Cultural adaptation and validation of the Wexner scale in patients with anal incontinence in a Brazilian population.

INTRODUCTION AND HYPOTHESIS: Jorge and Wexner devised a questionnaire for anal incontinence (AI), known as the Wexner scale (WS). Specific validated questionnaires are essential for the assessment of symptom severity. The objective was to accomplish the cultural adaptation and validation of the Portuguese version of the WS. METHODS: The WS was validated according to the international criteria. A Brazilian version was tested, including the item "I do not understand" at the end of each question. If this answer was reported at a rate higher than 15 %, the item would be considered difficult to understand and would thus be modified. The final version of the WS and the Fecal Incontinence Quality of Life (FIQL) were completed by 50 women. Convergent validity was assessed by comparing the data from the first interview of the WS with the FIQL using Spearman's test. Reproducibility was assessed by means of a 2-week test-retest procedure using Cronbach's alpha coefficient. RESULTS: In the initial version of the questionnaire, we did not obtain a response of "I do not understand" at a rate greater than 15 % and this version was considered definitive. A significant negative relationship (r = -0.63) was found between the FIQL total score and the WS. The answers obtained on the "test-re-est" questionnaires showed a significant correlation according to the intraclass correlation coefficient (ICC). A high level of internal consistency was found, as demonstrated by a Cronbach's alpha of 0.932. CONCLUSION: The Brazilian Portuguese version of the WS is a reliable, consistent, and valid instrument.

Quality of information regarding abnormal uterine bleeding available online.

INTRODUCTION: The Internet and electronic devices with Internet access allow for a greater fluidity of information and speed of communication, especially in the field of health. Abnormal uterine bleeding (AUB) affects approximately 3-30% of women and can negatively impact their health and quality of life. Information regarding AUB that is available on the Internet may not be clear or accurate, rendering it difficult to understand and likely to result in delayed medical evaluation, which subsequently leads to worsening of the AUB. OBJECTIVE: To evaluate the quality of the information regarding AUB currently available on the Internet, including information regarding treatments. METHODS: The Google Trends website was searched for the most widely used English terms related to AUB. The identified descriptors were searched individually on the Google, Yahoo!, and Bing search engines. The first 10 results of each search were pre-selected and evaluated for inclusion in this study. Selected websites were categorically divided into two groups (news/magazine and academic) and individually analyzed by three experts using the DISCERN quality criteria (reliability, general quality, and quality of information) and the presence or absence of the Health on the Net Foundation Code of Conduct (HONcode®) seal. RESULTS: Of the 168 websites included in this study, 60.1% were allocated to the news/magazine group and 39.9% were allocated to the academic group. Over half of the websites (54.2%) did not have the HONcode® quality seal. Websites in the academic group were more likely to include accurate information regarding AUB with greater reliability than websites in the news/magazine group. There were no statistical differences regarding the general quality of the websites. Most websites were rated as either moderate quality (70.8%) or low quality (28.6%). The HONcode® criterion was found to be a confounding factor of the analyses, as the grouping and quality results of websites without this seal were significantly associated. In addition, websites in the news/magazines group were 6.7 times more likely to provide low quality information than websites in the academic group (odds ratio: 6.7; 95% confidence interval: 2.1-21.4). CONCLUSION: The information regarding AUB that is available on the Internet is of low to moderate quality. Academic websites present more reliable information of greater quality. The presence of the HONcode® seal is considered important to determine the quality of the content of a website, especially for news/magazine websites, and may help Internet users identify websites that contain more reliable information. Algorithms and applications that categorize the quality of information and the reliability of health content may be useful tools that can help patients clarify their symptoms for several conditions including AUB.

Evaluating the quality of HPV vaccine-related information on the Portuguese Internet.

Human papillomavirus (HPV) is considered the second largest human carcinogen after tobacco and is responsible for 5% of all cancers, 10% of cancers in women, and 15% of all cancers in developing countries. Among these, cervical cancer is the most prevalent. An HPV vaccine has recently been developed to provide primary protection against the viral infection. In 2014, Brazil's National Immunization Program (Programa Nacional de Imunizações, PNI) started making a quadrivalent vaccine available to the public. However, after 2014, the vaccine coverage dropped and did not reach the PNI's targets. Among other factors, this low uptake was due to the quality of information on the Internet. Using Google Trends, the main search terms used to search for vaccine-related information on the Internet were identified. The content of the identified websites was analyzed using the DISCERN instrument and their reach was determined using their page authority score. Most of the texts analyzed were not of high quality. The data that most commonly reach the lay public are from sites that lack scientific rigor. We found a weak correlation between the DISCERN and page authority scores. Based on our analysis, we inferred that the information that reaches the user is not always the most accurate and can lead to harmful decisions on vaccination. The content that reaches the user most easily is not always of sound quality. New analyses are important, especially on the impact of social networks that present even fewer criteria in publications and are more easily accessible.

The Effectiveness of Anticholinergic Therapy for Overactive Bladders: Systematic Review and Meta-Analysis.

The overactive bladder (OAB) has a significant negative impact on the quality of life of patients. Antimuscarinics have become the pharmacological treatment of choice for this condition. The objective of this systematic review and meta-analysis is to examine the evidence from randomized clinical trials about the outcomes of the antimuscarinic drugs available in Brazil on OABs. We searched MEDLINE and the Cochrane Central Register of Controlled Trials from the inception of these databases through to September 2015. The primary outcome measures were the mean decrease in urge urinary incontinence episodes and the mean decrease in the frequency of micturition. The results suggest that there is a moderate to high amount of evidence supporting the benefit of using anticholinergic drugs in alleviating OAB symptoms when compared with placebo. It is still not clear whether any of the specific drugs that are available in Brazil offer advantages over the others. These drugs are associated with adverse effects (dry mouth and constipation), although they are not related to an increase in the number of withdrawals.

The Effectiveness of Anticholinergic Therapy for Overactive Bladders: Systematic Review and Meta-Analysis / Eficácia da terapia anticolinérgica na bexiga hiperativa: revisão sistemática e metanálise

Abstract The overactive bladder (OAB) has a significant negative impact on the quality of life of patients. Antimuscarinics have become the pharmacological treatment of choice for this condition. The objective of this systematic review and meta-analysis is to examine the evidence from randomized clinical trials about the outcomes of the antimuscarinic drugs available in Brazil on OABs. We searched MEDLINE and the Cochrane Central Register of Controlled Trials from the inception of these databases through to September 2015. The primary outcome measures were the mean decrease in urge urinary incontinence episodes and the mean decrease in the frequency of micturition. The results suggest that there is a moderate to high amount of evidence supporting the benefit of using anticholinergic drugs in alleviating OAB symptoms when compared with placebo. It is still not clear whether any of the specific drugs that are available in Brazil offer advantages over the others. These drugs are associated with adverse effects (dry mouth and constipation), although they are not related to an increase in the number of withdrawals.

Resumo A bexiga hiperativa determina um impacto negativo na qualidade de vida dos nossos pacientes. Os antimuscarínicos tornaram-se o tratamento farmacológico de escolha para essa condição. O objetivo desta revisão sistemática e metanálise é examinar as melhores evidências científicas sobre estas medicações disponíveis no Brasil no tratamento de mulheres com bexiga hiperativa. As bases de dados utilizadas foram MEDLINE e a biblioteca da Cochrane, das quais selecionamos os ensaios clínicos randomizados até setembro de 2015. Os principais desfechos analisados foram a diminuição dos episódios de incontinência urinária de urgência e a diminuição da frequência de micção. Os resultados sugerem que as drogas existentes no Brasil sustentam o benefício dos anticolinérgicos no alívio dos sintomas da bexiga hiperativa quando comparadas como placebo. Emtermos de eficácia, as medicações apresentam resultados semelhantes no controle dos sintomas. Essas drogas estão associadas a efeitos adversos importantes, tais como boca seca e constipação, e esses efeitos adversos não influenciaram no uso da medicação.