Effect of weight loss on urinary incontinence in women.

BackgroundThe purpose of this research was review the epidemiology of the association of obesity and urinary incontinence, and to summarize the published data on the effect of weight loss on urinary incontinence.MethodsA literature review of the association between urinary incontinence and overweight/obesity in women was performed. Case series and clinical trials reporting the effect of surgical, behavioral, and/or pharmacological weight loss on urinary incontinence are summarized.ResultsEpidemiological studies demonstrate that obesity is a strong and independent risk factor for prevalent and incident urinary incontinence. There is a clear dose-response effect of weight on urinary incontinence, with each 5-unit increase in body mass index associated with a 20%-70% increase in risk of urinary incontinence. The maximum effect of weight on urinary incontinence has an odds ratio of 4-5. The odds of incident urinary incontinence over 5-10 years increase by approximately 30%-60% for each 5-unit increase in body mass index. There appears to be a stronger association between increasing weight and prevalent and incident stress incontinence (including mixed incontinence) than for urge incontinence. Weight loss studies indicate that both surgical and nonsurgical weight loss leads to significant improvements in prevalence, frequency, and/or symptoms of urinary incontinence.ConclusionEpidemiological studies document overweight and obesity as important risk factors for urinary incontinence. Weight loss by both surgical and more conservative approaches is effective in reducing urinary incontinence symptoms and should be strongly considered as a first line treatment for overweight and obese women with urinary incontinence

A Randomized Controlled Trial of Device Guided, Slow-Paced Respiration in Women with Overactive Bladder Syndrome.

PurposeWe evaluated the effects of device guided, slow-paced respiration on urgency associated urinary symptoms, perceived stress and anxiety, and autonomic function in women with overactive bladder syndrome.Materials and methodsWe performed a randomized, parallel group trial of slow-paced respiration to improve perceived stress and autonomic dysfunction as potential contributors to overactive bladder. Ambulatory women who reported at least 3 voiding or incontinence episodes per day associated with moderate to severe urgency were randomized to use a portable biofeedback device to practice daily, slow, guided breathing exercises or a control device which appeared identical and was reprogrammed to play music without guiding breathing. During 12 weeks we evaluated changes in urinary symptoms by voiding diaries, perceived stress and anxiety by validated questionnaires, and autonomic function by heart rate variability and impedance cardiography.ResultsIn the 161 randomized participants, including 79 randomized to paced respiration and 82 randomized to the control group, the average ± SD baseline frequency of voiding or incontinence associated with moderate to severe urgency was 6.9 ± 3.4 episodes per day. Compared to controls the participants randomized to paced respiration demonstrated greater improvement in perceived stress (average Perceived Stress Scale score decrease 2.8 vs 1.1, p=0.03) but not in autonomic function markers. During 12 weeks the average frequency of voiding or incontinence associated with moderate to severe urgency, which was the study primary outcome, decreased by a mean of 0.9 ± 3.2 episodes per day but no significant between group difference was detected.ConclusionsAmong women with overactive bladder slow-paced respiration was associated with a modest improvement in perceived stress during 12 weeks. However, it was not superior to a music listening control for reducing urinary symptoms or changing autonomic function

The Michigan incontinence symptom index (M‐ISI): A clinical measure for type, severity, and bother related to urinary incontinence

Aims To develop a clinically relevant, easy to use, and validated instrument for assessing severity and bother related to urinary incontinence. Methods Survey items were piloted and refined following psychometric principles in five separate patient cohorts. Patient and expert endorsement of items, factor analyses, Spearman rank correlations and response distributions were employed for item selection. Formal reliability and validity evaluation were conducted for the final questionnaire items. Results Expert physicians and patient focus groups confirmed face and content validity for the measure. A 10‐item measure called the Michigan Incontinence Symptom Index (M‐ISI) was developed with two domains: a Total M‐ISI Domain consisting of subdomains for stress urinary incontinence, urgency urinary incontinence, and pad use, and a Bother Domain. High construct validity was demonstrated with a Cronbach's alpha for the Total M‐ISI Domain (items 1‐8) of 0.90 and for the Bother Domain (items 9‐10) of 0.82. Cronbach's alpha for the subdomains were all > 0.85. Construct validity, convergent and divergent validity, internal discriminant validity, and predictive validity were all robust. The minimally important difference for the measure was determined to be 4 points (out of 32) for the Total M‐ISI Severity Domain, and 1‐2 points (out of 8‐12) for the individual subdomains. Conclusions The M‐ISI is a parsimonious measure that has established reliability and validity on several levels and complements current clinical evaluative methods for patients with urinary incontinence. Neurourol. Urodynam. 33:1128–1134, 2014 . © 2013 Wiley Periodicals, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/108319/1/nau22468.pd

More Similarities Than Differences? An Exploratory Analysis Comparing the Sexual Complaints, Sexual Experiences, and Genitourinary Health of Older Sexual Minority and Sexual Majority Adults.

BackgroundLittle is known about sexual problems and genitourinary health of older sexual minority adults, who comprise up to 4% of the adult population but may differ in experiences of genitourinary aging, given known health disparities and behavior differences.AimTo examine and compare genitourinary and sexual complaints among older sexual minority and sexual majority adults.MethodsWe analyzed data from the 2010-2011 National Social Life, Health, and Aging Project (NSHAP), a nationally representative sample of older community-dwelling U.S. adults. Sexual minority men were defined as those who have sex with men or with both women and men. Sexual minority women were those who have sex with women or with both women and men. Descriptive statistics, weighted frequencies, and the chi-square test were used to compare outcomes by sexual orientation group and gender.Main outcome measuresStructured questionnaires examined sexual activity, practices, and genitourinary problems such as erectile dysfunction, insufficient vaginal lubrication, and urinary incontinence (UI).ResultsOf 2,813 participants (median age 69.6 years), 4.2% were sexual minorities (5.3% of men, 3.5% of women). Among men, sexual minorities were more likely to report UI (35.6% vs 21.8%; P = .029), but otherwise the 2 groups had similar prevalences of other urinary symptoms, importance of sexual activity, sexual practices, sexual activity within the last 3 months, and erectile difficulty (P > .10 for all). Among women, sexual minorities were more likely to report receiving oral sex (42.5% vs. 21.2%; P = .004), but otherwise the 2 groups had similar prevalences of UI, other urinary symptoms, importance of sexual activity, sexual activity within the last 3 months, and difficulty with lubrication (P > .10 for all).Clinical implicationsSexual activity and sexual problems may be as common among older sexual minority adults as in their sexual majority counterparts, whereas UI may be more common in sexual minority men compared with sexual majority men. Therefore, clinicians should employ culturally-relevant health screening, diagnosis, and treatment to ensure reaching all adults regardless of sexual orientation.Strengths & limitationsStrengths include a national population-based sample of older adults that describes sexual and genitourinary health. Statistical power was limited by the small numbers of sexual minority individuals.ConclusionHere we provide new evidence that older sexual minority men may experience UI more often than sexual majority men, and that sexual practices may differ between sexual minority and majority women, but frequency of sexual problems is similar. Given the challenges faced by sexual minority individuals in accessing equitable health care, clinicians must ensure that diagnosis and treatment are relevant to people of all sexual orientations. Obedin-Maliver J, Lisha N, Breyer BN. More Similarities Than Differences? An Exploratory Analysis Comparing the Sexual Complaints, Sexual Experiences, and Genitourinary Health of Older Sexual Minority and Sexual Majority Adults. J Sex Med 2019;16:347-350

Becoming HEARING: Describing Co-Construction of Expert ASL/English Interpreter Deaf-World Cultural Competence

This article describes deaf and hearing expert interpreter participants’ perspectives on Deaf-World cultural competence (DWCC). DWCC is a concept explicitly and implicitly embedded in the Conference of Interpreter Trainer’s (CIT’s) mission statement. American deaf and mainstream cultures coexist and interpreters facilitate communication between individuals not sharing a common language. The author completed a qualitative study and dissertation, and relied on expert deaf and hearing participants’ responses given during narrative interviews. Participants described their lived experience entering and maintaining ties to the Deaf-World. The inquiry explored participants’ identity transformations as they came to be described by their deaf-conferred ASL label, HEARING. Salient concepts raised in this article include a proposed description of interpreter DWCC, and a tacit seven-step process of Deaf-World connections, the interpreter affiliation/alliance narrative (IAAN). Being ascribed ASL/English interpreter status includes co-constructed community and cultural connections between two language worlds explained comprehensively via the interpreting spectrum (IS)

Risk factors and functional abnormalities associated with adult onset secondary nocturnal enuresis in women

Aims The study aims to evaluate bothersome lower urinary tract symptoms (LUTS), risk factors, and associated functional abnormalities in women reporting adult onset secondary nocturnal enuresis (SNE), to help understand factors associated with SNE. Methods 12,795 women (age \u3e18) attending a tertiary referral centre underwent a comprehensive standardized evaluation including urodynamic testing in accordance with the International Continence Society recommendations. Records of all patients reporting bedwetting while asleep were evaluated under various categories. Multiple logistic regression was used to identify statistically significant risk factors and urodynamic findings associated with SNE. Results The prevalence of SNE in women undergoing urodynamic testing for bothersome LUTS was 14.4% (1,838). High BMI (OR = 1.47, P \u3c 0.001), cigarette smoking (OR = 2, P \u3c 0.001), antidepressant usage (OR = 1.8, P \u3c 0.001), neurological conditions (OR = 2.12, P \u3c 0.001), and previous hysterectomy (OR = 1.19, P = 0.03) were significantly associated with SNE. Women with SNE significantly complained of overactive bladder (OAB) symptoms (OR = 1.65, P \u3c 0.001) and slightly higher mean nocturia episodes (OR = 1.38, P \u3c 0.0001). Low maximum urethral closure pressure (MUCP) (OR = 1.34, P \u3c 0.0001) and detrusor overactivity incontinence (DOI) (OR = 1.75, P \u3c 0.0001) were significantly associated with SNE. There was no significant association with the symptom of stress urinary incontinence (P = 0.264), urodynamic stress incontinence (P = 0.454) or detrusor overactivity (P = 0.231). Conclusion Women with adult SNE usually present with OAB symptoms. SNE is associated with high BMI, cigarette smoking, antidepressant use, and neurological conditions. DOI and a low MUCP are possible pathophysiological mechanisms in SNE. Neurourol. Urodynam. 36:188–191, 2017. © 2015 Wiley Periodicals, Inc

A data support infrastructure for Clean Development Mechanism forestry implementation: an inventory perspective from Cameroon

Clean Development Mechanism (CDM) forestry project development requires highly multi-disciplinary and multiple-source information that can be complex, cumbersome and costly to acquire. Yet developing countries in which CDM projects are created and implemented are often data poor environments and unable to meet such complex information requirements. Using Cameroon as an example, the present paper explores the structure of an enabling host country data support infrastructure for CDM forestry implementation, and also assesses the supply potential of current forestry information. Results include a conceptual data model of CDM project data needs; the list of meso- and macro-level data and information requirements (Demand analysis); and an inventory of relevant data available in Cameroon (Supply analysis). From a comparison of demand and supply, we confirm that data availability and the relevant infrastructure for data or information generation is inadequate for supporting carbon forestry at the micro, meso and macro-levels in Cameroon. The results suggest that current CDM afforestation and reforestation information demands are almost impenetrable for local communities in host countries and pose a number of cross-scale barriers to project adoption. More importantly, we identify proactive regulatory, institutional and capacity building policy strategies for forest data management improvements that could enhance biosphere carbon management uptake in poor countries. CDM forestry information research needs are also highlighted

Assessing accountability for carbon dioxide in the atmosphere

Thesis (M.C.P.)--Massachusetts Institute of Technology, Dept. of Urban Studies and Planning, 1989.Includes bibliographical references (leaves 123-124).by Susan Subak.M.C.P