Environmental health knowledge and competences in Basque health workers. A comparison of different professional profiles.

Environmental exposures are responsible for a quarter of morbidity and mortality rates globally. Primary care professionals work in a privileged position to detect and intervene on environmental health matters. Nevertheless, due to lack of specific training, international literature shows that primary care health professionals have limited skills to deal with those. The objectives of this study were to assess the levels of environmental health (EH) knowledge and competence of a sample of 446 health professionals and students in the Basque Country and explore the presence that EH has on their daily practice. Only a very small proportion of participants had received training and took environmental clinical history regularly. Participants were confident to deal, and actually dealt, with tobacco, pollen and sun exposures but less able to address topics like biomarkers, pesticides and endocrine disruptors. Finally, and in accordance to previous works, we found moderate levels of EH knowledge and skills in our sample, and observed that nurses and nursing students reported higher EH skills than other professional profiles but scored lower in knowledge. Despite the manifold impacts of environmental exposures on health, interventions to strengthen health professionals' EH competence are required.

Factors involved in the persistence of stress urinary incontinence from postpartum to 12 years after first delivery.

AIMS: The aim of this study was to investigate constitutional-, pregnancy-, labor-, and delivery-related factors involved in the long-term persistence of stress urinary incontinence (SUI) from 6 months postpartum to 12 years after first delivery. We also evaluated severity and impact on quality of life of persistent SUI. METHODS: This was a longitudinal study including primigravid women who gave birth at our Public Health Hospital during 2007. Urinary symptoms were investigated at inclusion, 6 months and 12 years after delivery. Persistent SUI was defined as SUI reported both at 6 months postpartum and 12 years after first delivery. The International Consultation on Incontinence-Urinary Incontinence-Short Form (ICIQ-UI-SF) and the Incontinence Severity Index (ISI) were used to evaluate SUI. RESULTS: During the inclusion period, 479 pregnant women were interviewed, 381 attended the 6-month follow-up visit, and 315 formed the study group. SUI persisted in 36 out of 44 (81.8%) women. With the ISI, 52.8% of these women were categorized as having slight, 41.7% moderate, and 5.6% severe incontinence. The mean ICIQ-UI-SF score was 7.13 (SD 3.51). Pregnancy SUI (odds ratio [OR], 4.54; 95% confidence interval [CI], 2.10-9.80) and active second stage of labor more than or equal to 1 hour (OR, 3.68; 95% CI, 1.21-11.14) were independently associated with persistent SUI. CONCLUSIONS: Women who reported SUI during pregnancy, and those who had pushed for more than or equal to 1 hour in the second stage of labor were at greater risk of SUI persisting from 6 months postpartum to long after delivery. We found this independent association after controlling for several constitutional-, pregnancy-, labor-, and delivery-related variables.

Robotic retroperitoneal paraaortic lymphadenectomy at Donostia University Hospital.

The purpose of this study was to describe our robotic retroperitoneal para-aortic lymphadenectomy technique and its associated outcomes as well as the advantages and disadvantages. We prospectively collected data on all retroperitoneal aortocaval lymphadenectomy procedures performed at Donostia University Hospital from December 2011 to April 2013 using the da Vinci S robotic system (Intuitive Surgical, Sunnyvale,CA). A total of 13 of these procedures were performed. The mean patient age was 60.3 years (SD, 10.18). Most patients were obese with a mean body mass index of 31.95 kg/m(2) (SD, 5), and 9 had endometrial cancer. Five individuals were restaged: 4 because of lymphovascular space invasion and 1 because of lymphovascular space invasion with G3 histology. There were 2 cases of Fédération Internationale de Gynécologie et d'Obstétrique stage IB endometrial cancer: 1 of papillary serous histology and 1 of G3. Two patients had advanced cervical cancer, and 2 had early-stage ovarian cancer. The median para-aortic lymph node yield was 12 (range, 4-21). In 3 patients, it was necessary to convert the procedure to transperitoneal access because of technical difficulties; 1 of these required laparotomy. The mean surgical time was 323 minutes (SD, 58) although this included additional complex procedures. Robotic para-aortic retroperitoneal lymphadenectomy is feasible and offers the advantages of retroperitoneal access.

Postpartum impairment of pelvic floor muscle function: factors involved and association with prolapse.

INTRODUCTION AND HYPOTHESIS: The aim of this study is to assess factors involved in the impairment of pelvic floor muscle (PFM) function from antepartum to 6 months postpartum. We also investigated whether reduced PFM strength was associated with pelvic organ prolapse (POP) postpartum. METHODS: This was a prospective cohort study including 319 primigravid women delivered vaginally. PFM function was assessed in pregnant women at term and 6 months postpartum by digital palpation and perineometry. Prolapse was explored using the POP quantification (POP-Q) system. RESULTS: Instrumental delivery, larger newborn head circumference, and older maternal age were independent risk factors for impaired PFM function postpartum. Women with POP-Q stage ≥ II postpartum had a significant decrease in PFM strength with respect to the antepartum period, and lower PFM strength than women without such prolapse. CONCLUSIONS: Both constitutional and obstetric factors are involved in impairment of PFM function postpartum. Reduced PFM strength is associated with prolapse in the postpartum period.

Factors involved in stress urinary incontinence 1 year after first delivery.

INTRODUCTION AND HYPOTHESIS: The aim of the study was to investigate the risk factors involved in stress urinary incontinence (SUI) 1 year after first delivery. METHODS: This was a longitudinal study of 352 primigravid women who gave birth at Donostia Hospital during 2007. Urinary symptoms were investigated (Abrams et al., Neurourol Urodyn 21:167-178, 2002) on inclusion and 1 year after delivery, and the incontinence severity index (ISI) was calculated. Incontinent women answered the International Consultation on Incontinence short form questionnaire. Pelvic floor muscle strength and joint hypermobility were evaluated. RESULTS: SUI affected 40 (11.4%) women 1 year after first delivery. The ISI distribution was: 62.5% slight, 32.5% moderate, 2.5% severe and 2.5% very severe. The only factor independently associated with SUI after delivery was the development of SUI during pregnancy (OR, 5.79; 95% CI, 2.79-12.00). CONCLUSIONS: The new onset of SUI during pregnancy is an independent risk factor for SUI in the postpartum period.

What Accounts for Physical Activity during Pregnancy? A Study on the Sociodemographic Predictors of Self-Reported and Objectively Assessed Physical Activity during the 1st and 2nd Trimesters of Pregnancy.

Physical activity (PA) during pregnancy has positive health implications for both mother and child. However, current literature indicates that not all pregnant women meet the international recommendations for PA (at least 150 min/week of moderate-to-vigorous PA). The main objective of this study was to assess PA levels among pregnant women in the city of Donostia-San Sebastian and identify their main sociodemographic predictors. We recruited 441 women in the 12th week of pregnancy from the local public obstetric health services. Women wore an accelerometer for one week during two separate time points (1st and 2nd trimesters of pregnancy) and completed a questionnaire assessing several sociodemographic variables as well as self-reported PA. With this information, we estimated women's overall PA levels during both time points. The fulfillment of PA recommendations raised up to 77% and 85% during the first and second trimesters, respectively. We found that a higher number of children and a greater preference for exercise positively predicted light-to-moderate PA, being the most consistent predictors. The availability of a greater number of cars negatively predicted moderate-to-vigorous PA.

Factors involved in the persistence of stress urinary incontinence from pregnancy to 2 years post partum.

OBJECTIVE: To identify factors involved in the persistence of stress urinary incontinence (SUI) from pregnancy to 2 years post partum. METHOD: In a longitudinal study at Donostia Hospital, San Sebastián, Spain, 458 primigravid women were recruited from April to October 2007. SUI was diagnosed via the 2002 International Continence Society definition. Severity was assessed via the Incontinence Severity Index, and impact on quality of life via the International Consultation on Incontinence Questionnaire. Means (Student t test and analysis of variance) and percentages (χ(2) and Fisher exact tests) were compared, and multiple logistic regression analysis was performed with variables that were significant or close to significant in a univariate analysis (P<0.2). RESULTS: Among 272 eligible women attending follow-up at 2 years post partum, 26 (9.5%) women reported persistent SUI since pregnancy. Incontinence severity was slight or moderate in most cases and the impact on quality of life was low. A higher body mass index (BMI) in pregnant women at term was the only factor found to be associated with persistent SUI (odds ratio 1.19; 95% confidence interval 1.08-1.32). CONCLUSION: Higher BMI in pregnant women at term was an independent risk factor for the persistence of SUI from pregnancy to 2 years post partum.

Stress urinary incontinence six months after first vaginal delivery.

OBJECTIVE: To determine the prevalence, severity and impact on quality of life of stress urinary incontinence (SUI) six months after the first vaginal delivery, as well as to investigate the risk factors associated with it. STUDY DESIGN: We designed a prospective study that included 396 women who had their first vaginal delivery in the Hospital Donostia. Diagnosis and identification of the type of urinary incontinence were carried out considering the 2002 ICS definitions. Women were interviewed and examined twice, at term and six months after delivery. The severity of the symptoms was evaluated with the Incontinence Severity Index (ISI) and the impact on quality of life was evaluated with the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form. The statistical analysis included comparison of means (Student's t-test or analysis of variance) and proportions (Chi square and Fisher's exact tests). Multiple logistic regression analysis was performed using variables that were close to statistical significance. RESULTS: 15.1% of the women reported SUI six months after their first vaginal delivery. The ISI was slight or moderate in the majority of the cases and the impact on quality of life was low. The presence of SUI in pregnant women at term was the only independent risk factor associated with SUI after delivery (OR: 3.71; 95% IC: 1.95-7.06). The type of vaginal delivery did not influence in SUI six months after the birth, not even in women who were continent during pregnancy. CONCLUSIONS: Slight or moderate SUI was common after the first vaginal delivery and the impact on quality of life was low. Urinary incontinence during pregnancy was the only risk factor independently associated with the presence of SUI six months after the first vaginal delivery.

Influence of maternal weight on the new onset of stress urinary incontinence in pregnant women.

INTRODUCTION AND HYPOTHESIS: The aim of the study was to investigate the incidence and severity of stress urinary incontinence (SUI) in primigravid women at term and its association with maternal body weight. METHODS: This was an observational study of 458 primigravid women who came to give birth at Donostia Hospital during 2007. Urinary symptoms were investigated (2002 ICS definitions), and a physical examination including height, weight, pelvic floor muscle strength, and fetal presentation was performed. We calculated the incontinence severity index (ISI) and the women answered the International Consultation on Incontinence short form questionnaire. RESULTS: SUI affected 139 (30.3%) primigravid women. The ISI distribution was 40.3% slight, 54.7% moderate, 4.3% severe, and 0.7% very severe. Pregnant women at term with body weight >or=75 kg appear to have more than doubled the risk of presenting SUI. CONCLUSIONS: The incidence of SUI is high in pregnancy. Increased maternal body weight at term is an independent risk factor for incontinence.