Brazil has an aging population, with an associated increase in the prevalence of chronic diseases. Postmenopausal osteoporosis is of particular concern because it leads to an increased risk of fractures, with subsequent negative impacts on health in older women. In recent years, efforts have been made to better understand the epidemiology of osteoporosis in Brazil, and to manage both direct and indirect costs to the Brazilian health care system. The reported prevalence of osteoporosis among postmenopausal women in Brazil varies from 15% to 33%, depending on the study methodology and the use of bone densitometry data or self-reporting by participants. A diagnosis of osteoporosis can be made on the basis of fractures occurring without significant trauma or on the basis of low bone mineral density measured by dual energy X-ray absorptiometry. To reduce the risk of osteoporosis, all postmenopausal women should be encouraged to maintain a healthy lifestyle, which includes physical activity and a balanced diet. Smoking and alcohol use should also be addressed. Special attention should be given to interventions to reduce the risk of falls, especially among older women. Calcium intake should be encouraged, preferably through diet. The decision to recommend calcium supplementation should be made individually because there is concern about a possible increased risk of cardiovascular disease associated with this treatment. Brazilian women obtain a minimal amount of vitamin D from their diet, and supplementation is warranted in women with little exposure to solar ultraviolet-B radiation. For women diagnosed with osteoporosis, some form of pharmacologic therapy should be initiated. Compliance with treatment should be monitored, and the treatment period should be individualized for each patient. The Brazilian government provides medication for osteoporosis through the public health system free of charge, but without proper epidemiological knowledge, the implementation of public health programs is impaired.

Menopause symptoms were common in HIV-infected women. HIV infection was independently associated with menopause symptoms, whereas age and being retired were associated with the occurrence of these symptoms in HIV-infected women.

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Objective: The aim of this study was to compare the effects of fractional CO2 laser therapy, promestriene, and vaginal lubricants on genitourinary syndrome treatment and sexual function in postmenopausal women. Methods: We performed a randomized clinical trial including 72 postmenopausal women over the age of 50 years. The women were randomized into three intervention groups to receive one of the following treatments: three sessions of intravaginal fractional CO2 laser therapy; 10 mg of intravaginal promestriene cream 3 times a week; and vaginal lubricant application alone. Vaginal maturation, Vaginal Health Index (VHI) score, and Female Sexual Function Index (FSFI) were evaluated at baseline and after 14 weeks of therapy. Results: We observed an improvement in the vaginal elasticity, volume, moisture, and pH in the CO2 laser and promestriene groups. The VHI score at 14 weeks was higher in the CO2 laser group (mean score 18.68) than in the promestriene (15.11) and lubricant (10.44) groups (P < 0.001). Regarding vaginal maturation, basal cells were reduced and superficial cells were increased after treatment. This improvement was more significant in the CO2 laser group (P <0.001). The FSFI score only showed improvement in the desire and lubrication domains in the CO2 laser group. There were no differences in total FSFI score among the three treatment groups. There were no adverse effects associated with any of the treatments. Conclusions: The use of fractional CO2 laser therapy to treat genitourinary syndrome resulted in better short-term effects than those of promestriene or lubricant with respect to improving the vaginal health in postmenopausal women.

Comparar o conhecimento sobre DST/AIDS e avaliar fatores associados ao conhecimento adequado e ao uso consistente do preservativo masculino, em adolescentes de escolas públicas e privadas do Município de São Paulo. Participaram 1.594 adolescentes entre 12 e 19 anos, de 13 escolas públicas e 5 privadas, que responderam um questionário sobre DST/AIDS e uso de preservativo. Calcularam-se as razões de prevalência com intervalo de confiança de 95%. O escore de conhecimento sobre DST teve o ponto de corte equivalendo a 50% de acerto. Os testes estatísticos foram qui-quadrado e Wilcoxon-Gehan. Realizou-se regressão múltipla de Poisson. O uso consistente de preservativo foi 60% nas escolas privadas e 57,1% nas públicas (p > 0,05) e esteve associado ao sexo masculino e menor nível sócio-econômico. O sexo feminino, maior escolaridade, escola privada, cor branca e estado marital solteiro associaram-se ao maior conhecimento sobre DST. Os adolescentes de escola pública e privada apresentam conhecimento adequado sobre prevenção de DST, entretanto esse conhecimento não determina adoção de atitudes efetivas de prevenção. Programas de conscientização sobre DST/AIDS devem ser ampliados visando minimizar as vulnerabilidades.

The prevalence of UI was high. Mixed incontinence was the most frequent type of UI. Many associated factors can be prevented or improved. Thus, health policies targeted at these combined factors could reduce their prevalence rate and possibly decrease the prevalence of UI.

OBJETIVO: Comparar o conhecimento sobre métodos anticoncepcionais e identificar os fatores associados ao conhecimento adequado dos adolescentes de escolas públicas e privadas. MÉTODOS: Realizou-se estudo transversal, do qual participaram 1.594 adolescentes entre 12 e 19 anos, de 13 escolas públicas e cinco privadas do Município de São Paulo entre junho e dezembro de 2003. As escolas foram selecionadas aleatoriamente e os alunos responderam um questionário sobre características sociodemográficas, reprodutivas e métodos anticoncepcionais. As razões de prevalência foram calculadas com intervalo de confiança de 95% para cada questão sobre conhecimento de métodos e o tipo de escola. Atribuiu-se meio ponto para cada questão correta sobre conhecimento de anticoncepcionais, o ponto de corte foi 50% de acerto. Os testes estatísticos utilizados foram o qui-quadrado, o Wilcoxon-Gehan e a regressão múltipla de Poisson. RESULTADOS: Dentre os adolescentes, 61% eram do sexo feminino nos dois grupos de escolas. Predominou nível socioeconômico baixo nas escolas públicas e alto nas privadas (p<0,001). Cerca de 18,6% dos adolescentes nas escolas privadas e 28,6% nas públicas tinham atividade sexual (p<0,002). Quanto ao conhecimento, 25,7% dos adolescentes das escolas públicas e 40,8% das privadas apresentaram escore superior ou igual a cinco. Os fatores associados ao maior conhecimento foram ser do sexo feminino, estudar em escola privada, estar no ensino médio, ter nível socioeconômico alto, ter relação sexual e ter maior idade. CONCLUSÕES: O nível de conhecimento adequado sobre métodos anticoncepcionais foi baixo para os adolescentes de ambos os tipos de escolas. Os resultados revelam que, assim como os mais desfavorecidos, os adolescentes de maior nível socioeconômico necessitam de informações adequadas sobre planejamento familiar, visando a melhorar esse conhecimento para mudança seu comportamento.

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.