Presence Of Incontinence Research Articles

Functional Assessment of >18 Years Old Patients at Internal Medicine Ward—Relationship with In-Hospital and 30-Day Mortality

ObjectiveTo evaluate the connection between the items included in the AVD-DezIs score (a questionnaire about basic and instrumental activities of daily living and other topics related to social and personal life) and in-hospital and 30-day mortality after discharge. MethodsProspective cohort study of hospitalizations in the Internal Medicine ward from 2014 to 2020, including >18 years old patients with a fully completed AVD-DezIs. To identify in-hospital and 30 days mortality, univariate and multivariate logistic models were applied, including random effects if justified. ResultsA total of 19,771 episodes of hospitalization were included. In the univariate analysis, except for the presence of isolation and financial insufficiency, all the items were predictors of mortality in-hospital or within 30 days after discharge. In multivariate analysis, older age, male sex, longer hospital stay, higher Charlson score, deficiency in all four activities of daily living, deficiency in meal preparation and housekeeping, presence of pain/depression, immobility, and malnutrition are associated with a higher probability of in-hospital death whereas older age, male gender, higher Charlson score, longer length of hospital stay, deficiency in personal hygiene, ambulation, and eating habits, as well as the presence of incontinence and malnutrition, are associated with a higher probability of 30 days after discharge death. Discussion/ConclusionExcept for isolation and financial insufficiency, all items were individually associated with the outcomes. When they are considered in conjunction and taking into account sex, age, comorbidities and length of stay, the predictive ability of in-hospital and 30 days mortality differed.

Predictors of Urinary and Fecal Incontinence in Prefrail and Frail Older Adults: A Cross-Sectional Study of the FRAGSALUD Project.

Frailty is associated with urinary and fecal incontinence, which are common geriatric syndromes. This study aims to identify health factors associated with incontinence in prefrail or frail older adults living in the community. This multicenter cross-sectional study included 225 older adults (75.0 ± 6.4 years) with prefrailty or frailty based on the 5-component Fried phenotype. Physical function was assessed using the Short Physical Performance Battery (SPPB). Physical activity, inactivity, and sleep were estimated using a wrist-worn accelerometer. Urinary or fecal incontinence was registered using the Barthel scale (urine and bowel items). Multivariable logistic regression analyses, with age as a covariate, were conducted to identify associations of incontinence. In our participants, 27% presented urinary or fecal incontinence with no sex differences (p = .266). Our results showed that age, daily medication count, and number of falls in the previous year independently predicted incontinence in frail and prefrail older adults (p < .05). Some Fried's criteria, including self-reported exhaustion, gait speed, and handgrip strength, were associated with the presence of incontinence (p < .05), but not Fried's classification. The SPPB total score and its isolated variables were significantly associated with the urinary and fecal incontinence (p < .05). However, none of the accelerometer outcomes showed significant associations with incontinence status. According to this study, age, number of medications, and falls (but not sex) are linked to urinary and fecal incontinence in frail or prefrail older adults living in the community, recommending the assessment of physical function using the SPPB rather than estimating daily physical activity, inactivity, or sleep.

The Evaluation of the Burden and Burnout Levels of the Caregivers of the Inpatients in Palliative Care

The study was conducted to evaluate the care burden and burnout levels of caregivers for patients hospitalized in palliative care. This descriptive study was conducted with 76 caregivers who were hospitalized in the palliative care services of a university and state hospital between 02.12.2019 and 02.06.2022 in Turkey. After obtaining the permissions of the ethics committee and the institution, the data were collected with the Descriptive Characteristics Form, Palliative Performance Scale, Caregivers Burden Inventory, and Maslach Burnout Inventory. The total score of the Caregivers Burden Inventory was 50.31±15.37, sub-dimensions of time-dependency burden, developmental burden, physical burden, social burden, and emotional burden scores were 18.30±3.23, 10.94±6.03, 13.54±5.99, 4.09±4.68, and 3.42±3.89, respectively. The Maslach Burnout Inventory sub-dimensions were emotional exhaustion, depersonalization, and personal accomplishment, with mean scores of 24.78±10.33, 11.59±4.20, and 28.64±5.67, respectively. The mean Palliative Performance Scale score of the patients was 32.76±16.86. As the burden of caregivers increased, so did their exhaustion scores. Caregivers had moderate care burdens, high time dependency and physical burdens, high emotional exhaustion, and low personal accomplishment burnout. All patients who were cared for were bedridden. The presence of incontinence in the patient affected the time dependency burden of the caregivers, and the presence of chronic disease in the caregiver and living with the patient also affected the caregivers' emotional exhaustion. These results show that studies must be conducted to develop multidisciplinary interventions to reduce caregivers’ care burden and burnout.

342 THE DISCRIMINATORY VALUE OF ANP-LED CGA ON PATIENT REPORTED SYMPTOMS AND IMPACT ON CARERS: A CROSS-SECTIONAL STUDY

Abstract Background Comprehensive Geriatric Assessment (CGA) is a cornerstone in geriatric care. Objective findings from CGA may differ to patient and carer reported symptoms. This study compared patient reported symptoms with objective metrics collected during CGA and explored the relationship with carer burnout. Methods Cross-sectional study of patients attending an Advanced Nurse Practitioner (ANP)-led integrated care clinic. Patient-reported geriatric syndromes included low mood, memory concerns, incontinence, falls or dizziness. CGA metrics collected included Barthel Index, Lawton IADLs, MOCA scores, Geriatric depression scale scores, Rockwood Clinical Frailty Scale (CFS) scores and presence or absence of carer burnout. Descriptive statistics were used to compare the relationship between these variables and logistic regression explored the magnitude of association with carer burnout. Results We reviewed 99 CGAs over three months. Median age was 81 (IQR 75–86) with 62% female. Cognitive impairment was present in 96% of patients. Self-reported memory trouble was associated with lower MOCA scores (9 vs 23, p &amp;lt; 0.001) and the presence of dizziness was associated with an increased prevalence of falls (89% vs 24%, &amp;lt; 0.001). The presence of incontinence and functional dependency on IADL were both associated with carer strain and a larger magnitude of association with carer strain was seen with increasing frailty (OR 13.7, 95% CI 3.8-58.8 for moderate to severe frailty) than moderate to severe cognitive impairment (OR 8, 95% CI 3.0–24.1) Conclusion Older people reported a wide range of symptoms often subtle, some of which are unmasked during CGA. The resultant frailty syndromes often represent increasing degrees of functional impairment impacting on patient and carer quality of life. Striking the balance between patient reported symptoms and objective measurement is important to allow individualised care pathways to be developed as well as highlighting patients at risk of functional and cognitive decline.

COVID-19 associated lower urinary tract symptoms in children

IntroductionSARS-COV-2 is associated with unexpected symptoms. Several studies in adults reported urinary frequency with COVID-19. The aim of this study is to reveal lower urinary tract symptoms associated with COVID-19 (CALUTS) in children.Patients-MethodsAll children diagnosed with COVID-19 and associated multisystem inflammatory syndrome in children (MIS-C) between November 2020-June 2021 in our hospital were reviewed and asked for urinary symptoms at the time of or following their disease. The ones reporting symptoms were invited for further evaluation. Parents were inquired for their child’s former bladder and bowel function, their symptoms after the diagnosis of COVID-19 or MIS-C, onset and duration of the symptoms, and their current state. They were questioned for the frequency of voiding as well as dysuria, odor, and the presence of incontinence as well as other symptoms of COVID-19. The patients who reported symptoms at the time of inquiry were followed for cessation of symptoms. The parameters age, sex, need for hospitalization and admission to ICU were also compared to the whole group to evaluate the main characteristics of patients with lower urinary tract symptoms.ResultsIn total 20 patients (18/216 with acute disease and 2/36 with MIS-C) reported CALUTS (figure). Age and sex distribution were not significantly different from the patients without urinary symptoms (p=0.777 and p=0.141 respectively). All were otherwise healthy children with no concomitant chronic diseases other than overactive bladder in two. There were 13 girls and 7 boys. Mean age was 11 years (±5 years). Thirteen of the patients were older than 10 years; however, there were also 3 children under 5 years of age. All parents described a sudden onset of extremely increased urinary frequency and urgency lasting for weeks which disappeared gradually. Median bladder and bowel dysfunction questionnaire (BBDQ) score before COVID-19 was 2.5 (1-18) which increased to a median of 22 (15-29) at the time of the symptoms (p<0.001). The timing of onset and duration of symptoms were variable and not associated with symptom severity (p=0.306 and p=0.450 respectively). Eight patients (40%) reported diarrhea. The duration of diarrhea was limited to less than one week in all.ConclusionsOur study revealed that SARS-COV-2 can be associated with lower urinary tract symptoms also in children both during the acute phase and MIS-C. Further studies are necessary to understand the etiopathogenesis and prevalence of this unexpected aspect of COVID-19.

Edmonton frailty scale score predicts postoperative delirium: a retrospective cohort analysis

BackgroundFrailty has been associated with postoperative delirium (POD). Studies suggest that the Fried phenotype has a stronger association with POD than the Edmonton Frailty Scale (EFS) criteria. Although phenotypic frailty is recognized as a good predictor of delirium, the EFS has higher ratings for feasibility in the surgical setting. Thus, our aim was to determine the association between EFS-assessed vulnerability and POD in an elective surgical population of older adults. A secondary aim was to determine which domains assessed by the EFS were closely associated with POD.MethodsAfter IRB approval was received, electronic medical records of surgical patients at our institution were downloaded from 12/1/2018 to 3/1/2020. Inclusion criteria included age ≥ 65 years, preoperative EFS assessment within 6 months of surgery, elective surgery not scheduled for intensive care unit (ICU) stay but followed by at least 1 day postoperative stay, and at least two in-hospital evaluations with the 4 A’s test (arousal, attention, abbreviated mental test-4, acute change [4AT]) on the surgical ward. Vulnerability was determined by EFS score ≥ 6. Patients were stratified into two groups according to highest postoperative 4AT score: 0–3 (no POD) and ≥ 4 (POD). Odds of POD associated with EFS score ≥ 6 were evaluated by using logistic regression adjusted for potential confounders.ResultsThe dataset included 324 patients. Vulnerability was associated with higher incidence of POD (p = 0.0007, Fisher’s exact). EFS ≥6 was consistently associated with POD in all bivariate models. Vulnerability predicted POD in multivariable modeling (OR = 3.5, 95% CI 1.1 to 11.5). Multivariable analysis of EFS domains revealed an overall trend in which higher scores per domain had a higher odds for POD. The strongest association occurred with presence of incontinence (OR = 3.8, 95% CI 1.2 to 11.0).ConclusionsEFS criteria for vulnerability predict POD in older, non-ICU patients undergoing elective surgery.

Hammock, Diaphragm, or Floor: Pelvic Anatomy for Healthcare Students

The pelvic region is a complex three‐dimensional conglomeration of muscles, fascias, nerves, vessels, and viscera in an osteoligamentous ring. Unfortunately, the use of dissection limits the comprehension of the pelvic region because of the donor‐cadaver’s thin, possibly atrophied muscles. Virtual reality is also limited in accurately rendering the dimensions, interactions, and relationships with essential organs, nerves, and vessels – not to mention the inconsistency of branching patterns. However, knowledge of pelvic anatomy is essential to pelvic health. The presence of incontinence, pelvic pain, sexual discomfort or dysfunction, and the use of episiotomies are just a smattering of clinical reasons for improving competence in pelvic anatomy. This portion of the Master Class will present the current evidence regarding pelvic anatomy, specifically regarding the recent imaging, histological, and structural publications.

Treatment of idiopathic overactive bladder with botulinum toxin: real-life results and patients' expectations.

Overactive bladder (OAB) is a prevalent syndrome affecting 11% to 16% of the adult population. When first-line pharmacological therapy is not effective, intradetrusorial injections of onabotulinumtoxinA (BTX-A) might have an important role in controlling symptoms. The main aim of this study was to access both the efficacy and safety of intradetrusor injections of 100U BTX-A in real clinical practice, among women with idiopathic OAB (iOAB). Retrospective study, based on clinical diaries in 136 iOAB female patients, with or without urinary incontinence, submitted to BTX-A injections, between 2005 and 2018 in a tertiary university hospital. Positive response was considered only when the patient mentioned she had great improvement after the injection, otherwise, it was considered negative. A positive response was obtained in 90 patients (66%) after the first injection. Women with a positive response after the first treatment had 7.5 times more chances to improve with the second (P = .01). Discontinuation of the therapy after the first injection was neither dependent on the presence of incontinence at baseline (P = .73) nor it was related to age (P = .6). On univariate analyses, none of the parameters evaluated was useful of predicting successful response, although there was a trend in women who had had a previous midurethral sling surgery for stress urinary incontinence, to have a lower chance of having a positive response after the first injection (P = .06).Thirty-nine women (29%) had at least 1 adverse event, urinary tract infection, and straining to void were the most frequent. Women above 65 years old had less risk of developing a urinary tract infection (P = .04). In real clinical practice, BTX-A injection is an effective (66%) and safe treatment, capable of improving quality of life. Moreover, responding to the first injection seems to predict good clinical outcomes in the second treatment. This procedure can be done with minimal restrictions.

Prevalence of Overactive Bladder Symptoms Among Women With Interstitial Cystitis/Bladder Pain Syndrome.

Symptoms of urinary frequency, urgency, and urinary leakage are characteristic of overactive bladder (OAB) syndrome. However, frequency and urgency symptoms are also present in most patients with interstitial cystitis/bladder pain syndrome (IC/BPS). Our objective was to describe the urge incontinence among women with IC/BPS, which may indicate true overlap of OAB and IC/BPS. This is a prospective study of women with IC/BPS diagnosed clinically in the Veterans Affairs Health Care system. Patients completed the OAB and Female Genitourinary Pain Index (F-GUPI) questionnaires. Questions from the OAB questionnaire were used to analyze symptoms of urinary urgency and urge incontinence. Pain symptoms, urinary symptoms, and impact on quality of life were assessed based on the F-GUPI. Patient demographics, comorbidities, and symptoms were reviewed. Within the cohort of 144 women with IC/BPS, 100 (69%) had urinary leakage associated with the strong desire to void and were more likely to have incontinence compared with healthy controls (P < 0.001). The IC/BPS group also had higher total and pain scores on the F-GUPI (P < 0.001), but pain scores were not affected by the presence of incontinence (P = 0.478). The prevalence of OAB symptoms of urinary leakage is high among women with IC/BPS. This may explain the efficacy of OAB medication and third-line therapies in this population.

Diyarbakır’da Yaşayan Suriyeli ve Türkiyeli Çocuklarda Fonksiyonel Gündüz İnkontinans Sıklığının Karşılaştırılması

Objective: Functional daytime incontinence is one of the common urological problems in children. Its etiology is multifactorial and environmental factors and emotional events increase the frequency of incontinence.The objective of this study is to compare the frequency of functional daytime incontinence among Syrian children who were exposed to stressful experiences and Turkish pirmary school children. Method: In study, the sociodemographic data of children between the ages of 6 and 10 who came to pediatric surgery and child health clinics of our hospital between September 2017 and August 2019 were analyzed. A total of 332 Syrian and 341 Turkish children were included in the study. Data collection forms consisting of three sections were created. In the first section, age, gender, height, weight, maternal education level, functional constipation were evaluated. In the second section the depression scale for children was used to evaluate the psychological state of children. In the third section, lower urinary tract symptoms and presence of incontinence in the family were questioned. Families were contacted by phone by two nurses, and one translator independent of the study and data collection forms were filled. Results: The frequency of functional daytime incontinence in Syrian and Turkish children were 6.6% and 5.2% respectively. There were no statistically significant differences between the Syrian and Turkish children in terms of functinal daytime incontinence (p&gt;0.05). Statistically significant differences were not detected among daytime incontinence gender, scores of depression scale for children, body mass index, maternal education level (p&gt;0.05). Statistically significant differences were found among functional daytime incontinence and positive family hisftory, enuresis nocturna, and functional constipation (p&lt;0.05). Conclusion: Syrian migrant and Turkish children showed no differences in terms of the frequency of functional daytime incontinence.

Características sociodemográficas e clínicas em nonagenários e centenários com e sem incontinência urinária

Objetivos: analisar as características sociodemográficas e clínicas em indivíduos nonagenários e centenários com e sem incontinência urinária. Métodos: trata-se de um estudo transversal e analítico, envolvendo 234 nonagenários e centenários avaliados nos seus domicílios, que foram aleatoriamente selecionados na cidade de Porto Alegre, RS. A presença de incontinência foi avaliada com relação às características clínicas e sociodemográficas cujas associações foram testadas pelo qui-quadrado e as diferenças nas médias testadas pelo t de Student usando o Programa Epi Info. Resultados: a prevalência de incontinência urinária foi de 56,41%, sendo 63,53% entre as mulheres e 37,5% entre os homens (p=0,0003). A relação entre presença de perda de urina e de estado conjugal foi significativa (p=0,0049), com maior frequência entre os viúvos. Os incontinentes saíam menos de casa, participavam menos de atividades físicas e sociais, tinham maior número de doenças crônicas e sintomas depressivos e pior pontuação na avaliação cognitiva. Em relação aos sintomas urinários, a maioria dos incontinentes referiu que a urina ou bexiga atrapalha a sua vida (p&lt;0,0001) e, que a urina ou bexiga, causa embaraço (p&lt;0,0001). Entre os participantes continentes, 25% relatou que a urina ou bexiga atrapalha a sua vida. Conclusões: a incontinência urinária foi mais frequente entre mulheres, participantes mais velhos, viúvos e indivíduos que moravam sozinhos. Apesar de maior prevalência entre as mulheres, chama atenção uma prevalência importante entre os homens. Ao fim, concluímos que a incontinência urinária impacta diretamente na vida social e na saúde de nonagenários e de centenários. Então, a incontinência urinária deve ser um importante componente na avaliação desse grupo. Observamos, também, que um número importante de nonagenários e de centenários apresentam incômodos relacionados à urina, mesmo sem incontinência urinária.

MP31-20 URINARY INCONTINENCE AND QUALITY OF LIFE IN FEMALE-TO-MALE TRANSGENDER SUBJECTS ON HORMONE THERAPY

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Non-neurogenic Voiding Dysfunction II (MP31)1 Apr 2020MP31-20 URINARY INCONTINENCE AND QUALITY OF LIFE IN FEMALE-TO-MALE TRANSGENDER SUBJECTS ON HORMONE THERAPY Austin Fernstrum*, Al Ray, Britt Conroy, David Sheyn, and Juan Pablo del Rincon Austin Fernstrum*Austin Fernstrum* More articles by this author , Al RayAl Ray More articles by this author , Britt ConroyBritt Conroy More articles by this author , David SheynDavid Sheyn More articles by this author , and Juan Pablo del RinconJuan Pablo del Rincon More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000875.020AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To investigate whether lower urinary tract symptoms (LUTS) impact quality of life (QOL) in female-to-male transgender persons on chronic testosterone therapy. Secondarily, we aimed to identify patient-related physical and social factors that contribute to differences in QOL. METHODS: Transgender female-to-male subjects, 18 years or older, treated with testosterone for at least 12 months were recruited from a public health care system. Subjects were excluded if they had prior surgery for incontinence, pelvic organ prolapse, or gender affirmation or an active urinary tract infection. LUTS were assessed using the American Urologic Association Symptom Score (AUASS) and the International Consultation on Incontinence Questionnaire (ICIQ). The WHOQOL-BREF instrument was used to investigate QOL, and the CES-D 8 instrument was used to screen for depression. T-test and Chi-square were used to compare continuous and categorical variables, respectively. The relationship between patient factors and QOL was evaluated using multivariable logistic regression. RESULTS: Overall, 141 transmen were included in the study. Subjects were subdivided into two cohorts based on presence of urinary incontinence defined by the ICIQ score. In the incontinence group [n=49, (34.8%)], individuals were older [30.6 vs 26.2 years, p =0.01], had a higher body mass index (BMI) [p=0.015], and cigarette smoking history [p=0.01] compared to those without incontinence [n=92 (65.2%)]. The incontinence group had a higher prevalence of positive screening for depression [63.3 vs 39.1%, p=0.006] and were more frequently classified as having a poor QOL index [20.4 vs 3.3%, p=0.0008]. On multivariate analysis, limited medical transportation [aOR: 0.23, CI: 0.06-0.91], lack of money for food [aOR: 0.23, CI: 0.07-0.90], and increased BMI [aOR: 0.92, CI: 0.86-0.99] were factors influencing poor QOL. CONCLUSIONS: Presence of incontinence in female-to-male transgender persons is associated with increased age, higher BMI, and smoking history. Despite these findings, presence of LUTS was not found to be independently associated with QOL after adjusting for psychosocial factors. Source of Funding: National Institute of Diabetes and Digestive and Kidney Disease (NIDDK) grant, 5K12DK100014 © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e482-e483 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Austin Fernstrum* More articles by this author Al Ray More articles by this author Britt Conroy More articles by this author David Sheyn More articles by this author Juan Pablo del Rincon More articles by this author Expand All Advertisement PDF downloadLoading ...

The Relationship of Balance Disorders with Falling, the Effect of Health Problems, and Social Life on Postural Balance in the Elderly Living in a District in Turkey.

The aim of this study was to determine the prevalence of balance disorders; the effects of sociodemographic, medical, and social conditions on postural balance; and the relationship between balance and falls in elderly individuals. The study design was cross-sectional. A total of 607 community-dwelling elderly individuals with a mean age of 73.99 ± 6.6 years were enrolled after being selected by stratified random sampling. The study was performed as a face-to-face survey in the homes of elderly individuals. Sociodemographic and medical data were obtained from elderly individuals using the Elderly Identification Form. Balance disorders were determined using the Berg Balance Scale (BBS). In this study, the prevalence of balance disorders was found to be 34.3% in the community-dwelling elderly. Older age, physical disability, having four or more chronic illnesses, the presence of incontinence, having a history of falls, not walking regularly, absence of free time activity, and obesity were found to be associated with an increased prevalence of balance disorders. Balance disorders are commonly seen in the elderly and may be triggered by a variety of biological and social factors. It is crucial to develop and implement national health and social policies to eliminate the causes of this problem, as well as to prioritize preventive health services in the ever-increasing elderly population.

Diferenças de sexo na relação entre indicadores de força e resistência muscular de membros inferiores e a presença de incontinência urinária em nonagenários e centenários

Aims: To verify the possible relation between urinary incontinence and lower limbs strength and resistance indicators and the sex influence in this relation.Methods: Cross-sectional and analytical study with nonagenarians and centenarians from “Multiprofessional Attention to the oldest-old” project. Presence of incontinence, the ease to walking and climbing stairs, Timed up and Go test, sex, age, marital status and depression symptoms were the study variables. Descriptive and analytical analysis (chi-square tests, analysis of variance and univariate and sex-adjusted logistic regression) were performed accepting p&lt;0.05.Results: We evaluated 238 oldest-old, 174 women. The ease of walking 400 meters and stand up from a chair and the time during the Timed Up and Go were significant indicators of muscle strength and resistance in the correlation between incontinence and muscle strength and resistance adjusted by sex (respectively, RC=0.832, p=0.011, RC=0.846, p=0.012 and RC=0.352, p=0.002). Sex was the most significantly related to incontinence (RC=0.349, p=0.001) and its presence in the complete model decreased the significance of other variables. Depressive symptoms increase the chance of presenting incontinence in men.Conclusions: Incontinence can be associated with strength and resistance in lower limbs, mainly in women. Strength and resistance exercises focus on lower limbs can be added to traditional and recognized prevention programs to incontinence.

Investigation of the prevalence of pressure ulcers and patient-related risk factors in hospitals in the province of Erzurum: A cross-sectional study

BackgroundPressure ulcers are a significant health care problem all across the world due to their associated high mortality and morbidity rates and high health care costs. The prevalence of pressure ulcers serves as one of the most important indicators of the quality of nursing care. Study aimThis study aims to determine the prevalence of pressure ulcers and patient-related risk factors in inpatients receiving treatment in the province of Erzurum, located in the eastern part of Turkey. DesignThis is a cross-sectional study. Participantswhich included 832 inpatients hospitalized for at least 24 h after admission in five hospitals in the province of Erzurum. All of the study patients were 18 years of age or older and agreed to participate in the research. Patients hospitalized in the obstetric, emergency, and pediatric clinics were excluded from the study (due to the low probability of pressure ulcers in these clinics). InstrumentsFor the collection of data, the “Introductory Information Form” was used to learn the socio-demographic and clinical characteristics of the patients, and the “Braden Risk Assessment Scale” was used to determine the risk of pressure ulcers. The stage of the pressure ulcers of the patients was determined according to the classification of the National Pressure Ulcer Advisory Panel (NPUAP). MethodsSince the study was planned as a point prevalence study, research data were gathered by the researchers and interviewers on a single day designated for each hospital during the first week of October 2016. ResultsAmong the patients included in the study, 53.1% were male, mean age was 56.62 ± 17.95, 57.2% were treated in internal clinics, and the mean hospital stay was 9.02 ± 13.36 days. In terms of the patients' risk of pressure ulcers, it was determined that 28% were at risk. The overall prevalence of pressure ulcers was calculated to be 12.7% (for stages I-IV), with the overall prevalence decreasing by 6.7% when the patients with stage-I were excluded. Furthermore, it was found that 48.3% of the pressure ulcers were stage-I, and that the sacral region (37.3%) was the most affected region. According to the logistic regression analysis conducted to determine the factors, along with their weights, that affect the development of pressure ulcers, the age of the patient, the duration of the hospital stay, the presence of incontinence, albumin level problems, and a Braden score below 17 were found to have an impact (p < 0.05). ConclusionIn this study, the prevalence of pressure ulcers was calculated to be 12.7%, with the highest prevalence found in intensive care clinics (35.3%). The age of the patient, the duration of the hospital stays, the presence of incontinence, albumin level problems, and a Braden score below 17 were found to be effective in the development of pressure ulcers.

Living with incontinence: The experience of people with dementia.

Dementia is a distressing condition in which individuals progressively require the support of others. Many people experience problems with incontinence and continence management. The presence of incontinence is influential in decisions for people with dementia to move into a care home. This study, in the interpretative tradition, investigates for the first time the person with dementia’s perspective on these problems and their strategies for managing them. We conducted semi-structured conversational interviews with seven people with mild-to-moderate dementia and analysed the transcripts thematically. Our participants described both a variety of problems with incontinence and continence management, and their embarrassment and humiliation. Strategies included managing their presentation of self to others to keep such problems hidden, although it was evident that for some their cognitive problems led to strategies that were potentially problematic for others. In addition, some described the ways in which they acted to protect others, such as spouses, from the stigmatising effect of the incontinence.

Nocturnal incontinence in children with fetal alcohol spectrum disorders (FASD) in a South African cohort

Fetal alcohol spectrum disorders (FASD) are one of the leading preventable causes of intellectual disabilities (ID). Not much is known about the topic of pediatric incontinence related to FASD, for example nocturnal enuresis (NE), daytime urinary incontinence (DUI), and fecal incontinence (FI). So far, incontinence problems have been examined among children with other specific syndromes. The aim of the present study is to investigate the possible presence of incontinence among children with FASD in a South African cohort. The South African version of the combined questionnaire including the "Parental Questionnaire: Enuresis/Urinary Incontinence" and "Encopresis Questionnaire - Screening Version"; and lower urinary tract symptoms (LUTS) were assessed by the "International-Consultation-on-Incontinence-Questionnaire - Pediatric Lower Urinary Tract Symptom" (ICIQ-CLUTS) among 99 interviewees (e.g. mothers, grandparents) of children with FASD. Moreover, scores on the "Griffiths Mental Development Scales - Extended Revised" (GMDS-ER) were obtained of all included children for further statistical analysis. The overall incontinence rate was 20% (n=20), in children diagnosed within the FASD spectrum (fetal alcohol syndrome or FAS n=17, partial fetal alcohol syndrome or pFAS, n=1, alcohol related neurodevelopmental disorder or ARND n=2). NE affected 16% (n=16) of children with a FASD (FAS n=13, pFAS n=1, and ARND n=2). DUI was reported in one child (FAS), and FI in 4% (n=4) of children (again, only FAS). No indication of lower urinary tract symptoms (LUTS) in the clinical range was reported (sample mean score=5.17). Based on the GMDS-ER, 88% of the children scored lower than 10th percentile. This is a first study to examine the problems of incontinence among children diagnosed within the spectrum of FASD. The rates for children with a FASD are lower than the rates for many children with special needs, but much higher than for typically developing children. Children with a FASD are mainly affected by NE. The problem of incontinence among children with a FASD in South Africa needs to be assessed and considered for clinical management. Future research is necessary to examine problems of incontinence in relation to cognitive and behavioral functioning among children with a FASD, as well as identifying possible causes.

Evaluation of sexual function in females with exstrophy-epispadias-complex: A survey of the multicenter German CURE-Net

Standardized knowledge about genital function in adult female individuals with exstrophy-epispadias complex (EEC) is scarce. The aim of this study was to investigate sexual function using the standardized Female Sexual Function Index (FSFI), and to assess the influence of bladder and vaginal reconstruction and the presence of incontinence on FSFI results. Sixty-one females (aged ≥18 years) recruited by the German multicenter network for congenital uro-rectal malformations (CURE-Net) were asked to complete the FSFI and a self-designed semi-structured questionnaire assessing comprehensive medical data, gynecological, and psychosocial items. Twenty-one eligible females (34%) returned both questionnaires (mean±standard deviation [SD] age of 26±5.1 years). In 43% of participants, a staged or single-staged approach had been used for reconstruction, and these had their bladder in use. A primary or secondary urinary diversion (UD) after cystectomy had been performed in 38% of participants. Of the participants, 57% lived in a committed partnership, and 62% had sexual intercourse on a regular basis, with a further 19% experiencing pain or discomfort thereby. Introitus plasty was done in 43%. Mean total FSFI for all participants was 21.3 (SD 1.9). Most domain scores of patients after introitus plasty were similar compared with those without an operative vaginal approach, except for satisfaction (p=0.057) and pain (p=0.024). Comparing incontinent with continent patients, significant differences were found for desire (mean 4.6 vs. 3.5, p=0.021), lubrication (mean 3.1 vs. 4.2, p=0.049), and satisfaction (mean 1.6 vs. 3.6, p=0.0065). In contrast pain was not significant between groups. Sexual activity rate in the present study was similar to that reported in the literature (81% vs. 89%), whereas dyspareunia rate was lower in our cohort (19% vs. 24%). The risk for sexual dysfunction seems to be lower in patients reconstructed with primary or secondary UD than patients with bladder in use. It is surprising that lubrification was better after UD than after bladder neck surgery. Incontinence and in some parts the history of an introitus plasty may play an additional role in development of sexual dysfunction in EEC. Although most of the female EEC patients lived in a committed partnership and had sexual intercourse, total FSFI values <26.55 clearly indicate a risk of sexual dysfunction. Although continence itself played a major role, females reconstructed with UD seem to have better sexual function. Further evaluation of sexual outcome and improvement of care for these patients is mandatory.

Pressure Relief, Visco-Elastic Foam with Inflated Air? A Pilot Study in a Dutch Nursing Home.

Objective: There is still little evidence regarding the type of mattress that is the best for preventing pressure ulcers (PUs). In a Dutch nursing home, a new type of overlay mattress (air inflated visco-elastic foam) was tested to analyze the opportunity for replacement of the normally used static air overlay mattress in its three-step PU prevention protocol In this small pilot the outcome measures were: healing of a category one pressure ulcer, new development or deterioration of a category one PU and need for repositioning. Methods: We included 20 nursing home residents with a new category one pressure ulcer, existing for no longer than 48 h following a consecutive sampling technic. All residents were staying for more than 30 days in the nursing home and were lying on a visco-elastic foam mattress without repositioning (step one of the 3-step protocol) at the start of the pilot study. They had not suffered from a PU in the month before. The intervention involved use of an air inflated foam overlay instead of a static air overlay (normally step 2 of the 3-step protocol). At the start; the following data were registered: age; gender; main diagnosis and presence of incontinence. Thereafter; all participating residents were checked weekly for PU healing tendency; deterioration of PUs; new PUs and need of repositioning. Only when residents showed still a category one PU after 48 h or deterioration of an existing pressure ulcer or if there was development of a new pressure ulcer, repositioning was put into practice (step 3 of the PU protocol). All residents participated during 8 weeks. Results: Seven residents developed a new pressure ulcer category one and still had a category one pressure ulcer at the end of the study period. One resident developed a pressure ulcer category 2. Fifteen residents needed repositioning from one week after start of the study until the end of the study. Conclusions: Overall 40% of the residents developed a pressure ulcer. Seventy five percent of the residents started with repositioning because there was no healing tendency of their category one PU diagnosed at the start of the pilot. Because this new type of overlay mattress resulted in an increased PU incidence, and almost standard need of repositioning with accompanied high costs, this type of overlay mattress gives no benefit above the traditional visco-elastic foam mattresses in combination with the originally used static air overlay.

Incontinência urinária no puerpério de parto vaginal e cesárea: revisão de literatura

Objective: The present study aimed to review the literature regarding the presence of incontinence (UI) in postpartum of delivery and section. Materials and Methods: A survey was conducted in the databases PubMed/Medline, COCHRANE and EMBASE, which were selected the following types of study: prospective multicenter study, case-control, prospective study, cohort study, prospective observational multicenter study, randomized controlled study, prospective observational study, cohort study controlled, cross-sectional, population-based, published in the period 2002-2012, in english and portuguese, where the keywords were in the title or abstract. The keywords used are: vaginal cesarean and urinary incontinence. Results: The 14 studies analyzed evaluated the presence of UI in postpartum of delivery and cesarean. We observed that section to have your protective role in the appearance of the UI in the puerperium must be performed electively. The pelvic floor disorders are linked with maternal age, smoking, obesity, forceps, multiparity, episiotomy, second stage of labor, pregnancy and chronic constipation. Conclusions: It is concluded that prolonged second stage of labor has a significant role in the presence of UI in the puerperium in both modes of delivery, and section would have its protective value in the development of UI puerperal only if performed electively. Of the 14 selected articles, only one study was conducted in the brazilian population, showing the importance of further studies on UI postpartum in Brazil.