A Qualitative Exploration of the Perceptions of Women Living with Pelvic Floor Disorders and Factors Related to Quality of Life.

Background: Pelvic floor dysfunction encompasses conditions like urinary and fecal incontinence, pelvic organ prolapse, and pelvic pain, significantly affecting women's quality of life. Despite its prevalence, few studies have adopted a qualitative approach to understanding women's perceptions and emotions regarding these issues. This study aims to delve into how women with pelvic floor disorders perceive their condition and its impact on their daily lives. Methods: We analyzed qualitative data from interviews with 160 women suffering from pelvic floor dysfunctions. Using inductive qualitative content analysis, we systematically examined the data to identify variations, differences, and similarities. Results: The analysis revealed four primary themes in the women's narratives: "Physical Impacts", "Emotional and Psychological Impacts", "Social and Relational Impacts", and "Sexual Health Impacts", along with 12 subthemes. The findings predominantly highlight how pelvic floor dysfunctions detrimentally affect women's quality of life and emotional well-being, instilling fear and insecurity in daily activities, compounded by sleep disturbances and sexual dysfunction. Conclusions: Women living with pelvic floor dysfunction face multifaceted challenges that adversely affect various aspects of their lives, diminishing their overall quality of life. This includes notable impacts on sleep, physical, and sexual activities. However, not all affected women report these issues, often due to fear of stigma, choosing instead to conceal their struggles in an effort to maintain an appearance of normalcy.

Influence of Pelvic Floor Disorders on Sleep Quality in Women.

Pelvic floor disorders, the impact of their symptoms, and their association with sleep quality and sleep disorders is a little studied area. The aim of this study was to determine if an association exists between pelvic floor disorders in women and sleep disorders. An observational study was conducted among women in Spain during 2021 and 2022. A self-developed questionnaire was used to collect sociodemographic and employment data, previous medical history and health status, lifestyle and habits, obstetric history, and health problems. A validated questionnaire, the Pittsburgh Sleep Quality Index (PSQI), was used to assess the quality of sleep. The presence and impact of pelvic floor problems was assessed with the Pelvic Floor Distress Inventory (PFDI-20). Odds ratios (OR) and adjusted odds ratios (aOR) with their respective 95% confidence intervals were calculated using logistic regression. A total of 1396 women participated in the study. The total PSQI indicated that 75.36% (1052) of women have altered general sleep quality. Women with pelvic floor disorders have a higher probability of developing sleep alterations (aOR: 1.32; 95% CI: 1.22-1.42; for every 20 points). A high BMI (aOR: 1.04; 95% CI: 1.01-1.07; for each point) and the presence of musculoskeletal disorders (aOR: 3.14; 95% CI: 1.20-8.27) are also associated with sleep quality in women. Women with pelvic floor disorders are more likely to develop sleep disorders, probably due to all the discomfort they entail.

Influence of pelvic floor disorders on sexuality in women.

OBJECTIVE: To determine the association between different pelvic floor disorders and the presence of sexual dysfunction in women. METHOD: An observational study of non-pregnant women was carried out in Spain in 2021 and 2022. To assess the presence of pelvic floor problems, the Pelvic Floor Distress Inventory (PFDI-20) was used, consisting of the subscales Pelvic Organ Prolapse Distress Inventory-6 (POPDI-6; prolapse symptoms), Colorectal-Anal Distress Inventory (CRADI-8; colorectal symptoms), and Urinary Distress Inventory-6 (UDI-6; urinary symptoms). The validated tool, Female Sexual Function (FSF), was used to evaluate female sexual function. RESULTS: In total, 1008 women participated. Of these, 288 (28.6%) had some type of sexual dysfunction. Regarding symptoms, 52 (5.2%) stated that they do not reach orgasm and 172 (17.1%) said they had never or occasionally felt sexual desire in the last month. Women with sexual dysfunctions had higher mean scores on the POPDI-6, CRADI-8, and UDI-6 subscales than those who did not have sexual dysfunction (P ≤ 0.005). Risk factors identified included being postmenopausal, with an adjusted odds ratio (aOR) of 2.98 (95% confidence interval [CI] 2.12-4.18), and a greater impact of the symptoms of pelvic floor problems as assessed by the PFDI-20 scale, in such a way that for each point increase the probability of sexual dysfunction increases with an aOR of 1.008 (95% CI 1.005-1.011). CONCLUSION: Women with pelvic floor disorders and postmenopausal women present sexual dysfunction more frequently.

Influence of pelvic floor disorders on quality of life in women.

Objective: To determine whether the different pelvic floor disorders are associated with changes in perceived quality of life (QoL), globally and in its sub-dimensions. Methods: An observational study was conducted with women in Spain between 2021 and 2022. Information was collected using a self-developed questionnaire on sociodemographic data, employment, history and health status, lifestyle and habits, obstetric history, and health problems. The SF-12 questionnaire was used to assess quality of life. The Pelvic Floor Distress Inventory (PFDI-20) was used to assess the presence and impact of pelvic floor problems, and includes the POPDI-6 subscales for prolapse, CRADI- 8 for colorectal symptoms, and UDI-6 for urinary symptoms. Crude (MD) and adjusted mean differences (aMD) were estimated with their respective 95% confidence intervals (CI). Results: Thousand four hundred and forty six women participated in the study with a mean age of 44.27 (SD = 14.68). A statistical association was observed between all the pelvic floor disorders and QoL, overall and in all its dimensions (p <0.001), in the bivariable analysis. The lowest scores were observed in the emotional component. After adjusting for confounding factors, the pelvic floor disorders in general (aMD -0.21, 95% CI: -0.23 to -0.20), the impact of uterine prolapse symptoms (aMD -0.20, 95% CI: -0.27 to -0.12), the colorectal-anal symptoms (aMD -0.15, 95% CI: -0.22 to -0.09), and urinary symptoms (aMD -0.07, 95% CI: -0.13 to -0.03) was negatively associated on the score on the SF-12 questionnaire (p <0.05). Conclusions: Women who have a pelvic floor dysfunction, symptoms of pelvic organ prolapse, colorectal-anal symptoms, or urinary symptoms, have a worse perceived quality of life in all dimensions. Prolapse symptoms have the biggest impact, and the emotional component of QoL is the most affected sub-domains.

Pelvic floor dysfunction: prevalence and associated factors.

BACKGROUND: Pelvic floor dysfunction in women encompasses a wide range of clinical disorders: urinary incontinence, pelvic organ prolapse, fecal incontinence, and pelvic-perineal region pain syndrome. A literature review did not identify any articles addressing the prevalence of all pelvic floor dysfunctions. OBJECTIVE: Determine the prevalence of the group of pelvic floor disorders and the factors associated with the development of these disorders in women. MATERIAL AND METHODS: This observational study was conducted with women during 2021 and 2022 in Spain. Sociodemographic and employment data, previous medical history and health status, lifestyle and habits, obstetric history, and health problems were collected through a self-developed questionnaire. The Pelvic Floor Distress Inventory (PFDI-20) was used to assess the presence and impact of pelvic floor disorders. Pearson's Chi-Square, Odds Ratio (OR) and adjusted Odds Ratio (aOR) with their respective 95% confidence intervals (CI) were calculated. RESULTS: One thousand four hundred forty-six women participated. Urinary incontinence occurred in 55.8% (807) of the women, fecal incontinence in 10.4% (150), symptomatic uterine prolapse in 14.0% (203), and 18.7% (271) reported pain in the pelvic area. The following were identified as factors that increase the probability of urinary incontinence: menopausal status. For fecal incontinence: having had instrumental births. Factors for pelvic organ prolapse: number of vaginal births, one, two or more. Factors for pelvic pain: the existence of fetal macrosomia. CONCLUSIONS: The prevalence of pelvic floor dysfunction in women is high. Various sociodemographic factors such as age, having a gastrointestinal disease, having had vaginal births, and instrumental vaginal births are associated with a greater probability of having pelvic floor dysfunction. Health personnel must take these factors into account to prevent the appearance of these dysfunctions.

Impact and Influence of Urinary Incontinence on Physical Activity Levels.

Background: The benefits of physical activity are numerous on both physical and mental levels. Urinary incontinence (UI) can influence physical activity level; among US women, nearly two out of three view this problem as a barrier to physical activity, meaning that they do not exercise, exercise less, or even have to change their activity routines to accommodate this pelvic floor dysfunction. Objective: To determine whether UI influences the pattern of physical activity and whether a greater impact of urinary symptoms could influence the level of physical activity. Design setting and participants: An observational study was carried out with women in 2021 and 2022 in Spain. Outcome measurements and statistical analysis: The main dependent variable was level physical activity, as measured by the International Physical Activity Questionnaire (IPAQ). The Urogenital Distress Inventory (UDI-6) scale was used to determine the presence of UI and its impact. Sociodemographic, health status, lifestyle and obstetric data were obtained. Bivariate and multivariate analyses were performed using binary logistic regression, obtaining adjusted odds ratio (aOR) with its 95% confidence interval (95% CI). Results and limitations: A total of 1446 women participated, of whom 55.8% (807) had UI and 25.7% (371) reported low physical activity. Mixed incontinence (aOR: 1.53; 95% CI: 1.09-2.15) overall and a greater intensity of urinary symptoms (UDI-6 score; aOR: 1.014; 95% CI: 1.01-1.02) in the group of women with incontinence were statistically associated with a higher frequency of low physical activity. Other variables related to low physical activity were age, body mass index, pelvic pain, and income level (p < 0.001). Conclusions: Mixed-type UI is associated with low-level physical activity or inactivity in the whole group of women, while among women with UI, the greater impact of the symptoms increases the probability of low physical activity or inactivity. Patient summary: In this report, it is analyzed how urinary incontinence affects physical activity. It was found that women who suffer from mixed-type urinary incontinence have a low level of physical activity or inactivity, while those who experience a greater impact of urinary incontinence symptoms have an increased likelihood of having low physical activity or inactivity.

Association between sexual function in women and sleep quality.

Objective: To determine the relationship between sexual dysfunction and sleep disorders. Methods: Observational study was conducted in 2021 and 2022 including 975 Spanish women over 18 years of age. The Women's Sexual Function Questionnaire (FSM-12) was used as a source of information, and the Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality. A bivariate and multivariate analysis was performed using binary logistic regression, adjusting for confounding variables. Crude (OR) and adjusted (aOR) odds ratios were estimated with their respective 95% confidence intervals (CI). Results: Around 29.2% (285) of the women presented some type of sexual dysfunction, and 73.4% (716) showed sleep disturbance with scores ≥5 on the PSQI scale. The mean score on the PSQI was 8.23 points (SD = 3.93). All the dimensions of the sexual function scale were statistically related to sleep disturbance (p ≤ 0.05), except for sexual activity and the reasons for sexual activity not having penetration. In the multivariable analysis, women with sexual dysfunction presented an aOR of sleep disturbance of 1.88 (95% CI: 1.29-2.76) compared to women without dysfunction. Conclusion: Global sexual dysfunction and almost all the dimensions that make up sexual function are related to changes in sleep quality.

Magnitude of general anxiety disorder among nursing students and its associated factors.

Background: University training in nursing together with other student variables can increase the risk of anxiety in students. It is important to assess the student's level of anxiety, which can have repercussions on their training and mental health. There are several validated tools such as the generalized anxiety disorder scale (GAD-7). Objective: To know which factors are associated with the appearance of anxiety and which protect against it in university nursing students. Method: A cross-sectional descriptive study was carried out in which 170 university nursing students from University of Jaén participated. A bivariate and multivariate analysis was performed, calculating odds ratio and adjusted odds ratio (aOR) with 95% confidence intervals (CIs) to determine which factors were associated with a higher score on the GAD-7 questionnaire, and therefore with the presence of anxiety. Results: In total, 66.5% (113) of the students have suffered an anxiety crisis on some occasion and 48.8% (83) of the students did not carry out activities of any kind to control anxiety and stress. Practicing religious and spiritual beliefs increased the probability of having anxiety compared to those who did not have religious beliefs (aOR = 3.92; 95% CI = 1.09, 14.08), as well as having previously suffered an anxiety crisis (aOR = 5.13; 95% CI = 2.39, 11.04). Protective factors against anxiety appear to be second-year students (aOR = 0.33; 95% CI = 0.16, 0.72) and being deeply satisfied with the teaching staff (aOR = 0.03; 95% CI = 0.01, 0.79). Discussion/Implications for practice: Knowing the factors that are associated with the appearance of anxiety is necessary to facilitate early detection and care in nursing university students.

Nursing students' attitudes towards sexuality before training in sexual and reproductive health.

AIM: To know the attitudes towards sexuality of nursing students and those sociodemographic and cultural factors that can influence it. DESIGN: An observational study was carried out on Nursing degree students. One hundred and eighteen nursing degree students who were going to take the sexual and reproductive health nursing course. METHODS: A self-administered online questionnaire. This questionnaire had several parts specifically designed to collect sociodemographic variables. In order to determine the attitudes towards sexuality, the questionnaire based on the ATSS (Attitudes Towards Sexuality Scale). The Double Standard Scale (DSS) was also used. This scale evaluates double standards within the area of sexuality. The Rape Supportive Attitude Scale (RSAS), was included to determine beliefs about rape, rapists and their victims. RESULTS: The ATSS shows a statistically significant association with religious beliefs (p = 0.005), with mean scores of 113.84 (SD = 9.81) for non-believers (no religion), 108.36 (SD = 15.68) for non-practicing believers and 102.32 (SD = 17.87) for believers (those who practice their faith). The mean score in the DSS shows a statistically significant association with alcohol consumption (p = 0.001). The mean score on the RSAS is statistically significantly associated with the place of residence (p = 0.050), the means were 44.32 (SD = 9.26) for those who lived in the city, 34.94 (SD = 19.21) if the place of residence was between 10,000 and 5000 inhabitants and 32.54 (SD = 15.01) if the family home was in a town with less than 5000 inhabitants. CONCLUSION: Religious beliefs reduce liberalism and positive attitudes towards sexuality, whereas sporadic alcohol consumption increases them. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Pandemic-related stress in pregnant women during the first COVID-19 lockdown and neonatal development.

BACKGROUND: Maternal stress and psychopathology have a negative effect on mothers and neonates. Maternal stress may affect neonatal growth and development both physically and psychologically. PURPOSE: To study the impact of pandemic-related pregnancy stress and maternal psychopathological symptoms during the COVID-19 lockdown in 2020 on neonatal development. METHODS: A two-phase prospective study was carried out on a sample of 181 pregnant women ranged from 18 to 40 years old in Spain (Europe). Phase 1: Pandemic-related pregnancy stress (PREPS), Prenatal Distress Questionnaire (PDQ), Perceived Stress Scale (PSS) and the revised version of the Symptom Checklist-90 (SCL-90-R) were used to assess psychological symptoms during the lockdown. In the follow-up (Phase 2), obstetric, birth-related and anthropometric variables were collected from 81 pregnant women-neonates dyads. RESULTS: Primiparous women showed higher psychopathological symptoms and higher levels of pandemic-related pregnancy stress than multiparous women. A multiple linear regression model showed that pandemic-related pregnancy stress could predict the length of neonate by adjusting for maternal age and gestational age, especially for primiparous women. IMPLICATIONS FOR RESEARCH: Studies assessing neonates development should evaluate the long-term effect of the COVID-19 pandemic on neonates´ length. IMPLICATIONS FOR PRACTICE: States the relation between pandemic-related pregnancy stress and neonatal development by being able to track the effects on neonates whose mothers had high levels of stress during the COVID-19 pandemic.

Differences in Psychological Symptoms in Pregnancy and Postpartum before and during COVID-19: A Cross-sectional Study / Las diferencias en los síntomas psicológicos durante el embarazo y el postparto antes y después del COVID-19: un estudio transversal

Rationale: Pregnant women are especially vulnerable to mental health problems, including stress, anxiety, and depression. This risk has been increased during the COVID-19 pandemic and differences in psychological symptoms in pregnancy and postpartum before and during COVID-19 exists. Mental health problems can have adverse effects on both the woman, and the neonate, including miscarriages, premature births, low birth weight, and higher rates of cesarean sections and instrument-assisted deliveries. Aim: To evaluate the prevalence of psychological symptoms of pregnant women before and during the COVID-19 pandemic. Method: A cross-sectional study was carried out to assess the psychological profile in a sample of pregnant women selected before the pandemic and a sample of women studied during the first wave of the pandemic. A total of 122 women were selected prior to the pandemic and 181 women during the COVID-19 outbreak. The Symptom Checklist-90 Revised (SCL-90-R) was used to assess depression and anxiety during pregnancy and in the postpartum period. Results: The prevalence of symptoms of depression and anxiety during pregnancy were higher in the sample of women studied during the pandemic (SCL-90-R: M = 54.6 vs. 42.6 and M = 62.6 vs. 51.7 respectively). In the postpartum the difference between both samples of women was even higher for depression and anxiety (SCL-90-R: M = 50.4 vs. 35.0 and M = 51.3 vs. 36.0 respectively). Being a pregnant woman at the COVID-19 outbreak was directly associated with a higher score of depression symptoms (aOR = 8.67, 95% CI [3.26, 23.02], p < .001). Anxiety during childbirth was more frequently reported by women before the pandemic (aOR = 5.13, 95% CI [2.53, 10.44], p < .001). The variable stage (before /during pandemic) was also associated with having a clinical SCL-90-R score above 70 (aOR = 7.61, 95% CI [2.7, 21.47], p < .001). (AU)

Justificación: Las mujeres embarazadas son especialmente vulnerables a los problemas de salud mental, como el estrés, la ansiedad y la depresión. Este riesgo se ha incrementado durante la pandemia de COVID-19, habiendo diferencias en los síntomas psicológicos en el embarazo y el puerperio antes y después de la pandemia. Los problemas de salud mental pueden tener efectos perjudiciales tanto en la mujer como en el recién nacido, como abortos espontáneos, partos prematuros, bajo peso al nacer y tasas más altas de cesáreas y partos asistidos. Objetivo: Evaluar la prevalencia de síntomas psicológicos de gestantes antes y durante la pandemia de COVID-19. Método: Se realizó un estudio transversal para evaluar el perfil psicológico en una muestra de mujeres embarazadas seleccionadas antes de la pandemia y una muestra de mujeres estudiadas durante la primera ola de la pandemia. Se seleccionó un total de 122 mujeres antes de la pandemia y 181 mujeres durante el brote de COVID-19. Se utilizó la Inventario de Verificación de Síntomas-90 Revisada (SCL-90-R) para evaluar la depresión y la ansiedad durante el embarazo y el puerperio. Resultados: La prevalencia de síntomas de depresión y ansiedad durante el embarazo fue mayor en la muestra de mujeres estudiadas durante la pandemia (SCL-90-R: M = 54.6 vs. 42.6 y M = 62.6 vs. 51.7 respectivamente). En el postparto la diferencia entre ambas muestras de mujeres fue aún mayor para depresión y ansiedad (SCL-90-R: M = 50.4 vs. 35.0 y M = 51.3 vs. 36.0 respectivamente). Ser mujer embarazada en el brote de COVID-19 se asoció directamente con una mayor puntuación de síntomas de depresión (aOR = 8.67, IC 95% [3.26, 23.02, p < .001). Las mujeres manifestaron ansiedad durante el parto con mayor frecuencia antes de la pandemia (aOR = 5.13, IC 95% 2.53, 10.44], p < .001). La variable estadio (antes/durante la pandemia) también se asoció con tener una puntuación clínica SCL-90-R superior a 70 (aOR = 7.61, IC 95% [2.7, 21.47], p < .001). (AU)

Self-Confidence, Satisfaction, and Knowledge of Nursing Students with Training in Basic Life Support in Pregnant Women: A Cross-Sectional Study.

BACKGROUND: A flipped classroom integrating clinical simulation has been shown to be effective for basic life support (BLS) competencies in nursing students. Cardiopulmonary arrests (CPAs) in pregnant women have a low incidence but high morbidity and mortality. Current trends show an increasing incidence; however, most official university nursing training curricula do not include specific training modules for BLS in pregnant women. This study aims to know the satisfaction and self-confidence of nursing students with respect to a training intervention regarding in BLS in pregnant women. Additionally, it aims to assess the adequacy of this intervention for acquiring the necessary knowledge on the subject. METHODS: A cross-sectional study was conducted at the University of Jaen in 2022. Data were collected on sociodemographic factors, previous contact with the topic, and topic knowledge in addition to the use of an SCLS questionnaire to measure satisfaction. Participants took the BLS training (a flipped classroom integrating clinical simulation on this topic) before answering the questionnaire. RESULTS: A total of 136 students participated. The mean score on the BLS questionnaire was 9.10 out of 10 (SD = 1.01). The mean score for the SCLS questionnaire for females was 62.36 (SD = 7.70) and 56.23 (SD = 16.94) for the male group. Age showed a statistically significant association with SCLS score: the score decreased with an increase in age (p < 0.001). CONCLUSIONS: The flipped classroom, integrating simulation for BLS in pregnant women, improves self-confidence, satisfaction, and knowledge on the topic.

Maternal Psychopathological Profile during Childbirth and Neonatal Development during the COVID-19 Pandemic: A Pre-Posttest Study.

The coronavirus SARS-CoV-2 generated an alert that became a state of emergency in health issues worldwide, a situation that affected the entire population, including pregnant women. The present study aims to understand the effect of the psychopathological profile of a sample of pregnant women at the time of the COVID-19 pandemic on themselves during childbirth (Phase 1) and after childbirth and the anthropometric measures of the neonate at birth (Phase 2). The total sample comprises 81 pregnant women aged 32.07 years (SD = 5.45) and their neonates. Sociodemographic and obstetric data of the sample were collected. During pregnancy, psychopathology was measured by means of the SCL-90, as well as other psychological measures on stress and social support. Cluster k-means techniques were used to uncover the heterogeneous profiles of psychopathology in Phase 1. Two main psychopathological profiles were found (Cluster 1: High psychopathological symptoms; Cluster 2: Low psychopathological symptoms). The clusters generated show significant differences in all the SCL-90-R subscales used and in the general index at Phase 1. After childbirth, high psychopathology profile membership was associated with a greater probability of having a non-eutocic delivery. On the other hand, the low psychopathological symptoms cluster shows higher levels of depressive symptoms, hostility, paranoid ideation, and psychotic symptoms in Phase 2. In conclusion, there seemed to exist two heterogeneous profiles of psychopathology in pregnant women during the pandemic; the stress related to the pandemic seemed uninfluential on the development of a profile of high psychopathological symptoms and the psychopathology profile may influence delivery and postpartum outcomes.

Prevalencia de las lesiones cutáneas relacionadas con la dependencia en centros de atención primaria de salud de España: resultados del 6º Estudio Nacional del GNEAUPP 2022 / Prevalence of pressure injuries and other dependence-related skin lesions in primary healthcare centers in Spain: Results of the 6th GNEAUPP National Study 2022

Objetivos: Obtener indicadores epidemiológicos actualizados para laslesiones cutáneas relacionadas con la dependencia en centros de atenciónprimaria de salud españoles, tanto globales como ajustados. Analizarlas características demográficas y clínicas de las personas con lesionescutáneas relacionadas con la dependencia y de las lesiones. Metodología:Estudio observacional, transversal, tipo encuesta epidemiológica (6.ºEstudio Nacional de Prevalencia), dirigido a todos los centros deatención primaria de salud en España. Recogida de datos medianteformulario seguro online. Variables: características de los centros deatención primaria, población total, población mayor de 65 años ypoblación en programas de atención domiciliaria, pacientes con cadatipo de lesiones cutáneas relacionadas con la dependencia, clasificaciónde las lesiones. Se estimó la prevalencia cruda global poblacional yajustada en mayores de 65 años y en personas en programas de atencióndomiciliaria. Resultados: Se han obtenido datos de una población de1.754.228 personas atendidas en 131 centros de atención primaria desalud españoles. La prevalencia de lesiones cutáneas relacionadas conla dependencia en las personas en pacientes atendidos en programasde atención domiciliaria (ATDOM) fue del 5,82%. Solo un 7,7% delos centros declararon no tener ninguna persona con lesiones cutáneasrelacionadas con la dependencia atendida en el momento de obtenerlos datos. La prevalencia casi se duplica en los centros rurales (7,1%)y mixtos (6,0%) respecto a los centros urbanos (3,9%). Las lesiones seoriginaron en el mismo domicilio del paciente en un 79,8% de los casos,y solo un 18,7% se originaron durante el ingreso del paciente en unainstitución. (AU)

Objectives: To obtain updated epidemiological indicatorsfor dependence-related skin lesions (DRSL) in SpanishPrimary Health Care (PHC) centres, both global andadjusted. To analyse the demographic and clinicalcharacteristics of people with DRSL and lesions. and thelesions. Methodology: Observational, cross-sectional,epidemiological survey-type study (6th NationalPrevalence Study), aimed at all PHC centres in Spain. Datacollection by means of a secure on-line form. Variables:characteristics of primary care centres, total population,population over 65 years of age and population in homecare programmes, patients with each type of DRSL,classification of lesions. We estimated the overall crudeprevalence in the population and adjusted prevalence,in people over 65 years of age and in people in homecare programmes. Results: Data were obtained from apopulation of 1,754,228 people cared for in Spanish PHCcentres in 131 centres. The prevalence of DRSL in personsin patients attended in home care programmes (HCP) was5.82%. Only 7.7% of the centres reported not having anypersons with DRSL in care at the time of data collection.The prevalence almost doubles in rural (7.1%) and mixed(6.0%) centres compared to urban centres (3.9%). Injuriesoriginated in the patient’s own home in 79.8% of cases,and only 18.7% originated during the patient’s admissionto an institution. The profile is that of an 83-year-oldwoman with mixed incontinence and using a staticmattress surface. Conclusions: The prevalence of primary care DRSL in Spain remains similar to previous studies,with great variability depending on the location of thecentre. Four out of 5 lesions develop in the patient’shome. (AU)

Validation of General Anxiety Disorder (GAD-7) questionnaire in Spanish nursing students.

Background: Nursing students are at risk of anxiety during their university education. Objective: To determine the psychometric characteristics of the General Anxiety Disorder (GAD-7) questionnaire in a population of university nursing students. Methods: A cross-sectional study was carried out with 170 students at the University of Jaen (Spain) in 2022. An online questionnaire was administered that included sociodemographic and student profile variables, the GAD-7 questionnaire, and the Goldberg anxiety subscale. An exploratory factor analysis (EFA), validation with convergence, and reliability analysis using Cronbach's α were performed. Results: The EFA identified a single component that explained 63.50% of the variance. It was positively correlated with the Goldberg anxiety subscale (r = 0.653; p < 0.001). A statistically significant association was observed with academic year, gender, and having experienced an anxiety crisis (p < 0.005). Internal consistency with Cronbach's α was 0.903. Conclusion: The GAD-7 presents appropriate psychometric characteristics for use in a university population of nursing students. It is capable of detecting symptoms and generalized anxiety disorder, making it a useful and simple tool for detecting anxiety-related problems in this population.

Determinants and Factors Associated with the Maintenance of Exclusive Breastfeeding after Hospital Discharge after Birth.

The benefits of exclusive breastfeeding are well known for both mother and baby. Despite this, rates of exclusive breastfeeding remain low. The present study aimed to determine the factors associated with the maintenance of this type of feeding after being discharged from the hospital after childbirth. A cross-sectional study was carried out with 1200 postpartum women in Spain. Sociodemographic, obstetric, and neonatal data were collected. Odds ratios (OR) and adjusted odds ratios (aOR) with 95% confidence intervals were calculated. Early breastfeeding initiation was identified as a factor that favors breastfeeding after hospital discharge (aOR: 2.47; 95%CI: 1.77, 3.45). Other factors that favor breastfeeding after discharge included the woman feeling very supported by her partner during pregnancy, childbirth, and the puerperium (aOR: 2.54; 95%CI:1.30, 5.00) and having previously breastfed other children (aOR: 1.97; 95%CI: 1.40, 2.76). Among the factors that hindered exclusive breastfeeding after discharge were multiple or twin pregnancies (aOR: 0.31; 95%CI 0.12, 0.83), induction of labor (aOR: 0.73; 95%CI: 0.53, 0.99), admission of the newborn to the neonatal intensive care unit (NICU) (aOR: 0.31; 95%CI 0.19, 0.52), using epidural pain relief during labor (aOR: 0.41; 95%CI: 0.27, 0.64), or a preterm newborn (aOR: 0.38; 95%CI: 0.21, 0.69). For all these reasons, it is essential to promote certain practices such as the early start of breastfeeding or the induced onset of labor, among others, in order to promote the maintenance of exclusive breastfeeding beyond hospital discharge after childbirth.

Relationship between perceived obstetric violence and the risk of postpartum depression: An observational study.

OBJECTIVE: To determine the relationship between perceived obstetric violence and the risk of postpartum depression (PPD). DESIGN: A cross-sectional observational study SETTING: During 2019 in Spain PARTICIPANTS: 782 women who had given birth in the preceding 12 months in Spain. MEASUREMENTS: Online questionnaires were distributed to the women via their midwives and women's associations. The questionnaire included sociodemographic and clinical variables, and questions regarding the mothers' perception of obstetric violence globally and in its different forms: verbal, physical and psycho-affective. The response rate was 93.65%. Crude and adjusted odds ratios (OR and aOR, respectively) were estimated using binary logistic regression. Risk of PPD was estimated by the Edinburgh Postnatal Depression Scale (EPDS). FINDINGS: The mean EPDS score was 8.34 points (standard deviation: 3.80), with 25.4% (199) at risk of PPD (≥ 10 points). Risk factors for PPD included, multiparity (aOR: 1.62, 95% CI:1.10-2.39), newborn NICU admission (aOR: 1.93, 95% CI: 1.06-3.51), experiencing verbal obstetric violence (aOR: 2.02, 95% CI: 1.35-3.02), and psycho-affective obstetric violence (aOR: 2.65, 95% CI: 1.79-3.93). The perception of support during pregnancy, birth, and the puerperium was found to be a protective factor: aOR 0.15 (95% CI: 0.04-0.54) for women who perceived enough support and aOR 0.13 (95% CI: 0.0-0.45) for women who received much support KEY CONCLUSIONS: One in four women are at risk of PPD. Multiparous women, those whose newborn required NICU admission, those who lacked partner support, and those who experienced verbal or psycho-affective obstetric violence had a higher prevalence of PPD risk. FUNDING: The authors declare that this study was conducted without funding.

Obstetric factors associated with postpartum post-traumatic stress disorder after spontaneous vaginal birth.

BACKGROUND: This study aimed to determine whether there is an association between clinical practices carried out during spontaneous vaginal birth (SVB), or clinical situations that arise during vaginal birth, and the incidence of post-traumatic stress disorder (PTSD). METHODS: A cross-sectional study with 839 puerperal women in Spain was conducted. The Perinatal Post-traumatic Stress Disorder Questionnaire (PPQ) was administered online. The relationship between the risk of postpartum PTSD and various intrapartum complications was studied in addition to practices or procedures performed during the intrapartum period. RESULTS: PTSD (PPQ scores ≥19) was identified in 8.1% (68) of the women who participated. Among the risk factors for PTSD was a concerning intrapartum FHR tracing (adjusted OR: 2.24, 95% CI: 1.07-4.66). Other intrapartum practices also put women at risk of PTSD, including the administration of an enema (aOR: 7.01, 95% CI: 2.14-23.01), being required to stay lying down throughout the labor and birth (aOR: 5.75, 95% CI: 3.25-10.19), artificial amniorrhexis without consent (aOR: 2.28, 95% CI: 1.31-3.97), administration of synthetic oxytocin without consent (aOR: 2.18, 95% CI: 1.26-3.77), fundal pressure during pushing (aOR: 3.14, 95% CI: 1.72-5.73), repeated vaginal examinations performed by different people (aOR: 4.84, 95% CI: 2.77-8.47), and manual removal of the placenta without anesthesia (aOR: 3.45, 95% CI: 1.81-6.58). CONCLUSIONS: Various intrapartum clinical practices, all related to dehumanized treatment, and intrapartum complications, were associated with an increased risk of PTSD. There is a need to eradicate obstetric mistreatment and to increase access to evidence-informed, respectful care in Spain. Care practitioners need to better appreciate their roles in preventing PTSD.

Factors Associated with Postpartum Post-Traumatic Stress Disorder (PTSD) Following Obstetric Violence: A Cross-Sectional Study.

To determine the association between experiencing obstetric violence and the incidence of postpartum post-traumatic stress disorder (PTSD). A cross-sectional study with puerperal women was conducted in Spain following ethical approval. The Perinatal Posttraumatic Stress Disorder Questionnaire (PPQ) was administered online. Sociodemographic, clinical, and obstetric violence variables and the risk of dichotomized PTSD (low/high) were studied by bivariate and multivariate analysis with binary logistic regression. 955 women were invited to participate. 53 women refused to participate, three did not complete all survey questions and, finally, 899 women were included. The risk of PTSD (score ≥ 19) using the PPQ was 12.7% (114). The mean score was 9.10 points (SD = 8.52). Risk factors identified were having a delivery plan that was not respected (aOR: 2.85, 95% CI 1.56-5.21), elective caesarean delivery (aOR: 2.53, 95% CI 1.02-2.26), emergency caesarean section (aOR: 3.58, 95% CI 1.83-6.99), admission of the newborn to the neonatal intermediate care unit (aOR: 4.95, 95% CI 2.36-10.36), admission to the intensive care unit (aOR: 2.25, 95% CI 1.02-4.97), formula feeding on discharge (aOR: 3.57, 95% CI 1.32-9.62), verbal obstetric violence (aOR: 5.07, 95% CI 2.98-8.63), and psycho-affective obstetric violence (aOR: 2.61, 95% CI 1.45-4.67). Various clinical practices were identified with the risk of PTSD, highlighting various types of obstetric violence. Partner support and early breastfeeding were identified as protective factors. Sensitizing professionals is essential to prevent the risk of PTSD.

Validation of perinatal post-traumatic stress disorder questionnaire for Spanish women during the postpartum period.

To determine the psychometric properties of the Perinatal Post-Traumatic Stress Disorder (PTSD) Questionnaire (PPQ) in Spanish. A cross-sectional study of 432 Spanish puerperal women was conducted, following ethical approval. The PPQ was administered online through midwives' associations across Spain. The Edinburgh Postnatal Depression Scale was used to diagnose postnatal depression for examining criterion validity. Data were collected on sociodemographic, obstetric, and neonatal variables. An exploratory factorial analysis (EFA) was performed with convergence and criterion validation. Internal consistency was evaluated using Cronbach's α. The EFA identified three components that explained 63.3% of variance. The PPQ's convergence validation associated the risk of PTSD with variables including birth plan, type of birth, hospital length of stay, hospital readmission, admission of the newborn to care unit, skin-to-skin contact, maternal feeding at discharge, maternal perception of partner support, and respect shown by healthcare professionals during childbirth and puerperium. The area under the ROC curve for the risk of postnatal depression (criterion validity) was 0.86 (95% CI 0.82-0.91). Internal consistency with Cronbach's α value was 0.896. The PPQ used when screening for PTSD in postpartum Spanish women showed adequate psychometric properties.