Faecal incontinence: an unrecognised epidemic in rural North Queensland? Results of a hospital‐based outpatient study

OBJECTIVES: We explored the prevalence of faecal incontinence (FI) in a referral hospital outpatient population, to explore suspicions that FI is inadequately studied, underestimated and poorly appreciated in the rural North Queensland (NQ) community. DESIGN: Prospective cross-sectional study using a specifically designed questionnaire. SETTING: The Townsville Hospital, a referral centre serving rural NQ. SUBJECTS: A total of 435 consecutive patients attending the gynaecology (n = 261) and colorectal clinics (n = 174) between 31 January and 12 June 2003 were enrolled (participating proportion 96.5%). MAIN OUTCOME MEASURES: FI prevalence, severity, impact on patients' lives, and risk factors. RESULTS: The prevalence of FI in the study population (median age 53 years) was 20.7%. Amongst affected patients (n = 90) the median duration of FI was 2 years with more than half of those affected soiling themselves at least once a month. Many patients with FI (42%) reported feeling hopeless at least some of the time. Rectal prolapse, chronic constipation, psychiatric problems, colon disease, and urinary incontinence were all significantly associated with FI. A CART analysis revealed that many patients (45%) with urinary incontinence and chronic constipation also experienced FI. CONCLUSIONS: This FI prevalence in a clinical setting in NQ is, apart from nursing home studies, the highest reported in the literature. FI negatively impacted on affected persons' lives. In patients presenting with urinary incontinence and chronic constipation, physicians should specifically enquire whether FI is also present. Definitive community studies to determine the scale of this 'silent epidemic' in northern Australia are now required.     

盆底综合康复治疗对老年女性尿失禁的相关研究

目的探讨盆底综合康复治疗对老年女性压力性尿失禁患者的临床疗效及其对焦虑抑郁情绪的影响。方法选取2015年7月~2016年7月在北京老年医院妇科就诊的老年女性轻中度压力性尿失禁患者80例,随机分为试验组和观照组各40例。分别用生物反馈电刺激联合盆底肌肉锻炼法及单独的盆底肌肉锻炼法进行治疗并随访,比较两组尿失禁的治愈率、自觉症状评分及焦虑抑郁评分的改变。结果采用盆底综合康复治疗的试验组治疗后和随访后的尿失禁治愈率分别为90%(36/40)和72.5%(29/40),均显著高于对照组(P0.05)。试验组治疗后和随访后的症状评分均显著低于治疗前(P0.05)。试验组在治疗后及随访后的焦虑自评量表评分和老年抑郁评分均显著低于治疗前及同时期的对照组(P0.05)。结论盆底综合康复治疗更有效地改善老年女性压力性尿失禁的症状,同时减轻患者焦虑抑郁的负面情绪。     

子宫切除术后压力性尿失禁尿动力学分析

目的:从尿动力学角度探讨子宫切除术后压力性尿失禁患者尿控能力损伤的特点。方法:对84例临床诊断为压力性尿失禁的患者进行尿动力学检查,其中15例为子宫切除术后压力性尿失禁(手术组),69例无盆腔手术史(无手术组),对比两组尿动力学参数。结果:手术组的ALPP较无手术组低(P0.01);而两组膀胱功能异常率及尿道压力参数MUCP、FUL比较,无显著性差异。结论:子宫切除术后压力性尿失禁患者静息状态下尿控能力无明显变化,而应力性尿控能力下降。     

Prevalence and detection of urinary incontinence among older Medicaid recipients

Low-income older adults have higher rates of many medical disorders than those with higher income, but rates of urinary incontinence have not been examined in this population. A random sample of older Medicaid recipients was interviewed (n=910) and medical records examined for the subset with urinary incontinence (n=236). Nursing home residents were randomly selected from Medicaid enrollment files (n=480). Forty-two percent of community residents reported urinary incontinence, with higher rates among women, older respondents, and whites. The medical records for only 22% of community-dwellers contained a diagnosis of urinary incontinence, compared with 77% for nursing home residents. Type of urinary incontinence was specified for 65% of diagnosed community dwellers and 7% of diagnosed nursing home residents. Urinary incontinence rates are high among Medicaid recipients compared with estimates from general population studies, but detection rates are lower for community-dwellers. Physicians may need to do more among low-income older adults in order to detect urinary incontinence.     

Quality of Life of Women with Urinary Incontinence: Cross-cultural Performance of 15 Language Versions of the I-QOL

Urinary incontinence (UI) has substantial and important impacts on health-related quality of life. The purpose of this research is to report the psychometric performance of 15 different language versions of the Incontinence-specific Quality of Life (I-QOL)measure, a patient-reported outcome measure specific to stress, urge and mixed urinary incontinence. The multi-national dataset consisted of data from four clinical trials for stress incontinent females and from two additional population studies, enrolling women with stress, urge and mixed UI. All enrolled patients completed the I-QOL and comparative measures at baseline. The clinical trial populations had multiple administrations up to 12 weeks, and the two population studies included a shorter retest. Country-specific psychometric testing for validity, reliability, and responsiveness followed standardized procedures. Confirmatory factor analyses were performed to assess the I-QOL subscales. The I-QOL measurement model was confirmed as three subscales. Summary and subscale scores for the 15 versions were internally consistent (alpha values = 0.91–0.96) and reproducible (ICC = 0.72–0.97). Using changes in the independent measures of incontinence episode frequency standardized response means were predominantly strong (ranged 0.71–1.05) across 13 versions (out of 15) in association with these measures and effect sizes. These additional language versions of the I-QOL instrument demonstrate psychometric properties similar to the original version. The I-QOL has shown good results in both community studies and clinical trials with varying types and severity of urinary incontinence. It is a reliable and valid measure of HRQOL, suitable for use in a variety of international settings.     

中国10个地区中老年人尿失禁的描述性分析

目的 描述中国10个地区中老年人尿失禁患病率的人群和地区分布特征。方法 对完成中国慢性病前瞻性研究项目2020-2021年第三次重复调查的24 913名45~95岁的研究对象进行分析。通过调查员面对面询问了解研究对象发生尿失禁的情况，进一步区分单纯压力性尿失禁、单纯急迫性尿失禁和混合性尿失禁。分性别、年龄、地区等特征报告尿失禁及其亚型的患病率，并描述患者严重程度和接受治疗情况。结果 研究对象年龄为（65.4±9.1）岁。以2020年第七次全国人口普查数据进行年龄标化后，女性自报尿失禁标化患病率为25.4%，男性为7.0%。男性中单纯压力性尿失禁、单纯急迫性尿失禁和混合性尿失禁的标化患病率依次为1.7%、4.2%和1.2%，女性中对应的标化患病率依次为13.5%、5.8%和6.1%。男性尿失禁及各种亚型的患病率、女性尿失禁及除单纯压力性尿失禁以外的各亚型患病率均随年龄增长而升高（P<0.001）。调整年龄后，农村男、女性尿失禁患病率均高于城市（P<0.001）。男性和女性尿失禁患者自报接受治疗率分别为15.4%和8.5%。结论 我国中老年人群的尿失禁患病率较高，且女性高于男性，而尿失禁患者的治疗率较低。     

自我效能感在女性尿失禁患者中社会支持与抑郁之间的调节作用

目的 探讨自我效能感在女性尿失禁患者社会支持与抑郁之间调节作用,为降低尿失禁患者的抑郁水平提供参考。方法 选取2016年9月1日—2018年12月31日期间在三门峡市中心医院妇科诊断为尿失禁的患者作为本次的研究对象进行问卷调查,调查内容包括社会人口学资料、抑郁自评量表、一般自我效能感量表以及领悟社会支持评定量表等。结果 225例研究对象中,检出抑郁症状72例(32.0%),高龄、病程长、肥胖、离婚和丧偶、有抑郁家族史的患者抑郁检出率更高,差异有统计学意义(P<0.05);抑郁平均得分48.38.2,领悟社会支持平均得分为59.58.7,自我效能感平均得分为22.16.3;领悟社会支持(β=-0.251,P=0.002)和自我效能感(β=-0.324,P<0.001)对抑郁均呈负向作用,P<0.001),自我效能感在尿失禁患者社会支持与抑郁之间的关系中存在增强型调节作用(β=-0.114,P=0.020)。结论 女性尿失禁患者中抑郁检出率高,在提高其社会支持的前提下,同时提高自我效能,可进一步降低患者抑郁水平。     

急性缺血性脑卒中后尿失禁危险因素的研究

目的 探讨急性缺血性脑卒中后尿失禁的危险因素。方法 收集2014年5月至2014年10月在广州市5家三级甲等医院神经内科病房住院的594例急性缺血性脑卒中患者,采用Logistic回归分析影响急性缺血性脑卒中后尿失禁发生的因素。结果 急性缺血性脑卒中后尿失禁的发生率为37.7%。多因素分析显示,BI评分、病变部位、患者文化程度、照顾者是影响急性缺血性脑卒中后尿失禁发生的独立危险因素。结论 BI评分低、额叶病变、颞叶病变、患者文化程度为小学及以下、护工陪护的急性缺血性脑卒中患者易发生尿失禁,临床工作中对高危人群予以重点关注,开展有针对性的干预。     

Gender differences in health-related quality of life in patients with HIV/AIDS

Background: In studies evaluating the general US population, patients in primary care, and patients with chronic conditions, women consistently report poorer health-related quality of life (HRQoL) than men; however, studies evaluating HRQoL in patients with HIV/AIDS have not completely corroborated those findings. The objective of this study was to evaluate gender differences in HRQoL for participants in a large randomized trial comparing antiretroviral regimens. Methods: AIDS Clinical Trials Group (ACTG) 320 was a randomized, blinded, placebo-controlled trial comparing the 3-drug regimen of indinavir + zidovudine (or stavudine) + lamivudine with the 2-drug combination of zidovudine (or stavudine) + lamivudine in subjects with CD4 cell counts less than 200 cells/l and no prior treatment with protease inhibitors. Nine quality of life domains scored on 0–100 scales were assessed using the ACTG QOL 601-602 Health Survey at 3 points in the trial: baseline, 24 weeks and 40 weeks. Differences between men and women in HRQoL scores were assessed using the Wilcoxon rank-sum test and generalized estimating equation (GEE) models. Results: Overall, 202 females and 976 males were randomized to one of two treatment arms. Female participants were more likely to be black or Hispanic and tended to be younger. At baseline, females reported lower HRQoL scores than males in all of the domains except social functioning, and at week 40, women scored lower in all of the domains except overall health. In repeated measures models, women were found to score lower in all HRQoL domains except overall health, with significant differences of 3.5–6.7 points in 3 of the 9 quality of life domains: physical functioning, pain, and energy/fatigue. HRQoL scores improved for participants in the study over time and in response to potent treatment, and the improvements were similar for men and women. Conclusions: Women with HIV/AIDS report substantially poorer HRQoL than men with HIV/AIDS in several HRQoL domains. However, changes in domain scores over time and in response to treatment do not differ significantly by gender, implying that changes in domain scores may be better HRQoL outcomes to compare between HIV-infected men and women in clinical trials than mean domain scores.     

子宫内膜异位症术后尿失禁的相关危险因素分析

目的 探讨子宫内膜异位症(EMs)术后尿失禁的相关危险因素。方法 选择2016年1月—2019年5月在本院行腹腔镜手术治疗的360例EMs患者,无尿失禁334例,出现尿失禁26例。收集患者临床资料,分析尿失禁发生危险因素。结果 尿失禁组合并高血压、体质指数(BMI)≥25 kg/m2、尿失禁病史、合并糖尿病、术后腹压增加、并发尿路感染、阴道前后壁膨出、30 d内行重体力劳动的比率以及年龄、术后留置尿管时间均高于无尿失禁组,差异有统计学意义(P<0.05)。Logistic回归分析显示,合并高血压、BMI≥25 kg/m2、合并糖尿病、术后腹压增加、术后30 d内行重体力劳动、年龄≥35岁是EMs术后尿失禁发生的独立危险因素(P<0.05且OR>1)。结论 合并高血压、BMI≥25 kg/m2、合并糖尿病、术后腹压增加、术后30 d内行重体力劳动、年龄≥35岁是EMs术后尿失禁发生的独立危险因素,临床应结合上述危险因素,实施针对性的防治措施,以改善患者预后。     

Screen time and physical activity behaviours are associated with health-related quality of life in Australian adolescents

Purpose

To explore the cross-sectional relationships between health-related quality of life (HRQoL) and physical activity (PA) behaviours and screen-based media (SBM) use among a sample of Australian adolescents.

Methods

Data came from baseline measures collected for the It??s Your Move! community-based obesity prevention intervention. Questionnaire data on sociodemographics, PA, SBM and HRQoL were collected from 3,040 students (56% boys) aged 11?C18?years in grade levels 7?C11 in 12 secondary schools. Anthropometric data were measured.

Results

The highest level of PA at recess, lunchtime and after school was associated with higher HRQoL scores (boys, by 5.3, 8.1, 6.3 points; girls, by 4.2, 6.1, 8.2 points) compared with not being active during these periods. Exceeding 2?h of SBM use each day was associated with significantly lower HRQoL scores (boys, by 3.2 points; girls, by 4.0 points). Adolescents who were physically active and low SBM users on school days had higher HRQoL scores (boys, by 6.6 points; girls, by 7.8 points) compared with those who were not physically active every school day and high SBM users on school days.

Conclusions

Several of the relationships between low PA and high SBM use and HRQoL were comparable to those previously observed between chronic disease conditions and HRQoL, indicating that these behaviours deserve substantial attention.     

Variation in Chinese population health related quality of life: Results from a EuroQol study in Beijing,China

The purpose of this study is to measure Chinese population health related quality of life (HRQoL) using European quality of life (EQ-5D) instrument, to examine the validity of EQ-5D in measuring Chinese population HRQoL, to explore the relationships between EQ-5D and other health determinants, and to display the similarities and differences of HRQoL between the Chinese population and the populations of other countries. The data used in this study includes 2994 respondents whose age are 12 years and older, which is from the 2000 Beijing Household Health Survey. Univariate and bivariate analyses have been used to examine the level of HRQoL and the relationships between HRQoL and other variables. Multi-variate analyses have been used to explore the relationships between the EQ-5D Visual Analogue Scale (VAS) and the EQ-5D five dimension indicators. There are four principal findings from this study. First, the EQ-5D instrument is a valid measure for Chinese HRQoL, but with a significant ceiling effect. Second, Pain/Discomfort and Anxiety/Depression are the major Chinese HRQoL problems and the extents of these problems differ in subgroup populations. Third, typically mean scores are lower for older age group; this is observed at lower ages in the Chinese population than in populations from developed countries. Fourth, Chinese HRQoL has strong association relationship with population socio-economic status (SES), which might imply that issues brought on by the rapid economic transition have both positive and negative impacts on Chinese HRQoL.     

The extent and severity of urinary incontinence amongst women in UK GP waiting rooms

INTRODUCTION: Few women seek help for urinary incontinence. Subsequently, there may be many women accessing primary care services who would benefit from treatment or advice. If high levels of unexpressed need are present in this population, a more proactive approach to continence management may be appropriate, but the feasibility of this depends on an accurate assessment of the level of unmet need in this population. AIM: To assess the prevalence of urinary incontinence in a female population attending primary care and the extent of treatment seeking in relation to level of need. METHODS: A cross-sectional survey of urinary incontinence of adult women attending primary care practices in West Yorkshire, London, Glasgow and Leicestershire during a 10- or 15-day period. RESULTS: Three thousand two hundred and seventy-three (54%) women responded. Twenty-one per cent reported stress urinary incontinence only, 3.5% reported urge incontinence only and 21% reported mixed stress and urge incontinence during the preceding month (9% had moderate or severe symptoms). Fifty-three per cent of these had not consulted a health care professional, which is equivalent to 1 in 20 of women in GP waiting rooms, most of whom have stress and urge incontinence (75%) or stress incontinence only (21%). CONCLUSIONS: Nearly half of female primary care attendees had experienced incontinence during the preceding month, but only a minority had sought help. Even amongst the nearly 1 in 10 women with moderate or severe incontinence only about half had sought help. There remains considerable health decrement due to urinary incontinence in those not receiving help in a population readily accessible to primary care services.     

The impact of incontinence on health-related quality of life in a South Australian population sample

OBJECTIVE: To assess prevalence of incontinence in a South Australian representative population sample and compare the health-related quality-of-life impact of incontinence with other chronic conditions. METHOD: The 1998 South Australian Health Omnibus Survey interviewed 3,010 male and female respondents aged 15 to 97 years (response rate 70.2%). This representative population survey included questions to determine the prevalence of urinary (stress and urge), and anal (faecal and flatus) incontinence, and other chronic conditions. Respondents also completed the MOS SF-36 questionnaire. RESULTS: Self-reported prevalence of all types of incontinence was 26.0%. The prevalence of anal and urinary incontinence were 10.5% and 20.3% respectively, with 4.8% of respondents experiencing both. Univariate analysis found the prevalence of incontinence was statistically significantly higher among females, and those who were older, widowed, had no post-school education, and lower incomes. After adjusting for differences in age and sex, it was found that people with incontinence were significantly impaired across all dimensions of the SF-36, scoring in the lowest 42% of the population, compared with those people without incontinence. People with incontinence exhibited different SF-36 profiles to those with other chronic conditions. CONCLUSIONS: Incontinence is common in South Australia, affecting more than one-quarter of the population, particularly older women (56.2% for 60 years and over). The impact of incontinence on health-related quality of life is characteristically different to that demonstrated by other chronic conditions. IMPLICATIONS: In an ageing population, identification of the impact of incontinence is necessary to direct policy development and resource allocation to this area.     

Fecal incontinence in older patients

Fecal incontinence (FI), the involuntary passage of fecal material through the anus, is a common medical problem in older people, especially in frail older nursing home residents. FI is often associated with urinary incontinence. Severe constipation leading to fecal impaction, laxative abuse, diarrhea, cognitive impairment, senescence, and neuromuscular disorders including autonomic neuropathy, are among the leading causes of FI in older patients. FI affects patients' physical and psychological well-being, and is responsible for considerable morbidity and mortality in older patients. This results in significant healthcare costs. Comprehensive management of this disorder requires a systematic approach including thorough history, physical examination, and step-wise evaluation. This review in contrast to others published in last decade, focuses on management of FI in frail older nursing home patients, who require an individualized approach, which should be minimally invasive and cost-effective. In many cases of FI, treatment of the underlying condition; adequate control of diarrhea, constipation, or fecal impaction; adjustment of medications; and proper feeding may control or reduce FI. Advanced tests are often not necessary in this population.     

Patient Characteristics Impacting Health State Index Scores, Measured by the EQ-5D of Females with Stress Urinary Incontinence Symptoms

Objective:  To describe the characteristics of women seeking treatment for symptoms of stress urinary incontinence (SUI) and to investigate the association of SUI symptoms with generic health-related quality of life (HRQoL) as measured by the EuroQol (EQ-5D) instrument.
Methods:  The Stress Urinary Incontinence Treatment (SUIT) study was a 12-month observational study in four European countries that evaluated the cost-effectiveness of duloxetine compared with other forms of nonsurgical intervention in the treatment of the symptoms of SUI. Four hundred thirty-one physicians observed women seeking treatment for their SUI, and recorded the care provided and the outcomes of that care at enrollment and at 3, 6 and 12 months afterward The impact of SUI on baseline HRQoL as expressed by the EQ-5D index score was assessed by linear and logistic regression.
Results:  Three thousand seven hundred sixty-two women were enrolled into SUIT, with the largest patient group from Germany. Overall, the majority of women were postmenopausal, had a mean age of 58.0 years, were not current smokers, and tended to be overweight (mean body mass index [BMI] = 27.7 kg/m²), with at least one comorbidity. The health state index scores were significantly and independently influenced by the presence of comorbidity(ies) affecting quality of life, total number of stress and urge incontinence episodes, urinary incontinence subtype, comorbidity(ies) affecting incontinence, BMI, socioeconomic status, educational status, age, and country.
Conclusion:  This article describes the characteristics of patients at the SUIT enrollment visit, and demonstrates that the number of incontinence episodes has a significant impact on the EQ-5D index score.     

产科因素与尿失禁患病关系的流行病学调查

目的:探讨分娩方式及其它产科因素与尿失禁的关系。方法:对洛阳市某大型企业在职及退休女工采取整层随机抽样进行尿失禁问卷调查。结果:①尿失禁患病率为41.82%,随着年龄的增加而升高(P<0.001);②尿失禁患者体重指数(BMI)和非尿失禁患者比较有显著性差异(P<0.001);③分娩方式与尿失禁明显相关,阴道分娩明显高于剖宫产(P<0.001);④新生儿体重、母乳喂养以及流产次数与尿失禁无关(P>0.05)。结论:工厂女工尿失禁患病率较高,年龄及BMI与患病情况密切相关,分娩方式与尿失禁明显相关。应加强孕产期保健,降低尿失禁患病率,提高女性生活质量。     

Cumulative and bidirectional association of physical activity and sedentary behaviour with health-related quality of life in adolescents

Background

The directionality of the association of physical activity (PA) and sedentary behaviour (SB) with health-related quality of life (HRQoL) remains unknown in adolescents. This study aimed to investigate the association of 2-year cumulative level of PA and SB with HRQoL and the reverse association.

Methods

We included 1445 adolescents in France from a 2-year longitudinal study with three follow-up times (PRALIMAP trial). At each follow-up, adolescents completed the International Physical Activity Questionnaire for PA and SB and the Duke Health Profile for HRQoL. Statistical analyses involved linear and logistic regressions adjusted for socio-demographic characteristics.

Results

The cumulative number of times an adolescent achieved the PA recommendations during the 2 years was associated with better physical, mental, social and general HRQoL (p for trend <0.0001). In contrast, high SB predicted low HRQoL for most dimensions except social HRQoL (p = 0.12). Combining PA and SB, the effect of recommended PA on HRQoL was offset in part by high SB. In the reverse association, high HRQoL predicted high PA (overall, vigorous, moderate and recommended PA), but was not associated with SB.

Conclusions

The association between PA and HRQoL was cumulative and bidirectional among adolescents, whereas low HRQoL seemed to be a consequence of high SB rather than a cause (cumulative but not bidirectional). Promoting recommended PA and low SB may help improve HRQoL among adolescents, with a possible virtuous cycle with regard to PA.

     

Health related quality of life in patients with neuroendocrine tumors compared with the general Norwegian population

Purpose  Health related quality of life (HRQoL) was characterized among patients with neuroendocrine tumor (NET) and compared with the general Norwegian population. Methods  A cross sectional, comparative design was chosen, and the samples comprised 196 NET patients and 5,258 individuals from the general Norwegian population. We used Chi-square cross tab calculations to evaluate sociodemographic characteristics, T-tests for independent samples and Analysis of Variance (ANOVA) in order to compare HRQoL (SF-36) scores across a range of background variables. Furthermore, T-tests were used to analyze differences in HRQoL scores between the samples. Results  NET patients demonstrated significantly lower on all HRQoL subscales when compared with the general population with the lowest values on general health, physical limitation and vitality. Individuals above 70 years reported lower scores on physical functioning and physical limitations compared with those who were younger. Individuals with higher levels of education reported increased physical functioning compared with those with less education and full-time or part-time workers described higher physical functioning and less physical limitations compared with those who were retired. Conclusions  All SF-36 HRQoL scores were significantly lower among the NET patients when compared with the general population. Assistance from health personnel to NET patients should focus on those domains.     

强化生物反馈联合家庭盆底肌锻炼治疗女性真性压力性尿失禁

目的:探讨强化生物反馈联合家庭盆底肌锻炼治疗不同程度女性真性压力性尿失禁(GSUl)的近期疗效。方法:选取50例GSUI女性患者,依据临床症状分为轻度(20例)、中度(15例)和重度(15例)3组,进行12周的强化生物反馈联合家庭盆底肌功能锻炼治疗。在治疗前、后分别记录排尿日记,填写国际尿失禁咨询委员会问卷简表(ICI-Q-SF),并进行尿动力学测定。结果:各组治疗后总漏尿事件次数和ICI-Q-SF评分均显著低于治疗前,valsalva漏尿点压和最大尿道闭合压均显著高于治疗前(P<0.05)。轻度组治疗后总漏尿事件次数和ICI-Q-SF显著低于中度和重度组,而功能性膀胱容量、val-salva漏尿点压和最大尿道闭合压显著高于中度和重度组;中度组治疗后总排尿次数和ICI-Q-SF显著低于重度组,而功能性膀胱容量和valsalva漏尿点压显著高于重度组(P<0.05)。治疗结束后3个月随访有效率:轻度组为95%,显著高于中度组(67%)和重度组(53%)(P<0.05)。结论:强化生物反馈联合家庭盆底肌锻炼更适用于轻度女性GSUl患者,尿动力学检查是评估其疗效的重要方法。