Randomized controlled trial of biofeedback for fecal incontinence

BACKGROUND & AIMS: Behavioral treatment (biofeedback) has been reported to improve fecal incontinence but has not been compared with standard care. METHODS: A total of 171 patients with fecal incontinence were randomized to 1 of 4 groups: (1) standard care (advice); (2) advice plus instruction on sphincter exercises; (3) hospital-based computer-assisted sphincter pressure biofeedback; and (4) hospital biofeedback plus the use of a home electromyelogram biofeedback device. Outcome measures included diary, symptom questionnaire, continence score, patient's rating of change, quality of life (short-form 36 and disease specific), psychologic status (Hospital Anxiety and Depression scale), and anal manometry. RESULTS: Biofeedback yielded no greater benefit than standard care with advice (53% improved in group 3 vs. 54% in group 1). There was no difference between the groups on any of the following measures: episodes of incontinence decreased from a median of 2 to 0 per week (P < 0.001). Continence score (worst = 20) decreased from a median of 11 to 8 (P < 0.001). Disease-specific quality of life, short-form 36 (vitality, social functioning, and mental health), and Hospital Anxiety and Depression scale all significantly improved. Patients improved resting, squeeze, and sustained squeeze pressures (all P < 0.002). These improvements were largely maintained 1 year after finishing treatment. CONCLUSIONS: Conservative therapy for fecal incontinence improves continence, quality of life, psychologic well-being, and anal sphincter function. Benefit is maintained in the medium term. Neither pelvic floor exercises nor biofeedback was superior to standard care supplemented by advice and education.     

Demands of Multiple Behavior Change in Type 2 Diabetes Risk Reduction

The purpose of this study was to explore individual experiences of participation in multiple activities recommended for type 2 diabetes risk reduction. Twelve individuals at risk for type 2 diabetes described their experiences regarding risk-reduction activities. A grounded theory method guided data collection and analysis. Data analysis revealed facilitators and inhibitors associated with participation in recommended multiple behavior change for type 2 diabetes risk reduction. Our findings emphasize social and personal factors that increase or decrease the likelihood of adherence to prevention recommendations. Findings suggest that health care providers provide structured yet individualized recommendations to support multiple behavior change efforts.     

Risk behaviours for HIV and hepatitis infection among anabolic-androgenic steroid users

This study examined HIV and hepatitis risk behaviours among anabolic-androgenic steroid (AAS) users and controls, providing a detailed assessment of both injection and sexual practices. Fifty AAS-using and 40 non-AAS-using weight trainers completed a semi-structured interview followed by a detailed questionnaire. The 'high risk' behaviour of sharing needles and syringes was not current practice among the AAS-using sample, with only one user reporting sharing injecting equipment in the past. However, for some users it was common practice to share multi-dose vials (19%) and to divide drugs using syringes (17%). Both these practices are potential routes for HIV and hepatitis infection. Significantly more AAS users (36%) reported increases in sex drive over the last three months than did the control subjects (5%). More AAS users than controls were engaging in sex with more than one partner while infrequently using condoms. These findings support the maintenance of needle exchange schemes which are essential to continued safe injecting practices among AAS users. The elevated sexual risk behaviour of AAS users could be due to AAS's effect of increasing sex drive or to a 'risk taking' personality trait among AAS users.