Increased risk of oncogenic human papillomavirus infections and incident high-grade cervical intraepithelial neoplasia among smokers: experience from the Latin American screening study

Background: The purpose of this study was to assess the effect of smoking on the prevalence and incidence of high-risk human papillomavirus (hr-HPV) infection and cervical intraepithelial neoplasia (CIN) in a large sample of Latin American women. Methods: The study examines baseline data on over 12,000 women included in the Latin American Screening Study (Brazil and Argentina), and over 1000 women followed-up for a period of 36 months. Three groups were formed: never smokers, current, and past smokers. The prevalence of hr-HPV infection and CIN were compared between the study groups. In the prospective analysis, women were controlled at 6-month intervals to assess the cumulative risk of incident hr-HPV infection, smear abnormalities, and CIN. Results: A higher prevalence (21.7%) of hr-HPV infection was found among current smokers as compared to never smokers (16.5%) or past smokers (13.5%). Being current smoker was significantly (P <0.01) associated with hr-HPV detection (OR = 1.6; 95% CI = 1.2-2.1). Being a current smoker was a significant predictor of incident hr-HPV during the follow-up [Hazards ratio (HR) = 1.4; 95% CI 1.0-1.9]. For incident CIN2+, being a past smoker (HR = 3.6; 95% CI 1.6-9.8) or current smoker (HR = 3.6; 95% CI 1.5-8.6) were the significant independent predictors. Current and past smokers had a significantly increased risk of incident CIN2+ (P <0.01). Conclusions: Smoking increases the risk of contracting hr-HPV infection and modifies the effect of a persistent hr-HPV infection by further increasing the risk of developing CIN2+. It seems that this effect modification persists over several years after smoking cessation.Supported by the INCO-DEV Program of the European Commission (Project No. ICA4-CT-2001-10013)

Queixa de perda urinária: um problema silente pelas mulheres Queja de pérdida urinaria: un problema silencioso para las mujeres Complaint of urinary loss: a silent woman's problem

O estudo buscou analisar a prevalência e interferência da incontinência urinária sobre a vida diária de mulheres de um Centro de Saúde em Fortaleza, Ceará. Estudo transversal, analítico e quantitativo na população (168) que realizou consulta para Hipertensão e/ou Diabetes em setembro de 2009. A coleta de dados ocorreu através de entrevista e aplicação do "International Consultationon Incontinence Questionnaire". Para análise inferencial utilizou-se testes qui-quadrado e exato de Fisher. Da análise amostral (59), resultaram mulheres: com idade entre 42 e 59 anos (52,5%), baixa escolaridade (55,9%), sem companheiro (57,6%), aposentada (50,8%), não fumantes (81,4%) e peso aumentado (71,2%). Apenas escolaridade associou-se à incontinência. A prevalência foi 61,0%. Para 55,5% das incontinentes, perder urina interfere de forma grave ou muito grave em sua vida diária. A perda urinária ocorreu ao tossir ou espirrar (72,2%) e antes de chegar ao banheiro (61,1%). A incontinência urinária apresentou alta prevalência, interferindo negativamente na vida das mulheres.<br>El estudio buscó analizar la prevalencia e interferencia de la incontinencia urinaria en la vida diaria de las mujeres de un Centro de Salud en Fortaleza, Ceará, Brasil. Estudio transversal, analítico y cuantitativo en la población (168) que realizó consulta para Hipertensión y/o Diabetes en septiembre de 2009. La recolecta de datos se realizó mediante entrevista y aplicación del "International Consultationon Incontinence Questionnaire". Para análisis inferencial se utilizaron los test qui-cuadrado y exacto de Fisher. En el análisis de la muestra (59), fueron mujeres: con edad entre 42 y 59 años (52,5%), baja escolaridad (55,9%), sin compañero (57,6%), jubiladas (50,8%), no fumadoras (81,4%) y con sobrepeso (71,2%). Solamente escolaridad se asoció a incontinencia. La prevalencia fue 61,0%. Para 55,5% de las incontinentes, perder orina interfiere de forma grave o muy grave en su vida diaria. La pérdida urinaria ocurrió al toser o estornudar (72,2%) y antes de llegar al lavabo (61,1%). La incontinencia urinaria presentó alta prevalencia, interfiriendo negativamente en la vida de las mujeres<br>This study investigates the prevalence of urinary incontinence and how it interferes in the daily life of women from a health center in the city of Fortaleza, state of Ceará, Brazil. This is a cross-sectional, analytical and quantitative study. The studied population was of 168 women who had appointments for hypertension and / or diabetes in September 2009. The data was collected through interviews and the application of the "International Consultation on Incontinence Questionnaire." For inferential analysis, we used chi-square and Fisher's exact test. Women from the analysis sample (59) were: aged between 42 and 59 years (52.5%), low educational level (55.9%), without a partner (57.6%), retired (50.8%), nonsmokers (81.4%) and overweight (71.2%). Only the low educational level was associated with incontinence. Prevalence was of 61.0%. For 55,5% of incontinents, losing urine intervenes in a grave or very grave way with their daily life. The urinary loss occurred while coughing or sneezing (72.2%) and before arriving at the bathroom (61.1%). The urinary incontinence presented a high prevalence, intervening negatively with these women's lifes

Educação de funcionárias de unidade básica de saúde acerca da atenção fisioterapêutica na incontinência urinária: relato de experiência Education of employees of primary health care unit about physical therapy in urinary incontinence: report of experience

A incontinência urinária (IU) é um problema de saúde pública, devendo ser abordada em centros de saúde (CS). A educação dos profissionais é necessária para que saibam prestar assistência às usuárias. O objetivo deste estudo foi relatar a experiência do projeto "Cuidar de Quem Cuida", desenvolvido em CS para educar funcionárias acerca da IU. O programa foi realizado na forma de uma dinâmica teórico-prática com duração de 2 horas, sendo que as 28 participantes foram divididas em 2 grupos. Cada grupo participou do programa em dias diferentes de forma que as atividades usuais do CS puderam ser mantidas. Foram discutidos os tipos de IU, fatores de risco, possibilidades terapêuticas e medidas preventivas, destacando-se o cuidado com os hábitos urinários e intestinais e o treinamento dos músculos do assoalho pélvico (MAP). Após sua realização, as participantes relataram que passaram a desenvolver hábitos urinários saudáveis e realizar exercícios para os MAP. Observou-se aumento do número de usuárias referenciadas para a Fisioterapia. Assim, o programa instrumentalizou as funcionárias a desenvolver o autocuidado e identificar necessidade de assistência às usuárias. Esta abordagem poderá ser efetiva em outros serviços como um primeiro passo na implantação de assistência fisioterapêutica a mulheres com IU nos CS.<br>Urinary incontinence (UI) is considered a public health problem that should be firstly approached in the primary care units (PCU). Educational programs target to professionals who work in these units are a key component in the management of this condition. The aim of this study was to report the experience of the "Caring for Who Cares", a project developed in a PCU aimed at educating employees about UI. The educational program was carried out as a dynamic, with theoretical and practical character, lasting 2 hours. The 28 participants were divided into 2 groups. Each group participated in the program on different days so that the usual activities of the PCU could be maintained. Issues such as types of UI, risk factors, preventive and therapeutic measures, especially urinary and bowel habits and pelvic floor muscle (PFM) training, were discussed. The participants reported being more attentive to their urinary habits after the educational program; some of them had incorporated exercises for the PFM. There were also an increasing number of users referred to the physiotherapy care service. Therefore, the project successfully educated the employees of the PCU for their own care and allowed the implementation of UI preventative and treatment programs in this unit. This experience may be helpful to other professionals when implementing the physical therapy assistance for women with UI in PCU