Posttraumatic growth and its associations with perceived stress and core beliefs in women after traumatic childbirth during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic added new challenges and stressors to the childbirth period, potentially increasing the risk of traumatic childbirth experiences. There is little known about posttraumatic growth (PTG) in a childbearing population. This study describes PTG in women after traumatic childbirth during the COVID-19 pandemic and its association with sociodemographic, birth-related characteristics, traumatic childbirth events, perceived stress, and core beliefs, as well as explores what factors predict PTG. METHODS: A cross-sectional study was conducted with 202 women who self-identified as having experienced traumatic childbirth. Measures included sociodemographic and birth-related characteristics, traumatic childbirth events, self-reported stress during childbirth, the PTG Inventory, and the Core Beliefs Inventory (CBI). RESULTS: Perceived stress at the time of birth was very high in 70% of the respondents. CBI showed moderate disruption of core beliefs. 41.6% of mothers indicated substantial PTG. Education and type of birth were related to perceived stress levels; higher disruption of core beliefs was observed in individuals who experienced perineal trauma and lack of partners' presence during childbirth, and higher disruption of core beliefs was positively associated with PTG. Predictive models showed that perceived stress had a minimal effect, while the disruption of core beliefs showed a significant positive association with PTG. CONCLUSION: Traumatic childbirth experiences during the COVID-19 pandemic were positively related to PTG. Health professionals should create an environment where women can explore their feelings and emotions. Changes in current practices are also necessary as cesareans have been shown to be highly associated with high levels of perceived stress.

Psychometric properties of the European Portuguese version of the Wijma Delivery Expectancy/Experience Questionnaire in pregnant women.

The researchers' aim is to examine the psychometric properties of the European Portuguese version of the Wijma Delivery Expectancy/Experience Questionnaire version A (WDEQ-A). Data from 669 pregnant Portuguese women was collected between June and October of 2019. From the initial 33-item Portuguese version of the WDEQ-A, a 27-item instrument was developed. Five-factor solution explained 63.8% of the total variance. The factors defined by the researchers were: fear/lack of self-efficacy, loneliness, negative appraisal, lack of positive anticipation and concern for the child. Cronbach's alpha coefficient was 0.934. The European Portuguese version of the WDEQ-A is a reliable and valid tool to measure fear of childbirth on both nulliparous and multiparous women and can be a useful tool for cross-cultural research. Moreover, researchers support the use of this tool in clinical practice to recognize and address fearful women during prenatal period.

Antitumor Properties of the Essential Oil From the Leaves of Duguetia gardneriana.

Duguetia gardneriana, popularly known in the Brazilian northeast as "jaquinha", is a species belonging to the family Annonaceae. The aim of this work was to assess the chemical composition and antitumor properties of the essential oil from the leaves of D. gardneriana in experimental models. The chemical composition of the essential oil was analyzed via gas chromatography-flame ionization detector and gas chromatography-mass spectrometry. In vitro cytotoxic activity was determined in cultured tumor cells, and in vivo antitumor activity was assessed in B16-F10-bearing mice. The identified compounds were ß-bisabolene (80.99%), elemicin (8.04%), germacrene D (4.15%), and cyperene (2.82%). The essential oil exhibited a cytotoxic effect, with IC50 values of 16.89, 19.16, 13.08, and 19.33 µg/mL being obtained for B16-F10, HepG2, HL-60, and K562 cell lines, respectively. On the other hand, ß-bisabolene was inactive in all of the tested tumor cell lines (showing IC50 values greater than 25 µg/mL). The in vivo analysis revealed tumor growth inhibition rates of 5.37-37.52% at doses of 40 and 80 mg/kg/day, respectively. Herein, the essential oil from the leaves of D. gardneriana presented ß-bisabolene as the major constituent and showed cytotoxic and antitumor potential.

Redox-Active Profile Characterization of Remirea maritima Extracts and Its Cytotoxic Effect in Mouse Fibroblasts (L929) and Melanoma (B16F10) Cells.

Remirea maritima is a tropical plant with a reticulated root system belonging to the family Cyperaceae, also known to have biologically active secondary metabolites. However, very few data on R. maritima's biological actions are available and there are no reports regarding the redox-active profile of this plant. In this study, we examined the total phenolic content of Remirea maritima hydroalcoholic (RMHA) extracts, redox properties against different reactive species generated in vitro and their cytotoxic effect against fibroblasts (L929) and melanoma (B16F10) cells. Total reactive antioxidant potential index (TRAP) and total antioxidant reactivity (TAR) results revealed that RMHA at all concentrations tested showed significant antioxidant capacity. RMHA was also effective against hydroxyl radical formation, reduction of Fe3+ to Fe2+ and in scavenging nitric oxide (NO) radicals. In vitro, the level of lipid peroxidation was reduced by RMHA extract and the data showed significant oxidative damage protection. The RMHA cytotoxicity was evaluated by a neutral red assay in fibroblast (L929) and melanome (B16F10) cells. The obtained results showed that the RMHA (40 and 80 µg/mL, respectively) reduced 70% of the viable cells. In conclusion, this study represents the first report regarding the antioxidant and anti-proliferative potential of R. maritima against B16F10 melanoma cells.

Development of an online nursing management course: successful experience between Brazil and Portugal. / Desenvolvimento do curso de gerenciamento em enfermagem on-line: experiência exitosa entre Brasil e Portugal.

Objective To describe the experience of planning and developing online refresher courses in nursing management for nurses in the contexts of Brazil and Portugal. Method The instructional design was based on meaningful learning theory, andragogy, and dialectical methodology, so it valued interaction between the actors, emphasizing the scenarios of practice and applying the concepts covered. The course structure is divided into nine theoretical units, four case studies, and an essay exam. Results The course was positively evaluated by the participants, who reported opportunities for acquisition of new knowledge, interaction and exchange of experiences, motivation to study the topics, and self-learning. Conclusion It is expected that description of this experience will stimulate proposals for new courses and programs in distance education modalities, improving the processes of teaching and learning so as to give support to future analyses of their impact on the development and enhancement of management skills in nursing.

Chemical composition, antinociceptive, anti-inflammatory and redox properties in vitro of the essential oil from Remirea maritima Aubl. (Cyperaceae).

BACKGROUND: The present study was carried out to evaluate antioxidant, antinociceptive and anti-inflammatory activities of essential oil from R. maritima (RMO) in experimental protocols. METHODS: The essential oil from the roots and rhizomes of RMO were obtained by hydrodistillation using a Clevenger apparatus, and analyzed by gas chromatography/mass spectrometry (GC/MS). Here, we evaluated free radical scavenging activities and antioxidant potential of RMO using in vitro assays for scavenging activity against hydroxyl radicals, hydrogen peroxide, superoxide radicals, and nitric oxide. The total reactive antioxidant potential (TRAP) and total antioxidant reactivity (TAR) indexes and in vitro lipoperoxidation were also evaluated. The ability of RMO to prevent lipid peroxidation was measured by quantifying thiobarbituric acid-reactive substances (TBARS). NO radical generated at physiological pH was found to be inhibited by RMO, that showed scavenging effect upon SNP-induced NO production at all concentrations. Antinociceptive and anti-inflammatory properties were evaluated by acetic acid writhing reflex, Formalin-induced nociception and Carrageenan-induced edema test. RESULTS: The majors compounds identified was remirol (43.2%), cyperene (13.8%), iso-evodionol (5.8%), cyperotundone (5.7%), caryophyllene oxide (4.9%), and rotundene (4.6%). At the TRAP assay, RMO concentration of 1 mg.mL(-1) showed anti-oxidant effects and at concentration of 1 and 10 ng.mL(-1) RMO showed pro-oxidant effect. RMO at 1 mg.mL(-1) also showed significant anti-oxidant capacity in TAR measurement. Concentrations of RMO from 1 ng.mL(-1) to 100 µg.mL(-1) enhanced the AAPH-induced lipoperoxidation. RMO reduced deoxyribose oxidative damage, induced by the Fenton reaction induction system, at concentrations from 1 ng.mL(-1) to 100 µg.mL(-1). We observed that RMO caused a significant increase in rate of adrenaline auto-oxidation. On the other hand RMO did not present any scavenging effect in H2O2 formation in vitro. The results of this study revealed that RMO has both peripheral and central analgesic properties. The RMO, all doses, orally (p.o.) administered significantly inhibited (p < 0.05, p < 0.01 and p < 0.001) the acetic acid-induced writhings and two phases of formalin-induced nociception in mice. CONCLUSION: The RMO demonstrated antioxidant and analgesic profile which may be related to the composition of the oil.

Evaluation of the anti-inflammatory and antinociceptive effects of the essential oil from leaves of Xylopia laevigata in experimental models.

Xylopia laevigata (Annonaceae) is a medicinal plant used in folk medicine to treat pain and inflammation. Thus, we investigated the possible antioxidant, antinociceptive, and anti-inflammatory effects of X. laevigata leaf essential oil (EOX) in animal models. Our EOX sample showed the presence of γ-muurolene (17.78%), δ-cadinene (12.23%), bicyclogermacrene (7.77%), and α-copaene (7.17%) as main compounds. EOX presented a strong antioxidant potential according to the DPPH, TBARS, and nitrite production tests. Additionally, pretreatment with EOX, in mice, also significantly produced (P < 0.05 or P < 0.001) antinociceptive effect by reduction of nociceptive behavior (in formalin and writhing tests). The EOX showed c-Fos label in the olfactory bulb, piriform cortex, and periaqueductal gray. Acute administration of EOX exhibited a significant (P < 0.01 or P < 0.001) anti-inflammatory profile in the carrageenan-induced peritonitis and by the carrageenan-induced hindpaw edema tests in mice. Our results provide evidence for the use of X. laevigata by traditional medicine practitioners in the management of pain and inflammatory disorders.

Discussing the midwifery scope of practice within the NANDA-I taxonomy.

PURPOSE: To discuss the midwifery scope of practice within the NANDA-I taxonomy. METHODS: Review of the NANDA-I taxonomy followed by critical analysis of the nursing diagnoses (NDs) within the scope of midwifery practice. Search terms were defined. Two authors independently analyzed all diagnoses, and another author validated the results. FINDINGS: Of the 267 NDs in the NANDA-I taxonomy, 39 (14.6%) perceived a relationship with midwifery's scope of practice, and among these, 15 (5.6%) guaranteed greater specificity and accuracy for clinical reasoning. CONCLUSIONS: The suitability of NDs for the broad spectrum of the midwifery scope of practice may need to be completed. Women's responses to life events and health conditions are simultaneously complex and specific, and many NDs in the NANDA-I terminology may be far from fully identified and developed to represent these responses. IMPLICATIONS FOR NURSING PRACTICE: Improvements in NANDA-I diagnosis would contribute to advanced terminology and increased specificity and accuracy of the diagnostic process. This is important in achieving appropriate outcomes and safe and effective interventions for which the nurses and nurse-midwives are accountable. Many NDs would not necessarily be used in any other context since they are specific to midwifery; however, it would help to develop a NANDA-I taxonomy that is more inclusive and comprehensive internationally.

OBJETIVO: Discutir o âmbito da prática de atenção materna dentro da taxonomia da NANDA­I. MÉTODOS: Revisão da taxonomia da NANDA­I com análise crítica dos diagnósticos de enfermagem, no âmbito da prática de atenção materna. Os termos de pesquisa foram definidos. Dois autores analisaram, independentemente, todos os diagnósticos e um outro autor validou os resultados. RESULTADOS: Dos 267 diagnósticos de enfermagem da taxonomia NANDA­I, em 39 (14,6%) percebe­se relação com o âmbito da prática de atenção materna. Além disso, destes 38 diagnósticos incluídos, 15 (5,6%) garantem maior especificidade e acurácia para o raciocínio clínico. CONCLUSÕES: A adequação dos diagnósticos de enfermagem ao amplo espectro da prática de atenção materna pode precisar ser completada. As respostas das mulheres aos acontecimentos de vida e às condições de saúde são, simultaneamente, complexas e específicas e muitos diagnósticos de enfermagem na terminologia da NANDA­I podem não estar totalmente identificados e desenvolvidos para representar essas respostas. IMPLICAÇÕES PARA A PRÁTICA DE ENFERMAGEM: Melhorias nos diagnósticos da NANDA­I contribuiriam para uma terminologia avançada e para o aumento da especificidade e precisão do processo de diagnóstico. Isto é importante para a obtenção de resultados apropriados e intervenções seguras e eficazes, pelas quais os enfermeiros de atenção à saúde materna são responsáveis. Muitos diagnósticos de enfermagem não seriam necessariamente usados em qualquer outro contexto, uma vez que são específicos da atenção materna; no entanto, ajudaria a desenvolver uma taxonomia NANDA­I mais inclusiva e abrangente, a nível internacional.

Posttraumatic growth in women after a childbirth experience: The influence of individual characteristics and intrusive and deliberate rumination.

OBJECTIVE: This study targets women who had a self-defined traumatic childbirth experience to (a) explore the differences between sociodemographic-, obstetric-, and trauma-related variables in relation to the rumination style; (b) determine differences between intrusive and deliberate rumination in relation to posttraumatic growth (PTG) dimensions, and (c) test whether intrusive rumination is associated with deliberate rumination, which in turn is associated with PTG dimensions. METHOD: A cross-sectional study design was employed using a web-based survey method for data collection. In total, 202 women who identified their childbirth experience as traumatic participated in this study. RESULTS: Intrusive rumination and deliberate rumination were positively associated with all dimensions of PTG in women following the traumatic childbirth event. Deliberate rumination fully explained the relationship between intrusive rumination and PTG aspects of relating to others, new opportunities, and personal strength, and partially explained the relationship between intrusive rumination and PTG aspects of spiritual changes and appreciation of life. CONCLUSIONS: The results suggest that deliberate rumination can contribute to explain the occurrence of PTG. These findings could help develop psychosocial interventions to maximize opportunities for deliberate rumination for women with traumatic childbirth experiences. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Chemical constituents and anticancer effects of the essential oil from leaves of Xylopia laevigata.

Xylopia laevigata, popularly known as "meiú" and "pindaíba", is a medicinal plant used in the folk medicine of the Brazilian Northeast for several purposes. The chemical constituents of the essential oil from leaves of X. laevigata, collected from wild plants growing at three different sites of the remaining Atlantic forest in Sergipe State (Brazilian Northeast), were analyzed by GC/FID and GC/MS. The effect of the essential oil samples was assessed on tumor cells in culture, as well on tumor growth in vivo. All samples of the essential oil were dominated by sesquiterpene constituents. A total of 44 compounds were identified and quantified. Although some small differences were observed in the chemical composition, the presence of γ-muurolene (0.60-17.99%), δ-cadinene (1.15-13.45%), germacrene B (3.22-7.31%), α-copaene (3.33-5.98%), germacrene D (9.09-60.44%), bicyclogermacrene (7.00-14.63%), and (E)-caryophyllene (5.43-7.98%) were verified as major constituents in all samples of the essential oil. In the in vitro cytotoxic study, the essential oil displayed cytotoxicity to all tumor cell lines tested, with the different samples displaying a similar profile; however, they were not hemolytic or genotoxic. In the in vivo antitumor study, tumor growth inhibition rates were 37.3-42.5%. The treatment with the essential oil did not significantly affect body weight, macroscopy of the organs, or blood leukocyte counts. In conclusion, the essential oil from the leaves of X. laevigata is chemically characterized by the presence of γ-muurolene, δ-cadinene, germacrene B, α-copaene, germacrene D, bicyclogermacrene, and (E)-caryophyllene as major constituents and possesses significant in vitro and in vivo anticancer potential.

Women's fear of childbirth during pregnancy: A concept analysis.

PURPOSE: To map and analyze the concept of women's fear of childbirth (FOC) during pregnancy and to develop a new nursing diagnosis (ND). METHODS: Concept analysis based on Walker and Avant's methodology. An integrative literature search was conducted in Scopus, Web of Science, and CINAHL Complete databases, including peer-reviewed articles published in English from January 1981 to October 2022. FINDINGS: Thirty-one studies were included in the review. Women's FOC during pregnancy comprises three central categories: attributes, antecedents, and consequences. Nine main characteristics (attributes) are related to one or more of eight prior conditions (antecedents) that have the potential to exert negative or favorable impacts (consequences), depending on whether coping strategies have been a part of a fearful woman's pregnancy. These elements and relationships among them should be viewed as dynamic. CONCLUSIONS: Women's FOC during pregnancy is a subjective, multidimensional, and dynamic concept that benefits prenatal care responses. A conceptual matrix on prenatal care will consider the factors underlying women's FOC and their potential mechanisms, how fearful pregnant women respond, the aspects that shape FOC, and how it influences outcomes when supporting pregnant women with FOC. Therefore, the study findings can be used to inform ways of identifying fearful women or as a basis for interventions to manage fears and enhance the confidence of pregnant women for childbirth. IMPLICATIONS FOR NURSING PRACTICE: The results of this study help nurses, OB nursing practitioners, nurse-midwives, and midwives to identify the condition of women's FOC during pregnancy and guide nursing therapeutic interventions to decrease the negative effects on women's health and well-being. Therefore, there are valuable reasons to propose using "fear of childbirth" as a ND in the class "coping responses" within domain coping/stress tolerance, contributing to refining the NANDA-I taxonomy.

OBJETIVO: Mapear e analisar o conceito de medo do parto em mulheres durante a gravidez e desenvolver um novo diagnóstico de enfermagem. MÉTODOS: Análise de conceito com base na metodologia de Walker e Avant. Foi realizada uma pesquisa integrativa da literatura nas bases de dados Scopus, Web of Science e CINAHL Complete e incluiu artigos revistos por pares, publicados em inglês, de janeiro de 1981 a outubro de 2022. RESULTADOS: Trinta e um estudos foram incluídos na revisão. O medo do parto em mulheres durante a gravidez é composto por três categorias centrais: atributos, antecedentes e consequências. Nove características principais (atributos) estão relacionadas com uma ou mais das oito condições anteriores (antecedentes) que têm o potencial de exercer um impacto negativo ou favorável (consequências), dependendo se estratégias de coping fizeram parte da gravidez de uma mulher com medo. Estes elementos e as relações entre eles devem ser vistos como dinâmicos. CONCLUSÕES: O medo do parto em mulheres durante a gravidez é um conceito subjetivo, multidimensional e dinâmico que beneficia de respostas pelos cuidados pré-natais. Uma matriz conceptual sobre cuidados pré-natais considerará os fatores subjacentes ao medo do parto nas mulheres e os seus potenciais mecanismos, como as mulheres grávidas com medo respondem, os aspetos que moldam o medo do parto, e como influenciam os resultados quando as mulheres grávidas com medo do parto são apoiadas. Portanto, os resultados do estudo podem ser usados para identificar mulheres com medo ou desenvolver intervenções que permitam gerir os medos e aumentar a confiança das mulheres grávidas para o parto. IMPLICAÇÕES PARA A PRÁTICA DE ENFERMAGEM: Os resultados deste estudo ajudarão os enfermeiros de atenção à saúde materna a identificar a condição do medo do parto nas mulheres durante a gravidez e orientar intervenções terapêuticas de enfermagem, no sentido de diminuir os efeitos negativos do medo na saúde e no bem-estar das mulheres. Portanto, há razões relevantes para propor a utilização do "medo do parto" como um diagnóstico de enfermagem na classe "coping responses" do domínio "coping/stress tolerance", contribuindo para o refinamento da taxonomia NANDA-I.

Wild food plants of Brazil: a theoretical approach to non-random selection.

Ethnobiological investigations have focused on identifying factors that interfere with the criteria adopted for selection of plants, especially medicinal plants, by different populations, confirming the theory that plant selection is not random. However, regarding wild food plants, little effort has been made to confirm the theory in this context, especially in Brazil. Therefore, this systematic review aimed to contribute to the establishment of theoretical bases of the non-random selection of wild food plants by local populations in Brazil. For this, searches were made in 4 databases, namely, Web of Science, Scielo, Scopus and PubMed, using 8 sets of keywords in English and Portuguese in order to identify wild food plants occurring in Brazil. The steps were: application of inclusion and exclusion criteria, screening of articles, selection of studies based on risk of bias, data treatment and, finally, data analysis. Eighty articles met the inclusion criteria of this review. However, 45 of them were considered to present high risk of bias and thus 35 articles were kept for the identification of overused and underused families. The results were inferred through two different approaches (IDM and Bayesian). Annonaceae, Arecaceae, Basellaceae, Cactaceae, Capparaceae, Caryocaraceae, Myrtaceae, Passifloraceae, Rhamnaceae, Rosaceae, Sapotaceae, Talinaceae, and Typhaceae were considered overused. Eriocaulaceae, Orchidaceae, and Poaceae were considered underused. Therefore, considering that some families are more (or less) used than others, we confirm that the wild food plants occurring in Brazil, known and used by different populations, are not chosen at random.

Patterns of use of wild food plants by Brazilian local communities: systematic review and meta-analysis.

BACKGROUND: This systematic review and meta-analysis sought to investigate the patterns of use of native wild food plants of Brazil (native and non-cultivated). METHODS: We searched ethnobiological works with food plants in Web of Science, Scielo, Scopus and PubMed using different sets of keywords. Initially, the studies were evaluated based on inclusion criteria (systematic data collection instruments, such as interviews; specification of methods for data collection; and the presence of a species list). The methodological quality of each study was evaluated to define the risk of bias. A total of 20 articles met all criteria and were included in the review. RESULTS: The results showed that there was a predominance of consumption of fruits, followed by leaves and seeds, which together represented 85.8% of the total parts. As for the meta-analysis, there was a predominance of use of plant parts classified as reproductive, non-persistent, non-destructive and parts of woody plants. There was no interference from the type of ecosystem (seasonally dry x moist). The results did not support the seasonality hypothesis. CONCLUSIONS: The concentration of studies in the Northeast, Southeast and South regions of Brazil and in the Atlantic Forest and Caatinga biomes points to the need for a greater effort in terms of quantitative ethnobotanical research in other regions and biomes. The predominance of fruits and plant parts classified as reproductive, non-persistent and non-destructive points to the high potential for implementation of sustainable management strategies aimed at these plants in the country.

Evaluation of the cytotoxic activity of some Brazilian medicinal plants.

Plants are promising sources of new bioactive compounds. The aim of this study was to investigate the cytotoxic potential of nine plants found in Brazil. The species studied were: Annona pickelii Diels (Annonaceae), Annona salzmannii A. DC. (Annonaceae), Guatteria blepharophylla Mart. (Annonaceae), Guatteria hispida (R. E. Fr.) Erkens & Maas (Annonaceae), Hancornia speciosa Gomes (Apocynaceae), Jatropha curcas L. (Euphorbiaceae), Kielmeyera rugosa Choisy (Clusiaceae), Lippia gracilis Schauer (Verbenaceae), and Hyptis calida Mart. Ex Benth (Lamiaceae). Different types of extractions from several parts of plants resulted in 43 extracts. Their cytotoxicity was tested against HCT-8 (colon carcinoma), MDA-MB-435 (melanoma), SF-295 (glioblastoma), and HL-60 (promielocitic leukemia) human tumor cell lines, using the thiazolyl blue test (MTT) assay. The active extracts were those obtained from G. blepharophylla, G. hispida, J. curcas, K. rugosa, and L. gracilis. In addition, seven compounds isolated from the active extracts were tested; among them, ß-pinene found in G. hispida and one coumarin isolated from K. rugora showed weak cytotoxic activity. In summary, this manuscript contributes to the understanding of the potentialities of Brazilian plants as sources of new anticancer drugs.

Prevalence and predictive factors for fear of childbirth in pregnant Portuguese women: A cross-sectional study.

OBJECTIVE: To measure the prevalence of the fear of childbirth (FOC) and determine which factors predict severe FOC among pregnant Portuguese women. METHODS: An online cross-sectional study among pregnant Portuguese women aged ≥ 20 years who were recorded using a convenience sampling. Self-administered questionnaires were used for data collection: socio-demographic and obstetric questionnaire and European Portuguese version of Wijma Delivery Expectancy Questionnaire-version A (WDEQ-A). Data of 669 participants were collected successfully from June 9 to October 30, 2019. Predictive factors for severe FOC were investigated using a multivariate logistic regression analysis. Odds ratios (OR) and 95% confidence intervals were calculated. RESULTS: The prevalence of severe FOC (WDEQ-A ≥ 85) among pregnant Portuguese women was 10%. Severe FOC was significantly associated with lower educational level, single/divorced marital status, and negative previous childbirth experience. Multivariate logistic regression analysis indicated that being single or divorced and having a negative previous childbirth experience were predictive variables for severe FOC. CONCLUSION: Pregnant Portuguese women have FOC, although with varying severity. The data suggest that marital status and women's perceptions of previous childbirth experience may be useful variables to predict severe FOC. Further research for extending the predictive factors of FOC should be refined. The results are clinically relevant for midwifery care, as they should be used in the sense of early identification of fearful pregnant women to provide adequate support strategies to reduce FOC.

Midwives' interventions for reducing fear of childbirth in pregnant women: a scoping review.

OBJECTIVE: The objective of this review was to map and analyze midwives' interventions for reducing fear of childbirth in pregnant women. INTRODUCTION: Fear of childbirth is a phenomenon negatively affecting women's health and well-being before and during pregnancy. Over the past few decades, there has been growing research interest in interventions for reducing fear of childbirth in pregnant women. One of the challenges in midwifery care is to provide an appropriate model of care for pregnant women with fear of childbirth. Further research efforts are needed to identify midwives' interventions for reducing fear of childbirth in pregnant women and to examine their characteristics. INCLUSION CRITERIA: This scoping review considered studies that included midwives' interventions for reducing fear of childbirth in pregnant women. Specifically, interventions were led and/or implemented by midwives during the antenatal period, and integrating all possible midwifery practice settings. Quantitative, qualitative, and mixed methods studies were included. This review also considered systematic reviews, text and opinion papers, and conference abstracts. METHODS: The JBI methodology for conducting scoping reviews was used. Published and unpublished literature in English, Portuguese, and Spanish from January 1981 to October 2020 was included. MEDLINE (PubMed), CINAHL Complete, APA PsycINFO, Scopus, Embase, Web of Science, SciELO, MedicLatina, Academic Search Complete, ERIC, Psychology and Behavioral Sciences Collection, and the Cochrane Library databases were searched. Searches for gray literature were also undertaken on the Repositório Científico de Acesso Aberto de Portugal, ProQuest Dissertations and Theses, British Library EThOS, OvidSP Resource Center, Banco de Teses da CAPES, and OpenGrey. A three-step search strategy was followed, and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews checklist was used. Two independent reviewers extracted the data using a data extraction tool developed specifically for this scoping review. RESULTS: A total of 3704 articles were identified and screened, of which 34 articles were included. The majority of studies had been published in the past 10 years (88%) in Scandinavian countries or Australia (79%). Several midwives' antenatal interventions were found, such as midwife-led team models of care. Midwives played a facilitator role that varied across the included studies. In 20 studies (59%), midwives led and implemented the interventions alone ( n   =  13; 38%) or with the participation of other health professionals ( n   =  7; 21%). In the remaining 14 studies (41%), midwives were part of a multidisciplinary team that included different health professionals (mainly obstetricians and psychologists) who had been involved in delivering interventions alongside midwives or with minor participation from midwives. Counseling ( n   =  12; 35%) and psychoeducation ( n   =  8; 24%) were the most common midwife interventions for reducing fear of childbirth in pregnant women. CONCLUSIONS: Midwives working across their full scope of practice play a pivotal role in reducing fear of childbirth, which may explain the variety of midwives' antenatal interventions. Reducing fear of childbirth in pregnant women and promoting normal childbirth as a positive experience are key features of midwives' interventions, which should include women's empowerment measures. Evidence-based midwife-led intervention programs for pregnant women with fear of childbirth should be designed and tested to improve clinical practice as well as women's reproductive outcomes and perinatal experiences.

Antenatal care policies for low-risk pregnant women in high-income countries with a universal health system: a scoping review protocol.

OBJECTIVE: The aim of this scoping review is to map the available evidence on the nature, extent, and range of antenatal care policies for low-risk pregnant women in high-income countries with a health system founded on the Beveridge Model. INTRODUCTION: Low-risk women in high-income countries have good evolutionary perinatal outcomes but high intervention rates in pregnancy and childbirth, which ultimately leads to high morbidity. This has implications at all levels including families, the health care system, and society. This review aims to inform future policy and identify the viability of the adoption of alternative models to the Portuguese context that can reduce unnecessary interventions. INCLUSION CRITERIA: Studies, protocols, guidelines, and policies that provide guidance on antenatal care for low-risk pregnant women in high-income countries with a health system founded on the Beveridge Model (universal health care) will be considered. Documents from 2005 to present will be included, and no language restrictions will be imposed. METHODS: An initial search will be conducted in databases including MEDLINE (via PubMed) and CINAHL (via EBSCOhost), followed by a manual search of the reference lists from the documents accepted for inclusion, and a hand search of gray literature. For the countries whose policies are not available through the earlier steps, key persons from health ministries and academia will be contacted. Search results will be exported and data extracted using charting forms. Data will be synthesized using narrative description.

Fear of childbirth in time of the new coronavirus pandemic.

OBJECTIVE: Reflect on how the new coronavirus pandemic triggered or accentuated the fear of childbirth in pregnant women and affected childbirth care practices. METHODS: Reflective analysis of women's pregnancy and childbirth experiences during the current pandemic, supported by the latest scientific evidence and recommendations on the topic. RESULTS: Pregnancy and childbirth are life-changing events for women, but during the new coronavirus pandemic, fear and uncertainty have taken on an unprecedented dimension in the negative way that many pregnant women have anticipated and experienced childbirth. FINAL CONSIDERATIONS: The current period has accentuated a chronic problem: a paternalistic system of health institutions in the approach to childbirth, dense with additional levels of fear in pregnant women. In this context, addressing the fear of childbirth means not giving up the promotion of safe and positive birth experiences for women.

Midwifery interventions to reduce fear of childbirth in pregnant women: a scoping review protocol.

OBJECTIVE: The objective of the review is to map and analyze midwifery interventions to reduce fear of childbirth in pregnant women. INTRODUCTION: Fear of childbirth is a phenomenon negatively affecting women's health and well-being before and during pregnancy, as well as after childbirth. During the previous few decades, there has been a growing interest in research into interventions to reduce the fear of childbirth in childbearing women. Currently, providing an appropriate model of care for pregnant women with fear of childbirth is a challenge in midwifery care. Therefore, further efforts are needed to identify and examine the characteristics of different midwifery interventions to reduce fear of childbirth in pregnant women. INCLUSION CRITERIA: This scoping review will consider studies that include interventions to reduce fear of childbirth in pregnant women, led and implemented by midwives, during the antenatal period, in all possible birth scenarios. Quantitative, qualitative, and mixed methods studies will be included. METHODS: The JBI methodology for conducting scoping reviews will be employed. Published and unpublished literature in English, Portuguese, and Spanish, from 1981 to the present, will be included. MEDLINE, CINAHL Complete, Scopus, Web of Science, Embase, and Cochrane Library databases will be searched. Searches for gray literature will be performed. Data will be extracted using a tool developed specifically for the scoping review objectives.

Conflict management strategies used by Portuguese nurse managers.

OBJECTIVES: to analyze the perception and conflict management strategies used by nurses in the management of people in Portuguese health services. METHODS: descriptive, correlational study, carried out in Portuguese health services, with an intentional non-probabilistic sample, totaling 95 nurse managers. A questionnaire and Conflict Management Scale were used, analyzing the variables of managerial activities and conflict management, with the aid of software. RESULTS: it was identified that 60% of the managers, report having to mediate conflicts daily, and the majority report adopting dialogue in conduct. However, through the Kruskal-Wallis test, it was shown that enforcement strategies in conflict management prevail (p = 0.008), with collaborative ones being more restricted to monthly intervals (p = 0.049). CONCLUSIONS: managers perceive the importance of collaboration in the mediation of conflicts, however, in their daily lives; they tend to maintain imposing behaviors, signaling for a little transformational leadership style.