Urinary incontinence (UI) is a common condition that causes significant harm to the wellbeing and quality of life of pregnant women. This cross-sectional population-based study aimed to estimate the prevalence and identify factors associated with the occurrence of UI during pregnancy in women living in the municipality of Rio Grande (RS), Southern Brazil, between January 1 and December 31 of 2016, and included all puerperae living in this municipality that had a child in one of the two local maternity hospitals. The previously trained interviewers used a single standardized questionnaire, within 48 hours after delivery to retrieve information on maternal demographic, behavioral and reproductive/obstetric history, as well as socioeconomic status of the household and care received during pregnancy and childbirth. The multivariate analysis followed a previously defined hierarchical model using Poisson regression with robust variance adjustment and prevalence ratio (PR) as a measure of effect. As a result, 2,716 puerperae were identified, of which 2,694 (99.2%) participated in this study. The prevalence of urinary incontinence in the gestational period was 14.7% (95%CI: 13.4%-16.1%). After adjusted analysis, the likelihood of UI occurring varied significantly as per women's characteristics. For example, the PR for the occurrence of UI among women over 30 years of age was 2.05 (95% CI: 1.39-3.01) compared to adolescents. In two other groups of women who had their first pregnancy before the age of 20 or after the age of 30, the PR for UI was 1.36 (95% CI: 1.04-1.76) and 1.59 (95% CI: 1.01-2.51), respectively, when compared to those who became pregnant for the first time between 20 and 29 years of age. Finally, in two other groups of women, namely, those who reached 90 kg and over at the end of pregnancy and those who performed regular physical exercise and reported frequent urinary urgency, the PR was 2.49 (95% CI: 1.74-3.57), and 2.90 (95% CI: 2.10-4.00) compared to those who did not exercise and did not report urinary urgency, respectively. The authors concluded that UI showed a high prevalence in the study population. The identified risk factors can be well administered at primary health care level. The recommendation of regular physical exercise in pregnancy must be reviewed and better investigated with more robust designs because of possible facilitators for the occurrence of UI in this period.
INTRODUCTIONPopulation-wide screening for prostate cancer remains a controversial topic, given the need for an individualized approach to patients regarding the risks and benefits of prostate-specific antigen testing and digital rectal examination. Treatment of prostate cancer may prove challenging because of matters such as biopsy procedures, which may lead to local complications (e.g. infection); and also because of the possibility of sexual impotence and urinary incontinence secondary to treatment. 1,2 The combination of prostate-specific antigen testing and digital rectal examination has been considered to be an effective approach, since 18% to 45% of tumors would not have been diagnosed, had one of these two methods not been performed. 3 The American Cancer Society advises that, among men whose life expectancy exceeds 10 years, screening should be done annually, through informed consent. This should be started at the age of 50 years for those at moderate risk; at the age of 45 for those at high risk (afro-descendants and individuals with a history of prostate cancer in first-degree family members at ages younger than 65 years); and at the age of 40 for those at very high risk (multiple family members diagnosed with prostate cancer before the age of 65). 4 In an official note, in 2017, the Brazilian Society of Urology advised that from the age of 50 years onwards, the male population should seek a specialist annually, for assessment and discussion of the risks and benefits of prostate cancer screening. The Brazilian Society of Urology recommends that men aged 45 who present risk factors should undergo screening for prostate cancer; but for individuals aged 75 and older, this is valid only for those with life expectancy greater than 10 years. 2
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