Validação de escala de avaliação de profissionalismo traduzida e adaptada em cenário de simulação / Validation of a translated and adapted professionalism assessment scale in a virtual simulation scenario

Resumo: Introdução: O Professionalism Mini-Evaluation Exercise (P-MEX) é instrumento que avalia 21 habilidades de profissionalismo, distribuídas em quatro domínios. Objetivo: Este estudo teve como objetivos traduzir, adaptar e validar um instrumento de avaliação de profissionalismo médico. Método: Após a autorização do autor do P-MEX, realizaram-se a tradução do instrumento para a língua portuguesa, a análise de equivalência linguística e validade de conteúdo por especialistas em educação, e o exame de validade operacional em OSCE virtual entre estudantes do internato médico. Resultado: Houve elevada equivalência dos itens da versão em português do Brasil por especialistas em educação. O índice de validade de conteúdo da escala foi de 0,96. Seis professores validaram o P-MEX em ambiente de simulação para 27 estudantes do internato médico. Conclusão: A versão brasileira do P-MEX demonstrou ser adequada para avaliar o profissionalismo médico no contexto brasileiro, com boa validade operacional em cenário de simulação virtual.

Abstract: Introduction: "Professionalism Mini-Evaluation Exercise" (P-MEX) is an instrument that assesses 21 professionalism skills, distributed in four domains. Objective: To translate, adapt and analyze the validity of the medical professionalism evaluation exercise. Methods: After authorization from the author, the following tasks were performed: translation into Portuguese; linguistic equivalence and content validity analysis by education experts; operational validity analysis in virtual OSCE among medical clerkship students. Results: There was high equivalence of the items in the Brazilian Portuguese version by education specialists. The Scale Content Validity Index was 0.96. Six teachers validated the P-MEX in a simulation environment to 27 medical clerkship students. Conclusion: The Brazilian version of the P-MEX proved to be adequate to assess medical professionalism in the Brazilian context, and showed good operational validity in a virtual simulation scenario.

Blue Light-Emitting Diode Therapy for Chronic Vulvovaginitis Symptoms: A Series of Cases.

Objective: This pilot study aimed to evaluate the characteristic signs and symptoms of chronic vulvovaginitis after blue light-emitting diode (LED) treatment. Methods: Women with characteristic signs and symptoms of vulvovaginitis were interviewed to obtain clinical and sociodemographic data. They answered the Female Sexual Function Index (FSFI) and the World Health Organization Quality of Life (WHOQOL)-bref questionnaires. Women with a suspected diagnosis of vulvovaginitis underwent clinical examination by a gynecologist, followed by microbiological evaluation, potassium hydroxide testing, vaginal pH assessment, and collection of vaginal fluid for oncotic cytology and fungal culture. The study participants were instructed to return after 15 days to undergo the 405 nm blue LED treatment, which consisted of three biweekly sessions. After 28 days of treatment completion, the patients returned for clinical re-evaluation and reassessment of the FSFI and WHOQOL-bref scores. Results: All eight women reported improvement or cure of at least one characteristic sign or symptom of vulvovaginitis, and five showed improvement in total FSFI and WHOQOL-bref scores. Conclusions: Treatment with blue LED may improve or cure symptoms associated with vulvovaginitis, sexual function, and the global quality of life score. Clinical Trial registration: NCT03075046 dated March 9, 2017.

Access to contraception during the Covid-19 pandemic: barriers and perspectives / Acesso à contracepção durante a pandemia de Covid-19: barreiras e perspectivas

Abstract Background The SARS-CoV-2 pandemic, which started in December 2019, was declared by the World Health Organization (WHO) as an international public health emergency in January 2020, with an impact on access to sexual and reproductive health services for women. Objective To discuss contraception in the pandemic context, based on current public policies and the world and Brazilian scenario. Method This is an opinion article, which describes the barriers and possible solutions for access to qualified sexual and reproductive health care for women. Results Relevant topics were explored, such as: the change in the logistics of services, the reduction in the number of consultations, the difficulty in importing contraceptives, the lack of trained professionals, and the bureaucratization of access to contraceptives methods. The use of telemedicine and the strengthening of Primary Health Care are considered strategies to guarantee access and change the reality of women. Conclusion In this context, it is necessary to maintain the actions of sexual and reproductive planning services to prevent injuries from unplanned pregnancies and increase maternal morbidity and mortality.

Resumo Introdução A pandemia por SARS-CoV-2, iniciada em dezembro de 2019, foi declarada pela Organização Mundial da Saúde (OMS) como emergência de saúde pública internacional em janeiro de 2020, com impacto sobre o acesso a serviços de saúde sexual e reprodutiva para as mulheres. Objetivo Discutir a contracepção no contexto pandêmico, a partir das políticas públicas vigentes e do cenário mundial e brasileiro. Método Trata-se de um artigo de opinião, onde se descreve as barreiras e possíveis soluções para o acesso à assistência de saúde sexual e reprodutiva qualificada para as mulheres. Resultados Explorou-se temas relevantes como: mudança na logística dos serviços, redução do número de consultas, dificuldade na importação de contraceptivos, falta de profissionais capacitados, burocratização do acesso a métodos contraceptivos. O uso da telemedicina e o fortalecimento da Atenção Primária à Saúde são consideradas estratégias para garantia do acesso e modificação da realidade das mulheres. Conclusão Faz-se necessário nesse contexto, a manutenção das ações dos serviços de planejamento sexual e reprodutivo para prevenir agravos provenientes de gestações não planejadas e aumento na morbimortalidade materna.

Female sexual function in women using LARC methods.

OBJECTIVE: This study aims to assess sexual function (SF) and quality of life (QoL) among women using copper intrauterine devices (Cu-IUD), levonorgestrel-releasing intrauterine system (LNG-IUS) or etonogestrel(ENG)-releasing subdermal implant. METHODS: This is a cross-sectional study involving 213 women who are sexually active, using Cu-IUD, LNG-IUS or ENG implant for at least one year. SF assessment was carried out through the Female Sexual Function Index (FSFI) and QoL was made through The Short Form Health Research. RESULTS: Frequency of sexual dysfunction score in Cu-IUD users was 33.8%; 47.2% in LNG-IUS users and 47.8% in ENG-implant users, without difference between groups. Desire domain had higher score in Cu-IUD users (Cu-IUD:4.20 ± 1.15 × LNG-IUS:3.76 ± 1.17 × ENG-implant:3.63 ± 1.15; p = .009). Between Cu-IUD and LNG-IUS users there was no difference in FSFI score. Total FSFI score was higher in Cu-IUD group when compared only to ENG-implant (Cu-IUD:27.48 ± 6.14 × Implant:25.07 ± 6.89; p = .029). Regarding the QoL score, difference was found only in general health domain (Cu-IUD:65.22 ± 14.91 × LNG-IUS:62.61 ± 19.04 × Implant:58.33 ± 16.46; p = .034), with lower score for implant group. CONCLUSION: There was no difference in the SF total score between the users of Cu-IUD, LNG-IUS and ENG implant. However, the score of the FSFI desire domain and general health status were higher among users of the Cu-IUD.

Sexual function in women of fertile age with epilepsy.

PURPOSE: To evaluate Sexual Function Scores in women of childbearing age with epilepsy. METHOD: Cross-sectional study and comparison of two groups, one with and the other without epilepsy. The instruments used were: semi-structured socioeconomic, demographic and clinical questionnaire; Beck Anxiety and Depression Inventories; Word Health Organization Quality of Life (WHOQOL-brief); Female Sexual Function Index (FSFI); and Female Genital Self Image Scale (FGSIS). Statistical analysis was performed using Fisher's Exact Test, Chi-Square, Mann-Whitney, and Spearman's Correlation, considering p < 0.05 as a measure of significance. RESULTS: 110 women were included (55 with epilepsy and 55 without epilepsy) with a mean age of 32 years. Both groups had sexual dysfunction (with epilepsy: 19.28 vs. without epilepsy: 21.05; p = 0.416). There was no significant difference between groups in the analysis of self-image of the genitalia, Quality of Life, or Anxiety. However, there was a statistical difference in Depression Symptoms (with epilepsy: 11.44 vs. without epilepsy:13.82, p = 0.038). When evaluating the influence of epilepsy on sexual function score, women who used enzyme-inducing drugs had worse scores in desire domain (5.21 vs. 6.65; p = 0.020) and lubrication domain (9.48 vs. 12.95; p = 0.047) when compared to women who used non-enzyme-inducing drugs, respectively. In the correlation of Sexual Function with Anxiety, Depression, Quality of Life, and Self-Image of the genitalia, it was observed that when Depression levels increase, desire is impaired [-0.273(p = 0.043)]. In Quality of Life, the psychological [0.311(p = 0.021)] and environmental [0.268(p = 0.048)] domains positively influenced desire. The social relationships domain improved desire [0.504(p = 0.000)], excitement [0.461(p = 0.000)], lubrication [0.342(p = 0.011)], orgasm [0.425(p = 0.001)], satisfaction [0.449(p = 0.001)], and decreased pain [0.402(p = 0.002)]. Consequently, these influence appeared to improve sexual function [0.521(p = 0.000)]. CONCLUSION: Women of childbearing age with epilepsy have sexual dysfunction. The presence of signs of depression and the use of enzyme-inducing drugs must be carefully analyzed, as they can worsen the sexual function score. Health professionals need to be aware that sexual dysfunction must be investigated because this issue influences the quality of life of these women.

Quality of life among women with epilepsy during their reproductive years.

PURPOSE: The purpose of this study was to assess the health-related quality of life (HRQoL) of women with epilepsy during their reproductive years. METHOD: A cross-sectional study comparing two groups, one with and another without epilepsy, was conducted. Semistructure questionnaires regarding socioeconomic, demographic, and clinical profiles were used. The HRQoL was measured using the Quality of Life in Epilepsy Inventory (QOLIE-31), for comparison within the group with epilepsy, and World Health Organization of Quality of Life (WHOQOL)-bref, for comparison between the groups with and without epilepsy. Statistical analysis was performed using Fisher's exact test, Mann-Whitney test, and multivariate linear regression. A measure of significance was considered as p < 0.05. RESULTS: Eighty women were included (40 with epilepsy and 40 without epilepsy) with mean age of 28.2 ±â€¯6.51 years. Women of childbearing age with epilepsy tend to have lower quality of life than those without epilepsy (with epilepsy: 85.15 ±â€¯13.50 vs. without epilepsy: 90.75 ±â€¯12.17, p = 0.051). The groups were similar in relation to most sociodemographic characteristics, with the exception of the percentage of women with epilepsy outside the labor market (with epilepsy: 57.5% vs. without epilepsy: 30%, p = 0.012) and with clinical (with epilepsy: 27.5% vs. without epilepsy: 7.5%, p = 0.018) and psychiatric comorbidities (with epilepsy: 20% vs. without epilepsy: 0%, p = 0.003). However, logistic regression showed no influence of these variables on the HRQoL of women with epilepsy. The clinical variables associated with the worsening of HRQoL were seizure control and antiepileptic drugs (AEDs) adverse effects. CONCLUSION: Epilepsy has a negative impact on the HRQoL of women of childbearing age, and the clinical variables controlling seizures and adverse effects of AEDs influenced HRQoL in this population.

Low prevalence of contraceptive use among Brazilian women of reproductive age with systemic lupus erythematosus.

This was a cross-sectional study of women of reproductive age with systemic lupus erythematosus (SLE) being treated at Bahiana School Rheumatology Service in Brazil. The study aimed to assess the prevalence of contraceptive counselling and use. An interview was performed, and the results were analysed before and after the SLE diagnosis. Eighty-five women were included; the mean age of the group was 32.98 ± 8.39 years. Before SLE diagnosis, most of the patients had used some contraceptive method; mainly oral contraceptives (54%) or hormone injections (21%). After SLE diagnosis, 53% of patients did not use any contraceptive method. Among the remaining patients who continued using contraceptives, 22% used condoms, 11% used combined oral contraceptives and 7% used hormone injections. Although 62% of the patients regularly visited the gynaecologist, 56% were unaware of which contraceptive method could be used safely. Thus, a better contraceptive counselling of women of a reproductive age should be performed after SLE diagnosis. Impact Statement What is already known on this subject? Women diagnosed with SLE have inadequate counselling about family planning. What the results of this study add? Brazilian women with SLE have a low prevalence of contraceptive use after their diagnosis and are exposed to having high-risk pregnancies. What the implications are of these findings for clinical practice and/or further research? The results we found highlight the importance of continued medical educational programmes and establish questions for further studies in order to investigate the interventions used to improve the contraceptive use for women diagnosed with SLE.

Low Level of Knowledge of Contraceptive Methods among Pregnant Teens in Brazil.

STUDY OBJECTIVE: To describe knowledge and use of contraceptive methods among pregnant teens in Brazil. DESIGN: A cross-sectional survey. SETTING: A tertiary care center in Bahia, Brazil. PARTICIPANTS: Pregnant teens 10-19 years old. INTERVENTIONS: Participants were asked about contraceptive knowledge and previous contraceptive use. MAIN OUTCOME MEASURES: Contraceptive knowledge, previous contraceptive use, and contraceptive intentions for after pregnancy. Other survey topics included demographic characteristics, school attendance, and sexual history. RESULTS: A total of 90 participants wereincluded in the study, with an average age of 15.4 ± 1.7 years, and a mean age at first sexual intercourse of 13.8 ± 1.2 years. Most participants were unmarried (58/90), of mixed race (57/90), had a household income below minimum wage (59/83), lived with their parents (54/90), and unemployment (81/90). More than 80% were not using contraception or were using it irregularly whenthey became pregnant. Most participants reported knowledge of condoms (82/90), of the combined oral contraceptive pill (75/90) and of injectable contraceptives (68/90). However, less than half reported knowledge oflong-acting reversible contraceptive methods. In terms of contraceptive intentions after pregnancy, the most commonly cited methods were the contraceptive injection (36/90), the intrauterine device (17/90) and the combined pill (9/90). CONCLUSION: In this study we found a low level of knowledge of contraceptive methods, and especially of long-acting reversible contraceptive methods, among pregnant teens in Northeast Brazil. Low socioeconomic status and high rates of unplanned pregnancy might be reasons for insufficient sexual and reproductive health counseling in this population.

Long-Acting Reversible Contraception.

Unwanted pregnancy is a major public health problem both in developed and developing countries. Although the reduction in the rates of these pregnancies requires multifactorial approaches, increasing access to long-acting contraceptive methods can contribute significantly to change this scenario. In Brazil, gynecologists and obstetricians play a key role in contraceptive counseling, being decisive in the choice of long-acting reversible methods, characterized by intrauterine devices (IUDs) and the contraceptive implant. The vast scope due to the reduced number of situations to indicate long-acting methods should be emphasized in routine contraceptive counseling. On the other hand, gynecologists and obstetricians should adapt the techniques of insertion of long-acting methods, and engage in facilitating conditions to access these contraceptives through public and private health systems in Brazil. This study is part of a project called Diretrizes e Recomendações FEBRASGO (Guidelines and Recommendations of the FEBRASGO - Brazilian Federation of Gynecology and Obstetrics Associations from the Portuguese acronym). It aims to review the main characteristics of long-acting contraceptives and critically consider the current situation and future prospects to improve access to these methods, proposing practical recommendations of interest in the routine of gynecologists and obstetricians.

A gravidez não planejada representa importante problema de saúde pública tanto em países desenvolvidos quanto naqueles em desenvolvimento. Embora a redução das taxas dessas gestações requeira abordagens multifatoriais, o aumento no acesso aos métodos contraceptivos de longa ação pode contribuir de forma expressiva na mudança desse cenário. No Brasil, os ginecologistas e obstetras têm papel fundamental no aconselhamento contraceptivo, sendo decisivos na escolha dos métodos reversíveis de longa ação, caracterizados pelos dispositivos intrauterinos (DIUs) e pelo implante anticoncepcional. A grande abrangência decorrente do pequeno número de situações que contraindicam os métodos de longa ação deve ser enfatizada no aconselhamento contraceptivo de rotina. Por outro lado, os ginecologistas e obstetras devem se adaptar às técnicas de inserção dos métodos de longa ação, bem como se engajar na facilitação de condições para o acesso a esses contraceptivos por meio do sistema de saúde pública e privada no Brasil. Este estudo, parte do projeto denominado "Diretrizes e Recomendações FEBRASGO", tem por objetivo revisar as principais características dos contraceptivos de longa ação, além de considerar de forma crítica o panorama atual e as perspectivas futuras, visando melhorar o acesso a esses métodos, com recomendações práticas de interesse na rotina do ginecologista e obstetra.

Long-Acting Reversible Contraception / Contracepção reversível de longa ação

Abstract Unwanted pregnancy is a major public health problem both in developed and developing countries. Although the reduction in the rates of these pregnancies requires multifactorial approaches, increasing access to long-acting contraceptive methods can contribute significantly to change this scenario. In Brazil, gynecologists and obstetricians play a key role in contraceptive counseling, being decisive in the choice of long-acting reversible methods, characterized by intrauterine devices (IUDs) and the contraceptive implant. The vast scope due to the reduced number of situations to indicate long-acting methods should be emphasized in routine contraceptive counseling. On the other hand, gynecologists and obstetricians should adapt the techniques of insertion of long-acting methods, and engage in facilitating conditions to access these contraceptives through public and private health systems in Brazil. This study is part of a project called Diretrizes e Recomendações FEBRASGO (Guidelines and Recommendations of the FEBRASGO - Brazilian Federation of Gynecology and Obstetrics Associations from the Portuguese acronym). It aims to review the main characteristics of long-acting contraceptives and critically consider the current situation and future prospects to improve access to these methods, proposing practical recommendations of interest in the routine of gynecologists and obstetricians.

Resumo A gravidez não planejada representa importante problema de saúde pública tanto em países desenvolvidos quanto naqueles em desenvolvimento. Embora a redução das taxas dessas gestações requeira abordagens multifatoriais, o aumento no acesso aos métodos contraceptivos de longa ação pode contribuir de forma expressiva na mudança desse cenário. No Brasil, os ginecologistas e obstetras têm papel fundamental no aconselhamento contraceptivo, sendo decisivos na escolha dos métodos reversíveis de longa ação, caracterizados pelos dispositivos intrauterinos (DIUs) e pelo implante anticoncepcional. A grande abrangência decorrente do pequeno número de situações que contraindicam os métodos de longa ação deve ser enfatizada no aconselhamento contraceptivo de rotina. Por outro lado, os ginecologistas e obstetras devem se adaptar às técnicas de inserção dos métodos de longa ação, bem como se engajar na facilitação de condições para o acesso a esses contraceptivos por meio do sistema de saúde pública e privada no Brasil. Este estudo, parte do projeto denominado "Diretrizes e Recomendações FEBRASGO", tem por objetivo revisar as principais características dos contraceptivos de longa ação, além de considerar de forma crítica o panorama atual e as perspectivas futuras, visando melhorar o acesso a esses métodos, com recomendações práticas de interesse na rotina do ginecologista e obstetra.

Bleeding patterns of HIV-infected women using an etonogestrel-releasing contraceptive implant and efavirenz-based or lopinavir/ritonavir-based antiretroviral therapy.

OBJECTIVES: The use of progestogen-only contraceptives may cause a change in bleeding pattern, which is a common cause of discontinuation of these methods. Co-administration with some antiretroviral therapies (ART) changes the bioavailability of the etonogestrel (ENG)-releasing contraceptive implant, possibly affecting the bleeding pattern. Bleeding patterns were evaluated in HIV-positive users of the ENG implant co-administered with two common ART regimens. METHODS: Forty-five HIV-positive women who wished to use an ENG implant were included in this study: 15 had received zidovudine/lamivudine (AZT/3TC) + lopinavir/ritonavir (LPV/r) for ≥3 months (LPV/r-based ART group), 15 had received AZT/3TC + efavirenz (EFV) for ≥3 months (EFV-based ART group), and 15 had not received ART (non-ART group). Bleeding patterns were evaluated at 3 and 6 months after implant placement using a standard bleeding calendar. RESULTS: Amenorrhoea and infrequent bleeding rates were higher in the LPV/r-based ART group (50% and 36%, respectively) than in the other groups (non-ART group, 36% and 29%, respectively; EFV-based ART group, 7% and 14.5%, respectively; p = 0.01). The EFV-based ART group more frequently had regular bleeding (71.5%) compared with the other groups (LPV/r-based ART group, 7%; non-ART group, 21%; p = 0.01). The proportions of women with frequent and prolonged bleeding were similar (p > 0.05) in the three groups. CONCLUSIONS: The co-administration of EFV-based or LPV/r-based ART with the ENG implant affected the expected bleeding patterns during use of the implant, although unfavourable bleeding (frequent and prolonged) was not associated with the medications under evaluation.

A importância da contracepção de longo prazo reversível / The importance of long-acting reversible contraception

A contracepção de longo prazo evoluiu a partir do conhecimento tecnológico da fisiologia reprodutiva. São considerados métodos contraceptivos de longa duração (LARCs) os métodos contraceptivos com mais de três anos de duração, sendo estes: dispositivo intrauterino (DIU), cobre e levonogestrel, e implantes hormonais. Devido à pequena relação entre a motivação da usuária e o uso dos LARCs, estes são considerados o melhor custo-benefício para a ação contraceptiva em populações especiais, tais como: adolescentes, usuárias de drogas ilícitas e mulheres vivendo com vírus da imunodeficiência humana (HIV). Entretanto, mesmo para população feminina em geral a taxa de eficácia dos LARCs é superior à dos métodos de curta duração, o que torna os primeiros uma excelente escolha contraceptiva.(AU)

Long-term contraception (LARC) evolved from the technological knowledge of reproductive physiology. LARCS are considered contraceptive methods with more than 3 years duration. There is in Brazil, two kind: IUD (copper and levonorgestrel) and hormonal implants. Due to small relationship between the user motivation and the use of LARCs these are considered the best cost-benefit contraceptive option for special populations, such as adolescents, illicit drug users and women living with HIV. However, even for the general female population, LARCs effectiveness rate is higher than that of short-term methods, making this an excellent choice contraceptive.(AU)

Oral anticoagulant therapy does not modify the bleeding pattern associated with the levonorgestrel-releasing intrauterine system in women with thrombophilia and/or a history of thrombosis.

BACKGROUND: Progestogen-only contraceptives (POCs) are suitable for women with thrombophilia and/or a history of venous thromboembolism (VTE). Several of these women, however, use oral anticoagulant therapy (OAT), which can impair the bleeding pattern associated with POC use. We evaluated the effects of OAT use on the bleeding pattern associated with the levonorgestrel-releasing intrauterine system (LNG-IUS) in women with thrombophilia and/or a history of VTE. STUDY DESIGN: This prospective cohort study followed two groups of women, all of whom were thrombophilic and/or had a history of VTE: OAT users and nonusers. Bleeding patterns, blood pressure, body mass index (BMI), weight, complete blood count and waist circumference were compared between the two groups before and 6 and 12 months after LNG-IUS insertion. RESULTS: The patient cohort consisted of 33 women aged 18 to 45 years old, including 16 OAT users and 17 nonusers. Body weight increased by 3.9% and BMI by 3.8% in OAT users 12 months after LNG-IUS insertion. Hemoglobin and hematocrit levels increased by approximately 10% in both groups. There was no difference between the groups in bleeding patterns, with amenorrhea being the most frequent pattern in both groups (41.2% each) 12 months after LNG-IUS insertion. OAT did not increase the frequency of prolonged and/or frequent bleeding. CONCLUSION: OAT users and nonusers had similar bleeding patterns after insertion of the LNG-IUS. Hemoglobin and hematocrit levels increased in both groups.