Infection By The Human Papillomavirus In Teenagers Sexually Active: Clinic And Subclinic Manifestations.

This research studies the association of the cervical condyloma with the intraepithelial neoplasia, during sex activity, pregnancy, diagnose methods, cytology and colposcopy in teenagers. The objective of this research is to study the propaedeutics for the uterine coli condyloma diagnose in a group of teenagers. For this purpose, we have studied 131 teenagers sexually active with ages between 14 and 19 years and presenting histologically confirmed uterine coli condyloma. Association with intraepithelial neoplasia, sexual activity duration, method of diagnose, pregnancy analysis, cytology and colposcopy results and association with vulva and vagina injuries were evaluated. The high association rate with condyloma and intraepithelial neoplasia after a short time of sexual activity and the none presence of macroscopic warts in the genital organs in 80% of cases presenting cervical condyloma, demonstrate that: a more careful investigation with colposcopy and biopsy of the inferior genitals of the women-teenagers sexually active is needed, when presenting modified cervical cytology.113494895

Decrease in Bone Mass in Women After Liver Transplantation: Associated Factors

AbstractBackgroundIn the future, an increasing number of female liver transplant recipients will reach the climacteric with osteoporosis as a common complication. We evaluated the factors associated with decreased bone mass among women after liver transplantation.MethodsA prospective, cross-sectional study of 23 outpatient transplant recipients followed from February 2009 to March 2010 included women of age ≥35 years after liver transplantations ≥1 year prior. We recorded patient histories, liver enzyme levels, as well as bone mineral densities measured at the lumbar spine and femur. Statistical analysis used Fisher's exact test, simple odds ratio (OR), and Spearman's rank correlation coefficient.ResultsThe mean patient age was 52.5 ± 11 years with 30.4% premenopausal, and 69.6% perimenopausal or postmenopausal. Approximately 21% showed osteoporosis and 35%, a low bone mass. Postmenopausal women: OR 69.0 (95% CI 2.89–1647.18; P < .0001), aged ≥49 years: OR 13.33 (95% CI 1.78–100.15; P = .0123) and receiving a transplant after 44 years of age: OR 49.50 (95% CI 3.84–638.43; P < .0001) were associated with a lower bone mass. Having undergone transplantation for more than 5.8 years lowered the risk of bone mass change: OR 0.11 (95% CI 0.02–0.78; P = .0361). Clinical and laboratory variables, including corticosteroid use, were not associated with decreased bone mass.ConclusionUnderstanding the prevalence and factors associated with osteoporosis among female liver transplant recipients is important to enhance the strategies to diagnose and treat these women, seeking to improve their quality of life

Quality Of Life And Menopausal Symptoms In Women With Liver Transplants [qualidade De Vida E Sintomas Da Menopausa Em Mulheres Transplantadas Hepáticas]

PURPOSE: To assess quality of life and climacteric symptoms in women with and without liver transplants. METHODS: This was a cross-sectional study of 52 women undergoing follow-up at a university hospital in southeastern Brazil from February 4th, 2009 to January 5th, 2011. Twenty-four of these women were 35 years old or older and had undergone liver transplantation at least one year before study entry. The remaining 28 women had no liver disease and were matched by age and menstrual patterns to the patients with transplants. The abbreviated version of the World Health Organization (WHOQOL-BREF) questionnaire was used to assess quality of life. Menopausal symptoms were assessed using the Menopause Rating Scale (MRS). Statistical analysis was carried out by Student's I{stroke} -test, Mann-Whitney test and analysis of variance. Correlations between MRS and the WHOQOL-BREF were established by correlation coefficients. RESULTS: The mean age of the women included in the study was 52.2 (±10.4) years and the mean time since transplantation was 6.1 (±3.3) years. Women with liver transplants had better quality of life scores in the environment domain (p=0.01). No difference was noted between the two groups in any domain of the MRS. For women in the comparison group, there was a strongly negative correlation between somatic symptoms in the MRS and the physical domain of the WHOQOL-BREF (p&lt;0.01; r=-0.8). In contrast, there was only a moderate association for women with liver transplants (p&lt;0.01; r=-0.5). CONCLUSIONS: Women with liver transplants had better quality of life scores in the domain related to environment and did not exhibit more intense climacteric symptoms than did those with no liver disease. Climacteric symptoms negatively influenced quality of life in liver transplant recipients, although less intensely than in women without a history of liver disease.353103110Saab, S., Ng, V., Landaverde, C., Lee, S.J., Comulada, W.S., Arevalo, J., Development of a disease-specific questionnaire to measure health-related quality of life in liver transplant recipients (2011) Liver Transpl, 17 (5), pp. 567-579Lim, K.B., Schiano, T.D., Long-term outcome after liver transplantation (2012) Mt Sinai J Med, 79 (2), pp. 169-189van Ginneken, B.T., van den Berg-Emons, R.J., van der Windt, A., Tilanus, H.W., Metselaar, H.J., Stam, H.J., Persistent fatigue in liver transplant recipients: A two-year follow-up study (2010) Clin Transplant, 24 (1), pp. E10-E16Bryan, S., Ratcliffe, J., Neuberger, J.M., Burroughs, A.K., Gunson, B.K., Buxton, M.J., Health-related quality of life following liver transplantation (1998) Qual Life Res, 7 (2), pp. 115-120Nickel, R., Wunsch, A., Egle, U.T., Lohse, A.W., Otto, G., The relevance of anxiety, depression, and coping in patients after liver transplantation (2002) Liver Transpl, 8 (1), pp. 63-71Masala, D., Mannocci, A., Unim, B., Del Cimmuto, A., Turchetta, F., Gatto, G., Quality of life and physical activity in liver transplantation patients: Results of a case-control study in Italy (2012) Transplant Proc, 44 (5), pp. 1346-1350Sirivatanauksorn, Y., Dumronggittigule, W., Limsrichamrern, S., Iramaneerat, C., Kolladarungkri, T., Kositamongkol, P., Quality of life among liver transplantation patients (2012) Transplant Proc, 44 (2), pp. 532-538Wang, G.S., Yang, Y., Li, H., Jiang, N., Fu, B.S., Jin, H., Health-related quality of life after liver transplantation: The experience from a single Chinese center (2012) Hepatobiliary Pancreat Dis Int, 11 (3), pp. 262-266de Bona, M., Ponton, P., Ermani, M., Iemmolo, R.M., Feltrin, A., Boccagni, P., The impact of liver disease and medical complications on quality of life and psychological distress before and after liver transplantation (2000) J Hepatol, 33 (4), pp. 609-615Jabiry-Zienjewicz, Z., Kaminski, P., Bobrowska, K., Pietrzak, B., Wielgos, M., Zieniewicz, K., Menstrual cycle and sex hormone profile in perimenopausal women after liver transplantation (2006) Transplant Proc, 38 (9), pp. 2909-2912Boin, I.F., Ataide, E.C., Leonardi, M.I., Stucchi, R., Sevá-Pereira, T., Pereira, I.W., Elderly donors for HCV(+) versus non-HCV recipients: Patient survival following liver transplantation (2008) Transplant Proc, 40 (3), pp. 792-796Guyton, A.C., Hall, J.E., (1996) Textbook of Medical Physiology, , Philadelphia, SaundersParolin, M.B., Rabinovitch, I., Urbanetz, A.A., Scheidemantel, C., Cat, M.L., Coelho, J.C., Impact of successful liver transplantation on reproductive function and sexuality in women with advanced liver disease (2004) Transplant Proc, 36 (4), pp. 943-944Mass, K., Quint, E.H., Punch, M.R., Merion, R.M., Gynecological and reproductive function after liver transplantation (1996) Transplantation, 62 (4), pp. 476-479Cundy, T.F., O'Grady, J.G., Williams, R., Recovery of menstruation and pregnancy after liver transplantation (1990) Gut, 31 (3), pp. 337-338Hickey, M., Davis, S.R., Sturdee, D.W., Treatment of menopausal symptoms: What shall we do now? (2005) Lancet, 366 (9483), pp. 409-421Hess, R., Thurston, R.C., Hays, R.D., Chang, C.C., Dillon, S.N., Ness, R.B., The impact of menopause on health-related quality of life: Results from the STRIDE longitudinal study (2012) Qual Life Res, 21 (3), pp. 535-544Ozkan, S., Alatas, E.S., Zencir, M., Women ́s quality of life in the premenopausal and postmenopausal periods (2005) Qual Life Res, 14 (8), pp. 1795-1801Dennerstein, L., Lehert, P., Guthrie, J., The effects of the menopausal transition and biopsychosocial factors on well-being (2002) Arch Womens Ment Health, 5 (1), pp. 15-22Mishra, G.D., Brown, W.J., Dobson, A.J., Physical and mental health: Changes during menopause transition (2003) Qual Life Res, 12 (4), pp. 405-412Kumari, M., Stafford, M., Marmot, M., The menopausal transition was associated in a prospective study with decreased health functioning in women who report menopausal symptoms (2005) J Clin Epidemiol, 58 (7), pp. 719-727Cheng, M.H., Lee, S.J., Wang, S.J., Wang, P.H., Fuh, J.L., Does menopausal transition affect the quality of life? A longitudinal study of middle-aged women in Kinmen (2007) Menopause, 14 (5), pp. 885-890Avis, N.E., Colvin, A., Bromberger, J.T., Hess, R., Matthews, K.A., Ory, M., Change in health-related quality of life over the menopausal transition in a multiethnic cohort of middle-aged women: Study of Women ́s Health Across the Nation (2009) Menopause, 16 (5), pp. 860-869Birkhauser, M.H., Barlow, D.H., Notelovitz, M., Rees, M.C., (2005) Management Handbook: Health Plan For the Adult Woman, , London, Taylor & FrancisHeinemann, L.A., Potthoff, P., Schneider, H.P., International versions of the Menopause Rating Scale (MRS) (2003) Health Qual Life Outcomes, 1, p. 28Fleck, M.P., Louzada, S., Xavier, M., Chachamovich, E., Vieira, G., Santos, L., Aplicação da versão em português do instrumento abreviado de avaliação da qualidade de vida WHOQOL-bref (2000) Rev Saúde Pública, 34 (2), pp. 178-183Santos, C., (2007) Estatística Descritiva - Manual De Auto-aprendizagem, , Lisboa, Edições SílaboTelles-Correia, D., Barbosa, A., Mega, I., Mateus, E., Monteiro, E., When does quality of life improve after liver transplantation? A longitudinal prospective study (2009) Transplant Proc, 41 (3), pp. 904-905Aadahl, M., Hansen, B.A., Kirkegaard, P., Groenvold, M., Fatigue and physical function after orthotopic liver transplantation (2002) Liver Transpl, 8 (3), pp. 251-259Goetzmann, L., Klaghofer, R., Wagner-Huber, R., Halter, J., Boehler, A., Muellhaupt, B., Quality of life and psychosocial situation before and after a lung, liver or an allogeneic bone marrow transplant (2006) Swiss Med Wkly, 136 (17-18), pp. 281-290Schwartz, C.E., Rapkin, B.D., Reconsidering the psychometrics of quality of life assessment in light of response shift and appraisal (2004) Health Qual Life Outcomes, 2, p. 16Dennerstein, L., Dudley, E., Guthrie, J., Barrett-Connor, E., Life satisfaction, symptoms, and the menopausal transition (2000) Medscape Womens Health, 5 (4), pp. E4Brzyski, R.G., Medrano, M.A., Hyatt-Santos, J.M., Ross, J.S., Quality of life in low-income menopausal women attending primary care clinics (2001) Fertil Steril, 76 (1), pp. 44-50Ekström, H., Hovelius, B., Quality of life and hormone therapy in women before and after menopause (2000) Scand J Prim Health Care, 18 (2), pp. 115-12

Multidisciplinary Experience In The Selection Of Patients For Tubal Sterilization.

Results of the use of a special protocol for evaluation of patients requiring tubal ligation is presented after applied by a multidisciplinary group. The authors conclude that the use of defined parameters of age, parity, marital union duration, number of children alive and the presence of maternal clinical pathology are useful to identify patients with smaller chances of regret after surgery.27% of reproductive-age women in Brazil have chosen surgical sterilization as their contraceptive method. Most of these women who have undergone tubal sterilization opted for cesarean surgery. However, given the young ages of many of these women, many regret having been sterilized. This paper summarizes the experience of a multidisciplinary group in evaluating women who apply for surgical sterilization at the Department of Tocogynecology, Faculdade de Ciencas Medicas, Universidade Estadual de Campinas in Sao Paulo. Detailed descriptions are presented of the medical and social characteristics of cases seen between June 1988 and July 1989. The authors conclude that the use of the defined parameters of age, parity, marital union duration, number of living children, and the presence of maternal clinical pathology are useful in identifying the patients who are least likely to regret undergoing surgical sterilization.113171572

Factors Associated With Fragility Fractures In Women Over 50 Years Of Age: A Population-based Household Survey [fatores Associados A Fraturas Por Fragilidade óssea Em Mulheres Acima De 50 Anos De Idade: Um Estudo De Base Populacional]

Purpose: To analyze the prevalence of and factors associated with fragility fractures in Brazilian women aged 50 years and older. Methods: This cross-sectional population survey, conducted between May 10 and October 31, 2011, included 622 women aged ≥50 years living in a city in southeastern Brazil. A questionnaire was administered to each woman by a trained interviewer. The associations between the occurrence of a fragility fracture after age 50 years and sociodemographic data, health-related habits and problems, self-perception of health and evaluation of functional capacity were determined by the χ2 test and Poisson regression using the backward selection criteria. Results: The mean age of the 622 women was 64.1 years. The prevalence of fragility fractures was 10.8%, with 1.8% reporting hip fracture. In the final statistical model, a longer time since menopause (PR 1.03; 95%CI 1.01-1.05; p&lt;0.01) and osteoporosis (PR 1.97; 95%CI 1.27-3.08; p&lt;0.01) were associated with a higher prevalence of fractures. Conclusion: These findings may provide a better understanding of the risk factors associated with fragility fractures in Brazilian women and emphasize the importance of performing bone densitometry.3511497502Instituto Brasileiro de Geografia e Estatística (IBGE) [Internet]., , http://censo2010.ibge.gov.br/resultados, Censo 2010: resultados [citado 2013 Fev 14]. Disponível emKanis, J.A., Odén, A., McCloskey, E.V., Johansson, H., Wahl, D.A., Cooper, C., A systematic review of hip fracture incidence and probability of fracture worldwide (2012) Osteoporos Int., 23 (9), pp. 2239-2256Hughson, J., Newman, J., Pendleton, R.C., Hip fracture management for the hospital-based clinician: A review of the evidence and best practices (2011) Hosp Pract (1995)., 39 (1), pp. 52-61Auron-Gomez, M., Michota, F., Medical management of hip fracture (2008) Clin Geriatr Med., 24 (4), pp. 701-719+ixPinheiro, M.M., Ciconelli, R.M., Martini, L.A., Ferraz, M.B., Clinical risk factors for osteoporotic fractures in Brazilian women and men: The Brazilian Osteoporosis Study (BRAZOS) (2009) Osteoporos Int., 20 (3), pp. 399-408Siqueira, F.V., Facchini, L.A., Hallal, P.C., The burden of fractures in Brazil: A population-based study (2005) Bone., 37 (2), pp. 261-266Pinheiro, M.M., Reis Neto, E.T., McHado, F.S., Omura, F., Yang, J.H.K., Szejnfeld, J., Risk factors for osteoporotic fractures and low bone density in pre and postmenopausal women (2010) Rev Saúde Pública., 44 (3), pp. 479-485Kanis, J.A., Johnell, O., Oden, A., Johansson, H., McCloskey, E., FRAX and the assessment of fracture probability in men and women from the UK (2008) Osteoporos Int., 19 (4), pp. 385-397Pinheiro, M.M., Eis, S.R., Epidemiology of osteoporotic fractures in Brazil: What we have and what we need (2010) Arq Bras Endocrinol Metabol., 54 (2), pp. 164-170FRAX: WHO Fracture Risk Assessment Tool [Internet]., , http://www.shef.ac.uk/FRAX/tool.aspx?country=55, Calculation tool [cited 2013 May 7]. Available fromLebrão, M.L., Duarte, Y.A.O., (2003) SABE-Saúde, bem-estar e envelhecimento-O projeto SABE no município de São Paulo: Uma abordagem inicial, , Brasília (DF): Organização Pan-Americana de Saúde(2008) Vigilância de fatores de risco e proteção para doenças crônicas não transmissíveis por entrevistas telefônicas (VIGITEL)., , http://portal.saude.gov.br/portal/arquivos/pdf/167_Q2008.pdf, Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde [Internet]. [citado 2013 Fev 14]. Disponível emGuralnik, J.M., Fried, L.P., Simonsick, E.M., Kasper, J.D., Lafferty, M.E., (1995) The women's health and aging study: Health and social characteristics of older women with disability., , editors. Bethesda: National Institute on Aging(NIH Pub. No. 95-4009)Altman, D.G., (1999) Practical statistics for medical research, , Boca Raton: Chapman & Hall/CRCBarros, A.J.D., Hirakata, V.N., Alternatives for logistic regression in cross-sectional studies: An empirical comparison of models that directly estimate the prevalence ratio (2003) BMC Med Res Methodol., 3, p. 21Baim, S., Leslie, W.D., Assessment of fracture risk (2012) Curr Osteoporos Rep., 10 (1), pp. 28-41(2010) Clinician's guide to prevention and treatment of osteoporosis, , National Osteoporosis Foundation. Washington, DC: National Osteoporosis FoundationBaccaro, L.F., McHado, V.S.S., Costa-Paiva, L., Sousa, M.H., Osis, M.J., Pinto-Neto, A.M., Treatment for menopausal symptoms and having health insurance were associated with a lower prevalence of falls among Brazilian women (2013) Maturitas., 75 (4), pp. 367-372Baccaro, L.F., McHado, V.S.S., Costa-Paiva, L., Souza, M.H., Osis, M.J., Pinto-Neto, A.M., Factors associated with osteoporosis in Brazilian women: A population-based household survey (2013) Arch Osteoporos., 8 (1-2), p. 138Kärkkäinen, M., Rikkonen, T., Kröger, H., Sirola, J., Tuppurainen, M., Salovaara, K., Association between functional capacity tests and fractures: An eight-year prospective population-based cohort study (2008) Osteoporos Int., 19 (8), pp. 1203-1210Recker, R., Lappe, J., Davies, K., Heaney, R., Characterization of perimenopausal bone loss: A prospective study (2000) J Bone Miner Res., 15 (10), pp. 1965-1973Ohta, H., Sugimoto, I., Masuda, A., Komukai, S., Suda, Y., Makita, K., Decreased bone mineral density associated with early menopause progresses for at least ten years: Cross-sectional comparisons between early and normal menopausal women (1996) Bone., 18 (3), pp. 227-231Gerdhem, P., Obrant, K.J., Bone mineral density in old age: The influence of age at menarche and menopause (2004) J Bone Miner Metab., 22 (4), pp. 372-375Portaria no 1101/GM, 12 junho 2002, , http://dtr2001.saude.gov.br/sas/PORTARIAS/Port2002/Gm/GM-1101.htm, Brasil. Ministério da Saúde [Internet]. [citado 2013 Fev 14]. Disponível em(2009) Indicadores sociodemográficos e de saúde no Brasil: 2009., , http://www.ibge.gov.br/home/estatistica/populacao/indic_sociosaude/2009/com_esca.pdf, Instituto Brasileiro de Geografia e Estatística (IBGE) [Internet]. Rio de Janeiro: IBGEEscassez e fartura: distribuição da oferta de equipamentos de diagnóstico por imagem no Brasil [citado 2013 Fev 14]. Disponível e

Accuracy Of Sonography And Hysteroscopy In The Diagnosis Of Premalignant And Malignant Polyps In Postmenopausal Women [acurácia Da Ultrassonografia E Da Histeroscopia No Diagnóstico De Pólipos Endometriais Pré-malignos E Malignos Na Pós-menopausa]

PURPOSE: To evaluate the accuracy of sonographic endometrial thickness and hysteroscopic characteristics in predicting malignancy in postmenopausal women undergoing surgical resection of endometrial polyps. METHODS: Five hundred twenty-one (521) postmenopausal women undergoing hysteroscopic resection of endometrial polyps between January 1998 and December 2008 were studied. For each value of sonographic endometrial thickness and polyp size on hysteroscopy, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated in relation to the histologic diagnosis of malignancy. The best values of sensitivity and specificity for the diagnosis of malignancy were determined by the Receiver Operating Characteristic (ROC) curve. RESULTS: Histologic diagnosis identified the presence of premalignancy or malignancy in 4.1% of cases. Sonographic measurement revealed a greater endometrial thickness in cases of malignant polyps when compared to benign and premalignant polyps. On surgical hysteroscopy, malignant endometrial polyps were also larger. An endometrial thickness of 13 mm showed a sensitivity of 69.6%, specificity of 68.5%, PPV of 9.3%, and NPV of 98% in predicting malignancy in endometrial polyps. Polyp measurement by hysteroscopy showed that for polyps 30 mm in size, the sensitivity was 47.8%, specificity was 66.1%, PPV was 6.1%, and NPV was 96.5% for predicting cancer. CONCLUSIONS: Sonographic endometrial thickness showed a higher level of accuracy than hysteroscopic measurement in predicting malignancy in endometrial polyps. Despite this, both techniques showed low accuracy for predicting malignancy in endometrial polyps in postmenopausal women. In suspected cases, histologic evaluation is necessary to exclude malignancy.356243248Anastasiadis, P.G., Koutlaki, N.G., Skaphida, P.G., Galazios, G.C., Tsikouras, P.N., Liberis, V.A., Endometrial polyps: Prevalence, detection, and malignant potential in women with abnormal uterine bleeding (2000) Eur J Gynaecol Oncol., 21 (2), pp. 180-183Clevenger-Hoeft, M., Syrop, C.H., Stovall, D.W., van Voorhis, B.J., Sonohysterography in premenopausal women with and without abnormal bleeding (1999) Obstet Gynecol., 94 (4), pp. 516-520Goldstein, S.R., Zeltser, I., Horan, C.K., Snyder, J.R., Schwartz, L.B., Ultrasonography-based triage for perimenopausal patients with abnormal uterine bleeding (1997) Am J Obstet Gynecol., 177 (1), pp. 102-108Nagele, F., O'Connor, H., Davies, A., Badawy, A., Mohamed, H., Magos, A., 2500 outpatient diagnostic hysteroscopies (1996) Obstet Gynecol., 88 (1), pp. 87-92van Bogaert, L.J., Clinicopathologic findings in endometrial polyps (1988) Obstet Gynecol., 71 (5), pp. 771-773Dreisler, E., Stampe Sorensen, S., Ibsen, P.H., Lose, G., Prevalence of endometrial polyps and abnormal uterine bleeding in a Danish population aged 20-74 years (2009) Ultrasound Obstet Gynecol., 33 (1), pp. 102-108Lieng, M., Istre, O., Sandvik, L., Qvigstad, E., Prevalence, 1-year regression rate, and clinical significance of asymptomatic endometrial polyps: Cross-sectional study (2009) J Minim Invasive Gynecol., 16 (4), pp. 465-471Schmidt, T., Breidenbach, M., Nawroth, F., Mallmann, P., Beyer, I.M., Fleisch, M.C., Hysteroscopy for asymptomatic postmenopausal women with sonographically thickened endometrium (2009) Maturitas., 62 (2), pp. 176-178Lee, S.C., Kaunitz, A.M., Sanchez-Ramos, L., Rhatigan, R.M., The oncogenic potential of endometrial polyps: A systematic review and meta-analysis (2010) Obstet Gynecol., 116 (5), pp. 1197-1205Martínez, M.A., Jou, P., Nonell, R., Cardona, M., Alonso, I., Vanrell, J.A., Pólipos endometriales: Riesgo de malignización y correlación clínico-anatómica (2004) Prog Obstet Ginecol., 47 (11), pp. 506-510Antunes Jr., A., Costa-Paiva, L., Arthuso, M., Costa, J.V., Pinto-Neto, A.M., Endometrial polyps in pre-and postmenopausal women: Factors associated with malignancy (2007) Maturitas., 57 (4), pp. 415-421Savelli, L., de Iaco, P., Santini, D., Rosati, F., Ghi, T., Pignotti, E., Histopathologic features and risk factors for benignity, hyperplasia, and cancer in endometrial polyps (2003) Am J Obstet Gynecol., 188 (4), pp. 927-931Lieng, M., Istre, O., Qvigstad, E., Treatment of endometrial polyps: A systematic review (2010) Acta Obstet Gynecol Scand., 89 (8), pp. 992-1002Baiocchi, G., Manci, N., Pazzaglia, M., Giannone, L., Burnelli, L., Giannone, E., Malignancy in endometrial polyps: A 12-year experience (2009) Am J Obstet Gynecol., 201 (5), pp. 462. e1-462. e4Rahimi, S., Marani, C., Renzi, C., Natale, M.E., Giovannini, P., Zeloni, R., Endometrial polyps and the risk of atypical hyperplasia on biopsies of unremarkable endometrium: A study on 694 patients with benign endometrial polyps (2009) Int J Gynecol Pathol., 28 (6), pp. 522-528Ben-Arie, A., Goldchmit, C., Laviv, Y., Levy, R., Caspi, B., Huszar, M., The malignant potential of endometrial polyps (2004) Eur J Obstet Gynecol Reprod Biol., 115 (2), pp. 206-210Ferrazzi, E., Zupi, E., Leone, F.P., Savelli, L., Omodei, U., Moscarini, M., How often are endometrial polyps malignant in asymptomatic postmenopausal women? A multicenter study (2009) Am J Obstet Gynecol., 200 (3), pp. 235. e1-235. e6Whiting, P., Rutjes, A.W., Reitsma, J.B., Bossuyt, P.M., Kleijnen, J., The development of QUADAS: A tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews (2003) BMC Med Res Methodol., 3, p. 25Osmers, R., Völksen, M., Schauer, A., Vaginosonography for early detection of endometrial carcinoma? (1990) Lancet., 335 (8705), pp. 1569-1571Seelbach-Göbel, B., Rempen, A., Kristen, P., Vaginal sonography of the endometrium in postmenopause. Initial results of a prospective study (1991) Gynakol Rundsch., 31 (SUPPL. 2), pp. 253-255. , GermanGrimbizis, G.F., Tsolakidis, D., Mikos, T., Anagnostou, E., Asimakopoulos, E., Stamatopoulos, P., A prospective comparison of transvaginal ultrasound, saline infusion sonohysterography, and diagnostic hysteroscopy in the evaluation of endometrial pathology (2010) Fertil Steril., 94 (7), pp. 2720-2725Weigel, M., Friese, K., Strittmatter, H.J., Melchert, F., Ultrasound assessment of the postmenopausal endometrium (1994) Is measuring thickness adequate?] Ultraschall Med., 15 (3), pp. 117-121. , GermanCepni, I., Ocal, P., Erkan, S., Saricali, F.S., Akbas, H., Demirkiran, F., Comparison of transvaginal sonography, saline infusion sonography and hysteroscopy in the evaluation of uterine cavity pathologies (2005) Aust N Z J Obstet Gynaecol., 45 (1), pp. 30-35Jacobs, I., Gentry-Maharaj, A., Burnell, M., Manchanda, R., Singh, N., Sharma, A., Sensitivity of transvaginal ultrasound screening for endometrial cancer in postmenopausal women: A case-control study within the UKCTOCS cohort (2011) Lancet Oncol., 12 (1), pp. 38-48Wang, J.H., Zhao, J., Lin, J., Opportunities and risk factors for premalignant and malignant transformation of endometrial polyps: Management strategies (2010) J Minim Invasive Gynecol., 17 (1), pp. 53-58Fernández-Parra, J., Rodríguez Oliver, A., López Criado, S., Parrilla Fernández, F., Montoya Ventoso, F., Hysteroscopic evaluation of endometrial polyps (2006) Int J Gynaecol Obstet., 95 (2), pp. 144-148Shushan, A., Revel, A., Rojansky, N., How often are endometrial polyps malignant? (2004) Gynecol Obstet Invest., 58 (4), pp. 212-215Gregoriou, O., Konidaris, S., Vrachnis, N., Bakalianou, K., Salakos, N., Papadias, K., Clinical parameters linked with malignancy in endometrial polyps (2009) Climacteric., 12 (5), pp. 454-458Krampl, E., Bourne, T., Hurlen-Solbakken, H., Istre, O., Transvaginal ultrasonography sonohysterography and operative hysteroscopy for the evaluation of abnormal uterine bleeding (2001) Acta Obstet Gynecol Scand., 80 (7), pp. 616-622Salim, S., Won, H., Nesbitt-Hawes, E., Campbell, N., Abbott, J., Diagnosis and management of endometrial polyps: A critical review of the literature (2011) J Minim Invasive Gynecol., 18 (5), pp. 569-581AAGL practice report: Practice guidelines for the diagnosis and management of endometrial polyps (2012) J Minim Invasive Gynecol., 19 (1), pp. 3-10. , American Association of Gynecologic Laparoscopist

Urinary Incontinence Among Climateric Brazilian Women: Household Survey

Objective. To investigate the prevalence of stress urinary incontinence and its associated factors in perimenopause women using a population-based household survey. Methods. A descriptive, exploratory cross-sectional population-based study with secondary analysis of a population-based household survey on perimenopause and menopause was conducted among women living in the city of Campinas, Brazil. Through a sampling process, 456 women between 45 and 60 years old were selected. Complaints of urinary incontinence and related risk factors, such as age, socioeconomic status, education level, race, parity, smoking habits, body mass index, previous gynecological surgeries, menopausal status, and hormonal replacement therapy were explored. Data were collected through home interviews using an adapted version of the structured pre-tested questionnaire elaborated by the International Health Foundation, International Menopause Society and the American Menopause Society. Statistical analysis were performed using prevalence rates (CI 95%). Results. Thirty-five percent of the interviewees referred stress urinary incontinence. None of the sociodemographic factors studied was associated to the risk of urinary incontinence. In addition, parity did not significantly change the risk of urinary incontinence. Other factors, such as previous gynecological surgeries, body mass index, and smoking habits, were not associated with the prevalence of stress urinary incontinence. Also, menopausal status and hormonal replacement therapy did not change the risk of stress urinary incontinence. Conclusion. Though there was a high prevalence of stress urinary incontinence among perimenopause women, there was not found any associations with sociodemographic and reproductive factors.355428435Bortolotti, A., Bernardini, B., Colli, E., Di Benedetto, P., Giocoli Nacci, G., Landoni, M., Prevalence and risk factors for urinary incontinence in Italy (2000) Eur Urol, 37, pp. 30-35Brown, J.S., Grady, D., Ouslander, J.G., Herzog, A.R., Varner, R.E., Posner, S.F., Prevalence of urinary incontinence and associated risk factors in postmenopausal women (1999) Obstet Gynecol, 94, pp. 66-70. , Hert & Estrogen/Progestin Replacement Study (HERS) Research GroupBurgio, K.L., Mathews, K.A., Engel, B.T., Prevalence, incidence and correlates of urinary incontinence in healthy, middle-aged women (1991) J Urol, 146, pp. 1255-1259Comportamento sexual da população brasileira e percepção sobre o HIV/AIDS: Relatório final de pesquisa (1999), pp. 34-37. , Centro Brasileiro de Análise e Planejamento (CEBRAP), Ministério da Saúde-SPS-CNDST/HIV/AIDS. São PauloChiarelli, P., Brown, W., Mc Elduf, F.P., Leaking urine: Prevalence and associated factors in Australian women (1999) Neurourol Urodyn, 18, pp. 567-577Elving, L.B., Foldspang, A., Lam, G.W., Mommsen, S., Descriptive epidemiology of urinary incontinence in 3100 women age 30-59 (1989) Scand J Urol Nephrol, 125 (SUPPL.), pp. 37-43Fantl, J.A., Cardozo, L., Mc Clish, D.K., Estrogen therapy in the management of urinary incontinence in postmenopausal women: A meta-analisys (1994) Obstet Gynecol, 83, pp. 12-18. , First report of the Hormones and Urogenital Therapy CommiteeFantl, J.A., Bump, R.C., Robinson, D., Efficacy of estrogen supplementation in the treatment of urinary incontinece (1996) Obstet Gynecol, 88, pp. 745-749Guarisi, T., Pinto-Neto, A.M., Costa-Paiva, L.H.S., Pedro, A.O., Faúndes, A., Sintomas urinários e genitais em mulheres climatéricas (1998) J Bras Ginecol, 108, pp. 125-130Jaszmann, L., Epidemiology of climateric and postclimateric complaints (1973), pp. 22-24. , Van Keep PA, Lauritzen C, editors. Ageing and estrogens: front hormone research. Basel: KargerLaurenti, R., Mello-Jorge, M.L.P., Lebrão, M.L., Gotlieb, S.L.D., População: Recenseamento e estimativas (1987) Estatística de saúde., pp. 9-38. , editors. 2a ed. São Paulo: EPUMendonça, M., Reis, R.V., Macedo, C.B.M.S., Barbosa, K.S.R., Prevalência da queixa de incontinência urinária de esforço em pacientes atendidas no serviço de ginecologia do Hospital Júlia Kubitschek (1997) J Bras Ginecol, 107, pp. 153-155Moller, L.A., Lose, G., Jorgensen, T., The prevalence and bothersomeness of lower urinary tract symptons in women 40-60 years of age (2000) Acta Obstet Gynecol Scand, 79, pp. 298-305Thom, D.H., Brown, J.S., Reproductive and hormonal risk factors for urinary incontinence in later life: A review of the clinical and epidemiologic literature (1998) J Am Geriatr Soc, 46, pp. 1411-1417Van Geelen, J.M., Van de Weijer, P.H., Arnolds, H.T., Urogenital symptons and resulting discomfort in noninstitutionalized Dutch women aged 50-75 years (2000) Int Urogynecol J Pelvic Floor Dysfunct, 11, pp. 9-14Von Mühlen, D.G., Kritz-Silverstein, D., Barret-Connor, E., A community based study of menopause symptoms and estrogen replacement in older women (1995) Maturitas, 22, pp. 71-78Wilbur, J., Miller, A.M., Montgomery, A., Chandler, P., Sociodemographic characteristics, biological factors, an symptom reporting in midlife women (1998) Menopause, 5, pp. 43-5

Self-perception Of Sexual Life And Associated Factors: A Population Study Conducted In Women Aged 50 Or More Years [autopercepção De Vida Sexual E Fatores Associados: Estudo Populacional Em Mulheres Com 50 Anos Ou Mais]

Purpose: To evaluate the prevalence of women aged 50 years or more who are sexually active and their self-perception with respect to their sexual lives. Associated factors were also assessed. Methods: A cross-sectional, population-based, self-reported household survey involving 622 Brazilian women aged 50 years or more. Sociodemographic, clinical, and behavioral factors were evaluated. The sexual life self-perception was classified as very good, good, fair, poor, or very poor. Data were analyzed using the χ2 test, Fisher's exact test, and Poisson multiple regression analysis. Prevalence ratios and their 95% confidence intervals were also calculated. Results: Of the women in this sample, 228 (36.7%) reported having a sexual life and, of these, 53.5% classified it as very good or good, while 46.5% considered it fair, poor, or very poor. The bivariate analysis indicated that being postmenopausal (p=0.025) and using natural remedies to treat the menopause (p=0.035) were factors associated with the woman classifying their sexual lives as fair, poor, or very poor. Multiple regression analysis showed that more women who had used or were currently using natural remedies for the menopause scored their sexual lives as fair, poor, or very poor. Conclusions: More than half the women aged 50 years or more in this study were not sexually active. A poorer sexual life self-perception was associated with the use of natural remedies to treat menopausal symptoms. This may indicate a need to improve the way in which these women are evaluated and treated. Women's assessment of their own sexual lives may prove a useful tool in clinical practice.357295300Kaiser, F.E., Sexual function and the older woman (2003) Clin Geriatr Med., 19 (3), pp. 463-472(1981) Research on the menopause., , World Health Organization Scientific Group. Geneva: World Health Organization(Technical Report Series, 670)Wierman, M.E., Nappi, R.E., Avis, N., Davis, S.R., Labrie, F., Rosner, W., Endocrine aspects of women's sexual function (2010) J Sex Med., 7 (1 PART 2), pp. 561-585The 2012 hormone therapy position statement of: The North American Menopause Society (2012) Menopause., 19 (3), pp. 257-271. , North American Menopause SocietySturdee, D.W., Panay, N., Recommendations for the management of postmenopausal vaginal atrophy (2010) Climacteric., 13 (6), pp. 509-522. , International Menopause Society Writing GroupSimon, J.A., Identifying and treating sexual dysfunction in postmenopausal women: The role of estrogen (2011) J Womens Health (Larchmt)., 20 (10), pp. 1453-1465Valadares, A.L., Pinto-Neto, A.M., Osis, M.J., Conde, D.M., Sousa, M.H., Costa-Paiva, L., Sexuality in Brazilian women aged 40 to 65 years with 11 years or more of formal education: Associated factors (2008) Menopause., 15 (2), pp. 264-269Guthrie, J.R., Dennerstein, L., Taffe, J.R., Lehert, P., Burger, H.G., The menopausal transition: A 9-year prospective population-based study. The Melbourne Women's Midlife Health Project (2004) Climacteric., 7 (4), pp. 375-389McCoy, N.L., The McCoy Female Sexuality Questionnaire (2000) Qual Life Res., 9 (1 SUPPL.), pp. 739-745Rosen, R., Brown, C., Heiman, J., Leiblum, S., Meston, C., Shabsigh, R., The Female Sexual Function Index (FSFI): A multidimensional self-report instrument for the assessment of female sexual function (2000) J Sex Marital Ther., 26 (2), pp. 191-208Dennerstein, L., Anderson-Hunt, M., Dudley, E., Evaluation of a short scale to assess female sexual functioning (2002) J Sex Marital Ther., 28 (5), pp. 389-397Valadares, A.L., Pinto-Neto, A.M., Osis, M.J., Sousa, M.H., Costa-Paiva, L., Conde, D.M., Prevalence of sexual dysfunction and its associated factors in women aged 40-65 years with 11 years or more of formal education: A population-based household survey (2008) Clinics (Sao Paulo)., 63 (6), pp. 775-782Valadares, A.L., Pinto-Neto, A.M., de Sousa, M.H., Osis, M.J., Sociocultural adaptation of the short personal experiences questionnaire (SPEQ) in Brazil (2010) Rev Bras Ginecol Obstet., 32 (2), pp. 72-76. , PortugueseBem, D.J., Self-perception: An alternative interpretation of cognitive dissonance phenomena (1967) Psychol Rev., 74 (3), pp. 183-200Ali, M.M., Fang, H., Rizzo, J.A., Body weight, self-perception and mental health outcomes among adolescents (2010) J Ment Health Policy Econ., 13 (2), pp. 53-63Paula, J.S., Leite, I.C., Almeida, A.B., Ambrosano, G.M., Pereira, A.C., Mialhe, F.L., The influence of oral health conditions, socioeconomic status and home environment factors on schoolchildren's self-perception of quality of life (2012) Health Qual Life Outcomes., 10, p. 6Maier, H., Smith, J., Psychological predictors of mortality in old age (1999) J Gerontol B Psychol Sci Soc Sci., 54 (1), pp. P44-P54Levy, B.R., Slade, M.D., Kunkel, S.R., Kasl, S.V., Longevity increased by positive self-perceptions of aging (2002) J Pers Soc Psychol., 83 (2), pp. 261-270(2007) Distribuição da população por sexo, segundo os grupos de idade:Campinas (SP)., , http://www.censo2010.ibge.gov.br/sinopse/webservice/frm_piramide.php?codigo=350950&corhomem=3d4590&cormulher=9cdbfc, Instituto Brasileiro de Geografia e Estatística [Internet]. [citado 2011 Mar 6]. Disponível emAltman, D.G., (1999) Practical statistics for medical research., , Boca Raton: Chapman & Hall/CRCJohnson, R.A., Wichern, D.W., (1982) Applied multivariate statistical analysis., , Upper Saddle River: Prentice HallBarros, A.J., Hirakata, V.N., Alternatives for logistic regression in cross-sectional studies: An empirical comparison of models that directly estimate the prevalence ratio (2003) BMC Med Res Methodol., 3, p. 21Lindau, S.T., Schumm, L.P., Laumann, E.O., Levinson, W., O'Muircheartaigh, C.A., Waite, L.J., A study of sexuality and health among older adults in the United States (2007) N Engl J Med., 357 (8), pp. 762-774Freeman, E.W., Sammel, M.D., Lin, H., Liu, Z., Gracia, C.R., Duration of menopausal hot flushes and associated risk factors (2011) Obstet Gynecol., 117 (5), pp. 1095-1104Col, N.F., Guthrie, J.R., Politi, M., Dennerstein, L., Duration of vasomotor symptoms in middle-aged women: A longitudinal study (2009) Menopause., 16 (3), pp. 453-457McLennan, A.H., Broadbent, J.L., Lester, S., Moore, V., Oral oestrogen and combined oestrogen/progestogen therapy versus placebo for hot flushes (2004) Cochrane Database Syst Rev., (4), pp. CD002978The role of soy isoflavones in menopausal health: Report of The North American Menopause Society/Wulf H. Utian Translational Science (2011) Menopause., 18 (7), pp. 732-753. , North American Menopause Society, Symposium in Chicago, IL (October 2010)Borrelli, F., Ernst, E., Alternative and complementary therapies for the menopause (2010) Maturitas., 66 (4), pp. 333-343Patisaul, H.B., Luskin, J.R., Wilson, M.E., A soy supplement and tamoxifen inhibit sexual behavior in female rats (2004) Horm Behav., 45 (4), pp. 270-277Patisaul, H.B., Dindo, M., Whitten, P.L., Young, L.J., Soy isoflavone supplements antagonize reproductive behavior and estrogen receptor alpha-and beta-dependent gene expression in the brain (2001) Endocrinology., 142 (7), pp. 2946-295

Evidence for a mixed mass composition at the `ankle' in the cosmic-ray spectrum

We report a first measurement for ultra-high energy cosmic rays of the correlation between the depth of shower maximum and the signal in the water Cherenkov stations of air-showers registered simultaneously by the fluorescence and the surface detectors of the Pierre Auger Observatory. Such a correlation measurement is a unique feature of a hybrid air-shower observatory with sensitivity to both the electromagnetic and muonic components. It allows an accurate determination of the spread of primary masses in the cosmic-ray flux. Up till now, constraints on the spread of primary masses have been dominated by systematic uncertainties. The present correlation measurement is not affected by systematics in the measurement of the depth of shower maximum or the signal in the water Cherenkov stations. The analysis relies on general characteristics of air showers and is thus robust also with respect to uncertainties in hadronic event generators. The observed correlation in the energy range around the `ankle' at $\lg(E/{\rm eV})=18.5-19.0$ differs significantly from expectations for pure primary cosmic-ray compositions. A light composition made up of proton and helium only is equally inconsistent with observations. The data are explained well by a mixed composition including nuclei with mass $A > 4$. Scenarios such as the proton dip model, with almost pure compositions, are thus disfavoured as the sole explanation of the ultrahigh-energy cosmic-ray flux at Earth.Comment: Published version. Added journal reference and DOI. Added Report Numbe