Orientador: Carlos Arturo Levi D'Ancona / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-11T19:52:10Z (GMT). No. of bitstreams: 1 Campos_RenataMartins_M.pdf: 1119575 bytes, checksum: 397148d4be81905b2e9d46e70227d07b (MD5) Previous issue date: 2008 / Resumo: Introdução: A enurese polissintomática é uma alteração funcional caracterizada por perdas involuntárias de urina durante o dia e a noite, que acometem indivíduos de uma faixa etária na qual o controle miccional deveria estar estabelecido. Está estimado que 5 % a 10% das crianças na idade escolar experimentam esse sintoma. A enurese polissintomática está freqüentemente associada com infecções recorrentes no trato urinário inferior e constipação intestinal. Objetivos: Verificar os resultados do tratamento fisioterapêutico associado à reeducação comportamental nas crianças enuréticas; analisar os efeitos do tratamento medicamentoso associado à reeducação comportamental; e comparar os resultados do tratamento fisioterapêutico com o farmacológico. Material e Métodos: O desenho do estudo foi um ensaio clínico controlado. O grupo I, com 21 crianças, fez uso de oxibutinina, orientações higiênico-dietético, postura miccional e diário miccional lúdico. O grupo II, com 26 crianças, realizou fisioterapia, por meio do treinamento dos músculos do assoalho pélvico e acessório, orientações higiênico-dietético, postura miccional e diário miccional lúdico, durante três meses de tratamento. O diário miccional lúdico foi realizado pela criança por meio de desenhos coloridos sobre o sol e a chuva, registrando as perdas urinárias noturnas. Além disso, a criança era instruída a realizar somente um dos exercícios em casa por duas vezes semanais, com acompanhamento de um dos pais, previamente também orientados, a fim de motivá-los em todas as etapas. Resultados: A variável do diário miccional, ou seja, o número de dias com sol ou de noites secas, foi comparado a cada mês entre os grupos I e II, farmacológico e fisioterapêutico, respectivamente, por meio da análise de variância para medidas repetidas (ANOVA). No primeiro mês de tratamento as crianças do grupo I apresentaram 12±7 noites secas, no segundo mês 13±6 noites secas, chegando ao final do terceiro mês com 16±7 noites secas. Diferentemente, no grupo II, houve diferença significativa na evolução (p<0,001), ou seja, no primeiro mês de tratamento 15±8 noites secas, no segundo mês 21±6 noites secas, e finalmente no terceiro mês 24±5 noites secas. Conclusão: O tratamento fisioterapêutico associado às mudanças comportamentais, grupo II, comprovou sua eficácia nesses casos, sendo significativamente superiores ao tratamento farmacológico associado à mudança comportamental, o grupo I / Abstract: Introduction: Polysymptomatic enuresis is a functional alteration characterized by involuntary urine loss during the day and night that affects individuals of an age group in which the miction control should be established. It is estimated that 5%-10% of school age children experience this symptom. Polysymptomatic enuresis is frequently associated with recurrent infections of the low urinary tract and intestinal constipation Objectives: Verify the physiotherapeutic treatment results associated with behavioral reeducation in enuretic children, analyze the effects of medicines associated with behavioral reeducation, and compare the physiotherapeutic and pharmacological treatment results. Material and Methods: Twenty-one children in group I took oxybutynin, and received orientations concerning diet and hygiene, posture on the toilet, and miction schedule. Twenty-six children in group II underwent pelvic floor physiotherapy, received orientations about diet and hygiene, posture on the toilet, and miction schedule. Both groups were submitted to a three-month treatment period. The miction schedule was performed by the child through sun and rain pictures, registering urinary losses. In addition, the child was oriented to do only one of the exercises at home two times a week, being followed by one of their parents, who were also previously oriented to motivate them during all phases. Results: The ANOVA test was used to compare the variables of the miction schedule between the group I - pharmacological -, and the group II - physiotherapeutic -, according to the number of sun pictures. During the first treatment month, the children of the group I presented 12±7 dry nights, while during the second month, they presented 13±6 dry nights, arriving at the end of the third month with approximately 16±7 dry nights. On the other hand, the group II showed a significant difference (p<0,001), presenting15±8 dry nights during the first treatment month, 21±6 dry nights during the second month and, finally, 24±5 dry nights during the third month. Conclusion: Pelvic floor physiotherapy and orientations detailed before present better results than pharmacological treatment. Pelvic floor physiotherapy is a new treatment and could become an option for polysymptomatic enuresis / Mestrado / Cirurgia / Mestre em Cirurgia

Compared to males in almost any social group in all affluent nations, Australia's Aboriginal and Torres Strait Islander men suffer from substantially more serious illnesses and early death. To date, research done by or in collaboration with Indigenous communities has revealed the extent of the problems that arise from diabetes, heart disease, hypertension, cancers, respiratory diseases, psychological disorders, accidental injuries, violence and other causes. Reproductive health, however, rarely has been studied among Indigenous men. To date, research in this field has been limited mainly to studies of sexually transmitted infections. No data has been published on Aboriginal men's symptoms of prostate disease or erectile dysfunction, nor has the clinical screening and treatment of these disorders among these men been assessed. In-depth search of the worldwide web demonstrated that little information on these issues was available from other Indigenous populations. It does appear that Indigenous men in Australia, New Zealand and North America are less likely than European-ancestry men to die from prostate cancer, or for living cases to be recorded on cancer registries. This may arise because Indigenous men genuinely have a lower risk, or because they are not captured by official statistics, or because they do not live long enough to develop severe prostate disease. We also know very little about other reproductive health problems such as sexual dysfunction and specifically erectile difficulties. One reason for our scant knowledge is that research mainly relies on self-report of sensitive information. The aim of the research study was to improve the understanding of sexual and reproductive health problems experienced by Indigenous men. This is best gathered by Aboriginal males who are inside the culture of middleaged and older Indigenous men, but until now this has not been attempted. In this study we adopted the World Health Organization (WHO) definitions for Reproductive and Sexual Health (WHO, 2001). Thus, we consider reproductive system disorders (prostate disease, erectile dysfunction) and related health care-seeking, and also men's perceptions about a "satisfying and safe sexual life". The methodology was framed within an Aboriginal and Torres Strait Islander research protocol that advocates respect for cultural, social and community customs. A mixed method design combined qualitative inquiry (4 focus groups and 18 in-depth interviews) and quantitative survey (n=301) involving men living in remote, rural and urban communities (Tiwi Islands, Darwin and north and south-east Queensland). Survey data were compared to recently published self-reports from 5990 randomly selected men aged over 40 years in Australia (Holden et al., 2005, The Lancet, 366, 218-224. The qualitative interviews revealed that most men were silent about reproductive health. They were unwilling to reveal their inner feelings to wives or partners, and they were unwilling to discuss such issues with doctors and other health care workers. Men's reaction to sexual difficulties included shame, denial, substance abuse and occasionally violence. On a positive note many men said they want to learn about it, so they understand how to cope with such problems. The Indigenous men reported symptoms of erectile dysfunction at least as much as non-Indigenous men in other Australian studies. Bivariate analysis showed that erectile dysfunction was correlated with many health and lifestyle variable. However multivariate analysis revealed that only three factors significantly predicted ED: presence of chronic disease, presence of pain when working, and living in a remote geographic location The quantitative survey data indicate that Indigenous men have more symptoms of prostate disease than non-Indigenous men. The syndrome appears to be poorly managed in clinical practice (e.g. rates of PSA testing and digital-rectal examination are only one-third the rate reported by non-Aboriginal men, despite equivalent likelihood of GP visits). The research study adds to the literature by providing better insight and depth into the issues impacting on Aboriginal and Torres Strait Islander males experiencing reproductive and sexual health difficulties. It also provides a platform to undertake comprehensive research with Aboriginal and Torres Strait Islander men to explore a wider spectrum of questions in this important but neglected area. Implications for education of primary healthcare workers and community-based awareness campaigns for Indigenous males are discussed. Most of all, this study revealed "layers" of silence around sexual and reproductive health of Indigenous men. This includes silence in the scientific establishments in health services, and in the community. It is hoped that this study puts the voices of the men forward to help to break down this silence.