北京地区成年女性尿失禁患病率及就诊率调查

目的调查北京地区城乡成年女性尿失禁(UI)的患病率、就诊率及对医疗卫生服务的需求情况。方法采用分层多阶段整群系统抽样的方法,应用女性下尿路症状问卷(ICIQ-FLUTS)调查北京市6个区县24个调查点的20～79岁女性3058人。结果北京地区女性UI患病率为22.1%(675/3058)。居民对自身患病的知晓率为37.6%(254/675)。城区女性(63.5%)知晓率高于郊区女性(11.8%)(P0.05)。患UI的254例患者就诊率为19.7%(50/254)。以ICIQ-FLUTS为诊断标准,患者的就诊率为7.4%(50/675),治疗率为3.0%(20/675)。结论北京地区成年女性尿失禁患病率比较高,而知晓率和就诊率较低。     

上海市成年女性尿失禁的流行病学研究

目的:了解上海市成年女性尿失禁(UI)的患病率及相关高危因素。方法:2012年1月至9月采用UI调查问卷对上海市城区和农村成年女性进行横断面调查,同时调查UI相关流行病学因素,调查采用一对一问答方式。共完成调查问卷7884份,使用多因素Logistic回归分析方法确定UI高危因素。结果:上海市成年女性的UI患病率为28.7%,其中压力性尿失禁(SUI)患病率最高,为23.5%,混合性尿失禁(MUI)为2.5%,急迫性尿失禁(UUI)为2.1%,UI患病率随着年龄增高而逐渐增加。绝经(OR=1.10)、阴道分娩次数≥2次(OR=1.49)、妊娠超过20周次数≥2次(OR=1.34)、首次阴道分娩年龄20岁(OR=1.58)、盆腔手术史(OR=1.38)、最大新生儿出生体重4000g(OR=2.66)、低教育程度(OR=1.14)、器械助产(OR=2.75)、体重指数(BMI)≥30kg/m2(OR=2.37)、高血压(OR=1.33)及糖尿病(OR=1.14)均为高危因素。结论:上海市成年女性UI患病率较高,以SUI为主,患病率随年龄增大而上升。产科因素为UI发病主要高危因素。     

2007-2008年北京地区25～54岁已婚妇女子宫颈上皮内瘤变的高危因素分析

目的 探讨北京地区25～54岁已婚妇女宫颈上皮内瘤变(CIN)的高危因素.方法 采用横断面调查方法,于2007年3月至2008年9月,对北京地区12个区县共137个社区内随机抽取的25～54岁已婚妇女6339例进行问卷调查、妇科检查、宫颈细胞涂片液基薄层细胞学检查(TCT)、宫颈分泌物高危型人乳头状瘤病毒(HR-HPV)检测,并对TCT结果异常者行阴道镜下宫颈活组织检查.采用logistic回归分析方法,分析CIN的高危因素及危险度比值比(OR)和95%可信区间(95%CI).结果 6339例妇女中,CIN患病率为5.90%[(374/6339,包括4例鳞状上皮细胞癌(SCC)因例数少,未单独统计].多元回归分析结果显示,HR-HPV感染(95%CI=9.953～15.811)、滴虫性阴道炎病史(95%CI=1.046～2.104)、口服避孕药避孕(95%CI=1.087～1.806)以及年龄＜45岁(95%CI=1.069～1.828)等因素与CIN患病相关.结论 HR-HPV感染是CIN患病的独立危险因素,而滴虫性阴道炎病史、口服避孕药避孕及年龄＜45岁是CIN患病相关危险因素.     

高危型HPV感染及宫颈恶性病变与年龄的相关分析

目的:探讨自然人群中年龄与女性高危型HPV感染及宫颈恶性病变之间的关系。方法:选取2017年1月至2018年2月在襄阳地区行宫颈癌筛查的30岁及以上女性自然人群311382例,采用高危型HPV初筛为基础的宫颈癌筛查方法,结合年龄对HPV感染及宫颈恶性病变状况进行探索研究。结果:受试女性高危型HPV的总感染率为7.79%(24274/311382)。随着年龄层增加,高危型HPV的感染率由6.65%(30～35岁)升至9.85%(60岁);HPV16/18型感染率(r1=0.96,P=0.0005)、其他高危型HPV感染率(r2=0.90,P=0.0055)均与年龄呈正相关。受试女性的CIN总阳性率为0.56%,CINⅠ患病率0.27%,CINⅡ患病率0.12%,CINⅢ患病率0.17%。6681例行阴道镜及病理活检的女性中,41～45岁年龄组CINⅡ(17.15%)和CINⅢ(10.02%)的患病率最高。Logistic回归结果显示,41～45岁年龄组发生CINⅡ和CINⅢ的OR值均最高,分别是1.47(95%CI为1.05～2.07)和1.75(95%CI为1.10～2.79),HPV16/18型感染女性相较于其他高危型感染女性发生CINⅡ和CINⅢ的OR值分别为1.43(95%CI为1.20～1.70)和2.02(95%CI为1.58～2.58)。结论:筛查人群中,高危型HPV感染率随年龄增大而升高,大于60岁老年女性仍存在较高的高危型HPV感染率,41～45岁年龄段女性有最高的CINⅡ及CINⅢ的发病风险。     

辽宁地区成年女性尿失禁流行病学研究

目的:调查辽宁地区成年女性尿失禁的患病率,探索相关的影响因素,掌握辽宁省女性尿失禁的现状及发展趋势。方法:以具有辽宁地区户籍或固定居住在当地10年以上的成年女性(年龄≥18岁)为研究对象;按整群多级随机抽样原则,抽取4000人为调查对象,以女性下尿路症状国际尿失禁标准问卷予以调整后进行现场调查。结果:问卷回收率100%,共获得有效问卷3884份,有效率97.1%。辽宁地区成年女性尿失禁患病率21.9%(851/3884),其中压力性尿失禁、急迫性尿失禁和混合性尿失禁的患病率分别为16.9%(658/3884)、1.8%(71/3884)和3.0%(116/3884)。各类型尿失禁患病率趋势随着年龄增加而增加,绝经后期(58～68岁)达到高峰,68岁以后有所下降。多因素Lo-gistic回归表明:年龄、体重指数、重体力劳动、慢性盆腔痛、孕产史、新生儿体重是辽宁地区成年女性尿失禁发生的影响因素。结论;辽宁地区成年女性尿失禁患病率较高。且以压力性尿失禁为主,是影响女性生活质量的主要疾病。年龄、体重指数高、重体力劳动、慢性盆腔痛、孕产史、新生儿体重是辽宁地区成年女性尿失禁发生的危险因素。     

成年女性HPV认知及影响因素研究

目的:探讨成年女性对宫颈癌人乳头瘤病毒(HPV)的认知情况及其影响因素,为制定宫颈癌HPV健康教育措施提供理论依据。方法:选择在我院健康体检的女性进行问卷调查,内容主要包括年龄、教育水平、收入水平、婚育史、妇科疾病史、宫颈癌宣教等内容,常规行子宫颈细胞学检查。采用多因素Logistic回归分析影响HPV认知的相关因素。结果:1451例女性完成了问卷调查,平均年龄(45.1±10.8)岁,既往有HPV感染史者占0.5%,有妇科症状者占32.2%,子宫颈细胞学检查提示上皮细胞异常者占0.6%。HPV相关知识的认知率仅14.5%,愿意接受HPV疫苗接种者占31.4%。多因素Logistic回归分析结果显示,教育水平(≥高中与<高中比较)与HPV认知呈正相关(OR值为3.88,95%CI为1.24～10.72);收入水平与HPV认知呈正相关,与高收入水平(>10万元/年)相比,中等收入水平(3～10万元/年)和低收入水平(<3万元/年)与HPV认知相关的OR值分别为0.47和0.57,95%CI分别为(0.25～0.86)和(0.36～0.92);接受过子宫颈癌宣教者(与未接受过子宫颈癌宣教相比)与HPV认知呈正相关(OR值为2.19,95%CI为1.50～3.21)。结论:该研究人群成年女性的HPV认知情况较差,尤其是低教育水平、低收入人群,应进一步强化宫颈癌的宣传及筛查力度,加强宫颈癌的早期防治。     

207例不孕症妇女焦虑抑郁影响因素分析

目的:研究不孕症女性出现焦虑和抑郁症状的影响因素。方法:采用自制调查问卷和焦虑自评量表(SAS)、抑郁自评量表(SDS)对207名不孕女性的焦虑抑郁的可能影响因素进行调查。结果:焦虑症状的危险因素包括年龄(OR=1.488,95%CI=1.174~1.886)和既往治疗费用(OR=1.635,95%CI=1.202~1.223);而居住地为城镇是焦虑症状的保护因素(OR=0.400,95%CI=0.194~0.825)。抑郁症状的危险因素为不孕年限(OR=1.532,95%CI=1.315~1.785)和具有较高的文化程度:高中及中专(OR=3.227,95%CI=1.578~6.599),大专及以上(OR=2.528,95%CI=1.242~5.367)。结论:年龄、既往治疗费用、居住地、文化程度、不孕年限是不孕妇女焦虑抑郁发生的影响因素。     

吉林市非酒精性脂肪性肝病流行病学调查与分析

目的:调查吉林市5家单位在职及离退休人员体检人群非酒精性脂肪性肝病(NAFLD)患病情况及其主要危险因素。方法:调查2010年5月至2011年5月在我院进行健康体检的吉林市5家单位在职及离退人员2396例.内容涉及问卷调查、体格检查、生化检测及肝胆超声检查、心电图、胸透。结果:2103例体检者完成调查,共检出脂肪肝543例,其中非酒精性脂肪肝514例,患病率为24.44%,男性患病率为36.83%,女性患病率11.87%。男性NAFLD患病率在50岁之前随年龄增长而增加,50岁之后开始下降,女性在70岁之前NAFLD患病率随年龄增长而增加,除60～70岁年龄组男女两性患病率无差异(P>0.05)外,其他各组均显著高于女性(P<0.01);结论:吉林市事业单位健康体检人群非酒精性脂肪肝患病率高,糖尿病、高血脂、高血压、肥胖等指标与非酒精性脂肪性肝病密切相关,性别、年龄可能是NAFLD的间接因素。     

单中心559例卵巢癌患者淋巴结转移的危险因素分析与淋巴结切除术临床决策探讨

目的分析盆腔淋巴结转移(pelvic lymph node metastasis, PLNM)和腹主动脉旁淋巴结转移(PALNM)的相关因素并建立预测模型。方法回顾性分析2014年1月至2019年1月解放军总医院第一医学中心妇产科诊治的卵巢癌559例患者的临床病理资料,采用单因素和logistic多因素回归分析影响PLNM和PALNM的危险因素,建立预测模型。结果 559例卵巢癌患者中,盆腔淋巴结转移205例(36.67%),腹主动脉旁淋巴结转移117例(20.93%)。影响PLNM的独立危险因素为双侧病灶(OR=2.278, 95%CI:1.433～3.621)、盆腔转移病灶(OR=1.801, 95%CI:1.154～2.810)、腹腔转移病灶(OR=4.177, 95%CI:2.597～6.717)及阑尾转移(OR=2.332,95%CI:1.389～3.915);影响PALNM的独立危险因素为阑尾转移(OR=2.324, 95%CI:1.383～3.906)和PLNM(OR=7.629, 95%CI:4.615～12.610),年龄≥55岁(OR=0.566, 95%CI:0.350～0.915)为保护因素。PLNM与PALNM概率P的ROC曲线下面积(AUC)分别为0.803(95%CI:0.767～0.840)和0.793(95%CI:0.745～0.841)。结论双侧病灶、盆腔转移病灶、腹腔转移病灶和阑尾转移为影响卵巢癌患者PLNM的独立危险因素;阑尾转移和PLNM为影响PALNM的独立危险因素,≥55岁年龄为保护因素。     

北京市社区中老年妇女泌尿生殖道及盆底功能障碍性疾病相关因素分析

目的调查北京市社区中老年妇女泌尿生殖道症状及盆底功能障碍(pelvic floor dysfunction,PFD)的患病情况及其危险因素。方法选择2013年10—12月在北京市第二医院及月坛社区卫生服务中心所辖范围内3 000名40~70岁的女性进行调查。问卷内容包括一般资料、盆底功能障碍问卷简表(pelvic floor distress inventory-short form 20,PFDI-20)。结果 3 000名女性中,回收有效问卷2 601份,有效应答率86.70%,平均年龄为(53.61±7.06)岁。PFD患病率为65.24%(1 697/2 601)。阴道分娩者与剖宫产者PDF症状的患病率分别为68.23%(1 239/1 816)和58.90%(364/618)。阴道分娩者PFD患病率高于剖宫产者,两者比较,差异有统计学意义(P0.001)。PFD的危险因素为围绝经期及绝经期(OR=1.740,P0.05;OR=1.147,P0.05)、患有躯体疾病(OR=1.489,P0.001)、使用围绝经期药物(OR=1.748,P0.001)、患有外阴阴道萎缩(OR=2.840,P0.001)。保护因素为剖宫产(OR=0.683,P0.001),高中学历(OR=0.758,P0.05)。结论盆底功能障碍的发生与月经情况、分娩方式、躯体疾病、围绝经期药物应用情况及学历有关。     

Risk factors for female anal incontinence: new insight through the Evanston-Northwestern twin sisters study

OBJECTIVE: To evaluate risk factors for anal incontinence using an identical twin sisters study design to provide control over genetic variance. METHODS: A total of 271 identical twin sister pairs (mean age 47 years) completed the validated Colorectal Anal Distress Inventory questionnaire detailing the presence and severity of anal incontinence. Data were analyzed using a stepwise logistic regression with repeated binary measures to account for correlated data within twin pairs. Three different statistical models were used to analyze nonobstetric as well as obstetric risk factors separately. RESULTS: Significant risk factors for anal incontinence and higher Colorectal Anal Distress Inventory anal incontinence subscale scores included age 40 years or older (fecal: odds ratio [OR] 2.82, 95% confidence interval [CI] 1.21-6.0; flatal: OR 1.90, 95% CI 1.11-3.24), menopause (fecal: OR 2.10, 95% CI 1.15-3.8; flatal: OR 2.11, 95% CI 1.43-3.13), increasing parity (parity > or = 2; fecal: OR 3.09, 95% CI 1.25-7.65; flatal: OR 2.72, 95% CI 1.65-4.51), and the presence of stress urinary incontinence (fecal: OR 2.11, 95% CI 1.12-3.98; flatal: OR 1.72, 95% CI 1.14-2.59). Obesity was associated with significantly higher Colorectal Anal Distress Inventory anal incontinence subscale scores (mean difference 5.18, P = .007). Cesarean delivery after initiation of labor was associated with a lower prevalence of anal incontinence than vaginal birth; however, this difference was not statistically significant (17% compared with 4%, P = .11). No anal incontinence was noted in women who had only elective cesarean deliveries. CONCLUSION: Age, menopause, obesity, parity, and stress urinary incontinence are the major risk factors for female anal incontinence.     

Prevalence of urinary incontinence and associated risk factors in postmenopausal women. Heart & Estrogen/Progestin Replacement Study (HERS) Research Group.

OBJECTIVE: To determine the prevalence of stress, urge, and mixed urinary incontinence and associated risk factors in postmenopausal women. METHODS: Before enrollment in a 4-year, randomized trial of combination hormone therapy to prevent coronary heart disease, 2763 participants completed questionnaires on prevalence and type of incontinence. We measured factors potentially associated with incontinence including demographics, reproductive and medical histories, height, weight, and waist-to-hip circumference ratio. We used multivariate logistic models to determine independent associations between those factors and weekly incontinence by type. RESULTS: The mean (+/- standard deviation [SD]) age of the participants was 67+/-7 years; 89% were white and 8% were black. Fifty-six percent reported weekly incontinence. In multivariate analyses, the prevalence of weekly stress incontinence was higher in white than black women (odds ratio [OR] 2.8, 95% confidence interval [CI] 1.6, 5.1), in women with higher body-mass index (BMI) (OR 1.1 per 5 units, 95% CI 1.0, 1.3), and higher waist-to-hip ratio (OR 1.2 per 0.1 unit, 95% CI 1.0, 1.4). The prevalence of weekly urge incontinence was higher in older women (OR 1.2 per 5 years, 95% CI 1.1, 1.3), diabetic women (OR 1.5, 95% CI 1.1, 2.0) and women who had reported two or more urinary tract infections in the prior year (OR 2.0, 95% CI 1.1, 3.6). CONCLUSION: Stress and urge incontinence are common in postmenopausal women and have different risk factors, suggesting that approaches to risk-factor modification and prevention also might differ and should be specific to types of incontinence.     

Mode of delivery and fecal incontinence at midlife: a study of 2,640 women in the Gazel cohort

OBJECTIVE: To estimate obstetric risk factors of fecal incontinence among middle-aged women. METHODS: We conducted a mail survey of the Gazel cohort of volunteers for epidemiologic research. In 2000, a questionnaire on anal incontinence was mailed to 3,114 women who were then between the ages of 50 and 61 years; 2,640 (85%) women returned the completed questionnaire. Fecal incontinence was defined by involuntary loss of stool. Logistic regression was used to estimate the effect of obstetric and general risk factors. RESULTS: Prevalence of fecal incontinence in the past 12 months was 9.5% (250). Significant risk factors for fecal incontinence were completion of high school (adjusted odds ratio [OR] 1.5, 95% confidence interval [CI] 1.1-2.0), self-reported depression (OR 2.1, 95% CI 1.6-2.7), overweight or obesity measured by body mass index (BMI) (OR 1.5 for BMI of 25-30, 95% CI 1.1-2.0; OR 1.6 for BMI more than 30, 95% CI 1.1-2.5), surgery for urinary incontinence (OR 3.5, 95% CI 2.0-6.1), and anal surgery (OR 1.7, 95% CI 1.1-2.9). No obstetric variable (parity, mode of delivery, birth weight, episiotomy, or third-degree perineal tear) was significant. Prevalence of fecal incontinence was similar for nulliparous, primiparous, secundiparous, and multiparous women (11.3%, 9.0%, 9.0%, and 10.4%, respectively), and among parous women, it was similar for women with spontaneous vaginal, instrumental (at least one), or only cesarean deliveries (9.3%, 10.0%, and 6.6%, respectively). CONCLUSION: In our population of women in their 50s, fecal incontinence was not associated with either parity or mode of delivery.     

Urinary and anal incontinence in morbidly obese women considering weight loss surgery

OBJECTIVE: To estimate prevalence and correlates of urinary and anal incontinence in morbidly obese women undergoing evaluation for laparoscopic weight loss surgery. METHODS: From October 2003 to February 2005, 180 women with body mass index (BMI) of 40 or greater underwent evaluation for laparoscopic weight loss surgery. Using an established Web site, questionnaires were completed to assess symptoms of urinary incontinence, including the Medical, Epidemiological, and Social Aspects of Aging Questionnaire (MESA). Anal incontinence was assessed by asking, "Do you have any uncontrolled anal leakage?" A number of clinical and demographic variables were examined as potential risk factors for urinary incontinence and anal incontinence. RESULTS: Mean age was 39.8 years (range 16-55). Body mass index ranged from 40 to 81 (mean 49.5). Prevalence of urinary incontinence was 66.9% and anal incontinence was 32.0% (45.6% loss of gas only, 21.1% liquid stool only, 24.6% gas and liquid stool only, 8.8% solid stool). In simple logistic regression, presence of urinary incontinence was associated with age (odds ratio [OR] 1.05, 95% confidence interval [CI] 1.01-1.09), number of children (OR 1.54, 95% CI 1.15-2.07), anal incontinence (OR 6.34, 95% CI 2.52-15.93), arthritis (OR 6.04, 95% CI 1.76-20.78), and sleep apnea (OR 2.30, 95% CI 1.21-4.37). Multivariable logistic regression identified 3 factors independently associated with urinary incontinence: number of children (OR 1.55, 95% CI 1.12-2.12), arthritis (OR 5.46, 95% CI 1.51-19.73), and anal incontinence (OR 6.27, 95% CI 2.42-16.26). Presence of anal incontinence was associated only with the presence of urinary incontinence (OR 6.34, 95% CI 2.52-15.93). CONCLUSION: Prevalence of urinary and anal incontinence is high in this group of morbidly obese women as compared with the general population. Studies are needed to determine the effect of weight loss on urinary and anal incontinence symptoms in the morbidly obese woman.     

分娩方式对产后妇女粪失禁及尿失禁的影响

目的 调查女性产后粪失禁和尿失禁的发生率及其相关因素.方法 电话随访2006年10月1日至2007年9月30日在北京大学第一医院妇产科分娩的产妇,共纳入2012例妇女,收集其产后6个月内粪失禁和尿失禁的症状.采用Logistic回归法分析分娩方式与尿失禁和粪失禁的关系.结果 (1)参与调查的2012例产后妇女,14例(0.70％)有粪失禁症状.Logistic回归分析显示,粪失禁与阴道产钳助产(OR=20.09,95％ CI:3.64～110.90,P=0.000)和会阴侧切术分娩相关(OR=6.11,95％ CI:1.29～28.80,P=0.024).(2)2012例妇女中产后尿失禁、压力性尿失禁(stress urinary incontinence,SUI)、急迫性尿失禁(urge urinary incontinence,UUI)、混合性尿失禁(mixed urinary incontinence,MUI)的发病率分别为10.04％(202例)、8.15％ (164例)、0.94％(19例)和0.94％(19例).Logistic回归分析显示,与SUI相关的因素有:母亲年龄(OR=1.07,95％ CI:1.04～1.11,P=0.000)、母亲分娩前体重(OR=1.04,95％CI:1.02～1.06,P=0.001)、新生儿头围(OR=1.20,95％ CI:1.05～1.39,P=0.010)、会阴侧切术分娩(OR=4.96,95％ CI:3.05～8.07,P=0.0005)、阴道自然分娩(OR=5.22,95％ CI:2.53～10.76,P=0.000)和阴道产钳助产(OR=9.20,95％ CI:4.07～20.79,P=0.000).与UUI相关的因素有:产妇分娩前体重(OR=1.51,95％CI:1.12～2.05,P=0.008).与MUI相关的因素有:产妇分娩前体重(OR=1.06,95％ CI:1.00～1.11,P=0.049)、第二产程时限(OR=1.01,95％ CI:1.00～1.03,P=0.010)、会阴侧切术分娩(OR=7.76,95％ CI:1.42～42.52,P=0.017)和阴道产钳助产(OR=15.21,95％ CI:1.61～143.44,P=0.018).(3)产后4d和产后42 d SUI的发病率较高分别为7.95％和9.10％.结论 (1)本院产后妇女粪失禁和尿失禁的发病率较先前报道的其他地区的发病率低.(2)阴道分娩是妇女产后粪失禁和尿失禁发生的高危因素,特别是阴道产钳助产和会阴侧切术分娩.(3)母亲的年龄、分娩前体重、新生儿出生时头围、阴道自然分娩、产钳助产、会阴侧切术是发生尿失禁的高危因素.     

Stress urinary incontinence 4 years after the first delivery: a retrospective cohort survey

BACKGROUND: Our aim was to estimate the prevalence of stress urinary incontinence 4 years after the first delivery and analyze its risk factors. METHODS: A retrospective cohort survey was conducted in a French university hospital. The 669 primiparous women who delivered in our department in 1996 a singleton in a vertex position between 37 and 41 weeks of amenorrhea were included. A mailed questionnaire was sent 4 years after the indexed delivery. The main outcome measure was stress urinary incontinence 4 years after the first delivery. RESULTS: Three hundred and seven women replied, 274 had moved and 88 did not respond. Four years after the first delivery, prevalence of stress urinary incontinence was 29% (89/307). According to multiple logistic regression analysis, the independent risk factors were urine leakage before the first pregnancy [odds ratio (OR) 18.7; 95% confidence interval (CI) 3.6-96.4], urine leakage during the first pregnancy (OR 2.5; 95% CI 1.3-4.8), duration of first labor > or = 8 h (OR 3.1; 95% CI 1.7-5.7), mother's age > 30 years at the first delivery (OR 2.4; 95% CI 1.4-4.2) and cesarean section at the first delivery (OR 0.3; 95% CI 0.1-0.9). CONCLUSION: Our results suggest that stress urinary incontinence after pregnancy arises from a multifactorial condition. The main risk factors are: age, previous incontinence (before or during the first pregnancy), prolonged labor and vaginal delivery.     

Risk factors for lower urinary tract symptoms in women 40 to 60 years of age

OBJECTIVE: To determine the relationship between lower urinary tract symptoms and possible associated risk factors in women 40-60 years old. METHODS: In a normal population study, 502 women with lower urinary tract symptoms and 742 women with no symptoms (controls) were asked about possible associated factors. RESULTS: Four hundred eighty-seven women (97.0%) with symptoms and 564 controls (76.0%) completed the study. Stress incontinence was associated with parity (primipara odds ratio [OR] 2.2, 95% confidence interval [CI] 1.0, 4. 9; para 2 OR 3.9, 95% CI 1.9, 8.0; para 3 OR 4.5, 95% CI 2.1, 9.5), use of diuretics (OR 2.2, 95% CI 1.2, 3.9), hysterectomy (OR 2.4, 95% CI 1.6, 3.7), and increased body mass index (BMI). Urge incontinence was associated with use of diuretics (OR 4.0, 95% CI 2. 2, 7.1) and BMI. Urgency was associated with parity (primipara OR 1. 9, 95% CI 0.9, 4.2; para 2 OR 3.0, 95% CI 1.5, 5.9; para 3 OR 3.1, 95% CI 1.5, 6.5), use of diuretics (OR 2.7, 95% CI 1.5, 4.7) and BMI. Associations between non-incontinence symptoms (except urgency) and observed factors were weak and inconsistent. Straining at stool and constipation were inversely associated with lower urinary tract symptoms. Overall, lesion of sphincter ani, episiotomy, fetal weight, physical activity, and hormonal status had minor association with lower urinary tract symptoms. CONCLUSION: Lower urinary tract symptoms were associated positively with parity, BMI, prior hysterectomy, use of diuretics, straining at stool, and constipation.     

Incontinence severity and major depression in incontinent women

OBJECTIVE: Research has shown an association between urinary incontinence and depression. Studies that use community-based samples and major depressive disorder diagnostic criteria are needed. The objective of this study was to estimate the prevalence of and factors associated with major depression in women with urinary incontinence. METHODS: We conducted an age-stratified postal survey of 6,000 women aged 30-90 years. Subjects were randomly selected from enrollees in a large health maintenance organization in Washington state. Main outcome measures were prevalence of current major depression and adjusted odds ratios for factors associated with major depression in women with urinary incontinence. RESULTS: The response rate was 64% (n = 3,536) after applying exclusion criteria. The prevalence of urinary incontinence was 42% (n = 1,458). The prevalence of major depression was 3.7% (n = 129), with 2.2% in those without incontinence versus 6.1% in those with incontinence. Among women with incontinence, major depression prevalence rates differed by incontinence severity (2.1% in mild, 5.7% in moderate, and 8.3% in severe) and incontinence type (4.7% in stress, 6.6% in urge/mixed). Obesity (odds ratio [OR] 2.3, 95% confidence interval [CI] 1.3-4.0), current smoking (OR 2.7, 95% CI 1.5-4.9), lower educational attainment (OR 2.0, 95% CI 1.2-3.3), moderate incontinence (OR 2.7, 95% CI 1.1-6.6), and severe incontinence (OR 3.8, 95% CI 1.6-9.1) were each associated with increased odds of major depression in women with urinary incontinence, controlling for age and medical comorbidity. Compared with women with incontinence alone, women with comorbid incontinence and major depression had significantly greater decrements in quality of life and functional status and increased incontinence symptom burden. CONCLUSION: Women with moderate-to-severe urinary incontinence should be screened for comorbid major depression and offered treatment if depression is present. LEVEL OF EVIDENCE: II-2.     

Risk factors for placental abruption in an Asian population

The objective of this study was to identify risk factors for placental abruption in an Asian population. The authors conducted a retrospective review of 37 245 Taiwanese women who delivered between July 1990 and December 2003. Pregnancies complicated by placenta previa, multiple gestation, and fetal anomalies were excluded. Multivariable logistic regression was used to adjust for potentially confounding variables and to identify independent risk factors for placental abruption. Three hundred thirty-two women had placental abruption (9 per 1000 singleton deliveries). Women who smoked during pregnancy (adjusted odds ratio [OR] = 8.4; 95% confidence interval [CI] = 3.0-23.9), had gestational hypertensive diseases (adjusted OR = 4.9; 95% CI = 3.3-7.3), pregnancies complicated by oligohydramnios (adjusted OR = 4.2; 95% CI = 2.7-6.7), polyhydramnios (adjusted OR = 3.3; 95% CI = 1.4-7.7), preterm premature rupture of membranes (adjusted OR = 1.9; 95% CI = 1.1-3.1), entanglement of umbilical cord (adjusted OR = 1.6; 95% CI = 1.2-2.1), were of or more than 35 years of age (adjusted OR = 1.5; 95% CI = 1.1-2.0), and had a low prepregnancy body mass index (adjusted OR = 1.3; 95% CI = 1.0-1.6) were at increased risk for placental abruption. Some risk factors for placental abruption among Taiwanese women are the same as those of other ethnic groups, whereas some of the risk factors are different.     

Predictors of urinary incontinence in a prospective cohort of postmenopausal women

OBJECTIVE: To prospectively assess risk factors associated with occurrence of urinary incontinence among postmenopausal women. METHODS: We followed up 1,017 postmenopausal health maintenance organization enrollees, aged 55 to 75 years, for 2 years. The primary outcome measures were any urinary incontinence and severe incontinence reported at 12- or 24-month follow-up visits. RESULTS: Baseline prevalence of any amount or frequency of urinary incontinence in the past year was 66%. Among the 345 women without incontinence at baseline, 65 (19%) at 1 year and 66 (19%) at 2 years reported any incontinence. Ninety-two of 672 (14%) and 96 of 672 (14%) women with incontinence at baseline reported no incontinence at years 1 and 2. In an adjusted multiple logistic regression model, independent predictors of any incontinence included white race (odds ratio [OR] 1.7, 95% confidence interval [CI] 1.1-2.6), vaginal estrogen cream (OR 2.0, CI 1.1-3.7), vaginal dryness (OR 1.6, CI 1.2-2.2), vaginal discharge (OR 1.5, CI 1.0-2.2), 6 or more lifetime urinary tract infections (OR 1.8, CI 1.2-2.6), and diabetic peripheral neuropathy (OR 1.7, CI 1.0-3.1). In adjusted models, predictors of severe incontinence were history of hysterectomy (OR 1.8, CI 1.1-2.7) and any vaginal symptom (OR 1.7, CI 1.0-2.8). CONCLUSION: A substantial proportion of incontinence-free postmenopausal women developed urinary incontinence during 2 years of follow-up. Because vaginal symptoms are associated with urinary incontinence, their relationship with other risk factors, including vaginal Escherichia coli colonization and vaginal estrogen cream use, warrant additional study. Similarly, diabetic peripheral neuropathy and hysterectomy associations suggest areas for future investigation. LEVEL OF EVIDENCE: II-2.