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Can the delivery method influence lower urinary tract symptoms triggered by the first pregnancy?
Botelho, Simone;Silva, Joseane Marques da;Palma, Paulo;Herrmann, Viviane;Riccetto, Cassio;
International braz j urol , 2012, DOI: 10.1590/S1677-55382012000200016
Abstract: introduction and objectives: the increase of the intensity of urinary symptoms in late pregnancy and postpartum has been well documented by several authors, but their causes remain uncertain, partly because of its probable multifactor origin. there are also controversies whether the etiology of lower urinary tract symptoms during pregnancy is the same as postpartum and whether the method of delivery could influence the risk of onset of urinary symptoms. this study aimed to evaluate the urinary symptoms triggered during pregnancy and its evolution in the late puerperium, correlating them with the delivery method. materials and methods: a longitudinal study was conducted, which included 75 primigravidae women, classified according to method of delivery as: (vd) vaginal delivery with right mediolateral episiotomy (n = 28); (cs) elective caesarean section (n = 26); and (ec) emergency caesarean section (n = 21). urinary symptoms were assessed in the last trimester of pregnancy and at 45 days (± 10) of puerperium with validated versions for portuguese language of the following questionnaires: international consultation on incontinence questionnaire - urinary incontinence short form (iciq-ui sf) and the international consultation on incontinence questionnaire overactive bladder (iciq-oab). results: it was observed that frequency, urgency, nocturia and urge incontinence, triggered during pregnancy, decreased significantly in the postpartum period, regardless of the delivery method (p = 0.0001). however, symptoms related to urinary loss due to stress persisted after vaginal delivery (p = 0.0001). conclusions: urgency, frequency and nocturia triggered during pregnancy tend to disappear in the late postpartum period, regardless of the delivery method, but the symptoms related to urinary loss due to stress tend to persist in late postpartum period after vaginal delivery.
Pelvic floor exercises with biofeedback for stress urinary incontinence
Capelini, Maria V.;Riccetto, Cassio L.;Dambros, Miriam;Tamanini, Jose T.;Herrmann, Viviane;Muller, Virginia;
International braz j urol , 2006, DOI: 10.1590/S1677-55382006000400015
Abstract: objective: prospective study to objectively evaluate the benefits of pelvic floor strengthening exercises associated to biofeedback for the treatment of stress urinary incontinence. materials and methods: fourteen patients diagnosed with stress urinary incontinence (sui) were selected for this study. all patients underwent a pelvic floor training associated to biofeedback for 12 consecutive weeks. urodynamic tests, pad test and bladder diary were analyzed at the beginning of the study, at the end and after 3 months. the king's health questionnaire (khq) was applied before and after treatment to assess the impact in the quality of life. results: there was a significant reduction in the pad weight (from 14.21 g to 1 g), number of urinary leakage episodes (from 8.14 per day to 2.57 per day) and daytime frequency (from 7.93 per day to 5.85 per day). at urodynamics the authors observed a significant increase in valsalva leak-point pressure (from 103.93 cm h2o to 139.14 cm h2o), cistometric capacity (from 249.29 ml to 336.43 ml, p = 0.0015) and bladder volume at first desire to void (from 145 ml to 215.71 ml). those differences were kept during the first 3 months of follow up. the khq revealed significant differences except in the case of "general health perception", which covers health in general and not exclusively urinary incontinence. conclusion: treatment of sui with pelvic floor exercises associated to biofeedback caused significant changes in the parameters analyzed, with maintenance of good results 3 months after treatment.
Electroestimulación del nervio tibial posterior para el tratamiento de la vejiga hiperactiva: Estudio prospectivo y controlado
Bellette,Patricia O.; Rodrigues-Palma,Paulo C.; Hermann,Viviane; Riccetto,Cássio; Bigozzi,Miguel; Olivares,Juan M.;
Actas Urológicas Espa?olas , 2009, DOI: 10.4321/S0210-48062009000100011
Abstract: the aim of this study was to evaluate the efficacy of the posterior tibial nerve stimulation in women with overactivity bladder symptoms and the impact in the quality of life using the overactivity bladder questionnaire (oabq). methods: thirty seven women from female urology outpatient clinic of the hospital das clínicas de campinas (hc/unicamp) were enrolled in this prospective, controlled and randomized clinical trial. the patients were randomly placed in one of two groups: treatment group: patients were submitted to tibial posterior nerve electrical stimulation (n=21) and sham group: patients had electrodes placed without electricity (n = 16). after informed consent the patients underwent a physiotherapeutic evaluation, that included voiding diary and the overactivity bladder questionnaire(oabq). the treatment schedule included eight sessions of electrical stimulation in the posterior tibial nerve, twice a week. results: there were significant changes in symptoms such as frequency and nocturia (p=0,003 e p=0,001). the urgency and quality of life was improved in both group after treatment. conclusion: the posterior tibial nerve electrical stimulation is an effective treatment in overactive bladder.
Sintomas urinários irritativos após parto vaginal ou cesárea
Scarpa, Kátia Pary;Herrmann, Viviane;Palma, Paulo Cesar Rodrigues;Riccetto, Cassio Luis Zanettini;Morais, Sirlei Siani;
Revista da Associa??o Médica Brasileira , 2009, DOI: 10.1590/S0104-42302009000400016
Abstract: objective: this study intended to investigate the frequency of irritative bladder symptoms three years after delivery in women previously interviewed in the third trimester of pregnancy and its correlation to mode of delivery, parity, maternal age, birth weight, episiotomy and forceps. methods: from 340 women previously evaluated at the third trimester of pregnancy, 120 were interviewed three years after delivery, between june and october 2006. correlation of postpartum irritative bladder symptoms and mode of delivery (exclusively vaginal or c-section), parity, maternal age, birth weight, episiotomy and forceps was analyzed. associations between irritative bladder symptoms and obstetric parameters were assessed by the fisher's exact test and chi-square (p< 0.05). results: the study group consisted of 37.5% primiparous and 62.5% multiparous women. mode of delivery was exclusively vaginal in 53 women and exclusively c-section in 42. no statistical difference was found between irritative bladder symptoms and mode of delivery and parity. no statistical difference was found between irritative symptoms and maternal age (> 35), birth weight (> 4000g), episiotomy and forceps. conclusion: after childbirth, dysfunction of the lower urinary tract, characterized by irritative bladder symptoms, was not associated with mode of delivery, parity, maternal age, birth weight, episiotomy and forceps.
Leiomioma uretral durante a gravidez: relato de caso Urethral leiomyoma during pregnancy: a case report
Arlon Breno Figueiredo Nunes da Silveira,Cássio Luis Zanettini Riccetto,Viviane Herrmann,Paulo César Rodrigues Palma
Revista do Colégio Brasileiro de Cirurgi?es , 2012,
Abstract: The authors report a case of urethral leiomyoma diagnosed during pregnancy, which was conservatively treated up to the 38th week, when the pregnancy was interrupted. Thirty days after delivery, exeresis of the lesion was performed from the upper border of the urethral meatus and sutured with interrupted delayed-absorbable suture. The patient evolved favorably and presented no lesion recurrence during three months of follow up.
Valida??o do International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB) para a língua portuguesa
Pereira, Simone Botelho;Thiel, Rosane do Rocio Cordeiro;Riccetto, Cássio;Silva, Joseane Marques da;Pereira, Larissa Carvalho;Herrmann, Viviane;Palma, Paulo;
Revista Brasileira de Ginecologia e Obstetrícia , 2010, DOI: 10.1590/S0100-72032010000600004
Abstract: purpose: to translate, culturally adapt and validate the questionnaire "international consultation on incontinence questionnaire overactive bladder" (iciq-oab) for the portuguese language. methods: two brazilian translators acquainted with the objectives of this research translated the iciq-oab into portuguese and both translations were back-translated by two other native english speaking translators. the differences between the versions were brought to agreement and pre-tested in a pilot study. the final version of the iciq-oab was applied together with the previously translated and tested version of the international consultation on incontinence questionnaire - short form (iciq-sf) in 142 male and female patients with irritative urinary symptoms. for the validation of the iciq-oab the following psychometric features were evaluated: reliability (internal consistency and test-retest) and validity of the survey. the retest was performed four weeks after the first interview. results: the reliability of the instrument was demonstrated through the cronbach α coefficient, with a general result of 0.7. the test-retest corroborated the stability of the instrument through the intraclass correlation coefficient and presented a result of 0.91 and 0.95 when compared to both the iciq-oab and iciq-sf, respectively. when the instruments were compared by the pearson correlation coefficient the result was 0.7 (p=0.0001), that confirms the validity of the study criterion. the concurrent validity was evaluated by the correlation between some clinical and sociodemographic variants and the iciq-oab score. conclusion: the culturally adapted version of the iciq-oab translated into brazilian portuguese presented satisfactory reliability and survey validity and was considered valid for the evaluation of irritative urinary symptoms of brazilian patients of both genders.
Carbon Capture and Storage and the UNFCCC: Recommendations to Address Trans-Boundary Issues  [PDF]
Viviane Romeiro, Virginia Parente
Low Carbon Economy (LCE) , 2012, DOI: 10.4236/lce.2012.323017
Abstract: This paper is mainly focused on the eligibility of trans-boundary Carbon Dioxide Capture and Storage (CCS) as a Clean Development Mechanism (CDM) project activity and it aims to explore a broad range of CCS transboundary issues whereby the United Nations Framework Convention on Climate Change (UNFCCC) and national governments could take into consideration. Much work is still to be done by the CCS community (including the Institute) to ensure that the implementation of CCS under the CDM is both environmentally effective and commercially attractive. The recommendations focus on technical issues, with the aim of helping Parties evaluate a robust strategy for CCS as part of international negotiations and establish CCS best practice criteria for governments and the international process, thereby enhancing transparency and ensuring that CCS deployment is safe and effective. When considering CDM projects activities with a transboundary component, it is recommend that the rules of the main international treaties related to CCS be considered by the UNFCCC, especially the London Protocol guidelines for risk assessment and management and the 2006 IPCC Guidelines. Additionally, national governments should apply the rules and guidelines as delineated under the relevant existing international treaties and CCS national regulations.
Aplicaciones clínicas de la teoría integral de la continencia
Riccetto,C.; Palma,P.; Tarazona,A.;
Actas Urológicas Espa?olas , 2005, DOI: 10.4321/S0210-48062005000100005
Abstract: currently, urinary incontinence cannot be treated without taking into consideration the comprehensive theory of urinary incontinence. according to this theory, stress incontinence, urge incontinence and alterations in bladder emptying result from alterations in the elements of suburethral support, ligaments and muscles of the pelvis floor. alterations in the forces applied by muscles and ligaments to the fascia adjacent to the vaginal wall and the urethra cause the vesical neck and the urethra to open or close. alterations in the forces applied to the vagina can also cause premature activation of the micturition reflex, triggering involuntary contractions of the detrusor muscle. knowledge of the anatomic substrate of the upper, intermediate and lower layers of the pelvic floor and of the main pubourethral, urethropelvic and uterosacral ligamentous elements is essential before any surgical approach of incontinence can be attempted. depending on the location of the fascial or ligamental muscle lesion and of the sensitivity of the local nerve endings, stress incontinence, urge incontinence, altered bladder emptying or combinations of these conditions can develop. there are 6 basic defects which should be systematically investigated: defect in the suburethral support ("hammock"), tethered vagina syndrome, distended pubourethral ligaments, distended uterosacral ligaments and support of the vaginal apex, lesions of vaginal insertion of pubococcygeal muscles, lesions of the striated muscles of the pelvic floor levator plate.
Ensino de língua materna e Análise de Discurso Crítica
Ramalho, Viviane;
Bakhtiniana: Revista de Estudos do Discurso , 2012, DOI: 10.1590/S2176-45732012000100011
Abstract: in this paper, we intend to reflect on possible contributions of critical discourse analysis for teaching-learning portuguese as a native language. considering a research-action experience with supervised internship students of portuguese language at the university of brasilia, we discussed some of the paths taken in the training of educators who are capable of critically analyzing discourses that circulate in society; promoting critical linguistic awareness and, above all, reflectively analyzing their own teaching practices.
The monetary transmission mechanism in Brazil: evidence from a var analysis
Luporini, Viviane;
Estudos Econ?micos (S?o Paulo) , 2008, DOI: 10.1590/S0101-41612008000100001
Abstract: this article presents evidence on the interest channel of the monetary policy for the brazilian economy of the 1990s analyzing the effects of an unexpected change in the baseline interest rate on output, prices and the exchange rate in a vector autoregression system. our main results are: a) a tightening in the monetary policy affects economic activity immediately, reducing the rate of growth of real gdp; b) the exchange rate and prices are affected only after a time interval, with inflation assuming a downward trend only two months after the monetary shock; c) results do not change when the specification is controlled for international conditions, commodity prices or other measures of inflation and economic activity; d) monetary shocks have a significant impact on the volatility of output and inflation in the benchmark model e) monetary shocks have a significant impact on the volatility of the debt/gdp ratio in the control-model.
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