Ultra-processed foods and the nutritional quality of the diet of Brazilian pregnant women.

OBJECTIVE: The aim of this study was to evaluate the consumption of ultra-processed foods by Brazilian pregnant women and its association with the nutritional quality of the diet. METHODS: This is a prospective and cross-sectional study with food consumption data of Brazilian pregnant women from the 2017 to 2018 Family Budgets Survey (Pesquisa de Orçamentos Familiares). Food consumption was measured using two 24-h food recalls, and the foods were categorized according to the NOVA classification. The averages of absolute and relative energy consumption for each of the NOVA groups and subgroups were estimated. The sociodemographic characteristics described the diet's caloric contribution of ultra-processed and non-ultra-processed food fractions. Linear regression models were used to describe the association between quintiles of the caloric contribution of ultra-processed foods and the average content of nutrients in the diet. RESULTS: Consumption of ultra-processed foods represented 20.9% of the total calories in the diet of Brazilian pregnant women. There was a higher energy contribution of ultra-processed foods in the diet of pregnant women living in urban areas (22%), with higher per capita income (23.7%), and in the south region of the country (26.9%). In addition, the data showed an association between higher consumption of ultra-processed foods with reduced intake of protein, carbohydrate, fiber, potassium, iron, zinc, and folate and increased intake of total fat, saturated fat, trans fat, and free sugar. CONCLUSION: Results show that higher consumption of ultra-processed foods is associated with a reduction in the nutritional quality of the diet of Brazilian pregnant women.

Ultra-processed foods and the nutritional quality of the diet of Brazilian pregnant women

SUMMARY OBJECTIVE: The aim of this study was to evaluate the consumption of ultra-processed foods by Brazilian pregnant women and its association with the nutritional quality of the diet. METHODS: This is a prospective and cross-sectional study with food consumption data of Brazilian pregnant women from the 2017 to 2018 Family Budgets Survey (Pesquisa de Orçamentos Familiares). Food consumption was measured using two 24-h food recalls, and the foods were categorized according to the NOVA classification. The averages of absolute and relative energy consumption for each of the NOVA groups and subgroups were estimated. The sociodemographic characteristics described the diet's caloric contribution of ultra-processed and non-ultra-processed food fractions. Linear regression models were used to describe the association between quintiles of the caloric contribution of ultra-processed foods and the average content of nutrients in the diet. RESULTS: Consumption of ultra-processed foods represented 20.9% of the total calories in the diet of Brazilian pregnant women. There was a higher energy contribution of ultra-processed foods in the diet of pregnant women living in urban areas (22%), with higher per capita income (23.7%), and in the south region of the country (26.9%). In addition, the data showed an association between higher consumption of ultra-processed foods with reduced intake of protein, carbohydrate, fiber, potassium, iron, zinc, and folate and increased intake of total fat, saturated fat, trans fat, and free sugar. CONCLUSION: Results show that higher consumption of ultra-processed foods is associated with a reduction in the nutritional quality of the diet of Brazilian pregnant women.

Effects of Bryophyllum pinnatum Administration on Wistar Rat Pregnancy: Biochemical and Histological Aspects.

INTRODUCTION: Bryophyllum pinnatum is widely used in folk medicine. It has neuropharmacological, anti-inflammatory, immunomodulatory, antidiabetic, hepatoprotective, and nephroprotective effects, among others. It also acts on uterine contractility. It is prescribed by practitioners of anthroposophic medicine for preterm labor, insomnia, and emotional disorders, and has other potential uses in obstetrics. As all drugs currently used in preterm labor have side effects, new tocolytic agents remain an area of active research. OBJECTIVE: To evaluate the effect of B. pinnatum mother tincture (MT) on albino rats and their offspring throughout pregnancy from a biochemical and histological standpoint. METHODS: Longitudinal, prospective, randomized controlled bioassay. This is the second stage of a trial that investigated 60 animals distributed across six equal groups: controls C1 and C2, which received 1 and 25 times the vehicle dose (30% ethanol), B1 and B2 (1- and 25-fold doses of B. pinnatum MT), and B3 and B4 (which received 50- and 100-fold doses of B. pinnatum concentrate). At this stage, blood chemistry parameters (glucose, alanine aminotransferase [ALT], aspartate aminotransferase [AST], creatinine, and blood urea nitrogen) were measured in dams, as well as histological aspects of dam liver, kidney, placenta, and uterine tissue and fetal liver, kidney, heart, and brain. RESULTS: No differences were found between group B1 (therapeutic dose) and its control C1 in relation to glucose, AST, ALT, and creatinine. Group B2 exhibited lower glucose levels than groups C1, B3, and B4. There was no difference in AST across groups. Groups B3 and B4 exhibited higher ALT levels than groups C1 and B1. Groups B1-B4 exhibited higher urea nitrogen levels than group C1. Creatinine levels were higher in groups B2 and B3 than group C1. On morphological evaluation, fatty infiltration of the liver was observed in the alcoholic vehicle control groups (C1 and C2). CONCLUSIONS: Daily administration of B. pinnatum at therapeutic doses (group B1) to pregnant albino rats appears to be safe, with reduced glucose at dose B2, elevated ALT at doses B3 and B4, and increased urea at doses B1 to B4 and creatinine at B2 and B3, but never exceeding the normal reference range. It was not associated with histological changes in specimens of the maternal or fetal structures of interest.

Usual-Risk Pregnant Women's Health-Related Quality of Life through Pregnancy and Puerperium with Anthroposophical Prenatal Care: A Retrospective Study.

INTRODUCTION: Pregnancy is a physiological event that can lead to a decrease in quality of life. Symptoms within this period lack riskless treatment options. However, the anthroposophical integrative view points out the stimulation of vital energy recuperation as a possible inducer of changes in health perception for pregnant women. OBJECTIVE: The aim was to observe the health-related quality of life variation in women during pregnancy and puerperium. The evaluation was based on the Medical Outcomes Study 36-Item Short-Form (SF-36). METHOD: This is a retrospective longitudinal study of SF-36 questionnaires administered at 3 different time points: at the first appointment, at an appointment between the 36th ± 1 week of pregnancy and at another appointment within the puerperium period. RESULTS: Sixty-five patients completed the 3 questionnaires within the period of the study. The 8 domains of SF-36 and women's behaviors throughout the prenatal and puerperal care period were analyzed. Quality of life decreased by the third trimester, with recuperation in the puerperium. Physical components were reduced significantly, while emotional and social components did not change significantly. Scores in mental health and vitality, as well as general health status, were higher in puerperium. CONCLUSION: Multiprofessional intervention broadened by the anthroposophical perspective fosters the health-related quality of life of women through gestation and puerperium.

Women's satisfaction with childbirth in a public hospital in Brazil.

OBJECTIVE: The purpose of this study was to evaluate women's satisfaction with vaginal birth in a public hospital in São Paulo, Brazil. METHODS: A total of 372 low-risk postpartum women were interviewed. Maternal satisfaction was measured by the Mackey Childbirth Satisfaction Rating Scale (MCSRS), validated to Brazilian Portuguese. The scale is divided into six subscales: self-evaluation, partner, baby, nursing, physicians, and overall satisfaction. Childbirth care data were related to maternal mobility, shower bath, birth ball exercises, manual massage, and the health care providers assisting delivery. RESULTS: The MCSRS total score was significantly higher in women living with their partners than those not living with a partner (median 145.5 vs 133.0; P = 0.019), in women with a companion during childbirth than those with no labor support (146.0 vs 136.5; P = 0.047), and in women who early breastfed within the first hour compared with those who did not (146.0 vs 137.0; P = 0.001). Multiple regression identified 'living with partner' (coefficient 6.205; P = 0.043) and 'breastfeeding within the first hour' (coefficient 7.856; P = 0.005) as independent variables that determine the total score of MCSRS. CONCLUSIONS: Our findings indicate that living with one's partner and early initiation of breastfeeding are key factors enhancing satisfaction with vaginal birth in women who received care at a public Brazilian hospital.

Psychometric properties of the Mackey Childbirth Satisfaction Rating Scale cross-culturally adapted to Brazilian Portuguese.

OBJECTIVE: To analyze the psychometric properties of the Brazilian version of Mackey Childbirth Satisfaction Rating Scale (MCSRS). METHODS: The MCSRS questionnaire was applied to postpartum mothers before discharge at low-risk maternity hospital in Brazil. The inclusion criteria were maternal age between 18 and 34 years, delivery of a live infant, and gestational age at birth over 36 weeks. In analyzing psychometric properties, dimensionality was evaluated by exploratory factor analysis and reliability by Cronbach's alpha and McDonald's omega. RESULTS: Fifty-three questionnaires were filled out by the postpartum mothers for an analysis of psychometric properties. Of the participants, 84.9% had vaginal deliveries; and 58.5% had deliveries by obstetricians and 41.5% by midwives. Two latent dimensions model was significantly better than those obtained with the single-factor model (Dc233 = 145.9, p < .001). The first dimension explains 35% of the variance related to the items covering care giving, and the second explains 17% of the variance related to self-satisfaction and satisfaction with the partner. High communality was found for factor 1 (0.36-0.71) and factor 2 (0.28-0.50). For factors 1 and 2, Cronbach's alpha was 0.96 and 0.92, and McDonalds' omega was 0.96 and 0.89, respectively. The reliability coefficient omega for the overall reliability of the questionnaire was 0.97. CONCLUSION: The psychometric properties of the Brazilian version of the MCSRS yielded two dimensions related to professional care giving and family. This version demonstrated good reliability and is thus a potential instrument to promote improvement of childbirth care in the country. Nonetheless, confirmation of the structural model of the tool should be sought.

Type of Childbirth and its Association with the Maternal-Filial Interaction.

OBJECTIVE: The purpose of the present study was to evaluate the quality of mother-child bonding in three different contexts related to the labor, that is, vaginal delivery, elective cesarean section, and intrapartum cesarean section. METHODS: This was an observational, cross-sectional clinical study conducted in two cities within the state of São Paulo, Brazil. The study sample consisted of 81 babies born without any major complications during pregnancy and labor, aged 3 to 4 months, and their respective mothers, aged between 20 and 35 years old, primiparous, living in the cities of Palmital and Ourinhos, state of São Paulo, Brazil. The evaluation of the quality of the maternal-filial interaction was performed through video-image analysis, using the Mother-baby Interaction Observation Protocol from 0 to 6 months (POIMB 0-6, in the Portuguese acronym). RESULTS: Mothers who had vaginal delivery had higher amount of visual contact or attempted visual contact (p = 0.034), better response to the social behavior of the child (p = 0.001) and greater sensitivity (p = 0.007) than the others. Their children also showed more interaction with them, as they looked more frequently at the mother's face (p ≤ 0.008) and responded more frequently to the mother's communicative stimulus (p < 0.001). CONCLUSION: Considering the occurrence of vaginal delivery, it is concluded that the interaction between the mother-child dyad is quantitatively larger and qualitatively better when compared with intrapartum or elective cesarean section.

OBJETIVO: O objetivo do presente estudo foi avaliar a qualidade do vínculo mãe-filho em três contextos diferentes relacionados ao trabalho de parto, ou seja, parto vaginal, cesariana eletiva e cesariana intraparto. MéTODOS: Estudo clínico observacional, transversal, realizado em duas cidades do estado de São Paulo, Brasil. A amostra do estudo foi composta por 81 recém-nascidos sem maiores complicações durante a gravidez e o parto, com idades entre 3 e 4 meses, e suas respectivas mães, com idades entre 20 e 35 anos, primíparas, residentes nas cidades de Palmital e Ourinhos, estado de São Paulo, Brasil. A avaliação da qualidade da interação materno-filial foi realizada por meio de análise de vídeo-imagem, utilizando o Protocolo de Observação da Interação Mãe-Bebê de 0 a 6 meses (POIMB 0­6). RESULTADOS: Mães que tiveram parto vaginal tiveram maior quantidade de contato visual ou tentativa de contato visual (p = 0,034), melhor resposta ao comportamento social da criança (p = 0,001) e maior sensibilidade (p = 0,007) que as demais. Os filhos também mostraram maior interação com elas, pois olhavam com mais frequência para o rosto da mãe (p < 0,008) e respondiam com mais frequência ao estímulo comunicativo da mãe (p < 0,001). CONCLUSãO: Considerando a ocorrência do parto vaginal, conclui-se que a interação entre a díade mãe-filho é quantitativamente maior e qualitativamente melhor quando comparada à cesariana intraparto ou eletiva.

Quantitative assessment of pelvic floor muscle extensibility in pregnant women with a perineal elasticity meter.

Objective: The objective of this study was to compare measurements of pelvic floor muscle extensibility in pregnant women obtained through the Epi-no® and perineal elasticity meter (PEM) devices.Methods: This was an observational, cross-sectional study with a consecutive sample, conducted in a prenatal care outpatient clinic. The pelvic floors of 62 healthy pregnant women with gestational ages between 35 and 40 weeks were assessed. Perineal extensibility was measured using the Epi-no® and PEM devices. Through the linear regression method, a formula was created to calculate the Epi-no® values from the PEM values. To determine the degree of relationship between both variables, Pearson's correlation coefficient was used.Results: In the comparison of the results for 62 pregnant women using the two perineal extensibility assessment methods, the value obtained in the Pearson correlation coefficient analysis (0.621) indicated a moderate relationship between the variables. This finding was not confirmed by the Kappa correlation test. When the measurements were classified into three groups, a slight correlation was identified (perineum with restrictions, moderate extensibility, and good extensibility).Conclusion: There was a relationship between Epi-no® and PEM from slight to moderate agreement.

Content and Face Validity of the Mackey Childbirth Satisfaction Rating Scale Questionnaire Cross-culturally Adapted to Brazilian Portuguese.

OBJECTIVE: The aim of this study was to determine the content and face validity of the Mackey Childbirth Satisfaction Rating Scale (MCSRS) questionnaire cross-culturally adapted to Brazilian Portuguese. METHODS: The MCSRS is a questionnaire with 34 items related to childbirth satisfaction. The forward- and back-translated versions were compared with the original material, and 10 experts analyzed each item according to the following criteria: clarity, semantic equivalence, appropriateness, and cultural relevance. The final version was presented to 10 mothers for face validation to ensure the questionnaire would suit the target population. RESULTS: The total of 34 items assessed by experts for clarity, semantic equivalence, appropriateness, and relevance showed positive agreement of 0.85, 0.92, 0.97 and 0.97; negative agreement of 0.13, 0.09, 0.04 and 0.04; and total agreement of 0.75; 0.85, 0.94 and 0.94, respectively. Multilevel linear modeling was applied with crossed random effects and with nested random effects for each judge. The intercept of each criterion was as follows: clarity, 0.87; semantic equivalence, 0.92; appropriateness, 0.96; and cultural relevance, 0.96. The overall mean of agreement was 92.8%. The face validity measurement yielded 80% of agreement on the items, all of them clearly understood. CONCLUSION: The final version of the Brazilian Portuguese MCSRS questionnaire had face and content validity confirmed. This instrument of evaluation of maternal satisfaction during childbirth was validated to be applied in the Brazilian female population.

OBJETIVO: O objetivo deste estudo foi determinar a validação de face e conteúdo da Escala Mackey de Avaliação da Satisfação com o Parto (MCSRS, na sigla em inglês), transculturalmente adaptada para o português brasileiro. MéTODOS: O MCSRS é um questionário com 34 itens relacionados à satisfação com o parto. As versões traduzida e retrotraduzida foram comparadas com o material original, e 10 especialistas analisaram cada item de acordo com os seguintes critérios: clareza, equivalência semântica, pertinência e relevância cultural. A versão final foi apresentada a 10 mães para validação de face, para garantir que o questionário fosse adequado à população-alvo. RESULTADOS: O total de 34 itens avaliados por especialistas para clareza, equivalência semântica, pertinência e relevância apresentou concordância positiva de 0,85, 0,92, 0,97 e 0,97; concordância negativa de 0,13, 0,09, 0,04 e 0,04; e concordância total de 0,75; 0,85, 0,94 e 0,94, respectivamente. A modelagem linear multinível foi aplicada com efeitos aleatórios cruzados e com efeitos aleatórios aninhados para cada juiz. A intercepção de cada critério foi a seguinte: clareza, 0,87; equivalência semântica, 0,92; pertinência, 0,96; e relevância cultural, 0,96. A média geral de concordância foi de 92,8%. A mensuração da validade de face foi 80% de concordância nos itens, todos claramente entendidos. CONCLUSãO: A versão final do questionário MCSRS do português brasileiro teve validade de face e conteúdo confirmada. Este instrumento de avaliação da satisfação materna durante o parto foi validado para ser aplicado na população feminina brasileira.

Translation and validation of Warmometer, a tool for assessing warmth in patient-provider relationships, for use in Brazilian Portuguese.

BACKGROUND: Empathy in the patient-provider relationship is associated with important outcomes in healthcare practice. Our aim was to translate and validate Warmometer, a visual tool for assessing warmth in patient-provider relationships, for use in Brazilian Portuguese. DESIGN AND SETTING: Cross-sectional study conducted at an antenatal clinic of a public university hospital in São Paulo, Brazil. METHODS: The instrument was translated into Brazilian Portuguese and culturally adapted. It was tested for reliability and validity among 32 pregnant women, between June 2015 and January 2016. To assess construct validity, it was correlated with the Consultation and Relational Empathy (CARE) scale (gold standard for patient-provider relationships) and the Interpersonal Reactivity Index (IRI). RESULTS: The translated version of Warmometer had good face and content validity, low intra-observer reproducibility (intraclass correlation coefficient, ICC: 0.224; 95% confidence interval, CI -0.589 to 0.621;P = 0.242) and high inter-observer reproducibility (ICC: 0.952; 95% CI 0.902 to 0.977; P < 0.001). There was a strong correlation between Warmometer and CARE (r = 0.632) and a weak correlation between Warmometer and IRI (r = 0.105). CONCLUSIONS: Warmometer was translated, culturally adapted and validated for use in Brazilian Portuguese. The translated version is a reliable tool for assessing the degree of empathy perceived by the patient in a patient-provider relationship.

Distance education course about sexuality for obstetrics and gynecology residents / Curso de educação a distância sobre sexualidade para residentes em obstetrícia e ginecologia

Abstract Purpose To describe the experience of a distance education course on sexual issues during pregnancy and after birth for residents. Methods This prospective educational intervention study was conducted by investigators from the Universidade Federal de São Paulo, Brazil, between April and September 2014. The participants were 219 physicians (residents from the 1st to the 6th years). The duration of the course was of 24 hours (10 video lectures and online chats). At baseline, the participants answered questions about their training, attitude and experience regarding sexual issues during pregnancy and after birth; before and after the course, they answered questions to assess their knowledge about the topic; at the end of the course, they answered questions on the quality of the course. The Student t-test was used to compare the before and after scores of the knowledge tests; values of p < 0.05 were considered statistically significant. Results A total of 143 residents concluded the course; most were in their 1st (27.2%) or 3rd (29.4%) years of residency. There was a significant increase in themean scores of the questionnaires that assessed the knowledge of the topic: 4.4 (1.6) versus 6.0 (1.3; maximum score: 10), before and after the course respectively (p < 0.0001). Most of the participants (74.1%) declared that the quality of the course as a whole reached their expectations, and 81.1% would recommend the course to a friend. Conclusions The online Sexology course for Obstetrics and Gynecology residents increased their knowledge about the sexual issues during pregnancy and after birth, and fulfilled the participants' expectations. The experience described heremay serve as a model for other sexuality courses targeting similar audiences.

Resumo Objetivos Relatar a experiência de um curso de educação a distância sobre questões sexuais na gestação e puerpério para médicos residentes. Métodos Estudo prospectivo de intervenção educacional, realizado entre abril e setembro de 2014, por investigadores da Universidade Federal de São Paulo. Os participantes foram 219 médicos (R1 a R6). O curso teve carga horária de 24 horas (10 videoaulas e discussões online). No início do curso, os participantes responderam perguntas sobre treinamento, atitude e prática relativas a questões sexuais na gestação; antes e após o curso, responderam perguntas de conhecimento sobre o tema; ao final, preencheram questionário sobre a qualidade do curso. O teste t de Student foi utilizado para comparar os testes de conhecimento, antes e após o curso; valores de p < 0,05 foram considerados estatisticamente significantes. Resultados Um total de 143 residentes concluiu o curso; a maioria estava no 1° (27,2%) ou 3° (29,4%) anos de residência. Houve aumento significativo nas notas médias dos questionários que avaliavam o conhecimento sobre o tema: 4,4 (1,6) versus 6,0 (1,3; nota máxima: 10), no início e final do curso, respectivamente (p < 0,0001). A maioria dos participantes (74,1%) declarou que a qualidade geral do curso atingiu suas expectativas, e 81,1% recomendariam o curso a um amigo. Conclusões O curso de Sexologia online para residentes de Ginecologia e Obstetrícia promoveu o aumento do conhecimento sobre questões sexuais no ciclo gravídico puerperal, e atendeu às expectativas dos participantes. Essa experiência pode servir de modelo para outros cursos de sexualidade voltados para esse público.

Distance Education Course about Sexuality for Obstetrics and Gynecology Residents.

Purpose To describe the experience of a distance education course on sexual issues during pregnancy and after birth for residents. Methods This prospective educational intervention study was conducted by investigators from the Universidade Federal de São Paulo, Brazil, between April and September 2014. The participants were 219 physicians (residents from the 1st to the 6th years). The duration of the course was of 24 hours (10 video lectures and online chats). At baseline, the participants answered questions about their training, attitude and experience regarding sexual issues during pregnancy and after birth; before and after the course, they answered questions to assess their knowledge about the topic; at the end of the course, they answered questions on the quality of the course. The Student t-test was used to compare the before and after scores of the knowledge tests; values of p < 0.05 were considered statistically significant. Results A total of 143 residents concluded the course; most were in their 1st (27.2%) or 3rd (29.4%) years of residency. There was a significant increase in the mean scores of the questionnaires that assessed the knowledge of the topic: 4.4 (±1.6) versus 6.0 (±1.3; maximum score: 10), before and after the course respectively (p < 0.0001). Most of the participants (74.1%) declared that the quality of the course as a whole reached their expectations, and 81.1% would recommend the course to a friend. Conclusions The online Sexology course for Obstetrics and Gynecology residents increased their knowledge about the sexual issues during pregnancy and after birth, and fulfilled the participants' expectations. The experience described here may serve as a model for other sexuality courses targeting similar audiences.

Objetivos Relatar a experiência de um curso de educação a distância sobre questões sexuais na gestação e puerpério para médicos residentes. Métodos Estudo prospectivo de intervenção educacional, realizado entre abril e setembro de 2014, por investigadores da Universidade Federal de São Paulo. Os participantes foram 219 médicos (R1 a R6). O curso teve carga horária de 24 horas (10 videoaulas e discussões online). No início do curso, os participantes responderam perguntas sobre treinamento, atitude e prática relativas a questões sexuais na gestação; antes e após o curso, responderam perguntas de conhecimento sobre o tema; ao final, preencheram questionário sobre a qualidade do curso. O teste t de Student foi utilizado para comparar os testes de conhecimento, antes e após o curso; valores de p < 0,05 foram considerados estatisticamente significantes. Resultados Um total de 143 residentes concluiu o curso; a maioria estava no 1° (27,2%) ou 3° (29,4%) anos de residência. Houve aumento significativo nas notas médias dos questionários que avaliavam o conhecimento sobre o tema: 4,4 (±1,6) versus 6,0 (±1,3; nota máxima: 10), no início e final do curso, respectivamente (p < 0,0001). A maioria dos participantes (74,1%) declarou que a qualidade geral do curso atingiu suas expectativas, e 81,1% recomendariam o curso a um amigo. Conclusões O curso de Sexologia online para residentes de Ginecologia e Obstetrícia promoveu o aumento do conhecimento sobre questões sexuais no ciclo gravídico puerperal, e atendeu às expectativas dos participantes. Essa experiência pode servir de modelo para outros cursos de sexualidade voltados para esse público.

Experience of an online course on sexuality during pregnancy for residents.

OBJECTIVE: Many obstetrics and gynecology (Ob/Gyn) residents report insufficient knowledge about female sexuality and this has a negative impact on their capacity to manage their patients. The aim of this study was to describe an online course about sexuality during pregnancy for Brazilian Ob/Gyn residents and evaluate their knowledge acquisition. METHODS: This longitudinal educational intervention study involved 219 Brazilian Ob/Gyn residents. The online course lasted 24h (10 video lectures and discussion chats). Upon enrollment, the participants answered a questionnaire in regard to their training, attitudes and practices about sexuality during pregnancy. Participants' knowledge acquisition was assessed using a pre- and post-course test about sexuality during pregnancy. At the end of the course, participants were asked to evaluate their educational experience. Student's t and chi-square tests were used to analyze the pre- and post-course test scores. P values<0.05 were considered statistically significant. RESULTS: A total of 143 Ob/Gyns (65.3% of those enrolled) completed the course. At baseline, most participants reported that they did not have any sexology classes as undergraduates (62.5%) or in their residency (52.1%), and that they lacked specific knowledge in this area to manage their patients. Mean test scores increased significantly at the end of the course: 4.4 (±1.6) versus 6.0 (±1.3) (out of a maximum score of 10), before and after the course, respectively (p<0.0001). Most of the residents rated the overall quality of the course as "higher than expected". CONCLUSION: An online course for Ob/Gyn residents was associated with a significant increase in knowledge about sexuality during pregnancy.

Determination of a cutoff value for pelvic floor distensibility using the Epi-no balloon to predict perineal integrity in vaginal delivery: ROC curve analysis. Prospective observational single cohort study / Determinação de um valor de ponto de corte para a extensibilidade do assoalho pélvico pelo balão Epi-no para predizer integridade perineal no parto vaginal: análise pela curva ROC. Estudo prospectivo observacional de coorte única

CONTEXT AND OBJECTIVE: Several risk factors are involved in perineal lacerations during vaginal delivery. However, little is known about the influence of perineal distensibility as a protective factor. The aim here was to determine a cutoff value for pelvic floor distensibility measured using the Epi-no balloon, which could be used as a predictive factor for perineal integrity in vaginal delivery. DESIGN AND SETTING: Prospective observational single cohort study conducted in a maternity hospital. METHODS: A convenience sample of 227 consecutive at-term parturients was used. All women had a single fetus in the vertex presentation, with up to 9.0 cm of dilation. The maximum dilation of the Epi-no balloon was measured using a tape measure after it had been inflated inside the vagina up to the parturients' maximum tolerance. The receiver operating characteristic (ROC) curve was used to obtain the Epi-no circumference measurement with best sensitivity and specificity. RESULTS: Among the 161 patients who were included in the study, 50.9% underwent episiotomy, 21.8% presented lacerations and 27.3% retained an intact perineum. Age > 25.9 years; number of pregnancies > 3.4; number of deliveries > 2.2 and circumference measured by Epi-no > 21.4 cm were all directly correlated with an intact perineum. Circumference measurements using the Epi-no balloon that were greater than 20.8 cm showed sensitivity and specificity of 70.5% and 66.7% (area under curve = 0.713), respectively, as a predictive factor for an intact perineum in vaginal delivery. CONCLUSION: Circumferences greater than 20.8 cm achieved using the Epi-no balloon are a predictive factor for perineal integrity in parturients.

CONTEXTO E OBJETIVO: Diversos fatores de risco estão envolvidos nas lacerações do períneo durante o parto vaginal, contudo, pouco se sabe sobre a influência da extensibilidade perineal como um fator protetor. O objetivo foi avaliar o ponto de corte da extensibilidade do assoalho pélvico medido pelo balão Epi-no, o qual poderia ser usado como fator preditor de integridade perineal no parto vaginal. TIPO DE ESTUDO E LOCAL: Estudo prospectivo observacional de coorte única conduzido em maternidade. MÉTODOS: Uma amostra de conveniência de 277 parturientes consecutivas no termo foi utilizada. Todas as mulheres tinham feto único com apresentação cefálica fletida, com até 9,0 cm de dilatação. A máxima dilatação do balão Epi-no foi medida com fita métrica após a sua insuflação dentro da vagina até a tolerância máxima da parturiente. Uma curva característica de operação do receptor (ROC) foi utilizada para obter a medida da circunferência com a melhor sensibilidade e especificidade. RESULTADOS: Dentre as 161 pacientes que foram incluídas no estudo, 50,9% sofreram episiotomia, 21,8% lacerações e 27,3% tiveram o períneo intacto. Idade > 25,9 anos; número de gestações > 3,4; número de partos > 2,2; e medida do perímetro do Epi-no > 21,4 cm foram todos diretamente correlacionados com períneo intacto. Os valores do perímetro com o balão Epi-no que estavam acima de 20,8 cm mostraram sensibilidade e especificidade de 70,5% e 66,7% (área sob a curva = 0,713), respectivamente, como fator preditor de períneo intacto no parto vaginal. CONCLUSÃO: Circunferência medida pelo balão Epi-no maior que 20,8 cm é fator preditor de integridade perineal em parturientes.

Can Abdominal Hypopressive Technique Change Levator Hiatus Area?: A 3-Dimensional Ultrasound Study.

This study aimed to evaluate the levator hiatus area (LHA) at rest and during the performance of maximal pelvic floor muscle (PFM) contractions, during the abdominal hypopressive technique (AHT), and during the combination of PFM contractions (PFMCs) and the AHT. The study included 17 healthy nulliparous women who had no history of pelvic floor disorders. The LHA was evaluated with the patients in the lithotomy position. After a physiotherapist instructed the patients on the proper performance of the PFM and AHT exercises, 1 gynecologist performed the 3-dimensional translabial ultrasound examinations. The LHA was measured with the patients at rest. The PFMC alone, the AHT alone or the AHT in combination with a PFMC with 30 seconds of rest between the evaluations were performed. Each measurement was performed 2 times, and the mean value was used for statistical analysis. The Wilcoxon test was used to test the differences between the 2 maneuvers. Similar values were observed when comparing the LHA of the PFM at rest (12.2 ± 2.4) cm and during the AHT (11.7 ± 2.6) cm (P = 0.227). The AHT+ PFMC (10.2 ± 1.9) cm demonstrated lower values compared with AHT alone (11.7 ± 2.6) cm (P = 0.002). When comparing the PFMC (10.4 ± 2.1) cm with the AHT + PFMC (10.2 ± 1.9) cm, no significant difference (P = 0.551) was observed. During PFMC, the constriction was 1.8 cm; during the AHT, the constriction was 0.5 cm; and during the AHT + PFMC, it was 2 cm. The LHA assessed by 3-dimensional ultrasound did not significantly change with AHT. These results support the theory that AHT does not strengthen PFM.

Determination of a cutoff value for pelvic floor distensibility using the Epi-no balloon to predict perineal integrity in vaginal delivery: ROC curve analysis. Prospective observational single cohort study.

CONTEXT AND OBJECTIVE: Several risk factors are involved in perineal lacerations during vaginal delivery. However, little is known about the influence of perineal distensibility as a protective factor. The aim here was to determine a cutoff value for pelvic floor distensibility measured using the Epi-no balloon, which could be used as a predictive factor for perineal integrity in vaginal delivery. DESIGN AND SETTING: Prospective observational single cohort study conducted in a maternity hospital. METHODS: A convenience sample of 227 consecutive at-term parturients was used. All women had a single fetus in the vertex presentation, with up to 9.0 cm of dilation. The maximum dilation of the Epi-no balloon was measured using a tape measure after it had been inflated inside the vagina up to the parturients' maximum tolerance. The receiver operating characteristic (ROC) curve was used to obtain the Epi-no circumference measurement with best sensitivity and specificity. RESULTS: Among the 161 patients who were included in the study, 50.9% underwent episiotomy, 21.8% presented lacerations and 27.3% retained an intact perineum. Age > 25.9 years; number of pregnancies > 3.4; number of deliveries > 2.2 and circumference measured by Epi-no > 21.4 cm were all directly correlated with an intact perineum. Circumference measurements using the Epi-no balloon that were greater than 20.8 cm showed sensitivity and specificity of 70.5% and 66.7% (area under curve = 0.713), respectively, as a predictive factor for an intact perineum in vaginal delivery. CONCLUSION: Circumferences greater than 20.8 cm achieved using the Epi-no balloon are a predictive factor for perineal integrity in parturients.

Erythrina mulungu Mart. ex Benth e Erythrina velutina Willd: Aspectos farmacológicos e perspectiva antroposófica de plantas brasileiras / Erythrina mulungu Mart. ex Benth and Erythrina velutina Willd: Pharmacological aspects and anthroposophic view of these Brazilian plants

As plantas brasileiras Erythrina mulungu Mart. ex Benth e Erythrina velutina Willd. têm sido utilizadas na medicina popular como sedativas e calmantes naturais para estresse, ansiedade, depressão. São plantas angiospermas, que pertencem à família das leguminosas (Fabaceae/Leguminosae) e subfamília papilionácea (Papilionaceae). Em geral são utilizados extratos das cascas do caule, frutos e folhas da E. velutina e extratos das folhas e flores da E. mulungu. Representam a principal fonte de alcaloides tetracíclicos de atividade similar ao curare, responsáveis por causar paralisia muscular. Resultados de diversos trabalhos mostraram que os alcaloides eritrartina, eritravina, 11-hidroxi-eritravina e os derivados eritrínicos são os principais responsáveis pelo efeito ansiolítico. Através de um levantamento bibliográfico sobre as plantas E. velutina e E. mulungu, no qual as propriedades terapêuticas foram avaliadas em diversos estudos pré-clínicos, observamos atividade ansiolítica com efeitos semelhante aos efeitos dos benzodiazepínicos; atividade sobre o sistema nervoso central com alteração neurotransmissora dos receptores GABA, além de ação anticonvulsivante, sedativa e amnésica; atividade antibacteriana e atividade antinociceptiva. Os aspectos antroposóficos da E. velutina e da E. mulungu apontam para as propriedades da família das leguminosas e da subfamília papilionácea. Sua principal característica é a presença do nitrogênio e o seu princípio astral. As plantas possuem apenas organização física e vital (ou etérica). A ação do anímico (ou astral) ocorre sempre de fora para dentro na planta. Com o surgimento das flores, as plantas se aproximaram do reino animal, entrando em contato com forças astrais que deveriam permanecer no exterior das plantas. Se essa astralidade penetrar na planta, isso se traduz na alteração de forma, de cor, no surgimento de substâncias, como por exemplo, os alcaloides, como tentativa da planta de impedir um processo de "animalização". Portanto, uma planta rica em alcaloides, possui propriedades pertencentes ao reino animal, e quando ingerida por seres humanos, provoca alteração da organização anímica. Assim, as plantas E. velutina e E. mulungu, ricas em alcaloides, promovem paralisia flácida no ser humano, devido à retirada da astralidade da dinâmica neuromuscular, uma vez que esta é responsável pelo tônus muscular e consciência sensorial no organismo. Essa ação deslocadora da organização anímica é responsável pelo efeito ansiolítico e sedativo em casos de distúrbios de ansiedade, estresse, tensão e insônia.(AU)

The Brazilian plants Erythrina mulungu Mart. ex Benth and Erythrina velutina Willd. have been used by the popular medicine as natural sedative and tranquilizing agent for stress, anxiety, depression and insomnia. They are angiosperm plants, which belong to the pea family (Fabaceae/Leguminosae) and the Papilionaceae subfamily. In general, the parts used are stem bark, fruits and leaves (E. velutina), and leaves and inflorescences (E. mulungu). These plants represent the main source of tetracyclic alkaloids and they have curare-like activity, causing muscular paralysis. The result of several studies demonstrated that the alkaloids erythrartin, erythravine, 11-hydroxy-erythravine and the erythrin derivatives are mainly responsible for the anxiolytic effect. After a literature review, in which the therapeutic properties of E. velutina and E. mulungu were analyzed in several preclinical studies, we observed the following: anxiolytic activity with benzodiazepine-like effects; central nervous system activity with alteration of GABA receptors, besides anticonvulsant, sedative and amnesic action; antibacterial activity and antinociceptive activity. The E. velutina and E. mulungu's anthroposophic aspects point to the properties of the pea family and the papilionaceous subfamily. The nitrogen and the astral principle are the main characteristics of these plants. Normally, plants have only physical and vital organization. However, with the flowering process, these plants get closer to the animal kingdom, getting in touch with astral forces that should remain in the external parts of the plants. If the astral forces penetrate into the plant, it will produce poison substances (alkaloids) as an attempt to avoid an "animalization" process. Therefore, an alkaloidrich plant has properties that belong to the animal sphere, and when it is used as medicine by humans, it modifies the soul organization. Thus, E. velutina and E. mulungu, which are rich in alkaloids, cause flaccid paralysis in humans due to the astrality's removal from neuromuscular dynamics, once it is responsible for muscle tone and sensory awareness in the body. This dislocated action of the soul organization is responsible for the anxiolytic and sedative effects in cases of anxiety, stress, tension and insomnia.(AU)

Plantas, metais e planetas: o caso do Bryophyllum / Plants, metals and planets: the case of Bryophyllum

Neste presente trabalho, os autores realizam um estudo fenomenológico da relação entre ritmos cósmicos e terrestres, e sua influência na organização vital humana. A partir disto, aprofundam-se no conhecimento de um ritmo cósmico arquetípico (o da Lua) e sua relação direta com as qualidades do metal que reflete estas forças na natureza: a prata (Argentum). O conhecimento da ação dinâmica das forças lunares no organismo humano, assim como a observação de uma planta tipicamente lunar, o Bryophyllum calycinum, permite a compreensão efetiva de suas indicações terapêuticas.(AU)

In this paper, the authors perform a phenomenological study on the relationship between cosmic and terrestrial rhythms, and its influence over the human vita lorganization. From this, they deepen in the knowledge of an archetypal cosmic rhythm (of the Moon) and its direct relationship with the qualities of the metal which reflects these forces in the nature: the silver (Argentum). The knowledge about the dynamic action of lunar forces over the human organism, as well as the observation of a typically lunar plant, Bryophyllum calycinum, allows an effective understanding of its therapeutic indications.(AU)