A Dermatite Associada à Incontinência (DAI) representa um grande desafio para os profissionais de saúde que prestam assistência aos pacientes no Centro de Terapia Intensiva. A ocorrência desta reação inflamatória da pele associada à umidade predispõe a pessoa à dor representando um impacto negativo na qualidade de vida dos pacientes, aumentam o tempo de internação hospitalar e consequentemente o custo do tratamento. Os objetivos do estudo foram: identificar e descrever as características sociodemográficas e clinicas dos pacientes com incontinência e daqueles com DAI internados em um Centro de Terapia Intensiva de um hospital privado; identificar os índices de prevalência pontual da incontinência e da DAI; descrever as características da DAI e os produtos usados para o cuidado da pele perineal dos pacientes; verificar a associação entre a presença da DAI e as variáveis demográficas e clínicas. Trata-se de um estudo transversal, descrito e analítico, quantitativo, aprovado pelo Comitê de Ética em Pesquisa. A coleta de dados aconteceu em um único dia, no Centro de Terapia Intensiva, com 93 participantes. A maioria deles (78,5%) tinha idade acima de 60 anos (média 72, DP 18,2), sexo feminino (50,5%), pele branca (80%). Dentre os diagnósticos médicos, as doenças do aparelho respiratório e circulatório representaram 29% e 19,4%, respectivamente. O tempo de internação médio foi de 18,3 dias (DP 24,4). A prevalência da incontinência urinária foi de 33,3% e a fecal, 51,6%. O cateter vesical estava sendo utilizado em 24,7% dos pacientes e a fralda em 66,7%.Quanto a eliminação das fezes, a maioria dos pacientes internados na UTI (83,3%) apresentou fezes semilíquidas e líquidas, com a ocorrência de diarreia em 20,4% dos pacientes. A prevalência pontual da DAI foi de 40,9% e a prevalência da DAI em pacientes incontinentes, 59,2%. O local onde a DAI apresentou maior prevalência nos pacientes incontinentes foi a UTI. O eritema da pele lidera a lista de manifestação mais prevalente (89,4%), seguida pela erosão (21,1%). A maioria (76,3%) das DAI ocorreu na região perianal, seguida pela região perineal (39,5%) e região interglútea (34,2%). A presença da DAI apresentou associação estatisticamente significante quanto à alteração do nível de consciência, uso de antibiótico, corticoide, jejum ou uso da via enteral para suporte nutricional, uso de tubo orotraqueal para oxigenação, restrição mecânica, presença da incontinência, frequência evacuatória, consistência das fezes, emprego de cateter vesical de demora e/ou fralda. Adotou-se película líquida em 40% dos pacientes para prevenção da DAI e em 47,3% para o tratamento. Empregou-se o limpador sem enxague em 36,8% dos pacientes com DAI. A prescrição de ao menos um produto preventivo não foi encontrada em 34,5% dos pacientes. Não houve prescrição de tratamento em 13,1% dos pacientes com DAI. Os resultados encontrados contribuem para o diagnóstico situacional da ocorrência da DAI. Este estudo poderá contribuir para a sistematização das práticas clínicas e adoção de protocolos assistenciais visando a qualidade e segurança do paciente / Incontinence-associated dermatitis (IAD) represents a significant health challenge for professionals who provide care to patients in the Intensive Care Unit (ICU). The occurrence of moisture-associated skin damage can cause pain with a negative impact on quality of life and can increase the length of hospital stay and the cost of treatment. The objectives of this study were to: identify and describe the sociodemographic and clinical characteristics of patients with incontinence and with IAD admitted to the ICU of a private hospital; Identify the prevalence rate of incontinence and IAD; Describe the characteristics of IAD and the perineal skin care products; Verify the association between the presence of IAD and the demographic and clinical variables. This cross sectional, descriptive, analytical, quantitative study was approved by a Research Ethics Committee. Data were collected on a single day, in the intensive care unit, totaling 93 patients. Most patients were female (50.5%), with white skin (80%) and mean age 72 +/- 18.2 years. Among medical diagnoses, respiratory and circulatory diseases accounted for 29%, and 19.4%, respectively. mean hospitalization time was 18.3 +/- 24.4 days. The overall prevalence of urinary incontinence was 33.3% and fecal in 51.6%. Urinary catheter was being used in 24.7% and diaper in 66.7% of the patients. Regarding stool elimination, the majority of patients admitted to the ICU (83.3%) had semi-liquid and liquid stools, with diarrhea occurring in 20.4% of the patients. The point prevalence of IAD was 40.9% and the prevalence of IAD in incontinent patients was 59.2%. The ICU was the site that DAI was most prevalent in incontinent patients. Erythema was the most common skin manifestation (89.4%), followed by erosion (21.1%). Most of the IAD (76.3%) occurred in the perianal region, followed by the perineal one (39.5%) and intergluteal area (34.2%). The presence of IAD was associated with the change in the level of consciousness, use of antibiotic, corticoid, fasting or enteral nutritional support, orotracheal tube, mechanical restriction, presence of incontinence, stools frequency and consistency, urinary catheter and / or diaper. Liquid film was used in 40% of patients for IAD prevention and 47.3% for treatment. The cleaner without rinsing was used in 36.8% of patients with IAD. Prescription of a preventive product was not found in 34.5% of patients. There was no prescription of treatment in 13.1% of patients with IAD. The results found contribute to the situational diagnosis of the occurrence of IAD. This study may contribute to the systematization of clinical practices and adoption of assistance protocols aiming at the quality and safety of the patient

Made available in DSpace on 2016-04-27T13:10:23Z (GMT). No. of bitstreams: 1 Aline Fernanda Negri.pdf: 1813249 bytes, checksum: 619a566754cc2e292183550506860c41 (MD5) Previous issue date: 2014-03-20 / Urinary incontinence is a condition of loss of bladder control that causes several changes in the social life of women. The treatments offered to these women include medical, surgical and behavioral treatment. This study followed four women with stress urinary incontinence, instituting behavioral therapy as treatment and using behavioral analysis as a method. Aiming to check the change in muscle strength with the guidance of a program to strengthen the muscles of the perineum, alternating the use of self-monitoring. Conducting weekly individual consultations at different times for each participant, 6-14 weeks of follow-up period. The data were analyzed and compared individually for each participant. At the end of the follow three participants obtained higher values in the objective assessment of muscle strength compared with the original, the four women had higher values in the subjective assessment of muscle strength of the muscles of the perineum and all reported improvement of symptoms. Self-monitoring was considered an important tool to monitor these women / A incontinência urinária é uma condição de perda do controle vesical que ocasiona diversas alterações no convívio social das mulheres. Os tratamentos propostos a estas mulheres incluem tratamento medicamentoso, cirúrgico e comportamental. Este estudo acompanhou quatro mulheres com incontinência urinária de esforço, instituindo terapia comportamental como tratamento e utilizando análise comportamental como método. Teve como objetivo verificar a alteração de força muscular, com a orientação de um programa de fortalecimento da musculatura do períneo, alternando a utilização de automonitoramento. Realizou-se consultas individuais semanais em período diferentes para cada participante, de 6 a 14 semanas de acompanhamento. Os dados foram analisados e comparados individualmente por participante. Ao final do acompanhamento, três participantes obtiveram valores superiores na avaliação objetiva da força muscular comparado com a inicial; as quatro mulheres apresentaram valores superiores na avaliação subjetiva da força muscular da musculatura do períneo e todas relataram melhora dos sintomas. O automonitoramento foi considerado uma ferramenta importante para o acompanhamento destas mulheres

A Dermatite Associada à Incontinência (DAI) representa um grande desafio para os profissionais de saúde que prestam assistência aos pacientes no Centro de Terapia Intensiva. A ocorrência desta reação inflamatória da pele associada à umidade predispõe a pessoa à dor representando um impacto negativo na qualidade de vida dos pacientes, aumentam o tempo de internação hospitalar e consequentemente o custo do tratamento. Os objetivos do estudo foram: identificar e descrever as características sociodemográficas e clinicas dos pacientes com incontinência e daqueles com DAI internados em um Centro de Terapia Intensiva de um hospital privado; identificar os índices de prevalência pontual da incontinência e da DAI; descrever as características da DAI e os produtos usados para o cuidado da pele perineal dos pacientes; verificar a associação entre a presença da DAI e as variáveis demográficas e clínicas. Trata-se de um estudo transversal, descrito e analítico, quantitativo, aprovado pelo Comitê de Ética em Pesquisa. A coleta de dados aconteceu em um único dia, no Centro de Terapia Intensiva, com 93 participantes. A maioria deles (78,5%) tinha idade acima de 60 anos (média 72, DP 18,2), sexo feminino (50,5%), pele branca (80%). Dentre os diagnósticos médicos, as doenças do aparelho respiratório e circulatório representaram 29% e 19,4%, respectivamente. O tempo de internação médio foi de 18,3 dias (DP 24,4). A prevalência da incontinência urinária foi de 33,3% e a fecal, 51,6%. O cateter vesical estava sendo utilizado em 24,7% dos pacientes e a fralda em 66,7%.Quanto a eliminação das fezes, a maioria dos pacientes internados na UTI (83,3%) apresentou fezes semilíquidas e líquidas, com a ocorrência de diarreia em 20,4% dos pacientes. A prevalência pontual da DAI foi de 40,9% e a prevalência da DAI em pacientes incontinentes, 59,2%. O local onde a DAI apresentou maior prevalência nos pacientes incontinentes foi a UTI. O eritema da pele lidera a lista de manifestação mais prevalente (89,4%), seguida pela erosão (21,1%). A maioria (76,3%) das DAI ocorreu na região perianal, seguida pela região perineal (39,5%) e região interglútea (34,2%). A presença da DAI apresentou associação estatisticamente significante quanto à alteração do nível de consciência, uso de antibiótico, corticoide, jejum ou uso da via enteral para suporte nutricional, uso de tubo orotraqueal para oxigenação, restrição mecânica, presença da incontinência, frequência evacuatória, consistência das fezes, emprego de cateter vesical de demora e/ou fralda. Adotou-se película líquida em 40% dos pacientes para prevenção da DAI e em 47,3% para o tratamento. Empregou-se o limpador sem enxague em 36,8% dos pacientes com DAI. A prescrição de ao menos um produto preventivo não foi encontrada em 34,5% dos pacientes. Não houve prescrição de tratamento em 13,1% dos pacientes com DAI. Os resultados encontrados contribuem para o diagnóstico situacional da ocorrência da DAI. Este estudo poderá contribuir para a sistematização das práticas clínicas e adoção de protocolos assistenciais visando a qualidade e segurança do paciente / Incontinence-associated dermatitis (IAD) represents a significant health challenge for professionals who provide care to patients in the Intensive Care Unit (ICU). The occurrence of moisture-associated skin damage can cause pain with a negative impact on quality of life and can increase the length of hospital stay and the cost of treatment. The objectives of this study were to: identify and describe the sociodemographic and clinical characteristics of patients with incontinence and with IAD admitted to the ICU of a private hospital; Identify the prevalence rate of incontinence and IAD; Describe the characteristics of IAD and the perineal skin care products; Verify the association between the presence of IAD and the demographic and clinical variables. This cross sectional, descriptive, analytical, quantitative study was approved by a Research Ethics Committee. Data were collected on a single day, in the intensive care unit, totaling 93 patients. Most patients were female (50.5%), with white skin (80%) and mean age 72 +/- 18.2 years. Among medical diagnoses, respiratory and circulatory diseases accounted for 29%, and 19.4%, respectively. mean hospitalization time was 18.3 +/- 24.4 days. The overall prevalence of urinary incontinence was 33.3% and fecal in 51.6%. Urinary catheter was being used in 24.7% and diaper in 66.7% of the patients. Regarding stool elimination, the majority of patients admitted to the ICU (83.3%) had semi-liquid and liquid stools, with diarrhea occurring in 20.4% of the patients. The point prevalence of IAD was 40.9% and the prevalence of IAD in incontinent patients was 59.2%. The ICU was the site that DAI was most prevalent in incontinent patients. Erythema was the most common skin manifestation (89.4%), followed by erosion (21.1%). Most of the IAD (76.3%) occurred in the perianal region, followed by the perineal one (39.5%) and intergluteal area (34.2%). The presence of IAD was associated with the change in the level of consciousness, use of antibiotic, corticoid, fasting or enteral nutritional support, orotracheal tube, mechanical restriction, presence of incontinence, stools frequency and consistency, urinary catheter and / or diaper. Liquid film was used in 40% of patients for IAD prevention and 47.3% for treatment. The cleaner without rinsing was used in 36.8% of patients with IAD. Prescription of a preventive product was not found in 34.5% of patients. There was no prescription of treatment in 13.1% of patients with IAD. The results found contribute to the situational diagnosis of the occurrence of IAD. This study may contribute to the systematization of clinical practices and adoption of assistance protocols aiming at the quality and safety of the patient

Syfte och frågeställningar Syftet var att undersöka i vilken utsträckning mödrahälsovården i Stockholms läns landsting följer de riktlinjer som finns gällande bäckenbottenbedömning och information om knipträning vid eftervårdsbesöket och om det skiljer sig mot övriga landet. Syftet följs av ett flertal frågeställningar men den primära lyder; i vilken utsträckning har nyförlösta kvinnor fått information gällande knipövningsinstruktioner samt blivit erbjudna en vaginal undersökning hos mödrahälsovården? Metod Kvinnor i Sverige som fött barn 2018 deltog. Tillsammans med ett brev skickades en enkät ut till 6155 personer i 3 olika facebookgrupper och fanns tillgänglig i två veckor. Resultaten sammanställdes via överföring från Google formulär till tabeller i Excel. De data som samlades in analyserades i programmet SPSS. Av 155 svar inkluderades totalt 108 svar i analysen, 32 från Stockholm och 76 från övriga landet. 48 svar togs bort på grund av att de inte nådde upp till inklusionskriterierna. Resultat Sett till hela landet blev 73% (n=79) av kvinnorna erbjudna en vaginal undersökning vid eftervårdsbesöket hos mödrahälsovården medan 23% (n=25) inte blev det (vet ej, n=1, bortfall, n=3). I Stockholm blev 75% (n=24) erbjudna en undersökning. 51% (n=55) av alla kvinnor fick instruktioner om knipövningar, 44% (n=48) fick inte det (vet ej, n=3, bortfall n=2). Resultaten i Stockholm säger att 50% (n=16) fick knipinstruktioner. Av de kvinnor som förlösts vaginalt blev 79% (n=71) erbjudna en vaginal undersökning vid eftervårdsbesöket samtidigt som endast 44% (n=8) av de som förlösts med kejsarsnitt blev erbjudna samma undersökning (p=0,001). 10% (n=11) av kvinnorna uppgav att de hade urininkontinens och 73% (n=8) av de här kvinnorna ville ha fler träffar med utbildad personal för stöd och hjälp med knipträning. Slutsats Resultaten bekräftade hypotesen om att riktlinjerna ej efterföljdes i den utsträckning de borde, både gällande bäckenbottenbedömning och information om träning. Inga direkta skillnader kan ses vid jämförelser mellan Stockholm och övriga landet, med undantag för förekomst av urininkontinens, vilken var större i Stockholm. En viktig skillnad kan dock ses vid jämförelsen av att de som förlösts vaginalt i större utsträckning blev erbjudna en vaginal undersökning vid eftervårdsbesöket än de som förlösts med kejsarsnitt. Från de kommentarer kvinnorna lämnat går även att utläsa att flertalet vill ha mer och personligare information.

This thesis investigated lifestyle characteristics including cigarette smoking, alcohol consumption, dietary supplements intake, physical activity, and urinary incontinence status for Japanese patients with chronic obstructive pulmonary disease (COPD). Field studies were conducted in the middle of Japan. The study was conducted using a cross-sectional survey and all patients were recruited from the outpatient departments of six hospitals in three districts/prefectures, namely, Aichi, Gifu, and Kyoto. Three hundred referred COPD patients diagnosed by respiratory physicians were recruited in 2006. Inclusion criteria were (i) aged between 50 and 75 years; and (ii) had COPD as the primary functionally limiting illness which was diagnosed within the past four years. Diagnosis of COPD was confirmed by spirometry with FEV1/FVC < 70%, where FEV1 = forced expiratory volume in one second and FVC = forced vital capacity. A structured questionnaire was administered to collect information on lifestyle characteristics. All interviews, averaging 40 minutes, took place in the hospital outpatient departments. Clinical characteristics, height, weight and presence of any co-morbidity (e.g. diabetes, hypertension, cardiovascular disease), were retrieved from medical records. / A total of 278 eligible participants (244 men and 34 women) were available for analysis. The majority were men (88%) with mean age 66.5 (SD 6.7) years and mean body mass index (BMI) 21.9 (SD 3.6). Most of them were married (84%), had high school or below education (80%) and retired (55%). In relation to cigarette smoking, 62 (53 male and 9 female) participants (22.5%) were current smokers of whom the great majority (89%) smoked daily. Only six (2.1%) participants were never smokers. The prevalence of smoking by time from diagnosis was: 24.5% (< 1 year), 20.6% (1-2 years), and 18.9% (2-4 years). Continuous smoking was inversely associated with age (odds ratio (OR) = 0.94, 95% confidence interval (CI) 0.90-0.98), BMI (OR = 0.88, 95% CI 0.80-0.97) and disease severity vii (OR = 0.29, 95% CI 0.12-0.74 for severe COPD and OR = 0.29, 95% CI 0.09-0.92 for very severe COPD). For alcohol consumption, 158 (150 male and 8 female) patients (56.8%) drank alcohol regularly on at least a monthly basis, the majority of them (73.4%) being daily drinkers. Beer was the most preferred alcoholic beverage drank (30.9%). Alcohol intake appeared to be positively associated with the habit of adding soy sauce to foods, whereas dyspnoea of patients posed significant limitations for them to drink alcoholic beverages. / Also, female patients tended to have lower alcohol consumption levels than male patients. Regarding dietary supplements, 117 (101 male and 16 female) participants (42.1%) were dietary supplement users, but the prevalence for female patients (47.1%) was higher than male patients (41.4%). Younger patients (≤ 60 years) and those with severe COPD had relatively low proportion of users (27.3% and 28.9%, respectively). Dietary supplementation was found to be affected by age (p = 0.04), COPD severity (p = 0.03) and presence of co-morbidity (p = 0.03). Older patients over 60 years were more likely to take dietary supplements (OR = 2.44, 95% CI 1.03-5.80), whereas severe COPD patients (OR = 0.41, 95% CI 0.18-0.95) and those with a co-morbidity (OR = 0.54, 95% CI 0.32-0.94) tended not to use. With respect to physical activity of COPD patients, 198 (175 male and 23 female) of them (77%) participated in physical activities on at least weekly basis, but only 22% and 4% engaged in moderate and vigorous activities, respectively. Over 2/3 of them walked at least weekly. Regression analysis showed that perceived life-long physical activity involvement appeared to be positively associated with total physical activity, whereas patients with very severe COPD tended to have significantly lower total physical activity levels. / Besides COPD severity, both age and smoking exhibited a negative impact on walking. It is evident that walking activities decreased among very severe patients, current smokers and those in advanced age. The prevalence of urinary incontinence was 12.6% (10% for men and 32% for women). The most common occurrence of urine loss was before reaching the toilet (54%) followed by coughing/sneezing (23%). While urge incontinence was reported viii by 63% of male incontinent patients, 82% of female incontinent patients experienced stress incontinence. Incontinence was more likely among female patients (OR = 8.7, 95% CI 3.2-23.4) and older patients over 70 years (OR = 2.3, 95% CI 1.0-5.2). COPD severity was also found to be a significant factor (p = 0.007), with very severe patients at slightly higher risk of urinary incontinence (OR = 1.1, 95% CI 0.3-3.5) than mild COPD patients, though the relationship appeared not to be linear across the severity classifications. It is alarming to find mild and moderate COPD patients continue to smoke. The implementation of a co-ordinated tobacco control program immediately post diagnosis is needed for the effective pulmonary rehabilitation of COPD patients. The high alcohol consumption by COPD patients is also alarming. Alcohol control programs targeting male patients should be promoted during pulmonary rehabilitation in order to minimise the harm due to excessive drinking. Dietary supplements are popular for patients with COPD especially among older patients. / The findings are important to clinical trials and experimental interventions advocating nutritional supplementation therapy for pulmonary rehabilitation. Patients with COPD had lower physical activity levels than the general elderly population. Older patients with very severe COPD and those who currently smoke should be targeted for intervention and encouraged to increase their participation in physical activity so as to maintain their health and well being. The high prevalence yet underreporting of urinary incontinence suggested that education and regular assessment are needed after COPD diagnosis. Appropriate exercise and treatment tailored for the specific type of incontinence incurred should be incorporated within the rehabilitation program of COPD patients. To maintain a healthy lifestyle and to achieve optimal outcomes during the pulmonary rehabilitation of COPD patients, the identified factors should be taken into consideration and health awareness programs should be promoted in conjunction with respiratory physicians and allied health professionals.

The purpose of this thesis is to explore how men experience living with localized prostate cancer. It includes four substudies carried out between 1997 and 2005. To gather data, the men were interviewed at home and the interviews were recorded. The men (n=27; ages 60-70) who participated in the substudies had a PSA ≤10 ng/ml at the time of diagnosis, and had what is known as low-risk prostate cancer. Seven of the men chose to “wait and see” how the disease would progress after receiving the diagnosis. Twenty men chose curative treatment (10 men external radiation therapy, 10 men radical surgery). The interviews were analyzed using a phenomenological hermeneutical method inspired by the philosophy of Paul Ricoeur, and qualitative content analysis. Men who live with localized prostate cancer perceive the disease as life-threatening, unpredictable, and without early symptoms, which creates a sense of uncertainty, worry, anxiety, despair, and fear of death. Men primarily share perceptions of the disease and treatment with their wives and relatives, as well as with other men in the same situation. They avoid talking about their illness, and keep their innermost thoughts about their disease, prognosis, and the future to themselves. The choice to share their thoughts and feelings only sparingly with others is related in part to the perceived stigmatization of the diagnosis, as well as to consideration for friends and family. The men report that external radiation therapy and radical surgery have negative side effects such as erectile dysfunction, urinary incontinence, and intestinal leakage. They describe the side effects as socially isolating; for example, urinary leakage can require a change of incontinence pads and clothing, and they feel that they smell bad. Men with erectile dysfunction describe themselves as maimed, and their sex lives have changed or disappeared. They report a change in their self-esteem and identity as men and they long for life as it was before the diagnosis, when they felt they had control over their bodily functions. A few men describe a sense of being literally and figuratively “exposed” when they are undressed for examinations or participate in discussions with female doctors and nurses about their erectile dysfunction. They do not describe this perception in the same way with respect to contact with male personnel. In the new situation after treatment, men try to regain a perceived sense of control in their daily lives, over the disease and the effects of treatment. They experience a sense of control over the disease through regular PSA tests; the implications of regular PSA tests can be interpreted as a life preserver in an uncertain world, considering that at the time they were diagnosed they had no symptoms and only had a PSA elevation. The PSA is important for this sense of control, and each PSA test is preceded by tense expectation. The PSA level is described as a reliable expression of the medical condition. The men cannot trust that their own perception of feeling healthy means that the disease is under control. Low and stable PSA levels over a long period of time give a sense of safety, security, and control over the situation. If the PSA climbs, the men feel that despite everything, they have caught it in time for further treatment. Discussions with other men with prostate cancer are also described as a way of having control over the situation. The men's endeavor to reconcile themselves to the new situation can be understood as a process, where they describe various strategies which can be used to forget the “cancer perspective” and achieve a perception of safety and security. Reconciliation with a new situation can be interpreted as a reorientation after the trauma of the cancer diagnosis. The study results show that the men are restrained in communicating their needs to others, which can be interpreted as their having a greater need for support and information than indicated by their signals. Having an internal image of what a man should be like can be an obstacle to showing these needs.

Belastungsharninkontinenz (BHI) geht mit einem großen Verlust an Lebensqualität einher. Während bei der Frau durch Einführung der suburethralen Schlingen auf der Grundlage der Integraltheorie (Petros und Ulmsten) seit Jahren eine wirksame Therapieoption der BHI existiert, gibt es für den Mann bisher kein derart gereiftes theoretisches Konzept zur Erklärung der Inkontinenzmechanismen. Ein bestehendes Problem ist hier die noch immer kontrovers diskutierte Mikroanatomie, vor allem aber die Verankerung und das funktionelles Zusammenspiel der Kontinenz erzeugenden Einzelstrukturen. Anliegen dieser Arbeit ist es, eine Analyse der anatomischen Schnittstellen zwischen Beckenwand und Organen im Spatium retropubicum (ventraler vesikourethraler Suspensionsapparat, VVUS) beim Mann durchzuführen, um eine Ableitung von Aufgaben bei der Miktion und Erzeugung von Kontinenz herzustellen. Fernziele sind dabei, klinisch brauchbare Therapieformen der männlichen BHI voranzutreiben und einen Nutzen für die anatomische Lehre abzuleiten. Methodisch basiert die Arbeit auf makroskopisch-anatomischen Präparationen der sogenannten „puboprostatischen Bänder“ (PPL), des Arcus tendineus fasciae pelvis (ATFP) und der Beckenfaszien, ferner des M. pubococcygeus an Alkohol- und Thiel-fixierten männlichen Becken (n=11) mit kontinuierlicher Fotodokumentation. Die histologische Analyse ausgewählter Gewebeblöcke dient der Festlegung von Kontaktstellen der einzelnen Gewebe. Ein Pool aus 650 Dünnschnittpräparaten in HE- und Crossmon-Färbung wurde durch immunhistochemisch mit α-SMCA-AK markierten Schnitten zur exakten Differenzierung der muskulären Grundstruktur komplettiert. Die Schnittstelle zur Klinik bildet eine Pilotserie von MRT-Untersuchungen des VVUS bei 3 gesunden männlichen Probanden, die mit dem Präparationssitus verglichen wurde und Potenzial für zukünftige Studien aufzeigt. Wesentliche Erkenntnisse sind: 1. „Puboprostatische Bänder“ existieren nicht. Ein Komplex aus Einzelstrukturen, die vor allem Assoziation zur Harnblase haben, bildet das makroskopische Korrelat. 2. Die Mm. pubovesicales zeigen einen fächerförmigen Verlauf, daher sollte eine Neubezeichnung als M. collaris vesicae erfolgen. 3. Der ATFP dient als Aponeurose für die Mm. pubovesicales neben der Stabilisierung des vesikourethralen Überganges. 4. Die Endopelvine Faszie existiert, sie trägt zum Erhalt einer bestimmten Höhenlage des vesikourethralen Überganges bei und stabilisiert die Urethra durch ihren langstreckigen lateralen Verlauf. Die Evaluation der Abbildungsweise des VVUS in anatomischen Lehrmedien ist der studentischen Ausbildung geschuldet. Dabei wird auf seine ungleiche Darstellung hingewiesen und eine Revision angeregt. Die Voraussetzung für die Optimierung der männlichen Harnkontinenz bleibt in jedem Fall die enge Zusammenarbeit zwischen Anatomie und Klinik bei der Aus- und Fortbildung.

Background Stress urinary incontinence (SUI) is the leakage of urine when coughing, sneezing, or on exertion. It affects 10-35% of women, and can impair quality of life (QOL). First-line treatment is pelvic floor muscle training (PFMT). However, access barriers and embarrassment may prevent women from seeking care. There is a need for new, easily accessible ways to provide treatment. Aim To evaluate the treatment outcome, patient satisfaction, and cost-effectiveness of an Internet- based treatment programme for SUI. Methods We recruited 250 community-dwelling women aged 18-70 years, with SUI ≥1/week via our website. Participants were randomised to 3 months of PFMT with either an Internet-based programme (n=124), or a programme sent by post (n=126). We had no-face-to face contact with the participants, but the Internet group received individually tailored e-mail support from an urotherapist. Treatment outcome was evaluated after 4 months with intention-to-treat analysis. After treatment, we telephoned a strategic selection of participants (Internet n=13, postal n=8) to interview them about their experiences, and analysed the results according to grounded theory principles. We also performed a cost-utility analysis with a 1-year societal perspective, comparing the treatment programmes with each other and with a no-treatment alternative. To scrutinize our measure of QOL, we performed a reliability study of the ICIQ-LUTSqol questionnaire. Results Participants in both intervention groups achieved highly significant improvements (p&lt;0.001) with large effect sizes (&gt;0.8) in the primary outcomes symptom score (ICIQ-UI SF: mean change Internet 3.4 [SD 3.4], postal 2.9 [3.1]), and condition-specific QOL (ICIQ-LUTSqol: mean change Internet 4.8 [SD 6.1], postal 4.6 [SD 6.7]); however, the differences between the groups were not significant. Compared with the postal group, more participants in the Internet group perceived they were much or very much improved after treatment (40.9%, vs. 26.5%, p=0.01), reduced their use of incontinence aids (59.5% vs. 41.4%, p=0.02), and indicated satisfaction with the treatment programme (84.8% vs. 62.9%, p&lt;0.001). Results from the interviews fell into three categories: about life with SUI and barriers to seeking care; about the treatments and the patient-provider relationship; about the sense of empowerment many women experienced. A core category emerged: “Acknowledged but not exposed.” The extra cost per quality-adjusted life year (QALY) gained through use of the Internet-based programme compared with the postal programme was €200. The extra cost per QALY for the Internet-based programme compared with no treatment was €30,935. The condition-specific questionnaire ICIQ-LUTSqol is reliable in women with SUI, with high degrees of agreement between overall scores (Intraclass correlation coefficient 0.95, p&lt;0.001). Conclusion Internet-based treatment for SUI is a new, effective, and patient-appreciated treatment alternative, which can increase access to care in a sustainable way.

But : Cette étude a comme objectif principal d’évaluer la faisabilité d’utiliser une combinaison de renforcement des muscles du plancher pelvien (MPP) et de réadaptation par la réalité virtuelle (RRV) (programme d’entraînement MPP/RRV) pour traiter l’incontinence urinaire mixte (IUM) de la femme âgée. La faisabilité est évaluée par le taux de participation et d’achèvement du programme d’entraînement MPP/RRV et du programme d’exercices à domicile. Les objectifs secondaires de cette étude sont 1) d’évaluer l’effet du programme d’entraînement MPP/RRV sur la sévérité des symptômes urinaires, sur les dimensions de la qualité de vie, sur la fonction musculaire des MPP et sur les fonctions cognitives, plus précisément le processus exécutif de coordination de deux tâches, 2) d’évaluer, suite à l’intervention, la satisfaction des participantes. Le volet qualitatif a, quant à lui, pour objectif d’identifier les facteurs ayant influencé la participation au programme d’entraînement MPP/RRV ainsi que les avantages et les inconvénients associés à l’ajout de la RRV au traitement conventionnel de renforcement des MPP. Méthode : Les participantes ont effectué deux évaluations pré-traitement (pré-1 et pré-2), ont assisté à 12 classes hebdomadaires d’entraînement MPP/RRV et ont effectué une évaluation post-traitement. Elles ont aussi complété un programme d’exercices des MPP à domicile. Finalement, suite à la dernière classe, elles ont participé à un groupe de discussion. Les évaluations pré-1 et pré-2 ont été effectuées à deux semaines d’intervalle et étaient nécessaires pour s’assurer de la stabilité des mesures en l’absence d’une intervention. Résultats : 24 femmes ont participé à l’étude. Les taux de participation aux classes d’exercices hebdomadaires et au programme d’exercices à domicile étaient de 91 % et de 92 % respectivement. Le taux d’achèvement au programme d’entraînement MPP/RRV était de 96 %. Le programme d’entraînement MPP/RRV s’est avéré efficace dans l’amélioration des symptômes urinaires, de la qualité de vie ainsi que de la capacité à coordonner deux tâches simultanées chez les femmes âgées avec de l’IUM; il tend également à améliorer la fonction musculaire du plancher pelvien de ces femmes. L’appréciation de la composante RRV, par les participantes, était de 9.8/10 et ces dernières l’ont identifiée comme un facilitateur à leur participation hebdomadaire au traitement. Conclusion : Ce projet de maîtrise a permis de démontrer qu’une combinaison de renforcement des MPP et de RRV est une approche de traitement acceptable pour les femmes âgées souffrant d’IUM puisqu’elles sont capables de suivre les exigences de ce programme d’entraînement. / Aims: The main objective of the study was to evaluate the feasibility of using a combination of pelvic floor muscle (PFM) training and virtual reality rehabilitation (VRR) (PFM/VRR training program) to treat mixed urinary incontinence (MUI) among older women. Feasibility was defined as the participants’ rate of participation and completion of the PFM/VRR training program and of the home exercise program. The other study objectives were to evaluate the effectiveness of the PFM/VRR program on MUI symptoms, on quality of life (QoL), on PFM function and on cognitive functions, more precisely on dual-task executive functioning. Patient satisfaction was also assessed after the intervention. The study included a qualitative component aiming to gather information regarding: (1) patient-perceived facilitators and barriers to weekly PFM/VRR class attendance and (2) patient-perceived advantages and inconveniences associated with the use of VRR as a component of conventional PFM rehabilitation. Methods: Every woman participated in two pre-intervention evaluations (pre-1 & pre-2) followed by 12 weeks of a PFM/VRR training program and one post-intervention evaluation (post). Participants were also given a 20-minute static PFM home exercise program. At the end of the twelfth class, a participant group discussion was conducted. The first two evaluations were conducted 2 weeks apart to ensure consistency in the incontinence, PFM and executive functions measures prior to the intervention. Results: 24 women participated in the study. The majority of participants complied with the study demands in terms of attendance to the weekly treatment sessions (91 %), adherence to the home exercise program (92%) and completion of the three (pre-1, pre-2 and post) evaluations (96 %). The PFM/VRR training program was effective in reducing urinary incontinence symptoms, in enhancing QoL, in improving the ability of older women with MUI to manage dual-task situations and tends to improve PFM function of these women. The participant appreciation of the VRR component was 9.8/10 and the VRR component was identified by the participants as a facilitator to their weekly class participation. Conclusion: A combined PFM/VRR is an acceptable functional training approach for older women with MUI as they are capable of complying with treatment program demands.

Made available in DSpace on 2016-06-02T20:45:43Z (GMT). No. of bitstreams: 1 6736.pdf: 3120923 bytes, checksum: 2dd17cbfec9fe83d0e343f029a88e1b4 (MD5) Previous issue date: 2015-02-02 / Urinary incontinence (UI) is defined as the complaint of any involuntary loss of urine. It is a highly prevalent condition in women which impacts strongly their quality of life. In spite of this, it remains underdiagnosed and undertreated because a great number of women doesn´t seek for treatment, health professionals don´t ask them about these symptoms and/or they don´t provide appropriate treatments to women. In Family Health Strategy (FHS), physicians and nurses, who are general professionals, provide urogynecology assistance. This study aimed to examine knowledge, attitudes and practice of physicians and nurses from the FHS in a city into São Paulo state about female UI. This is a cross sectional study, classified as a survey on primary care. At total 33 FHS´s professionals participate of the study, being 15 physicians and 18 nurses. To collect data was developed and used a self-application questionnaire with open and closed questions. Results show that most professionals have an adequate level of knowledge about UI´s clinical propaedeutic. However, a great number of them doesn´t know complementary tests and treatment for the initial management of UI in women, mainly for the Urgency UI. In general, there wasn´t significant difference at level of knowledge between physicians and nurses about UI, except the fact that nurses were more familiar with the current definition of UI than doctors. Related to the attitudes, the majority considers that doing diagnostic investigation and treatment of non-complicated UI are part of their attribution. About the practice, an expressible amount of these professionals doesn´t prescribe pelvic floor strengthening exercises, doesn´t perform popular education in health actions with the women or doesn´t promote permanent education with the health team in their working places. These findings suggest the requirement for investment in matrix support teams, such as Support Centre for Family Health (NASF) or by the partnership with graduation and post graduation health courses from local universities. / A incontinência urinária (IU) é definida como a queixa de qualquer perda involuntária de urina. É uma condição altamente prevalente na população feminina, que impacta substancialmente a qualidade de vida. Apesar disso, permanece subdiagnosticada e subtratada pelo fato de muitas mulheres não procurarem assistência, pelos profissionais não as questionarem acerca dos sintomas e/ou não ofertarem as opções terapêuticas apropriadas. Na Estratégia Saúde da Família (ESF) médicos e enfermeiros com formação generalista são os responsáveis pela assistência uroginecológica. O objetivo deste estudo foi analisar conhecimentos, atitudes e prática de médicos e enfermeiros da ESF de um município no interior de São Paulo em relação à IU feminina. Trata-se de um estudo de corte transversal do tipo inquérito na atenção primária. Participaram do estudo 33 profissionais da ESF, sendo 15 médicos e 18 enfermeiros. Para a coleta de dados foi desenvolvido e utilizado um questionário autoaplicável com questões abertas e fechadas. Os resultados demonstram que a maioria dos profissionais possui um nível de conhecimento adequado em relação à propedêutica clínica da IU. No entanto, uma parcela significativa desconhece os exames complementares e a conduta terapêutica para a abordagem inicial das mulheres com IU, principalmente naquelas com IU de Urgência. De modo geral, não houve diferença significativa no nível de conhecimento de médicos e enfermeiros sobre a IU, exceto pelo fato de os enfermeiros estarem mais familiarizados do que os médicos com a definição atual da IU. Em relação às atitudes, a maioria considera que realizar a investigação diagnóstica e o tratamento da IU não complicada faz parte de suas atribuições. Quanto à prática, um número expressivo desses profissionais não prescreve exercícios de fortalecimento do assoalho pélvico, não realiza ações de educação em saúde com as mulheres ou promove atividades de educação permanente com a equipe de trabalho. Os resultados sugerem a necessidade de investimento em equipes de apoio matricial, seja mediante os Núcleos de Apoio à Saúde da Família (NASF) ou por meio de parcerias com cursos de graduação e pós graduação das universidades locais.