Orientadores: Rogério de Fraga, Paulo César Rodrigues Palma / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-19T13:53:02Z (GMT). No. of bitstreams: 1 Portugal_HelioSergioPinto_M.pdf: 2598145 bytes, checksum: dc80f2aa29eafa9cfc4a4e9612a4e9a7 (MD5) Previous issue date: 2011 / Resumo: Introdução e objetivos: O estudo da Anatomia humana se faz imprescindível para o conhecimento e compreensão do corpo humano como um todo, na importância e interação de todas as suas estruturas e características de cada um de seus órgãos ou partes, como meio essencial para promover a vida e cura dos males, intenção primária no ato de cuidar, enquanto técnica, arte e ciência, no seu mais expressivo compromisso (1). Além disto, a aula prática com o uso de componentes anatômicos manipuláveis é essencial para um bom processo de ensino e aprendizagem. Portanto, o componente pedagógico do material utilizado é essencial, de forma que as ferramentas escolhidas possam agregar valor na construção de uma aprendizagem significativa dos alunos. Os objetivos deste estudo foram avaliar: 1- o Modelo Anatômico Sintético de Assoalho Pélvico (MASAP) como uma ferramenta didática, comparando o mesmo com a pelve cadavérica (PC) durante a aula prática de Anatomia, e 2- a satisfação dos estudantes com ambos os métodos. Materiais e métodos: Foram utilizadas pelves cadavéricas e modelos anatômicos sintéticos de pelve. A pesquisa foi do tipo experimental, desenvolvida através de estudo prospectivo longitudinal. Sessenta e sete estudantes de Medicina, voluntários para este estudo, foram submetidos a um teste teórico preliminar (TTP) e a uma aula teórica de anatomia do assoalho pélvico. Após esta aula os estudantes foram randomizados em três grupos: G1, G2 e G3. G1 submeteu-se a aula prática tradicional de anatomia (APT) com o uso de PC, e G2 submeteu-se à aula prática proposta com uso do MASAP (APM). G3, denominado grupo controle, não foi submetido à aula prática. Um teste teórico final (TTF) foi aplicado para todos os grupos G1, G2 e G3. G1 e G2 foram submetidos a uma avaliação de satisfação relativa ao método utilizado para realização da aula prática (Avaliação do método - AM). Resultados: A média de idade foi 19.41 (± 1.58) em G1, 19.31 (± 3.43) em G2 e 19.42 (± 3.35) em G3. A análise estatística foi realizada utilizando-se ANOVA e teste não paramétrico Mann-Whitney. O nível de significância foi determinado como p ? 0.05. Ao TTF G3 apresentou escores mais baixos do que G1 (p=0,041) e G2 (p=0,000). Não foi encontrada diferença estatisticamente significante entre G1 e G2 (p>0,05). G2 apresentou maior satisfação com o método (p=0,001). Conclusão: PC e MASAP provaram serem ferramentas didáticas efetivas. G3 apresentou escores inferiores em relação a G1 e G2 possivelmente por não ser submetido a aulas práticas. G2 apresentou maior satisfação / Abstract: The study of human anatomy is indispensable for knowledge and understanding of the human body as a whole, that is to say, the importance and interaction of all its structures and characteristics of each of its organs or parts, as an essential means to promote life and healing ills, primary intention in the act of caring, while technical, art and science, in its most significant commitment (1). Furthermore, the practice class using a comprehensive and manageable anatomic component is fundamental for a good teaching and learning process. The goals of this study were to evaluate: 1- the synthetic anatomic model of pelvic floor (SAMPF) as a didactic tool comparing it to the traditional anatomic class using cadaveric pelvis (CP) and 2- the satisfaction of the students with both didactic methods. Sixty seven medicine students, volunteers for this study, received a conventional theoretic anatomy class. Following this class, all students were randomized in 3 groups (G1, G2 and G3). G1 and G2 attended anatomical classes with different didactic methods, respectively: traditional practice anatomy class (TPC), practice anatomy class with SAMPF (SPC). G3 denominated control group which had no practice class. A preliminary theoretical test (PTT) was applied to all groups. The G1 underwent to a TC and G2 to a SC. A final theoretical test (FTT) was applied to all groups G1, G2 and G3. G1 and 2 underwent to the evaluation of their satisfaction about the anatomic component used for the practice class (Evaluation of the method - EM). The mean age was 19.41 (± 1.58) in G1, 19.31 (± 3.43) in G2 and 19.42 (± 3.35) in G3. Statistical analysis was done using ANOVA and Mann-Whitney test. At FTT G3 presented lower scores than G1 (p=0.041) and G2 (p=0.000). Difference between G1 and G2 was not found (p > 0.05). G2 presented more satisfaction with the method (p = 0.001). We concluded that CP and SAMPF proved to be effective didactic tools. G3 presented lower scores than G1 and G2 possibly for not having attended to practical classes. G2 showed higher satisfaction / Mestrado / Fisiopatologia Cirúrgica / Mestre em Ciências

Orientadores: Paulo César Giraldo, Rose Luce Gomes do Amaral / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T18:50:12Z (GMT). No. of bitstreams: 1 Souza_SamanthadeMirandaFerreira_M.pdf: 2352034 bytes, checksum: 0109448068875c097377e02f427e2449 (MD5) Previous issue date: 2013 / Resumo: Introdução: O treinamento dos músculos do assoalho pélvico (TMAP) é uma técnica amplamente utilizada pela fisioterapia com o objetivo de aumentar a força muscular, aumentar o fluxo sanguíneo local e a mobilidade pélvica, além de informar a mulher sobre a sua anatomia e melhorar a conscientização corporal. O treinamento com esse foco poderia influenciar de maneira positiva a função dos músculos do assoalho pélvico (MAP) e a função sexual feminina. Objetivo: Avaliar as funções muscular e sexual feminina pré e pós TMAP de mulheres em idade reprodutiva sem disfunção uroginecológica e/ou sexual. Métodos: Ensaio clínico incluindo 68 mulheres nulíparas em idade reprodutiva sem disfunção uroginecológica e/ou sexual. A função dos MAP foi mensurada pré e pós TMAP pelas pressões intravaginais, potencial eletromiográfico de superfície (sEMG) e palpação bidigital. A função sexual foi avaliada pré e pós TMAP pelo questionário Female Sexual Function Index (FSFI) que enfatiza seis domínios (desejo, excitação, lubrificação, orgasmo, satisfação sexual e dor). O TMAP foi realizado em grupo, uma vez por semana durante 8 semanas, com 45 minutos de duração, usando 11 diferentes posições. Para cada posição foram solicitadas 5 contrações tônicas sustentadas por 6 segundos com igual tempo de relaxamento entre cada contração e 5 contrações fásicas, totalizando 110 contrações a cada sessão. As voluntárias foram orientadas a realizar em casa 30 contrações todos os dias da semana. Resultados: Foram observadas diferenças significativas ao compararmos os valores máximos das avaliações das pressões intravaginais pré e pós TMAP das contrações fásicas 41,7±13,7 vs. 47±14 (p=0,0023), tônicas de 10 segundos 42,7±13,8 vs. 47,7±15 (p=0,0085) e tônicas de 60 segundos 42,1±13 vs. 47,5±14,5 (p=0,0013) respectivamente. Também foram observadas diferenças significativas nos valores máximos do sEMG das avaliações pré e pós TMAP das contrações fásicas 27,7±11,2 vs. 31,3±12,6 (p=0,0009), tônicas de 10 segundos 27,7±10,9 vs. 31,5±13,6 (p=0,0017), tônicas de 60 segundos 28,6±11,8 vs. 31,1±13 (p=0,0232) e tempo de contração em segundos 41,7±22,1 vs. 49,3±27,7 (p=0,0252) respectivamente. Foram encontradas diferenças significativas pré e pós TMAP no escore total do FSFI 29,8±3,7 vs. 31,9±2,7 (p<0,0001) e nos domínios desejo 4,4±0,9 vs. 4,7±0,8 (p=0,0076), excitação 4,8±0,8 vs. 5,2±0,5 (p=0,0001), lubrificação 5,2±0,8 vs. 5,5±0,5 (p=0,0140) e orgasmo 4,5±1,4 vs. 5,3±0,9 (p<0,0001) respectivamente. Conclusão: O TMAP aumenta a função dos MAP e melhora a função sexual de mulheres em idade reprodutiva sem disfunção uroginecológica e/ou sexual / Abstract: Introduction: Pelvic floor muscles training (PFMT) is a technique widely used for physical therapy in order to increase muscle strength, increase local blood flow and pelvic mobility and inform women about their anatomy and improve awareness body. Training with this focus could positively influence the function of the pelvic floor muscles (PFM) and female sexual function. Objective: To evaluate the muscular function and female sexual function pre and post PFMT of women of reproductive age without urogynecologic and/or sexual dysfunction. Methods: A clinical trial including 68 nulliparous women of reproductive age without urogynecologic and/or sexual dysfunction. The function of the PFM was measured before and after the PFMT intravaginal pressures, potential surface electromyography (sEMG) and palpation bidigital. Sexual function was assessed before and after the PFMT the survey Female Sexual Function Index (FSFI) that emphasizes six domains (desire, arousal, lubrication, orgasm, sexual satisfaction, and pain). The PMAT group was performed once a week for 8 weeks, with 45 minutes using 11 different positions. For each position were requested 5 tonic contractions sustained for 6 seconds with equal relaxation time between contractions and 5 phasic contractions, totaling 110 contractions each session. The volunteers were instructed to perform 30 contractions at home every day of the week. Results: Significant differences were observed when comparing the maximum rating of intravaginal pressure pre and post PFMT of phasic contractions 41.7±13.7 vs. 47±14 (p=0.0023), tonic contractions of 10 seconds 42.7±13.8 vs. 47.7±15 (p=0.0085) and tonic of 60 seconds 42.1±13 vs. 47.5±14.5 (p=0.0013) respectively. There were also significant differences in the maximum values of sEMG pre and post PFMT of phasic contractions 27.7±11.2 vs. 31.3±12.6 (p=0.0009), tonic contractions of 10 seconds 27.7±10.9 vs. 31.5±13.6 (p=0.0017), tonics of 60 seconds 28.6±11.8 vs. 31.1±13 (p=0.0232) and contraction time in seconds 41.7±22.1 vs. 49.3±27.7 (p=0.0252), respectively. There were significant differences pre and post PFMT in total score FSFI of 29.8±3.7 vs. 31.9±2.7 (p<0.0001) and in those areas desire 4.4±0.9 vs. 4.7±0.8 (p=0.0076), arousal 4.8±0.8 vs. 5.2±0.5 (p=0.0001), lubrication 5.2±0.8 vs. 5.5±0.5 (p=0.0140) and orgasm 4.5±1.4 vs. 5.3±0.9 (p<0.0001) respectively. Conclusion: The PFMT increases the function of PFM and improves sexual function in women of reproductive age without urogynecologic and/or sexual dysfunction / Mestrado / Fisiopatologia Ginecológica / Mestra em Ciências da Saúde

Orientadores: Cássio Luís Zanettini Riccetto, Benedicto de Campos Vidal / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculade de Ciências Médicas / Made available in DSpace on 2018-08-21T00:28:08Z (GMT). No. of bitstreams: 1 Feitosa_IsabelCristinaAlbuquerque_M.pdf: 2111462 bytes, checksum: 4056f4a3329834819c83f886cc2bfe79 (MD5) Previous issue date: 2012 / Resumo: Introdução: A incontinência urinária é um problema de saúde muito prevalente, afetando entre 10% a 50% das mulheres em algum momento de sua vida, causando morbidade social e redução na qualidade de vida. Nas mulheres entre 40-59 anos a incontinência urinária de esforço é mais frequente e naquelas acima de 60 anos a urge-incontinência é mais prevalente. A mudança de padrão de incontinência com o aumento da idade pode sugerir que o envelhecimento em geral e as alterações fisiológicas decorrentes deste processo possam contribuir com a sua patogênese. Há vários anos foi demonstrado que os tecidos originados do seio urogenital são sensíveis aos hormônios sexuais, principalmente o estrógeno. Recentemente, tem surgido importante interesse no uso da suplementação de andrógenos nas mulheres. Embora existam significativos interesses nas aplicações clínicas dos andrógenos em mulheres, não se sabe exatamente como se dá a atuação destes hormônios no assoalho pélvico e trato urinário inferior. Objetivo: Analisar o efeito da suplementação de metiltestosterona sobre as propriedades anisotrópicas das fibras musculares e colágenas periuretrais de ratas. Métodos: Foi realizado um estudo experimental com 30 ratas que foram divididas em dois grupos: 15 ratas submetidas a suplementação de metiltestosterona por 60 dias e 15 ratas controles. Posteriormente foi removida a bexiga, uretra e região perineal em bloco. A região periuretral foi analisada através de microscopia de polarização, com quantificação da birrefringência das fibras musculares e colágenas. Resultados: A densidade média de brilho da musculatura, no grupo controle foi de 65,3070. No grupo com suplementação de testosterona foi 84,7624, portanto com diferença estatisticamente significativa (p =0,006). Quanto às medidas da birrefringência do colágeno periuretral nos grupos controle e com suplementação de testosterona, foram obtidas com mediana de 95,9436 no controle e a mediana foi de 100,8646 no grupo com testosterona, com diferença estatisticamente significativa entre os dois grupos avaliados, com p = 0,005. Conclusão: O uso de testosterona promoveu um aumento nos valores de birrefringência das fibras colágenas e musculares periuretrais de ratas submetidas a suplementação de metiltestosterona quando comparadas com o grupo controle / Abstract: Introduction: Urinary incontinence is a prevalent health problem, affecting between 10% and 50% of women at some point in their lives, causing social morbidity and reduced quality of life. Among women between 40-59 years of age, stress urinary incontinence is more frequent and in those above 60 years of age urge incontinence is more prevalent. The changing pattern of incontinence with increasing age may suggest that the aging process and the physiological changes resulting from this process may play a role in its pathogenesis. It has been shown for the last years that the tissues derived from urogenital sinus are sensitive to estrogen. Recently, there has been significant interest in the use of androgen supplementation in women. Although there is significant interest in clinical applications of androgens in women, it is not known exactly how occurs the action of these hormones in the pelvic floor and lower urinary tract. Objective: To analyze the effect of methyltestosterone supplementation on the anisotropic properties of the periurethral collagen and muscle fibers of rats. Methods: We conducted an experimental study with 30 female rats that were divided into 2 groups: 15 rats subjected to supplementation of methyltestosterone for 60 days and 15 control rats. Bladder, urethra, and perineum were removed en block after sacrifice. The periurethral region was analyzed by polarized light microscopy with quantification of the birefringence of muscle and collagen fibers. Results: The mean density of brightness of the muscles in the control group was 65.3070. In the group with testosterone supplementation was 84.7624, so the difference was statistically significant (p = 0.006). The measurements of birefringence of periurethral collagen fibers in control and testosterone groups were obtained with a median of 95.9436 in control and 100.8646 in the testosterone group, with statistically significant difference between them, with p = 0.005. Conclusion: The use of testosterone promoted an increase in the values of birefringence of periurethral collagen fibers and muscle tissue of rats submitted to methyltestosterone supplementation when compared with the control group / Mestrado / Fisiopatologia Cirúrgica / Mestre em Ciências

Anal acoustic reflectometry (AAR) is a technique that is currently under investigation for the assessment of faecal incontinence. It uses reflected sounds waves to measure cross sectional area at different pressures leading to a profile of the anal canal, and in particular the high pressure zone of the anal sphincters. The cross sectional area from the high pressure zone is then plotted on a graph to give seven characteristic parameters. AAR has been shown to be reproducible and reliable, able to distinguish between continence and incontinence, correlate with the severity of incontinence and able to discriminate between the three patterns of incontinence (urge, passive and mixed). Opening pressure has been shown to be an independent predictor of success with peripheral nerve evaluation, the trial period before sacral nerve stimulation. This thesis aimed to validate AAR against manometry and explore its physiological and clinical potential. A retrospective analysis of 265 patients who had undergone AAR was undertaken in order to develop a surrogate marker for anal canal length. The surrogate marker did find the expected difference between men and women but this was not clinically significant. Furthermore, the surrogate marker was unable to differentiate between incontinence and continence. A technical limitation (Gibbs phenomenon) of AAR was subsequently shown to explain this unexpected result. Prior manometry could possibly interfere with the interpretation of AAR, and therefore a prospective randomised cohort study of 30 patients was conducted to assess two orders of data collection. Reassuringly it does not matter which one of these investigations is undertaken first. In order to test the hypothesis that the greater the challenge to the anal sphincter, the greater the response, the effect of two rates of anal canal stretch was investigated in a prospective randomised cohort study of 50 patients with faecal incontinence. No difference was found between normal or fast rates of AAR. This study has validated a faster method of AAR that can be used alongside manometry in any order. A pudendal nerve block was used to investigate whether AAR assesses primarily internal or external sphincter function in a prospective cohort study of 15 patients using both AAR and manometry. Bilateral pudendal nerve block reduced the function of the external anal sphincter but had no effect on the internal sphincter using both techniques. This study suggests that AAR at rest is predominately an investigation of the internal anal sphincter. A prospective study of 30 patients with faecal incontinence was carried out to establish if AAR can predict the outcome from posterior tibial nerve stimulation. Posterior tibial nerve stimulation improved rectal sensation, manometry squeeze pressures, quality of life, severity of incontinence and was more effective for patients with urge incontinence. A variety of demographic, clinical and physiological measures were unable to predict the success of posterior tibial nerve stimulation. The results presented in this thesis suggest that the full clinical potential of AAR has yet to be realised and it will be necessary to compare it with high resolution anal manometry in the future. Progress in this field would be greatly facilitated by establishing the normal values for this technique and the development of a robust AAR assessment of the external anal sphincter.

Physiotherapist-supervised pelvic floor muscle (PFM) training is the recommended first-line treatment for women with stress urinary incontinence (SUI); however, only up to 50% of women are cured with this treatment. The primary objective of this study was to develop a predictive model of successful physiotherapy intervention outcomes among women with SUI using predictors that are accessible to clinicians. The secondary objective of this study was to run a preliminary investigation of morphologic differences between women with SUI who were cured with a physiotherapy intervention and those who were not cured, using a subset of ultrasound imaging data. Seventy-nine women with SUI were assessed at baseline on measures of demographic data (i.e. age, body mass index, etc.), 3-day bladder diary, 30-minute standardized pad test, clinical assessments of PFM strength and tone, and transperineal ultrasound assessments of PFM morphology. Women then attended a 12-week physiotherapy intervention and returned for a follow-up assessment. The multivariate logistic regression model was significant (p < .001) with two predictors: baseline ICIQ-FLUTS UI subscale (SUI severity; p = .01) and parity (p = .06). A significant ROC curve for the ICIQ-FLUTS UI subscale (p ˂ .01) predicts physiotherapy intervention outcomes with 55.6% sensitivity and 80.8% specificity at a cut-off score of 7.50. Women most likely to be cured with a physiotherapy intervention were those with lower scores on the ICIQ-FLUTS UI subscale and those who have given birth to fewer children. Significant differences were found in a subset of data between women with SUI who are cured with the physiotherapy intervention and women who are not cured on morphologic measures in standing of bladder neck height at peak cough (p = .03), descent of the bladder neck during maximal Valsalva maneuver (MVM; p = .04), levator hiatus circumference at rest (p = .03) and at maximal voluntary contraction in both standing and supine (MVC; p = .01; p = .03). Variables that were trending towards significance included bladder neck height in standing at rest, levator plate length (LPL) at maximal excursion during a cough and MVM in standing, and mid-urethral wall cross-sectional area. These significant differences indicate potential value in using ultrasound imaging outcomes as predictors of a cure with physiotherapy intervention in future models, and a combination of demographic, clinical, and morphologic variables may build a more robust predictive model.

Orientador: Eliana Martorano Amaral / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-24T09:22:10Z (GMT). No. of bitstreams: 1 Aiello_NathaliaAndreatti_M.pdf: 2711143 bytes, checksum: f003f162bdbfd33d275bd6287b804dc1 (MD5) Previous issue date: 2014 / Resumo: Objetivo: Avaliar a influência do parto vaginal espontâneo ou instrumental por fórcipe na contração muscular do assoalho pélvico de primíparas e na incontinência urinária (IU). Métodos: Estudo de coorte prospectivo, realizado no Hospital Universitário da Faculdade de Medicina de Jundiaí (HU-FMJ). Foram selecionadas 133 primíparas, no puerpério imediato, com idade entre 18-35 anos, que tiveram parto vaginal com episiotomia espontâneo ou instrumental por fórcipe. A contração dos músculos do assoalho pélvico (MAP) foi avaliada 40-55 dias após o parto, por meio de eletromiografia de superfície - EMGs (avaliando-se tônus de base ¿ TB, contração voluntária máxima - CVM e contração sustentada média - CSM) e por graduação de força segundo Escala de Oxford Modificada (graus 0-5). Avaliou-se a presença de IU durante a gestação e puerpério, utilizando o Internacional Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF). Os métodos estatísticos utilizados foram teste de Qui-Quadrado (X2) ou exato de Fisher para comparar proporções e teste Mann Whitney para comparar médias. Resultados: A média de idade foi de 22,3 anos (±4,2), o IMC gestacional foi de 27,6 Kg/m2 (±5,1). Apenas 44 mulheres realizaram avaliação puerperal, sendo uma descontinuada, 72,1% submetidas ao parto vaginal (PV) e 27,9% ao parto fórcipe (PF). A ocorrência de laceração perineal foi mais frequente no grupo PF (33,3%) do que no grupo PV (3,2%), mas as complicações devidas à episiotomia foram relatadas em apenas 7,0% dos casos, todos no grupo PV. A prevalência de IU foi de 37,6% durante a gestação e 39,5% no puerpério, sendo 32,3% do grupo PV e 58,3% do grupo PF. Houve mais IU desencadeada no puerpério no grupo PF [RR=3,10 (IC=95% 1,16-8,28); p=0,0468]. O sintoma urinário predominantemente referido no puerpério em ambos os grupos foi a urgeincontinência (29,5%), e a média do escore ICIQ foi 2,3 (±3,8) para o grupo PV e 4,2 (±3,9) para o grupo PF, não havendo diferença significativa entre os grupos. Apresentaram grau reduzido de força muscular 66,7% das puérperas do grupo PF e 27,6% do grupo PV. Os valores médios encontrados para TB, CVM e CSM do grupo PV foram 4,6?V, 23,2?V e 16,8?V e do grupo PF 3,4?V, 14,2?V e 10,7?V, respectivamente, havendo diferença significativa para TB e CVM. Conclusão: Entre as mulheres do estudo em questão observou-se associação do parto fórcipe com a diminuição da função dos MAP 40-55 dias após o parto na graduação de força por palpação e parâmetros eletromiográficos de TB e CVM, sem associação com IU / Abstract: Objective: To evaluate the influence of the spontaneous or instrumental vaginal delivery by forceps in the muscular contraction of the pelvic floor of primiparas and urinary incontinence (UI). Methods: Prospective cohort study, carried out in the University Hospital of the Faculty of Medicine of Jundiaí (HU-FMJ). 133 primiparas in the immediate puerperium, aged between 18-35, that have had vaginal delivery with spontaneous or instrumental episiotomy by forceps were selected. The contraction of the pelvic floor muscles (PFM) was evaluated 40-55 days after delivery, by means of surface electromyography - EMGs (evaluating tonus of basis - TB, maximum voluntary contraction - MVC and average of sustained contraction - ASC) and by muscle strenght graduation according to the Modified Scale of Oxford (degrees 0-5). The presence of UI during pregnancy and puerperium was evaluated according to the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF). The statistical methods used were the Qui-Square test (X2) or the accurate Fisher indicator to compare ratio and the Mann Whitney test to compare averages. Results: The average age was 22,3 years old (±4,2), gestacional BMI was 27,6 Kg/m2 (±5,1). Only 44 women returned for the puerperal evaluation and one volunteer was discontinued, 72.1% gave birth via spontaneous vaginal delivery (VD) and 27.9% via instrumental vaginal delivery (FD). The occurrence of perineal laceration was more frequent in the FD group (33.3%) than in the VD group (3.2%), but complications due to episiotomy were reported in only 7.0% of the cases, all in the VD group. There were more UI triggered puerperium in the group PF [RR=3,10 (CI=95% 1,16-8,28); p=0,0468]. The prevalence of UI was of 37,6% during pregnancy and 39.5% in the puerperium, where 32,3% of the VD group and 58,3% in the FD group. The urinary symptom predominantly related in the puerperium in both groups was the urge incontinence (29.5%), and the average of the ICIQ score was 2,3 (±3,8) for the VD group and 4,2 (±3,9) for the FD group, without significant differences between the groups. Showed reduced degree of muscular strength 66,7% of the puerperal in the FD group and 27.6% of the VD group. The found average values for TB, MVC and SVC in the VD group was 4,6 ?V, 23,2?V and 16,8?V and in the FD group was 3,4 ?V, 14,2?V and 10,7?V, respectively, with significant difference for TB and MVC. Conclusion: Among the women of the study concerned noted an association of forceps delivery and the reduction of the function of MAP was observed 40-55 days after delivery in the graduation of muscle strenght for palpation and electromyographic parameters of TB and MVC, not associated with UI / Mestrado / Saúde Materna e Perinatal / Mestra em Ciências da Saúde

Orientadores: Cássio Luís Zanettini Riccetto, Simone Botelho / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-26T20:25:50Z (GMT). No. of bitstreams: 1 Pereira_LarissaCarvalho_D.pdf: 1455670 bytes, checksum: 028e9285ce960006ae96f31fc2bd7369 (MD5) Previous issue date: 2015 / Resumo: O assoalho pélvico (AP) feminino é uma estrutura complexa e vulnerável, suscetível a uma série de alterações funcionais ao longo da vida. Ampliar o conhecimento sobre esta estrutura poderia prevenir ou mesmo tratar tais disfunções. Objetivo: (1) Avaliar e comparar a contratilidade dos músculos do assoalho pélvico (MAP) em diferentes fases do ciclo vital feminino: nuligestas; primigestas; puérperas primíparas; climatéricas e pós-menopausadas. (2) Correlacionar a contratilidade dos MAP e sua coativação a partir da contração dos músculos transverso abdome/oblique interno (TrA/OI) com os fatores: idade; prática de atividade física; gestação; Índice de Massa Corpórea (IMC); paridade; presença e severidade dos sintomas urinários. Métodos: 331 mulheres participaram do estudo e foram avaliadas através dos questionários: International Consultation on Incontinence Questionnaire - Short Form (ICIQ UI-SF) e International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB) para estudo dos sintomas urinários e eletromiografia (EMG) dos MAP para avaliação da contratilidade. Destas mulheres 92 foram submetidas também à EMG dos músculos TrA/OI e analisadas de acordo com os fatores propostos para estudar a influenciar da contratilidade na coativação. Resultado: Entre os grupos estudados, as nuligestas apresentam maior contratilidade (46.59±16.83?V) dos MAP, seguido do grupo das primigestas (35.31±18.22?V), puérperas de parto cesariana (33.28±13.00?V), puérperas de parto vaginal (31.23±16.12?V), climatéricas (25.81±17.57?V) e pós menopausadas (21.23±15.11?V). Houve correlação negativa entre a contratilidade dos MAP e a idade (p<0.0001), paridade (p<0.0001), ICIQ-SF (p=0.0001) e ICIQ OAB (p=0.0006). Não foi verificada correlação entre MAP e IMC (p=0.1348) e as mulheres que praticam atividade físca apresentam maior contratilidade dos MAP (p=0.03). Sobre os fatores que podem interferir na coativação foram significativos: a gestação (p=0.01), prática de atividade física (p=0.03) e altos valores do escore do ICIQ IU SF (p<0.0001). Em análise multivariada a atividade física juntamente com ICIQ IU SF influenciaram a contratilidade dos MAP e TrA/OI (p<0.001). Conclusão: A contratilidade dos MAP durante o ciclo vital feminino apresenta-se na seguinte ordem decrescente: nuligestas, primigestas, primíparas pós parto cesariana, primíparas pós parto vaginal, climatéricas e pós menopausadas. Os MAP apresentam sua contratilidade correlacionada inversamente com a idade, paridade, e escores do ICIQ SF e ICIQ OAB. A coativação entre o TrA/OI e os MAP é influenciada diretamente pela atividade física, e inversamente pela gestação e ICIQ IU SF. Em análise multivariada, verificou-se que, conjuntamente, a coativação é influenciada diretamente pela prática de atividade física e inversamente pelo escore ICIQ IU SF / Abstract: The female pelvic floor (PF) is a complex and vulnerable structure, susceptible to a number of functional changes throughout life. Increasing the knowledge of this structure could prevent or even treat such disorders. Objective: (1) To evaluate and compare the contractility of the pelvic floor muscle (PFM) at different stages of the female life cycle: nulliparous; primigravidae; primiparous postpartum women; climacteric and menopause. (2) To correlate the contractility of the PFM and their coactivation from the contraction of the transversus abdomen muscles/ internal oblique (TrA/IO) with the following factors: age; physical activity; pregnancy; Body Mass Index (BMI); parity; presence and severity of urinary symptoms. Methods: 331 women were evaluated through questionnaires: International Consultation on Incontinence Questionnaire - Short Form (ICIQ-UI SF) and International Consultation on Incontinence Questionnaire Overactive Bladder (OAB-ICIQ) for study of urinary symptoms and PFM electromyography (EMG) for contractility assessment. Of these women 92 were also submitted to the TrA EMG / IO muscles and analyzed according to the proposed factors to study the influence of contractility in coactivation. Results: Among the groups, the nulliparous have greater contractility (46.59 ± 16.83_V) of PFM, followed by the group of first pregnancy (35.31 ± 18.22_V), cesarean birth mothers (33.28 ± 13.00_V), vaginal birth mothers (31.23 ± 16.12_V), weather (25.81 ± 17.57_V) and postmenopausal (± 15.11_V 21:23). There was a negative correlation between the contractility of PFM and age (p <0.0001), parity (p <0.0001), ICIQ-SF (p = 0.0001) and ICIQ OAB (p = 0.0006). There was no correlation between the contractility of PFM and BMI (p = 0.1348). Women who practice physical activity have greater contractility of PFM About the factors that can interfere with coactivation were significant: pregnancy (p = 0.01), physical activity (p = 0.03) and high values of the ICIQ UI SF score (p<0.0001). In multivariate analysis, physical activity along with ICIQ UI SF influence the contractility of PFM and TrA/IO (p<0.001). Conclusion: The contractility of PFM during the female life cycle is presented in the following descending order: nulliparous, primiparous, primiparous after cesarean delivery, primiparous after vaginal delivery, climateric and postmenopausal. The PFM present their contractility inversely correlated with age, parity, and scores of ICIQ SF and ICIQ OAB. The co-activation between the TrA /IO and PFM is directly influenced by physical activity, and inversely by pregnancy and ICIQ UI SF. In multivariate analysis, it was found that, together, the co-activation is directly influenced by physical activity and inversely by ICIQ UI SF score / Doutorado / Fisiopatologia Cirúrgica / Doutora em Ciências

Urinary incontinence is a health condition that is associated with involuntary leakage of urine. Stress urinary incontinence (SUI) describes involuntary leakage of urine on effort or exertion and can impact one’s ability to participate in activities and affect quality of life. Furthermore, clinical management of this health condition is challenging as individuals who experience urinary incontinence often do not report this concern to a health care provider. Stress urinary incontinence is not typically a health concern associated with young, healthy athletes. However, researchers have begun to examine the presence of this health condition amongst both a younger population and in athletes. Therefore, the purpose of this study is to assess the prevalence of stress urinary incontinence in collegiate female athletes. This study involved the development of an electronic survey tool to assess the prevalence of SUI in the female collegiate athlete. Female collegiate athletes from six different NCAA Division I schools were asked to complete the survey. The overall response rate for the survey was 32.6% (333/1020). Results indicate that SUI does in fact occur in NCAA Division I collegiate female athletes. Overall, 68.5% of female collegiate athletes surveyed reported ever experiencing SUI. During daily life activities (cough, sneeze, laugh), 54.2% of female collegiate athletes reported experiencing SUI. During participation in their sport, 40.0% of female collegiate athletes reported experiencing SUI, referred to as sports-related SUI. When reporting SUI experienced during either sport participation or during other exercise-based activities, 58.2% of female collegiate athletes reported SUI. The proportion of female athletes reporting sports-related SUI varied by sport. The highest prevalence of leakage in sport was reported by gymnasts (80%) and the lowest prevalence was reported by those who participated in rifle (0%). Over half (52.3%) of female athletes who reported sports-related SUI said their symptoms first began in high school. While majority of female collegiate athletes stated they did not avoid their sport because of SUI, one-fifth (20.5%) of athletes with sports-related SUI reported they alter how they move in their sport out of concern for leakage. The impact of sports-related SUI on other aspects of life (family, social, or school life) were reported to be minimal. Athletes who experience sports-related SUI are most likely to tell either a teammate (49%) or no one (36%). Very few female athletes have told someone in healthcare about this concern: doctor (3%), athletic trainer (4%); physical therapist (1%). Furthermore, only 3% of female collegiate athlete with sports-related SUI reported ever seeking treatment and only 25.8% reported they would find value in seeing a healthcare provider to discuss SUI. Most (76.7%) female collegiate athletes, whether they reported SUI or not, stated they had never been instructed on exercises to strengthen the pelvic floor muscles and 60.6% reported they would find educational programs involving exercises to decrease or prevent SUI beneficial. In conclusion, SUI does occur in the female collegiate athlete and is often not reported to healthcare providers. Based on this information, the general practice of screening athletes for relevant health conditions during pre-participation physicals may need to include additional questions for SUI. Further investigation needs to explore how to best engage and educate female collegiate athletes on the subject of SUI and how to successfully communicate with and address those with the condition.

Bakgrund Bäckenbottendysfunktion (BBD) är vanligt hos personer som genomgått förlossning, och kan påverka den hälsorelaterade livskvaliteten. Fysioterapeutisk behandling av BBD kan både symptomlindra och förbättra den hälsorelaterade livskvaliteten (HRQoL). Syfte Att beskriva hur personer 1-5 år postpartum skattar sina bäckenbottenbesvär och sin hälsorelaterade livskvalitet, samt att utreda sambandet mellan BBD och HRQoL. Att utreda hur många av deltagarna som fått behandling av fysioterapeut. Metod I tvärsnittsstudien deltog 205 personer med bäckenbottendysfunktion (medelålder 33,56 år, SD=±4,7). En webbenkät publicerades på fyra Facebooksidor. För korrelationerna användes icke-parametrisk statistik och beräknades med Spearmans korrelationskoefficient. Resultat Medianvärdet för deltagarnas skattade BBD med PFDI-20 var 95. Högst skattat av deltagarnas HRQoL mätt med RAND-36 var delskalan fysisk funktion med medianvärde 80, lägst var vitalitet med 35. Korrelationerna mellan BBD och olika delar av HRQoL varierade mellan delskalan smärta (r= -0,550) som högst, emotionell rollfunktion (r= -0,358) som lägst, och alla korrelationer hade p&lt;0.001. Starkast negativ korrelation mellan sexuell dysfunktion och HRQoL hittades inom dimensionen fysisk funktion (r= -0,517), och svagast för vitalitet (r=-0,235). Samtliga korrelationer hade p&lt;0,001. Av samtliga deltagare har 40% träffat fysioterapeut/sjukgymnast. Konklusion Deltagarna skattade sin BBD högre än en normalpopulation. Studien påvisar en negativ korrelation både mellan BBD mätt med PFDI-20, en egenformulerad fråga om sexuell dysfunktion och skattad HRQoL mätt med RAND-36. Trots upplevd BBD har enbart hälften av deltagarna fått vård för sina besvär. / Background Pelvic floor dysfunction (BBD) is common among people post partum, and it can affect the health-related quality of life (HRQoL). Physiotherapy for the pelvic floor can both ease symptoms and improve HRQoL. Purpose To describe how people 1-5 years postpartum estimate their BBD and their HRQoL, and to investigate the correlation between BBD and HRQoL. To investigate how many of the participants that have received treatment from a physiotherapist. Method In this cross-sectional study 205 people with BBD participated (mean age 33.56 years, SD=± 4.7). A web survey was published on four Facebook pages. Non-parametric statistics were used, and calculated with Spearman's correlation coefficient. Results The median value for the participants' estimated BBD with PFDI-20 was 95. The highest of the participants' HRQoL measured with RAND-36 was the subscale physical function with a median value of 80 and the lowest was vitality with 35. The correlations between BBD and the various subscales for HRQoL varied between pain (r = -0.550) as the highest, and emotional role function (r = -0.358) as the lowest, and all correlations had p &lt;0.001. The strongest negative correlation between sexual dysfunction and HRQoL was physical function (r = -0.517), and the weakest was vitality (r = -0.235). All correlations had p &lt;0.001. Of all participants, 40% have seen a physiotherapist. Conclusion The participants rated their BBD higher than an average population. The study shows a negative correlation between BBD measured with PFDI-20, a question about sexual dysfunction and estimated HRQoL measured with RAND-36. Despite perceived BBD, only half of the participants have received care for their problems.

Objectives Despite their growing prevalence, pelvic floor disorders (PFDs) remain undertreated and not well understood by patients, with treatment disparities noted in specific subgroups of women. The goal of the present study was to determine the basic understanding of PFDs of women in the southern Appalachian region of the United States, to determine factors that predict knowledge, and to explore the possible disparities in seeking access to care among women in this region who reported symptoms. Methods A survey of patient knowledge of PFDs, specifically urinary incontinence (UI) and pelvic organ prolapse (POP), was conducted in Johnson City, Tennessee, and involved 305 female patients from this city and the surrounding region. Results Almost half of the participants (43%) reported UI symptoms, with only 25% of these participants reporting treatment. A much smaller percentage (5%) reported POP symptoms, but 44% reported receiving treatment. Overall proficiency for UI knowledge was 54.4%, and 69.5% for POP knowledge. Higher UI knowledge was predicted (P < 0.05) by age younger than 60 years, annual income >$50,000, more than a high school education, and being married. UI knowledge was unrelated to the presence of UI symptoms, receipt of UI treatment, or having seen a urospecialist. Higher POP knowledge was predicted (P < 0.05) by annual income >$50,000, more than a high school education, and presence of POP symptoms. The only factor significantly predicting seeking treatment among women with UI symptoms was marital status. Conclusions Overall knowledge of both UI and POP was reasonably high in this population, suggesting appropriate self-education or education by providers in the region. The women most affected by UI, particularly those older than 60 years, were not well informed, and education by providers does not appear to specifically target women seeking treatment. We must continue to educate and further reduce the gap of knowledge and treatment regarding PFDs in southern Appalachia.