Objective
Urinary incontinence (UI) is often considered to be an age‐related disease that develops gradually as women grow older. Much remains to be learnt about factors that promote its incidence or ...its remission. Our objective was to assess its incidence and risk factors.
Design
Longitudinal cohort study.
Setting
French GAZEL cohort.
Population
A cohort of 4127 middle‐aged women (aged 47–52 years at baseline) over an 18‐year period (1990–2008).
Methods
UI was defined as ‘difficulty retaining urine’. The question was asked at baseline and repeated every 3 years over an 18‐year period. Two groups (UI incidence and remission) were analysed according to status at baseline (continent or incontinent). A multivariable analysis (Cox model) was used to estimate the risk factors for UI incidence and remission.
Main outcome measures
Annual incidence and remission rates and risk factors for UI incidence and remission.
Results
The annual incidence and remission rates for UI were 3.3% and 6.2%, respectively. High educational level (hazard ratio HR = 1.28; 95% confidence interval 95% CI = 1.05–1.55), parity, i.e. at least one baby versus no baby (HR = 1.64; 95% CI = 1.19–2.27), menopause (HR = 5.44; 95% CI = 4.47–6.63), weight gain, i.e. for each kilogram change in weight (HR = 1.00; 95% CI = 1.00–1.02), onset of depressive symptoms (HR = 1.31; 95% CI = 1.09–1.57) and impairment in health‐related quality of life incidence (social isolation dimension HR = 1.29; 95% CI = 1.04–1.60 and energy dimension HR = 1.41; 95% CI = 1.17–1.70) were associated with an increased probability of UI. The factors associated with persistent UI were age (HR = 0.58; 95% CI = 0.55–0.61), weight gain (HR = 0.99; 95% CI = 0.98–0.99) and transition to menopausal status (HR = 1.54; 95% CI = 1.19–1.99).
Conclusions
Our study suggests that, in our population of middle‐aged women, age, menopause, weight gain, onset of depression and impaired health‐related quality of life may promote UI.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Objective
To assess the short‐term incidence of serious complications of surgery for urinary incontinence or pelvic organ prolapse.
Design
Prospective longitudinal cohort study using a surgical ...registry.
Setting
Thirteen public hospitals in France.
Population
A cohort of 1873 women undergoing surgery between February 2017 and August 2018.
Methods
Preliminary analysis of serious complications after a mean follow‐up of 7 months (0–18 months), according to type of surgery. Surgeons reported procedures and complications, which were verified by the hospitals’ information systems.
Main outcome measures
Serious complication requiring discontinuation of the procedure or subsequent surgical intervention, life‐threatening complication requiring resuscitation, or death.
Results
Fifty‐two women (2.8%, 95% CI 2.1–3.6%) experienced a serious complication either during surgery, requiring the discontinuation of the procedure, or during the first months of follow‐up, necessitating a subsequent reoperation. One woman also required resuscitation; no women died. Of 811 midurethral slings (MUSs), 11 were removed in part or totally (1.4%, 0.7–2.3%), as were two of 391 transvaginal meshes (0.5%, 0.1–1.6%), and four of 611 laparoscopically placed mesh implants (0.7%, 0.2–1.5%). The incidence of serious complications 6 months after the surgical procedure was estimated to be around 3.5% (2.0–5.0%) after MUS alone, 7.0% (2.8–11.3%) after MUS with prolapse surgery, 1.7% (0.0–3.8%) after vaginal native tissue repair, 2.8% (0.9–4.6%) after transvaginal mesh, and 1.0% (0.1–1.9%) after laparoscopy with mesh.
Conclusions
Early serious complications are relatively rare. Monitoring must be continued and expanded to assess the long‐term risk associated with mesh use and to identify its risk factors.
Tweetable
Short‐term serious complications are rare after surgery for urinary incontinence or pelvic organ prolapse, even with mesh.
Tweetable
Short‐term serious complications are rare after surgery for urinary incontinence or pelvic organ prolapse, even with mesh.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Abstract Objective Social inequalities in cervical cancer screening may be related to either lack of access to care or inadequate delivery of preventive care by providers. We sought to characterize ...social inequalities among women consulting general practitioners with a wide range of social position indicators. Methods In 2005–06, 59 randomly recruited general practitioners from the Paris metropolitan area enrolled every woman aged 50–69 years seen during a two-week period. Cervical cancer screening status (overdue if the last cervical cancer screening had been more than 3 years earlier) was analyzed for 858 women in a logistic mixed model that considered: occupational class (in 5 levels, based on last occupation), education, income, characteristics related to family, housing, neighborhood, household wealth (social allocations, perceived financial difficulties in 4 levels, income tax), employment status, supplementary health insurance, and social network (4 levels). Results The rate of overdue patients did not vary between general practitioners (21%). social position indicators associated with overdue status (odds ratio between 2 adjacent decreasing social levels) were occupational class (1.20, 95% CI: 1.03–1.41), social network (1.52, 95% CI: 1.18–1.94), financial difficulties (1.42, 95% CI: 1.07–1.88), neighborhood safety (2.15, 95% CI: 1.10–4.20), and allocations (3.34, 95% CI: 1.12–9.96). Conclusions Even among women visiting general practitioners we observed marked social inequalities that persist above and beyond occupational class.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPUK, ZRSKP
Given the benefits of breastfeeding (BF), healthcare institutions recommend that a child should be breastfed for the first 6 months of its life. This study provides a review of BF as a function of ...socioeconomic criteria in various industrialized countries.
A review was carried out between 1st January 1998 and 1st March 2009, using Medline and the Public Health Database. The papers were selected independently by two persons, using a methodological grid designed to evaluate the quality of the studies. From 1126 initially selected papers, 26 from 16 different countries were retained for further analysis.
The prevalence of exclusive BF initiation was the highest in Norway, Denmark, and Japan with, respectively, 99, 98.7, and 98.3%. This prevalence was the lowest in the United Kingdom, the United States, and France with, respectively, 70, 69.5, and 62.6%. Women who breastfeed less were most commonly found to be young, single, from a low socioeconomic group, or with a low level of education. Women from immigrant population groups breastfed more than the native-born population during their pregnancy.
Knowledge of the sociodemographic distribution of women who breastfeed is essential for the definition of preventive policies, which are needed to reduce health-related social inequalities. An in-depth analysis of existing primary healthcare programs would allow new strategies to be defined.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPUK, ZAGLJ, ZRSKP
Abstract
Objectives The Women's Health Questionnaire has been developed for the assessment of symptom perception in mid-aged women. It explores a range of psychological and physical symptoms and is ...one of the most used health-related quality of life measures. It was developed in the English language and is available in several other languages. The aim of this study was to evaluate the psychometric properties of the Tunisian-Arabic version of the questionnaire.
Methods A Tunisian-Arabic translation of the original version of the Women's Health Questionnaire (36-item WHQ) was produced using the forward-backward translation method recommended by the designers. A total of 1231 women were anonymously recruited from the general population using the quota method of sampling. All women were administered the WHQ as part of a broader questionnaire; 1150 records were finally retained for analysis. Psychometric evaluation was performed for the original version of the WHQ (36 items) and then for the 23-item revised version proposed by the MAPI Research Institute.
Results The acceptability and comprehensibility of the scale were good. The 36-item version showed overall good reliability, but some subscales lacked internal consistency. The validity was explored by principal component analysis and showed significant differences with the original English instrument and some deficiencies in its dimensional structure. The validity of the 23-item revised version was better. Finally, we suggest some adjustments to improve the reliability and validity of the instrument.
Conclusion The Tunisian-Arabic version of the WHQ is globally reliable and valid, but we recommend the use of an improved shortened version, more specific to mid-aged women.
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DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Abstract Aim Recent guidelines for the management of type 2 diabetes (T2DM) in the elderly recommend adjusting the therapeutic target (HbA1c ) according to the patient's health. Our study aimed to ...explore the association between achieving the recommended personalized HbA1c target and the occurrence of major clinical events under real-life conditions. Methods The T2DM S.AGES cohort was a prospective multicentre study into which 213 general practitioners recruited 983 non-institutionalized T2DM patients aged > 65 years. The recommended personalized HbA1c targets were < 7%, < 8% and < 9% for healthy, ill and very ill patients, respectively. Major clinical events (death from any cause, major vascular events and/or hospitalization) were recorded during the 3-year follow-up. Mixed-effects logistic regression models were used for the analyses. Results Of the 747 patients analyzed at baseline, 551 (76.8%) were at their recommended personalized HbA1c target. During follow-up, 391 patients (52.3%) experienced a major clinical event. Of the patients who did not achieve their personalized HbA1c target (compared with those who did), the risk (OR) of a major clinical event was 0.95 (95% CI: 0.69–1.31; P = 0.76). The risk of death, major vascular event and hospitalization were 0.88 (95% CI: 0.40–1.94; P = 0.75), 1.14 (95% CI: 0.7–1.83; P = 0.59) and 0.84 (95% CI: 0.60–1.18; P = 0.32), respectively. Conclusion Over a 3-year follow-up period, our results showed no difference in risk of a major clinical event among patients, regardless of whether or not they achieved their personalized recommended HbA1c target. These results need to be confirmed before implementing a more permissive strategy for treating T2DM in elderly patients.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPUK, ZRSKP
The aim of this review was to examine the relationship between menopause and urinary incontinence (UI).
Our work is based on a review of the literature on the epidemiology of UI in women and the ...effects of hormone therapy on symptoms of urinary leakage. A search of the Medline database between January 2000 and April 2012 was performed by crossing the keywords "urinary incontinence, stress urinary incontinence (SUI), urge incontinence, over active bladder, menopause, estrogen therapy".
Twenty-nine articles over the 482 articles were initialy selected. The UI was a common symptom during menopause, with a prevalence of 15 to 30% and an annual incidence of 5 to 10%. The association between UI and menopause was controversial. Indeed, although underpinned by pathophysiological mechanisms such as the sensitivity of tissues of the urogenital sinus to estrogen, the epidemiological data available were contradictory and should be interpreted, if possible, depending on the type of UI. Thus, it remained difficult to distinguish the effect of menopause of the aging. The effects of estrogen on IU differed depending on the route of administration and of the type of UI. Randomized trials showed that oral administration of estrogen after menopause increased the occurrence of UI or SUI. However a vaginal administration of estrogen improved urge urinary incontinence (UUI) and overactive bladder.
The data of this review were consistent with the French and European guidelines.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPUK, ZAGLJ, ZRSKP
Abstract
Introduction
In France, public health authorities recommend cervical cancer screening (CCS) by a Pap test every 3 years for all sexually active women aged 25 to 65 years. Socioeconomic ...inequalities are observed in CCS and disparities in screening practices according to immigration status has been reported. The aim of this study was to compare income inequalities in cervical screening depending on immigration status.
Methods
The study was based on the 2012-2016 baseline data in the Constances cohort (N = 28905 women). Delayed CCS was defined by having last CCS for more 3 years. The main independant variables were monthly household income and immigration status. The women’s origin was divided into the following categories: French women born to two French parents (French origin), French women born to at least one foreign parent (immigrant origin), and women born to two foreign parent (immigrants). Immigrants were divided into two categories: women with French or not nationality (naturalized or foreign immigrant). The slope index inequality (SII) was computed to measure the income inequality in CCS non-adherence. Interaction test was used to compare SII depending on immigration status. We used imputation model.
Results
We confirmed the existence of a gradient with respect to migration origin for delaying CCS (21,9 % women of French origin, 26,5 % women of immigrant origin, 28,8 % immigrant, p < 10-4). More income inequalities were observed depending on immigration status (SII French origin= 0,17 0,16-0,18, SII immigrant origin= 0,28 0,24-0,32, SII immigrant = 0,27 0,25-0,31, p interaction <0,001). Among immigrant women, we observed difference in social inequalities depending on French nationality (SII naturalized= 0,19 0,15-0,23, SII foreign immigrant= 0,35 0,30-0,40, p interaction <10-4).
Conclusions
French women of immigrant origin and immigrant women are underscreened and social inequalities are stronger among them than French women of French origin.
Key messages
French women of immigrant origin and immigrant women are less detected for cervical cancer screening than French women.
French women of immigrant origin and immigrant women are detected for cervical cancer screening with more social inequalities than French women of french origin.
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NUK, OILJ, UL, UM, UPUK, VSZLJ
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