20 resultados para quality index
Resumo:
Fibromyalgia (FM) is a chronic rheumatic syndrome characterized by diffuse muscle-skeletal pain, and aerobic exercises represent a fundamental portion in therapeutic approach. Objective of this study was to evaluate the effectiveness of aerobic exercises accomplished in the water of the sea (thalassotherapy) for women with FM and to compare with exercises accomplished in the swimming pool, involving a multidisciplinary team, composed by rheumatologists, physical therapists, students of physical therapy and students of physical education. Forty six (46) women with age between 18 and 60 years with FM were randomized in 2 groups: a swimming pool group (23 patients) and a sea group (23 patients). 80th groups trained a week with the same program of aerobic conditioning 3 times (60 minutes each) for 12 weeks. Ali the patients were evaluated, before and immediately after treatment, with Visual Analogical Scale (VAS) for pain and fatigue, number of tending points, Fibromyalgia Impact Ouestionnaire (FIO), Short Form 36 Health Survey (SF-36), Pittsburgh Sleep Ouality Index (PSOI) and Beck Oepression Inventory (BOI). For statistical analysis, it was used paired-t test for analysis intra-group and non-paired test for inter-groups analysis, significance levei of p <0,05. Four patients, of each group, didn't complete the training programo Groups were homogeneous and they were compared in initial evaluation, except for BOI (p <0,05). Both groups presented statistically significant improvement for ali appraised parameters in the post-treatment compared with initial evaluation, there were reduction of intensity of pain and fatigue, number of tending points, better functional capacity (FIO), life quality (SF-36), quality of sleep (PSQI) and depression indexes (BOI). However, in comparison among the groups, group of sea (thalassotherapy) presented better results for ali parameters, however with statistically significant difference just only for depression indexes (BOI). At the end, it was observed that accomplishment of aerobic exercises in sea water or swimming pool was effective as part of treatment for patients with FM. However, exercise programs with thalassotherapy seems to bring more benefits, mainly related to emotional aspects, could be a therapeutic option of low cost for patients with FM in our area
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O estudo tem como objetivo principal comparar o limiar e a tolerância à dor em mulheres com fibromialgia e mulheres sem sintomas de dor, correlacionando com capacidade funcional, qualidade do sono e força de preensão manual. Trata-se de um estudo descritivo de corte transversal realizado na Universidade Potiguar e na Universidade Federal do Rio Grande do Norte, envolvendo uma equipe multidisciplinar com fisioterapeutas, médicos e educadores físicos. Setenta e duas mulheres foram divididas em dois grupos: grupo com fibromialgia (GF, n = 40) e grupo controle (GC, n = 32) sem sintomas de dor, pareadas por idade e índice de massa corporal. Questionários foram usados para medir capacidade funcional (Fibromyalgia Impact Questionnaire FIQ) e qualidade do sono (Pittsburgh Sleep Quality Index - PSQI). Limiar e tolerância à dor foram medidas por um algômetro de pressão e para determinar força foi usado um dinamômetro de preensão manual. Na análise estatística o teste T de Student foi usado para comparar grupos e o coeficiente de correlação de Spearman foi usado no GF para correlacionar limiar e tolerância à dor com as demais medidas. O GF mostrou piores resultados nas medianas comparado ao GC: limiar de dor 2 kg/cm2 versus 5,5 kg/cm2 (p <0,001), tolerância à dor 2,8 kg/cm2 versus 7,2 kg/cm2 (p <0,001) e força de preensão manual 14,5 kgf versus 25,2 kgf (p <0,001). Adicionalmente os dois questionários apresentaram resultados piores também no GF em relação ao GC, respectivamente: FIQ 65 versus 14,3 (p <0,001) e PSQI 13 versus 5 (p <0,001). No GF foi observada correlação negativa tanto entre o limiar de dor quanto a tolerância à dor com os escores do FIQ e do PSQI. No GF foram observadas correlações positivas tanto entre o limiar de dor (p <0,01) quanto a tolerância à dor (p <0,01) com força de preensão manual. É possível concluir que limiar de dor e tolerância à dor estão correlacionados com capacidade funcional, qualidade do sono e força de preensão manual em mulheres com fibromialgia
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This study presents a comparative analysis of methodologies about weighted factors considered in the selection of areas for deployment of Sanitary Landfills, applying the methodologies of classification criteria with scoring bands Gomes, Coelho, Erba & Veronez (2000); Waquil et al, 2000. That means, we have the Scoring System used by Union of Municipalities of Bahia and the Quality Index Landfill Waste (IQR) which are applyed for this study in Massaranduba Sanitary Landfill located in the municipality of Ceará Mirim /RN, northeastern of Brazil. The study was conducted in order to classify the methodologies and to give support for future studies on environmental management segment, with main goal to propose suited methodologies which allow safety and rigor during the selection, deployment and management of sanitary landfill, in the Brazilian municipalities, in order to help them in the process to extinction of their dumps, in according of Brazilian Nacional Plan of Solid Waste. During this investigation we have studied the characteristics of the site as morphological, hydrogeological, environmental and socio-economic to permit the installation. We consider important to mention the need of deployment from Rio Grande do Norte State Secretary of Environment and Water (SEMARH), Institute of Sustainable Development and Environment of RN (IDEMA), as well, from Federal and Municipal Governments a public policies for the integrated management of urban solid waste that address environmental preservation and improvement of health conditions of the population of the Rio Grande do Norte
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Environmental pollution has become a subject of public interest throughout the world. Not only have developed countries been affected by environmental problems but also the developing nations have started to suffer from the serious impacts of pollution. Within this context it is necessary to collect simplified environmental data to assist in the management of water resources by the appropriate authorities. These data are obtained through an environmental index that allows a space-time comparison of points distributed in the same aquatic body, or between different water bodies, for physico-chemical and bacteriological parameters. The aim of this present study was to determine the environmental status of the Lagoa de Baixo at Guamaré/RN, where a production unit of PETROBRAS RN/CE is located. For this purpose the Water Quality Index (WQI) was used in both an add and multiply form, the Trophic State Index (TSI) and the Environmental Quality Quotient (EQQ), as well as determining the concentrations of metals. The average values obtained for the WQI, in its two forms were 68,67 and 62,76 respectively which were inside the good qualification. According to the TSI the lagoon showed characteristics of a middle trophic state, and an impact level of regular as determined by the EQQ
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The Pirangi beach is located in the eastern coastline of Rio Grande do Norte state, in the municipality of Parnamirim and Nísia Floresta. In it flow into Pirangi Watershed (PW), whose water receives large amounts of pollutants, mainly domestic and industrial sewage from districts where pass the rivers that consist it, compromising, thus, the bathing water quality of the Pirangi beach. Bearing in mind the importance of water sanitary quality to ensure an environment that no present risk to the bathers s health, this work had as main objective to assess the influence of the PW s waters in the bathing water quality of the Pirangi beaches. To that end, were made collections of water in the beaches and in the rivers with the intention of quantify the fecal contamination indicators thermotolerant coliforms and enterococci, to then classify the conditions of bathing water quality according with the CONAMA Resolution number 274 of 2000. For the purposes greater knowledge about the health conditions of the Beaches Pirangi and about the influence the PW s waters exert on it, was done parallely to the study of the water quality, an investigation of the sand sanitary quality. Furthermore, it was made an evaluation of the PW s Water Quality through Water Quality Index (WQI). Starting from the results obtained in the research present was possible to verify, among other aspects, that the entry of the PW s waters in the Pirangi beaches exerts direct influence in the bathing water quality of the same ones, being the North Pirangi beach (point tracking PA-02) the most influenced. There was noticed also a significant reduction in the conditions of bathing water quality of the beaches in the rainy season. However, the precariousness do sewerage system of the Natal metropolitan region and the absence of a right system of treatment an final disposal of domestic sewage and industrial are the main factors responsi le for deterioration of the PW s Water Quality, and as a consequence, compromising the bathing water quality of the Pirangi beaches
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It is known that sleep plays an important role in the process of motor learning. Recent studies have shown that the presence of sleep between training a motor task and retention test promotes a learning task so than the presence of only awake between training and testing. These findings also have been reported in stroke patients, however, there are few studies that investigate the results of this relationship on the functionality itself in this population. The objective of this study was to evaluate the relationship between functionality and sleep in patients in the chronic stage of stroke. A cross-sectional observational study was conducted. The sample was composed of 30 stroke individuals in chronic phase, between 6 and 60 months after injury and aged between 55 and 75 years. The volunteers were initially evaluated for clinical data of disease and personal history, severity of stroke, through the National Institute of Health Stroke Scale, and mental status, the Mini-Mental State Examination. Sleep assessment tools were Pittsburgh Sleep Quality Index, the Questionnaire of Horne and Ostberg, Epworth Sleepiness Scale, the Berlin questionnaire and actigraphy, which measures were: real time of sleep, waking after sleep onset, percentage of waking after sleep onset, sleep efficiency, sleep latency, sleep fragmentation index, mean activity score. Other actigraphy measures were intraday variability, stability interdiária, a 5-hour period with minimum level of activity (L5) and 10-hour period with maximum activity (M10), obtained to evaluate the activity-rest rhythm. The Functional Independence Measure (FIM) and the Berg Balance Scale (BBS) were the instruments used to evaluate the functional status of participants. The Spearman correlation coefficient and comparison tests (Student's t and Mann-Whitney) were used to analyze the relationship of sleep assessment tools and rest-activity rhythm to measures of functional assessment. The SPSS 16.0 was used for analysis, adopting a significance level of 5%. The main results observed were a negative correlation between sleepiness and balance and a negative correlation between the level of activity (M10) and sleep fragmentation. No measurement of sleep or rhythm was associated with functional independence measure. These findings suggest that there may be an association between sleepiness and xii balance in patients in the chronic stage of stroke, and that obtaining a higher level of activity may be associated with a better sleep pattern and rhythm more stable and less fragmented. Future studies should evaluate the cause-effect relationship between these parameters
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Introduction: The aging process causes quantitative and qualitative changes in sleeping. Such changes affects more than half of the adults above 65 years old, that live in the community and 70% of the institutionalized, a great negative impact in their quality of life. One of the pathological displays of aging, that share some characteristics with sleeping disorders and predict similar results, is the Frailty Syndrome, that characterize the most weakened and vulnerable elderly. The way sleeping disorders play a role in the frailty pathogeneses remains uncertain. Objective: Evaluate the relation between the sleeping and the frailty syndrome on institutionalized elderly. Methodology: A transversal study was performed with 69 elderly in institutions in the city of João Pessoa PB. Were used the Pittsburgh Sleeping Quality Index and actigraphy to subjective and objective variables, respectively, and questionnaires and specific tests to frailty phenotype variant (Fried Frailty Criteria). In the statistic analysis were used the Pearson correlation test, Chi Square and One-way ANOVA test, with Tukey-Krammer posttest. Subsequently, a Simple Linear Regression model was built. On every statistical analysis were considered a confidence interval of 95% and a p < 0,05. Results: The sample was characterized by the prevalence of the frail (49,3%), women (62,3%), single (50,7%) and 77,52 (±7,82).The frail elderly obtained the worst sleeping quality 10,37 (±4,31) (f = 4,15, p = 0,02), when compared with the non-frail. The sleep latency influenced more the frailty (R2 = 0,13, β standard = 1,76, β = 0,41, p = 0,001). Weren t found differences between the standard resting-activity variable and the frailty phenotype categories. Conclusion: Sleeping alterations, including bad sleeping quality, prolonged sleep latency, low sleep efficiency and day drowsiness, influenced the frailty in institutionalized elderly
Resumo:
Brain injury can be associated with changes in the sleep-wake cycle. However, studies about sleep disturbances and their relationship with quality of sleep are scarce. Besides, it remains to be known how stroke affects the mechanisms of sleep. The aim of this study was to investigate quality of sleep, complaints of sleep disturbances and associated factors in stroke patients from the Physical Therapy services in Natal -RN. This was a cross-sectional descriptive study involving 70 individuals (aged 45-65 years), 40 patients (57 ± 7 years), 11 ± 9 months after injury, and 30 healthy individua ls (52 ± 6 years), evaluated with the Pittsburgh Sleep Quality Index (PSQI) and Sleep Habits Questionnaire. The data were analyzed by Chi-square test, t Student test and logistic regression. Poor quality sleep was found in 57,5% of the patients (6,3 ± 3,5) and was significantly higher than in the control population (3,9 ± 2,2) (t Student test, p=0,002). The patients showed significantly higher value of PSQI than controls: sleep latency (p=0,019), length of sleep (p=0,039) and dysfunction during the day (p=0,001). Regarding complaints of sleep disturbances (dyssomnias and parasomnias) analyzed by Chi-square test, the complaint of insomnia was the most prevalent (patients: 37,5%; healthy subjects: 6,7%; p=0,007). Regression analysis showed that sl eep latency (p=0,036) and complaint of insomnia (p=0,036) were associated with quality sleep. In addition, female gender (p=0,036) and complaint of broken sleep (p=0,003) were considered risk factors for the presence of insomnia. Our results show that stroke affects the homeostatic process of sleep. Shorter sleep latency and the absence of insomnia are considered protective factors for good sleep quality and this should be taken into consideration in the diagnostic and therapeutic strategies
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Shift work consists of an array of unusual work hours, such as evenings and weekends, and increasing workload, in order to meet the uninterrupted production, which leads to changes in the quality, duration and regularity of sleep. Research indicates that sleep alteration cause cognitive processes to become slower, unstable and prone to errors, leading to loss of cognitive functions such as visuospatial perception. In this sense, this research aimed to evaluate sleep quality and its relation to visuospatial perception in workers in alternating shifts. Participants were 21 panel operators in a petrochemical company, male, aged 19-53 years. All participants were subjected to schedules of alternating shifts (day and night) of 12 nonstop hours and data were collected from 10 workers who were assigned to the day shift and 11 workers assigned to the night shift. For the sleep evaluation were used the Sleep Diary, the Sleep Habits Questionnaire, the Chronotype Identification Questionnaire and the Pittsburgh Sleep Quality Index (PSQI). The visuospatial skills were assessed using the Rey Complex Figure Test and attention was assessed using a portable version of the Psychomotor Vigilance Task (PVT). The results showed that the general sample of workers obtained poor sleep quality on working days and good sleep quality during the work break. There was shortened sleep duration in the work week and appropriate duration in the work break. No losses were found in the workers visuospatiality, but the good quality of sleep during the work break was correlated to adequate visuospatial performance, for the day shift workers. The attention performance oscillated throughout the work hours, especially on the night shift. It is concluded that the alternating shifts work scheme can be detrimental to the sleep quality workers and a good sleep quality can contribute to a better visuospatial performance
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This study is an environmental diagnosis of the Jundiaí-Potengi/RN estuarine system waters, using calculations of pollution indicator indices such as the Water Quality Index (WQI) and the Toxicity Index (TI). The samples were collected at twelve points on the estuary, at high and low tide, between August and November 2007, over four campaigns. The study area, located in a high impact region, has various activities on its banks such as: discharge of untreated or undertreated domestic and industrial sewage, shrimp farming, immunizer stabilization lakes, riverside communities, etc. All the parameters analyzed were compared to the limits of CONAMA Resolution No. 357 of 2005 for healthy and saline Class 1 waters. The results found prove the impact caused by various activities, mainly the parameters related to the presence of organic material, such as DQO, DBO, COT and thermotolerant colliforms. The IQA for most of the collection points was of medium quality. For the metals, although values above the Resolution limits were found, most of them were lower than the detection limits of ICP-OES used, indicating that they tend to be transported by the dynamic of the tides or rainfall and are deposited in bottom sediments, resulting in a TI of 1.0 in this water, when they are absent, which occurs in most cases, or 0.0, when heavy metals are found in these waters
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The problems of water supply in Northeast Brazil are severe and require more focused studies. This work was intended to assess water quality in the watershed Pirangi, located in the Northeastern state of the newborn using the Water Quality Index, AQI associated with the Index of Toxicity-IT. The data presented in this study were collected in November 2008, June 2009 and March 2010 at eight sampling stations distributed throughout the basin. The study covered nine parameters, based on guidelines established by CETESB, and seven members of Metal Toxicity index-IT. These waters are framed in the classification between GOOD and BAD showing AQI 41.34 minimum and a maximum of 76.23. Virtually all seven metals analyzed were below the detection limits of ICP-OES giving IT a water equal to one when they are absent and 0 when there are levels of trace metals
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This paper presents the public square as a subsystem of the city for the potential integration of elements 'natural' and built environment. But sometimes the suitability of projects and the social processes involved are not compatible and favorable to their real functions in urban space. The city of Natal, with a population of 803,739 inhabitants has 253 public parks not uniformly distributed in the urban area, but mostly in central areas and their absence in some peripheral neighborhoods. In this sense, the objective of this paper is to analyze the quality and spatiality of the city's public squares within the urban socio-environmental problems. For this, use of simple random sampling to define the sample and the proportional allocation of districts, totaling 168 squares to be raised. We prepared a form to collect data on the field that includes aspects of leisure, infrastructure and environment. For each square sampled was calculated Square Quality Index (PQI), then calculating the average per IQP neighborhood. The rates found were crossed with census data and Municipal Public Administration by neighborhood, using multivariate analysis. We generated maps, charts and tables, considered appropriate to each question format, focused comparison. The public square appears as an indicator of environmental challenges present in intra-urban spaces of the city. Their spatial distribution is not consistent demand population, both by disposition and by how much. In terms of quality are characterized by different levels of inadequacy and degradation aspects of leisure, environmental and infrastructure, often causing disfigurement, abandonment and improper occupation in such spaces. Multivariate analysis point to a central concentration and their problems in certain administrative units, not only as regards the public squares, but also to aspects of education, income, and other violence, perpetuating the problem. The various levels of inadequacy and degradation of public squares have been more blatant in the poorest neighborhoods of the city, pointing to a structural pattern associated with the intrinsic characteristics of the neighborhood and the socioeconomic profile of the local population. These are problems of social and environmental dimensions, threaded in and influenced the political, economic and broader social process of transformation of the city and the urban. Based on an uneven process in which space necessarily reflect the contradictions inherent in the active forces and interests. Thus evidencing the importance of managing the necessary public effectively engaged with the problems that are present there, in order to equate them, without being prioritized certain areas of the city at the expense of others
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The insomnia disorder is defined as a difficulty initiating or maintaining sleep or waking up earlier than expected unable to return to sleep, followed by a feeling of nonrestorative and poor quality sleep, present for at least three months, with consequences on daytime functioning. Studies have shown that insomnia affects cognitive function, especially executive functions. However, researches that sought to investigate the relationship between primary insomnia and executive functioning were quite inconsistent from a methodological point of view, especially in regard to the variability of the used methods, the heterogeneity of diagnostic criteria for insomnia and the control of sleep altering drugs. In this sense, the present study aimed to investigate the relationship between insomnia and executive functions in adults. The participants were 29 people, from both genders, aged 20-55 years old. Participants were divided into three groups, one composed of 10 people with primary insomnia who used sleep medication (GIM), nine people with primary insomnia who did not use medication (GInM) and 10 healthy people who composed the control group (CG). The research was conducted in two stages. The first one involved a diagnostic evaluation for insomnia disorder through a clinical interview and the application of the following protocols: the Athens Insomnia Scale, the Insomnia Severity Index, Sleep Journal (for 14 days), Pittsburgh Sleep Quality Index (PSQI), the Stanford Sleepiness Test, depression and anxiety Beck inventories, and Lipp’s Iventory of stress symptoms for adults. After this stage, the evaluation of executive functions was performed by applying a battery of neuropsychological tests composed by the following tests: Wisconsin, Stoop Test, Colored trails Test, the Tower of London Test, Iowa Gambling Task (IGT) and WAIS III subtest digit span, which measured selective attention, inhibitory control, cognitive flexibility, planning, problem solving, decision making and working memory, respectively. The results showed that insomniacs (GIM and GInM) showed higher sleep latency, shorter sleep duration and lower sleep efficiency compared to the CG. In regard to the performance in executive functions, no statistically significant difference between groups was observed in the evaluated modalities. However, the data show evidence that, compared to GInM and GC, the performance of GIM was lower on tasks that required quick responses and changes in attention focus. On the other hand, GInM, when compared to GIM and GC, showed a better performance on tasks involving cognitive flexibility. Furthermore, impaired sleep measures were correlated with the worst performance of insomniacs in all components evaluated. In conclusion, people with the insomnia disorder showed a performance similar to healthy people’s in components of the executive functioning. Thus, one can infer that there is a relationship between primary insomnia and executive functions in adults.
Resumo:
The teaching profession is often associated with extensive workload inside and outside the classroom, poor teaching conditions, among other challenges that can cause sleep problems. These problems may be even greater in women, due to the professional and domestic work hours and to the major sleep necessity. Considering that sleeping problems may result from the practice of poor sleep habits, sleep education programs are conducted with the aim to reduce sleep deprivation, irregularity on sleep schedules, daytime sleepiness and improve sleep quality. In this sense, the objective of this study is to evaluate the influence of working hours, gender and a sleep education program on sleeping habits, quality of sleep, daytime sleepiness and the level of stress in teachers of elementary and secondary education. For that, teachers filled the questionnaires that assessed: 1. Sleeping habits (Sleep & Health), 2. Chronotype (Horne & Ostberg), 3. Daytime sleepiness (Epworth Sleepiness Scale), 4. Sleep Quality (Pittsburgh Sleep Quality Index), 5. Level of stress (The Inventory of Stress for Adults of Lipp) and 6. Daily pattern of sleep/wake cycle (Sleep Diary). The questionnaires 1, 4, 5 and 6 were repeated 3 weeks after the sleep education program. Teachers who begin work in the morning (7:11 ± 0:11 h) wake up earlier in the week and often have poor sleep quality compared to those who start in the afternoon (13:04 ± 00:12 h). Among those who begin work in the morning, the intermediate types and those with an evening tendency were more irregular in the wake up time than morning types and increased sleep duration on weekend. In relation to gender, women had longer sleep duration than men, although the majority presented excessive daytime sleepiness and poor sleep quality. However, when work schedule and age are similar between genders, the difference in sleep duration becomes a tendency and the difference in the percentage of excessive daytime sleepiness disappears, but the poor sleep quality persists in women. With respect to teachers who have gone through the sleep education program, there was an increase in knowledge about the subject, which may have contributed to the reduction in the frequency of coffee consumption close to bedtime and to the sleep quality improved in 18 % of participants. In the control group, there were random differences in knowledge in 3rd stage, and sleep quality improved in only 9% of teachers. The participation in the sleep education program was not enough to change the hours of sleep and decrease stress of teachers. Therefore, the start time school in the morning was preponderant in determining the wake up time of teachers, especially for intermediates types and those with an evening tendency. Furthermore, the poor quality of sleep was more common in women, and the sleep education program contributed to increase knowledge on the subject and to improve sleep quality.
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INTRODUCTION: Human sexuality is recognized as one of the pillars of quality of life. In women, sexual function is influenced throughout life by many factors that can lead to the appearance of changes in the cycle of sexual response, and hence the quality of life (QOL). Pregnancy is a period of change, leaving them physically and mentally vulnerable, which may affect sexual function and quality of life during pregnancy. OBJECTIVE: To investigate the relationship between sexual function, presence of depressive symptoms and quality of life in pregnant women. METHODS: The study included 207 pregnant women attending prenatal examination of the Maternity Divine Love, Parnamirim / RN and the participants of the Course for Pregnant Women of the Department of Physical Therapy at UFRN (central campus). Initially it was applied, a questionnaire containing questions about sociodemographic, gynecological and obstetric data, as well as body and sexual self-knowledge. Sexual function was assessed using the Sexual Function Index Female (Female Sexual Function Index - FSFI). To assess the quality of life, we used the Quality Index Ferrans Life & Powers mom. The presence of depressive symptoms was verified by applying the Beck Depression Inventory. The Shapiro-Wilk test for normality was carried variables, Mann-Whitney test for carrying out the comparisons and the Wilcoxon test for comparing the monthly sexual frequency before and during pregnancy. Multiple linear regression was used to verify the relationship between sexual function, depressive symptoms and quality of life. We used the Spearman correlation to check correlation between the variables. Ap value <0.05 was adopted. RESULTS: Sexual function and depressive symptoms were related quality of life (R2 = 0.30, p <0.001). Depression had a moderate negative correlation with quality of life (0.53; p <0.001), whereas sexual function showed a positive correlation with low quality of life (0.22; p = 0.001). The planning of pregnancy, education and income shown to influence depression scores. With respect to sexual function, it was seen that during pregnancy, a reduction in the monthly frequency of sexual partner (Z = -10.56; p <0.001). Among the sexual domain, just the pain, showed a statistically significant difference compared between the second and third quarter (Z = -1.91, p <0.05). The score of the quality of life of women with sexual dysfunction was xvii significantly lower than that pregnant women without dysfunction (Z = -2.87, p = 0.004). Conclusion: Sexual function and the presence of depressive symptoms are related to the quality of life of pregnant women.