Effectiveness of vestibular rehabilitation on postural balance in Parkinson's disease: a systematic review and meta-analysis of randomized controlled trials.

INTRODUCTION: Postural balance impairment can affect the quality of life of patients with Parkinson's disease. Previous studies have described connections of the vestibular system with postural functions, suggesting a potential participation of the basal ganglia in receiving vestibular stimuli. This systematic review aims to summarize the evidence on the effectiveness of vestibular rehabilitation on postural balance in patients with Parkinson's disease. METHODS: A systematic review was conducted using the electronic databases: PubMed, Embase, Scopus and PEDro. The study selection was independently conducted by two reviewers, and disagreements were evaluated by a third reviewer. The included studies had no restrictions on publication dates or languages and the last update occurred in July 2023. RESULTS: From the 485 studies found in the searches, only 3 studies were deemed eligible for the systematic review involving a total of 130 participants. The Berg Balance Scale was described as the tool for evaluation of postural balance in all studies. The meta-analysis showed statistically significant results in favor of vestibular rehabilitation (MD = 5.35; 95% CI = 2.39, 8.31; P < 0.001), regardless of the stage of Parkinson's disease. Although the effect size was suggested as a useful functional gain, the analysis was done with caution, as it only included 3 randomized controlled trials. The risk of bias using the RoB-2 was considered as being of "some concern" in all studies. Furthermore, the quality of the evidence based on the Grading of Recommendations Assessment Development and Evaluation system, produced by pooling the included studies was considered very low. CONCLUSION: Compared to other interventions, vestibular rehabilitation has potential to assist the postural balance of patients with Parkinson's disease. However, the very low quality of the evidence demonstrates uncertainty about the impact of this clinical practice. More robust studies are needed to confirm the benefits of this therapy in patients with Parkinson's disease. This study was prospectively registered in PROSPERO: CRD42020210185.

Reliability and validity of the Brazilian version of the world health organization disability assessment schedule (WHODAS 2.0) questionnaire for women with urinary incontinence.

PURPOSE: To analyze the reliability and validity of the WHODAS 2.0 instrument for women with urinary incontinence (UI). METHODS: This is a methodological study with Brazilian women with complaints of urge, stress or mixed UI, over 18 years old, without cognitive disorders. The WHODAS 2.0 (36-item version) and the auxiliary instruments were applied through face-to-face and telephone interviews after 7-14 d. The psychometric properties evaluated were: Cronbach's alpha for internal consistency, intraclass correlation coefficient (ICC) for intra-rater test-retest, Spearman's correlation coefficient (rho) for construct validity of WHODAS 2.0 with auxiliary instruments; and ANOVA for discriminative validity with UI severity. RESULTS: 101 women with UI with a mean age of 50.71 ± 10.39 were included. WHODAS 2.0 showed good reliability in all domains and excellent reliability in the total score (>0.80). The intra-evaluator test-retest showed ICC values between 0.59 and 0.87 (p < 0.001). We observed a positive correlation between the WHODAS 2.0 domains and the instruments recommended by International Continence Society (ICS), with greater emphasis on moderate correlation with the Urinary Impact Questionnaire (IUQ-7) subscale (rho = 0.730 p < 0.001). CONCLUSION: The WHODAS 2.0 instrument is a reliable and valid questionnaire for investigating the functioning and disability of women with UI.

The WHODAS 2.0 is a valid and reliable tool for future functioning research with women with urinary incontinence.The WHODAS 2.0 can be used in clinical practice to assess disabilities in women with urinary incontinence.The validation of WHODAS 2.0 reinforces the need for rehabilitation based on the functioning needs of each patient with urinary incontinence.The WHODAS 2.0 assesses functioning based on the biopsychosocial model, supported by the ICF (International Classification of Functioning, Disability and Health).

Effectiveness of photobiomodulation therapy on pain intensity in postpartum women with nipple or perineal trauma: protocol for a multicentre, double-blinded, parallel-group, randomised controlled trial.

INTRODUCTION: Photobiomodulation (PBM) using low-level laser can affect tissue repair mechanisms and seems promising in reducing pain intensity. However, few studies support the effectiveness of PBM on postpartum period complications, such as nipple and/or perineal trauma and pain, probably due to the low doses used. The primary objective of this study is to analyse the effectiveness of PBM on pain intensity in the nipple and perineal trauma in women in the immediate postpartum period. Secondary objectives are to evaluate the effect on tissue healing and the women's satisfaction. METHODS AND ANALYSIS: A double-blind, multicentre, parallel-group, randomised controlled trial will be performed in two public referral maternity hospitals in Brazil with 120 participants, divided into two arms: 60 participants in the nipple trauma arm and 60 participants in the perineal trauma arm. Participants will be women in the immediate postpartum period, who present with nipple trauma or perineal trauma and report pain intensity greater than or equal to 4 points on the Numerical Rating Scale for Pain. Block randomisation will be performed, followed by blinding allocation. In the experimental group, one application of PBM will be performed between 6 hours and 36 hours after birth. For the sham group, the simulation will be carried out without triggering energy. Both participants and the research evaluator will be blinded to the allocation group. Intention-to-treat method and the between-group and within-group outcome measures analysis will be performed. ETHICS AND DISSEMINATION: This research protocol was approved by the Research Ethics Committees of the University of Campinas, Brazil, and of the School Maternity Assis Chateaubriand, Brazil (numbers CAAE: 59400922.1.1001.5404; 59400922.1.3001.5050). Participants will be required to sign the informed consent form to participate. Results will be disseminated to the health science community. TRIAL REGISTRATION NUMBER: Brazilian Registry of Clinical Trials (RBR-2qm8jrp).

Validation of the Brazilian version of the World Health Organization Disability Assessment Schedule in women with chronic pelvic pain / Validação da versão brasileira do World Health Organization Disability Assessment Schedule em mulheres com dor pélvica crônica

ABSTRACT BACKGROUND AND OBJECTIVES: Chronic pelvic pain (CPP) is a persistent pain perceived in structures related to the pelvis. It is often associated with negative functioning consequences that generate disability. There are currently no validated tools in the literature for measuring functioning according to the theoretical-conceptual model presented by the International Classification of Functioning, Disability and Health (ICF) for patients with CPP. The objective of this study was to test the measurement properties of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) for women with CPP. METHODS: This is a validation study. The auxiliary instruments used in the validation process of the WHODAS 2.0 were: the 12-item Short-Form Health Survey (SF-12), the Numerical Pain Rating Scale, and a form with sociodemographic and clinical data. Internal consistency was analyzed using Cronbach's alpha coefficient, construct validity was assessed using Spearman's correlation coefficient, discriminative validity was analyzed using the analysis of variance, and test-retest reliability was analyzed using the Intra-class Correlation Coefficient (ICC). RESULTS: The study included 128 women with CPP. Reliability analysis showed satisfactory results in terms of internal consistency (a=0.71 to 0.94) and excellent in test-retest reliability (IIC= 0.69 to 0.91). Validity analysis showed a strong to moderate correlation in construct validity between the total WHODAS score and the physical (rho=0.7, p<0.001) and mental components of the SF-12 (rho-0.67, p<0.0001), and statistically significant values for discriminative validity according to pain intensity in the last 30 days. CONCLUSION: The WHODAS 2.0 instrument proved to be a reliable and valid questionnaire for investigating the functioning and disability of women with CPE

RESUMO JUSTIFICATIVA E OBJETIVOS: A dor pélvica crônica (DPC) é uma dor persistente percebida em estruturas relacionadas à pelve. Está frequentemente associada a consequências negativas que geram incapacidade, entretanto, atualmente não existem ferramentas validadas para medir a funcionalidade segundo a Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) em pacientes com DPC. O objetivo deste estudo foi testar as propriedades de medida do World Health Organization Disability Assessment Schedule (WHODAS 2.0) para mulheres com DPC. MÉTODOS: Trata-se de um estudo de validação. Os instrumentos utilizados no processo de validação do WHODAS 2.0 foram: o 12-item Short-Form Health Survey (SF-12), a Escala Numérica da Dor e um formulário com dados sociodemográficos e clínicos. A consistência interna foi analisada pelo coeficiente alfa de Cronbach, a validade de construto foi avaliada pelo coeficiente de correlação de Spearman, a validade discriminativa foi analisada pela Análise de Variância e a confiabilidade teste-reteste foi analisada pelo coeficiente de correlação intraclasse (ICC). RESULTADOS: O estudo incluiu 128 mulheres com DPC. As análises de confiabilidade mostraram resultados satisfatórios em termos de consistência interna (a=0,71 a 0,94) e excelentes na confiabilidade teste-reteste (ICC=0,69 a 0,91). As análises de validade mostraram uma correlação forte a moderada na validade de construto entre o escore WHODAS total e os componentes físicos (rho=0,7, p<0,001) e mentais do SF-12 (rho=0,67, p<0,0001) e valores significativos para validade discriminativa de acordo com a intensidade da dor nos últimos 30 dias. CONCLUSÃO: O instrumento WHODAS 2.0 mostrou-se um questionário confiável e válido para investigar a funcionalidade de mulheres com DPC.

Physical Exercise Pattern for Undergraduate Students and Its Importance in the Quality of Life, Well-Being, and Future Patient Orientation.

Background: This study evaluated physical activity (PA), physical exercise (PE), quality of life (QoL), PE barriers and benefits, contents learned about PA, and related factors of PE practice among undergraduate medical and nursing students. Methods: This cross-sectional study conducted an online survey. We collected sociodemographic data and previous knowledge regarding PA/PE. We applied the International Physical Activity Questionnaire (IPAQ), Well-being and Quality of Life Index (WHO-5), and scale of benefits and barriers for PE. We performed bivariate, univariate, and multivariate logistic regression analyses. Results: Participants who exercised were identified as "active" and "very active" by the IPAQ, had better health self-perception, higher general total metabolic equivalent, and higher WHO-5 scores, perceived more PE benefits than barriers, and desired more information about PA/PE. Conclusion: Undergraduate students should be encouraged to participate in PE. Adequate knowledge could be a resource they value and disseminate to their future patients.

Women know about perineal trauma risk but do not know how to prevent it: Knowledge, attitude, and practice.

OBJECTIVE: To evaluate the knowledge, attitude, and practice (KAP) of pelvic floor muscle (PFM) preparation for birth among postpartum women, and its related factors. METHODS: Cross-sectional study conducted in a maternity unit among Brazilian women aged 14 years or older during the first 72 h postpartum, who desired and had vaginal birth. Sociodemographic, clinical, and obstetric data were collected using a standardized form from medical charts. A 15-question questionnaire was used to measure the KAP of PFM preparation for birth. Knowledge was categorized as: poor, average, and good. RESULTS: In all, 326 women completed the survey (mean age 24.3 ± 6.2 years) and 167 (51.2%) women had poor knowledge. The attitude of searching for information on how to prevent perineal trauma was reported by 14 (4.3%) women. Only 13 (4.0%) participants reported that they had practiced at least one session of PFM preparation during pregnancy (PFM training, perineal massage, etc.) Multivariate analysis showed that lower educational level was associated with poor knowledge (P < 0.05). CONCLUSION: The KAP of PFM preparation for birth is inadequate among postpartum women. Health education regarding PFM care during pregnancy and postpartum should be addressed among pregnant women, specifically younger women with lower levels of education and income.

Self-reported exercise or physical activity level: what matters to a better quality of life in the third trimester of pregnancy?

This study evaluated the relationship of self-reported exercise, physical activity (PA) level, and Quality of Life (QoL) among women in their third trimester of pregnancy and verified which factors are associated with physical exercise (PE) and QoL. A cross-sectional study was performed with women who have been pregnant for at least 28 weeks and who can engage in PE. Data on self-reported exercise, sociodemographic characteristics, PA level, and QoL were collected through the International Physical Activity Questionnaire (IPAQ) and the World Health Organization Quality of Life Questionnaire BREF version (WHOQOL-BREF). Frequencies, bivariate analyses, and logistic and linear regression were performed. Among 405 pregnant women, 103 (25.43 percent) reported practicing PE. The self-reported PE was associated with better scores in the physical and environmental domains of the WHOQOL-BREF. Several IPAQ variables and the WHOQOL-BREF environmental score were associated with self-reported exercise. The majority classified as "active" by the IPAQ was due to employment and not the PE practice. A correct conceptual approach to PA and PE during antenatal care has a different impact on health and QoL during pregnancy.

Exercise and Physical Activity Levels and Associated Factors Among High-Risk Pregnant Women / Fatores associados com o nível de atividade física e a prática de exercício em gestantes de alto risco

Abstract Objective To assess the levels of physical activity and exercise practice, and examine the associated maternal characteristics; as well as the anxiety levels of high-risk pregnant women. Methods A cross-sectional study conducted with pregnant women at a High-risk Prenatal Clinic (HRPC) in a tertiary maternity. Pregnant women of 18 to 40-years-old, with a single fetus, and with gestational age up to 38 weeks were included. The level of physical activity and exercise practice of the study's participants were investigated using the Pregnancy Physical Activity Questionnaire (PPAQ). Maternal sociodemographic, anthropometric, and medical data were investigated using a specific form. For anxiety levels, the short version of the State-Trait Anxiety Inventory (STAI) was applied. We used the Student t-test, chi-square test, odds ratio (OR) with 95% confidence interval (95% CI) and multiple logistic regression. The significance level was 5%. Results Among the 109 pregnant women included, 82 (75.2%) were classified as sedentary/little active. The higher energy expenditure were for domestic activities (133.81±81.84 METs), followed by work-related activities (40.77±84.71 METs). Only 19.3% women exercised during pregnancy (4.76±12.47 METs), with slow walking being the most reported exercise. A higher level of education was the most important factor associated with women being moderately or vigorously active (OR=29.8; 95% CI 4.9-117.8). Nulliparity (OR=3.1; 95% CI 1.0-9.1), low levels of anxiety (OR=3.6; 95% CI 1.2-10.7), and unemployment (OR=4.8; 95% CI 1.1-19.6) were associated with the practice of exercise during pregnancy. Conclusion Most women with high-risk pregnancies exhibited a sedentary pattern, with low prevalence of physical exercise practice. Recognizing factors that hinder the adoption of a more physically active lifestyle is essential for an individualized guidance regarding exercise during pregnancy.

Resumo Objetivo Analisar o nível de atividade física e a prática de exercício físico, examinar as características maternas associadas, assim como níveis de ansiedade de gestantes de alto risco. Métodos Estudo observacional, transversal e quantitativo, realizado no ambulatório de Pré-Natal de Alto Risco (PNAR) de uma maternidade terciária. Foram incluídas gestantes comidade entre de 18 e 40 anos; feto único e comidade gestacional (IG) até 38 semanas.O nível de atividade física e prática de exercício físico das participantes do estudo foram investigados usando o Questionário de Atividade Física na Gestação (QAFG). Os dados sociodemográficos, antropométricos e médicos maternais foram investigados usando um formulário específico. Para níveis de ansiedade, a versão curta do Inventário de Ansiedade Traço-Estado (STAI) foi aplicado. Usamos o teste t de Student, teste qui-quadrado, razão de chances (OR) com um intervalo de confiança de 95% (IC 95%) e regressão logística multinomial. O nível de significância considerado foi 5%. Resultados Das 109 gestantes incluídas no estudo, 82 (75,2%) foi classificada como sedentária/pouco ativa. Os maiores gastos energéticos foram em atividades domésticas (133.81±81.84 METs), seguidas pelas atividades ocupacionais (40.77±84.71 METs). Apenas 19.3% praticaram exercício físico durante a gravidez (4.76±12.47 METs), sendo a caminhada lenta a atividade mais relatada. Maior grau de escolaridade foi o fator mais importante associado a gestante ser moderadamente ou vigorosamente ativa (OR=29,8; IC 95% 4,9-117,8) . Nuliparidade (OR=3,1; IC 95% 1,0-9,1), baixos níveis de ansiedade (OR=3,6; IC 95% 1,2-10,7) e não trabalhar na gestação (OR=4,8; IC 95% 1.1-19,6) foram associados à prática de exercício físico durante a gestação. Conclusão A maioria das gestantes de alto risco desenvolveram um padrão sedentário, com baixa prevalência da prática de exercício físico. Reconhecer os fatores que dificultam a adoção de um estilo de vida mais ativo fisicamente é fundamental para a orientação adequada e individualizada acerca da prática de exercício físico durante a gestação.

Exercise and Physical Activity Levels and Associated Factors Among High-Risk Pregnant Women.

OBJECTIVE: To assess the levels of physical activity and exercise practice, and examine the associated maternal characteristics; as well as the anxiety levels of high-risk pregnant women. METHODS: A cross-sectional study conducted with pregnant women at a High-risk Prenatal Clinic (HRPC) in a tertiary maternity. Pregnant women of 18 to 40-years-old, with a single fetus, and with gestational age up to 38 weeks were included. The level of physical activity and exercise practice of the study's participants were investigated using the Pregnancy Physical Activity Questionnaire (PPAQ). Maternal sociodemographic, anthropometric, and medical data were investigated using a specific form. For anxiety levels, the short version of the State-Trait Anxiety Inventory (STAI) was applied. We used the Student t-test, chi-square test, odds ratio (OR) with 95% confidence interval (95% CI) and multiple logistic regression. The significance level was 5%. RESULTS: Among the 109 pregnant women included, 82 (75.2%) were classified as sedentary/little active. The higher energy expenditure were for domestic activities (133.81 ± 81.84 METs), followed by work-related activities (40.77 ± 84.71 METs). Only 19.3% women exercised during pregnancy (4.76 ± 12.47 METs), with slow walking being the most reported exercise. A higher level of education was the most important factor associated with women being moderately or vigorously active (OR = 29.8; 95% CI 4.9-117.8). Nulliparity (OR = 3.1; 95% CI 1.0-9.1), low levels of anxiety (OR = 3.6; 95% CI 1.2-10.7), and unemployment (OR = 4.8; 95% CI 1.1-19.6) were associated with the practice of exercise during pregnancy. CONCLUSION: Most women with high-risk pregnancies exhibited a sedentary pattern, with low prevalence of physical exercise practice. Recognizing factors that hinder the adoption of a more physically active lifestyle is essential for an individualized guidance regarding exercise during pregnancy.

OBJETIVO: Analisar o nível de atividade física e a prática de exercício físico, examinar as características maternas associadas, assim como níveis de ansiedade de gestantes de alto risco. MéTODOS: Estudo observacional, transversal e quantitativo, realizado no ambulatório de Pré-Natal de Alto Risco (PNAR) de uma maternidade terciária. Foram incluídas gestantes com idade entre de 18 e 40 anos; feto único e com idade gestacional (IG) até 38 semanas. O nível de atividade física e prática de exercício físico das participantes do estudo foram investigados usando o Questionário de Atividade Física na Gestação (QAFG). Os dados sociodemográficos, antropométricos e médicos maternais foram investigados usando um formulário específico. Para níveis de ansiedade, a versão curta do Inventário de Ansiedade Traço-Estado (STAI) foi aplicado. Usamos o teste t de Student, teste qui-quadrado, razão de chances (OR) com um intervalo de confiança de 95% (IC 95%) e regressão logística multinomial. O nível de significância considerado foi 5%. RESULTADOS: Das 109 gestantes incluídas no estudo, 82 (75,2%) foi classificada como sedentária/pouco ativa. Os maiores gastos energéticos foram em atividades domésticas (133.81 ± 81.84 METs), seguidas pelas atividades ocupacionais (40.77 ± 84.71 METs). Apenas 19.3% praticaram exercício físico durante a gravidez (4.76 ± 12.47 METs), sendo a caminhada lenta a atividade mais relatada. Maior grau de escolaridade foi o fator mais importante associado a gestante ser moderadamente ou vigorosamente ativa (OR = 29,8; IC 95% 4,9­117,8) . Nuliparidade (OR = 3,1; IC 95% 1,0­9,1), baixos níveis de ansiedade (OR = 3,6; IC 95% 1,2­10,7) e não trabalhar na gestação (OR = 4,8; IC 95% 1.1­19,6) foram associados à prática de exercício físico durante a gestação. CONCLUSãO: A maioria das gestantes de alto risco desenvolveram um padrão sedentário, com baixa prevalência da prática de exercício físico. Reconhecer os fatores que dificultam a adoção de um estilo de vida mais ativo fisicamente é fundamental para a orientação adequada e individualizada acerca da prática de exercício físico durante a gestação.

Pelvic floor ultrasound finds after episiotomy and severe perineal tear: systematic review and meta-analysis.

AIM: Vaginal delivery is a well-known risk factor for pelvic floor muscle (PFM) injuries, mainly when associated to prolonged labor, instrumental birth and perineal trauma such as episiotomy and perineal tears. The purpose of this meta-analysis was to test the hypothesis that episiotomy and severe perineal tear may increase the risk of pelvic floor damage. METHODS: We performed a systematic literature search through electronic databases including MEDLINE via PubMed, LILACS via BVS, Embase via Elsevier and Cochrane Library up to January 2019. We included articles that reported as outcome one or more morphological aspects of the PFM evaluated by ultrasonography in primiparous women three to 24 months postpartum. This review is registered in the PROSPERO database (registration number: CRD42017075750). RESULTS: the final selection was composed of 18 articles for the systematic review, and 10 for the meta-analysis. Women with levator ani muscle (LAM) avulsion were 1.77 times more likely to have undergone episiotomy (OR = 1.77, CI 95% 1.25-2.51, five trials), 4.31 times more likely to have severe perineal tear (OR = 4.31, CI 95% 2.34-7.91, two trials). Women with defects in the anal sphincters were 2.82 times more likely to have suffered severe perineal tear (OR = 2.82, 95% CI 1.71-4.67, three trials). CONCLUSIONS: Both episiotomy and severe perineal tear are risk factors for LAM avulsion and anal sphincter injury, and this can be useful for identifying women who are at greater risk of developing PFM dysfunctions.

Probable sarcopenia and obesity in women with urinary incontinence in the climacteric period / Provável sarcopenia e obesidade em mulheres com incontinência urinária no climatério

Abstract Introduction: Sarcopenia and obesity are associated with several health conditions. Few studies, however, have analyzed the presence of these conditions in climacteric women with incontinence, and the association between these conditions and the severity of urinary incontinence (UI) is not clear. Objective: To analyze probable sarcopenia, sarcopenia, and obesity in climacteric women with different UI severities, and the association between sarcopenia and UI severity. Methods: This was a cross-sectional study in a public maternity hospital in Northeast Brazil, with women aged ≥ 40 years. Sociodemographic issues, urogynecological history, UI severity (Incontinence Severity Index - ISI), grip strength, and anthropometric measures (waist circumference and body mass index - BMI) were evaluated. Means, standard deviations, absolute and relative frequencies, T test, and Fisher exact test were used (significance at 5%). Results: The sample comprised 177 women, with a mean age of 56.3 (± 9.7) years. Regarding UI, 69 (39.0%) women presented mixed UI, and 53.1% presented moderate UI severity. Only 18.1% women had normal BMIs, and 46.8% had general obesity and 80.3% had abdominal obesity. Probable sarcopenia (low strength) was observed in 35 (20%) women, and sarcopenia, in 3.4%. Women with severe/very severe UI presented lower grip strengths (p = 0.02) and higher BMIs (p = 0.04). Sarcopenia was associated with greater UI severity (p = 0.005). Conclusion: Probable sarcopenia and higher BMI were observed in women with greater UI severities, and sarcopenia was associated with greater UI severity. Preventive measures are needed in such conditions to avoid future complications.

Resumo Introdução: Sarcopenia e obesidade têm relação com diversas condições de saúde. Poucos estudos, entretanto, têm analisado a presença destas condições em mulheres incontinentes no climatério, e não está claro se existe associação destas com a gravidade da incontinência urinária (IU). Objetivo: Analisar provável sarcopenia, sarcopenia e obesidade em mulheres com diferentes gravidades de IU na fase do climatério e a associação da sarcopenia com a gravidade da IU. Métodos: Estudo transversal realizado em maternidade pública do nordeste do Brasil, em mulheres com IU a partir de 40 anos. Foram avaliadas questões sociodemográficas, histórico uroginecológico, gravidade da IU (Incontinence Severity Index - ISI), força de preensão e medidas antropométricas (circunferência abdominal e índice de massa corporal - IMC). Foram analisadas médias e desvios-padrão, frequências absolutas e relativas, teste T e exato de Fisher (significância de 5%). Resultados: Amostra de 177 mulheres com média de 56,3 (± 9,7) anos. Sobre a IU, 69 (39,0%) mulheres apresentavam IU mista e 53,1% gravidade moderada. Apenas 18,1% apresentavam IMC normal, 46,8% obesidade geral e 80,3% obesidade abdominal. Provável sarcopenia (baixa força) foi observada em 35 (20%) mulheres e sarcopenia em 3,4%. Mulheres com IU grave ou muito grave apresentaram menor força de preensão (p = 0,02) e maior IMC (p = 0,04). A sarcopenia foi associada à maior gravidade de IU (p = 0,005). Conclusão: Observou-se provável sarcopenia e maior IMC em mulheres com maior gravidade de IU e associação da sarcopenia com a maior gravidade de IU. São necessárias medidas preventivas quanto a tais condições, evitando futuras complicações.

Impact of verbal instructions on pelvic floor contraction in the immediate postpartum / Impacto das instruções verbais na contração do assoalho pélvico no puerpério imediato

Abstract Introduction: Pregnancy predisposes the emergence of pelvic floor dysfunctions (PFD), postpartum being the opportune moment to assess these muscles. Objective: To investigate the effect of instructions and verbal feedback on the contraction capacity of pelvic floor muscles (PFM) in postpartum women. Methods: Quasi-experimental study with 109 women in the immediate vaginal postpartum at a reference maternity hospital in Fortaleza, Ceará state, Brazil. PFM were visually inspected using the visual contraction scale (0 = no visible contraction; 1 = weak visible contraction; 2 = visible contraction with perineal elevation), in addition to observing the use of accessory muscles and movements. Assessments occurred in consecutive moments: 1 - PFM contraction at a verbal command; 2 - contraction after instructions on structure, function and correct contraction; and 3 - contraction after feedback on the use of accessory muscles and reinforcement of correct contraction. Cochran's Q test and a 5% significance level were used to compare the outcomes between different moments. Results: At the first assessment, 15.6% of the postpartum women did not exhibit visible PFM contraction (grade 0). Of these, 70.5% changed their contraction grade after instructions and feedback. At the end, 45.9% of women correctly contracted their PFM with perineal elevation (grade 2) (p < 000.1). The use of accessory muscles (abductors, abdominals and gluteal) declined after instructions and feedback (p < 000.1). Perineal trauma, forceps delivery, previous information and fear of feeling pain were not associated with contraction grade. Conclusion: Instructions and verbal feedback are useful tools for correct PMF contraction in the immediate postpartum.

Resumo Introdução: A gestação predispõe o surgimento de disfunções do assoalho pélvico (DAP), sendo o pós-parto momento oportuno para avaliar essa musculatura. Objetivo: Investigar o efeito das instruções e feedback verbais na capacidade de contração dos músculos do assoalho pélvico (MAP) em puérperas. Métodos: Estudo quase-experimental com 109 mulheres no pós-parto vaginal imediato em uma maternidade de referência em Fortaleza-CE. Realizou-se inspeção visual dos MAP pela escala visual de contração (0 = nenhuma contração visível; 1 = contração visível fraca; 2 = contração visível com elevação perineal), além de observação da utilização de musculatura e movimentos acessórios. As avaliações foram em momentos consecutivos: 1 - contração dos MAP ao comando verbal; 2 - contração após instruções sobre estrutura, função e correta contração; e 3 - contração após feedback sobre a utilização de musculatura acessória e reforço da correta contração. Para comparação dos desfechos entre os momentos foi utilizado o teste Q de Cochran e significância de 5%. Resultados: No primeiro momento, 15,6% das puérperas não apresentaram contração visível dos MAP (grau 0). Dessas, 70,5% modificaram o grau de contração após instruções e feedback. Ao final, 45,9% das mulheres contraíram corretamente os MAP com elevação perineal (grau 2) (p < 000,1). A utilização de músculos acessórios (adutores, abdominais e glúteos) diminuiu após instruções e feedback (p < 000,1). Trauma perineal, parto a fórceps, informações prévias e medo de sentir dor não se associaram ao grau de contração. Conclusão: Instruções e feedback verbais são ferramentas úteis para contração correta dos MAP no pós-parto imediato.

Behavioral therapy in the treatment of urinary incontinence: quality of life and severity / Terapia comportamental no tratamento da incontinência urinária: qualidade de vida e gravidade

Abstract Introduction: Behavioral therapy (BT) is an association of techniques that aim to minimize or abolish urinary symptoms, including urinary incontinence (UI), through education about the health condition, changes in lifestyle and nutritional habits, and bladder training. Objective: To analyze whether there is a change in the quality of life and severity of UI after group behavioral therapy in women with UI. Methods: Prospective observational study conducted in a pelvic physical therapy public service. Women with UI of any etiology, over 18 years of age, who completed a protocol of four weekly group BT meetings as the first treatment option for UI were included. Outcomes (impact of UI on QoL and classification of UI severity) were assessed before, immediately after, and one month after BT using the King's Health Questionnaire (KHQ) and the Incontinence Severity Index (ISI). Results: Sample of 146 participants. A reduction in the impact of UI on QoL was observed in the KHQ domains: impact of UI, physical limitations, personal relationships, emotions, general health perception (p < 0.05) immediately after BT. After one month, there was a reduction in the UI impact domains, daily activity limitations, physical limitations, general health perception, emotions, and sleep (p < 0.05). In addition, there was a reduction in the classification of UI severity assessed by the ISI (p < 0.001). Conclusion: There was an improvement in QoL and a decrease in UI severity in women with UI who completed a BT group as the first treatment option.

Resumo Introdução: A terapia comportamental (TC) é uma associação de técnicas que visam minimizar ou abolir sintomas urinários, incluindo a incontinência urinária (IU), por meio da educação sobre a condição de saúde, mudanças em hábitos de vida e alimentares e treinamento vesical. Objetivo: Analisar se existe alteração da qualidade de vida e da gravidade da IU após terapia comportamental em grupo de mulheres com IU. Métodos: Estudo observacional prospectivo realizado em um serviço público de fisioterapia pélvica. Mulheres com IU de qualquer etiologia e maiores de 18 anos foram submetidas a um protocolo de quatro encontros de TC em grupo, semanalmente, como primeira opção de tratamento para IU. Os desfechos, impacto da IU na qualidade de vida (QV) e classificação da gravidade da IU foram avaliados antes, imediatamente após e um mês depois da TC pelos questionários King's Health Questionnaire (KHQ) e Incontinence Severity Index (ISI). Resultados: Amostra de 146 participantes. Observou-se redução do impacto da IU na QV nos domínios do KHQ: impacto da IU, limitações físicas, relações pessoais, emoções, percepção geral de saúde (p < 0,05) imediatamente após a TC. Após um mês, observou-se redução nos domínios de impacto da IU nas limitações de atividades diárias, limitações físicas, percepção geral de saúde, emoções e sono (p < 0,05), além da redução na classificação de gravidade da IU avaliada pelo ISI (p < 0,001). Conclusão: Houve melhora da QV e diminuição da gravidade da IU em mulheres com IU submetidas à TC em grupo como primeira opção de tratamento.

Pelvic floor dysfunction distress is correlated with quality of life, but not with muscle function.

OBJECTIVE: To analyze the relationship between the symptoms of pelvic floor dysfunction (PFD) and quality of life (QoL), as well as the function of the pelvic floor muscle (PFM) in women with urinary incontinence (UI). METHODS: A cross-sectional study conducted in two centers in Brazil (Northeast and Southeast regions) with women with stress urinary incontinence (SUI) and mixed urinary incontinence (MUI). Data on pelvic floor symptoms, discomfort and impact on QoL were collected using the Pelvic Floor Distress Inventory-short form (PFDI-SF-20) and the Pelvic Floor Impact Questionnaire (PFIQ-7) instruments. PFM function was assessed by palpation (PERFECT scale) and manometry. Pearson's correlation test, analysis of variance (ANOVA) and the Student's t test were used to discriminate the differences, adopting a significance level of 5%. RESULTS: A total of 72 women participated in the study (mean age 51.7 ± 11.9 years). The presence and discomfort of pelvic floor symptoms (PFDI-SF-20) were correlated with QoL (PFIQ-7) (r = 0.52, p < 0.001). Deficits in PFM function (power and pressure) were observed, however, there was no correlation between these with the presence and discomfort of the pelvic floor symptoms (PFDI-SF-20). CONCLUSION: Greater discomfort due to PFD symptoms were correlated with a worse QoL. However, the relationship between symptoms and PFM function was not significant. These results reinforce the need to assess the aspects of activity and participation which compose functionality and QoL, and not only the PFM functions in women with UI.

Cross-cultural adaptation to Brazilian Portuguese and assessment of the measurement properties of the Questionnaire for Urinary Incontinence Diagnosis (QUID).

OBJECTIVE: This study aimed to adapt the Questionnaire for Urinary Incontinence Diagnosis (QUID) into Brazilian Portuguese (QUID-Br) and evaluate its measurement properties, given as reliability, validity, and responsiveness in women with urinary incontinence. STUDY DESIGN: It was a methodological study which enrolled 168 women (mean age = 55.1, standard deviation = 17.9 years old). Translation and cross-cultural adaptation were done and subsequently analysis of the measurement properties of QUID-Br were tested: structural validity (by exploratory and confirmatory factory analysis) internal consistency (Cronbach's α) construct validity (Pearson Correlation), and test-retest reliability (Intraclass Correlation Coefficient). RESULTS: The QUID-Br two-factor was confirmed showing two domains with three items each: stress urinary incontinence (SUI) and urge urinary incontinence (UUI). Furthermore, QUID-Br showed acceptable internal consistency for both scales (Cronbach's α > 0.70), reliability [intraclass correlation coefficient (ICC = 0.85 for SUI and 0.87 for UUI)] with 95 % confidence interval (CI) and construct validity - with all the hypothesis raised a priori being confirmed. CONCLUSIONS: The results of the present investigation showed that the QUID-Br is a valid, reliable, and consistent instrument to be administered to Brazilian women and its use is recommended in clinical practice and research.

Responsiveness of Pelvic Floor Distress Inventory (PFDI-20) and Pelvic Floor Impact Questionnaire (PFIQ-7) after pelvic floor muscle training in women with stress and mixed urinary incontinence.

OBJECTIVE: To evaluate the responsiveness of Brazilian-Portuguese version of Pelvic Floor Distress Inventory-20 (PFDI-20) and Pelvic Floor Impact Questionnaire-7 (PFIQ-7) after pelvic floor muscle training (PFMT) in women with stress urinary incontinence (SUI) and mixed urinary incontinence (MUI). STUDY DESIGN: This is an observational study with 72 women (51.8 ± 11.9SD years) with SUI (n = 33) and MUI (n = 39). Participants answered PFDI-20 and PFIQ-7 before and after PFMT, which consisted of a 12 weeks protocol supervised by a physiotherapist once a week with 30 min of a duration. Wilcoxon test, effect size (ES) and standardized response mean (SRM) were performed on baseline and after three months. RESULTS: We found a significant reduction in PFDI-20 and PFIQ-7 after PFMT (p < 0.001), except for Pelvic Organ Prolapses Distress Inventory (POPDI-16), Colorectal-Anal Impact Questionnaire (CRAIQ-7) and Pelvic Organ Prolapse Impact Questionnaire (POPIQ-7). The responsiveness of both questionnaires was considered moderate for PFDI-20 (ES = 0.49; SEM = 0.61; p < 0.0001) and PFIQ-7 (ES = 0.51; SEM = 0.52; p < 0.0001). CONCLUSIONS: PFDI-20 and PFIQ-7 Brazilian Portuguese version presented moderate responsiveness in women with SUI and MUI who performed a PFMT.

Relationship between maternal adverse childhood experiences and infant development: A systematic review (protocol).

INTRODUCTION: Twenty years ago, the first study was conducted to access adverse childhood experiences (ACEs) and their relation to outcomes in adulthood. The effects of exposure to childhood trauma can also be transmitted to other generations. There are some studies that suggest the hypothesis that intergenerational transmission may begin during intrauterine life through the change in placental-fetal physiology due to maternal exposure to adverse events in childhood. Those exposures can lead to a variety of conditions such as altered brain architecture, increase in placental corticotrophin hormone (pCRH) at the end of gestation, or emotional and behavioral changes during childhood and adolescence. The systematic review, therefore, is established to determine if there is a reliable association between maternal ACEs in childhood and altered child development. METHOD: We will conduct a systematic review according to the guidelines of the meta-analysis of observational studies in epidemiology (MOOSE) and with the preferred reporting items for systematic review with a focus on health equity (PRISMA-E). A comprehensive search strategy will be conducted in the following databases: MEDLINE, EMBASE, CINAHL, Web of Science, SCOPUS, Lilacs, and SciELO. Following a 2-step screening process, data including the full reference, objectives, target population, description of the exposure (ACEs), outcome measures, study design, length of follow-up period, and the study results will be extracted, synthesized, and reported. Risk of bias and quality of the studies will also be assessed. DISSEMINATION AND ETHICS: The results of this review will be disseminated through peer-reviewed publication. Because all of the data used in this systematic review has been published, this review does not require ethical approval. DISCUSSION: This systematic review of the last 20 years will summarize and present the evidence for the relationship between maternal ACEs and the development of her child. SYSTEMATIC REVIEW REGISTRATION: PROSPERO #CRD42018111456.

The misleading choice for safer births in Brazilian's most developed region: a cross-sectional study.

PURPOSE: To analyze the Cesarean Section (CS) rate in Brazilian women according to category of health insurance and individual characteristics associated with the mode of delivery. MATERIALS AND METHODS: A cross-sectional study was performed in three maternity services (one public tertiary referral center, one maternity service for both public and private care, and one private maternity service) in Campinas city, Brazil. Eligibility criteria were: inpatient during the immediate postpartum period, hospital birth, single pregnancy, and live newborn. Sociodemographic and anthropometric data, reproductive history, pregnancy planning, and prenatal care information was obtained from participants. Comorbidities, type of birth, and newborn data were collected from medical records. The mode of delivery was categorized as either CS or vaginal delivery. RESULTS: A total of 1276 women were included in this study. The overall CS rate was 57.5%. CS rates were 41.6, 54.8, and 90.1% for public, mixed (public and private), and private maternity services, respectively. Mean age was higher in women who had a CS (28.0 ± 6.0 years versus 25.9 ± 6.5 years, p < .0001) as was the mean Body Mass Index (25.2 ± 5.3 kg/m2 versus 23.8 ± 4.5 kg/m2, p < .0001). CS was related to higher education, employment, white skin color, planned pregnancy, antenatal care in a private service, and primiparity. CONCLUSIONS: The overall CS rate was high (greater than 50%); in the private service, almost all participants had a CS delivery (90.1%). Better socioeconomic conditions and primiparity were associated with higher CS rates in Brazil. Political pressure for the management of unnecessary CSs is vital in Brazil. Together with the provision of real incentives for normal deliveries in public and, most importantly, private services.

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.

Body mass Index changes during pregnancy and perinatal outcomes - A cross-sectional study / Mudanças do índice de massa corporal na gravidez e resultados perinatais - um estudo transversal

Abstract Objective To evaluate the relation between changes the body mass index (BMI) percentile, reflected in the Atalah curve, and perinatal outcomes. Methods A cross-sectional study with 1,279 women was performed. Data regarding gestational weight, sociodemographic characteristics and perinatal outcomes were collected through medical charts, prenatal card and interviews in the postpartum period. Women could be classified according to the Atalah curve in the following categories: low weight, adequateweight, overweight, and obese. The BMIwas calculated at the first and at the last prenatal care visits, and these values were compared. Results An increase in the BMI category according to the Atalah classification occurred in 19.9% of pregnant women, and an increase of 3.4, 5.8 and 6.4 points of BMI were found for women respectively classified in the adequate weight, overweight and obese categories at the first prenatal visit. Women with high school education presented a lower chance of increasing their BMI (odds ratio [OR] 0:47 [0.24- 0.95]). Women who evolved with an increase in the the Atalah classification were associated with cesarean section (OR 1.97-2.28), fetalmacrosomia (OR 4.13-12.54) and large for gestational age newborn (OR 2.88-9.83). Conclusion Pregnant women who gained enough weight to move up in their BMI classification according to the Atalah curve had a higher chance of cesarean section and macrosomia. Women classified as obese, according to the Atalah curve, at the first prenatal visit had a high chance of cesarean section and delivering a large for gestational age newborn.

Resumo Objetivo Avaliar a relação entre mudanças no percentual do índice de massa corporal (IMC), refletidas na curva de Atalah, e resultados perinatais. Métodos Foi realizado um estudo transversal com 1.279 mulheres. Os dados sobre o peso na gestação, características sociodemográficas e resultados perinatais foram coletados através de prontuários, cartão pré-natal e entrevistas no pós-parto. As mulheres foramclassificadas de acordo coma curva de Atalah nas seguintes categorias: baixo peso, peso adequado, sobrepeso e obesidade. O IMC foi calculado na primeira e na última visita ao pré-natal e esses valores foram comparados. Resultados Houve aumento na categoria do IMC segundo a classificação de Atalah em 19,9% das mulheres grávidas e um aumento de 3,4; 5,8 e 6,4 pontos do IMC foram encontrados para mulheres respectivamente classificadas nas categorias peso adequado, sobrepeso e obesidade na primeira consulta pré-natal. As mulheres com educação secundária apresentaram menor chance de aumentar sua classificação de IMC (odds ratio [OR] 0:47 [0,24- 0,95]). As mulheres que evoluíram com o aumento na classificação de Atalah foramassociadas a cesariana (OR 1,97-2,28),macrossomia fetal (OR 4,13-12,54) e recém-nascido grande para a idade gestacional (OR 2,88-9,83). Conclusão Gestantes com ganho de peso excessivo, o suficiente para aumentar sua classificação do IMC segundo a curva de Atalah, tiverammaiores chances de cesariana e macrossomia. As mulheres classificadas como obesas na primeira visita pré-natal, de acordo com a curva de Atalah, tiveram uma grande chance de cesariana e recémnascido grande para a idade gestacional.