Objective: To determine the occurrence of cardiorespiratory alterations and to identify adverse events during the intrahospital transport of patients on invasive ventilation. Methods: A prospective observational non-randomized study was conducted at two tertiary hospitals between April of 2005 and December of 2006. We included patients on invasive ventilation who required intrahospital transport during the study period. Exclusion criteria were as follows: being under suspicion of brain death; being submitted to alternate periods of mechanical ventilation/nebulization via a T-piece; and being transported to the operating room. Prior to and after transport, we evaluated blood gas analysis results, vital signs, use of medications by means of a continuous infusion pump, parameters regarding the mechanical ventilator, duration of transport, transport distance and number of professionals involved. Results: We included 48 patients in a total of 58 intrahospital transports. Relevant cardiorespiratory alterations were identified in 39 transports, totaling 86 episodes, as well as 16 adverse events related to equipment or personnel failure, such as problems related to batteries and to miscommunication. Conclusions: During the intrahospital transport of patients on invasive ventilation, cardiorespiratory alterations were common (67.2%), and adverse events occurred in 75.7% of the transports. ResumoObjetivo: Verificar a ocorrência de alterações cardiorrespiratórias e identificar eventos adversos durante o transporte intra-hospitalar de pacientes sob ventilação invasiva. Métodos: Estudo observacional prospectivo não-randomizado, conduzido em dois hospitais terciários, entre abril de 2005 e dezembro de 2006. Foram incluídos pacientes sob ventilação invasiva que necessitaram de transporte intra-hospitalar durante o período do estudo. Os critérios de exclusão foram: estar sob suspeita de morte encefálica; ter sido submetido a períodos de ventilação mecânica e de nebulização em tubo T; e ter sido transportado para o centro cirúrgico. Antes e após o transporte, os seguintes parâmetros foram avaliados: gasometria arterial, sinais vitais, uso de medicamentos através de uma bomba de infusão contínua, parâmetros do ventilador mecânico, duração do transporte, distância percorrida e número de profissionais envolvidos. Resultados: Foram incluídos 48 pacientes, num total de 58 transportes. Observou-se alteração cardiorrespiratória importante em 39 transportes, totalizando 86 episódios, assim como 16 eventos adversos relacionados à falha de equipamento e falha da equipe, dentre eles problemas com baterias e falhas de comunicação. Conclusões: Durante o transporte intra-hospitalar de pacientes submetidos à ventilação invasiva, alterações cardiorrespiratórias foram frequentes (67,2%), e eventos adversos ocorreram em 75,7% dos transportes realizados Descritores: Transferência de pacientes; Cuidados intensivos; Respiração artificial; Respiradores mecânicos.

BackgroundPelvic floor dysfunctions (PFDs) affect the female population, and the postpartum period can be related to the onset or aggravation of the disease. Early identification of the symptoms and the impact on quality of life can be achieved through assessment instruments.ObjectiveThe purpose of this systematic review is to evaluate questionnaires used to assess PFD in the postpartum period.MethodsA systematic review study was conducted, following Preferred Reporting Items for the Systematic Reviews and Meta-Analyses (PRISMA) criteria, using the databases: PubMed, Biblioteca Virtual de Saúde (BVS), Web of Science, and Scopus, and the keywords PFD or pelvic floor disorders, postpartum or puerperium, and questionnaire. Articles published up till May 2018 were included, searching for articles using validated questionnaires for the evaluation of PFDs in postpartum women. The articles included were evaluated according to a checklist, and the validation studies and translated versions of the questionnaires were identified.ResultsThe search of the databases resulted in 359 papers, and 33 were selected to compose this systematic review, using nine validated questionnaires to assess PFDs in the postpartum period: International Consultation on Incontinence Questionnaire – Vaginal Symptoms (ICIQ-VS), Pelvic Floor Distress Inventory 20 (PFDI-20), Pelvic Floor Impact Questionnaire (PFIQ-7), PFDI-46, Pelvic Floor Impact Questionnaire (PFIQ-31), Pelvic Floor Bother Questionnaire (PFBQ), Female Pelvic Floor Questionnaire, electronic Personal Assessment Questionnaire – Pelvic Floor, and PFD questionnaire specific for pregnancy and postpartum. The most frequently reported questionnaires included PFDI-20, PFIQ-7, and ICIQ-VS and are recommended by ICI. In addition, the review identified a specific questionnaire, recently developed, to access PFD during pregnancy and postpartum.ConclusionThe questionnaires used to evaluate PFD during postpartum period are developed for general population or urology/gynecology patients with incontinence and reinforce the paucity of highly recommended questionnaires designed for postpartum, in order to improve early and specific approach for this period of life.

SUMMARY PURPOSE To analyze the level of knowledge about and the acceptability of the HPV vaccine among vaccinated and unvaccinated adolescents in the Western Amazon. METHODS A cross-sectional study on adolescents aged 10 to 19 years. The instrument used to collect data contains demographic and socioeconomic information and 27 questions that assess the knowledge and acceptability of the HPV vaccine. To compare the prevalence of vaccinated adolescents with the correct answers to questions about HPV and acceptability and vaccination, the robust variance Poisson regression model was used in the Stata 13.0 software. FINDINGS A total of 190 adolescents participated in the study, 60.5% in the age group of vaccination recommended by the Brazilian government, among them, 53.9% reported not having been vaccinated (p <0.001). A total of 150 (78.9%) adolescents correctly recognized HPV as a virus; 121 (63.7%) recognized HPV as a cause of cervical cancer. Participants who know HPV is a causative factor for cervical cancer are 1.94 times more likely to have been vaccinated than those who do not. Among the interviewees, the main sources of knowledge about the vaccine were schools (51.6%) and health professionals (22.6%). CONCLUSION Unvaccinated adolescents have knowledge gaps about HPV and its vaccine when compared to those vaccinated. Our results emphasize the need for effective campaigns to deliver adequate information about HPV and its vaccine to adolescents, their parents, and health professionals.

PurposeTo analyze the postpartum pelvic floor disorders (PFD) and mode of delivery among adolescents, late adolescents, and young women from Western Amazon.Patients and methodsCross-sectional study was carried out in the urban area of Western Amazon in the city of Rio Branco, Acre, Brazil, from October 2016 to February 2017. This is a convenience sample of women up to 30 years who completed six months postpartum, separated in three groups according to maternal age: adolescents (age ≤19 years), late adolescents (20–24 years), and young women (25–30 years). Participants were home interviewed and answered Pelvic Floor Distress Inventory-20 (PFDI-20). Delivery clinical data were collected from patient’s medical records.ResultsIn total, 285 participants were interviewed: 41 adolescents, 103 late adolescents, and 141 young women. After controlling for confounding factors, prevalences of PFD were higher in the adolescents’ group compared with the young women’s group (urinary incontinence [UI], prevalence ratio [PR] = 1.75, 95% CI 1.14–2.69; urge urinary incontinence [UUI], PR = 1.88, 95% CI 1.02–3.47; stress urinary incontinence, PR = 2.00, 95% CI 1.11–3.62; fecal incontinence [FI], PR = 4.40, 95% CI 1.36–14.27). PFDI-20 scores also presented higher values in the adolescent group (Pelvic Organ Prolapse Distress Inventory [POPDI], PR = 2.02, 95% CI 1.49–2.75; urinary distress inventory [UDI], PR = 2.09, 95% CI 1.47–2.98; PFDI, PR = 2.12, 95% CI 1.47–2.98). Analyzing the influence of cesarean section, adolescents have higher prevalence of UI (PR = 1.84, 95% CI 1.04–3.26, P=0.037), UUI (PR = 2.36, 95% CI 1.03–5.40, P=0.042), and FI (PR = 4.09, 95% CI 1.21–13.81, P=0.023). In addition, POPDI (PR = 2.15, 95% CI 1.60–2.89, P<0.001), UDI (PR = 2.25, 95% CI 1.61–3.16, P<0.001), and PFDI (PR = 2.27, 95% CI 1.68–3.08, P<0.001) scores are also higher among adolescents where the baby is born by cesarean section.ConclusionAdolescents present higher prevalence and symptoms of PFD; furthermore, cesarean delivery has a greater negative influence on the pelvic floor of adolescents when compared with young women. This reinforces the importance of PFD investigation among the adolescent population, mainly in developing countries which have high rates of adolescent pregnancy and cesarean section.

SUMMARY OBJECTIVE The association between gynecological diagnoses and their distribution across healthcare sectors benefits health promotion and the identification of topics for continued education of gynecological care. This study aimed to identify healthcare diagnoses and referral flow in climacteric women. METHODS This is a cross-sectional study conducted at the Women’s Health Clinic of the University Hospital, University of São Paulo, with a reference to gynecology and training for Residents of Family and Community Medicine, between 2017 and 2018. The medical records of 242 women whose sociodemographic and clinical information, gynecological diagnoses, and distribution of healthcare services (primary, secondary, and tertiary) had been processed were collected. Statistical analysis included the chi-square test and odds ratio. RESULTS Smoking (OR = 2.27, 95% CI 1.05–4.89; p = 0.035) was associated with the referral of climacteric women to higher complexity services. Considering the distribution of non-oncological diagnoses in climacteric patients, the chance of women being referred to medium- and high-complexity health services presented a 2-fold increase in cases of breast diseases, a 2.35-fold increase in cases of noninflammatory disorders of the female genital tract, and a 3-fold increase in cases of inflammatory diseases of the pelvic organs. CONCLUSION Climacteric women aged over 55 years, postmenopausal women, and smoking women were most frequently referred to medium- and high-complexity outpatient surgery.

Objective: Systemic arterial hypertension and obesity are major public health problems that increase risks of serious cardiovascular diseases and kidney failure as well as increase mortality. Substances that can alleviate these problems are desirable. We evaluated the beneficial effects of nutritional supplementation with gamma-linolenic acid in postmenopausal hypertensive women. Methods: This was a prospective, double-blind, placebo-controlled, randomized study involving 96 postmenopausal women. Participants were divided into two groups either receiving 1,000 mg of borage oil rich in gamma-linolenic acid + vitamin E (drug) or only vitamin E (placebo) capsules for 6 months. They were followed up monthly to assess the impact on systemic blood pressure and body composition. To verify group homogeneity, Fisher's exact and Student t tests were performed. To evaluate differences in various parameters between the two groups and at various times, repeated measures analysis of variance was performed, with Bonferroni correction. Results: The power of the test was calculated based on the difference in the mean systolic blood pressure between baseline and after 6 months of treatment in the placebo group and in the drug group. A 92.9% test power was found with a 95% confidence interval. There was a significant reduction in the systolic and diastolic pressure as well as a significant change in waist-hip ratio (P < 0.01) in the drug group as compared with the placebo group. Conclusions: Supplementation with borage oil rich in gamma-linolenic acid had significant beneficial short-term effects without showing any adverse effect. There remains a need for further studies to evaluate long-term benefits.

This review was based on a systematic research conducted on January 2020 using PubMed, Web of Science, Embase, and PsycINFO databases and followed the PICO (P=Population, I=Intervention, C=comparison, and O=outcome) strategy, in order to obtain the keywords at Medical Subject Headings (MeSH) and Embase subject headings (Emtree) -empty nest, full nest, menopause, climacteric, premenopause, and postmenopause (Appendix 1). Inclusion criteriaStudies published in English were selected if they met the following criteria:(1) studies related to women in the climacteric period and(2) that approach FNS and ENS.There was no restriction on sample size or publication date. Exclusion criteriaThe articles were excluded if:(1) they were not data-based (i.e., books, theoretical articles, or minor revisions), (2) had population not clearly identified in the climacteric period, and

Background: The National Policy of Comprehensive Women’s Health Care was implemented more than two decades ago, and the monitoring of potential benefits should be explored. Menopause is a period of life for which there are prevention and health promotion actions carried out by the government’s all-encompassing sole Unify Health System (UHS) and factored into Brazilian policies. It is thus our purpose to identify menopausal women’s main causes of death, as well as the mortality trend of such causes, especially after PNAISM implementation. Methods: This is an ecological study with secondary data analysis conducted by the Setor de Atenção Primária, Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia da Faculdade de Medicina da Universidade de São Paulo from 2018 to 2019. Data were retrieved from the Brazilian Health Department by accessing the mortality information system of the IT Department of SUS between 1996 and 2016, divided in two periods 1996 to 2004 and 2005 to 2006 according to implementation of the National Police. The data included the death records of Brazilian women aged 35 to 64 years who had a precise diagnosis (ICD-10). Trend and differences between periods were evaluated by linear regression. The significance level was set at 5%. Stata 11® (StataCorp, LCC) was used. Results: Menopausal women’s main causes of death were the circulatory system diseases (29.39%, 736,972 deaths), neoplasms (26.17%, 656,385 deaths), respiratory system diseases (7.29%, 182,812 deaths), endocrine (29.39%), nutritional, and metabolic (6.81%, 170,881 deaths) diseases, and external causes of morbidity and mortality (5.49%, 137,674 deaths). Implementation of PNAISM led to increasing reduction in mortality from circulatory system diseases (β=-0.58; 95% CI, -0.68 to -0.48; r²=0.93; p<0.001), but not to any significant changes in neoplasm mortalities (β=0.07; 95% CI, -0.01 to 0.15; r²=0.22; p=0.070). Conclusions: The leading causes of death among menopausal women are circulatory system diseases, neoplasms, respiratory system diseases, nutritional, metabolic, and endocrine diseases, and external causes of morbidity and mortality. The trend of mortality rates among menopausal women, following PNAISM implementation, was a decline in circulatory system diseases and in nutritional, metabolic, and endocrine diseases, with no changes for neoplasms and respiratory system diseases.