Objective To evaluate the use of the home pad test in the management of patients with urinary dysfunction with reference to feasibility, normal data, reproducibility, compliance and accuracy when compared to video urodynamics. Design A prospective study to determine 1. the accuracy of weighing pads by healthcare workers compared to weighing by patients with a spring balance; 2. the effects of evaporation; 3. the pad weight increase in continent women; 4. the compliance over 194 tests in terms of acceptability and feasability; 5. the reproducibility in 112 women for the 24 h and 48 h tests, 6. the comparison with video urodynamic studies in 149 patients. Setting A London teaching hospital. Main outcome measures Coefficient of variation and mean deviation analysis were employed to determine the accuracy of measurement. Percentage changes in standardised wet pad weights over a period of 8 weeks were used to determine the rate of weight loss due to evaporation. The percentage of patients completing the test satisfactorily was documented. The increase in the weights of all the pads worn during the test period was measured in continent volunteers and incontinent patients. Video urodynamic diagnoses were used as the Gold Standard for comparison. Results Twelve perineal pads were weighed by 15 healthcare workers with a resulting coefficient of variation equal to 1.55% (standard error = 0.09%). The mean deviation between patient‐measured pad weights and staff‐measured weights was 49% (SD = 132%). Pads wetted with saline showed no difference in weight after 1 week and less than 5% change in weight after 8 weeks, with the upper 95% confidence limit of less than 10% loss. The mean pad weight increase over 48 h in continent women was 7.13 g (SD = 4.32 g) giving a 95% upper confidence level of less than 15 g. Compliance was reasonably high with 161 (83%) carrying out the test perfectly. Test‐retest analysis of the 24 h and 48 h tests showed a strong relationship with correlation coefficients of 0.90 and 0.94 respectively. The reproducibility was also good, with differences as a percentage of the mean between the first and second test being 6.9% and 1.6% for the 24 h and 48 h tests respectively. There was good concordance when the urodynamic study data was compared with pad weight data in terms of incontinence compared with no incontinence (kappa = 0.65), but a high false positive rate was detected for the pads. When eight of these patients with a false positive pad test had repeat video urodynamic studies, six were found to have detrusor instability on the second study. Conclusions The home pad test combined with frequency volume chart documentation is an easy test to perform. It is quite robust and reasonably reproducible. This test should be added to complement the routine urodynamic tests and may have a role in detecting occult detrusor instability.

ObjectiveTo study the prevalence of climacteric, urogenital and sexual symptoms in a population of Brazilian women. MethodsA cross-sectional descriptive population-based study was conducted. The selection of 456 women aged 45-60 years, living in Campinas, SP, in 1997, was done through area cluster sampling, according to data from the Brazilian Institute of Geography and Statistics. Data were collected via home interviews, using structured pretested questionnaires. Data were analyzed using the chi-squared test and the nonparametric Kruskal-Wallis test; a probability of <0.05 was considered statistically significant. The degree of climacteric symptoms was analyzed through circulatory and psychological indices. Analysis of the main components was used to determine symptom interrelationships. ResultsThe most prevalent symptoms were nervousness (82%), hot flushes (70%), headache (68%), irritability (67%) and sweating (59%). Hot flushes, sweating and insomnia were significantly more prevalent in the peri and postmenopausal phases. The frequency (severity) of vasomotor and psychological symptoms did not vary according to the menopause phase. The prevalence of urinary incontinence was 27.4%. Complaints of dyspareunia and vaginal dryness were infrequent. Decreased libido was the most frequent sexual complaint. It was observed that some climacteric complaints were interrelated. The first cluster included hot flushes and sweating (vasomotor cluster). The second cluster included nervousness, depression and irritability (psychological cluster). The third cluster included dizziness and palpitation (atypical cluster). ConclusionsClimacteric symptoms in this population were highly prevalent and similar to those described in developed Western countries.

Despite screening programs, Brazil has a high cervical cancer mortality rate. The objective of this cross-sectional study was to analyze knowledge, attitudes, and practices related to the Pap smear and to understand why women fail to submit to this screening test. A structured questionnaire was used to interview 138 women: 90 with high grade intraepithelial neoplasia and 48 with invasive cervical cancer. Inadequate practices were more frequent among women with invasive cancer. In terms of difficulties in obtaining medical care, more than 80% of women reported lack of motivation, 60% reported that physicians failed to conduct a complete physical examination, and some 50% reported that physicians' schedules were busy. Having a Pap smear usually depended on a physician's request and the woman being symptomatic. Women over than 56 years old showed more frequent inadequate knowledge, attitudes and practices. However, those with more schooling were more knowledgeable of the Pap smear procedure. Age and less schooling could be barriers against women participating in screening programs, but socioeconomic problems must also be considered for improving practices related to the Pap smear.

Maria José duarte osis 5 Artigo originalResumo OBJETIVO: avaliar o efeito do treinamento dos músculos do assoalho pélvico (TMAP) sobre as disfunções sexuais femininas. MÉTODOS: para esse ensaio clínico com abordagem antes e depois, foram incluídas 26 mulheres que apresentavam diagnóstico de disfunção sexual (transtorno de desejo sexual, de excitação, orgástico e/ou dispareunia). As participantes foram avaliadas antes, na metade (após cinco sessões) e ao final do tratamento (após dez sessões), por meio da palpação vaginal bidigital (avaliação da força dos músculos do assoalho pélvico-MAP), eletromiografia (EMG) intravaginal (captação das amplitudes de contração dos MAP) e Female Sexual Function Index (FSFI), questionário de avaliação da função sexual. As mulheres foram submetidas ao TMAP em diferentes posições, por dez sessões (uma ou duas vezes na semana). Para análise estatística, utilizou-se frequências absolutas e relativas para características clínicas e força dos MAP. Empregou-se teste de Friedman para comparação dos escores dos domínios do FSFI e valores da EMG, t de Student para associação entre esses valores e características das mulheres e Wilcoxon para modificação percentual da EMG. O teste Mann-Whitney permitiu comparar esses valores com características clínicas. Para correlacionar os valores da EMG com escore total médio, utilizou-se teste de correlação de Spearman. Adotou-se nível de significância de p<0,05. RESULTADOS: foi observada melhora significativa (p<0,0001) dos escores do FSFI ao final do tratamento quando comparado às avaliações inicial e intermediária. Em relação à EMG, as amplitudes das contrações fásicas e tônicas aumentaram significativamente (p<0,0001) ao longo do tratamento. Houve aumento na força do assoalho pélvico, com 69% das mulheres apresentando grau 4 ou 5 na avaliação final e melhora total das queixas sexuais. CONCLUSÕES: o TMAP resultou na melhora da força muscular e amplitudes de contração pela EMG, com melhora na função sexual, o que indica que essa abordagem terapêutica pode ser utilizada com sucesso no tratamento das disfunções sexuais femininas.Abstract PURPOSE: to evaluate the effect of pelvic floor muscle training (PFMT) on female sexual dysfunctions. METHODS: twentysix women with a diagnosis of sexual dysfunction (sexual desire, arousal, orgasmic disorders and/or dyspareunia) were included in a clinical trial with a before/after approach . The assessment was carried out before, during (after five sessions) and at the end of the treatment (after ten sessions) by two-digit palpation (assessment of pelvic floor muscle, PFM, strength), intravaginal electromyography (EMG) (capture of PFM contraction amplitudes) and Female Sexual Function Index (FSFI, a questionnaire for the evaluation of sexual function). The women underwent PFMT in different positions for ten sessions (once or twice a week). For statistical analysis, absolute and relative frequencies were used for clinical characteristics and PFM strength. The Friedman test was used to compare the FSFI domain scores and ...

Background: To identify all the records within the Brazilian Hospital Information System (HIS) that contained information suggestive of severe maternal morbidity (near miss); to describe the diagnoses and procedures used; to identify variables associated with maternal death.

ObjectivesTo determine if portable video media (PVM) improves patient's knowledge and satisfaction acquired during the consent process for cystoscopy and insertion of a ureteric stent compared to standard verbal communication (SVC), as informed consent is a crucial component of patient care and PVM is an emerging technology that may help improve the consent process. Patients and MethodsIn this multi-centre randomised controlled crossover trial, patients requiring cystoscopy and stent insertion were recruited from two major teaching hospitals in Australia over a 15-month period (July 2014-December 2015. Patient information delivery was via PVM and SVC. The PVM consisted of an audio-visual presentation with cartoon animation presented on an iPad. Patient satisfaction was assessed using the validated Client Satisfaction Questionnaire 8 (CSQ-8; maximum score 32) and knowledge was tested using a true/false questionnaire (maximum score 28). Questionnaires were completed after first intervention and after crossover. Scores were analysed using the independent samples t-test and Wilcoxon signed-rank test for the crossover analysis. ResultsIn all, 88 patients were recruited. A significant 3.1 point (15.5%) increase in understanding was demonstrable favouring the use of PVM (P < 0.001). There was no difference in patient satisfaction between the groups as judged by the CSQ-8. A significant 3.6 point (17.8%) increase in knowledge score was seen when the SVC group were crossed over to the PVM arm. A total of 80.7% of patients preferred PVM and 19.3% preferred SVC. Limitations include the lack of a validated questionnaire to test knowledge acquired from the interventions. ConclusionsThis study demonstrates patients' preference towards PVM in the urological consent process of cystoscopy and ureteric stent insertion. PVM improves patient's understanding compared with SVC and is a more effective means of content delivery to patients in terms of overall preference and knowledge gained during the consent process.

Vulnerabilidade de gênero para a paternidade em homens adolescentesGender vulnerability for parenthood among male adolescents RESUMO OBJETIVO: Analisar as relações de gênero vivenciadas por adolescentes do sexo masculino e como elas contribuem para torná-los vulneráveis à gravidez na adolescência. MÉTODOS:Estudo qualitativo realizado em Campo Grande, Mato Grosso do Sul, em 2003. Participaram 13 adolescentes masculinos com menos de 20 anos, com um único fi lho de até 11 meses, cuja mãe estava na mesma faixa etária do pai. Realizaram-se entrevistas semi-estruturadas gravadas. Após transcrição, procedeu-se à análise temática de conteúdo. RESULTADOS:Identifi caram-se estereótipos de gênero em que se destacavam papéis de líder, provedor e ativo sexualmente, bem como a rejeição a ser cuidador. Esses papéis apareceram consolidados principalmente na perspectiva dos entrevistados acerca do trabalho como marcador de sua condição de homem e provedor da família. A liderança dos adolescentes prevaleceu no relacionamento com a mãe de seu fi lho, notadamente na iniciativa das relações sexuais e no uso de contraceptivos. A gravidez foi considerada por eles como "por acaso" e inesperada, mas a paternidade foi vivenciada como uma prova fi nal de sua condição de homens adultos. CONCLUSÕES:Verifi cou-se a condição de vulnerabilidade dos adolescentes para a paternidade em virtude da socialização de gênero nos moldes tradicionais. Isso foi evidenciado com a ausência dos papéis relativos ao cuidado consigo próprio e com os outros, com a incorporação precoce de papéis de dominação sexual masculina e de trabalhador e pai, ou seja, deixar de ser criança e alcançar a condição de homem.

OBJETIVO: Investigar os fatores relacionados à decisão das mulheres em amamentar e a duração planejada e, de fato observada, do aleitamento exclusivo entre trabalhadoras que dispõem de creche na empresa. MÉTODOS: Estudo qualitativo no qual se comparou um grupo de 15 trabalhadoras cujos bebês estavam sendo alimentados apenas com leite materno quando começaram a freqüentar a creche da empresa com outro similar que incluía mulheres cujos bebês que, ao ingressar, já estavam recebendo, além do leite materno, outros alimentos. Foram realizadas entrevistas semi-estruturadas e grupos focais. RESULTADOS: Evidenciaram-se como fatores relacionados à decisão de iniciar a amamentação e mantê-la ao retornar ao trabalho: o desejo de amamentar, embasado no valor que as mulheres dos dois grupos atribuíam ao aleitamento materno, bem como seus maridos e outras pessoas significativas (por exemplo: mãe, irmã, amigas). A duração do aleitamento exclusivo relacionou-se principalmente à orientação do pediatra que cuidava do bebê, que foi distinta em cada um dos grupos estudados. CONCLUSÃO: A existência da creche no local de trabalho aparece como elemento relevante para a manutenção do aleitamento após a licença de maternidade, especialmente o materno exclusivo. A decisão sobre quanto tempo amamentar de forma exclusiva esteve relacionada às informações recebidas acerca do assunto antes e durante a gestação, e no pós-parto. A diferença entre os dois grupos estudados foi que as mulheres que mantiveram o aleitamento exclusivo por quase seis meses acreditavam que quanto mais tempo dessem somente o leite materno, mais benefícios o bebê teria, enquanto as mulheres do outro grupo acreditavam que três meses de aleitamento exclusivo eram suficientes.