Sexual function and associated factors at 24 months postpartum: a cohort study / Função sexual e fatores associados aos 24 meses de pós-parto: um estudo de coorte

The aim of this study was primarily to investigate the rates of indicative sexual dysfunction (SD) in the last gestational month and at 24 months postpartum. As a secondary objective, we sought to identify the main factors associated with SD at 24 months. The study sample included 131 women who gave birth in maternity wards at two public hospitals in southern Brazil between the period of October 2018 and April 2019. In the first stage (T1), an interview was carried out while the participants were hospitalized, during the immediate postpartum period, based on a clinical record and on the female sexual function questionnaire (Female Sexual Function Index – FSFI). In the second stage (T2), assessments were made via telephone, given the restrictions of the Covid-19 pandemic, 24 months after the initial data collection. At this stage, an updated clinical record was used, followed by the FSFI questionnaire. The final sample consisted of 82 women. Data analysis was performed using descriptive statistics. Data normality was verified using the Kolmogorov-Smirnov test. The chi-square test was used to compare categorical variables in two stages. The Wilcoxon test was used to compare the FSFI score and its domains, both in the last gestational month and at 24 months postpartum. To analyze the correlation of factors associated with the FSFI score, Spearman's test was used. As for sexual function (SF), of the women who were sexually active in the last four weeks of pregnancy (n=33), 39.4% (n=13) indicated SD, while at 24 months postpartum, the percentage was reduced to 20.7% (n=17). There was no statistically significant difference between the total FSFI scores for the two periods observed; however, the analysis of the FSFI domains showed a significant improvement in sexual desire (p=0.01) and a reduction in pain during intercourse (p=0.04) at the 24-month postpartum follow-up. Thus, indications of SD, both in the last month of pregnancy and at 24 months postpartum, can be considered moderate. Furthermore, it was possible to identify factors associated positively, as well as negatively, with SF at 24 months postpartum

Physical therapy in sexually dysfunctional women: a systematic review

The World Health Organization (WHO) considers Female Sexual Dysfunctions (FSDs) to be a public health issue. There are a multitude of disorders such as female sexual arousal disorder, hypoactive sexual desire disorder, orgasmic disorder, dyspareunia, and vaginismus. FSDs are detected in 67.9% of the women in the world and are present in 50% of Asians, in 30-50% of Americans, and in 30% of Brazilians. Objective: To systematically review the literature on the different physiotherapy techniques used in the treatment of FSDs. Methods: A systematic search was conducted in the databases EMBASE, PEDro, and MedLine in data as recent as June 2013, by combining words and descriptors of physical therapy treatments and female sexual dysfunctions. Excluded from review were articles concerning male sexual dysfunction, pilot studies, multicentric papers of projects, and those which were either not available in their entirety or were duplicated in another database. After the selection of studies was complete, the randomized clinical trials were scored on the PEDro Evaluation Scale. Results: Eleven articles were included, six of which went on to be qualitatively evaluated on the PEDro scale. The present study followed the methodological structure of PRISMA (Statement for Reporting Systematic Reviews and Meta-Analyses of Studies). All studies found used questionnaires to assess the effects of physical therapy on FSDs. A total of five different types of interventions were verified: kinesiotherapy (Kegel exercises and pelvic floor muscle training - PFMT), Cognitive behavioral therapy (CBT), biofeedback, electrotherapy (transcutaneous electrical stimulation - TENS, and therapeutic ultrasound - US), and manual therapy. The limitations found in this systematic review were related to the unavailability of the articles in full and the low methodological quality of the studies. Conclusion: All studies showed improvements in sexual function after physical therapy intervention. There is no consensus on any intervention with better results; however, kinesiotherapy using PFMT proved to be advantageous because of its easy application, low cost, easy learning curve, and lasting results achieved in a short period. However, there are methodological shortcomings that still need to be dealt with to determine the most suitable physical therapy treatment for FSDs, as well as defining the best dosage, the protocol to be followed, and the duration of therapy, as well as the best cost-benefitAs disfunções sexuais femininas (DSFs) são consideradas um problema de saúde pública pela Organização Mundial da Saúde (OMS). Consistem em inúmeras desordens, como distúrbio da excitação feminina, distúrbio do desejo sexual hipoativo, transtorno sexual do orgasmo feminino, dispareunia e vaginismo. As DSFs são detectadas em 67,9% das mulheres no mundo e estão presentes em 50% das asiáticas, em 30 a 50% das americanas e em 30% das brasileiras. Objetivo: Revisar sistematicamente a literatura sobre as diferentes técnicas de fisioterapia utilizadas no tratamento das DSFs. Métodos: Realizou-se uma busca sistemática, nas bases de dados EMBASE, PEDro e MedLine, de artigos publicados até junho de 2013, através da combinação entre palavras e descritores de tratamentos fisioterapêuticos e disfunções sexuais femininas. Foram excluídos os artigos sobre disfunção sexual masculina, estudos pilotos, papers ou projetos multicêntricos, que não estivessem disponíveis na íntegra ou duplicados em outra base de dado. Após a seleção final dos estudos, foi verificada a pontuação dos ensaios clínicos randomizados na Escala de Avaliação PEDro. Resultados: 11 artigos foram incluídos e, destes, seis passaram para a avaliação qualitativa na Escala PEDro. Este estudo seguiu a estruturação metodológica do PRISMA (Statement for Reporting Systematic Reviews and Meta-Analyses of Studies). Todos os estudos encontrados utilizaram questionários para avaliar os efeitos da intervenção fisioterapêutica nas DSFs. Foi verificado um total de cinco tipos de intervenções diferentes: cinesioterapia (exercícios de Kegel e treinamento muscular do assoalho pélvico - TMAP), terapia cognitivo-comportamental (CGBT), biofeedback, eletroterapia (TENS - eletroestimulação transcutânea e US - ultrassom terapêutico) e terapia manual. As limitações encontradas nesta revisão sistemática foram referentes a não disponibilização dos artigos na íntegra e à baixa qualidade metodológica dos estudos. Conclusão: Todos os estudos mostraram melhora na função sexual após intervenção fisioterapêutica. Não há um consenso sobre a intervenção com melhores resultados, no entanto, a cinesioterapia através do TMAP mostrou-se vantajosa por ser de fácil aplicação, baixo custo, aprendizado imediato e promover resultados duradouros em um curto período de tempo. No entanto, existem lacunas metodológicas que ainda precisam ser preenchidas para determinar o tratamento fisioterapêutico eletivo para as DSFs, assim como definir a melhor dosagem, o protocolo a ser seguido, a duração desta terapia, aliados ao melhor custo-benefíci

Intra-and interobserver reproducibility in the cobb angle in scoliosis patients

o objetivo deste estudo é analisar a variabilidade intra e interobservador do método de Cobb em indivíduos escolióticos. Foram avaliadas trinta e quatro radiografias de sujeitos com escoliose para mensuração do ângulo de Cobb. A avaliação intraobservador foi realizada por um avaliador, enquanto a avaliação interobservador foi realizada por três avaliadores. Foram controlados possíveis erros intrínsecos e extrínsecos de mensuração, mas não houve a pré-seleção das vértebras que caracterizam a escoliose. A concordância intra e interobservador foi avaliada pelo coeficiente de correlação de Pearson (p < 0,05). Não houve diferenças significativas de julgamento na condição intra e interobservadores. A magnitude dos coeficientes de correlação oscilou de bom até excelente nos níveis torácico e tóraco-lombar. Na coluna lombar não houve correlação em ambas as condições.the aim of this study is to assess intra and interobserver variability of the Cobb method in subjects who have scoliosis. Thirty four scoliosis radiographs were evaluated for measure of the angle of Cobb. The intra-observer assessment was carried out by an observer, while the inter-observer evaluation was carried out by three observers. It was controlled intrinsic and extrinsic errors of measurement, but there was no pre-selection of the vertebrae that characterized the scoliosis. Both intraobserver and interobserver reliabilities were assessed by calculating the Pearson correlation coefficient (p d"0.05). No significant differences were observed between intra-and interobservers. The magnitude of correlation coefficients ranged from very high to unreasonable in chest and thoracolumbar level. Lumbar spine did not correlate in both conditions

Perceptions, feelings and physical and emotional experiences of woman after breast cancer

Introduction: Breast cancer has the highest incidence worldwide. Recently, breast cancer was considered a major public health problem due to the high morbidity and mortality. The objective was to characterize the coping strategies of the disease developed by these women after breast cancer. Methods: We used a qualitative approach, a study of descriptive, which are collected through structured interview technique and processed by content analysis. Participants were twenty women with mastectomies, married, with more than twelve months after surgery and without breast reconstruction. Results: Two themes were constructed from the analysis of their statements: 1) Physical changes after breast cancer, which was understood as a change in lifestyle and acceptance of the modified body and 2) emotional changes after breast cancer and coping initiatives, built based on the emotional findings after illness. Conclusion: Breast cancer is a disease which characterizes risks to life and brings with it a series of experiments to women. The changes and difficulties caused by the disease imply adaptations and adjustments, both physical (due to sequels) and emotional (guilt, anger and negativity), enabling the experience of different feelings, even after twelve months of surgery

Mapeamento dinâmico da dor aos três, seis e nove meses após a cirurgia do câncer de mama / Dynamic pain mapping at three, six and nine months after breast cancer surgery

Purpose: To map pain frequency and pain intensity according to activities in the physical domain of the Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH), at three, six and nine months after breast cancer surgery. In addition, to verify the correlation between upper limb function and pain intensity. Methods: This is a prospective cohort study, with follow-up at three time points. 22 Brazilian women diagnosed with breast cancer were included at three months after breast surgery. They performed the DASH questionnaire, the Body Pain Diagram and the Visual Analogue Scale. Frequency measures were used to analyze the frequency and intensity of pain in the items of the physical domain of the DASH. Pearson's correlation coefficient between pain intensity and the DASH total score at the three different times was calculated, a 95% confidence interval was set. Results: For twenty-two women at three, six and nine months after surgery, the body area with the highest pain frequency was the upper limb (UL) homolateral to the surgery, although, the contralateral UL was also cited as one of the areas with the highest pain frequency at sixth and ninth month. Pain intensity at three and six months remained mild and moderate in ninth month. The DASH activities with the highest pain frequency were: “putting something on a shelf above your head”, “doing heavy household chores” and “carrying a heavy object”. The correlation between pain intensity and function of the UL contralateral to surgery at nine months was strong (r=0,718; p<0.01). Conclusion: The body area with the highest pain frequency at all three times points of analysis was the UL homolateral to the surgery, although the contralateral UL was also present in sixth and ninth month. There was an increase in pain intensity over time. The most painful activities were those that required large amplitudes in different planes of motion. At the ninth month, pain in the contralateral UL showed a strong correlation with limb dysfunction

Produção científica da área da saúde sobre a sexualidade humana

Background: Human sexuality is often treated in a limited way during academic formation, harming knowledge building. The analysis of scientific production facilitates the understanding of the identity of the research field and points the way forward. Objective: To analyze health scientific production on human sexuality and discuss foci of attention and knowledge gaps. Method: Three electronic databases were consulted: LILACS, PUBMED, SCIELO; and using the keywords “knowledge”, “attitude”, “comfort” and “curriculum” in Portuguese and english. All these were combined with the term “human sexuality”. It included papers published in English and Portuguese in the period between 2000 and 2010. Results: We selected 20 articles from 2022 analyzed. Of the total 50% came from nursing, 45% from medicine and 5% from occupational therapy. 65% of the analyzed articles were published in English and 35% in Portuguese. Conclusion : nursing and medicine produce the largest number of articles related to human sexuality. Although most of the articles analyzed were produced outside of Brazil, the country is increasing its production, showing a growing concern over an area that more and more reveals its importance in health professionals clinical practice.Embasamento: A sexualidade humana é frequentemente tratada de forma limitada na formação acadêmica, prejudicando a construção do conhecimento. A análise da produção científica facilita a compreensão da identidade da área de pesquisa e aponta perspectivas futuras. Objetivo: analisar a produção científica da área da saúde sobre sexualidade humana e discutir focos de atenção e lacunas de conhecimento. Método: três bases de dados eletrônicas foram consultadas: LILACS, SCIELO e PUBMED, utilizando-se os descritores “conhecimento/knowledge”, “atitude/attitude”, “conforto/confort” e “formação acadêmica/curriculum”. Todos esses foram combinados com o termo “sexualidade humana”. Incluíram-se artigos científicos publicados em inglês e português no período entre 2000 e 2010. Resultados : Selecionaram-se 20 artigos dos 2.022 analisados. Do total, 50% foram escritos na área da enfermagem, 45% eram da área de medicina e 5% da Terapia Ocupacional. Dentre os artigos analisados, 65% foram publicados em inglês e 35% em português. Conclusão : Enfermagem e medicina produzem maior número de artigos relacionados à sexualidade humana. Apesar de maior parte dos artigos analisados terem sido produzidos fora do Brasil, o País vem aumentando sua produção, demonstrando crescente preocupação por uma área que cada vez mais evidencia sua importância na prática clínica do profissional da área da saúde

Motor and learning disabilities in school children with low academic performance

The study aimed to identify the motor and learning difficulties in students with low academic performance. Took part in the study 19 students, with 08 boys and 11 girls, mean age of 10.3 (± 1.20) years in a school, municipality of São José / SC-BR. The selection of participants occurred through the suggestion of teachers, pupils who had a history of poor academic performance during the semester. We used two scales: Movement Assessment Battery for Children and the School Performance Test. It was found that there was agreement between the results and initial indication of the teachers, as almost all pupils had learning difficulties, especially in reading and writing, as well as a representative number of students indicating they had motor difficulties. A significant number of children presented together with an indication of learning difficulties, problems with motor coordination. It is suggested to conduct research that will explore both the identification of developmental difficulties, and programs aimed at stimulating the economic well being, quality of life and health of children with learning and motor disabilities.O objetivo é verificar as dificuldades motoras e da aprendizagem em escolares com baixo desempenho escolar. Participaram da pesquisa 19 escolares, sendo oito meninos e onze meninas, com média de idade de 10,3 (± 1,20) anos de uma escola estadual, do município de São José/SC-BR. A seleção dos participantes ocorreu por meio da indicação dos professores, de alunos que apresentavam histórico de baixo desempenho escolar durante o semestre. Foram utilizados dois instrumentos de medida: a Movement Assessment Batery for Children e o Teste de Desempenho Escolar. Aproximadamente 20% das crianças apresentaram indicativo de dificuldades motoras e apenas uma criança não apresentou dificuldades de aprendizagem. Um número significante de crianças teve o indicativo de dificuldades de aprendizagem e problemas na coordenação motora. Sugere-se a realização de pesquisas que venham a explorar tanto a identificação de dificuldades desenvolvimentais, quanto programas de estimulação visando favorecer o bem estar, a qualidade de vida e a saúde de crianças com dificuldades de aprendizagem e motoras

Is the frequency of crossfit practice correlated with stress urinary incontinence? a transversal study of prevalence/ A frequência da pratica de crossfit esta correlacionada com a incontinência urinaria de esforço? Um estudo transversal de prevalência

Objective: To verify the prevalence of SUI symptoms in practitioners of high intensity physical activities, such as CrossFit, and to analyze the correlation of the high frequency of this activity with urinary losses, in a CrossFit gym in Greater Florianópolis - SC. Methods: This is a cross-sectional study in which the sample was composed of women who had practiced the CrossFit modality for over a month and over 18 years of age. A questionnaire was applied to assess the data regarding personal characteristics, reproductive life, training frequency and Crossfit time, perceptions about urine loss and evaluation by the Pad-test. Results: The final sample was 34 women, the average age of the participants was 30.3 ± 6.43 years. Among them, 76.4% were nulliparous, 61.7% had been practicing the sport for at least 8 months, 14% reported perceiving urine loss on a daily basis and 88.2% had stress urinary incontinence characterized as mild to moderate. A correlation of greater urinary loss was found the greater the frequency of weekly training Conclusion: Most of the women participating presented urine loss on exertion, classified as mild to moderate. Demonstrating that high intensity activities, such as Crossfit, and their weekly frequency can directly influence stress urinary incontinence. There is a need for further research with a larger sample, greater homogeneity of training and individualization in the evaluation

SEXUALIDADE NO BRASIL: CONTRIBUIÇÕES DOS GRUPOS DE PESQUISA CADASTRADOS NO CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO (CNPq)

This descriptive study investigated the Brazilian Research Groups registered in the CNPq Directory which supposed to publish in the sexuality field in the form of journals, books and chapters of books in the last three years (2010-2012). It was found 343 groups, responsible for 3670 published articles, 597 books and 2017 books’ chapters. However, in only 2.91% of articles, 7.03% of books and 9.17% of books’ chapters referred to the theme sexuality, with 82.24% of scientific articles related to the topic were indexed in theLatindex and Lilacs. Finally, it is concluded that few research groups were found, as well as, scarce scientific literature in the area of Physical Education to the thematic of sexuality. This initiative represents an important tool for identifying the state of the art about sexuality in Brazil, besides to disseminate the knowledge about the needs and demands on this scientific field

Factors associated with depression symptoms in women after breast cancer

OBJECTIVE: To analyze the factors associated with the presence of depression symptoms in women after breast cancer. METHODS: Cross-sectional study with 181 women with breast cancer, aged 57.0 years (SD = 9.5), who were undergoing treatment or after treatment in the Oncology Research Center in Florianópolis, state of Santa Catarina, Brazil. The questionnaire comprised items addressing general and health information, economic level, anthropometric measures, depression symptoms (Beck Depression Inventory), self-esteem (Rosenberg Self-Esteem Scale), and body image (Body Image After Breast Cancer Questionnaire). Descriptive and inferential statistical analysis were performed by chi-square and Fisher’s exact tests to verify association, Mann-Whitney U test to compare the groups and Poisson regression to identify the prevalence ratio of the factors associated with presence of depression symptoms (p < 0.05). RESULTS: We found an association between the presence of depression symptoms and the group of younger women (aged 40–60 years), those who had another disease besides cancer, those who had mastectomy surgery, those who suffered from lymphedema, and those who presented low–medium self-esteem. Less educated women presented more depressive symptoms, as did women with worse body image on the subscales of limitations, transparency, and arm concerns. CONCLUSIONS: Age, educational attainment, diagnosis of other diseases, type of surgery, lymphedema, self-esteem, and body image were factors associated with the presence of depression symptoms in Brazilian women after breast cancer. Health professionals should be aware of these relationships and try to detect depression symptoms earlier and improve the care they provide to these women