Concepción Tomás Aznar

Validación de la versión española de las formas cortas del Urogenital Distress Inventory (UDI-6) y del Incontinence Impact Questionnaire (IIQ-7) en mujeres embarazadas

OBJECTIVE To validate two measurement instruments, the UDI-6 and the IIQ-7, for the study of urinary incontinence and its impact on the quality of life of pregnant women. METHODS We carried out a validation study of a diagnostic tool. A total of 181 pregnant women completed the UDI-6 and IIQ-7 questionnaires. Feasibility, internal consistency, reliability, and construct and criteria validity were analyzed. RESULTS Self-administration of the short forms of the UDI-6 and IIQ-7 questionnaires took less than 5minutes and the maximum rate of no answer per item was 3.3%. Cronbachs alpha was 0.667 for the UDI-6 and was 0.910 for the IIQ-7. The reliability of the UDI-6 in the diagnosis of urinary incontinence showed Kappa statistic values of between 0.856 and 0.966, and the intra-class correlation coefficients of the UDI-6 and IIQ-7 were 0.902 and 0.954, respectively. Average values of the UDI-6 and IIQ-7 were higher in women with mixed incontinence, were lower in women with stress incontinence and increased with daily losses (p<0.01). The correlation between the UDI-6 and the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) (CCI=0.497; 95% CI: 0.326-0.625) and between the IIQ-7 and ICIQ-SF (CCI=0.472; 95% CI: 0.268-0.619) was moderate. The sensitivity and specificity of the UDI-6 for the diagnosis of urinary incontinence was 98.9% and 86.5%, respectively. CONCLUSIONS The Spanish versions of the IIQ-7 and UDI-6 are feasible, reliable, consistent and valid in the measurement of symptoms and quality of life in pregnant Spanish women with urinary incontinence.

Labia Minora Elongation and its Implications on the Health of Women: A Systematic Review

ABSTRACT Objectives: Labia minora elongation (LME) is a female genital modification practice categorized among the types included in the fourth group of female genital mutilation. In this article, we display the results of a systematic review of the evidence-based knowledge published on the health risks and benefits of LME as informed by African female respondents who are insiders of the practice. No other systematic review on this specific topic has been published before. Methods: A methodological bibliographic search was done in scientific databases by manual referencing and by contacting experts on this area of knowledge. Seventeen articles were eligible for this review, which corresponded to nine different studies. Eight of these studies were conducted in Eastern and Southern African countries and one was carried out in Italy. Results: This review concludes that pain at the beginning of the practice, nuisances related to the use of caustic herbs, and stigmatization in failing to comply with the practice are the principal health risks associated with LME. At the same time, there is evidence that labial elongation may benefit the sexual health and well-being of women. Conclusions: More research of a quantitative nature is necessary to determine the prevalence of LME across the practicing cultures and to determine its implications on the sexual and reproductive health of women who engage in this female genital modification.

Zambian Women in South Africa: Insights Into Health Experiences of Labia Elongation

Labia minora elongation consists in the manual stretching of the inner lips of the external genitalia. This practice is documented in east and southern Africa. The experiences of African women in the diaspora practicing elongation are not thoroughly understood. The purpose of this qualitative study was to explore the health harms and benefits associated with this practice of Zambian women who have migrated to Cape Town, South Africa. Twenty women and seventeen men participated in this study. Between December 2013 and May 2014, in-depth interviews and natural group discussions were conducted with the participants. The focus of this article is to report on the emic of the women related to notions of health, hygiene, and well-being. Labial elongation is perceived as a practice involving minor, short-term adverse effects that can be prevented by following some basic hygiene. Overall, personal and social value is placed on this practice because of its reported benefits for the sexual health of men and women, and for womens femininity and self-image. Further research is necessary on how female genital modifications influence Zambians’ sexual preferences to inform the development of culturally appropriate health promotion interventions.

Autoerotism, Homoerotism, and Foreplay in African Women Who Practice Labia Minora Elongation: a Review

ABSTRACT. Objectives: Labia minora elongation is a female genital modification in which some women in certain linguistic groups from Africa engage. One of the purposes is to enhance sexual pleasure for their male partners. Methods: The literature has been reviewed to describe how labia minora elongation serves for women to increase their sexual pleasure, both as an autoerotic method and in the context of homoerotic and heterosexual relationships. Results and Conclusions: This aspect deserves to be investigated, as there are narratives from some women practitioners of labial elongation that this practice might contribute to improve the sexual health of some of the women who engage in it.

Urinary incontinence and weight changes during pregnancy and post partum: a pending challenge.

OBJECTIVE to analyse the association between urinary incontinence and maternal weight, and its variations in pregnancy and post partum. DESIGN observational study of a cohort of women from the start of pregnancy until six months post partum. SETTING Hospital San Pedro in La Rioja, Spain. PARTICIPANTS 402 pregnant women without urinary incontinence at the start of pregnancy. MEASUREMENTS AND FINDINGS the dependent variable was urinary incontinence, assessed using the Urogenital Distress Inventory-Short Form questionnaire. The main independent variables were body mass index (BMI) at the first antenatal visit and six months post partum, weight gain during pregnancy, postpartum weight loss, and weight retained from the start of pregnancy to six months post partum. The association between urinary incontinence and the main independent variables was measured using Students t-test. Three simple logistic regression models were used to assess the strength of this association, one for each of the independent variables that showed a significant association with urinary incontinence (p<0.05), and three multiple regression models that included the possible variable effect modifiers were also used. At the start of pregnancy, 20.1% of the women were overweight and 8.7% were obese. Six months post partum, 30.3% of the women were overweight and 11.4% were obese. The mean (±standard deviation) retained weight was 2 (±3.1) kg. Postpartum urinary incontinence was associated with BMI at six months post partum, postpartum weight loss and retained weight at six months post partum (p<0.05). The association of urinary incontinence with these variables was significant, and remained stable in both simple and multiple regression analyses with BMI at six months post partum [odds ratio (OR) 1.09 versus 1.08], weight loss from delivery to six months post partum (OR 0.88 versus 0.88), and retained weight from the beginning of pregnancy until six months post partum (OR 1.23 versus 1.19). KEY CONCLUSIONS high BMI and weight retention at six months post partum increase the risk of urinary incontinence, whereas postpartum weight loss decreases the risk of urinary incontinence, even if other urinary incontinence risk factors co-exist. IMPLICATIONS FOR PRACTICE primary care midwifes can make a major contribution towards the prevention and rehabilitation of urinary incontinence in women. It is important for the midwife and the woman to keep in contact in the first six months post partum. Individualised advice about eating and exercise habits to avoid weight retention after pregnancy may have a considerable impact on decreasing the risk of urinary incontinence.

Grounded Theory: A Methodology Choice to Investigating Labia Minora Elongation Among Zambians in South Africa

A study on how Zambian migrants living in Cape Town perceive and experience the implications of labial elongation on women’s health was conducted. Labia minora elongation (LME) is a genital modification that some women in east and southern Africa practice. This tradition is not common in Western Cape province (southwestern part of South Africa). The aim of this article is to discuss the methodological choices made in the design and conduct of this study, in which a White European male interviewed the female study participants on the health implications of a practice that is considered a woman’s private issue. Constructivist grounded theory informed by a feminist perspective was chosen as the most suitable methodological approach to enable cogeneration of knowledge with the female participants. The methods and tools used by the lead investigator facilitated access to the participants’ emic views. Grounded theory methodology holds the potential to be an appropriate methodological approach for researchers who seek to erode the power imbalances influencing research processes that aim to explore the associated meanings and health implications of female genital modifications, such as LME, as narrated by the women who practice them.

Variables sociodemográficas relacionadas con embarazos no planificados en jóvenes de 13 a 24 años

Fundamentos: El embarazo no planificado (EnoP) sigue siendo un problema de salud publica. El objetivo de este estudio fue conocer los comportamientos sexuales y practicas contraceptivas relacionados con EnoP en las mujeres jovenes. Metodos: 583 mujeres de edades entre 13 y 24 anos, atendidas en una consulta de anticoncepcion durante el ano 2012. Variable dependiente: EnoP. Independientes: sociodemograficas, comportamientos sexuales y practicas contraceptivas. Analisis bivariante, pruebas de chi² y t de Student. Analisis multivariante mediante regresion logistica binaria. Resultados: 174 (29,8%) mujeres tuvieron un EnoP. El riesgo de EnoP aumento en mujeres inmigrantes [OR: 2,858 (IC95%:1,808-4,519)], en las jovenes con menor nivel de estudios (OR: 2,343 [IC95% 1,361-4,035]), en las que no utilizaron un metodo anticonceptivo seguro (todos menos el coitus interruptus) durante su primer coito (OR:3,043 (IC95% 1,900-4,875)], en las que manifestaron inconvenientes con el uso de los metodos anticonceptivos (OR: 2,092 [IC95% 1,267-3,454]) y en las que tuvieron asistencia irregular a la consulta (OR: 2,063 [IC95% 1,275-3,339]). No hubo relacion con la edad (adolescentes/jovenes). El modelo se considero aceptable: Hosmer-Lemeshow no significativo y con un poder de discriminacion del 77%. Conclusiones: Las variables predictoras de embarazo no planificado en mujeres jovenes son: ser inmigrante, tener bajo nivel de estudios, no utilizar metodo anticonceptivo seguro durante el primer coito, manifestar inconvenientes con los metodos anticonceptivos y tener una asistencia irregular a la consulta de anticoncepcion.

Condicionantes de género en anticoncepción: diseño y validación de un cuestionario

Resumen Objetivos Diseñar y validar un cuestionario sobre condicionantes de género en anticoncepción, para mujeres jóvenes. Método Se elaboró un cuestionario a partir de expresiones de las jóvenes atendidas en consulta de anticoncepción del Centro Municipal de Promoción de la Salud de Zaragoza. Autocumplimentaron el cuestionario 200 jóvenes entre 13 y 24 años, una joven no respondió. Se analizó la fiabilidad, con el coeficiente alfa de Cronbach y la validez de constructo con un análisis de componentes principales, con autovalores superiores a 1 y rotación Quartimax con kaiser. Resultados Cuestionario de 36 ítems. Tiempo de autoaplicación: 10 min. Consistencia interna buena, alfa de Cronbach de 0,853. Se establecieron 12 factores, con una explicación del 61,42% de varianza, y se configuraron 3 ejes descriptivos: la dimensión relacional («actitud sumisa», «actitud ciega», «dejarse llevar por afecto», «pareja dominante»), la identidad de género («maternidad como identidad», «maternidad no idealizada», «rol tradicional», «inseguridad en rol de género» «vergüenza en sexualidad») y el cuidado humano. Conclusiones Este cuestionario permite identificar los condicionantes de género que intervienen en la anticoncepción y servirá para investigar en qué modo los diferentes modelos de relación entre los sexos influyen en los problemas de salud sexual y reproductiva de las mujeres jóvenes, en nuestro entorno.OBJECTIVES To design and validate a questionnaire for young women on gender-determinant factors in contraception. METHOD A questionnaire was developed from conversations with young women attending contraception clinic in the Health Promotion Municpal Centre, Zaragoza. A total of 200 young women between the ages of 13 and 24 self-completed the questionnaire, with only one no response. Several items were analysed: reliability, using Cronbachs alpha coefficient, and construct validity by analysis of the main components with eigenvalues above 1, and Quartimax rotation with Kaiser normalisation. RESULTS The questionnaire contained 36 items and took 10minutes to self-complete. There was good internal consistency, with a Cronbachs alpha 0,853. Twelve factors were established with an explanation of 61.42% variance, and three descriptive lines: relationship dimension («submissive attitude», «blind attitude», «let go due to affection», «dominant partner»), gender identity («maternity as identity», «non-idealised maternity», «traditional role», «insecurity», «shame») and caring. CONCLUSIONS This questionnaire enabled gender determinant-factors that take part in contraception to be identified, and will be useful to find out how the different ways of relating between the sexes influence the problems of sexual and reproductive health in young women in our environment.

Assessing gender stereotypes and sexual risk practices in men who have sex with men

OBJECTIVE To analyze the construct validity and the internal consistency of the 12-item Bem Sex Role Inventory (BSRI-12) questionnaire and to study the association between gender stereotypes and sexual risk practices in men who have sex with men (MSM). METHODS Cross-sectional study of 601 MSM who voluntarily and anonymously responded to an online survey on risk practices and gender stereotypes. The BSRI-12 was used to obtain gender stereotypes (masculine, feminine, undifferentiated and androgynous). For data analysis, exploratory factor analysis (EFA) of the BSRI-12 and logistic regression were performed. RESULTS Two main factors (Cronbach alpha 0.95 and 0.81) were obtained from the EFA. Using the androgynous roles as the reference category, we found lower odds of engaging in unprotected anal intercourse (UAI) among those who endorse feminine roles (OR: 0.53; 95%CI: 0.29-0.95). Endorsing masculine roles with alcohol consumption (OR: 1.92; 95%CI: 1.15-3.20) or the undifferentiated when not knowing the partners serological status (OR: 1.55; 95%CI: 1.02-2.35) were associated with higher odds of UAI compared to those endorsing the androgynous roles. Undifferentiated participants also perform receptive UAI using poppers (OR: 2.19; 95%CI: 1.24-3.87), and insertive UAI not knowing the serological status of the sexual partner (OR: 1.69; 95%CI: 1.04-2.76) compared to androgynous participants. CONCLUSION The BSRI is a valid and consistent instrument for identifying gender stereotypes in MSM. A greater proportion of participants within the undifferentiated and the masculine category engage in risk practices with the influence of substance consumption and unawareness of their sexual partners serological status. The information obtained may be useful to define intervention and prevention programs.

Descripción de los instrumentos de medida de la movilidad en personas mayores de 65 años: revisión sistemática

BACKGROUND People over 65 are the ones who have higher levels of functional limitations. There are many instruments to measure mobility in this age range that causes a lack of international consensus on what are the most suitable for this purpose. The aim is to analyze and identify which instruments provide greater data reliability and validity in measuring mobility in elderly people. METHODS Systematic review of the instruments used to measure mobility in people over 65 years published between 2001-2013, conducted in PubMed and Science Direct. RESULTS The 34 items selected instruments were grouped into 4 categories: doubly labeled water (DLW), motion detectors, objective measures of mobility and questionnaires. We identified, 23 are questionnaires, 4 accelerometers, 3 to objective measures of mobility and 2 both pedometers as DLW. The other 2 to combined analysis of different instruments. CONCLUSIONS We conclude that assessing objective and subjective data obtains the most accurate measures of mobility. To obtain objective data, objective measures of mobility will be opposed to pedometers and accelerometers, while questionnaires were selected for subjective data due to its ease of use and sociodemographic data that provides. Among these instruments, the Short Physical Performance Battery (SPPB) and Minnesota Leisure Time are the most appropriate instruments to estimate the mobility of the elderly in Spain.BACKGROUND People over 65 are the ones who have higher levels of functional limitations. There are many instruments to measure mobility in this age range that causes a lack of international consensus on what are the most suitable for this purpose. The aim is to analyze and identify which instruments provide greater data reliability and validity in measuring mobility in elderly people. METHODS Systematic review of the instruments used to measure mobility in people over 65 years published between 2001-2013, conducted in PubMed and Science Direct. RESULTS The 34 items selected instruments were grouped into 4 categories: doubly labeled water (DLW), motion detectors, objective measures of mobility and questionnaires. We identified, 23 are questionnaires, 4 accelerometers, 3 to objective measures of mobility and 2 both pedometers as DLW. The other 2 to combined analysis of different instruments. CONCLUSIONS We conclude that assessing objective and subjective data obtains the most accurate measures of mobility. To obtain objective data, objective measures of mobility will be opposed to pedometers and accelerometers, while questionnaires were selected for subjective data due to its ease of use and sociodemographic data that provides. Among these instruments, the Short Physical Performance Battery (SPPB) and Minnesota Leisure Time are the most appropriate instruments to estimate the mobility of the elderly in Spain.Fundamentos: Las personas mayores de 65 anos son quienes presentan diferentes niveles de limitaciones funcionales. Existen multiples instrumentos de medicion de la movilidad en este grupo de edad y una falta de consenso internacional sobre cuales son los mas idoneos. El objetivo fue describir los instrumentos de medicion de la movilidad en personas mayores de 65 anos, determinar sus ventajas y limitaciones y comparar las caracteristicas de validez de cada instrumento para poder establecer cuales son los mas validos para este fin. Metodos: Revision sistematica de la bibliografia sobre instrumentos utilizados para medir la movilidad en personas mayores de 65 anos publicados entre 2001 a 2013. La busqueda se realizo en las bases de datos Pubmed y Science Direct. Resultados: Los 34 articulos seleccionados permitieron agrupar los instrumentos en 4 grupos: agua doblemente marcada (DLW), detectores de movimiento, medidas objetivas de la movilidad y cuestionarios. Del total de articulos, 23 correspondieron a cuestionarios, 4 fueron sobre acelerometros, 3 sobre medidas objetivas de la movilidad y 2 tanto sobre podometros como DLW. Los otros 2 hacian referencia al analisis combinado de diferentes instrumentos. Conclusiones: Las medidas de movilidad mas precisas se obtienen evaluando datos objetivos y subjetivos. Para obtener datos objetivos se usan las medidas objetivas de la movilidad frente a podometros y acelerometros, mientras que los cuestionarios son utilizados para obtener datos subjetivos debido a su facilidad de uso y a los datos sociodemograficos que aportan. Entre los instrumentos, el Short Physical Performance Battery (SPPB) y el Minesotta Leisure Time resultan los instrumentos mas idoneos para medir la movilidad de las personas mayores en Espana.People over 65 are the ones who have higher levels of functional limitations. There are many instruments to measure mobility in this age range that causes a lack of international consensus on what are the most suitable for this purpose. The aim is to analyze and identify which instruments provide greater data reliability and validity in measuring mobility in elderly people.Systematic review of the instruments used to measure mobility in people over 65 years published between 2001-2013, conducted in PubMed and Science Direct.The 34 items selected instruments were grouped into 4 categories: doubly labeled water (DLW), motion detectors, objective measures of mobility and questionnaires. We identified, 23 are questionnaires, 4 accelerometers, 3 to objective measures of mobility and 2 both pedometers as DLW. The other 2 to combined analysis of different instruments.We conclude that assessing objective and subjective data obtains the most accurate measures of mobility. To obtain objective data, objective measures of mobility will be opposed to pedometers and accelerometers, while questionnaires were selected for subjective data due to its ease of use and sociodemographic data that provides. Among these instruments, the Short Physical Performance Battery (SPPB) and Minnesota Leisure Time are the most appropriate instruments to estimate the mobility of the elderly in Spain.