BackgroundHuman papillomavirus (HPV) is a member of the Papillomaviridae family. The prevalence of HPV genotypes may vary according to the region and the population studied. Quilombo communities are ethnic and racial groups with difficult access to health services compared to the general population in Brazil. The aim of this study was to identify specific HPV types correlating with sociodemographic/behavioral characteristics and cervical smear cytological abnormalities in Quilombola women.MethodsThis cross-sectional study included 395 Quilombola women users of the Unified Health System of the Municipalities of Maranhão for the screening of cervical cancer. The samples were analyzed for the presence of cytological abnormalities by conventional methods and tested for 37 HPV genotypes using polymerase chain reaction with primers PGMY09/11 followed by reverse line blot hybridization performed with the Linear Array HPV Genotyping Test kit by Roche Molecular System®. The association between HPV types and cytological diagnosis was investigated according to the different age groups.ResultsHPV infection was detected in 12.6% (50/395) of the women. Infections by high-risk HPV types were more frequent. Genotypes 68 (26.0%); 58 and 52 (20.0%); 31 (10.0%) and 62 (8.0%) were the most prevalent. The highest prevalence (42.0%) of HPV infection occurred in women diagnosed with high-grade squamous intraepithelial lesion. There was a statistically significant association between HPV infection and the detection of cytological abnormalities in all age groups except in women over 60 years. There was a statistically significant association between the municipality of origin and the number of partners with HPV infection.ConclusionsIt is important to incorporate new cervical cancer screening techniques incorporating the cervical-vaginal cytology. For further studies, it is necessary to determine the level of knowledge of Quilombola population on health-related issues including HPV infection and cervical cancer. This will contribute to the continuous improvement of healthcare coverage among the population and enhance the implementation of cancer care in the state of Maranhão.

This study aimed to analyze aspects related to choice of type of delivery in two maternity hospitals, one public and the other private, in São Luís, Maranhão State, Brazil. This cross-sectional study compared 163 primiparous women in a public maternity hospital and 89 in a private hospital, with mean ages of 21.63 +/- 5.24 and 28.8 +/- 5.41 years, respectively. In the public hospital, 79.1% of the women reported preferring vaginal deliveries, while in the private hospital 67.4% of the women preferred cesareans (p < 0.0001). Cesareans were performed in 46% of the women in the public maternity hospital and 97.8% of those in the private hospital (p < 0.0001). Patient satisfaction was high for both modes of delivery, but the desire to repeat the same mode was reported more frequently by women with vaginal deliveries (71.6% vs. 41.3% in the public maternity hospital and 100% vs. 65.5% in the private). In the public maternity hospital, the cesarean subgroup included more white and higher-income women. The cesarean rate was thus high in both maternity hospitals and was significantly higher in the private hospital; the study also showed a preference for vaginal delivery in the public hospital and cesareans in the private.

Rastreamento do câncer do colo do útero no Estado do Maranhão, Brasil

Com o objetivo de estimar a cobertura, a periodicidade, e identificar fatores associados à não realização do exame preventivo de Papanicolau, 465 mulheres de 25 a 49 anos residentes no município de São Luís foram entrevistadas em 1998. Foi realizado inquérito domiciliar pelo método de amostragem por conglomerados em três estágios. Na análise estatística foram calculados intervalos de confiança de 95% corrigidos pelo desenho do estudo, e os "odds ratio" brutos e ajustados por regressão logística. A cobertura do Papanicolaou pelo menos uma vez na vida foi de 82,4% (Intervalo de Confiança 95%, 76,6 - 87,0%), praticamente atingindo a cobertura mínima necessária de 85% para causar impacto epidemiológico na incidência e mortalidade por câncer cérvico-uterino. O intervalo entre a realização dos exames foi curto, pois 65,8% das mulheres repetiram o exame com até um ano. Após o ajuste para fatores de confundimento foram associados à não realização do Papanicolaou: não ter companheiro, ter cinco a oito anos de escolaridade, não ter realizado consulta médica nos três últimos meses e morar em domicílio cujo chefe de família tem ocupação manual não especializada. Ter tido de dois a quatro parceiros sexuais nos três últimos meses foi associado a menor risco de não realização do preventivo. Em capital do Nordeste, a cobertura do exame preventivo de Papanicolaou foi semelhante à relatada em outros estudos nacionais. Entretanto, algumas mulheres realizaram citologias desnecessárias a intervalos curtos, implicando em desperdício de recursos e dificultando o acesso aos grupos mais vulneráveis que apresentaram maiores riscos de não testagem.

OBJETIVO: Fazer avaliação epidemiológica de 87 pacientes vítimas de traumatismo da medula espinhal, internados no hospital universitário da UFMA entre Janeiro de 2008 e Junho de 2009. MÉTODOS: Estudo transversal retrospectivo, segundo: sexo; idade; segmento da coluna comprometido e causa do traumatismo, submetendo estes dados à análise estatística (teste do quiquadrado). RESULTADOS: predomínio significativo (p<0,001) do sexo masculino, com 81,6% (71) dos casos, e da faixa etária entre 21 e 30 anos de idade (p<0,001), com 39,1% (34) dos casos. A média de idade foi 33,96±13,56 anos. A proporção de quedas de altura foi significativamente maior do que a dos acidentes automobilísticos (p<0,001) e motociclísticos (p<0,001). O segmento da coluna significativamente (p<0,001) mais comprometido foi o torácico 37,9% (33) dos casos. Os acidentes de trânsito aparecem em maior proporção entre os homens (p=0,014). A coluna cervical foi mais acometida no sexo masculino (p=0,043). As fraturas toracolombares foram provocadas, em maior proporção, pelas quedas de altura (p=0,003), enquanto que acometimento da coluna torácica é significativamente maior (p=0,016) nos acidentes de trânsito. CONCLUSÃO: o grupo de maior risco para o traumatismo da coluna espinhal é o de adultos jovens masculinos. Apesar de existir uma diferença entre os sexos quando se correlacionam os acidentes de trânsito, a queda de altura é a principal causa em ambos os sexos.

BackgroundMost women report negative experience about the symptoms of uterine leiomyoma (UL) in their lives, such as abnormal uterine bleeding and pelvic pain. Many studies have been conducted about efficacy of UL treatment, but little research has been performed about womens health related quality of life (HRQL).MethodsThis is a semi-structured, descriptive, observational, qualitative study that was performed during eight months. Focus group (FG) interviews were performed with women attending at a tertiary hospital in Brazil, who were consecutively included in the study. Seventy women with symptomatic UL were recruited to this study. FG duration was one hour with mediators with 5-6 women at each group. Collected data from discussions was processed according to thematic analysis and stored at a qualitative software.ResultsWomen were negatively influenced by the presence of symptomatic UL. The major themes that were noticed during analysis were: beliefs and attitudes towards UL; limitation to social and professional activities; sensation of fear/unfairness/discouragement towards the symptoms and adverse effects during treatment with GnRH analogs.ConclusionsSymptomatic UL has a negative impact on womens HRQL. Health providers should consider such impact when counseling women on their treatment options, since it may have an important influence in these patients’ decision-making process. While current pharmacological treatments may improve disease specific outcomes, such as bleeding intensity and tumor volume, they fail on actually improving quality of life.

Objective: The aim of the present study was to evaluate the effects that inspiratory muscle training (IMT) and respiratory exercises have on muscle strength, peak expiratory flow (PEF) and severity variables in children with asthma. Methods: This was a randomized analytical study involving 50 children with asthma allocated to one of two groups: an IMT group, comprising 25 children submitted to IMT via an asthma education and treatment program; and a control group, comprising 25 children who were submitted only to monthly medical visits and education on asthma. The IMT was performed using a pressure threshold load of 40% of maximal inspiratory pressure (MIP). The results were evaluated using analysis of variance, the chi-square test and Fisher's exact test, values of p < 0.05 being considered significant. Results: In the comparative analysis, pre-and post-intervention values of MIP, maximal expiratory pressure (MEP) and PEF increased significantly in the IMT group: MIP from −48.32 ± 5.706 to −109.92 ± 18.041 (p < 0.0001); MEP from 50.64 ± 6.55 to 82.04 ± 17.006 (p < 0.0001); and PEF from 173.6 ± 50.817 to 312 ± 54.848 (p < 0.0001). In the control group, however, there were no significant differences between the two time points in terms of MIP or MEP, although PEF increased from 188 ± 43.97 to 208.80 ± 44.283 (p < 0.0001). There was a significant improvement in the severity variables in the IMT group (p < 0.0001). Conclusions: Programs involving IMT and respiratory exercises can increase mechanical efficiency of the respiratory muscles, as well as improving PEF and severity variables.Keywords: Breathing exercises; Asthma/therapy; Asthma/rehabilitation. ResumoObjetivo: Avaliar efeitos do treinamento muscular inspiratório (TMI) e exercícios respiratórios na força muscular, pico de fluxo expiratório (PFE) e variáveis de gravidade em crianças asmáticas. Métodos: Estudo analítico, experimental aleatório em 50 crianças asmáticas alocadas aleatoriamente em dois grupos: um grupo composto de 25 crianças que realizaram TMI em um programa de assistência e educação em asma (grupo TMI); e um grupo controle, composto de 25 crianças que foram submetidas apenas às consultas médicas mensais e educação em asma. O TMI foi realizado com o threshold com a carga de 40% da pressão inspiratória máxima (PImáx). A análise dos resultados foi realizada através da análise da variância, teste de qui-quadrado e teste exato de Fisher, sendo considerado significante o valor de p > 0,05. Resultados: Na análise comparativa, observou-se aumento significativo da PImáx, da pressão expiratória máxima (PEmáx) e do PFE pré-e pós-intervenção no grupo TMI, como se segue: PImáx de −48,32 ± 5,7 para −109,92 ± 18 (p < 0,0001); PEmáx de 50,64 ± 6,5 para 82,04 ± 17(p < 0,0001); e PFE de 173,6 ± 50 para 312 ± 54 (p < 0,0001). Entretanto, não houve aumento significativo da PImáx e PEmáx no grupo controle, somente no PFE, de 188 ± 43,97 para 208,80 ± 44,283 (p < 0,0001). Houve melhora significativa das variáveis de gravidade no grupo TMI (p < 0,0001). Conc...

BackgroundThe polycystic ovary syndrome (PCOS) is considered the most common endocrine disease during the woman's reproductive life, with prevalence ranging from 5 to 10 % of women of reproductive age. There is a paucity of studies regarding the use of the lipid accumulation product (LAP) as a risk marker for the development of cardiovascular disease (CVD).MethodsA cross-sectional study was conducted on 78 women aged 18 to 42 years seen at University Hospital of Maranhão, with a diagnosis of polycystic ovary syndrome according to the Rotterdam criteria. The following variables of interest were recorded on a protocol form: sociodemographic and behavioral data, body mass index, waist circumference, fasting glucose, total cholesterol, triglycerides, low density lipoprotein cholesterol, high-density lipoprotein cholesterol, and systolic and diastolic blood pressure.ResultsLogistic regression showed that, except for HDL, all cardiovascular risk markers presented a higher chance of being altered when the lipid accumulation product was above the cut off value of 37.9 cm.mmol/L.ConclusionThe lipid accumulation product seems to be sufficient to indicate a risk of cardiovascular diseases in women with polycystic ovary syndrome.