Endometriosis in infertile women: an observational and comparative study of quality of life, anxiety, and depression.

BACKGROUND: A women's chances of getting pregnant decreases in cases of infertility, which may have several clinical etiologies. The prevalence of infertility is estimated as 10-15% worldwide. One of the causes of infertility is endometriosis, defined as the presence of an endometrial gland and/or stroma outside the uterus, inducing a chronic inflammatory reaction. Thus, infertility and endometriosis are diagnoses that significantly affect women's mental health. This study accessed and compared the levels of depression, anxiety, and quality of life in infertile women with and without endometriosis. METHODS: was an observational and cross-sectional study which included 201 infertile women, 81 of whom were also diagnosed with endometriosis. The STROBE Guidelines was used. The data were collected using validated scales: Hamilton D Questionnaire, Beck Depression Inventory, and Fertility Quality of Life Questionnaire; The data were collected at the Ideia Fertil Institute (Santo Andre, Brazil), between February 28 and June 8, 2019. RESULTS: the infertile women with endometriosis reported higher presence of depressive symptoms and a lower quality of life compared to women with infertility only. Similar presence of anxiety symptoms was observed regardless of being diagnosed with endometriosis. Women with infertility and endometriosis presented lower levels in quality-of-life domains when compared to women with infertility only - Mind and Body (58.33 × 79.17, p < 0.001), Relational (75 × 81.25, p = 0.009), Social (66.67 × 77.08, p = 0.001), Emotional (50.62 × 67.43, p < 0.001). CONCLUSION: the findings indicate the need for increased psychosocial support care for women suffering from infertility and endometriosis to assist them in maintaining and managing their own mental health and achieving their reproductive goals.

Oral health-related quality of life in patients aged 8 to 19 years with cleft lip and palate: a systematic review and meta-analysis.

BACKGROUND: Cleft lip and palate (CLP) is the most common facial birth defect worldwide and causes morphological, aesthetic, and functional problems with psychosocial implications for an individual's life and well-being. The present systematic review and meta-analysis assessed whether the treatment of CLP impacts the oral health-related quality of life (OHRQoL) in children and adolescents in comparison to healthy controls. METHODS: We searched MEDLINE/PubMed, EMBASE, and PsycINFO databases using terms related to CLP, and included articles until August 2023. Observational comparison studies that assessed OHRQoL in non-syndromic CLP patients aged 8-19 years with validated scales designed to such aim or scales capable to identify aspects related to oral health compared to healthy controls were included. We used the ROBINS-I tool for risk of bias assessment. A meta-analysis of continuous variables was performed using inverse variance for pooling estimates, Standardized Mean Difference (SMD) as a summary measure, with random effects model. Heterogeneity was estimated by the I2 statistics. Sensitivity analyses included subgrouping based on the scale, risk of bias and scale domains. Meta-regression was performed under a mixed-effects model considering the variables type of scale, scale domains and risk of bias. RESULTS: Fourteen studies were included comprising 1,185 patients with CLP and 1,558 healthy controls. The direction of the effect of OHRQoL favoured the healthy group (-0.92; 95% CI:-1,55;-0,10) and I2 = 95%. After removing three studies, I2 dropped to 80%. Meta-regression showed no influence on risk of bias (p = 0.2240) but influence of scale type (p = 0.0375) and scale domains (p < 0.001). The subgroup analysis indicated that the CPQ and COHIP scales presented very discrepant SMD values, despite pointing to the same effect direction. In contrast, the OHIP scale showed a non-significant difference between cases and controls, with estimates much lower than the other two scales. Results also suggest that OHRQoL associated with oral functionality and social well-being is more influential on outcomes than emotional well-being. CONCLUSION: The global OHRQoL is slightly worst in the CLP patients than control group. The difference between OHRQoL was mainly detected through OHIP. The most affected domains are functional, emotional and social. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42022336956.

Intimate partner violence: a cross-sectional study in women treated in the Brazilian Public Health System.

OBJECTIVE: To determine the prevalence and types of violence suffered by women and to identify the gender attitudes related to the situation. METHODS: This was a descritive, cross-sectional study incluiding 343 women who were assisted at the Brazilian Public Health System in countryside city in northeastern of Brazil. All participants were volunteers and they invited to participate during consultation at a Basic Health Unit. As participants, they filled out the World Health Organization Violence Against Women Questionnaire and responded to a sociodemographic questionnaire. RESULTS: The victims were, on average, 20.3 years old, and 53.2% of them were married. There was a prevalence of 52.9% of psychological violence, 30.5% of physical violence, and 12.3% of sexual violence. Participants reported alcoholism (67%) and jealousy (60.8%) as triggers to violence. The main psychological abuses were insults and humiliation. In terms of physical violence, the major ones were pushes and slaps. The sexual violence most reportedwere sexual intercourse against the will of the woman and sexual intercourse because of fear of the partner. A portion of the participants justified violence due to women's infidelity, refusal to have sex, and disobedience to her husband. CONCLUSION: Education in gender equality as a measure of opposition to the culture of female subjugation can reflect on the resignification of the violence suffered by them, and not on blaming the victim of violence by an intimate partner.

Assessing the care of doctors, nurses, and nursing technicians for people in situations of sexual violence in Brazil.

This study aimed to assess the quality of care for people in situations of sexual violence in health services, identifying positive and negative indicators, and suggest solutions. This is a cross-sectional study with a quantitative approach and convenience sampling. The sample consisted of 134 professionals (doctors, nurses, and nursing technicians) working in public health services. Three instruments were used, namely, a structure evaluation form, a questionnaire, and a process evaluation form. The results revealed eight positive indicators (adequate infrastructure; rooms for patient assistance; gynecological bed; visual and auditory privacy; waiting rooms; a professional team comprising physicians, nurses, nursing technicians, and receptionists; adequate training of staff to provide health services to people in situations of sexual violence; and most healthcare professionals asking their patients about possible sexual violence situations) and nine negative indicators (reduced number of rooms for patient assistance with toilets; absence of protocols to identify and assist people in situations of sexual violence; absence of leaflets, posters, and other materials on sexual violence; absence of a referral flow chart (specific for people in situations of sexual violence) to specialized services; reduced number of consultations with suspected and/or confirmed cases of sexual violence; non-use of specific protocols; not referral of these patients to the specialized care network; most professionals consider the health unit where they work as unable to help people in situations of sexual violence; a decrease in attendance at health facilities that do not have a protocol for assisting people in situations of sexual violence), making clear the interventions necessary to promote the provision of quality health services that meet the specific needs of people in situations of sexual violence. These indicators are expected to provide subsidies for the improvement of public policies aimed at listening, welcoming, identifying, and treating people in situations of sexual violence.

Transition to clinical practice during the COVID-19 pandemic: a qualitative study of young doctors' experiences in Brazil and Ireland.

OBJECTIVES: To explore and compare the perspectives of junior doctors in Brazil and Ireland regarding transition and professional socialisation during the COVID-19 pandemic, with the purpose of identifying better ways to support doctors as they assume their new professional role. DESIGN: 27 semistructured interviews. Transcripts were analysed using qualitative thematic analysis. Cruess' framework of professional socialisation in medicine supported the interpretation of these data. SETTING: Public health hospitals across four Brazilian states (Santa Catarina, São Paulo, Ceará, Paraíba) and County Cork in the South of Ireland. PARTICIPANTS: Twenty-seven male and female medical junior doctors who had graduated between November 2019 and April 2020. RESULTS: Fourteen Brazilian and 13 Irish junior doctors were interviewed for this study. Entry to clinical practice during the pandemic had a significant impact on factors influencing the professional socialisation of junior doctors. This impact was reflected across the following six thematic areas: lack of preparedness; disrupted trajectory of role adaptation; fewer opportunities for experiential learning; solidarity and isolation; altered interactions with patients; challenges to health and well-being. CONCLUSIONS: Transition to clinical practice is an important stage in junior doctors' professional socialisation and identity formation. The COVID-19 pandemic created the opportunity for medical graduates to enter the workforce earlier than usual. Entering the workforce during this period created a lack of confidence among junior doctors concerning the boundaries of their new role and responsibilities, while simultaneously disrupting their social integration. Priorities to mitigate the impact of COVID-19 and future pandemics on this transition are presented.

Development and validation of The Breaking Bad News Attitudes Scale.

BACKGROUND: Communication of bad news plays a critical role in the physician-patient relationship, and a variety of consensus guidelines have been developed to this purpose, including the SPIKES protocol. However, little is known about physicians' attitudes towards breaking bad news and to be trained to deliver it. This study aimed to develop and validate a self-report questionnaire to assess physicians' attitudes towards principles of the SPIKES protocol and training on them. METHODS: The Breaking Bad News Attitudes Scale (BBNAS) was administered to 484 pediatricians and 79 medical students, recruited at two scientific conferences and two medical schools in Brazil. The questionnaire structural validity, reliability, and associations with other variables were tested. RESULTS: The BBNAS showed adequate validity and good reliability, with two factors measuring attitudes towards the SPIKES strategy for braking bad news (α = 0.81) and the possibility to be trained on it (α = 0.77), respectively. CONCLUSION: The novel questionnaire is a psychometrically sound measure that provides information on physicians' agreement with the SPIKES protocol. The BBNAS can provide useful information for planning training and continuing education programs for clinicians on communication of bad news using the SPIKES as a framework.

The Infertility-Related Stress Scale: Validation of a Brazilian-Portuguese Version and Measurement Invariance Across Brazil and Italy.

Infertility constitutes an essential source of stress in the individual and couple's life. The Infertility-Related Stress Scale (IRSS) is of clinical interest for exploring infertility-related stress affecting the intrapersonal and interpersonal domains of infertile individuals' lives. In the present study, the IRSS was translated into Brazilian-Portuguese, and its factor structure, reliability, and relations to sociodemographic and infertility-related characteristics and depression were examined. A sample of 553 Brazilian infertile individuals (54.2% female, mean aged 36 ± 6 years) completed the Brazilian-Portuguese IRSS (IRSS-BP), and a subsample of 222 participants also completed the BDI-II. A sample of 526 Italian infertile individuals (54.2% female, mean aged 38 ± 6 years) was used to test for the IRSS measurement invariance across Brazil and Italy. Results of exploratory structural equation modeling (ESEM) indicated that a bifactor solution best represented the structure underlying the IRSS-BP. Both the general and the two specific intrapersonal and interpersonal IRSS-BP factors showed satisfactory levels of composite reliability. The bifactor ESEM solution replicated well across countries. As evidence of relations to other variables, female gender, a longer duration of infertility, and higher depression were associated with higher scores in global and domain-specific infertility-related stress. The findings offer initial evidence of validity and reliability of the IRSS-BP, which could be used by fertility clinic staff to rapidly identify patients who need support to deal with the stressful impact of infertility in the intrapersonal and interpersonal life domains, as recommended by international guidelines for routine psychosocial care in infertility settings.

Intimate partner violence: a cross-sectional study in women treated in the Brazilian Public Health System / Violência cometida pelo parceiro íntimo: estudo observacional com mulheres atendidas no Sistema Único de Saúde

ABSTRACT Objective: To determine the prevalence and types of violence suffered by women and to identify the gender attitudes related to the situation. Methods: This was a descritive, cross-sectional study incluiding 343 women who were assisted at the Brazilian Public Health System in countryside city in northeastern of Brazil. All participants were volunteers and they invited to participate during consultation at a Basic Health Unit. As participants, they filled out the World Health Organization Violence Against Women Questionnaire and responded to a sociodemographic questionnaire. Results: The victims were, on average, 20.3 years old, and 53.2% of them were married. There was a prevalence of 52.9% of psychological violence, 30.5% of physical violence, and 12.3% of sexual violence. Participants reported alcoholism (67%) and jealousy (60.8%) as triggers to violence. The main psychological abuses were insults and humiliation. In terms of physical violence, the major ones were pushes and slaps. The sexual violence most reportedwere sexual intercourse against the will of the woman and sexual intercourse because of fear of the partner. A portion of the participants justified violence due to women's infidelity, refusal to have sex, and disobedience to her husband. Conclusion: Education in gender equality as a measure of opposition to the culture of female subjugation can reflect on the resignification of the violence suffered by them, and not on blaming the victim of violence by an intimate partner.

RESUMO Objetivo: Verificar a prevalência dos tipos de violência sofridos por mulheres e identificar as atitudes de gênero em relação a eles. Métodos: Estudo descritivo, observacional com a participação de 343 mulheres atendidas no Sistema Único de Saúde em uma cidade no nordeste brasileiro. Todas as participantes eram voluntárias e estavam presentes em uma Unidade Básica de Saúde para realizar algum atendimento médico. As participantes preencheram o questionário World Health Organization Violence Against Women e responderam a um questionário sociodemográfico. Resultados: As vítimas tinham, em média, 20,3 anos de idade, e 53,2% eram casadas. Houve prevalência de 52,9% de violência psicológica, 30,5% de violência física e 12,3% de violência sexual. As participantes indicaram como disparadores de violência a bebida (67%) e o ciúme (60,8%). Os principais abusos psicológicos foram insultos e humilhação; os físicos foram empurrões e tapas, e os sexuais foram relação sexual contra a vontade da mulher e por medo do parceiro. Uma parcela das participantes justificou a violência sofrida com a infidelidade da própria mulher, a recusa em manter relações sexuais e a desobediência ao marido. Conclusão: A educação em igualdade de gênero como medida de contraposição à cultura de subjugo feminino pode refletir na ressignificação da violência sofrida e na não culpabilização da própria vítima de violência pelo parceiro íntimo.

Clinical aspects and the quality of life among women with endometriosis and infertility: a cross-sectional study.

BACKGROUND: The quality of life (QoL) of patients with endometriosis and infertility was assessed in different stages and correlated with the clinical features of the cases. METHODS: The present study was a cross-sectional study; 106 women were included, divided in two endometriosis groups (Grade I/II, 26 women, and Grade II/IV, 74 women). All participants attended the Endometriosis and Infertility Outpatient Clinic of the Instituto Ideia Fértil de Saúde Reprodutiva, Faculdade de Medicina do ABC, São Paulo, Brazil, were and responded to the Short Form (SF) Health Survey-36. Convenience sampling was used due to the authors' access to the study population; however, the sample number was calculated to be sufficient for 95% power in both groups. RESULTS: Homogeneity was observed between Grade I/II and Grade III/IV staging, with similar mean ages (35.27, ±3.64 years and 34.04, ±3.39 years, respectively, p = 0.133); types of infertility (p = 0.535); infertility time (p = 0.654); degrees of pain (p = 0.849); and symptoms common to endometriosis, namely, dysmenorrhea (p = 0.841), dyspareunia (0.466), chronic pelvic pain (p = 0.295), and intestinal (p = 0.573) or urinary (p = 0.809) diseases. Comparisons of median scores in the QoL domains demonstrated that the distributions of QoL and clinical symptoms were significantly related between the types of dyspareunia and the following domains: physical functioning (p = 0.017), role- emotional (p = 0.013), and general health (p = 0.001). Regarding pain outside of menstruation, there was significance in the pain domain (p = 0.017), and degree of pain was significance in physical functioning (p = 0.005) and role-physical (p = 0.011) domains. CONCLUSIONS: The present study pointed out that it is not the stage of endometriosis that interferes in the quality of life of women with endometriosis and infertility but rather the clinical manifestations, such as dyspareunia and pain. Thus, we can conclude that the patient's perception of the disease should be considered in health care and that the losses are independent of the degree of endometriosis in this population with the aggravating factor of infertility.

Attitudes and Values of Physical Education Professionals and Undergraduate Students about Their Role in Health Promotion.

Physical education (PE) is identified with health, with PE teachers and school PE regarded as legitimate instruments for health promotion. The PE teacher's conceptions, attitudes, and values regarding the role of PE are inseparable from their performance. Thus, the objective of the present work is to verify concepts and attitudes of PE professionals and undergraduate students, in order to verify how they value their role in health promotion. This was a cross-sectional study that used surveys to assess attitudes and values of PE professionals and undergraduate students about their concepts of the role of PE in health promotion. A total of 942 PE professionals and undergraduate students regards themselves as players in health promotion (86.9%) despite no clear definition about the concept of health or the curriculum to attain such a goal, mainly based on academic training only. Also, they attribute the responsibility for childhood obesity and lack of motivation for the practice of physical activity to external factors, such as media (72.6%), family (84.7%), and technologies (83.1%). Despite participants regarding themselves as players in health promotion, there is a loose definition on how to promote health, and how to provide curriculum and strategies to meet the needs of public health.

Prevalence of preeclampsia and eclampsia in adolescent pregnancy: A systematic review and meta-analysis of 291,247 adolescents worldwide since 1969.

OBJECTIVE: Hypertensive disorders are among the main causes of maternal and perinatal morbidity and mortality, and the findings regarding the occurrence of preeclampsia (PE) and eclampsia (E) in adolescent pregnancy are conflicting. We performed a systematic review and meta-analysis aimed to determining the prevalence of PE and E in adolescent pregnancy considering socioeconomic and temporal characteristics. STUDY DESIGN: MEDLINE, EMBASE and SciELO databases, with no time span restrictions. Studies that reported the occurrence of PE and E in adolescent pregnancy. Study selection, data extraction and bias assessment were performed by three independent investigators. Meta-analysis techniques comprised random-effects model and double-arcsine transformation; χ1 and I2 tests were used to assess heterogeneity. Meta-regression used Hunter-Schmidt model; publication bias were assessed by funnel and Baujat plots. RESULTS: Seventy studies were included, ranging from 1969 to 2019 and comprising 30 countries and 291,247 adolescents. The overall prevalence rate of PE/E was 6.7 % (95 % CI = 5.8-7.6). Subgroup analysis revealed association of PE/E (P = 0.050) and E (P = 0.0113) with country income, and the highest prevalences were found in low-and medium-income country groups (11.5 %, 95 % CI=7.8-15.8 and 10.6 %, 95 % CI=6.05-16.2). Association of PE with publication year (P = 0.0022) was also found with an observable reduction in prevalence rate across the years. CONCLUSIONS: The findings seem to confirm that socioeconomic and demographic characteristics play a role for the risk of PE/E in adolescent pregnancy. Although the occurrence of PE has declined worldwide, the problem has broader dimensions beyond health issues.

Quality of Life, BMI, and Physical Activity in Bariatric Surgery Patients: a Structural Equation Model.

PURPOSE: The purpose of this study was to use a structural equation model to clarify how physical activity (PA), sex, and BMI relate to quality of life (QoL) of post-bariatric surgery patients. METHODS: The study had a retrospective cohort design for a convenience sample population of 886 bariatric subjects (38 ± 8.49 years). QoL was assessed using World Health Organization Quality of Life-BREF, PA using the International Physical Activity Questionnaire, and BMI values were calculated. Structural equation analysis was conducted in Mplus. RESULTS: The physical domain presented positive relationships with BMI (p = 0.014) and the very active group and negative with the insufficiently active A and B groups and sex (p < 0.001). The psychological domain presented negative associations with BMI and the very active group and positive with the insufficiently active A group. The social relations domain presented negative associations with BMI (p < 0.009) and the very active group (p < 0.002) and positive with the insufficiently active A (p < 0.007) and B (p < 0.019) groups. The environmental domain was negatively associated with BMI (p < 0.004) and the very active group (p < 0.001) and positively with the insufficiently active B group (p < 0.049) and sex (p < 0.018). CONCLUSION: BMI is a negative predictor of QoL in bariatric patients and this trend was not observed in the physical domain only; also, the very active group was negatively associated with QoL. We believe that distortions in body weight/body size extend to PA, and research is needed to explore the psychological factors underlying the overestimation of the amount of PA performed.

Economic evaluation of an active search system to monitor the outcomes of health-related claims.

OBJECTIVE: Economic evaluation of a scientific advisory program with the Public Defenders Office to mitigate the impacts of the judicialization on health in the municipality, as well as the implementation of an active follow-up program to monitor health outcomes arising from court demands. METHODS: A two-step study, the first documental, retrospective, with data collection of lawsuits in the region of Barbalha (CE), Brazil, from 2013 to 2018, and the second stage, prospective and intervention, through mediation between the citizen and the Public Defenders Office, aiming to reduce the occurrence of the judicialization, and the monitoring of the health outcomes of the processes. The study adopted the Consolidated Health Economic Evaluation Reporting Standards protocol for economic health assessments. The data obtained from the processes were grouped and treated for characterization of the scenario. A comparison of the profile of the lawsuits in the period of 12 months before and after the installation of the program to delimit a complete fiscal cycle was carried out. RESULTS: The advisory service promoted a decrease of 40% (p=0.01) in lawsuits. There was a 31% reduction in court costs (p=0.003), with medicines accounting for 33% of this amount. There was a decrease in inputs outside the Sistema Único de Saúde lists (27%; p=0.003), however there was no statistical difference among several demanding groups, suggesting an equanimous approach. CONCLUSION: Data from the initial survey were comparable to those reported in Brazil regarding the profile of judicial demands. In view of the scenario, the proposal proved feasible as a means to mitigate the costs of the judicialization through mediation. Finally, the initiative can serve as a model for adoption by municipalities that have characteristics similar to those presented in this study.

Kisspeptin Levels in Girls with Precocious Puberty: A Systematic Review and Meta-Analysis.

BACKGROUND/AIMS: Kisspeptin (KP) is a key player in the regulation of the release of gonadotropin-releasing hormone (GnRH), which increases the secretion of gonadotropin during puberty to establish reproductive function and regulate the hypothalamic-pituitary-gonadal axis. Premature activation of GnRH secretion leads to idiopathic/central gonadotropin-dependent precocious puberty (CPP). We aimed to compare the blood KP concentrations in girls with CPP and healthy controls. METHODS: A systematic review and meta-analysis was performed. We searched MEDLINE, EMBASE, The Cochrane Library, and SciELO. Random-effects model and standardized mean difference (SMD) were used. Heterogeneity was assessed through I2. Meta-regression considered patient age, KP fraction, and analytical method for KP measurement. RESULTS: The 11 studies included comprised 316 CPP patients and 251 controls. Higher KP levels in the CPP group were found (SMD 1.53; CI 95% = 0.56-2.51). Subgroup analysis revealed association with patient age (p = 0.048), indicating a positive correlation between elevation in KP concentration and age in CPP group. A group of patients with precocious thelarche (PT) from 5 of the included studies comprising 121 patients showed higher levels of KP (1.10; -0.25-2.45: CI 95%) and high heterogeneity (I2 = 91%). The CPP/PT ratio for KP level indicates KP 36% higher on CPP than PT patients. CONCLUSIONS: A consistent difference in KP levels between girls with CPP and controls was identified. While there are important limitations in KP assays which argue against its use as a diagnostic tool, the KP levels in CPP versus control and PT children are consistent with the predicted mechanisms and pathophysiology of CPP.

Body fat distribution influences ART outcomes.

Body mass index (BMI) is the widely used method to evaluate obesity, but it cannot differentiate lean from fat mass neither mass distribution. Other methods have been proposed for this evaluation, as waist and hip circumferences (WC, HC) and ratio (WHR) and body fat analysis by bioimpedance (BF%), but they have not been applied to evaluate assisted reproduction (ART) outcomes. The present study aims at determining whether body composition and adipose tissue distribution are better than BMI on ART outcomes. Analysis was performed through five anthropometric measurements of 788 women submitted to controlled ovarian hyperstimulation and in vitro fertilization techniques. The increase of body fat, independently of the measurement method, was associated to worse reproductive results. However, a surprising finding was that eutrophic women with WC lower than 80 cm showed gestation rates two times superior (38.9% versus 14.3%) when compared to eutrophic women with WC larger than 80 cm (p = .002). Furthermore, obese women with WHR higher than 0.85 showed worse ART results, considering oocytes retrieved, mature oocytes and fertilization when compared to those with WHR lower than 0.85. As a conclusion, it was observed that the body fat distribution, especially WC, was more relevant than BMI to predict ART outcomes.

Antinociceptive activity of the Psidium brownianum Mart ex DC. leaf essential oil in mice.

Chronic pain management has several adverse effects and research looking for new and effective pain management drugs posing lower undesirable effects is necessary. Given the above, the pharmacological investigation of medicinal plants significantly contributes to the dissemination of plant-derived therapeutics. The aim of this study was to evaluate the antinociceptive activity of the Psidium brownianum Mart ex DC. leaf essential oil (PBEO) and the participation of the opioid pathway in this effect in mice. Swiss Mus musculus male mice were tested using acute nociception models (acetic acid induced abdominal contortions, formalin, capsaicin and hot plate tests). The possible myorelaxant action of the PBEO was tested using the rotarod test. The essential oil reduced animal nociception in chemical and heat models, with this action being devoid of a myorelaxant effect. Naloxone (2 mg/kg, intraperitoneally - i.p.) partially antagonized the PBEO activity, possibly acting via opioid receptors. The results obtained provide evidence that the traditional Psidium brownianum use may be effective for pain treatment.

Psychological stress levels in women with endometriosis: systematic review and meta-analysis of observational studies.

INTRODUCTION: Endometriosis is defined as the presence of endometrial-like tissue outside the uterus, associated with chronic and inflammatory reaction. Symptoms range from dysmenorrhea, dyspareunia, chronic pelvic pain, unexplained infertility to asymptomatic. The patients' quality of life is affected by anxiety, depression and stress. We aimed to verify the prevalence and levels of psychological stress among women with endometriosis. EVIDENCE ACQUISITION: The systematic review followed the PRISMA statement and the MOOSE guideline. Databases searched were MEDLINE, EMBASE, PsychNET and SciELO. The risk of bias was assessed with a modified Newcastle-Ottawa Scale. The meta-analysis of proportions used inverse variance method for pooling and random-effects model. For the stress levels we used the restricted maximum likelihood estimator for summary effects. Heterogeneity was assessed through I2 and Q statistics. Publication bias was assessed through funnel plots. Meta-regression adopted a mixed-effects model, considering patient age, endometriosis staging, stress assessment tool and data collection as categorical moderators. EVIDENCE SYNTHESIS: We included 15 studies encompassing 4,619 women with endometriosis. The overall prevalence of mild/high stress was 68% (95%CI:57%-79%), I2=98% and τ2=0.0228. The mean level of stress was 41.78% (95%CI =34.05%-49.51%), I2=99.9% and τ2=83.35. Meta-regression showed relationship with endometriosis staging. CONCLUSIONS: This is the first meta-analysis exploring the association between endometriosis and psychological stress. The interdisciplinary management of the disease should expand the mental health support in this patient care, beyond pain management. Finally, the attitude of the medical team acknowledging the patients' psychological stress may positively affect their treatment.

Economic evaluation of an active search system to monitor the outcomes of health-related claims / Avaliação econômica de um sistema de busca ativa para monitoramento de desfechos em demandas de saúde judicializadas

ABSTRACT Objective: Economic evaluation of a scientific advisory program with the Public Defenders Office to mitigate the impacts of the judicialization on health in the municipality, as well as the implementation of an active follow-up program to monitor health outcomes arising from court demands. Methods: A two-step study, the first documental, retrospective, with data collection of lawsuits in the region of Barbalha (CE), Brazil, from 2013 to 2018, and the second stage, prospective and intervention, through mediation between the citizen and the Public Defenders Office, aiming to reduce the occurrence of the judicialization, and the monitoring of the health outcomes of the processes. The study adopted the Consolidated Health Economic Evaluation Reporting Standards protocol for economic health assessments. The data obtained from the processes were grouped and treated for characterization of the scenario. A comparison of the profile of the lawsuits in the period of 12 months before and after the installation of the program to delimit a complete fiscal cycle was carried out. Results: The advisory service promoted a decrease of 40% (p=0.01) in lawsuits. There was a 31% reduction in court costs (p=0.003), with medicines accounting for 33% of this amount. There was a decrease in inputs outside the Sistema Único de Saúde lists (27%; p=0.003), however there was no statistical difference among several demanding groups, suggesting an equanimous approach. Conclusion: Data from the initial survey were comparable to those reported in Brazil regarding the profile of judicial demands. In view of the scenario, the proposal proved feasible as a means to mitigate the costs of the judicialization through mediation. Finally, the initiative can serve as a model for adoption by municipalities that have characteristics similar to those presented in this study.

RESUMO Objetivo: Avaliação econômica de um programa de aconselhamento científico junto à defensoria pública para minimizar o impacto da judicialização da saúde no município, bem como da implementação de um programa de pesquisa ativa para monitorar os desfechos em saúde provenientes de demandas judiciais. Métodos: Estudo conduzido em duas etapas. A primeira foi documental, retrospectiva, e composta por dados coletados de processos judiciais de 2013 a 2018 da região de Barbalha, no estado do Ceará. A segunda etapa foi prospectiva e de intervenção, conduzida por meio da mediação entre o cidadão e a defensoria pública, com o objetivo de reduzir a ocorrência da judicialização e monitorar os resultados dos processos de saúde. O estudo adotou o protocolo para avaliações econômicas em saúde Roteiro para Relato de Estudos de Avaliação Econômica. Os dados obtidos foram agrupados e tratados para caracterização do cenário. Comparou-se o perfil dos processos no período de 12 meses antes e após a instalação do programa para delimitar ciclo fiscal completo. Resultados: O serviço de consultoria promoveu redução de 40% (p=0,01) nas ações judiciais. Além disso, observou-se redução de 31% nos custos judiciais (p=0,003) com a medicação sendo responsável por 33% desse valor. Observou-se redução no uso de insumos não constantes nas listas do Sistema Único de Saúde (27%; p=0,003), contudo, sem diferença estatística entre os grupos. Conclusão: Os dados desta pesquisa foram comparáveis aos já relatados em pesquisas brasileiras quanto ao perfil de demandas. A proposta mostrou-se viável como meio de mitigar os custos da judicialização por meio da mediação. Essa iniciativa pode servir como modelo para os municípios que possuem características similares às apresentadas em nosso estudo.