Indices for studying urinary incontinence and levator ani function in primiparous women

• Urinary incontinence (UI) is a complex phenomenon that is prevalent in pregnant and parous women and requires the use of sophisticated measures to adequately reflect functioning of the continence system. • The purpose of this study was to develop reliable and valid measures of UI and levator ani function for use in research and clinical settings. • A Leakage Index (LI) and a Levator Ani Function Index (LAFI) were developed using data from a longitudinal study of primiparous women. Reliability and validity tests were conducted to: (i) estimate the internal consistency reliability of each index, (ii) determine whether the indices captured change in continence status and pelvic floor function during pregnancy through 1 year postpartum, and (iii) estimate association between the indices as a test of predictive validity. • Cronbach's alpha ranged from 0.72 to 0.84 for the LI and from 0.53 to 0.79 for the LAFI across the six data collection time points of the study. Average LI scores increased late in pregnancy and decreased postpartum, though not significantly. Average LAFI scores decreased significantly at 35 weeks gestation ( t  = 4.84, P  = 0.000) and increased significantly at 12 months postpartum ( t  = −3.51, P  = 0.002) relative to baseline. The LI and LAFI were significantly associated at 20 weeks gestation (Pearson r  = −0.40, P  = 0.007) and at 6 weeks postpartum (Pearson r  = −0.33, P  = 0.029). • The findings suggest the LI and LAFI are reliable and valid measures of UI and levator ani function in primiparous women, which can be used with confidence in clinical and research settings.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75514/1/j.1365-2702.2003.00747.x.pd

Validity of environmental audits using GigaPan® and Google Earth Technology

Abstract Background Health behaviors are shaped by the context in which people live. However, documenting environmental context has remained a challenge. More specifically, direct observation techniques require large investments in time and resources and auditing the environment through web-based platforms has limited stability in spatio-temporal imagery. This study examined the validity of a new methodology, using GigaPan® imagery, where we took photos locally and, stitched them together using GigaPan® technology, and quantified environmental attributes from the resulting panoramic photo. For comparison, we examined validity using Google Earth imagery. Methods A total of 464 street segments were assessed using three methods: GigaPan® audits, Google Earth audits, and direct observation audits. Thirty-seven different attributes were captured representing three broad constructs: land use, traffic and safety, and amenities. Sensitivity (i.e. the proportion of true positives) and specificity (i.e. the proportion of true negatives) were used to estimate the validity of GigaPan® and Google Earth audits using direct observation audits as the gold standard. Results Using GigaPan®, sensitivity was 80% or higher for 6 of 37 items and specificity was 80% or higher for 31 of 37 items. Using Google Earth, sensitivity was 80% or higher for 8 of 37 items and specificity was 80% or higher for 30 of 37 items. The validity of GigaPan® and Google Earth was similar, with significant differences in sensitivity and specificity for 7 items and 2 items, respectively. Conclusion GigaPan® performed well, especially when identifying features absent from the environment. A major strength of the GigaPan® technology is its ability to be implemented quickly in the field relative to direct observation. GigaPan® is a method to consider as an alternative to direct observation when temporality is prioritized or Google Earth imagery is unavailable.https://deepblue.lib.umich.edu/bitstream/2027.42/144541/1/12942_2018_Article_147.pd

Environmental and travel preferences of cyclists.

The Intermodal Surface Transportation Efficiency Act of 1991 provides fiscal support for integrating non-motor transport modes into the existing transportation system in an effort to increase travel efficiency. Current recommendations for designing bicycle facilities are based on experience rather than findings from scientific inquiry. Yet planners may be more successful designing improvements for cycling if they are informed of cyclists' preferences. This study was conducted to pool the opinions of cyclists on a variety of environmental design issues, to determine whether personal characteristics and cycling experience influence cyclists' preferences, evaluations of the travel environment, and decisions to commute or run errands by bicycle. Questionnaires were distributed to 552 cyclists at four recreational bicycle tours in Michigan during the summer of 1992. The survey methodology is noteworthy for its low cost and effectiveness for gathering data from cyclists with a range of personal characteristics and cycling experience. Analysis of variance and correlations were used to investigate relationships of interest. Data on route hilliness were compiled from topographic maps, and compared with cyclists' evaluations of hilliness, in an effort to develop a methodology for use in further research to evaluate acceptable road conditions for cycling, for important aspects of the cycling environment. Cyclists indicated their preferences for various route corridor options, and the importance they place on particular route attributes, such as traffic, surface quality, and scenery, in choosing recreational and commuting cycling routes. Findings from this study show personal characteristics and cycling experience are associated with cyclists' environmental preferences, and preferences are associated with evaluations of cycling conditions and cycling for transportation. Bike lanes are most preferred for recreational and commuting cycling regardless of cyclists' personal characteristics and cycling experience. Experienced cyclists are less sensitive to traffic and hills and they dislike bike paths. Older cyclists are concerned with scenery and surface quality. Differences in preferences and cycling behavior by gender suggest the need for further research on that topic. As expected, cyclists on mountain bikes are less sensitive to poor surface quality. Findings are discussed in light of current recommendations regarding safe cycling practices and bicycle facility design.Ph.D.RecreationSocial SciencesTransportationUrban planningUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/129108/2/9332009.pd

Wandering and the Physical Environment

Background/Rationale: Guided by the need-driven dementia-compromised behavior (NDB) model, this study examined influences of the physical environment on wandering behavior. Methods: Using a descriptive, cross-sectional design, 122 wanderers from 28 long-term care (LTC) facilities were videotaped 10 to 12 times; data on wandering, light, sound, temperature and humidity levels, location, ambiance, and crowding were obtained. Associations between environmental variables and wandering were evaluated with chi-square and t tests; the model was evaluated using logistic regression. Results: In all, 80% of wandering occurred in the resident’s own room, dayrooms, hallways, or dining rooms. When observed in other residents’ rooms, hallways, shower/baths, or off-unit locations, wanderers were likely (60%-92% of observations) to wander. The data were a good fit to the model overall (LR [logistic regression] w2 (5) ¼ 50.38, P \u3c .0001) and by wandering type. Conclusions: Location, light, sound, proximity of others, and ambiance are associated with wandering and may serve to inform environmental designs and care practices

Associations between body mass index, physical activity and the built environment in disadvantaged, minority neighborhoods: Predictive validity of GigaPan® imagery

Background: The built environment has been shown to influence health in studies of disadvantaged populations using different measurement methods. This study determined whether environmental exposures derived from GigaPan® images could serve as valid predictors of body mass index (BMI), walking and moderate to vigorous physical activity (MVPA) in a longitudinal study of low-income adults living in two primarily African American neighborhoods in Pittsburgh, Pennsylvania, USA. GigaPan® is a robotic system used to obtain high-resolution, panoramic images of environments. Methods: Microscale environmental features along 481 streets were audited in 2015–2016 using an audit form. Environmental exposures were estimated for 731 adult participants, using a sample of street segments within a 0.4 km (0.25 mile) network distance from each participant’s residential address. Summary environmental exposures were constructed using factor analysis. We tested associations between participant-level environmental exposures and objectively measured BMI, self-reported walking and objectively measured MVPA in regression models controlling for baseline health and demographic variables. Results: Three factors representing participants’ environmental exposures were constructed: pedestrian bicycle-amenities; hilly-vacant-boarded; physical activity-recreation/low housing density. Environments with infrastructure and amenities supportive of walking and bicycling were asso- ciated with lower BMI (Coef. 1⁄4 ‒0.47, p 1⁄4 0.02). Frequent walking was less likely in environments with more physical activity and recreation venues/low housing density (OR 1⁄4 0.81, 95% CI [0.67, 0.96]). MVPA was not associated with any of the environmental measures and the hilly- vacant-boarded factor was not associated with any of the outcomes. Conclusions: Predictive validity was demonstrated for an environmental exposure factor that captured features supportive of walking and cycling in a model predicting BMI, using built environment audit data from GigaPan® imagery. A complementary analysis found lower odds of frequent walking in the neighborhood among participants with exposure to more physical activity and recreational features, but fewer types and lower density of housing.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/162577/1/Antonakos_Associations_between_body_mass_index.pdfSEL

Wayfinding With Visuo-Spatial Impairment from Stroke and Traumatic Brain Injury

Visuo-spatial impairments are common following brain injury. The impairments differ in severity, involving symptoms such as partial vision loss, unawareness of one side of space, and topographic disorientation. In this exploratory study we investigated wayfinding difficulties experienced by four community-dwelling individuals with visuo-spatial impairments due to brain injury. Semi-structured interviews were conducted to elicit information about the type of travel the informants undertook independently, the environments they frequented, and the strategies they used to compensate for disability.One informant had a moderate visual field cut resulting from stroke, and was able to travel and work independently. Two informants had visual field deficits in addition to topographic disorientation. They used very systematic strategies based on landmarks and path learning to master navigating in a variety of settings. The fourth informant had diffuse brain injury resulting in topographic disorientation and short-term memory impairment. He relied on his spouse for transportation needs.The interactions of these informants with the environment provide information that may be useful for enhancing independence and quality of life following brain injury, and for identifying future directions for research on wayfinding with visuo-spatial impairment. Simple environmental modifications in the home may improve orientation. Travel outside the home presents considerable challenges related in part to environmental design

A longitudinal examination of objective neighborhood walkability, body mass index, and waist circumference: the REasons for Geographic And Racial Differences in Stroke study

Abstract Background Studies have shown neighborhood walkability is associated with obesity. To advance this research, study designs involving longer follow-up, broader geographic regions, appropriate neighborhood characterization, assessment of exposure length and severity, and consideration of stayers and movers are needed. Using a cohort spanning the conterminous United States, this study examines the longitudinal relationship between a network buffer-derived, duration-weighted neighborhood walkability measure and two adiposity-related outcomes. Methods This study included 12,846 Black/African American and White adults in the REasons for Geographic And Racial Differences in Stroke study. Body mass index (BMI) and waist circumference (WC) were assessed at baseline and up to 13.3 years later (M (SD) = 9.4 (1.0) years). BMI and WC were dichotomized. Walk Score® was duration-weighted based on time at each address and categorized as Very Car-Dependent, Car-Dependent, Somewhat Walkable, Very Walkable, and Walker’s Paradise. Unadjusted and adjusted logistic regression models tested each neighborhood walkability-adiposity association. Adjusted models controlled for demographics, health factors, neighborhood socioeconomic status, follow-up time, and either baseline BMI or baseline WC. Adjusted models also tested for interactions. Post-estimation Wald tests examined whether categorical variables had coefficients jointly equal to zero. Orthogonal polynomial contrasts tested for a linear trend in the neighborhood walkability-adiposity relationships. Results The odds of being overweight/obese at follow-up were lower for residents with duration-weighted Walk Score® values in the Walker’s Paradise range and residents with values in the Very Walkable range compared to residents with values in the Very Car-Dependent range. Residents with duration-weighted Walk Score® values classified as Very Walkable had significantly lower odds of having a moderate-to-high risk WC at follow-up relative to those in the Very Car-Dependent range. For both outcomes, the effects were small but meaningful. The negative linear trend was significant for BMI but not WC. Conclusion People with cumulative neighborhood walkability scores in the Walker’s Paradise range were less likely to be overweight/obese independent of other factors, while people with scores in the Very Walkable range were less likely to be overweight/obese and less likely to have a moderate-to-high risk WC. Addressing neighborhood walkability is one approach to combating obesity.http://deepblue.lib.umich.edu/bitstream/2027.42/173744/1/12966_2022_Article_1247.pd

Preventive Oral Health Behaviors among African-Americans and Whites in Detroit

Objective : This study compared the preventive oral health behaviors of African-Americans and whites. Methods : Face-to-face interviews were conducted with a probability sample of 384 African-American and 358 white adults living in the greater Detroit area. Questions focused on brushing, flossing, and dental visits. Results : More than 95 percent of both groups reported brushing daily; however, whites were more likely to brush all teeth, including parts that do not show. Frequency of flossing did not differ between groups. African-Americans, however, were less likely to floss all of their teeth. Whites were more likely than African-Americans to get dental check-ups at least once a year and much less likely to indicate they had never had a dental check-up. African-Americans tended to have less education and lower family income than whites and were more likely than whites to have Medicaid. Race differences in brushing thoroughness and annual check-ups were greatly reduced when income, education, and insurance were controlled statistically. Conclusion : African-Americans are less likely than whites to brush thoroughly, floss thoroughly, and get dental check-ups. These differences are partly traceable to differences in socioeconomic status and access to professional oral health care.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65355/1/j.1752-7325.1998.tb02999.x.pd