RESUMO
OBJECTIVE: To determine the incidence of surgically managed pelvic organ prolapse and urinary incontinence in a population-based cohort, and to describe their clinical characteristics. METHODS: Our retrospective cohort study included all patients undergoing surgical treatment for prolapse and incontinence during 1995; all were members of Kaiser Permanente Northwest, which included 149,554 women age 20 or older. A standardized data-collection form was used to review all inpatient and outpatient charts of the 395 women identified. Variables examined included age, ethnicity, height, weight, vaginal parity, smoking history, medical history, and surgical history, including the preoperative evaluation, procedure performed, and details of all prior procedures. Analysis included calculation of age-specific and cumulative incidences and determination of the number of primary operations compared with repeat operations performed for prolapse or incontinence. RESULTS: The age-specific incidence increased with advancing age. The lifetime risk of undergoing a single operation for prolapse or incontinence by age 80 was 11.1%. Most patients were older, postmenopausal, parous, and overweight. Nearly half were current or former smokers and one-fifth had chronic lung disease. Reoperation was common (29.2% of cases), and the time intervals between repeat procedures decreased with each successive repair. CONCLUSION: Pelvic floor dysfunction is a major health issue for older women, as shown by the 11.1% lifetime risk of undergoing a single operation for pelvic organ prolapse and urinary incontinence, as well as the large proportion of reoperations. Our results warrant further epidemiologic research in order to determine the etiology, natural history, and long-term treatment outcomes of these conditions.
Assuntos
Incontinência Urinária/epidemiologia , Prolapso Uterino/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Incidência , Pessoa de Meia-Idade , Estudos Retrospectivos , Incontinência Urinária/complicações , Incontinência Urinária/cirurgia , Prolapso Uterino/complicações , Prolapso Uterino/cirurgiaRESUMO
Nurses from many countries in the world continue to seek further education in the U.S. every year. This study examined their experiences (N = 83) and those of the host institutions (N = 35) in the U.S. regarding the difficulties each experienced in coping with unfamiliar curricula and cultural mores, as well as financial constraints.
Assuntos
Educação de Pós-Graduação em Enfermagem , Pessoal Profissional Estrangeiro/educação , Enfermeiras e Enfermeiros , Estudantes de Enfermagem , Adaptação Psicológica , Adulto , Cultura , Docentes de Enfermagem , Feminino , Humanos , Idioma , Masculino , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros/psicologia , Escolas de Enfermagem , Estudantes de Enfermagem/psicologia , Estados UnidosAssuntos
Idoso Fragilizado , Instituição de Longa Permanência para Idosos , Casas de Saúde , Incontinência Urinária/complicações , Incontinência Urinária/fisiopatologia , Urodinâmica , Idoso , Idoso de 80 Anos ou mais , Desidratação/complicações , Desidratação/epidemiologia , Comportamento de Ingestão de Líquido , Feminino , Humanos , Masculino , Fatores de Risco , Sede , Incontinência Urinária/epidemiologiaRESUMO
Behavioral interventions are recommended by Agency for Health Care Policy and Research Clinical Guideline as the first line of treatment for most types of urinary incontinence. This article defines and briefly describes the six behavioral treatment techniques and discusses the research base for the efficacy of each type of intervention. Caveats and needed research are also presented.
