have been used for treating several acute and chronic conditions. However, its application for managing post breast cancer surgery is still recent, often based on empirical evidence. Treating upper-limb lymphedema with low-level laser presented positive results, with reduction in the circumference or volume of the affected limb. Conclusion More studies of high methodological quality are needed in order to better understand the mechanism of action of low-level laser on the lymphatic system and its effects on lymphedema treatement.

Resumo: O objetivo do estudo foi examinar a prevalência e fatores associados a ter saído para trabalhar durante a epidemia da COVID-19, entre adultos com 50 anos ou mais que exerciam trabalho remunerado antes do seu início. Foram utilizados dados da segunda onda do Estudo Longitudinal da Saúde dos Idosos Brasileiros (ELSI-Brasil), conduzida por meio de entrevista face a face, entre agosto de 2019 e março de 2020 (antes do início da epidemia), em amostra nacional representativa de adultos com 50 anos ou mais, e dados obtidos por meio de entrevistas telefônicas realizadas entre esses participantes (iniciativa ELSI-COVID-19), conduzidas entre 26 de maio e 8 de junho de 2020 (durante a epidemia). As análises foram baseadas nas odds ratios (OR) estimadas pela regressão logística. A média de idade dos participantes foi 59,9 anos (DP = 6,5). A prevalência de ter saído para trabalhar nos sete dias anteriores foi de 38,4% (IC95%: 31,3-46,1), 50,2% entre os homens e 25,1% entre as mulheres (trabalho formal, por conta própria e informal). Os resultados mostraram que, entre os homens, a chance de ter saído para trabalhar foi menor entre aqueles de 60 a 69 anos em comparação com aqueles de 50 a 59 anos (OR = 0,27; IC95%: 0,15-0,48). Entre as mulheres, a probabilidade de ter saído para trabalhar foi menor entre aquelas que trabalhavam por conta própria (OR = 0,28; IC95%: 0,12-0,64) ou tinham vínculo informal de trabalho antes da epidemia (OR = 0,25; IC95%: 0,09-0,69), em comparação àquelas com vínculo formal de trabalho. Uma das hipóteses para explicar essa associação é que as mulheres com vínculo informal tenham sido dispensadas e aquelas que trabalhavam por conta própria tenham deixado de trabalhar durante a epidemia.

Considering that urban environments may affect self-rated health through behavioral and psychosocial mechanisms, the aim of this study was to investigate the association between self-rated health and perceived urban environment characteristics among adults living in four Latin American cities. Data is from a population-based survey by Development Bank of Latin America, encompassing adults between 20 and 60 years old in Buenos Aires, Lima, Mexico City, and Panama City. Self-rated health was measured using a single question and the response options were categorized as poor and good. The explanatory variables were empirical Bayes estimates of self-reported area physical disorder, social disorder, access to services, and access to leisure spaces derived from the survey. The covariates were: individual age, sex, education, wealth index, and length of residency in the neighborhood; and an area social environment index. Multilevel logistic regressions with two levels (individual and sub-city areas) were fitted. Poor self-rated health was reported by 34.73% (95% CI: 33.17 to 36.29) of the participants and was associated with physical disorder (OR = 1.16 per SD; 95% CI: 1.02 to 1.32). Our findings suggest that public policies to promote population health should consider area urban environment factors, especially those associated with disorder.