Bony pelvis dimensions in women with and without stress urinary incontinence

Aims To test the null hypothesis that bony pelvis dimensions are similar in women with and without stress urinary incontinence (SUI), both in the postpartum and midlife periods. Methods Secondary analyses were performed of two case–control studies comparing women with SUI to asymptomatic controls. One study examined primiparas in the first 9–12 months postpartum; the other study involved middle‐aged women. SUI was confirmed by full‐bladder stress test. All subjects underwent pelvic magnetic resonance imaging. The interspinous and intertuberous diameters, subpubic angle, and sacrococcygeal joint‐to‐the inferior pubic point distance were measured from the images independently by two authors. Results In the young cohorts, we compared primiparas with de novo postpartum SUI to both continent primiparas and nulliparas. Postpartum SUI is associated with a wider subpubic angle. There is also a trend towards wider interspinous and intertuberous diameters in the stress‐incontinent primiparas as compared to the continent cohorts, although this did not reach statistical significance with our sample sizes. By contrast, no significant differences in bony pelvis dimensions were identified when comparing middle‐aged women with SUI and their continent controls. Conclusions Bony pelvis dimensions are different in women with SUI than in matched continent controls. However, these differences are only identified in young primiparas in the postpartum period, not in middle‐aged women. Neurourol. Urodynam. 32: 37–42, 2013. © 2012 Wiley Periodicals, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/95230/1/22275_ftp.pd

Presidential Elections - The Right to Vote and Access to the Ballot

The following article is a tripartite effort by Mitchell Berger and Grace E. Robson, members of the Florida Bar; John B. Anderson, a member of the Nova Southeastern University\u27s Shepard Broad Law Center faculty; and a team of two of the students at that law school, Jason Blank and Tom Brogan, to examine the subject of ballot access for non-major party candidates in presidential elections in the wake of the recent decision of the Supreme Court of Florida in Reform Party of Florida v. Black.\u27 Mr. Berger has furnished a critical analysis of that decision. Our team of students has catalogued the ballot access laws of the fifty states and the District of Columbia. John B. Anderson has reviewed United States Supreme Court decisions on the subject of ballot access specifically, and then also more generally on the way in which they reflect on the electoral process; a process which for a century and a half has been dominated by our two major parties. His criticism of the resulting duopoly of political power and control should be attributed to him alone and not to the other members of this collaborative effort. However, both Mr. Berger and Mr. Anderson support the idea of a constitutional amendment putting forth an affirmative right to vote as both necessary and desirable as a predicate for any effort to achieve a more uniform approach to ballot access in future presidential contests. We also join in our appreciation for the research assistance of Messrs. Blank and Brogan and their contribution to our joint effort

Home opioid use following cesarean delivery: How many opioid tablets should obstetricians prescribe?

AimTo quantify home opioid use after cesarean delivery and identify factors associated with increased opioid use.MethodsA convenience sample of women discharged by postoperative day 2 following a term cesarean delivery of a singleton fetus from May 2015 to May 2016 were contacted 2 weeks post‐partum and questioned regarding opioid use, pain control and pain expectations.ResultsAmong 141 women included in the analysis, the median number of opioid tablets used was 36 (interquartile range 16–45) and the median number prescribed was 60 (interquartile range 42–65). Logistic regression identified operative time ≥59.5 min and number of opioid tablets prescribed as two factors independently associated with opioid use in the top quartile.ConclusionIn the first 2 weeks post‐partum, 75% of women used 45 or fewer opioid tablets. Operative time over 1 h and increased number of opioid tablets prescribed are factors associated with higher post‐partum opioid use.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/143657/1/jog13579.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/143657/2/jog13579_am.pd

Predicting postoperative day 1 hematocrit levels after uncomplicated hysterectomy

ObjectiveTo develop a model for predicting postoperative hematocrit levels after uncomplicated hysterectomy.MethodsIn a retrospective study, data were analyzed from the Michigan Surgery Quality Collaborative for non‐emergent hysterectomies performed for benign indications among women aged at least 18 years between January 1, 2012, and April 4, 2014. Linear mixed models were used for univariate and multivariate analyses.ResultsThe model was developed with data from 4747 hysterectomies and validated on 1184 cases. In the mixed multivariate analysis, higher postoperative day 1 (POD1) hematocrit levels were associated with higher weight (B = 0.03222, P < 0.001), higher preoperative hematocrit (B = 0.6587, P < 0.001), and non‐vaginal hysterectomy (B = 0.2815, P = 0.0055). Lower POD1 hematocrit was associated with higher preoperative platelet count (B = − 0.00457, P < 0.001), greater estimated blood loss (B = − 0.00652, P < 0.001), and larger intraoperative crystalloid volume (B = − 0.3303, P < 0.001). The final model predicted POD1 hematocrit within 4% points of the actual value for 91.7% of cases in the validation set.ConclusionUse of the model after uncomplicated hysterectomy might help to support the practice of selectively conducting postoperative hematocrit tests after hysterectomy in a clinically thoughtful and cost‐effective manner.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135182/1/ijgo19.pd

Transcutaneous Electrical Nerve Stimulation to Improve Female Sexual Dysfunction Symptoms: A Pilot Study

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146481/1/ner12846.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/146481/2/ner12846_am.pd

Racial differences in self‐reported healthcare seeking and treatment for urinary incontinence in community‐dwelling women from the EPI study

Aims Objectives of this study are: (1) to examine the prevalence of healthcare seeking among black and white women with self‐reported urinary incontinence (UI), (2) to investigate barriers to treatment for incontinence, and (3) To investigate commonly used therapeutic modalities for UI. Methods This is a planned secondary analysis of responses from 2,812 black and white community‐dwelling women living in southeastern Michigan, aged 35–64 years, who completed a telephone interview concerning UI, healthcare‐seeking behaviors and management strategies. The study population was 571 subjects (278 black, 293 white) who self‐identified as having urinary incontinence. Results Of these women with UI, 51% sought healthcare with no statistically significant difference between the two races (53% black, 50.6% white, P  = 0.64). In multivariate logistic regression analysis, a higher likelihood of seeking healthcare was associated with increased age, body mass index lower than 30 kg/m 2 , prior surgery for UI, having regular pelvic exams, having a doctor, and worsening severity of UI. There was no significant association between hypothesized barriers to care seeking and race. Almost 95% of the subjects identified lack of knowledge of available treatments as one barrier. Black and white women were similar in percentage use of medications and some self‐care strategies, for example, pad wearing and bathroom mapping, but black women were significantly more likely to restrict fluid intake than white women and marginally less likely to perform Kegels. Conclusions Black and white women seek healthcare for UI at similar, low rates. Improved patient‐doctor relationships and public education may foster healthcare seeking behavior. Neurourol. Urodynam. Neurourol. Urodynam. 30: 1442–1447, 2011. © 2011 Wiley Periodicals, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/87061/1/21145_ftp.pd

The Impact of Vulvar Lichen Sclerosus on Sexual Dysfunction

Background: Lichen sclerosus (LS) is a chronic inflammatory condition that is known to arise on the vulva. Many women with LS report vulvar pain, often affecting a patient's quality of life. In this study, the sexual function of LS patients, with and without pain, was compared to control populations. Materials and Methods: A case-control study to examine the relationship between LS and sexual dysfunction was conducted. A total of 335 women presenting to the gynecology clinic were included in the study: 197 women with biopsy confirmed LS were compared to two control groups (95 asymptomatic women were ?healthy? controls and 43 women had vulvovaginal candidiasis) on self-reported current health complaints, medical and surgical history and current symptoms such as pain and itching, type and frequency of sexual activity, and satisfaction with sexual activity. Results: Women with LS reported less frequent sexual activity than healthy controls (p=0.007) and Candida controls (p=0.04). Currently sexually active women with LS were significantly less likely to report vaginal intercourse (71.6%) than healthy controls (89.0%, p=0.003) or Candida controls (100%, p=0.0003), even though similar proportions of all three groups reported that vaginal intercourse was important. Satisfaction towards the quality of current sexual activity was significantly lower among women with LS compared with both the healthy and Candida control groups. 23.7% of women with LS reported that sexual activity was rarely or never satisfactory as compared with 0% of healthy controls (p<0.0001) and 6.5% of Candida controls (p=0.03). Conclusion: Women with LS have less frequent sexual activity and less satisfying sexual activity when compared with controls.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140128/1/jwh.2014.4805.pd

Adaptive mesh and geodesically sliced Schwarzschild spacetime in 3+1 dimensions

We present first results obtained with a 3+1 dimensional adaptive mesh code in numerical general relativity. The adaptive mesh is used in conjunction with a standard ADM code for the evolution of a dynamically sliced Schwarzschild spacetime (geodesic slicing). We argue that adaptive mesh is particularly natural in the context of general relativity, where apart from adaptive mesh refinement for numerical efficiency one may want to use the built in flexibility to do numerical relativity on coordinate patches.Comment: 21 pages, LaTeX, 7 figures included with eps