Effects of Age, Parity, and Adherence on Pelvic Muscle Response to Exercise

OBJECTIVE: To examine factors that affect pelvic muscle response to 12 weeks of pelvic muscle exercise. DESIGN: Repeated measures design in which intravaginal pressures during pelvic muscle contractions were recorded at baseline and after four exercise levels. SETTING: College of Nursing research site in Gainesville, Florida. PARTICIPANTS: Eighty-five parous, community-dwelling women, aged 35-78 years and without incontinence as a primary concern. INTERVENTIONS: A 12-week graded program of regular (three times per week, every other day) pelvic muscle exercise at home. MAIN OUTCOME MEASURES: The hypotheses were that younger age, lower parity, higher baseline intravaginal pressures, and adherence to the pelvic muscle exercise program each would result in significant improvement in maximum intravaginal pressures. RESULTS: The only factor showing significance in predicting a successful outcome was age (t = -2.29, df = 41, one-tail probability = .0136). CONCLUSIONS: Regular, graded exercise over several weeks is needed to build pelvic muscles, and some women who exercise do not improve. Although the reasons for not improving are unclear, age is a significant factor.     

Promoting inter-agency collaborátion in child services

Summary Effective collaboration between agencies is often difficult to achieve. Children and their families/carers, who have complex therapeutic needs, present particular difficulties in that agencies need to work together, if they are to produce a co-ordinated and integrated package of care. A Multi-Agency-Consultation-Team (MACT) was set up in an attempt to overcome some of these problems of interagency co-operation. This paper describes the protocol, types of children referred and the recommendations made by the team. Follow-up of these children at 4 months suggests that a MACT does have a role to play in developing high quality services.     

Health impact of head and neck cancer

A multidimensional Head and Neck Quality of Life (HNQOL) instrument and a general health status measure were administered to 397 patients with head and neck cancer. Scores for the 4 domains of the HNQOL (communication, eating, pain, and emotional well-being) were calculated. Patient demographics, comorbidities, clinical characteristics, treatment data, disability status, and a global "overall bother" score were assessed. When compared with the US population aged 55 to 64 years, the group had significantly worse scores in the 8 health domains of the SF-36. Patients' overall bother scores from the head and neck cancer treatment correlated best with the HNQOL emotion domain (r = 0.71) and the HNQOL pain domain (r = 0.63), and least with the patients' perception of their response to treatment (r = 0.39). Pain, eating, emotion, physical component summary score, age, and an interaction term between eating and emotion were significant predictors for overall bother. Of the 217 patients who were working before the diagnosis of cancer, 74 (34. 1%) reported that they had become disabled. Patients who had more than 1 type of treatment were 5.9 times more likely to report themselves as disabled (odds ratio [OR] = 5.94, P < 0.01), even after adjusting for age, emotion score, and physical component summary score, which were other factors that predicted disability.     

ALCOHOL AND THE YOUNG CHILD

With the increasing availability of alcohol in modern times,the child neglect and abuse portrayed in Hogarth's engravingGin Lane may once again be witnessed. Reports occur occasionallyof alcohol being given deliberately to infants to quieten them,but alcohol poisoning in the slightly older child is not uncommon. The introduction of child-proof containers has altered poisoningfigures recently. However, alcohol poisoning tends to occurat ages 3 and 4, that is, about 2 years after the peak of allpoisonings in children. This difference may be an indicationthat alcohol is taken in imitation of parents' drinking, a suggestionwhich has some support from reported cases of mouthwash poisoning.Holidays and high days where children and alcohol mix, are potentiallydangerous periods. Since alcohol poisoning can be fatal, yetif recognised is relatively easily managed, every child withthe slightest degree of drowsiness should be suspect until provenor not by blood alcohol. The prevention of alcohol poisoningin the young child consists in protecting the alcohol by lockand key, not setting an example by drinking or gargling in frontof childrenMany substances such as mouthwash and perfume shouldalso be under supervision. Once actual poisoning has occurred blood sugar is probably moreimportant than the level of blood ethanol and blood sugar levelsshould be monitored frequently and the child treated with glucose,preferably intravenously.