Encarnación Rubio Aranda

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.

Enfermedades cronicas y deterioro funcional para las actividades de la vida diaria en poblacion mayor no institucionalizada

OBJECTIVE To analyze the influence of chronic medical conditions on functional performance of activities of daily living, both basic (BADL) and instrumental (IADL), among the socially-active older population. METHODS We performed a cross-sectional study of 380 individuals aged over 64 years old who regularly attended community centers in the city of Zaragoza. The Older Americans Resources and Services (OARS) questionnaire was completed in a personal interview. A multivariate logistic regression model was used to analyze functional capacities for BADL and IADL as dependent variables, and socio-demographic variables and chronic medical conditions as predictive variables. RESULTS The risk of showing dependence for BADL significantly increased in the presence of mild and severe mental illness (OR=4.02; 95% CI=1.81-8.95; and OR=10.61; 95% CI=4.68-24.05, respectively), heart disease (OR=2.79; 95%CI=1.32-5.91), rheumatism/osteoarthritis (OR=2.75; 95% CI=1.42-5.33) and age 75 years or older (OR=2.70; 95% CI=1.42-5.13). For IADL, these risks increased with mild and severe mental illness (OR=2.11; 95% CI=1.10-4.04; and OR=4.50; 95% CI=2.27-8.90, respectively), age 75 years or older (OR=3.06; 95% CI=1.78-5.25) and heart disease (OR=2.64; 95% CI=1.35-5.16). CONCLUSION There was greater level of independence for BADL than for IADL. The factor creating most dependence was mental illness, followed by heart disease and rheumatism/osteoarthritis. A declining ability to perform IADL should prompt early assessment of dependence, as it is the first sign to appear. Prevention is fundamental for independent functioning in older people.

Correlación entre los valores de monóxido de carbono en el aire espirado y los sistemas de medición de dependencia nicotínica DSM-IV, test de Fagerström y ARUSMQ-9 en adolescentes fumadores

Fundamento y objetivo: Conocer la correlacion, en jovenes fumadores, entre los valores de monoxido de carbono (CO) en el aire espirado y carboxihemoglobina (COHb), determinados mediante cooximetria, y las versiones adaptadas para adolescentes de los criterios nosologicos DSM-IV para la dependencia a la nicotina (DSM-IVa), test de Fagerstrom (FTNDa) y test ARU-SMQ-9a, a fin de determinar la utilidad de dichos tests para la medicion de la dependencia nicotinica en adolescentes. Sujetos y metodo: Estudio observacional y transversal realizado en 41 centros escolares, en los que se encuesto a 2.647 escolares de 10 a 17 anos. Se calculo un tamano muestral para cada edad, considerada en anos, mediante la ecuacion de poblaciones finitas. Para cada edad el muestreo fue estratificado por sexo y tipo de centro, proporcionalmente al numero de individuos. La eleccion de centros y alumnos se hizo mediante una tabla de numeros aleatorios. Los adolescentes respondieron a un cuestionario que comprendia el DSM-IVa, FTNDa y ARU-SMQ-9a, y posteriormente se les hizo una cooximetria. El estudio se baso en los 583 escolares fumadores que realizaron la cooximetria. Resultados: El 23,1% de los sujetos eran fumadores. La correlacion entre los valores de CO y los tests de dependencia nicotinica fue: en el caso del DSM-IVa, ?o = 0,3390 (p = 0,000); en el FTNDa, ?o = 0,5853 (p = 0,000), y en el ARU-SMQ-9a, ?o = 0,4670 (p = 0,000). La correlacion con los valores de COHb fue: DSM-IVa, ?o = 0,3369 (p = 0,000); FTNDa, *o = 0,5498 (p = 0,000), y ARU-SMQ-9a, ?o = 0,4460 (p = 0,000). Conclusiones: La correlacion existente entre DSM-IVa, FTNDa y ARU-SMQ-9a, y los valores de CO y COHb en jovenes fumadores es baja pero significativa. Se debe seguir investigando en la busqueda de nuevos instrumentos sencillos, baratos y facilmente accesibles que permitan el correcto diagnostico y seguimiento del joven fumador.

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.

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.

Factors Associated With Treatment‐Seeking Behavior for Postpartum Urinary Incontinence

PURPOSE To identify the factors associated with treatment-seeking behavior for urinary incontinence (UI) among postpartum women. DESIGN This is a cross-sectional study. A total of 142 women with postpartum UI responded a telephone interview between August of 2010 and March of 2011. The association between the treatment-seeking and the predicting variables were measured through odds ratio and 95% confidence interval. RESULTS The treatment-seeking percentage was 37.3% and the treatment percentage was 27.5%. The result of multiple logistic regressions indicated that: counseling about UI in pregnancy, postpartum physical exercise, and Spanish nationality predicted 47.8% of the variance in treatment-seeking behavior CONCLUSIONS The lack of counseling largely determines the low rates of treatment-seeking among Spanish mothers. CLINICAL RELEVANCE Nursing counseling during pregnancy can contribute substantially to increasing the number of women treated for postpartum UI.

Cuidados familiares prestados por los ancianos del ámbito rural a distintas generaciones

Objectives: To describe the profile of caregivers higher in rural areas, to analyze sociodemographic differences in health and social relations between family caregivers and non-caregivers, and service needs unmet. Methodology: We surveyed 787 people over 64 noninstitutionalized belonging to the Basic Health Area of Zaragoza. Variables were collected through the questionnaire OARS-MAFQ (OARS): sociodemographic, need for services, assessment of social, economic and physical health. Other variables were: functional capacity for activities of daily living, basic and instrumental, body mass index and physical activity undertaken. Results: All caregivers of children/grandchildren were independent for activities of daily living, performed more physically active, had good physical and so perceived. Noncaregivers had the highest proportion of dependence and depression. The three groups had good social and economic resources, although significantly higher in those who care for children/grandchildren in which needs were perceived as more public transport and travel more. Non-caregivers reported more need for help with bathing, dressing, household chores and meal preparation. Caregivers of spouses/parents needed more treatment to personal or family problems. There was a great need for nursing care in the three groups. Conclusions: The profile, characteristics and needs of caregiver and no-caregiver were different, coinciding only in high need for nursing care.

Type of partner, socio-economic factors and risk practices in men who have sex with men

OBJECTIVE Men who have sex with men (MSM) perform risk practices that pose a challenge to prevention strategies. The aim of this study was to analyse the association between receptive and insertive unprotected anal intercourse (RUAI and IUAI) according to the type of partner and the practice of barebacking with socioeconomic factors. METHODS A descriptive study was conducted through a self-administered questionnaire distributed by a software tool in social networks and non-governmental organizations from June-2014 to January-2015. Participants consisted of 601 people living in Spain. Pearsons χ(2) test and logistic regression models were applied with odds ratios (OR) and 95% confidence intervals (95% CI). RESULTS In stable couples, the risk of RUAI increased in individuals with a medium income (OR: 1.79; 95%CI: 1.14-2.80) and in those who lived together (OR: 2.94; 95%CI: 1.74-4.98) and IUAI increased in individuals living with a partner (OR: 5.58; 95%IC: 3.24-9.59). When the partner was a friend, the risk of RUAI was higher among individuals with secondary education (OR: 2.20; 95%CI: 1.44-3.36) and those who were retired (OR: 3.6; 95%CI: 1.25-10.37), while living with a partner was a protective factor (OR: 0.56; 95%CI: 0.32-0.98). The risk of barebacking was greater in younger men (OR: 2.59; 95%CI: 1.27-5.28), in those with secondary education (OR: 1.51; 95%CI: 0.99-2.29) and in those living with a partner (OR: 3.64; 95%CI: 2.12-6.24). DISCUSSION There is a need to reduce vulnerability due to socioeconomic factors that influence engagement in risk practices and to highlight the importance of barebacking, mainly in young MSM. Partner-based interventions and harm reduction strategies should be incorporated into preventive strategies.

Pareja, situaciones socioeconómicas y prácticas de riesgo en hombres que tienen sexo con hombres

OBJECTIVE Men who have sex with men (MSM) perform risk practices that pose a challenge to prevention strategies. The aim of this study was to analyse the association between receptive and insertive unprotected anal intercourse (RUAI and IUAI) according to the type of partner and the practice of barebacking with socioeconomic factors. METHODS A descriptive study was conducted through a self-administered questionnaire distributed by a software tool in social networks and non-governmental organizations from June-2014 to January-2015. Participants consisted of 601 people living in Spain. Pearsons χ(2) test and logistic regression models were applied with odds ratios (OR) and 95% confidence intervals (95% CI). RESULTS In stable couples, the risk of RUAI increased in individuals with a medium income (OR: 1.79; 95%CI: 1.14-2.80) and in those who lived together (OR: 2.94; 95%CI: 1.74-4.98) and IUAI increased in individuals living with a partner (OR: 5.58; 95%IC: 3.24-9.59). When the partner was a friend, the risk of RUAI was higher among individuals with secondary education (OR: 2.20; 95%CI: 1.44-3.36) and those who were retired (OR: 3.6; 95%CI: 1.25-10.37), while living with a partner was a protective factor (OR: 0.56; 95%CI: 0.32-0.98). The risk of barebacking was greater in younger men (OR: 2.59; 95%CI: 1.27-5.28), in those with secondary education (OR: 1.51; 95%CI: 0.99-2.29) and in those living with a partner (OR: 3.64; 95%CI: 2.12-6.24). DISCUSSION There is a need to reduce vulnerability due to socioeconomic factors that influence engagement in risk practices and to highlight the importance of barebacking, mainly in young MSM. Partner-based interventions and harm reduction strategies should be incorporated into preventive strategies.

Incontinencia urinaria a los 6 meses del parto

BACKGROUND AND OBJECTIVE Urinary incontinence initiated before and right after delivery and persisting 3 months after delivery tends to become chronic. We intended to estimate the persistence of urinary incontinence 6 months postpartum and to analyse the different factors associated with it. PATIENTS AND METHODS Follow-up study 6 months after delivery of women presenting urinary incontinence symptoms in gestation or in the first 2 months of postpartum. The dependent variable was the persistence and the independent variables were grouped in obstetric and non-obstetric. Odds ratio (OR) were calculated with their confidence interval at 95% (IC 95%) in the bivariate analysis. The variables that showed an important risk of persistence of incontinence were used to perform a multivariate model of logistic regression. RESULTS The persistence of incontinence 6 months after delivery was 21.4% (CI 95% 16-26.7). The risk of persistence increased with the Kristeller maneuver (OR 7.89, CI 95% 3.04-20.49), not weight recovery (OR 3.64, CI 95% 1.10-12.02), not practising pelvic floor muscle exercises in postpartum (OR 9.36, CI 95% 2.71-32.33), appearance of incontinence after delivery (OR 6.66, CI 95% 2.37-18.68) and the weight of the newborn>3.5 kg (OR 6.76, CI 95% 2.54-18.03), all of them explaining 58% of the variability of persistence. CONCLUSION 21.4% of women with urinary incontinence caused by pregnancy/delivery will continue to have it 6 months postpartum. An important part of this persistence is associated with some factors easy to modify.