Use of the Relationship between Absolute Lymphocyte Count and CD4 Count to Improve Earlier Consideration of Pneumocystis Pneumonia in HIV-positive Emergency Department Patients with Pneumonia

Background

The ability to accurately assess the level of immunosuppression in HIV+ patients in the emergency department (ED) is often limited and can affect management of these patients.

Objective

To evaluate the relationship between the absolute lymphocyte count (ALC) and CD4 count in HIV patients admitted through the ED with pneumonia and how utilization of this relationship may affect early consideration and evaluation of Pneumocystis jiroveci pneumonia (PCP).

Methods

Retrospective multicenter 5-year study of HIV+ patients with an ICD-9 diagnosis of pneumonia. Included patients had an ALC measured on ED presentation and a CD4 count measured in < 24 h. A receiver operator curve (ROC), decision plot analysis, and McNemar test of proportions were used to characterize the relationship between study variables.

Results

Six hundred eighty six patients were enrolled, 23.2% (95% confidence interval [CI] 20.2–26.1) were diagnosed with PCP. The geometric mean CD4 count and ALC were 81 and 1089, respectively. The correlation between ALC and CD4 was r = 0.60 (95% CI 0.55–65, p < 0.01). The ROC was 0.78 (0.75–0.82). An ALC < 1700 cells/mm³ had a sensitivity of 84% (95% CI 80–87) and specificity of 55% (95% CI 48–70) for a CD4 < 200 cells/mm³. An ALC threshold of 1700 cells/mm³ would have identified 86% of patients with PCP but falsely identified 2.5 patients without PCP for every one accurately identified.

Conclusion

The ALC threshold of 1700 cells/mm³ retains significant discriminatory value and would moderately improve identification of patients with a CD4 < 200 cells/mm³ but is not likely to be reliable as the sole method of early recognition and evaluation of PCP.     

Co-infection of blood borne viruses in blood donors: A cross-sectional study from North India

Background

There are several studies on prevalence of individual infectious disease markers (mono-infection) in donors but none on prevalence of coinfection. Co-infection is significant as it leads to accelerated disease progression. We, therefore, evaluated the prevalence of co-infection among blood donors.

Residual risk of HIV,HCV and HBV in Canada

Background

Residual risk is estimated as the product of the incidence and the infectious window period, the time during which a blood donation could be infectious but the assay may not detect it. In 2011 nucleic acid multiplex testing (MPX) was implemented in 6 unit minipools (previously 24 unit minipools). MPX also included hepatitis B (HBV) NAT for the first time (complementing HBsAg screening) in addition to HIV-1 and hepatitis C (HCV) as before. We aimed to estimate window period risk-day equivalents for MPX, and the residual risk of viral infections in blood donations updated to reflect current incidence and testing.

Oxidative stress biomarkers and chromogranin A in uremic patients: Effects of dialytic treatment

Objective

To evaluate oxidative stress in uremia and dialysis and chromogranin A, a stress hormone that could be related to oxidative processes.

Methods

Plasma oxidative stress biomarkers (–SH, 8-OHdG, and ox-LDL) and chromogranin A were measured in 89 outpatients (21 uremic patients, 17 in peritoneal dialysis, and 51 in haemodialysis), and in 18 subjects with normal renal function.

Results

–SH groups were significantly reduced in heamodialysis, peritoneal, and uremic patients as compared with the control group (p = 0.01), while 8-OHdG was increased (p < 0.01). No differences were observed for ox-LDL. Chromogranin A was increased in uremic, peritoneal and haemodialysis patients (p < 0.01), showing a positive correlation to 8-OHdG (p < 0.01).

Conclusion

Oxidative stress biomarkers and chromogranin A levels differ between control subjects when compared to both uremic and dialysis patients. No differences were observed between uremic and dialysis patients, suggesting that uremia is the major source of the increase in oxidative stress and CgA levels in patients with end stage renal disease.     

Relationship between Leptin Levels and Suppressed CD4 Counts in HIV Patients

Objective

To examine the relationship between serum leptin levels and suppression of CD4 count in HIV-infected individuals with highly active antiretroviral therapy (HAART).

Subjects and Methods

Thirty seropositive HIV male patients selected from the Infectious Disease Hospital were classified into two groups according to their immunological and virological response to HAART. The first group included 15 male patients with low viral load and low CD4 counts; the second included 15 male patients with low viral load and high CD4 counts. Morning serum leptin and tumor necrosis factor-α levels of HIV patients were measured and correlated with fasting serum insulin, Homeostasis Model Assessment for Insulin Resistance (HOMA-IR), HIV viral load and CD4 count.

Results

Serum leptin levels were significantly higher in patients with high CD4 counts than in patients with low CD4 counts (mean serum leptin level 47.3 vs. 10.9 ng/ml, respectively; p < 0.0001). A positive correlation was observed between serum leptin levels and CD4 counts (r = 0.697; p < 0.0001); positive correlations were also seen between leptin levels and fasting serum insulin and HOMA-IR (r = 0.633, p < 0.0001, and r = 0.537, p < 0.003, respectively).

Conclusion

Serum leptin level was higher in HIV patients with high CD4 count and correlated with fasting serum insulin and HOMA-IR, thereby indicating that HAART treatment could lead to decreased levels of leptin in HIV patients, which might lead to impaired immunological recovery.Key Words: Human immunodeficiency virus, CD4 T cells, Leptin, Highly active antiretroviral therapy     

Serum galectin-3 levels in patients with nonalcoholic fatty liver disease

Objectives

Galectin-3 might serve as a biomarker of human metabolic alterations. We measured serum levels of galectin-3 in patients with nonalcoholic fatty liver disease (NAFLD) and examined their association with clinical and histological phenotypes.

Design and methods

Serum levels of galectin-3 were assayed in 71 patients with biopsy-proven NAFLD and 39 controls.

Results

Serum galectin-3 levels did not differ in patients with NAFLD (median 4.1 ng/mL; interquartile range: 1.5–5.5 ng/mL) compared with healthy controls (median 3.1 ng/mL; interquartile range: 0.8–7.5 ng/mL, P = 0.93). Among patients with NAFLD, however, serum galectin-3 levels correlated significantly with BMI (r = 0.267, P < 0.05). This association persisted after adjustment for potential confounders (β = 0.30; t = 2.11, P < 0.05).

Conclusions

Although galectin-3 was modestly associated with BMI, our results do not support the hypothesis that levels of this molecule are altered in patients with NAFLD.     

Plasma adenosine deaminase activity among HIV1 Clade C seropositives: relation to CD4 T cell population and antiretroviral therapy

BACKGROUND: Plasma adenosine deaminase and its isoenzymes(s) activities have been used as diagnostic marker for intracellular parasitism, including HIV infection, and malignancy of immune cells. HIV infection being primarily targeted against CD4 cells, it would be of interest to relate the activity of total plasma ADA and isoenzymes fractions to immune status and antiretroviral therapy. METHODS: In the present study, plasma total ADA activity (ADAT) including ADA1 and ADA2 isoenzyme(s) were assayed among HIV seropositive Clade C (n=90) comprising both asymptomatic (n=71) and symptomatic (n=19) and compared with that of HIV seronegatives (n=35). RESULTS: A significant increase in the activity of ADAT (16.30+/-0.80 v/s 6.18+/-0.30) as well as ADA1 (6.50+/-0.42 v/s 2.34+/-0.16) and ADA2 (9.79+/-0.53 v/s 3.85+/-0.23) isoenzyme(s) among the asymptomatic as well as the symptomatic subjects as compared to respective controls was noted. Increase in plasma ADAT activity, including ADA1 and ADA2 isoenzyme(s), were found to have negative correlation with CD4 counts (r, -0.273; p<0.05). The increased plasma ADAT activity among the asymptomatic HIV seropositive with CD4 counts>500 (13.2+/-1.65; p<0.01) as well as those who were on antiretroviral therapy (19.31+/-1.36; p<0.001) was evident. CONCLUSIONS: These findings suggest that plasma ADA can be a sensitive marker of an ongoing biological insult to host tissues either because of infection and/or side effects of medication. Measurement of plasma ADA activity, along with serological evidence for HIV infection may provide an alternate laboratory tool to monitor intracellular parasitism including secondary infection vis a vis the after effects of therapeutic outcome.     

3-Month physical activity checklist: development and validation with Taiwanese adults with mental illness

Background

Physical activity has been shown to be an effective intervention to improve psychological and emotional functions for individuals with mental illness. Many scales have been used to measure physical activity in general populations, but most existing scales may not be easily applied to individuals with mental illness.

Objective

The aim of this study was to test the reliability and validity of the 3-Month Physical Activity Checklist developed to measure physical activity performance in Taiwanese adults with mental illness.

Design

A survey questionnaire design was used to gather cross-sectional data for the scale.

Data collection and participants

Data were collected from a convenience sample of patients recruited in 2007–2010 from two mental health clinics in central Taiwan. The study was conducted in three phases: test–retest reliability and scale restructuring (n = 28), test–retest reliability and criterion-validity testing of the restructured scale (n = 60), and cross-sample testing (n = 273). In third phase, participants were diagnosed with anxiety disorders (n = 153), schizophrenia (n = 98), and bipolar disorders (n = 22).

Measures and analysis

Data were collected by self-report 3-Month Physical Activity Checklist and an administered Chinese version of the 7-Day Physical Activity Recall. Data were analyzed by intraclass correlation coefficients and chi-square test.

Results

The restructured scale had 2-week test–retest reliability coefficients for light, moderate, and vigorous activity of 0.71, 0.78, and 0.86, respectively. Moderate to high agreement was found between the two scales for light (r = 0.47), moderate (r = 0.64), and vigorous activities (r = 0.73). Recommended physical activity levels were achieved by 28.6% of participants (n = 78) and differed significantly by type of mental disorder (χ² = 21.98, p < 0.000).

Conclusions

The 3-Month Physical Activity Checklist has acceptable reliability and criterion validity to measure physical activity performance of Taiwanese adults with mental illness. The scale can be used by mental health professionals to identify levels and types of physical activity, which may be used to evaluate treatment effects or nursing care outcomes for patients with mental illness.     

Transcultural adaptation and psychometric properties of a Spanish-language version of physical activity instruments for patients with fibromyalgia

Munguía-Izquierdo, D, Legaz-Arrese A, Mannerkorpi K. Transcultural adaptation and psychometric properties of a Spanish-language version of physical activity instruments for patients with fibromyalgia.

Objectives

To develop a transcultural adaptation of the Leisure Time Physical Activity Instrument (LTPAI) and the Physical Activity at Home and Work Instrument (PAHWI) in Spanish and to assess their psychometric properties in women with fibromyalgia syndrome (FS).

Design

A cross-sectional transcultural adaptation and validation study.

Setting

Testing was completed at the university.

Participants

Seventy-five (N=75) women with FS (median age=51y; 25th–75th percentiles, 45–55y) and a median symptom duration of 16 years (25th–75th percentiles, 10–25y) were recruited for the study.

Intervention

Not applicable.

Main Outcome Measures

Cognitive function (Paced Auditory Serial Addition Task), physical activity habits (LTPAI, PAHWI, International Physical Activity Questionnaire [IPAQ]), and active energy expenditure using a multiple-sensor body monitor were used for the evaluations. The differences between the readings (test 1 – test 2) and the SD of the differences, intraclass correlation coefficient (ICC), 95% confidence interval (CI) for the ICC, coefficient of repeatability, intrapatient SD, standard error of the mean, minimal detectable change, Wilcoxon signed-rank test, and Bland-Altman graphs were used to examine reliability. The magnitude of the associations between LTPAI–PAHWI and IPAQ, and between LTPAI–PAHWI and the body monitoring device, were used to examine the validity of the construct.

Results

The median time that the study population spent performing physical activities during their leisure time was 5h/wk (25th–75th percentiles, 3–9h/wk). A satisfactory test–retest reliability was found for the total score of the LTPAI (ICC=.84; 95% CI, .76–.90) and for the workplace subscale of the PAHWI (ICC=.87; 95% CI, .81–.92). A significant association was observed between LTPAI and both the leisure time domain of the IPAQ (ρ=.61; P<.001) and the active energy expenditure of the body monitoring device (ρ=.27; P=.021). A significant association was found between the workplace subscale of the PAHWI and the work domain of the IPAQ (ρ=.58; P<.001) as well as between the subscale for housework of the PAHWI and the domestic domain of the IPAQ (ρ=.43; P<.001). However, no association was observed between PAHWI and the SenseWear Armband.

Conclusions

The Spanish version of the LTPAI and PAHWI is understandable, and its administration is feasible in patients with FS. LTPAI can be considered a fairly reliable and valid tool to assess leisure physical activities in Spanish women with FS. The PAHWI does not appear to be a reliable and valid tool to assess physical activities associated with work in Spanish women with FS. Although the PAHWI demonstrated acceptable test–retest reliability for the workplace subscale, a lower reliability was observed for the total score and for the housework subscale.     

Quantifying off-hour emergency physician coverage of in-hospital codes: a survey of community emergency departments

Background

Community emergency physicians (EPs) are often required to respond to unstable patients outside of their department during off-hours.

Objective

The primary objective of this study was to describe the critical care responsibility of community EPs outside of their departments.

Methods

A one-page survey was mailed to emergency department (ED) directors of 10 states and Washington, DC.

Results

Three hundred forty of 1169 surveys were returned. The median (interquartile range [IQR]) number of hospital and intensive care unit (ICU) beds was 145 (IQR 60–242) and 11 (IQR 6–20), respectively. Median ED annual volume and ICU admission percentage was reported to be 25 K (IQR 14–40) and 5% (IQR 2–10), respectively. Seventy-six percent of reporting institutions require EPs to leave their department and respond to medical codes on the floors after hours. In 57% of institutions, the EP was the only physician required to respond. In addition, 48% of EPs must respond to unstable patients in the ICUs after hours. Hospitals in which EPs were required to respond to medical codes and unstable ICU patients were more likely to have fewer hospital beds (137 vs. 275; p < 0.001), fewer ICU beds (12 vs. 27; p < 0.001), and have a smaller ED annual volume (24 K vs. 39 K; p < 0.001).

Conclusions

Many community EPs are responsible for covering critically ill patients outside of their ED. Further investigation is required to determine the impact on patient care.     

Evaluation of a caregiver education program to support memory and communication in dementia: a controlled pretest-posttest study with nursing home staff

Background

There is a need for simple multimedia training programs designed to upskill the dementia care workforce. A DVD-based training program entitled RECAPS and MESSAGE has been designed to provide caregivers with strategies to support memory and communication in people with dementia.

Objectives

The aims of this study were: (1) to evaluate the effects of the RECAPS and MESSAGE training on knowledge of support strategies, and caregiver satisfaction, in nursing home care staff, and (2) to evaluate staff opinion of the training.

Design

A multi-centre controlled pretest–posttest trial was conducted between June 2009 and January 2010, with baseline, immediately post-training and 3-month follow-up assessment.

Setting

Four nursing homes in Queensland, Australia.

Participants

All care staff were invited to participate. Of the 68 participants who entered the study, 52 (37 training participants and 15 controls) completed outcome measures at baseline and 3-month follow-up. 63.5% of participants were nursing assistants, 25% were qualified nurses and 11.5% were recreational/activities officers.

Methods

The training and control groups were compared on the following outcomes: (1) knowledge of memory and communication support strategies, and (2) caregiver satisfaction. In the training group, the immediate effects of training on knowledge, and the effects of role (nurse, nursing assistant, recreational staff) on both outcome measures, were also examined. Staff opinion of the training was assessed immediately post-training and at 3-month follow-up.

Results

The training group showed a significant improvement in knowledge of support strategies from baseline to immediately post-training (p = 0.001). Comparison of the training and control groups revealed a significant increase in knowledge for the training group (p = 0.011), but not for the control group (p = 0.33), between baseline and 3-month follow-up. Examination of caregiver satisfaction by care staff role in the training group revealed that only the qualified nurses showed higher levels of caregiver satisfaction at 3-month follow-up (p = 0.013). Staff rated the training positively both for usefulness and applicability.

Conclusion

The RECAPS and MESSAGE training improved nursing home care staff's knowledge of support strategies for memory and communication, and gains were maintained at 3-month follow-up. Moreover, the training was well received by staff.     

High-sensitivity C-reactive protein: discriminator between patients with primary and secondary antiphospholipid syndrome

Objective

It is not clear whether primary (PAPS) or secondary (SAPS) antiphospholipid syndrome represent distinct clinical entities or whether they are the same syndrome seen against different background. Therefore we examined whether hsCRP, C3, C4 and anti-oxLDL antibodies could discriminate between PAPS and SAPS patients.

Design and methods

This study included: 44 patients with PAPS and 20 patients with SAPS associated with SLE and 37 control subjects. Antibody levels were estimated by ELISA, while C3, C4 and hsCRP were determined by immunonephelometric method.

Results

SAPS patients had significantly elevated hsCRP (mg/L) concentrations in comparison to PAPS patients (8.00 (7.00–15.00) vs. 2.27 (0.68–6.89), Mann–Whitney, p = 0.000).

Conclusion

Measurement of hsCRP should be mandatory in the follow-up of SAPS patients in order to identify a subset with a high cardiovascular risk and in PAPS in order to identify patients with a risk of evolving to SLE.     

Out-of-hospital cardiac arrest: early in-hospital hypotension versus out-of-hospital factors in predicting in-hospital mortality among those surviving to hospital admission

Objective

The purpose of this study was to determine the prevalence of in-hospital hypotension in patients surviving to admission after resuscitation from out-of-hospital cardiac arrest and compare it to that of traditional Utstein factors in predicting in-hospital mortality.

Methods

Single-center retrospective cohort of adult patients surviving to hospital admission after resuscitation from out-of-hospital sudden death between January 1, 2006 and October 31, 2009. Study variables included Utstein template data: age, sex, initial rhythm, witnessed or nonwitnessed arrest, presence or absence of bystander CPR, location of arrest, response time (time of 9-1-1 dispatch to first vehicle arrival), and hypotension (systolic pressure < 90 or mean arterial pressure < 60) within 24 h of ROSC. Univariate comparisons of categorical variables were performed and the Wilcoxon rank-sum test was used to compare continuous variables. Multivariable logistic regression was then performed after inclusion of Utstein variables.

Results

73 patients met the inclusion criteria, and in-hospital mortality occurred in 54 (74%). On univariate analysis, in-hospital hypotension (OR = 3.5, 95%CI 1.1–10.0, p = 0.02), pre-hospital rhythm other than VF/VT (OR 4.3, 95%CI 1.4–13.3, p = 0.008), and an unwitnessed arrest (OR = 6.9, 95%CI 0.8–56.5, p = 0.04), were significant predictors of in-hospital mortality. On multivariable analysis, in-hospital hypotension (OR = 9.8, 95%CI 1.5, 63.0, p = 0.02), pre-hospital rhythm other than VT/VF (OR = 8.5, 95%CI 1.3–58.8, p = 0.03), and lack of bystander CPR (OR = 13.2, 95%CI 1.6–111, p = 0.02) remained statistically significant predictors of in-hospital mortality.

Conclusions

In-hospital hypotension was predictive of mortality, as was a pre-hospital nonshockable rhythm and lack of bystander CPR. In contrast, traditional pre-hospital risk factors: age, gender, public location of arrest, response time, and witnessed arrest, were not predictive.     

The effectiveness of protocol drive, nurse-initiated discharge in a 23-h post surgical ward: a randomized controlled trial

Background

A 23-h unit was established in June 2005 to relieve pressure on surgical beds. Patients were to be discharged by 0900 h without review by a doctor. However, discharge without review remained the exception rather than the rule.

Objective

The aim of the current trial was to asses the affect of a protocol driven, nurse-initiated discharge process on discharge time, patient satisfaction and adverse events.

Design

Randomised controlled trial.

Setting

A large, major metropolitan hospital in Queensland, Australia.

Participants

Patients undergoing a surgical procedure and requiring an overnight stay in the 23-h unit were eligible for inclusion. 182 were randomised and 131 patients completed the study.

Methods

Participants were randomly assigned into one of two groups: protocol driven, nurse-initiated or usual care. The primary end-point was the proportion of patients discharged by 0900 h. Patients completed a self-report questionnaire two weeks after hospital discharge, to evaluate their satisfaction.

Results

Of the 131 patients completing the trial, only 82 (62.6%) were discharged by 0900 h. In the Protocol group 45 (78.9%) patients were discharged on time compared with 37 (50.0%) in the usual care group. This difference was statistically significant (OR 3.75; 95% CI-1.74–8.21; p = 0.001). The average length of stay in the 23-h unit was 16.5 (SD 6.8) h. This did not differ by group (MD 0.29; 95% CI-2.13–2.71; p = 0.81). The overall mean satisfaction score was 95.4 (SD 8.8) and results were similar between groups (Protocol group 96.2 versus usual care group 94.6; p = 0.40).

Conclusions

A protocol driven, nurse-initiated discharge process in an overnight post surgery unit results in a higher proportion of patients being discharged by 0900 h without compromising patient satisfaction.     

Relationship of clinic-based gait speed measurement to limitations in community-based activities in older adults

Verghese J, Wang C, Holtzer R. Relationship of clinic-based gait speed measurement to limitations in community-based activities in older adults.

Objective

To examine the ability of clinic-based assessments of gait speed to capture limitations in a broad range of home- and community-based activities.

Design

Cross-sectional study.

Setting

Community-based aging cohort study.

Participants

Community-residing subjects (N=655; 61% women; age ≥70y; mean, 80.4y).

Interventions

None.

Main Outcome Measures

Limitations on 3 gait-related activities of daily living (walking inside home, climbing up and down stairs) and 6 motor-based but gait-independent activities (bathing, dressing, getting up from a chair, toileting, shopping, using public transportation).

Results

Gait speed was associated with the presence of self-reported difficulty for all 3 home-based activities that were directly gait related and 5 of 6 motor-based activities. Gait speed of 1m/s or less was associated with increased risk for limitations on at least 1 of the 9 selected activities (odds ratio, 3.21; 95% confidence interval, 2.24–4.58; P<.001).

Conclusions

Gait speed measured in clinical settings has ecologic validity as a clinical marker of functional status in older adults for use in clinical and research settings.     

Maternal severity of illness across levels of care: A prospective, cross-sectional study

Background

The severity of illness of women experiencing severe maternal morbidity has not been quantified outside of the intensive care setting yet is likely to have a bearing on clinical needs.

Aim

To examine severity of illness in women with severe maternal morbidity.

Methods

A prospective observational study of critically ill pregnant and postpartum women was undertaken in intensive care units (ICU), high dependency units (HDU) and delivery suites (DS) of seven tertiary-level hospitals in Melbourne, during 2002–2004. Severity of illness was scored using the Acute Physiology and Chronic Health Evaluation version II (APACHE II) and Therapeutic Intervention Scoring System 28 items (TISS 28).

Results

137 women participated in the study: ICU (n = 33), HDU (n = 46) and DS (n = 58). The mean APACHE II score was 8.6 (95% CI 7.7–9.5) and mean TISS 28 score was 22.5 (95% CI 21.2–23.9). Women in ICU were sicker according to both APACHE II (mean 12.6, 95% CI 8.3–16.9) and TISS 28 (mean 31.5, 95% CI 28.2–35.5) compared to women not admitted to ICU (p < .005). There was no difference in the mean APACHE II scores of women in HDU (7.7, 95% CI 5.5–9.9) and DS (7.0, 95% CI 5.2–8.8; p = .20). Women born outside of Australia were more likely to be admitted to ICU (OR 3.27, 95% CI 1.19–8.97). Known risk factors like multiple pregnancy, age ≥35 years and nulliparity were not associated with ICU admission.

Conclusions

There was no difference in the severity of illness in women cared for in HDU and DS. It was not possible to predict which women would require ICU admission. Measurement of severity of illness adds a valuable dimension to the study of severe maternal morbidity.     

The effects of multidimensional exercise treatment on community-dwelling elderly Japanese women with stress, urge, and mixed urinary incontinence: a randomized controlled trial

Background

Urinary incontinence is one of the most prevalent health problems and a significant cause of disability and dependence in the elderly. Pelvic floor exercise is effective in reducing stress urinary incontinence, but few studies have investigated the effect of behavioral management on urge and mixed incontinence.

Objectives

To determine the effects of multidimensional exercise treatment on reducing urine leakage in elderly Japanese women with stress, urge, and mixed urinary incontinence.

Design

Randomized controlled, follow-up trial.

Settings

Urban community-based study.

Participants

127 community-dwelling women aged 70 and older with stress, urge, and mixed urinary incontinence were randomly assigned to the intervention (n = 63) or the control group (n = 64).

Methods

Urine leakage and fitness data were collected at baseline, and after the intervention and follow-up. The intervention group received a multidimensional exercise treatment twice a week for 3-month. After treatment, the participants were followed for 7-month.

Results

There were significant differences in changes of functional fitness and incontinence variables between the intervention and control groups. The intervention group showed urine leakage cure rates of 44.1% after treatment and 39.3% after follow-up (χ² = 21.96, p < 0.001); whereas, the control group showed no significant improvement. The multidimensional exercise treatment was significantly effective in decreasing all three types of urinary incontinence. However, the effects of the exercise treatment were greater on stress urinary incontinence than on urge or mixed urinary incontinence. At the 7-month follow-up, while cure rates of all three types of urinary incontinence were significantly maintained, a slight reversal was seen only in the urge and mixed urinary incontinence (χ² = 10.28, p = 0.008). According to the logistic regression model, urine leakage volume (adjusted odds ratio OR = 0.69, 95% confidence interval CI = 0.39–0.98), compliance (OR = 1.03, 95%CI = 1.01–1.16), and BMI reduction (OR = 0.67, 95%CI = 0.48–0.89) were significantly associated with the cure of urine leakage after intervention. The cure rate of urine leakage after the follow-up was significantly associated with compliance (OR = 1.13, 95%CI = 1.02–1.29) and BMI reduction (OR = 0.78, 95%CI = 0.60–0.96).

Conclusions

The intervention group showed higher urine leakage cure rates than control group. This result suggests that multidimensional exercise strategies may be effective for all three types of urinary incontinence. BMI reduction and compliance to the intervention was the consistent predictor for the effectiveness of the exercise treatment.