Continence Across Continents To Upend Stigma and Dependency (CACTUS-D): study protocol for a cluster randomized controlled trial

Background: Urinary incontinence occurs in 40 % of women aged 65 years and over; however, only 15 % seek care and many delay healthcare seeking for years. Incontinence is associated with depression, social isolation, reduced quality of life, falls and other comorbidities. It is accompanied by an enormous cost to the individual and society. Despite the substantial implications of urinary incontinence on social, psychological and physical well-being of older women, the impact of continence promotion on urinary symptom improvement and subsequent effects on falls, quality of life, stigma, social participation and the cost of care remains unknown. Methods: This study is a mixed methods multi-national open-label 2-arm parallel cluster randomized controlled trial aiming to recruit 1000 community-dwelling incontinent women aged 65 years and older across Quebec, Western Canada, France and United Kingdom. Participants will be recruited through community organizations. Data will be collected at 6 time points: baseline and 1 week, 3 months, 6 months, 9 months and 12 months after baseline. One of the primary objectives is to evaluate whether the continence promotion intervention improves incontinence symptoms (measured with the Patient Global Impression of Improvement questionnaire, PGI-I) at 12 months post intervention compared to the control group. Other co-primary outcomes include changes in incontinence-related stigma, fall reduction, and incremental cost-effectiveness ratio and quality-adjusted life years. Data analysis will account for correlation of outcomes (clustering) within community organizations. A qualitative sub-study will explore stigma reduction. Discussion: Community-based continence promotion programs may be a cost-effective strategy to reduce urinary incontinence, stigma and falls among older women with untreated incontinence, and simultaneously improve quality of life and healthy active life expectancy.European Research Area on Ageing2 (ERA-AGE2) progra

Differences in pelvic floor morphology between continent, stress urinary incontinent, and mixed urinary incontinent elderly women : an MRI study

Aims To compare magnetic resonance imaging (MRI) of the pelvic floor musculature (PFM), bladder neck and urethral sphincter morphology under three conditions (rest, PFM maximal voluntary contraction (MVC), and straining) in older women with symptoms of stress (SUI) or mixed urinary incontinence (MUI) or without incontinence. Methods This 2008–2012 exploratory observational cohort study was conducted with community-dwelling women aged 60 and over. Sixty six women (22 per group), mean age of 67.7 ± 5.2 years, participated in the study. A 3 T MRI examination was conducted under three conditions: rest, PFM MVC, and straining. ANOVA or Kruskal–Wallis tests (data not normally distributed) were conducted, with Bonferroni correction, to compare anatomical measurements between groups. Results Women with MUI symptoms had a lower PFM resting position (M-Line P = 0.010 and PC/H-line angle P = 0.026) and lower pelvic organ support (urethrovesical junction height P = 0.013) than both continent and SUI women. Women with SUI symptoms were more likely to exhibit bladder neck funneling and a larger posterior urethrovesical angle at rest than both continent and MUI women (P = 0.026 and P = 0.008, respectively). There were no significant differences between groups on PFM MVC or straining. Conclusions Women with SUI and MUI symptoms present different morphological defects at rest. These observations emphasize the need to tailor UI interventions to specific pelvic floor defects and UI type in older women

Responsiveness and clinical utility of the geriatric self-efficacy index for urinary incontinence

OBJECTIVES: To report on the responsiveness testing and clinical utility of the 12-item Geriatric Self-Efficacy Index for Urinary Incontinence (GSE-UI). DESIGN: Prospective cohort study. SETTING: Six urinary incontinence (UI) outpatient clinics in Quebec, Canada. PARTICIPANTS: Community-dwelling incontinent adults aged 65 and older. MEASUREMENTS: The abridged 12-item GSE-UI, measuring older adults' level of confidence for preventing urine loss, was administered to all new consecutive incontinent patients 1 week before their initial clinic visit, at baseline, and 3 months posttreatment. At follow-up, a positive rating of improvement in UI was ascertained from patients and their physicians using the Patient's and Clinician's Global Impression of Improvement scales, respectively. Responsiveness of the GSE-UI was calculated using Guyatt's change index. Its clinical utility was determined using receiver operating curves. RESULTS: Eighty-nine of 228 eligible patients (39.0%) participated (mean age 72.6+5.8, range 65–90). At 3-month follow-up, 22.5% of patients were very much better, and 41.6% were a little or much better. Guyatt's change index was 2.6 for patients who changed by a clinically meaningful amount and 1.5 for patients having experienced any level of improvement. An improvement of 14 points on the 12-item GSE-UI had a sensitivity of 75.1% and a specificity of 78.2% for detecting clinically meaningful changes in UI status. Mean GSE-UI scores varied according to improvement status (P<.001) and correlated with changes in quality-of-life scores (r=0.7, P<.001) and reductions in UI episodes (r=0.4, P=.004). CONCLUSION: The GSE-UI is responsive and clinically useful

Sex in basic research – Concepts in the cardiovascular field

Women and men, female and male animals and cells are biologically different, and acknowledgement of this fact is critical to advancing medicine. However, incorporating concepts of sex-specific analysis in basic research is largely neglected, introducing bias into translational findings, clinical concepts and drug development.Research funding agencies recently approached these issues but implementation of policy changes in the scientific community is still limited probably due to deficits in concepts, knowledge and proper methodology. This expert review is based on the EUGenMed project (www.eugenmed.eu) developing a roadmap for implementing sex and gender in biomedical and health research. For sake of clarity and conciseness, examples are mainly taken from the cardiovascular field that may serve as a paradigm for others, since a significant amount of knowledge how sex and estrogen determine the manifestation of many cardiovascular diseases (CVD) has been accumulated. As main concepts for implementation of sex in basic research, the study of primary cell and animals of both sexes, the study of the influence of genetic versus hormonal factors and the analysis of sex chromosomes and sex specific statistics in genome wide association studies (GWAS) are discussed. The review also discusses methodological issues, and analyses strength, weaknesses, opportunities and threats in implementing sex-sensitive aspects into basic research

Acting on sex and gender in medical innovation is good for business.

Lavanya Vijayasingham and colleagues argue that as well as improving safety and efficacy, considering sex and gender related factors in medical research can have commercial benefit

Measurement of event background fluctuations for charged particle jet reconstruction in Pb-Pb collisions at sNN=2.76\sqrt{s_{\rm NN}} = 2.76 TeV

The effect of event background fluctuations on charged particle jet reconstruction in Pb-Pb collisions at $\sqrt{s_{\rm NN}} = 2.76$ TeV has been measured with the ALICE experiment. The main sources of non-statistical fluctuations are characterized based purely on experimental data with an unbiased method, as well as by using single high $p_{\rm T}$ particles and simulated jets embedded into real Pb-Pb events and reconstructed with the anti-$k_{\rm T}$ jet finder. The influence of a low transverse momentum cut-off on particles used in the jet reconstruction is quantified by varying the minimum track $p_{\rm T}$ between 0.15 GeV/$c$ and 2 GeV/$c$. For embedded jets reconstructed from charged particles with $p_{\rm T} > 0.15$ GeV/$c$, the uncertainty in the reconstructed jet transverse momentum due to the heavy-ion background is measured to be 11.3 GeV/$c$ (standard deviation) for the 10% most central Pb-Pb collisions, slightly larger than the value of 11.0 GeV/$c$ measured using the unbiased method. For a higher particle transverse momentum threshold of 2 GeV/$c$, which will generate a stronger bias towards hard fragmentation in the jet finding process, the standard deviation of the fluctuations in the reconstructed jet transverse momentum is reduced to 4.8-5.0 GeV/$c$ for the 10% most central events. A non-Gaussian tail of the momentum uncertainty is observed and its impact on the reconstructed jet spectrum is evaluated for varying particle momentum thresholds, by folding the measured fluctuations with steeply falling spectra.Comment: 21 pages, 5 captioned figures, 3 tables, authors from page 16, published version, figures at http://aliceinfo.cern.ch/ArtSubmission/node/350

Women's health priorities in late life : perceived strategies for successful aging

The objectives of this thesis were (1) to identify older women's health priorities for promoting physical, psychological and social well-being; and (2) to measure the extent to which women perceive that their health priorities are being met. A qualitative methodology using 3 focus group sessions with 36 community-dwelling women aged 65 year and older was used to elicit older women's health priorities. Priorities were categorized into three groups: disease-related priorities, disability-related priorities, and psychosocial-related priorities. A questionnaire was developed to quantify the extent to which women perceive that these different priorities are being addressed. The survey was administered to a convenience sample of 609 community-based women aged 55--93 years (mean age 70 +/- 9 years) attending outpatient medical clinics. Unaddressed disability-related priorities were most prevalent. Women aged 75 years and older were significantly less likely to perceive that their priorities were unmet compared to younger mature women (OR 0.564; 95% confidence interval: 0.387--0.821) when adjusting for other health and socio-demographic variables. The implications of these findings and opportunities for improving preventive health care for older women are discussed

Effectiveness of online learning on health researcher capacity to appropriately integrate sex, gender, or both in grant proposals

Abstract Background To describe the effectiveness of online learning to augment academic capacity to consider sex and gender in the conduct of basic science, clinical research, and population health studies. Method The analysis compares pre- and post-test scores from 1441 individuals who completed the Canadian Institutes of Health Research Institute of Gender and Health’s interactive e-learning modules between February 2016 and May 2017. The tests measured knowledge, self-efficacy, and self-reported intent to change behavior for three competencies: (1) the ability to appropriately define and distinguish between sex-related versus gender-related variables, (2) the application of methods for integrating sex and gender, and (3) the critical appraisal of sex and gender integration in the design, methods, and analysis plan of research proposals and publications. Results Of the 543 individuals who completed the basic science module, 62% demonstrated improved knowledge, and 86% increased self-efficacy across all competencies. Gains in knowledge and self-efficacy also occurred among 84% and 77% of completers of the human data collection module (n = 463) and among 73% and 82% of those who completed the secondary data analysis module (n = 435). In aggregate, 95% of participants reported an intent to change their behavior with respect to sex and gender in health research. Conclusions Interactive online learning combined with feedback and self-assessment results in improved knowledge and self-efficacy for integrating sex and gender in health research