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

Provider Support of Spontaneous Pushing During the Second Stage of Labor

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74899/1/0884217505281904.pd

Association of index finger palpatory assessment of pubovisceral muscle body integrity with MRIâ documented tear

AimsPubovisceral (PV) muscle tears are associated with pelvic floor disorders. The goal of this study was to determine whether index finger palpatory assessment of PV muscle body integrity through the lateral vaginal wall is a reliable indicator of PV muscle tear severity diagnosed by magnetic resonance imaging (MRI).MethodsWe studied 85 women, 7 weeks after vaginal birth. All had at least one risk factor for obstetricâ related PV muscle tear. The ordinal outcome measure of MRIâ documented PV muscle tear was defined as: none, less than 50% unilateral tear, 50% or greater unilateral tear or less than 50% bilateral tear, and 50% or greater bilateral tear. PV muscle body integrity by palpatory assessment was scored on a matrix, with each side scored independently and classified as PV muscle body â presentâ (assuredly felt), â equivocalâ (not sure if felt), or â absentâ (assuredly not felt). Proportional odds models were constructed to estimate the relationship between PV muscle body integrity palpatory assessment and MRIâ documented PV muscle tears.ResultsThirtyâ five percent of study participants exhibited varying degrees of MRIâ documented PV muscle tears. Using palpatory assessment, we identified â PV muscle body present bilaterallyâ in 20%, â equivocal unilaterally or present contralaterallyâ in 8%, â equivocal or absent unilaterallyâ or â equivocal bilaterallyâ in 62%, and â absent bilaterallyâ in 9%. The odds ratio for estimating MRI results from palpatory assessment was 3.62 (95% confidence intervalâ =â 1.70â 7.73, Pâ =â 0.001).ConclusionsA rapid and inexpensive palpatory assessment in the clinic was highly associated with the risk of MRIâ documented PV muscle tear and is a useful component of a clinical assessment.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149233/1/nau23967_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149233/2/nau23967.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 prevention of lower urinary tract symptoms (PLUS) research consortium: A transdisciplinary approach toward promoting bladder health and preventing lower urinary tract symptoms in women across the life course

Lower urinary tract symptoms (LUTS) are highly prevalent in women, and are expected to impose a growing burden to individuals and society as the population ages. The predominance of research related to LUTS has focused on underlying pathology, disease mechanisms, or the efficacy of treatments for women with LUTS. Although this research has been vital for helping to reduce or ameliorate LUTS conditions, it has done little to prevent the onset of LUTS. Health promotion and prevention require an expansion of scientific inquiry beyond the traditional paradigm of studying disease mechanisms and treatment to the creation of an evidence base to support recommendations for bladder health promotion and, in turn, prevention of LUTS. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) introduced the concept of prevention as an important priority for women's urologic research as a prelude to supporting the formation of the Prevention of Lower Urinary Tract Symptoms (PLUS) research consortium. In this article, we introduce the PLUS research consortium to the scientific community; share the innovative paradigms by which the consortium operates; and describe its unique research mission: to identify factors that promote bladder health across the life course and prevent the onset of LUTS in girls and women

Urinary incontinence symptoms during and after pregnancy in continent and incontinent primiparas

Examine patterns of urinary incontinence during and after pregnancy, as recalled by incontinent and continent primiparas.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45852/1/192_2006_Article_124.pd

The physical finding of stress urinary incontinenceamong African women in Ghana

The aim of this study is to determine the proportion of women with the physical sign of stress urinary incontinence in a sample of Ghanaian women. Two hundred randomly selected women from attendants at a convenience selected ultrasound clinic were interviewed about symptoms of urinary incontinence. A paper towel test was performed to objectively demonstrate the physical sign of stress urinary incontinence as leakage on coughing. Forty-two percent of the women had a positive paper towel test. The two major symptoms reported by the women with positive paper towel test were (1) loss of urine while waiting to use the toilet (48.2%) and (2) loss of urine on coughing (43.4%) in daily life. The physical sign of stress urinary incontinence could be present in up to 42% of Ghanaian women.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45851/1/192_2005_Article_62.pd

It is not just menopause: symptom clustering in the Study of Women’s Health Across the Nation

Abstract Background Patterns of symptom clustering in midlife women may suggest common underlying mechanisms or may identify women at risk of adverse health outcomes or, conversely, likely to experience healthy aging. This paper assesses symptom clustering in the Study of Women’s Health Across the Nation (SWAN) longitudinally by stage of reproductive aging and estimates the probability of women experiencing specific symptom clusters. We also evaluate factors that influence the likelihood of specific symptom clusters and assess whether symptom clustering is associated with women’s self-reported health status. Methods This analysis includes 3289 participants in the multiethnic SWAN cohort who provided information on 58 symptoms reflecting a broad range of physical, psychological and menopausal symptoms at baseline and 7 follow-up visits over 16 years. We conducted latent transition analyses to assess symptom clustering and to model symptomatology across the menopausal transition (pre, early peri-, late peri- and post-menopausal). Joint multinomial logistic regression models were used to identify demographic characteristics associated with premenopausal latent class membership. A partial proportional odds regression model was used to assess the association between latent class membership and self-reported health status. Results We identified six latent classes that ranged from highly symptomatic (LC1) across most measured symptoms, to moderately symptomatic across most measured symptoms (LC2), to moderately symptomatic for a subset of symptoms (vasomotor symptoms, pain, fatigue, sleep disturbances and physical health symptoms) (LC3 and LC5) with one class (LC3) including interference in life activities because of physical health symptoms, to numerous milder symptoms, dominated by fatigue and psychological symptoms (LC4), to relatively asymptomatic (LC6). In pre-menopause, 10% of women were classified in LC1, 16% in LC2, 14% in LC3 and LC4, 26% in LC5, and 20% in LC6. Intensity of vasomotor and urogenital symptoms as well as sexual desire) differed minimally by latent class. Classification into the two most symptomatic classes was strongly associated with financial strain, White race/ethnicity, obesity and smoking status. Over time, women were most likely to remain within the same latent class as they transitioned through menopause stages (range 39–76%), although some women worsened or improved. The probability of moving between classes did not differ substantially by menopausal stage. Women in the highly symptomatic classes more frequently rated their health as fair to poor compared to women in the least symptomatic class. Conclusion Clear patterns of symptom clustering were present early in midlife, tended to be stable over time, and were strongly associated with self-perceived health. Notably, vasomotor symptoms tended to cluster with sleep disturbances and fatigue, were present in each of the moderate to highly symptomatic classes, but were not a defining characteristic of the symptom clusters. Clustering of midlife women by symptoms may suggest common underlying mechanisms amenable to interventions. Given that one-quarter of midlife women were highly or moderately symptomatic across all domains in the pre-menopause, addressing symptom burden in early midlife is likely critical to ameliorating risk in the most vulnerable populations.https://deepblue.lib.umich.edu/bitstream/2027.42/137710/1/40695_2017_Article_21.pd

A Chemistry of Organization: Combinatory Structural Analysis and Design

This paper is a response to the call for models of organization design as a science revealing the inner composition of organization and specifying the laws to be respected when crafting it. It maintains that the needed science is a chemistry of organization, addressing the combination of 'organizational elements' playing a role analogous to that of chemical elements in composing a variety of substances. Drawing both on classic organization design theory and on configurational and complementarity-based approaches, the paper specifies a set of basic organizational elements and a set of combinatory laws regulating their effective combinations. Testable propositions are derived on the necessary and sufficient conditions that the composition of organizations should have respect for achieving high levels of efficiency and innovation. These propositions are tested empirically on a sample of firms, using an innovative application of Boolean algebra

The science of choice: an introduction

Introduction In October 2015, around 30 scholars convened at the Max Planck Institute for Demographic Research (MPIDR) in Rostock to discuss: (a) how individuals and families make decisions about marriage, child-birth, migration, retirement, and other transitions in the life course; and (b) how these decision processes can be operationalized in demographic models. The workshop was organized by the Scientific Panel on Microsimulation and Agent-Based Modelling con- vened by the International Union for the Scientific Study of Population (IUSSP) and by MPIDR. The report of this ‘Science of choice’ workshop and the papers presented are available from the workshop’s website (see IUSSP 2015). The five papers included in this Supplement are revised versions of papers presented at the workshop in Rostock