Prevalence of faecal incontinence in patients with inflammatory bowel disease: Severity and its relationship with quality of life.

AIMS: To describe the prevalence of faecal incontinence in patients with inflammatory bowel disease, assess its severity, and correlation with quality of life. We adhered to relevant EQUATOR guidelines, STROBE method. DESIGN: Correlational-descriptive study. METHODS: Hebrew-speaking patients seen at an inflammatory bowel disease clinic in a large tertiary medical center in Jerusalem between February 2020 and December 2020 completed the Faecal Incontinence Severity Index and the Faecal Incontinence Quality of Life Scale. RESULTS: Ninety-six patients participated in the study, of which 70 (72.9%) had Crohn's disease, and 26 (27.1%) had ulcerative colitis. Eighty-five (88.5%) reported faecal incontinence with an overall Faecal Incontinence Severity Index mean of 27.66 (SD 15.99), yet only 14 (14.7%) reported that their physician or nurse inquired about faecal incontinence. Quality of life scores for patients with faecal incontinence was the lowest on the coping/behaviour scale (M = 2.44; SD 0.94) and the highest on the depression/self-perception scale (M = 2.86; SD 1.04). Significant correlations were found between faecal incontinence severity and quality of life in all scales except for self-embarrassment. Moderate correlations in the same scales were noted in patients with Ulcerative Colitis, while no significant correlations were found in the Crohn's Disease group. CONCLUSION: A high proportion of inflammatory bowel disease patients reported faecal incontinence associated with impaired quality of life. Only a few were questioned about faecal incontinence by their physician or nurse. IMPACT: There is limited literature regarding the prevalence and severity of faecal incontinence in inflammatory bowel disease patients. A high proportion of patients reported faecal incontinence, which negatively correlated with quality of life. Physicians and nurses must inquire about faecal incontinence to improve patient care. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Mothers' Knowledge of Infants' Fever Management: A National Prospective Study.

OBJECTIVES: The aim of this study was to describe mothers' knowledge of infant fever management after birth and six months later and its association with sociodemographic characteristics, perceived support, sources of consultation and health education; and to assess determinants of change in mother's knowledge from birth to six months. METHODS: Mothers (n = 2804) answered a self-reporting questionnaire after giving birth in maternity wards in six hospitals in Israel; six months later follow- up interviews were conducted by telephone. RESULTS: The mothers' knowledge level of infant fever management was low after birth (mean = 50.5, range 0-100, SD = 16.1), and rose to a moderate level six months later (mean = 65.2, SD = 15.0). Mothers having their first born, with lower household income or education were less knowledgeable about infant fever management after birth. However, these mothers showed the largest improvement after six months. Mothers' perceived support or sources of consultation and health education (partner, family, friends, nurses, and physicians) were not associated with their knowledge at either time. Moreover, mothers stated self-learning from internet and other media as often as receiving health education by health professionals. CONCLUSIONS FOR PRACTICE: Public health policy for health professionals in hospitals and community clinics is essential to promote clinical interventions promoting mothers' knowledge of infant fever management. Efforts should focus at first time mothers, those with non-academic education, and those with a moderate or low household income. Public health policy enhancing communication with mothers regarding fever management in hospitals and community health settings, as well as accessible means of self-learning is warranted.

Exploring midwives' coping and functioning in the labour wards during the Covid-19 pandemic from the Labour Ward Head Nurses' perspective: A qualitative study.

AIM: The aim of this study is to explore midwives' coping and functioning in the labour wards during the Covid-19 pandemic from the Labour Ward Head Nurses' perspective. BACKGROUND: The World Health Organization announced the Covid-19 outbreak to be a pandemic in March 2020. Midwives worldwide were affected by this outbreak, working in risky environments, confronting the anxiety and fear of childbearing women. METHODS: A qualitative study using thematic analysis was conducted using semi-structured interviews done over the telephone. Thirteen Labour Ward Head Nurses were interviewed, and the texts were analysed. The study took place in April 2020 during the first Covid-19 lockdown in Israel. RESULTS: Three main themes were generated in the coding process: (a) stress, fear and anxiety, (b) joint efforts and (c) frustration. CONCLUSION: Our study illustrates the difficulties that arose at the beginning of the pandemic, a new and unfamiliar chaotic period. Midwives' managers can use the current research to learn about actions that may assist in improving staff resilience and cohesion during times of crisis. IMPLICATIONS FOR NURSING MANAGEMENT: Understanding the psychological impact of the Covid-19 pandemic among health care professionals is crucial for guiding policies and interventions to maintain staff's psychological well-being.

Are Paula method exercises effective for gastrointestinal reactivation post-elective cesarean delivery? Randomized controlled trial.

AIM: To examine the effectiveness of the Paula Method exercises in comparison to standard care on resumption of gastrointestinal (GI) activity in women postelective caesarean delivery (CD). DESIGN: Randomized controlled trial on a postpartum unit of a university medical centre. METHODS: Sixty-four women following elective CD performed under regional anaesthesia were recruited between 2 February-3 July 2018. Participants were randomized into two groups: The Paula Method exercise group (intervention group) and the control group. Women in the intervention group performed circular muscle exercises according to the Paula Method and received standard care, while those in the control group were treated only with standard care. Time to first bowel sounds, passage of first flatus and first defecation after CD were measured. RESULTS: A significant difference was found in the time to passage of first flatus, in favour of the intervention group (24.07 [6.85] hours versus 39.07 [10.37] hours; p < .001). No significant differences between the groups were found for other main outcome measures. CONCLUSION: Paula Method exercises post CD can serve as natural and convenient alternative to the standard, conservative treatment to promote resumption of GI activity. IMPACT: CD can be associated with postoperative ineffective peristalsis that can lead to a paralytic ileus. Since standard methods are not sufficient for all women, there is a need for alternative modalities to accelerate the resumption of bowel functioning. In the Paula Method exercise group, time to first flatus passage occurred significantly sooner compared with the control group. Time to first defecation was earlier in the Paula Method exercise group but this difference did not reach statistical significance. Along with gum chewing, Paula Method exercises can be part of a simple and inexpensive GI activation strategy post CD. Further research should be performed using these exercises post other operative procedures.

Nurses' professional stigma and attitudes towards postpartum women with severe mental illness.

AIMS AND OBJECTIVES: To examine professional stigma and attitudes of parenthood towards postpartum women with severe mental illness and the association between postpartum nurses' attitudes and nursing interventions that promote motherhood. BACKGROUND: Stigma and attitudes towards parenthood of women with severe mental illness may influence nurses' clinical practices. DESIGN: Cross-sectional, mixed methods. METHODS: The Stigma among Health Professionals towards People with Severe Mental Illness, Attitudes towards Parenthood among People with Severe Mental Illness and Nursing Interventions that Promote Becoming a Mother Questionnaires were used in the study, as well as qualitative analysis. RESULTS: Sixty-one postpartum nurses participated in the study. Increased stigma was associated with an increase in negative attitudes towards parenthood among people with severe mental illness, in general, and towards their parenthood skills, in particular. Postpartum nurses reported a decrease in nursing interventions and a therapeutic nurse-client relationship that fosters mother's empowerment. Themes that emerged from the qualitative analysis were postpartum nurse's perceptions of inadequacy, difficulty of postpartum nurses taking responsibility for managing women with severe mental illness and a paternalistic approach to these women, rather than empowerment, regarding infant care. CONCLUSION: Nurses providing care to postpartum women with severe mental illness and their infants may provide fewer routine postpartum interventions due to professional stigma and negative attitudes concerning parenting skills. Nurses should provide individualised, tailored care that allows women with severe mental illness to become a mother to the best of her ability. RELEVANCE TO CLINICAL PRACTICE: Not all women with severe mental illness are capable of caring for themselves and/or their baby. Nurses should provide individualised, tailored care that allows the women with severe mental illness to become a mother to the best of her ability.

Obstetric anal sphincter injuries and the role of the midwife.

Obstetric anal sphincter injuries (OASIS) can have a very negative impact on women's health and quality of life. Literature exists concerning the role of the surgeon and physiotherapist after OASIS, but there is a dearth of literature pertaining to the role of the midwife in the management of women following an obstetric anal sphincter injury. This article examines the midwife's role and describes a new service instituted at Hadassah-Hebrew University medical centre, Jerusalem, utilised in the early postpartum period while the woman is still in hospital, entitled Special Services for Perineal Trauma.

Gum chewing and gastrointestinal function following caesarean delivery: a systematic review and meta-analysis.

AIMS AND OBJECTIVES: The aims of this systematic review and meta-analysis were to summarise current knowledge regarding gum chewing intervention for activation of the gastrointestinal (GI) system following caesarean delivery. BACKGROUND: GI symptoms such as nausea, vomiting and defecatory difficulties are bothersome for women following a caesarean delivery. There is category A recommendation to not withhold oral intake postoperatively. However, current practice guidelines vary widely on time to initiate oral feeding post caesarean delivery, and additional research is needed. Gum chewing has been shown to stimulate the GI system in other postoperative patient populations. DESIGN: A systematic review and meta-analysis. METHODS: An electronic review was undertaken using the following resources: PubMed (Medline), CINAHL, EMBASE and ClinicalTrials.gov databases. Key words used in various combinations included cesarean section; cesarean delivery; postoperative chewing gum; bowel movement; bowel function and complications. RESULTS: A total of 171 articles were found of which 166 were excluded: 157 were duplicates and the remainder did not meet the inclusion criteria. Five randomised control trials were included in the meta-analysis, focusing on gum chewing as an intervention as compared with a nongum chewing intervention, with a total of 846 participants. Compared with the nongum chewing group, gum chewing showed a beneficial impact on the major outcomes of digestive system activation, including bowel sound, gas passage and defecation. CONCLUSIONS: This meta-analysis supports the effectiveness of gum chewing post caesarean delivery as a noninvasive/nonpharmacological intervention for reactivation of bowel movement. RELEVANCE TO CLINICAL PRACTICE: Gum chewing in the immediate postoperative period following caesarean delivery may provide a socially acceptable, low-cost and safe intervention to reduce postcaesarean delivery GI complications and restore GI function.

Self-reported Prevalence of and Knowledge About Urinary Incontinence Among Community-Dwelling Israeli Women of Child-Bearing Age.

PURPOSE: The aim of this study was to examine the prevalence of urinary incontinence (UI) among parous women of child-bearing age and compare their level of knowledge regarding UI to those women without the condition. METHODS: A convenience sample of women aged 20 to 50 years who had given birth at least once completed questionnaires regarding (1) demographic information, (2) knowledge of UI (PIKQ-Prolapse and Incontinence Knowledge Quiz and PIKQ+), and (3) prevalence of UI (ICIQ-UI questionnaire-International Consultation on Incontinence Questionnaire-Urinary Incontinence short form). Women who were pregnant or 3 months or less postpartum were excluded from the analysis of the ICIQ-UI. RESULTS: Three hundred twenty-three women, representing 89.7% of those approached, participated in the study. Their mean age was 35.3 ±5.0 years (mean ± SD), all completed the knowledge questionnaire while 260 (80.5%) completed the UI questionnaire. Eighty-three (31.9%) suffered from UI, and most (67.5%) were between 31 and 40 years of age. Participants' level of knowledge about UI was found to be moderate (mean = 7.37 ± 3.6) on the PIKQ+. Knowledge level was correlated with age (P = .017) and with higher levels of education (P < .001). There was a significantly higher level of UI knowledge (PIKQ+ scores) among women with UI (mean = 8.6; SD = 3.01) as compared to those who did not report UI (mean = 7.6; SD =±3.75; P < .001). CONCLUSION: Approximately one-third of parous women aged 20 to 50 years reported UI. Knowledge related to the condition tends to be moderate, increasing with higher age and education.

A Correlational Study Of Midwives' Self-Compassion, Psychosocial Health, and Well-Being During the First Wave of COVID-19: What Have We Learned?

INTRODUCTION: During the first wave of the COVID-19 pandemic, midwives worked in a threatening environment and worried about themselves and their families becoming infected. Self-compassion is defined as an attitude of self-kindness that is supported by a balanced attitude toward negative thoughts or feelings and may contribute to the psychosocial health and well-being. The purpose of this study was to describe midwives' self-compassion, psychosocial health, and well-being and the correlation between them. METHODS: This was a descriptive correlational study using a survey administered online during May, 2020. Participants included midwives who worked in labor and delivery units across Israel during the beginning of the COVID-19 pandemic. Measures included a demographic questionnaire; the Self-Compassion Scale Short Form (SCS-SF), which has 12 items in 6 subscales; and the psychosocial health and well-being questionnaire, a short version of the Copenhagen Psychosocial Questionnaire, which has 24 items in 6 subscales. RESULTS: Participants (N = 144) reported a moderate-high level of self-compassion with a mean (SD) SCS-SF score of 3.57 (0.69). The mean (SD) psychosocial well-being score was 30.72 (13.57). The burnout subscale score had the highest mean (46.27), representing a high level of burnout. A minority (11.3%) of midwives considered resigning their midwifery positions. A higher level of self-compassion correlated with better psychosocial well-being (r = -0.466; P < .001). The highest correlation was found between the SCS-SF and the psychosocial health and well-being subscale for depressive symptoms (r = -0.574; P < .001). DISCUSSION: During the first wave of the COVID-19 pandemic, midwives had a moderate-high grade of self-compassion and good psychosocial well-being. Midwives with higher self-compassion had better psychosocial well-being. The findings could inform the development of programs to increase midwives' self-compassion, and psychosocial well-being and the quality of midwifery care, in times of stability and during future pandemics or disasters.

Sexual function and quality of life of women with stress urinary incontinence: a randomized controlled trial comparing the Paula method (circular muscle exercises) to pelvic floor muscle training (PFMT) exercises.

AIM: To compare the effectiveness of the Paula method (circular muscle exercises) vs. pelvic floor muscle training (PFMT) exercises on sexual function (SF) and quality of life (QoL) of women with stress urinary incontinence (SUI). METHODS: A randomized controlled trial (RCT) was conducted in outpatient urban community clinics serving diverse socioeconomic populations between September 2004 and July 2005. The intervention included two exercise regimens: Paula method--12 weeks of private 45 minutes sessions; PFMT--12 weeks of group (up to 10 participants) sessions of 30 minutes in length once a week, for 4 weeks plus two additional sessions, 3 weeks apart. MAIN OUTCOME MEASURES: The Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire; the Incontinence Quality of Life Questionnaire; 1-hour clinic pad test; gynecological examination; demographic/health history. RESULTS: Sixty-six women in the Paula group and 60 women in the PFMT group. The mean SF scores post interventions were 38.72 (5.35) in the Paula group and 38.07 (5.80) in the PFMT group. SF score improvement was found to be significant in both groups (Paula, P = 0.01; PFMT, P = 0.05), as was in the QoL scores (Paula, P < 0.001; PFMT, P ≤ 0.001), with no significant difference between groups. There was a significant correlation between the mean SF score and the mean QoL score after the intervention (Paula: r = 0.4, P = 0.002; PFMT: r = 0.4, P = 0.009). A mild to moderate significant correlation was also found between the SF score and pad test results in both groups post intervention (r = -0.3, P = 0.02; r = -0.3, P = 0.04, respectively). CONCLUSION: This RCT study demonstrated the effectiveness of two exercise methods on SF and QoL in women suffering from SUI. The Paula method of exercise was presented for the first time in the literature as a conservative noninvasive treatment for SUI and SF.

Women's well-being after Manchester procedure for pelvic reconstruction with uterine preservation: a follow-up study.

PURPOSE: This study describes the outcomes of a modified Manchester procedure on the quality of life and sexual functioning of women with elongation of the uterine cervix with or without pelvic organ prolapse (POP). METHODS: Data on medical and demographic variables were collected from medical files and then women were invited to for follow-up examination and data collection. RESULTS: Follow-up data were collected from 53 out of 87 women who underwent reconstructive surgery with modified Manchester procedure (60.9% of the women). Prior the surgery, all women in this sample (n = 53) were medically examined and found to have uterine cervix elongation, 40/53 (75.4%) women also had cystocele, 10/53 women (18.8%) had uterine prolapse and 8/53 women (15.1%) had rectocele (all stages II-IV). On follow-up examination, all the cervical stumps were satisfactorily situated, recurrent cystocele was found among 12/53 women (22.6%) women; 13/53 (24.5%) had rectocele; and none of these women had uterine prolapse. Women with POP (cystocele and rectocele) (24/53) had less operative satisfaction (p = 0.004), lower quality of life (p < 0.05 in 3 out of 8 domains), and poorer sexual function (p = 0.03) compared to women without POP (29/53). CONCLUSION: The modified Manchester procedure including reconstructive surgery for women with cervix elongation, with or without POP, prevented recurrent uterine prolapse and was well received in terms of patient's satisfaction, quality of life, and sexual function.

Spiritual Interventions Used by Jewish Women to Facilitate the Family Continuum: A Qualitative Study.

Introduction: Spiritual interventions (SI) are used by patients and their families as a means to promote health. The family continuum (FC), which includes finding a partner/spouse, getting married, becoming pregnant, and having a safe pregnancy/birth, is an important concept for the Jewish culture as well as other cultures that have a traditional family-centered approach. There is a dearth of professional literature pertaining to SI to promote the FC. Although patients may use SI, this information is not routinely collected in a health history. The purpose of the study was to describe the experience of Jewish women's use of SI to promote the FC. Methods: This ethnographic study included interviews of Jewish women pertaining to FC, a text review, and field study. Coding of the text, site visits, and interviews were performed and reviewed to identify categories and themes and were refined until saturation was achieved. Results: Fifty-three observant and non-observant Jewish women participated in the study. Women expressed that SI were the means for them playing an active role in fulfilling the FC, and included intermediaries to God, self-improvement, and folk/spiritual remedies. The examples of SI included: visits to holy sites and spiritual leaders for blessings and advice, prayers, psalms, doing good deeds, eating special foods, wearing amulets, and performing certain SI with predesignated repetitions. Women attributed these SI to attaining an FC. Women who achieved each FC milestone without difficulty tended to use less SI, whereas women's SI usage increased the longer a milestone was not achieved. Conclusions: Jewish women are using many SI to promote the FC. Health care should be delivered in a culturally competent manner, which includes the incorporation of safe cultural practices. Obtaining a cultural assessment as part of the medical history could assist the health care professional in integrating safe SI into patient care.

Urinary incontinence type, symptoms, and quality of life: A comparison between grand multipara and non-grand multipara women aged ≥50 years.

AIM: Parity and age are risk factors for urinary incontinence (UI). The aim of this study was to compare grand multipara women (GMP) to non-grand multipara (NGMP) women concerning UI types (stress urinary incontinence [SUI], urge urinary incontinence [UUI]), symptoms, and quality of life. METHODS: This correlation-comparative study used three tools: a demographic/health questionnaire, Questionnaire for Urinary Incontinence Diagnosis (QUID), and Incontinence Quality of Life (I-QOL). RESULTS: The sample included 132 women, from 50-88 years of age: 65 NGMP women (mean age: 67.23 years) and 67 GMP women (mean age: 65.04 years). The GMP group had a higher score, compared to the NGMP group, for UI type (by QUID) and a lower QOL (by I-QOL) , with none of the scores found to be statistically significant. By dividing the sample into age groups, 50-59 and ≥60 years, the interaction between the parity and the age groups was found to be significant for both the SUI and UUI. CONCLUSION: The innovation of this study is the in-depth insight into the association between parity and age regarding UI type.

Association between severities of striae gravidarum and Obstetric Anal Sphincter Injuries (OASIS).

OBJECTIVES: to examine the association between the severities of Striae Gravidarum (SG) and Obstetric Anal Sphincter Injuries (OASIS) and to measure the symptoms regarding urinary incontinence, fecal/flatus incontinence, and dyspareunia, at 6 and 12 months postpartum. DESIGN: this is a cohort study. SETTING: four university teaching medical centers in Israel, two in the north and two in the center of the country. PARTICIPANTS: women with OASIS were interviewed and assessed for SG. OASIS was divided into 4 groups: 3A, 3B, 3C and 4. Inclusion criteria were:OASIS diagnosis, non-instrumental vaginal childbirth, birth between 37 and 42 gestational weeks, singleton newborn, neonatal birth weight of Severity scoring of SG severity scoring, using Atwal's Numerical Scoring System,observed 4 body sites; Abdomen, Breasts, Hips, and Buttocks., Total severity score (TSS) for all sites range between 0 and 24 and categorized: 0-3: no SG (NSG) and 4 and over: SG. The Pelvic Floor Symptom Bother Questionnaire (PFBQ),a validated, structured questionnaire, was used for the 6 and 12 month follow-up assessments, with nine items regarding pelvic floor dysfunction (urinary and bowel impairment uterine prolapse and sexual function). MEASUREMENTS AND FINDINGS: eighty women who had OASIS were enlisted, interviewed and assessed for SG. The average score for women with some SG was 6.10 (SD = 4.12). There were 58 (72.5%) women with OASIS level 3A; 12 (15%) had 3B; 4 (5.0%) had 3C and 6 (7.5%) had 4th degree anal injuries, respectively. Forty two (52.5%) of the women had SG and 38 (47.5%) had no SG. There was no association between SG severity and OASIS (3A, 3B, 3C+4th) χ2 (6) = 8.4014; p = 0.2. As there were only 10 women with OASIS of 3C and 4, we re-analyzed the association between SG severity and OASIS severity of 3A and 3B. There was a significant association between SG severity and OASIS severity (3A, 3B) χ2 (3) = 9.306; p = 0.025. ADDITIONAL FINDINGS: women with SG were younger (mean = 26.74, SD = 3.57) than women without SG (mean = 29.29, SD = 4.40) (t(78) = 2.86, p = .005). Three symptoms had a significant reduction in the bother degree between 6 and 12 months: urinary incontinence (p = 0.017), flatus incontinence (p = 0.031) and sexuality (p = 0.016). KEY CONCLUSIONS: the innovation of this research is the association between SG severity and OASIS severity (3A, 3B), added information regarding OASIS risk factors.

Health Promoting Lifestyle Among Israeli Adult Survivors of Childhood Cancer.

BACKGROUND: Childhood cancer survivors are at risk for recurrence of their primary cancer as well as other secondary site cancers. The survivors are also at increased risk for long-term effects such as chronic illnesses. Health promoting lifestyles are therefore especially important for childhood cancer survivors. The purpose of the study was to describe the health promoting behaviors of childhood cancer survivors and to determine whether these behaviors are associated with demographic and clinical characteristics. This is a descriptive-comparative study that took place in an oncology follow-up clinic in Israel. SAMPLE: Seventy-seven childhood cancer survivors. TOOLS: Health Promoting Lifestyle Profile 2, questionnaire (interpersonal relationships, spiritual growth, physical activity, nutrition, health responsibility, and stress management), and smoking and alcohol consumption and a demographic-clinical questionnaire. The mean item score was moderate-high. Survivors scored highest on interpersonal relationships and spiritual growth while the lowest scoring activities were physical activity and nutrition. About 30% of the survivors abstained from smoking and alcohol consumption. Women, as opposed to men, were more likely to have higher scores related to nutrition and interpersonal relationships while singles as opposed to those who were married were found to have higher scores related to spiritual growth. CONCLUSIONS: Health behaviors associated with interpersonal relationships and spiritual growth were more likely to be performed compared to physical activity, good nutrition, and decreased smoking and alcohol consumption. Special attention should be placed on promoting physical activity and good nutrition among survivors of childhood cancer.

Degree of bother from pelvic floor dysfunction in women one year after first delivery.

OBJECTIVE: To investigate rates and range of pelvic floor dysfunction complaints, including anterior and posterior compartments and sexual function, in an unselected population of primiparous women one year from delivery, and examine the degree of bother they cause. STUDY DESIGN: Cross sectional study. Primiparous women who delivered their first child in our delivery wards 10-14 months previously, were approached by phone and asked to complete the Pelvic Floor Symptom Bother Questionnaire (PFBQ) and provide general demographic information. Details regarding participants' labor and delivery were extracted from electronic medical records. PFBQ score was correlated to demographic and labor and delivery parameters. RESULTS: 198 women completed the questionnaire. Response rate was 94%. Scores ranged from 0 to 44.4 (out of a possible 100). At least one symptom of PFD was reported by 64% of respondents. Various degrees of urinary incontinence were reported by 9.1-12.1% of women. Some degree of fecal or flatus incontinence was reported by 10.1% of women; 11.1% reported some degree of obstructed defecation. Severe degree of bother from one or more PFD symptoms was reported by 40.1-90.9%. Some level of dyspareunia was reported by 37.3%. A "dose response" trend between mode of delivery and rate of dyspareunia was observed. CONCLUSIONS: Two-thirds of primiparous women one year after delivery suffer PFD symptoms that cause some degree of bother. When asked, women are willing to discuss pelvic floor function; caregivers should initiate discussion and refer women promptly to interventions where necessary.

Knowledge, attitudes and practices of physicians and nurses regarding the link between IVF treatments and breast cancer.

PURPOSE: The ovarian stimulating hormones used in In-Vitro Fertilization may increase the incidence of breast cancer. Little research has been conducted to ascertain health professionals' knowledge or practices regarding this possible connection and if they communicate this risk to their patients. This study described the knowledge, attitudes and practices of doctors and nurses regarding the causative link between In-Vitro Fertilization treatments and breast cancer, and to determine if these health professionals were assessing or communicating this possible risk to their patients. METHOD: Seventy gynecologists and nurses who worked in fertility clinics, had at least one year of experience in fertility and were literate in Hebrew were asked to complete the questionnaires. Ten clinics around the country were contacted and the questionnaires were distributed and collected on the same day. RESULTS: 35 Nurses and 35 gynecologists completed the survey. Although the majority of the physicians (68%) and nurses (69%) thought that there was a possible connection between the hormonal treatment of IVF and breast cancer, physicians were significantly more likely to inform their patients about the connection than were nurses. CONCLUSIONS: There is a gap between the attitudes and practices of both physicians and nurses in communicating possible cancer risk to IVF clients. It would be beneficial to create a standardized risk communication protocol that would include information and guidelines for practice. More research must be conducted in this area, as there is almost no data on possible maternal risk from IVF treatment.

Sexual function and quality of life for women with mild-to-moderate stress urinary incontinence.

INTRODUCTION: Sexual function is affected by stress urinary incontinence with or without pelvic organ prolapse. The aim of the study was to describe the sexual function of women with mild-to-moderate stress urinary incontinence, with or without pelvic organ prolapse (up to stage 2) and examine correlations with symptoms and quality of life. This investigation was part of a large, randomized, clinical trial of women with stress urinary incontinence who participated in an exercise intervention. METHODS: Women included in the study suffered from stress urinary incontinence as measured by a pad test and were interested in an exercise intervention. All participants underwent assessment for prolapse staging. Instruments included: the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12), Incontinence Quality of Life Questionnaire (I-QOL), and a health and urinary leakage questionnaire. RESULTS: One hundred and eighty-seven ambulatory women, aged 20 to 65 years, had a mean sexual function score of 36.9 (standard deviation [SD] 5.9). No significant correlation was found between the sexual function scores and quantity of urinary leakage. A significant correlation existed between the sexual function and I-QOL scores (P < .001). An additional finding was that women with urgency symptoms were older (P= .04) and had significantly lower sexual function scores (mean 35.7; SD 6.4) than those who did not report urgency (mean 38.7; SD 4.6; P < .001). DISCUSSION: Women with mild-to-moderate stress urinary incontinence, without or with lower stages of pelvic organ prolapse, demonstrated good sexual function, which correlated with physical and psychosocial factors. Health professionals need to perform multifaceted intake assessments on women with urinary leakage to customize their health promotion regimen.