Outcome measures for research of lower urinary tract dysfunction in frail older people.
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Aged↗
Biomedical subjects
P Ekelund
Publications and source records attributed to P Ekelund.
Localization of the brain lesion affects the lateralization of T-lymphocyte dependent cutaneous inflammation. Evidence for an immunoregulatory role of the right frontal cortex-putamen region.
We have previously demonstrated that brain lesions caused by stroke led to the lateralization of T-cell dependent inflammation. The purpose of this study was to assess the impact of localization of the brain lesion on lateralization of immune responsiveness. The delayed-type hypersensitivity (DTH) reaction was used as an in vivo measure of antigen specific T-lymphocyte reactivity. All stroke patients were examined with computed scan tomography (CT) of the brain to ascertain the localization and extent of the brain lesion. Patients with right-sided brain lesions displayed significantly larger (P = 0.008) DTH responses on the paretic side compared to the contralateral side. Detailed analysis of the localization of the brain lesion revealed that infarcts encompassing frontal lobe-putamen led to significantly larger (P = 0.007) DTH responses on the paretic side compared to the contralateral side. Localization of the brain lesion affects the lateralization of DTH, supporting an asymmetrical modulation of the immune response. In addition, our study points to the frontal cortex-putamen as a putative brain centre regulating the magnitude of immune responses.
Adult↗
An evaluation of multidisciplinary intervention governed by functional independence measure (FIMSM) in incontinent stroke patients.
Patients with acute hemispheric stroke and ensuring urinary incontinence were randomly allocated to a ward using conventional methods of rehabilitation (n = 13) or to a ward practicing rehabilitation governed by Functional Independence Measure (FIM) (n = 21). All patients were assessed on admission and on discharge using the Katz activities of daily living (ADL) index, the psychological general well-being index, item G of the FIM index (FIM-G), and a mobility score. Patients admitted to the ward utilizing FIM were additionally evaluated using the total FIM on admission, repeatedly during the rehabilitation period and on discharge. An individual rehabilitation programme based on the latest FIM score was used throughout rehabilitation. There were no differences on admission between groups regarding clinical and demographic characteristics, ADL, mobility and mood. Twenty patients in the intervention group regained continence before discharge compared to 3 (p < 0.01) in the control group. There was also a greater improvement in well-being in the intervention group compared to the control group (p < 0.01). This study has indicated that rehabilitation governed by the use of FIM reduced urinary incontinence and enhanced well-being better than conventional methods of rehabilitation. The results warrant a larger study to further investigate rehabilitation of incontinent stroke patients using FIM.
Activities of Daily Living↗
Association between urinary incontinence and urinary tract infections, and fractures in postmenopausal women.
OBJECTIVE: The association between urinary disorders, such as ongoing urinary incontinence (UI), history of urinary incontinence (HIST-UI) and urinary tract infections (UTI), and fractures in peri- and postmenopausal women was assessed in an epidemiological study. SUBJECTS AND METHODS: The sample consisted of 10000 women from seven birth cohorts, born between 1900 and 1940, who were investigated regarding urinary disorders, fractures and reproductive history by means of a postal questionnaire. RESULTS: The overall response rate was 74.6%. The respondents (n = 7459) represented 53% of the total population from the respective birth cohorts. There was a significant independent correlation between UI, HIST-UI and UTI, respectively, and fractures after the age of 30. In subjects with HIST-UI, tobacco smokers compared to non-smokers had significant more fractures in both the 1930 and 1940 birth cohorts (P < 0.01). Logistic multiple regression in the 1930 and 1940 cohorts demonstrated that age (P < 0.001), HIST-UI (P < 0.001) and tobacco smoking (P < 0.05), respectively, had an independent explanatory value for fractures. CONCLUSION: The prevalence of fractures increased with increasing age, in smokers compared to non-smokers and in women with a history of UI.
Age Factors↗
Urinary incontinence: a minor risk factor for hip fractures in elderly women.
OBJECTIVE: The aim of the study was to study the influence of urinary disorders as urinary incontinence on the prevalence of hip fracture in 85-year-old women. METHODS: A representative community-based population study was performed at the geriatric outpatient department of a university hospital in a sample consisting of 658 85-year-old women, of which 69% were living at home and 31% were living were living in institutions. The prevalence of hip fractures was registered and measurement with dual photon absorptiometry of the right calcaneum was performed. The subjects were questioned covering sociodemographic background, the occurrence, type, frequency and amount of urinary incontinence, medical examinations and investigations of the prevalence of hip fracture. RESULTS: Hip fracture was significantly associated with urinary incontinence (P < 0.001) for women and the odds ratio of hip fracture was twice that found in general population (OR = 2.42). Body mass index and weight were both significant higher (P < 0.01) among women with urinary incontinence and hip fracture. The frequency of urinary incontinence was also significant correlated to hip fracture (P < 0.001). Subjects with diabetes had a tendency to be associated with urinary incontinence (P < 0.06). In a logistic multiple regression analysis, body mass index, urinary incontinence and cancers were the only explanatory factors for hip fractures at 85 years of age. CONCLUSION: The association between postmenopausal urinary incontinence and hip fractures are multifactorial and whether this is a result of decreasing estrogen levels or a result of general aging process is still under debate. Women with urinary incontinence and earlier atrumatic multiple postmenopausal fractures should be considered a special target group for estrogen prophylaxis in order to prevent further severe fractures.
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Comparative assessment of pelvic floor function using vaginal cones, vaginal digital palpation and vaginal pressure measurements.
A group-comparative study to assess pelvic floor muscle function using vaginal cones, vaginal digital palpation, and vaginal pressure measurements in 30 women suffering from genuine stress urinary incontinence and in an age-matched group of continent women was undertaken. Vaginal digital palpation score and vaginal pressure during active contraction were greater (p < 0.001) in continent women (1.9 +/- 0.1 and 8.6 +/- 0.7 cm H2O, respectively) as compared with incontinent women (1.0 +/- 0.1 and 4.1 +/- 0.4 cm H2O, respectively). Continent women were able to retain a vaginal cone of greater weight (6.3 +/- 0.4; n = 9, weight ranging from 10 to 90 g) than women suffering from stress incontinence (4.7 +/- 0.5; p < 0.001). There was a better correlation between all three techniques of assessing pelvic floor function in continent as compared with incontinent women, especially in the comparisons involving vaginal cones. (Vaginal pressure measurement-vaginal digital palpation, r = 0.86/0.75; vaginal pressure measurement-vaginal cones. r = 0.57/0.10; vaginal digital palpation-vaginal cones, r = 0.60/0.18.) In some women, especially those with incontinence, heavy cones were retained in spite of a weak pelvic floor due to the transverse position of the cone in the vagina which was verified radiographically.
Adult↗
Urinary incontinence. Social and financial costs high.
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Age Factors↗
The influence of age, parity, oral contraception, hysterectomy and menopause on the prevalence of urinary incontinence in women.
The influence of age, parity, duration of previous oral contraceptive use, hysterectomy and menopause on the prevalence of urinary incontinence was evaluated by means of a postal questionnaire in women 46 to 86 years old who resided in the city of Göteborg, Sweden. A sample of 10,000 women from the 7 birth cohorts of 1900 to 1940 was obtained at random from the population register. The overall response rate was 74.6%. The prevalence of urinary incontinence increased (p < 0.001) in a linear fashion from 12.1% in the 1940 birth cohort to 24.6% in the 1900 birth cohort. The prevalence of urinary incontinence in nulliparous women was 7.7% in the 1930 birth cohort and 5.5% in the 1940 birth cohort. The corresponding figures for women who had experienced 1 delivery were 11.1% and 10.6%, compared to 14.0% and 16.4% among women who had had 3 or more deliveries. Urinary incontinence was more prevalent in women who had undergone hysterectomy (p < 0.05). The prevalence of urinary incontinence was unaffected by the duration of previous oral contraceptive use and there was no evidence to suggest that the prevalence of urinary incontinence increased at the time of the last menstrual period.
Age Factors↗
The influence of urinary incontinence on the quality of life of elderly women.
The quality of life assessed by the Nottingham Health Profile Questionnaire was compared in a group of women (n = 120) suffering from urinary incontinence (age 75.4 +/- 1.9, range 65-84 years) and an age-matched representative sample of the total population (n = 313). There were no significant differences between the two groups of women in occurrence of other illnesses or social characteristics. Women suffering from urinary incontinence obtained higher scores in the domains of emotional disturbances (p < 0.05) and social isolation (p < 0.001) than women from the control group. When subdividing the incontinent women by type of incontinence it was found that women suffering from urge and mixed incontinence reported emotional disturbances (p < 0.05) more than women from the control group. There was, however, no difference within the domain of emotional disturbances between stress-incontinent women and the control group. Women suffering from urge incontinence reported more disturbance of sleep (p < 0.05) than the control group. Women suffering from all types of urinary incontinence (p < 0.05) were socially more isolated than those from the age-matched group of women from the total population. Urinary incontinence in women has a detrimental effect on their daily lives and causes them to avoid social contacts.
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Long-term results of pelvic floor training in female stress urinary incontinence.
One hundred and seventy women with genuine stress urinary incontinence participated in a pelvic floor exercise (PFE) programme (duration 4.7 +/- 0.2 months, range 1-18). Twenty-seven women awaiting surgery for genuine stress urinary incontinence constituted the control group. The women were evaluated using a provocation test, vaginal palpation and subjective assessment before and after treatment. After the PFE programme, 23% of the women considered themselves cured, 48% were improved and 29% unchanged. According to the provocation test used in this study 64% were cured or improved following PFE. The long-term results of PFE were assessed by means of a postal questionnaire 2 to 7 years after completion of the supervised training period (response rate 152/170; 89%). During this time 38 women (25%) had undergone operative treatment. Of the remaining patients, 13 (11%) reported that they were still cured, 50 (44%) continued to be improved, 35 (31%) were unchanged and 16 (14%) had deteriorated. However, the frequency of PFE training during the follow-up period was unsatisfactory, as only 15% were training several times a day. This indicates that continued guidance from a physiotherapist could improve the long-term efficacy of PFE training.
Adult↗
Adapting incontinent patients incontinence aids to their leakage volumes.
The importance of adapting incontinence aids according to the patients leakage volume and comfort was investigated in 28 urinary incontinent 85-year-old men and women who were living at home. The patients incontinence was quantified by a 48-hour pad test and was graded as slight (max. leakage per pad < 5 g; total leakage/48 h < 30 g), moderate (max. leakage per pad 5-15 g; total leakage/48 h 30-70 g) or severe (max. leakage per pad > 15 g; total leakage/48 h > 70 g). Four women had slight urinary incontinence, eight were moderately incontinent and nine were severely incontinent. The corresponding figures for the seven men were as follows: slight, one; moderate, one; severe, five. After the primary assessment, incontinence aids were prescribed based on the measured leakage volumes. The correctly selected and adapted incontinence aid brought the patient better comfort and security. The importance of careful information and instructions how to apply the pad is emphasised. There is also a need to see the patient again at intervals as leakage volumes may vary. Thus, smaller packages of pads should be supplied as the choice of pad may need to be modified. The latter is also important from a financial point of view as the expense of otherwise wasted pads would unnecessarily increase costs.
Adaptation, Psychological↗
Factors influencing vaginal cytology, pH and bacterial flora in elderly women.
OBJECTIVE: To evaluate factors influencing the vaginal micro-environment in elderly women. STUDY DESIGN: Vaginal pH, cytology (Karyopyknotic index, KPI) and bacterial cultures were assessed in 350 women (age 72.2 +/- 1.4 years, range 65-84 years) who were not taking estrogens. RESULTS: Vaginal pH was 6.5 +/- 0.1, KPI was 3.0 +/- 0.9% and bacteria of fecal type dominated. However, in some women the vaginal micro-environment resembled that of fertile women, with a predominance of lactobacilli (n = 68), low pH (n = 41) and an increased maturation index (n = 57). KPI was higher (p < 0.001) in women weighing > or = 85 kg, or with a body mass > or = 9th decentile or with a diastolic blood pressure > or = 100 mmHg and in women (p < 0.05) with a high menopausal age (> or = 53 years). Vaginal pH was lower (p < 0.001), KPI was higher (p < 0.01) and there was an increased (p < 0.05) presence of lactobacilli in smokers compared to non-smokers. CONCLUSIONS: The latter finding is somewhat paradoxical as cigarette smoking has previously been shown to negatively influence estrogen metabolism. The influence of cigarette smoking on the vaginal micro-environment may be a direct local effect of nicotine.
Age Factors↗
[Urinary incontinence--an expensive national disease].
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Adult↗
[Urinary incontinence and other urogenital problems in women--cases for primary health care?].
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Attitude of Health Personnel↗
Enhancement of antigen-specific T-cell reactivity on the affected side in stroke patients.
We have analyzed the impact of stroke with subsequent hemiparesis and sensory loss on in vivo mediated immune functions. The delayed-type hypersensitivity (DTH) reaction to purified protein derivate (PPD, tuberculin) was used as a measure of antigen-specific T-cell reactivity, and subcutaneous immunization with influenza vaccine was employed to evaluate T-cell-dependent B-cell function. Thirty-two of the 50 stroke patients tested displayed positive DTH reaction to PPD. All but two showed equal or stronger DTH reaction on the paretic arm compared to the contralateral side (p less than 0.0001). This stroke-induced enhancement of DTH reactivity was evident in patients with combined motor and sensory deficit as well as in subjects with hemiparesis alone. In contrast, immunization of stroke patients with influenza vaccine, a T-cell-dependent B-cell antigen, raised equal antigen-specific serum IgG, IgA and IgM antibody responses irrespective of side (paretic or not paretic). We conclude that stroke enhances antigen-specific T-cell reactivity on the affected side of the body, and that motor but not sensory deficit seems to be required for this enhancement. Antigen-specific B-cell reactivity was not significantly influenced by the hemiparesis.
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Vaginal immunoglobulin A (IgA) levels in post-menopausal women: influence of oestriol therapy.
The concentration of secretory immunoglobulin A (IgA) in the vaginal fluid of 20 untreated post-menopausal women (aged 75.4 +/- 1.4 years) was compared with the levels in a group of 20 post-menopausal women (aged 73.2 +/- 1.5 years) treated with oral oestriol (E3) (2 mg/day) and a further group of 20 healthy, non-pregnant, fertile women (aged 28.2 +/- 1.8 years). Secretory IgA was determined using a paper disc modification of the single radial immunodiffusion technique. The vaginal concentration of IgA in the untreated women was 41.5 +/- 5.7 mg/l, which was higher than that recorded in those treated with E3 (20.8 +/- 5.7 mg/l, P less than 0.05) and in the fertile women (16.4 +/- 3.7 mg/l, P less than 0.01). Epithelial cells predominated in the wet smear preparations obtained from the women who received E3 and the fertile women, while a predominance of leucocytes was observed in the untreated women. Lactobacilli were found more frequently in the vaginal flora of the women in the E3 group (P less than 0.001) and the fertile women (P less than 0.001) than the untreated group. Faecal-type bacteria were seen more frequently in the vaginal flora of the untreated women than the E3 group (P less than 0.01) or the fertile women (P less than 0.001). The possible implications of the present findings with regard to the individual variation in the intensity of symptoms experienced by women suffering from the oestrogen deficiency syndrome are discussed.
Adult↗
Prevalence of fractures among 10,000 women from the 1900 to 1940 birth cohorts resident in Gothenburg.
The prevalence of fractures in women aged 45-86 years resident in the city of Gothenburg, Sweden, was investigated by means of a postal questionnaire. A sample of 10,000 women from seven birth cohorts (1900-1940) was obtained at random from the population register. The response rate was 70.1% in the 1900-1920 and 81.0% in the 1930 and 1940 birth cohorts. When the prevalence of fractures sustained between 25 and 46 years of age was analyzed a higher figure emerged for women from the 1930 and 1940 birth cohorts than for those from the 1900-1920 cohorts, indicating an increasing incidence of fractures over time. There was a significant independent correlation between early menopausal age and a high rate of fractures. Menopausal age decreased with increasing tobacco consumption. There was also a significant independent correlation between tobacco-smoking and a high fracture rate. The prevalence of tobacco-smoking increased from 30.0 to 38.1% between the 1930 and 1940 birth cohorts, which may further increase the fracture risk in future years. Despite increasing vitality and longevity among the elderly in Gothenburg, there are indications that the number of fractures will increase in the future.
Age Factors↗
Tamoxifen and partial oestrogen agonism in postmenopausal women.
The effect of tamoxifen on the vaginal mucosa and on serum oestrone, oestradiol and gonadotrophin concentrations was investigated in a group of nine postmenopausal women with non-metastatic breast cancer. Compared with fit age-matched controls, the vaginal pH in the tamoxifen-treated group was significantly lower and was comparable to levels in fertile women. Two thirds of tamoxifen-treated women had well oestrogenized vaginal smears compared with none in the control group. Follicle-stimulating hormone was significantly reduced, whilst oestrone and oestradiol levels remained unchanged. We conclude, therefore, that tamoxifen has oestrogen-agonistic properties particularly evident in postmenopausal women, even though it is primarily an antioestrogenic drug.
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