The significance of overlooked objects: Materiality and care at home for people with dementia.

An increase in the number of older people with dementia is currently a trend around the world. In low and middle countries, effective public health services are not yet well-developed, and family care-givers may be overwhelmed by the requirements of care. This paper has two purposes: to share findings from an ethnographic study about family dementia care practices in Brazil and to draw attention to the significance of the materiality of care practices in the family context. The study was conducted in Belo Horizonte, Brazil. We describe the care trajectory of one family and, analysing data using the insights of Actor Network Theory, show the significance of objects in a networked relation of care. In particular, we show how incontinence products such as adult diapers assume different positions in the network, acting as either mediator or intermediary of care in relation to other elements of the network composed of family members and their living situation, the person with dementia herself, the doctor, and Brazilian health policies. Although the diaper is often seen as an ordinary object for care providers, its participation in a care network shapes relations, activating conflict, financial constraint, and disciplining the body of the person with dementia.

Management of bladder dysfunction and satisfaction of life after spinal cord injury in Norway.

BACKGROUND: There is limited knowledge about bladder dysfunction and bladder management in persons with spinal cord injury (SCI) after discharge from the hospital in Norway. The impact of bladder dysfunction on satisfaction of life has been rarely explored. SETTING: Community-based survey from Norway. METHODS: An anonymous cross-sectional postal survey. A questionnaire was sent to the registered members of the Norwegian Spinal Cord Injuries Association. A total of 400 participants, with traumatic or non-traumatic SCI, received the questionnaire. RESULTS: A total of 248 subjects (62%), 180 men and 68 women, answered the questionnaire. Mean age was 54 years and mean time since injury 13.4 years. A total of 164 participants (66.1%) used intermittent catheterization for bladder emptying (48.5% women versus 72.8% men); more paraplegics than tetraplegics (77.2% versus 55.7%). Recommendations given at the Spinal Cord Units were thoroughly followed by persons who had used catheters more than 5 years. Use of incontinence pads were associated with reduced satisfaction of life. CONCLUSIONS: The most common method of management of bladder dysfunction is clean intermittent catheterization in Norway. Recommendations were followed more thoroughly by persons who have used intermittent catheterization for more than 5 years. Spinal Cord Units are important source for information and guidance.

Treatment of postprostatectomy male urinary incontinence with the transobturator retroluminal repositioning sling suspension: 3-year follow-up.

BACKGROUND: The AdVance male sling (American Medical Systems, Minnetonka, MN, USA) has been shown to be an efficacious device in short-term studies for postprostatectomy incontinence (PPI), but long-term studies are lacking. OBJECTIVE: Examine the intermediate-term outcome with the AdVance sling for PPI management. DESIGN, SETTING, AND PARTICIPANTS: A multicentre prospective evaluation was conducted on consecutive patients treated for PPI in three European tertiary reference centres. INTERVENTION: Patients were implanted with the AdVance male sling with no associated surgery. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Measurements included daily pad usage, maximum flow rate (Qmax), postvoid residual urine (PVR), the International Consultation on Incontinence Questionnaire-Short Form, the Incontinence Quality of Life questionnaires, and complications of surgery. Paired Wilcoxon signed rank test univariable and multivariable analyses were used. RESULTS AND LIMITATIONS: Follow-up was available for 156 patients for the majority of parameters. Pad usage was significantly decreased compared with baseline at 12 mo and 3 yr (p<0.0001). At 12 mo, 76.9% of patients could be classified as cured or improved; this percentage was maintained at 3 yr (76.8%). Cure rates (58.6% vs 42.3%) and improvement rates (23.2% vs 25.0%) were higher in patients with mild or moderate incontinence compared with severe incontinence. Univariable analysis showed that pretreatment pad usage and severity of incontinence were both significant predictors of success (p=0.0355 and p=0.0420, respectively). However, in multivariable analysis, only pad usage was an independent predictor of success. There were no perioperative or severe postoperative complications. Most complications were Dindo grade I. Seven patients required a second treatment for stress urinary incontinence. There was no worsening over time. Limitations of this study included no comparator group, quality of life questionnaires in only two centres, and no 24-h pad test. CONCLUSIONS: The transobturator retroluminal repositioning sling suspension is effective and safe in the longer term for treating PPI.

Terapia grupal de comportamiento mejora la calidad de vida en hombres post prostatectomía radical / Behavioural group-based therapy improves quality of life in men recovering from radical prostatectomy

Antecedentes: Este estudio valoró la eficacia de la terapia de comportamiento en grupo para mejorar la calidad de vida, durante 24 semanas, entre hombres que han sido tratados de cáncer de próstata localizado por medio de prostatectomía radical y presentan disfunciones relacionadas con el tratamiento: incontinencia urinaria y disfunción eréctil. Pacientes y Métodos: Se asignaron 30 hombres a un grupo de terapia de comportamiento durante 24 semanas. Esta participación se diseñó para mejorar la calidad de vida ayudando a los participantes a identificar y controlar de forma efectiva las experiencias traumáticas. Se centró en las secuelas relacionadas con el tratamiento de prostatectomía radical. Las diferencias en las variables se compararon al principio y al final del estudio por medio de la prueba t de Student para muestras pareadas. Se llevaron a cabo múltiples análisis por etapas de regresión lineal múltiple siguiendo el análisis de correlación bivariante de Pearson. Esto se logró con todas las predicciones (es decir la percepción de salud general, e impacto en la disfunción eréctil e incontinencia urinaria)y las covariables importantes (es decir la edad, la situación trabajo/jubilación, la adicción al alcohol, la actitud hacia el cáncer y la cirugía, la satisfacción sexual, y los planes futuros. Resultados: En todos los pacientes el tiempo transcurrido desde la cirugía a la asistencia al grupo de terapia del comportamiento superó los 24 meses. No hubo correlación significativa entre este momento y ninguna de las variables. Las puntuaciones de la percepción general de salud disminuyeron en el final del estudio (p=0,000), al igual que la puntuación de la incontinencia urinaria (p=0,023), lo que indica mejoría en ambos factores. La diferencia en las puntuaciones de la incontinencia urinaria se correlaciona significativamente y negativamente con la edad (p=0,04) y el trabajo/jubilación (p=0,05). Las múltiples etapas de regresión mostraron que la edad es la variable más importante (r2=26,0%). Teniendo en cuenta la edad y el trabajo/jubilación al mismo tiempo, hubo un aumento del 10,3% (r2 = 36,3%). La disfunción eréctil aumentó en el final del estudio (p=0,000), y la diferencia entre las puntuaciones de la disfunción eréctil se correlacionaron positiva y significativamente solamente con la satisfacción sexual (p=0,029), lo que significa que la satisfacción sexual anterior tuvo una influencia positiva sobre la disfunción eréctil (r2 = 15,8%). Conclusión: La terapia de comportamiento en grupo de 24 semanas fue eficaz para mejorar la percepción de calidad de vida, entre los hombres tratados con prostatectomía radical. Hubo cambios asociados con la terapia, especialmente la mejoría en la incontinencia urinaria y la disfunción eréctil (AU)

Background: This study evaluated the efficacy of 24-week, group-based, behavioral therapy in improving quality of life (QoL) among men treated for localized prostate carcinoma (PC) by means of radical prostatectomy (RP) who presented treatment-related dysfunctions: urinary incontinence (UI) and erectile dysfunction (ED). Patients and methods: Thirty men were assigned to 24-week behavioral group therapy. The intervention was designed to improve QoLby helping participants to identify and effectively manage stressful experiences. It focused on treatment-related sequelae from PC. Differences in variables were compared between the beginning and end of the study by means of Student’s t test for paired samples. Multiple analysis was carried out by stepwise multiple linear regression following bivariate Pearson’s correlation analysis. This was achieved for all predictors (i.e. general health perception, ED and UI impact) and relevant covariates (i.e. age, work/retirement status, alcohol addiction, attitude towards cancer and surgery, sexual satisfaction, and future plans).Results: In all patients the time elapsed from surgery to attending the behavioral group therapy exceeded 24 months. There was no significant correlation between this time and the predictor variables. General health perception scores decreased by the end of the study (p=0.000), as did the UI impact score (p=0.023), thus denoting improvement in both factors. The difference in UI impact scores correlated negatively and significantly with both age (p=0.04) and work/retirement (p=0.05). Multiple stepwise regression showed that age was the most important variable (r2=26.0%). Considering age and work/retirement simultaneously, there was an increase of 10.3% (r2=36.3%). ED increased by the end of the study (p=0.000), and the difference between the ED scores correlated positively and significantly with sexual satisfaction alone (p=0.029), which signifies that previous sexual satisfaction had a positive influence over erectile dysfunction (r2=15.8%). Conclusion: 24-week behavioral group therapy was effective in improving the perceived QoL among men treated for PC. There were changes associated with the therapy, particularly the improvement in UI and ED (AU)

Use of an absorbent dressing specifically for fecal incontinence.

PURPOSE: Use of an absorbent product is a self-care strategy for managing fecal incontinence that protects against visible soiling. The purpose of this study was to examine use of a small surgical dressing that can be placed between the buttocks to absorb leaked feces. DESIGN: Cross-sectional survey. SUBJECTS AND SETTING: A survey was mailed to 75 randomly selected community-living people in 25 states and the District of Columbia, who ordered the dressing more than once within the past year. Thirty-six people (age = 55 +/- 16 years mean +/- SD), 57% men and 94% white responded. INSTRUMENT: A 48-question survey that included questions asked about demographics and general health, emotional states (eg, anxiety and depression), bowel pattern and incontinence, quality of life, and use of an anorectal dressing was developed for this study. The survey also contained 2 tools, the Fecal Incontinence Severity Index and the Fecal Incontinence Quality of Life instrument. The Fecal Incontinence Severity Index is a tool that enables valid assessment of fecal incontinence severity using patient recall of symptoms of frequency and type of bowel leakage. The Fecal Incontinence Quality of Life instrument results in a valid and reliable evaluation of fecal incontinence-specific quality of life using 4 domains of lifestyle, coping/behavior, depression/self-perception, and embarrassment. RESULTS: The fecal incontinence severity score was 28 +/- 14 (mean +/- SD); 79% leaked loose/liquid feces, 50% leaked daily, and leaked feces remained between the buttocks in 64%; 21% also leaked urine. Eighty-five percent experienced incontinence-associated dermatitis. Of those who used the dressing, 50% were men. The anorectal dressing was preferred to a pad by 92%, prevented soiling in 88%, and its ability to stay in place was rated very good or good by 76%. Eighty percent of respondents rated the dressing's comfort very good or good; 85% rated its overall effectiveness very good or good. Use of the dressing lessened anxiety about fecal soiling in 81% and was thought to improve quality of life in 76%. CONCLUSION: An anorectal dressing offers an effective, comfortable alternative to a pad for absorbing leaked feces that seems acceptable to men.

A noninvasive continence management system: development and evaluation of a novel toileting device for women.

PURPOSE: This paper describes a project to develop and clinically evaluate a novel toileting device for women called the Non-Invasive Continence Management System (NICMS). The NICMS device is designed to provide an alternative toileting facility that overcomes problems some women experience when using conventional female urinals. DESIGN: A single product evaluation was completed; participants used the same device with 1 or 2 interface variants. SUBJECTS AND SETTING: Eighty women from 6 countries who were either mobile or wheelchair dependent evaluated the product over a 15-month period. RESULTS: The device was found to be useful in some circumstances for women and their caregivers. CONCLUSION: Significant further development is required for it to work reliably and to provide an acceptable device in terms of reliability, size, weight, noise, and aesthetics.

Absorbent products for incontinence: 'treatment effects' and impact on quality of life.

AIM: This study aimed to determine how the use and characteristics of absorbent products for incontinence impact on women's quality of life, and to examine the concept of 'treatment effects' in the context of pad use. METHOD: Key pad performance characteristics were identified from the literature and focus group work. Semi-structured interviews with 99 women with light incontinence were used to investigate the impact of pad use on women's quality of life, including both positive and negative 'treatment effects', and to rank pad characteristics by their importance. RESULTS: Achieving effective and discrete containment of urine was the dominant factor impacting on women's lives. Sub-themes embraced physical effects, psychological impact and social functioning. The five pad characteristics ranked most important for day time use were: 'to hold urine, to contain smell, to stay in place, discreteness, and comfort when wet. For night use discreteness was replaced by to keep skin dry'. High levels of reported anxiety were associated with perceived risk of poor pad performance, lack of discreteness and need for complex regimes for pad management. CONCLUSION: Insufficient attention has been paid to the balance between the beneficial and negative treatment effects of absorbent pads to date. Existing continence-related quality of life measures are not designed for conditions where change in symptoms is not an outcome measure. The study findings provide the basis for developing a more sensitive, patient-oriented, quality of life measure for pad-users which can aid product selection, new product development and inform future evaluative comparisons between products/products and treatments. RELEVANCE TO CLINICAL PRACTICE: This paper illustrates the complex influence on quality of life caused by using absorbent pads to contain incontinence. It raises awareness of the importance of careful selection of the most appropriate pad for each individual to minimize unfavourable side effects, and the need for a new quality of life measure designed for pad-users.

Continence pads: have we got it right?

Women listed in the Croydon Community Continence database were contacted with a self-assessment questionnaire regarding continence pad usage and quality of life. Completed questionnaires were received from 763 of 1509 (51%) participants. Pads were used for bladder dysfunction (88.1%) and bowel dysfunction (44%). The majority (82.5%) had concurrent medical disorders and problems with mobility with 77.5% being on one or more types of medication. Nearly 39% of women claimed that they would be happy to continue pad use indefinitely and only 28% expressed interest in seeking further help. Compared to bowel dysfunction, bladder dysfunction appeared to have a greater impact on women's quality of life (P < 0.001). Containment products make a substantial contribution in improving the quality of lives of women with bowel and bladder dysfunction. The financial burden of containment products has a major impact on the health budget and therefore, comprehensive clinical evaluation should be mandatory before relegating women to pads as a final resort.

Compromising and containing: self-management strategies used by men and women who live with multiple sclerosis and urinary incontinence.

This study aimed to expose the experiences of men and women living with Multiple Sclerosis (MS) and how they manage the challenge of urinary incontinence in their lives. We explore the commonalities and diversities between men and women living with MS and urinary incontinence and conclude the paper by making recommendations for nursing practice.

Urinary incontinence treatment preferences in long-term care.

OBJECTIVE: To elicit preferences for different urinary incontinence (UI) treatments in long-term care (LTC) from groups likely to serve as proxy decision makers for LTC residents. DESIGN: A descriptive, comparative study of preference for UI treatments of frail older adults, family members of nursing home (NH) residents, and LTC nursing staff. Surveys were mailed to families and self-administered by staff. Older adults were interviewed. SETTING: Four LTC facilities and two residential-care facilities in Los Angeles. PARTICIPANTS: Four hundred and three family members of incontinent NH residents were mailed surveys. Sixty-six nursing staff caring for these incontinent residents and 79 older adult residents of care facilities (nine cognitively intact NH respondents and 70 residential care residents) answered surveys. MEASUREMENTS: Preference rankings between seven paired combinations of five different UI treatments were measured on an 11-point visual analog scale, with the verbal anchors "definitely prefer" this treatment, "probably prefer" this treatment, and "uncertain." Respondents gave open-ended comments as well. RESULTS: Forty-two percent of family members (171/ 403) returned the mailed survey. Of all respondents, 85% "definitely" or "probably" preferred diapers, and 77% "definitely" or "probably" preferred prompted voiding (PV) to indwelling catheterization. Respondent groups occasionally differed significantly in their preferences. In choosing between treatment pairs using a visual analogue scale, nurses preferred PV to diapers significantly more than did older adults or families (both of whom preferred diapers) (F (2,295) = 13.11, P < .0001). Older adults, compared with family and nurse respondents, showed a significantly stronger preference for medications over diapers (F (2,296) = 41.54, P < .0001). In open-ended responses, older adults stated that they would choose a UI treatment based in part upon criteria of feeling dry, being natural, not causing embarrassment, being easy, and not resulting in dependence. Nurses said that they would base their choice of UI treatment upon increasing self-esteem and avoiding infection. CONCLUSIONS: Although there was wide variation within and between groups about preferred UI treatment, most respondents preferred noninvasive strategies (diapers and PV) to invasive strategies (indwelling catheters and electrical stimulation). Older adults preferred to a greater degree medications and electrical stimulation, therapies directed at the underlying cause of UI. Despite data documenting that diapering is a less time intensive way to manage UI and that toileting programs are difficult to maintain in LTC, nurses viewed PV as "natural" and strongly preferred it to diapering. Several family members and older adults viewed PV as "embarrassing" and "fostering dependence." These data highlight the need to elicit preferences for UI treatment among LTC residents and their families.

Use and costs of incontinence pads in female study volunteers. Continence Program for Women Research Group.

OBJECTIVES: We examined the use and cost of incontinence pads and the relationship to factors such as age, duration of incontinence, diurnal frequency, incontinence severity indices, urodynamic diagnosis, and quality of life. SUBJECTS AND SETTING: Three hundred fifteen women with urinary incontinence who volunteered to participate in 1 of 3 incontinence studies (behavioral intervention, estrogen supplementation, or surgery) were analyzed. Subjects were community-dwelling women aged 45 years and older living in 3 cities in the southeastern United States. METHODS: Pad use was recorded on a daily diary. The type of pads used was reported on the history. Average price of pad types was assessed at local stores and reported in 1995 dollars. Statistical comparisons used nonparametric methods. MAIN OUTCOME MEASURES: The number of pads used per week and annual cost of pads in 1995 dollars. RESULTS: Seventy-seven percent of subjects used pads at baseline. Median cost per year for the entire cohort was $46 (interquartile range $3-$138). For pad users, median annual cost was $76 (interquartile range $36-$177), with costs being greater for women with detrusor instability than those with pure genuine stress incontinence (median $135-$138 versus $63). This increased cost was likely associated with the greater use of special incontinence products among women with detrusor instability. For the entire cohort, cost and usage did not differ by urodynamic diagnosis. Cost and pad usage were significantly associated with number of incontinent episodes and quality of life, but not with age, pad weight, or duration of incontinence. CONCLUSIONS: The majority of incontinent women who sought treatment used absorbent pads at least once per week, with menstrual pads being the most common type of pad. The annual cost of pad usage was not as high as in previous estimates.

Quality of life and urinary incontinence pad use in women.

Women utilizing the free provision and home delivery of urinary incontinence pads by the Swedish health services were sent a questionnaire concerning their quality of life and pad use. Evaluable and complete replies were received from 460 of 521 women. The incontinence was chronic and moderate to severe, considerably restricting general and professional activities. Feelings of anxiety, isolation and depression were common, their prevalence rising with incontinence grade. Satisfaction with the supplied pads was generally good, with absorptive and antiodor properties most appreciated. The threatened introduction of charges for the pads was reported as a dominant anxiety. A drawback of free supply may be that, as in 24% of the present series, women primarily use the pads as a solution to the problem of incontinence, without a doctor's intervention and before a trial of continence-promoting or curative measures.