Scale of pregnant women's assessment of knowledge, attitude and practice related to urinary incontinence.

INTRODUCTION AND HYPOTHESIS: Urinary incontinence (UI) is prevalent during pregnancy and negatively affects quality of life. Despite this, few women seek professional assistance during prenatal care. Assessing the knowledge, attitude and practice (KAP) of pregnant women related to UI can contribute to the development and improvement of the quality of interventions performed during this period. For this, it is essential to apply targeted and valid instruments for this population. Thus, the present study aimed to construct and validate the content of a scale to evaluate the KAP of pregnant women related to UI. METHODS: Extensive literature review guided the operationalization of the instrument's initial items. Ten experts were selected for the theoretical analysis of the items, which was carried out using the Delphi technique, and the analysis of semantic adequacy proceeded from the application of the scale to 30 pregnant women. The data were analyzed using the content validity coefficient and kappa coefficient. RESULTS: The proposed Scale of Pregnant Women's Assessment of Knowledge, Attitude and Practice related to UI was approved by consensus by the experts, with a mean Cohen's kappa of 0.84 (p < 0.01), comprising 23 items. CONCLUSIONS: The results of the study confirm that the presented scale can be used as a valid tool to assess the KAP of pregnant women related to UI.

Symptomatic and anatomic improvement of pelvic organ prolapse in vaginal pessary users.

INTRODUCTION AND HYPOTHESIS: The vaginal pessary is a conservative method for treating pelvic organ prolapse (POP). It is able to reduce symptoms with minimal complications, improving quality of life (QOL). This study's hypothesis was that the use of pessaries decreases quantitative measures and improves women's QOL. We aimed to evaluate the effects of the use of a ring pessary on the quantitative measurements of POP by the Pelvic Organ Prolapse Quantification (POP-Q) and on QOL. METHODS: Prospective cohort study divided in two stages. In stage I POP-Q and QOL were assessed prior to the use of the ring pessary and in stage II after its use for at least 4 months with pessary removal 72 h before clinical evaluation. Wilcoxon tests were performed for necessary comparisons and Spearman's tests for calculating correlations. RESULTS: One hundred thirty-six women were evaluated, of which 50 were included. There was a decrease in POP in at least one of the vaginal compartments in the women included. When assessing individual measures (Ba, Bp and C), reductions in all measures were observed. There was also an improvement in the general and specific quality of life of women. CONCLUSION: The ring pessary proved to be a good therapeutic option, with a reduction in POP-Q measurements and/or absence of POP progression in the short term and an improvement in women's QOL.

Pessary evaluation for genital prolapse treatment: From acceptance to successful fitting.

AIMS: To determine the percentage of women with symptomatic pelvic organ prolapse who opted for pessary and had a successful pessary fitting trial; to identify the most commonly used size of pessary for stage of prolapse; and to identify risk factors associated with unsuccessful fitting. METHODS: We conducted a prospective cohort study of women with symptoms of genital prolapse referred to a public hospital tertiary care clinic (2013-2019). We used ring and ring with support pessaries for fittings. We collected patient demographics, pelvic organ prolapse quantification, size of pessary used and evaluated factors associated with pessary fittings. We defined unsuccessful fit as failure to continue pessary use at 4 weeks post fitting trial. We used Mann-Whitney and χ2 tests to compare variables between groups of successfully and unsuccessfully fitted. Using logistic regression, we built a prediction model for unsuccessful fit. RESULTS: All 170 women with symptomatic prolapse referred to our clinic accepted to undergo a pessary fitting. More than 70% (n = 124/72.9%) were successfully at 4 weeks. We used an average of 1.7 pessaries (range: 1-6) per patient to identify the best-fitting pessary and #2, 5, 3, 7, and 4 were the sizes commonly used (78.2%). Women with body mass index ≥30 kg/m2 (odds ratio [OR]: 4.74; 95% confidence interval [CI], 1.98-11.32; P < .001), total vaginal length <7.5 cm (OR: 3.78; 95% CI, 1.98-11.32; P < .001), and sexually active women (OR: 2.26; 95% CI, 1.04-4.91; P = .035) were associated with increased unsuccessful fitting. CONCLUSION: The vaginal pessary proved to be an excellent choice, with high acceptance and successful fitting rates.

A systematic review of the prevalence, risk factors, and impact of pelvic floor dysfunctions in nurses.

AIM: To investigate the prevalence, risk factors, and impact of pelvic floor dysfunctions in female nurses. DESIGN: A systematic review. DATA SOURCES: Searches were conducted in the following five electronic databases: PubMed/Medline, LILACS, SCIELO, Cochrane Library, and CINAHL. There were no period or language limitations. REVIEW METHODS: Data extraction and synthesis were conducted and the appraisal of the quality of the studies was performed using the Joanna Briggs Institute critical appraisal tool checklist for prevalence data. RESULTS: A total of 15 studies were included. The symptoms investigated were lower urinary tract symptoms, including urinary incontinence and its subtypes, sexual dysfunctions, constipation, faecal incontinence, and dual incontinence. Overall, prevalence ranged from 9.9% to 89.6%. Associated factors related to occupational roles were lifting heavy weights and poor bladder habits. Quality of life was significantly worse for nurses with pelvic floor disorders. CONCLUSION: Pelvic floor dysfunctions are very common among female nurses, considerably affecting their quality of life. Additional studies are needed to investigate the impact on work productivity, causal relationships with the occupation and the performance of prevention and treatment interventions directed toward this population.

Women's knowledge, attitude and practice related to urinary incontinence: systematic review.

INTRODUCTION: Knowledge, attitude and practice (KAP) investigations lead to an understanding of what a particular population group knows, thinks and does in relation to a certain subject. METHODS: This systematic review was conducted to identify women's KAP related to urinary incontinence (UI) described in the literature and the measurement/evaluation instruments used. A literature search, up to July 2017, was conducted in PUBMED, SCOPUS and BVS (Virtual Health Library) for articles dealing with women's KAP related to UI that described the validation procedure of any data collection instrument. Articles that investigated exclusively male subjects, provider performance or academic teaching strategies were excluded. Relevant studies were analyzed and briefly summarized. RESULTS: Initially, 799 articles were retrieved. After applying the inclusion and exclusion criteria, 19 remained for reading and summarizing. There has been interest in identifying and evaluating some of the KAP elements related to UI since 1994, with a wide variety of validated instruments used. Knowledge was evaluated in 15 articles and all concluded that there was misinformation about UI in the populations studied. Seven articles studied the intention to seek healthcare for UI, among which only one evidenced an adequate attitude in more than 70% of the participants. All the articles that investigated practice revealed low rates of seeking care. CONCLUSIONS: The KAP elements are influenced by specific questions in each of the studied populations, leading to unique results, which indicates the importance of investigations using standardized data collection instruments that have psychometric validity tested in the target populations.

Prevalence of lower urinary tract symptoms and social determinants in primary care users in Brazil.

INTRODUCTION AND HYPOTHESIS: Although lower urinary tract symptoms (LUTS) have considerable clinical relevance, few propose evaluating its association with social conditions. Our study aimed to evaluate LUTS prevalence in primary care and its association with the social determinants of health (SDH). METHODS: This is a cross-sectional study conducted with 322 females in the period of June to October 2016 that carried out consultations and screening to prevent gynecological cancer in a primary care unit. RESULTS: The ages ranged from 18 to 85 years (M = 40.53). Storage symptoms had a higher overall prevalence (64.6%), highlighting nocturia (n = 186, 57.8%) and urinary incontinence (n = 120, 37.3%). Storage symptoms were associated with three layers of SDH. The voiding and postmicturition symptoms were only related to operative vaginal delivery. CONCLUSIONS: The findings of this study suggest a relationship between SDH and LUTS. It is important to emphasize that the results not only imply a causal relationship, but also point to the social inequalities existing at a population level.

Pelvic floor muscle function and quality of life in postmenopausal women with and without pelvic floor dysfunction.

INTRODUCTION: This study aims to compare pelvic floor muscle (PFM) function in postmenopausal women with and without pelvic floor dysfunction (PFD) and the relation between PFM function and quality of life. MATERIAL AND METHODS: A case-control study with 216 postmenopausal women with (n = 126) and without (n = 90) PFD. PFM function was assessed by digital vaginal palpation using the PERFECT scale. Specific quality of life was evaluated using the King's Health Questionnaire for women with urinary incontinence and the Prolapse Quality-of-Life Questionnaire for women with pelvic organ prolapse. We analyzed women with PFD into two categories: Oxford's grade ≤2 or ≥3 using a chi-squared test. RESULTS: Out of 126 womem with PFD 44 (34.9%) presented stress urinary incontinence, 21 (16.6%) had pelvic organ prolapse and 61 (48.4%) had urinary incontinence + pelvic organ prolapse. Strength had a median value 2 (0-5) in all women studied and most of them had insufficient strength, reduced endurance and repetition without statistical difference between groups. Incontinent women with strength ≤2 had worse perception of general health domain of King's Health Questionnaire (p = 0.007). No association was found between PFM function and Prolapse Quality-of-Life Questionnaire. CONCLUSIONS: PFM function assessed by bidigital palpation in postmenopausal women was not sufficiently sensitive to differentiate between women with vs. women without PFM dysfunction and was not related with specific quality of life in women with urinary incontinence and pelvic organ prolapse, respectively. These data should be used to reinforce the widespread recommendation that PFM training is essencial in PFD treatment.

Effectiveness of educational interventions conducted by telephone to promote breastfeeding: a systematic review of the literature. / Eficácia de intervenções educativas realizadas por telefone para promoção do aleitamento materno: revisão sistemática da literatura.

OBJECTIVE: To assess the effectiveness of telephone educational interventions on the duration and exclusiveness of breastfeeding. METHOD: A systematic review of the literature was conducted including only Randomized Clinical Trials. The exposure factor was an educational intervention via telephone, and the outcomes were duration and exclusiveness of breastfeeding. Literature in Portuguese, English and Spanish published between 2010 and 2016 were searched for in the Cochrane, Lilacs, Medline and Scopus databases. The articles were analyzed through a results synthesis. RESULTS: 241 articles were identified, of which 231 did not meet the inclusion criteria. Therefore, only 10 articles were reviewed. Four studies showed no efficacy related to breastfeeding. Regarding common characteristics, these studies were performed in short periods and in pairs. The others revealed efficacy regarding duration and/or exclusiveness of breastfeeding. The latter were mostly studies with long-term interventions and carried out by nurse lactation consultants. CONCLUSION: The evidence demonstrates that the telephone is a viable technology for promoting breastfeeding, representing an alternative for the health units and health professionals that can contribute to mother-baby care.

Clinical impact of bowel symptoms in women with pelvic floor disorders.

INTRODUCTION AND HYPOTHESIS: The aim of this study was to evaluate the correlations between the POP-Q Bp point and the perineal body (Pb) and genital hiatus (Gh) measurements and constipation, anal incontinence, severity of symptoms and quality of life. METHODS: The patients were distributed into two groups according to the posterior vaginal wall Bp point: one group with Bp ≤-1 (without posterior vaginal wall prolapse, control group) and the other group with Bp ≥0 (with posterior vaginal wall prolapse, case group). Demographic data, defecatory dysfunction and SF-36 scores were compared between the groups. Correlations between severity of posterior prolapse (Bp, Gh, Pb and Gh + Pb) and severity of bowel symptoms were also calculated. RESULTS: A total of 613 women were evaluated, of whom 174 were included, 69 (39.7%) in the control group and 105 (60.3%) in the case group. The groups were similar in terms of anal incontinence, fecal urgency and/or constipation. There was no correlation between the severity of constipation and anal incontinence according to the Wexner score, and the severity of posterior vaginal wall prolapse measured in terms of point Bp. There were, however, statistically significant differences in Pb, Gh and Gh + Pb between the groups. The Pb and Gh + Pb measurements were positively correlated with symptoms of constipation, as well as with the scores of some SF-36 domains, but were not correlated with anal incontinence. CONCLUSIONS: These results suggest that the severity of posterior vaginal wall prolapse is not correlated with constipation or anal incontinence, but Pb and Gh + Pb measurements are correlated with constipation and SF-36 scores.

Simple approach based on maternal characteristics and mean arterial pressure for the prediction of preeclampsia in the first trimester of pregnancy.

AIM: To propose a simple model for predicting preeclampsia (PE) in the 1st trimester of pregnancy on the basis of maternal characteristics (MC) and mean arterial pressure (MAP). METHODS: A prospective cohort was performed to predict PE between 11 and 13+6 weeks of gestation. The MC evaluated were maternal age, skin color, parity, previous PE, smoking, family history of PE, hypertension, diabetes mellitus and body mass index (BMI). Mean arterial blood pressure (MAP) was measured at the time of the 1st trimester ultrasound. The outcome measures were the incidences of total PE, preterm PE (delivery <37 weeks) and term PE (delivery ≥37 weeks). We performed logistic regression analysis to determine which factors made significant contributions for the prediction of the three outcomes. RESULTS: We analyzed 733 pregnant women; 55 developed PE, 21 of those developed preterm PE and 34 term PE. For total PE, the best model was MC+MAP, which had an area under the receiver operating characteristic curve (AUC ROC) of 0.79 [95% confidence interval (CI)=0.76-0.82]. For preterm PE, the best model was MC+MAP, with an AUC ROC of 0.84 (95% CI=0.81-0.87). For term PE, the best model was MC, with an AUC ROC of 0.75 (0.72-0.79). The MC+MAP model demonstrated a detection rate of 67% cases of preterm PE, with a false-positive rate of 10%, positive predictive value of 17% and negative predictive value of 99%. CONCLUSION: The MC+MAP model showed good accuracy in predicting preterm PE in the 1st trimester of gestation.

Impact of urinary incontinence types on women's quality of life. / Impacto dos tipos de incontinência urinária na qualidade de vida de mulheres.

OBJECTIVE: To identify the most frequent type of urinary incontinence in women assisted in two outpatient clinics of urogynecology, and to compare general and specific quality of life among the different types of incontinence measured through validated questionnaires. METHOD: Cross-sectional study conducted at the urogynecology outpatient clinic. The following questionnaires were used for quality of life assessment: Medical Outcomes Study 36-item Short-Form Health Survey (SF-36), International Consultation Incontinence Questionnaire Short-Form (ICIQ-SF), King's Health Questionnaire (KHQ), and Pelvic Organ Prolapse Incontinence Sexual Questionnaire (PISQ-12). RESULTS: The study included 556 women. Mixed Urinary Incontinence was the most frequent type (n=348/62.6%), followed by Stress Urinary Incontinence (n=173/31.1%) and Urge Urinary Incontinence (n=35/6.3%). Women with mixed urinary incontinence had greater impact on the general (SF-36) and specific quality of life (KHQ and ICIQ-SF) compared to the others (p<0.05). In the evaluation of sexual function (PISQ-12), there was no difference between groups (p=0.28). CONCLUSION: All types of urinary incontinence interfere both in the general and specific quality of life, but women with mixed urinary incontinence are the most affected.

Prevalence of unreported bowel symptoms in women with pelvic floor dysfunction and the impact on their quality of life.

INTRODUCTION AND HYPOTHESIS: Little information is available on the recurrent coexistence of pelvic organ prolapse (POP), urinary (UI) and/or anal (AI) incontinence and defecatory dysfunctions and the relationship between these disorders. The purpose of this study is to report the prevalence, bother, and impact on quality of life (QoL) of unreported bowel symptoms in women presenting to a Brazilian tertiary urogynecology clinic. METHODS: The study was a cross-section survey of 172 patients with symptoms of pelvic floor disorders (PFD). Patients who reported any defecatory and/or continence disorders were included in the study group, and the others were included in the control group. Patients with UI were also compared with those with double incontinence (DI): AI and UI. Univariate analysis was conducted using the Mann-Whitney U test for continuous nonparametric data. RESULTS: After the interview, 54.6 % (n = 94) of patients presented AI and/or defecatory disorders: 67.0 % constipation, 41.4 % AI, and 34.0 % fecal urgency. Women from the study group scored worse in the QoL questionnaires compared with women from the control group. Among women with UI, 23.21 % had associated AI. Women with DI scored worse in the QoL questionnaires. CONCLUSION: Anal and urinary dysfunctions are usually associated and have a great impact on a woman's QoL. An integrated approach across specialties should lead to improved patient care. Therefore, our study is relevant because it emphasizes the importance of urogynecologists routinely investigating such symptoms. To do so, standardized questionnaires should be included in the evaluation of all these patients.

The Effects of Hysterectomy on Urinary and Sexual Functions of Women with Cervical Cancer: A Systematic Review.

OBJECTIVE: This systematic review aims at describing the prevalence of urinary and sexual symptoms among women who underwent a hysterectomy for cervical cancer. METHODS: A systematic search in six electronic databases was performed, in September 2019, by two researchers. The text search was limited to the investigation of prevalence or occurrence of lower urinary tract symptoms (LUTS) and sexual dysfunctions in women who underwent a hysterectomy for cervical cancer. For search strategies, specific combinations of terms were used. RESULTS: A total of 8 studies, published between 2010 and 2018, were included in the sample. The average age of the participants ranged from 40 to 56 years, and the dysfunctions predominantly investigated in the articles were urinary symptoms (n = 8). The rates of urinary incontinence due to radical abdominal hysterectomy ranged from 7 to 31%. The same dysfunction related to laparoscopic radical hysterectomy varied from 25 to 35% and to laparoscopic nerve sparing radical hysterectomy varied from 25 to 47%. Nocturia ranged from 13%, before treatment, to 30%, after radical hysterectomy. The prevalence rates of dyspareunia related to laparoscopic radical hysterectomy and laparoscopic nerve sparing radical hysterectomy ranged from 5 to 16% and 7 to 19% respectively. The difficulty in having orgasm was related to laparoscopic radical hysterectomy (10 to 14%) and laparoscopic nerve sparing radical hysterectomy (9 to 19%). CONCLUSION: Urinary and sexual dysfunctions after radical hysterectomy to treat cervical cancer are frequent events. The main reported disorders were urinary incontinence and dyspareunia.

OBJETIVO: Essa revisão sistemática visa descrever a prevalência de sintomas urinários e sexuais entre mulheres submetidas à histerectomia por câncer cervical. MéTODOS: Uma pesquisa sistemática foi realizada em seis bases de dados eletrônicas, em setembro de 2019, por dois pesquisadores. A busca foi limitada à investigação da prevalência e ocorrência de sintomas do trato urinário baixo e disfunções sexuais em mulheres após histerectomia por câncer cervical. Como estratégia de busca foi utilizada uma combinação específica de termos apenas em inglês. RESULTADOS: Um total de 8 estudos, publicados entre 2010 e 2018, foram incluídos na amostra. A idade média dos participantes foi de 40 a 56 anos, e as principais disfunções investigadas pelos artigos foram sintomas urinários (n = 8). Na literatura analisada, as taxas de incontinência urinária ligadas à histerectomia abdominal radical variaram de 7 a 31%. A mesma disfunção, para histerectomia radical laparoscópica, variou de 25 a 35%, e de 25 a 47% para histerectomia radical laparoscópica poupadora de nervo. A taxa de noctúria variou de 13%, antes do tratamento, a 30%, após histerectomia radical. A prevalência de dispareunia associada à histerectomia radical laparoscópica foi de 5 a 16%. Já a taxa de dispareunia relatada pós-histerectomia radical laparoscópica poupadora situou-se entre 7 e 19%. A dificuldade de alcançar o orgasmo foi relatada após histerectomia radical laparoscópica, variando de 10 a 14%, e também na histerectomia radical laparoscópica poupadora de nervo, variando de 9 a 19%. CONCLUSãO: Disfunções urinárias e sexuais após histerectomia para tratamento do câncer cervical são eventos frequentes. As principais desordens relatadas foram incontinência urinária e dispareunia.

Telephone intervention to promote maternal breastfeeding self-efficacy: randomized clinical trial.

OBJECTIVE: To analyze the effects of an educational intervention via telephone on maternal breastfeeding self-efficacy. METHOD: Randomized controlled clinical trial including 240 puerperae from a secondary care hospital randomized into two groups: control and intervention. The educational intervention took place at seven, 30, 90, and 150 days postpartum and centered on self-efficacy and motivational interviewing principles. Self-efficacy was measured by the Breastfeeding Self-Efficacy Scale - Short Form. The data followed the abnormal distribution, so non-parametric tests were used. RESULTS: The intervention group obtained higher median breastfeeding self-efficacy scores across the three outcome measures when compared to the control group (p < 0,001). Furthermore, the intervention group showed increased self-efficacy scores at all monitoring moments, which shows that the educational intervention was able to raise and maintain women's confidence in breastfeeding their child over time. CONCLUSION: The use of a telephone-based intervention focused on self-efficacy principles and delivered by trained nurses effectively promoted maternal confidence in breastfeeding. Brazilian Clinical Trial Registry: RBR-7m7vc8.

The effect of educational technology use to guide parturient women's companions: a randomized controlled study.

OBJECTIVE: To evaluate the companion's role during the labor and delivery processes, comparing the influence of the use of an educational technology. METHOD: A single-blind randomized controlled study, in which 73 participants were divided into two groups, 35 in the intervention group and 38 in the comparison group. To analyze the groups the chi-square and the Fisher's exact tests were used in categorical variables and the Student's t-test or the Mann-Whitney test in continuous variables. RESULTS: When comparing the experience and the support provided, it was found that there was no difference between the groups in relation to the level of support (p=0.48) and satisfaction with the experience of monitoring the delivery process (p=0.19). However, there was a difference regarding insecurity in monitoring (p=0.00) and concern regarding the parturient health status (p=0.00). CONCLUSION: The companions who received the intervention with educational technology were more likely to use physical, emotional and intermediation support actions. Registry of Brazilian Clinical Trials UTN: U1111-1231-8695.

[Analysis of coverage and of the Pap test exams not retired of a basic health unit]. / Análise da cobertura e dos exames colpocitológicos não retirados de uma unidade Básica de Saúde.

To analyze the coverage and the colpocytology exams that were not collected from a Health Center. This is a retrospective documentary study, in which the data were evaluated for coverage of 2007 and all 225 tests that were performed but were not collected by the patients unit until January 2008. Statistical analysis was performed using the frequency of the studied variables. The average monthly number of tests was 102.6 examinations. The coverage of the examination in 2007 was 11.22% among women with 25 to 59 years of age. Of the 938 tests conducted between February and November 2007, 225 (23.98%) women did not receive the result. Most women (67.5%) who performed the examination and had not returned were 30 years old or younger. The women's attitude of not returning to collect their exam results increases the difficulty of follow up, and providing comprehensive and continuity of care, contributing with an intervention in advanced stages of the disease.

[Risk factors for uterine cervical cancer according to results of VIA, cytology and cervicography]. / Fatores de risco para câncer de colo do útero segundo resultados de IVA, citologia e cervicografia.

This study aimed to evaluate the association between risk factors for uterine cervical neoplasms and cervical lesions by HPV by comparison of the visual inspection with acetic acid (VIA), cytology and cervicography results. A prevalence research was made with 157 women in a health center of Fortaleza in the period of June to September 2006. The SPSS program was used to codify the data. Inferences were made through statistical tests (chi2 = chi square and LR = likelihood ratio). The VIA, cervicography and cytology obtained 43.3%, 10.19% and 3.2% of altered results. The variables with important association to cervical lesions in the VIA were: aged less than 20 years old (p = 0.0001); one or more partners in the last three months (p = 0.015); use of contraceptives (p = 0.0008); presence of vaginal discharge (p = 0.0001) and moderate or accentuated inflammatory process (p = 0.0001). In the cytology: low instructional level (p = 0.0001) and high pH (p = 0.001). It wasn't found any significant association in the cervicography.

Women and healthcare providers' knowledge, attitudes and practice related to pessaries for pelvic organ prolapse: A Systematic review.

OBJECTIVE: To identify the knowledge, attitudes and practice of women and healthcare professionals in relation to pessary use for POP. METHOD: This systematic review was carried out in agreement with PRISMA recommendations. PubMed/MEDLINE, SCOPUS, Virtual Health Library, Web of Science, CAPES Periodicals and CINAHL databases were searched for studies without date or language limitations. Search strategies were developed for identifying studies examining knowledge, attitudes and practice toward vaginal pessaries use. Two reviewers independently screened titles and abstracts to identify eligible studies. Data extraction was performed independently in duplicate into a standardized form. Quality of included studies was assessed using the Joanna Briggs Institute quality assessment tool. The protocol was registered with the PROSPERO International prospective register of systematic reviews [CRD42018114236]. RESULTS: Fourteen studies were included. Knowledge and practice were the main domains investigated among patients and professionals, respectively. The results demonstrated poor patient knowledge; however, in urogynecologic patients, knowledge was better. Previous consultation with a Female Pelvic Medicine and Reconstructive Surgery specialist (p = .001) and a higher level of education (p = .006) were associated with improved knowledge of pessary use. Fear of vaginal discharge, irritation, bleeding, and pain were factors that supported the decision not to use a pessary. Previous consultation with a generalist gynecologist (p = .03)and a lower level of education (p = .03) predicted aversion to pessary use. Providers demonstrated adequate knowledge and recommended pessary in 86.4% to 98.0% of cases. Having specialist and pessary management training were some factors that influenced a better attitude towards pessaries among health professionals. CONCLUSION: The knowledge, attitudes and practice of women and health care providers about pessary use are seldom investigated. Developing a psychometrically valid instrument for assessment of knowledge, attitudes and practice is desirable to examine the complex interactions between these three constructs, expose barriers to pessary care, and develop targeted educational interventions.

Quality of Life in Women with Defecatory Dysfunctions: Systematic Review of Questionnaires Validated in the Portuguese Language.

OBJECTIVE: To identify the quality of life (QoL) assessment instruments related to the health of women with fecal incontinence (FI) or anal incontinence (AI). DATA SOURCES: Systematic review conducted in the Virtual Health Library (VHL), PubMed and Cochrane Library databases. The descriptors used were: Questionnaire, Questionnaires, Quality of life, validation, validation Studies, anal incontinence, fecal incontinence and constipation. The search was performed between December 26, 2017 and the beginning of January 2018. The limits used were female gender. SELECTION OF STUDIES: Initially, 5,143 articles were obtained in the search. The articles of validation for Portuguese of questionnaires for the evaluation of the impact of FI/AI on the QoL of women were considered eligible. DATA COLLECTION: The article search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guidelines. DATA SYNTHESIS: Of the 5,143 articles, only 2 fulfilled the inclusion and exclusion criteria: Fecal Incontinence Quality of Life (FIQL) and the Wexner scale (WS). The FIQL evaluates the QoL related to FI, not covering flatus incontinence. The WS assesses flatus incontinence and the severity of the AI. The WS obtained an interclass correlation coefficient (ICC) of 0.932 and a Cronbach α coefficient > 0.90. The FIQL obtained intraexaminer and interexaminer reproducibility ranging from 0.929 to 0.957 and from 0.944 to 0.969, respectively. CONCLUSIONS: The WS and the FIQL have satisfactory reliability and validity for use during gynecological consultations.

OBJETIVO: Identificar os instrumentos de avaliação da qualidade de vida (QV) relacionados à saúde de mulheres com incontinência fecal (IF) ou incontinência anal (IA). FONTES DOS DADOS: Revisão sistemática nas bases de dados da BVS, PubMed e Biblioteca Cochrane. Os descritores usados foram: Questionnaire, Questionnaires, Quality of life, validation, validation Studies, anal incontinence, fecal incontinence e constipation. A pesquisa foi realizada entre 26 de dezembro de 2017 até o início de janeiro de 2018. Os limites utilizados foram sexo feminino. SELEçãO DOS ESTUDOS: Inicialmente, 5.143 artigos foram obtidos na pesquisa. Os artigos de validação para o português de questionários de avaliação do impacto da IF/IA na QV das mulheres foram considerados elegíveis. COLETA DE DADOS: A busca de artigos foi conduzida de acordo com as diretrizes do Principais Itens para Relatar Revisões Sistemáticas e Meta-análises (PRISMA, na sigla em inglês). SíNTESES DOS DADOS: Dos 5.143 artigos, apenas 2 preencheram os critérios de inclusão e exclusão: Qualidade de Vida em Incontinência Fecal (FIQL, na sigla em inglês) e Escala de Wexner (WS, na sigla em inglês). O FIQL avalia a QV relacionada à FI, não abrangendo a incontinência de gases. O WS avalia a incontinência dos flatos e a gravidade da IA. O WS obteve um coeficiente de correlação interclasse (ICC, na sigla em inglês) de 0,932 e alfa de Cronbach > 0,90. O FIQL obteve reprodutibilidade intraexaminador e interexaminador variando de 0,929 a 0,957 e de 0,944 a 0,969, respectivamente. CONCLUSõES: O WS e o FIQL têm confiabilidade e validade satisfatória para uso durante consultas ginecológicas.

Telephone intervention in the promotion of self-efficacy, duration and exclusivity of breastfeeding: randomized controlled trial. / Intervenção telefônica na promoção da autoeficácia, duração e exclusividade do aleitamento materno: estudo experimental randomizado controlado.

OBJECTIVE: to evaluate the effect of a telephone intervention on the self-efficacy of puerperal women in the duration and exclusivity of breastfeeding. METHOD: randomized controlled trial composed of 85 breastfeeding mothers at 2 months and 77 at 4 months. The sample was randomized into two groups, control and intervention. The intervention consisted of a telephone follow-up performed at seven, 15 and 30 days after delivery using the precepts of Motivational Interview and Self-Efficacy in Breastfeeding. RESULTS: self-efficacy in breastfeeding at 2 months was similar in both groups (p = 0.773). However, at 4 months, the intervention group presented higher self-efficacy than the control group (p = 0.011). There was a difference between groups in the duration of breastfeeding at 2 months (p = 0.035). At 4 months, the intervention group remained in breastfeeding when compared to the control group (p = 0.109). Both groups did not show differences in exclusive breastfeeding at two (p = 0.983) and four months (p = 0.573). CONCLUSION: the telephone educational intervention was effective in improving self-efficacy and duration of breastfeeding, but not exclusivity. (ReBEC: UTN: U1111-1180-5341).