PURPOSE: The purpose of this study is to report preliminary evidence to support a new condition-specific measure of transition readiness that is theoretically grounded in the Stages of Changes framework. The Transition Readiness Assessment Questionnaire-Spina Bifida (TRAQ-SB) supplement is a newly developed tool used to measure independence and skill acquisition related to spina bifida. Similar to the Transition Readiness Assessment Questionnaire (TRAQ), the TRAQ-SB uses a 5-point Likert response set. METHODS: Working with a multi-disciplinary team with expertise in the care of children with spina bifida, the authors developed twelve items pertaining to main aspects of SB self-management. The items were reviewed and revised through several iterations by the team and patients. The items were then fielded at a spina bifida Specialty Clinic, where 93 consecutive patients 12–25 years of age were approached to participate and 90 were administered the 20-item TRAQ and a 12-item TRAQ-SB questionnaire. A principal component analysis (PCA) was conducted on the twelve items with oblique rotation (promax). Criterion validity was also assessed by examining the correlation of the TRAQ-SB supplement with the TRAQ and with age. RESULTS: Results of the factor analysis revealed that eleven of the twelve items loaded onto one factor with factor loadings ranging from 0.46 to 0.84. The scale yielded excellent internal reliability with a Cronbach alpha of 0.90. Correlations of the TRAQ-SB supplement scale score with the TRAQ overall scale score demonstrated good criterion validity (r= 0.74, p< 0.01). In addition, it was highly correlated with the TRAQ subscales, varying from 0.68 to 0.74 (all p< 0.01). Lastly, the TRAQ-SB was significantly correlated with age (r= 0.25, p< 0.01). CONCLUSIONS: Results of our analyses indicated that the TRAQ-SB demonstrated good internal reliability and criterion validity as evidenced by strong correlation with age and the validated TRAQ measure. The TRAQ-SB tool can be useful to incorporate transition readiness assessment and self-management training into routine care for adolescents with spina bifida.

PURPOSE: In order to transition to adulthood and independence, youth with spina bifida must assume significant self-management responsibilities including monitoring for shunt malfunction, maintaining intact skin in areas that are insensate, and maintaining proper bowel and bladder function. Validated measures of specific spina bifida self-management skills are lacking and this hampers the ability of clinical personnel to support successful transition for youth with spina bifida. METHODS: We developed a self-report measure specific to SB self-management skills consistent with the framework of the Transition Readiness Assessment Questionnaire (TRAQ). To test the predictive validity of the tool we surveyed 90 youth and young adults ages 12-25 with spina bifida attending a multidisciplinary clinic participating in the National Spina Bifida Patient Registry (NSBPR). RESULTS: Adjusted for age, gender, race, insurance status and lesion level, higher scores on the TRAQ-SB (increased self-management) were negatively associated with urinary incontinence in the past month. Only lesion level, and not TRAQ-SB scores, was a significant predictor of stool incontinence and skin breakdown. CONCLUSIONS: Higher TRAQ-SB scores are negatively associated with bladder incontinence in youth with spina bifida. While stool continence and skin breakdown were not associated with TRAQ-SB scores, this relation is complex and may be obfuscated by either reporting bias or outcome measurement bias. To further refine the questionnaire and understand this relationship we need to field it prospectively in the SB network with larger samples. The TRAQ-SB questionnaire, however, does have value in the clinical setting to help promote the acquisition of specific self-management skills among youth with spina bifida.

Urininkontinens är ett av våra stora folkhälsoproblem. Kvinnor drabbas oftare än män, men efter 75-års ålder är det ungefär lika vanligt hos båda könen. Syftet med studien var att undersöka hur mäns upplevelser av att leva med urininkontinens belystes i litteraturen. Metoden var en litteraturstudie som baserades på tio vetenskapliga artiklar, både kvalitativa och kvantitativa. Under bearbetningen av artiklarna framträdde olika teman som slutligen resulterade i tre övergripande rubriker. Dessa var ur psykologiskt perspektiv, praktiskt perspektiv och samhällsperspektiv. I resultatet framkom det att männens livskvalitet påverkades negativt. De inrättade sin vardag efter urininkontinensen och utvecklade strategier för att leva ett så normalt liv som möjligt. Ur praktiskt perspektiv ville männen alltid ha kontroll på var närmaste toalett fanns. De anpassade också intaget av dryck och gick på toaletten förebyggande. Männen kände skam och höll ofta inkontinensen hemlig för sin omgivning. Många upplevde problem inom samlivet och i relationen till sin partner. Studien visade att det fanns ett behov av riktlinjer och behandlingsstrategier inom området. Nyckelord: leva med, livskvalitet, män, upplevelse, urininkontinens. / Urinary incontinence is one of our major public health problems. Women are affected more often than men, but after 75 years of age, it is equally common in both sexes. The purpose of this study was to examine how men's experiences of living with urinary incontinence are highlighted in the literature. The method was a literature review based on ten scientific articles, both qualitative and quantitative. During the process different perspectives became apparent, i e psychological, practical and social. The results revealed that the men's quality of life was adversely affected. They organized their everyday living around their urinary incontinence, and developed strategies in order to live as normally as possible. From a practical perspective, the men would always make sure they knew where the nearest toilet was. They also adjusted their fluid intake and went to the bathroom as a preventive measure. Psychologically the men felt ashamed and often kept their incontinence a secret from their surrounding family and friends. Socially they experienced problems within their sexlife and in the relationship with their partner. The study showed that there is a need for guidelines and treatment strategies in this field.Keyword: experience, living with, men, quality of life, urinary incontinence.

No description available.

Mulheres com prolapso genital estádio 3 e 4 são consideradas de risco para desenvolver incontinência urinária de esforço após a correção cirúrgica do prolapso. A provável explicação para estas pacientes manterem-se, subjetivamente, continentes seria porque o prolapso poderia gerar um acotovelamento na uretra ou compressão da mesma. O objetivo do estudo foi avaliar o impacto de procedimentos anti-incontinência durante a correção cirúrgica de prolapso genital estádio 3 e 4 em mulheres sem sintomas de incontinência urinária de esforço. Método: Realizou-se revisão sistemática com ensaios clínicos. A casuística incluiu mulheres com prolapso genital estádio 3 e 4 sem sintomas clínicos de incontinência urinária de esforço. O desfecho primário foi a presença de incontinência urinária ou necessidade de tratamento para incontinência urinária. Os resultados serão apresentados com o risco relativo, com 95% de intervalo de confiança. Resultados: Inicialmente, 5618 estudos foram identificados com a estratégia de busca, mas apenas oito preencheram os critérios de inclusão. Realizou-se metanálise com as variáveis em comum dos estudos que tivessem mesma escala de quantificação. Observou-se que realizar qualquer procedimento anti-incontinência no mesmo momento do tratamento cirúrgico do prolapso não reduziu a incidência de incontinência urinária no pós-operatório (RR 0.61; 95%CI 0.34-1.10]). Todavia, quando os procedimentos são analisados separadamente, encontraram-se resultados distintos. O subgrupo de pacientes submetidas ao sling retropúbico foi o único que diminuiu a incidência de IUE (RR 0.09; 95%CI 0.02-0.36). Conclusão: O tratamento profilático em mulheres com prolapso genital estádio 3 e 4 com sling retropúbico reduziu a incidência de IUE / Women with high-grade pelvic organ prolapse (POP) are considered at risk of developing postoperative stress urinary incontinence (SUI) once the prolapse has been repaired The probable explanation for the patients to remain subjectively continent, is that POP can affect the urethra by urethral kinking or compression. Our objective was to evaluate the impact of anti-incontinence procedures during surgical POP correction stage 3 and 4 in women with no symptoms for stress urinary incontinence. Methods: A systematic review of randomized trials was performed. The subjects were women with severe POP and no symptoms of SUI. The primary outcomes were UI or treatment for this condition after the surgical procedure. The results were presented as relative risk (RR), with 95% confidence interval (95%CI). Results: Initially, 5618 studies were identified by the search strategy, but only eight trials met the inclusion criteria. We performed a meta-analysis with common variables of studies and with the same scale of quantification. We found that performing an anti-incontinence procedure at the same time of prolapse repair did not reduce the incidence of (SUI) post-operatively (RR 0.61; 95%CI 0.34-1.10]). However, when the types of anti-incontinence procedure were analyzed separately, we found different results. The subgroup of patients who underwent a retropubic sling surgery was the only one that benefited from the antiincontinence procedure, with a decrease in the incidence of SUI (RR 0.09; 95%CI 0.02- 0.36). Conclusions: A prophylactic treatment of women with severe POP using retropubic sling reduced the risk of SUI

Mulheres com prolapso genital estádio 3 e 4 são consideradas de risco para desenvolver incontinência urinária de esforço após a correção cirúrgica do prolapso. A provável explicação para estas pacientes manterem-se, subjetivamente, continentes seria porque o prolapso poderia gerar um acotovelamento na uretra ou compressão da mesma. O objetivo do estudo foi avaliar o impacto de procedimentos anti-incontinência durante a correção cirúrgica de prolapso genital estádio 3 e 4 em mulheres sem sintomas de incontinência urinária de esforço. Método: Realizou-se revisão sistemática com ensaios clínicos. A casuística incluiu mulheres com prolapso genital estádio 3 e 4 sem sintomas clínicos de incontinência urinária de esforço. O desfecho primário foi a presença de incontinência urinária ou necessidade de tratamento para incontinência urinária. Os resultados serão apresentados com o risco relativo, com 95% de intervalo de confiança. Resultados: Inicialmente, 5618 estudos foram identificados com a estratégia de busca, mas apenas oito preencheram os critérios de inclusão. Realizou-se metanálise com as variáveis em comum dos estudos que tivessem mesma escala de quantificação. Observou-se que realizar qualquer procedimento anti-incontinência no mesmo momento do tratamento cirúrgico do prolapso não reduziu a incidência de incontinência urinária no pós-operatório (RR 0.61; 95%CI 0.34-1.10]). Todavia, quando os procedimentos são analisados separadamente, encontraram-se resultados distintos. O subgrupo de pacientes submetidas ao sling retropúbico foi o único que diminuiu a incidência de IUE (RR 0.09; 95%CI 0.02-0.36). Conclusão: O tratamento profilático em mulheres com prolapso genital estádio 3 e 4 com sling retropúbico reduziu a incidência de IUE / Women with high-grade pelvic organ prolapse (POP) are considered at risk of developing postoperative stress urinary incontinence (SUI) once the prolapse has been repaired The probable explanation for the patients to remain subjectively continent, is that POP can affect the urethra by urethral kinking or compression. Our objective was to evaluate the impact of anti-incontinence procedures during surgical POP correction stage 3 and 4 in women with no symptoms for stress urinary incontinence. Methods: A systematic review of randomized trials was performed. The subjects were women with severe POP and no symptoms of SUI. The primary outcomes were UI or treatment for this condition after the surgical procedure. The results were presented as relative risk (RR), with 95% confidence interval (95%CI). Results: Initially, 5618 studies were identified by the search strategy, but only eight trials met the inclusion criteria. We performed a meta-analysis with common variables of studies and with the same scale of quantification. We found that performing an anti-incontinence procedure at the same time of prolapse repair did not reduce the incidence of (SUI) post-operatively (RR 0.61; 95%CI 0.34-1.10]). However, when the types of anti-incontinence procedure were analyzed separately, we found different results. The subgroup of patients who underwent a retropubic sling surgery was the only one that benefited from the antiincontinence procedure, with a decrease in the incidence of SUI (RR 0.09; 95%CI 0.02- 0.36). Conclusions: A prophylactic treatment of women with severe POP using retropubic sling reduced the risk of SUI

Introduction: Stress urinary incontinence is a common problem which affects a high percentage of women. Anti-incontinent surgery has played an important role in the treatment of stress urinary incontinence. Burch colposuspension was considered a gold standard in anti-incontinence surgery, with good long-term results. However, over the past decade this procedure has been largely replaced by the application of various types of TVTs (tensionfree vaginal tapes). In our study we have focused on comparing developments in the quality of life and the occurrence of complications in a long-term follow-up after TVT, TVT O and colposuspension. For subjective assessment of urinary incontinence we have chosen a validated specialized Incontinence Quality of Life questionnaire (I-QoL). The aim of our study was to monitor the trends with quality of life after TVT, TVT O and colposuspension procedures and to establish whether the occurrence of complications affects the quality of life (QoL) and compare of the quality of life among anti-incontinence procedures and longterm subjective and objective outcome. Methods: The study included 215 women who underwent a TVT, TVT O or Burch procedure between 1.6.2002 - 31.5.2005. Women were completely urogynecologic examined and urodynamic stress incontinence was documented....

Contexte : Après 65 ans, une femme sur deux souffre d’incontinence urinaire (IU) et de celles-ci, 25% souffrent de symptômes sévères (>10 épisodes/semaine). Une association positive a été établie entre l’IU liée à l’urgence (IUU) ou l’IU mixte (IUM) et les chutes. Cependant, les caractéristiques de force musculaire des membres inférieurs, d’équilibre, de mobilité et de fonction des femmes âgées avec IUU/IUM ont été peu étudiées jusqu’à maintenant. L’objectif principal de cette étude était donc de comparer la force des membres inférieurs, l’équilibre, la mobilité et la fonction chez les femmes âgées présentant ou non de l’IUU/IUM. L’objectif secondaire était de déterminer la relation de ces caractéristiques et la sévérité de l’IU. Méthode : Dans cette étude pilote transversale, 20 femmes avec IUU/IUM ont été appariées à 20 femmes continentes pour l’âge et l’IMC. Les participantes étaient âgées de 65 ans ou plus, vivaient à domicile et étaient capables de se déplacer de façon sécuritaire, sans aide technique. Des questionnaires validés et des tests standardisés ont permis de recueillir de l’information sur les symptômes d’IU (questionnaire ICIQ-UI SF), puis d’évaluer la force musculaire des membres inférieurs (dynamométrie des fléchisseurs et extenseurs des genoux, test du 30-Second Sit-to-Stand), l’équilibre (test d’équilibre unipodal, Four Square Step Test, questionnaire Activities-Specific-Balance-Confidence), la mobilité (10-Meter Walk Test, 6-Minute Walk Test) et la fonction (questionnaire Human Activity Profile, questionnaire SF-12). Résultats : Comparativement aux femmes continentes, les femmes avec IUU/IUM ont présenté des différences significatives au niveau de l’équilibre: temps réduit au test unipodal du côté dominant (p˂0,001) et non-dominant (p˂0,005); score inférieur sur la version adaptée du Activities-Specific Balance Confidence Scale (p=0,01). Les femmes avec IUU/IUM ont également présenté des différences significatives au niveau de la mobilité: vitesse de marche réduite (p=0,01); évaluation de la santé physique moins élevée mesurée à l’aide du SF-12 (p=0,01). Aucune différence n’a été observée entre les groupes quant à la force musculaire des membres inférieurs et la fonction. Aucune association significative n’a été observée entre la sévérité des symptômes d’IU rapportés par les femmes avec IUU/IUM et les mesures de force musculaire des membres inférieurs, d’équilibre, de mobilité et de fonction. Conclusion : Les résultats de cette étude suggèrent des atteintes à l’équilibre et la mobilité chez les femmes âgées avec IUU/IUM. D’autres études sont cependant nécessaires pour confirmer ces résultats. Les études futures sur cette clientèle devraient inclure l’évaluation de groupes musculaires additionnels (i.e. hanches, chevilles). En rapportant les calculs de puissance de tailles d’échantillon, cette étude pilote ouvre la voie à d’autres projets de plus large envergure. / Context : After the age of 65, the prevalence of urinary incontinence (UI) is one in two women. A positive correlation between falls and urgency UI (UUI) or mixed UI (MUI) has been identified. However, lower-extremity impairments in older women with UUI/MUI have not been thoroughly investigated. The primary goal of this study was to compare lower limb strength, balance, mobility and function in older women with and without UUI/MUI. The secondary goal was to evaluate the association between these measurements and UI severity. Methods : Forty older women with and without UUI/MUI completed standardized tests to gather data on UI symptoms (ICIQ-UI SF questionnaire) lower limb strength (knee flexor/extensor dynamometry, 30-Second Sit-to-Stand Test), balance (Single Leg Stance Test, Four Square Step Test, Activities-Specific-Balance-Confidence questionnaire), mobility (10-Meter Walk Test, 6-Minute Walk Test) and function (Human Activity Profile questionnaire, SF-12 questionnaire). Results : Significant differences in balance and mobility were observed between groups. Women with UI had shorter single leg stance times both on the dominant (p˂0.001) and non-dominant (p˂0.005) sides, lower balance confidence scores (p=0.01) and slower gait speeds (p=0.01). Women with UI also reported a significantly lower self-perceived health (p=0.01). No significant differences were observed in knee flexor/extensor strength and in function. No significant correlations were found between the severity of the UI symptoms reported by women with UI in the ICIQ-UI-SF and the measurements of lower limb muscle strength, balance, mobility or function Conclusion : The results from this pilot study suggest balance and mobility impairments in high-functioning older women with UUI/MUI. More studies are needed to confirm these results. By reporting power calculation for sample size, this pilot study provides a useful basis to design and conduct larger studies.

Introduction: Stress urinary incontinence is a common problem which affects a high percentage of women. Anti-incontinent surgery has played an important role in the treatment of stress urinary incontinence. Burch colposuspension was considered a gold standard in anti-incontinence surgery, with good long-term results. However, over the past decade this procedure has been largely replaced by the application of various types of TVTs (tensionfree vaginal tapes). In our study we have focused on comparing developments in the quality of life and the occurrence of complications in a long-term follow-up after TVT, TVT O and colposuspension. For subjective assessment of urinary incontinence we have chosen a validated specialized Incontinence Quality of Life questionnaire (I-QoL). The aim of our study was to monitor the trends with quality of life after TVT, TVT O and colposuspension procedures and to establish whether the occurrence of complications affects the quality of life (QoL) and compare of the quality of life among anti-incontinence procedures and longterm subjective and objective outcome. Methods: The study included 215 women who underwent a TVT, TVT O or Burch procedure between 1.6.2002 - 31.5.2005. Women were completely urogynecologic examined and urodynamic stress incontinence was documented....

published_or_final_version / Community Medicine / Master / Master of Public Health