Elizabeth Alves Gonçalves Ferreira

In recent decades, the remarkable scientific and technological progress in healthcare has been accompanied by a marked distancing in interpersonal relationships within care settings. This scenario contrasts with the definition of health proposed by the World Health Organization — as a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity¹ — and with the principles of Brazil’s National Humanization Policy (Política Nacional de Humanização, PNH) within the Unified Health System, which recognizes the centrality of the individual in all dimensions of care². In Brazil, the concept of health was further expanded in 1990, when it was established as a fundamental human right under the Law 8.080/1990³. In 2003, the National Humanization Policy was created to value all subjects involved in the care process — including users, professionals, and managers — guided by principles such as transversality, inseparability between care and management, and autonomy, co-responsibility, and protagonism of individuals and collectives²^,⁴. Humanization is therefore an essential component of both clinical practice and the education of healthcare professionals. In the training of such professionals, the development of competencies such as empathy, active listening, and receptiveness is fundamental to ensuring patient-centered care⁵⁻⁷. However, the growing gap between technical-scientific advancement and the quality of human interactions in healthcare underscores the need for educational strategies focused on humanized training⁸⁻¹². Within this context, the MadAlegria Project was created to foster humanized practices in both learning and professional behavior. Established in 2011 by students and faculty members at the University of São Paulo (USP), MadAlegria is a Culture and University Extension Project aimed at promoting humanization in healthcare education—particularly at the undergraduate level—and at improving the hospital environment, making it more welcoming for patients, families, and healthcare staff. Since 2012, the project has incorporated two artistic and playful languages: hospital clowning and storytelling. These approaches are used as pedagogical tools to enhance relational competencies such as empathy, active listening, teamwork, and sensitivity to others’ experiences¹³⁻¹⁵.

Introduction: IIllness often provokes distress in patients and their support networks. Humanization should be part of the training of healthcare professionals. Founded in 2011 by undergraduate students in Medicine, Physical Therapy, Occupational Therapy, Speech-Language Pathology, Nursing, and Nutrition, MadAlegria draws on storytelling and hospital clowning to foster empathy, promote humanized care, create more welcoming hospital environments, and expand students’ understanding of illness beyond its biological aspects. Objectives: To describe the MadAlegria Project, that promotes humanization in the education of healthcare professionals. Methods: MadAlegria develops two main activities: (1) annual training in Hospital Clowning or Storytelling; and (2) weekly visits to inpatients in oncology, dermatology, and obstetrics units. Teams engage in brief, respectful interactions guided by consent and institutional availability. Other actions include organizing the Humanization in Healthcare Symposium, participating in institutional events, promoting blood donation and integrative workshops. Results: Between 2017 and 2023, MadAlegria trained 578 volunteers, conducted 2.345 visits, involving 1.193 companions and 2,354 healthcare professionals. Data collected via REDCap® revealed that 99% of participants reported a positive impact, mainly in terms of empathy, humanization, and attentive listening. Only 6% of volunteers remain active. Discussion: MadAlegria has been achieving its goal of humanizing the training of healthcare professionals with empathy, while also conducting a large number of visits and interactions with patients, companions, and healthcare professionals in the hospital. Keeping volunteers active in the project for many years is a challenge influenced by other variables such as time and priority. Even if the volunteer does not continue with the project's activities, it is considered a success if they have become a more empathetic healthcare professional. Conclusion: MadAlegria strengthens humanized practice in healthcare education, promoting empathy and compassion in the hospital environment. The continuation of the project depends on institutional support.

The purpose of this study was to analyze the description quality of interventions with pelvic floor muscle training (PFMT) for dyspareunia treatment and to describe treatment modalities and protocols. This was a systematic review of randomized clinical trials, longitudinal studies, and before-after studies. We searched MEDLINE/PubMed, Web of Knowledge, Scopus, Cochrane, LILACS, PEDro, and Embase, last updated June 2024. The Consensus on Exercise Reporting Template recommendations and Consensus on Therapeutic Exercise Training document were used to analyze the description of PFMT protocols. Among 769 retrieved articles, 17 were included, involving 963 women 20 to 70 years of age with dyspareunia, vulvodynia, pelvic pain, and/or sexual dysfunction. Dyspareunia was assessed with tools such as numeric or subjective pain scales and questionnaires like the Female Sexual Function Index. The mean Consensus on Exercise Reporting Template score was 7.3 ± 2.7 (40% of items accomplished). The mean Consensus on Therapeutic Exercise Training score was 5.4 ± 1.3 (61% of items accomplished). Most protocols applied supervised exercises at outpatient clinics and prescribed nonsupervised home exercises. PFMT encompassed muscle contraction with varied duration (3-60 seconds) and intensity (phasic and tonic), followed by muscle relaxation. Most associated therapy was biofeedback, followed by manual therapy and electrical stimulation. Most descriptions of PFMT protocols for dyspareunia treatment did not follow recommended consensus tools, making it difficult to compare data and transpose to clinical practice. Protocols of PFMT are heterogeneous among studies.

The purpose of this study was to evaluate the changes in posture with 2 different bases of support for static posture. In this exploratory study, participants were photographed in a standing position from anterior, posterior, and lateral views, in both spontaneous standing base of support (SBoS) (feet in a freely adopted position) and closed feet base of support (CBoS) (feet held together). Styrofoam markers were attached to 32 anatomical reference points, and posture assessment was conducted using software (PAS/SAPO). The area of each base of support (BoS) and the deviation of the center of gravity (CG) from the reference point within the BoS were measured. Comparisons between CBoS and SBoS postures were performed using paired t-tests. One hundred and seven participants (81 women) and 856 photographs were evaluated. Average age was 25.65 ± 2.83 years and body mass index was 22.4 ± 2.8 kg/m². Alignment of the right and left lower limbs showed a difference in the frontal view; however, no differences were found in the posterior view. In the left lateral view, differences were noted in the hip angle (trunk and thigh), horizontal alignment of the pelvis, and knee angle. In the SBoS, the BoS area was greater, with a smaller deviation from the CG compared to the CBoS. This study found that foot positioning can influence the alignment of lower limbs, pelvis, base of support, and balance, without affecting trunk postural assessment.

Objective: To test the Intra‐ and inter‐rater reliability, measurement error and criteria and convergent validities of the Dualpex Plus (DP) for vaginal manometry in women with urinary incontinence (UI).Design: This is a clinimetric properties study.Setting: University Hospital in Brazil.Population: One hundred and two women with UI.Methods: Vaginal manometry was performed with DP and Peritron (Pr), in a random order. Intra‐rater reliability was tested within a 1‐week interval; inter‐rater reliability was tested on the same day by two different evaluators. Perception of contraction and comfort with each device were assessed and compared with Chi‐square or paired t tests. Reliability was evaluated by intraclass correlation coefficient (ICC) with a 95% confidence interval (CI). Criteria (with Pr) and convergent (with Oxford score) validities were evaluated by Pearson's correlation. The standard error of measurement (SEM) and the minimum detectable change were also calculated.Main Outcome Measures: Intra‐ and inter‐rater reliability, measurement error and criteria and convergent validities of the Dualpex Plus.Results: DP showed substantial inter‐rater and excellent intra‐rater reliability (ICC = 0.85; 95% CI 0.76–0.91 and 0.90; 95% CI 0.86–0.93, respectively); strong and positive criteria validity (r = 0.83; p < 0.001) and convergent validity (r = 0.45; p < 0.001). Pressure values for pelvic floor muscle contraction were different between DP and Pr [17.61 ± 12.22 vs. 34.91 ± 21.22 cmH₂O; p < 0.001]. SEM was doubtful (19%) and the minimum detectable change was 0.152 cmH₂O. DP was more comfortable than Pr and perception of contraction was higher for Pr.Conclusion: Dualpex Plus showed adequate clinimetric properties. Measurement error was considered doubtful. DP was more comfortable than Pr and perception of contraction was higher for Pr.

Introduction and Hypothesis The objective was to compare the functional assessment of the pelvic floor (PERFECT [P = power; E = endurance; R = repetitions; F = fast contractions; ECT = every contraction timed] scheme), vaginal manometry and transperineal ultrasound in women with and in those without stress urinary incontinence (SUI) and to evaluate the correlation among the variables of the three modalities of assessment in both groups. Methods This was a cross-sectional study involving nonpregnant women with and those without SUI aged between 18 and 60 years. Women with sphincter deficiency, Oxford scale = 0, and prolapse grade ≥ 2 were excluded. Women were evaluated using the PERFECT scheme, vaginal manometry, and transperineal ultrasound. Groups were compared using the Student’s t test, the chi-square test and general linear models. The Spearman correlation test was also performed. Results Fifty-one women with SUI (aged 48.5 ± 9.5 years) and 47 women without SUI (aged 47.2 ± 9.2 years) were evaluated. In women with SUI, there was a correlation between vaginal manometry and power (r = 0.87), endurance (r = 0.47) and fast (r = 0.69); between power and endurance (r = 0.53) and fast (r = 0.67); and between endurance and fast (r = 0.61). For the ultrasound variables, there was correlation between the bladder neck and H height, both at rest (r = 0.44) and under stress (r = −0.62); between the ureteric angle at stress and H height at rest (r = 0.49); the ureteric angle at rest (r = 0.74); and the levator anterior area (r = 0.40; p = 0.05 for all measures). None of the ultrasound variables correlated with the PERFECT scheme or the vaginal manometry. Conclusion There was no correlation between the ultrasound variables and vaginal manometry or the PERFECT scheme. There was correlation between specific measurements of the PERFECT scheme and vaginal manometry and among some of the ultrasound variables.

Comparing the efficacy of electrical stimulation (ES) and pelvic floor muscles training (PFMT) on urinary incontinence (UI) symptoms, quality of life and sexual function on women with stress UI. Also, to analyze the influence of supervised and non-supervised PFMT. Systematic review of randomized trials involving adult women with stress UI. Studies' review was performed by two independent researchers on PubMed, EMBASE, PEDro, Cochrane Library, LILACS. The PEDro scale was used to evaluate the quality of included studies. The certainty of evidence was analyzed by the GRADE. A meta-analysis was performed. Seven studies comprising 411 women with stress UI were included. Methodological quality ranged from 3 to 8 points. Treatment sessions varied from 5 to 45 min (PMFT) and 15 to 30 min (ES), from 4 weeks to 6 months. Studies varied regarding the type of electrical current and its characteristics. With very low certainty of evidence and severe risk of methodological bias, the meta-analysis showed that ES is not superior to supervised or unsupervised PFMT for any outcome. ES is not superior to PFMT for reducing urinary leakage or improving quality of life in women with stress UI.