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- Engström, Gabriella, 1965-, et al.
(författare)
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Prevalence of Three Lower Urinary Tract Symptoms in Men –a Population-Based Study.
- 2003
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Ingår i: Family Practice. - : Oxford University Press (OUP). - 0263-2136 .- 1460-2229. ; 20:1, s. 7-10
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Tidskriftsartikel (refereegranskat)abstract
- Background. Lower urinary tract symptoms are a common and costly public health issue. In earlier studies, the prevalence of urinary symptoms can be seen to fluctuate because there is no consensus about how to define and categorize the severity of the symptoms. Objectives. The study was undertaken in order to investigate the prevalence of three common lower urinary tract symptoms (urgency, stress incontinence and post-micturition dribbling) and analyse health care-seeking behaviour. Methods. A self-administered questionnaire was developed to investigate all men aged 40-80 years residing in the community of Surahammar, Sweden. The questionnaire included items on three specific urinary symptoms: urgency, stress incontinence and post-micturition dribbling, and one question about health care-seeking behaviour. Results. A response rate of 86% was obtained in the questionnaire study. The overall prevalence of the lower urinary tract symptoms was 24%. The prevalence increased from 20% in the group aged 40-49 years to 28% in the group aged 70-80 years (P < 0.01). Post-micturition dribbling (21%) was the most frequent symptom, and stress incontinence (2.4%) was the least frequent symptom. The number of participants who sought health care was low (4%) and increased significantly with age (P < 0.001). Conclusions. The present study showed that 24% of the Swedish cohort of men of 40-80 years of age reported at least one of the following symptoms: urgency, stress incontinence or postmicturition dribbling. This study is consistent with other research regarding the low consultation frequency for these symptoms. Moreover, the study is also in accord with those findings indicating that for the majority of men with urinary symptoms, their health care providers are not aware of their problem.
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- Hägglund, Doris, 1949-, et al.
(författare)
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Changes in urinary incontinence and quality of life after four years : a population-based study of women aged 22-50 years
- 2004
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 22, s. 112-117
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES:To investigate (a) the incidence and remission rates of female urinary incontinence (UI), (b) changes in type of UI and quality of life (QoL), and (c) whether professional help had been consulted regarding UI.DESIGN:A 4-year follow-up population-based cohort study.SETTING:Surahammar, Sweden, a community of 10,500 inhabitants.SUBJECTS:All 118 incontinent and 130 continent women aged between 22 and 50 years.MAIN OUTCOME MEASURES:Changes in type of UI were measured using the Detrusor Instability Score (DIS), which was used to distinguish between the stress incontinent and the urge incontinent women. Changes in QoL were measured using the SF-36 Health Survey.RESULTS:The mean annual incidence and remission rates of UI were the same (4%). The majority of women (83%) reported unchanged UI after 4 years and 77% of these women had stress incontinence. At follow-up, the changes in QoL scores were significantly greater in five out of eight dimensions in the persistently incontinent group compared with the persistently continent group. QoL scores did not change significantly from baseline to the 4-year follow-up within the incidence and remission groups. Three of four women with UI had not sought professional help.CONCLUSIONS:At 4-year follow-up the type of UI is fairly stable in women below 50 years of age. The QoL decreases in five dimensions, but the clinical relevance of this might be questioned. Most women with UI had not sought professional help.
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- Hägglund, Doris, et al.
(författare)
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Quality of life and seeking help in women with urinary incontinence
- 2001
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 80:11, s. 1051-1055
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The aims of this population-based study were to compare the quality of life (QoL) in; (a) women with urinary incontinence (UI) and women without urinary incontinence (wUI) in relation to age, (b) women with stress incontinence and women with urge incontinence, and (c) women who had, vs. women who had not, consulted a health care service because of UI. METHODS: Totally, 787 women who reported symptoms of UI and 787 women who did not report symptoms of UI, aged 18-72 years, were mailed the Short Form-36 QoL questionnaire (SF-36) and a question concerning professional consultation. They were also mailed the Detrusor Instability Score questionnaire, which was used to clarify the women as being stress vs. urge incontinent. RESULTS: Women with UI had significantly lower scores on all eight dimensions of the SF-36. There were low correlations between age and the QoL scores in women with or without UI. Both women with stress incontinence and women with urge incontinence had significantly lower scores on all eight QoL dimensions compared with the women without UI. However, the absolute difference was smaller for women with stress incontinence. Women with urge incontinence consult health care service more often than women with stress incontinence. Women with UI who had consulted health care had significantly lower QoL scores than women with UI who had not consulted health care in seven out of eight dimensions. CONCLUSIONS: The QoL, in this female general population, is more affected by women with urge incontinence than women with stress incontinence. Help seeking is associated with substantially lower QoL scores and with urge incontinence.
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- Hägglund, Doris, et al.
(författare)
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Reasons why women with long-term urinary incontinence do not seek professional help : a cross-sectional population-based cohort study
- 2003
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Ingår i: International Urogynecology Journal. - : Springer Science and Business Media LLC. - 0937-3462 .- 1433-3023. ; 14:5, s. 296-304
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Tidskriftsartikel (refereegranskat)abstract
- The aims of this study were to investigate the reasons why some women with long-term urinary incontinence (UI) seek professional help whereas others do not, their experiences and satisfactions with the healthcare services, and how women deal with their incontinence. In total, 95 women aged 23–51 years with persistent UI (median 10 years, range 6–20 years) were included in this telephone interview survey. Seventy-four percent of the women with long-term UI had not sought help. The most common reason given was that the disorder was considered a minor problem, which they felt they could cope with on their own. When women did consult professional help they did so because they were afraid of the odor of urine and that they perceived the leakage as shameful and embarrassing. These women felt that the healthcare service offered appropriate care for their condition. Pelvic floor exercises were the most commonly used management methods for all participants.
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- Walker-Engström, Marie-Louise, et al.
(författare)
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4-year follow-up of treatment with dental appliance or uvulopalatopharyngoplasty in patients with obstructive sleep apnea : A randomized study
- 2002
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Ingår i: Chest. - : Elsevier BV. - 0012-3692 .- 1931-3543. ; 121:3, s. 739-746
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Tidskriftsartikel (refereegranskat)abstract
- Study objectives: To evaluate the effects of treatment with a dental appliance or uvulopalato-pharyngoplasty, (UPPP) on somnographic variables in patients with mild-to-moderate obstructive sleep apnea (OSA) followed up for 4 years, and compliance,and complementary treatment.Design: Randomized study.Setting: Central Hospital, Västerås, Uppsala University, Sweden.Patients: Ninety-five male patients with confirmed mild-to-moderate OSA (apnea index (AI) > 5 and < 25) were randomized to treatment with a dental appliance or UPPP. Sleep studies were performed before and 1 year and 4 years after intervention. Thirty-two patients in the dental-appliance group and 40 patients in the UPPP group completed the 4-year follow-up.Results: The success rate (percentage of patients with at least 50% reduction in AI) in the dental-appliance group was 81%, which was significantly higher than in the UPPP group, 53% (p < 0.05). Normalization (AI < 5 or apnea/hypopnea index < 10) was observed in 63% of the dental-appliance group and 33% of the UPPP group after 4 years. The difference between the groups was significant (p < 0.05). The compliance to use of the dental appliance was 62% at the 4-year follow-up. Thirty patients (75%) in the UPPP group continued without complementary treatment. The dental appliances had few adverse effects on the stomatognathic system, and the number of adjustments and repairs of the appliances over time was moderate. Pronounced complaints of nasopharyngeal regurgitation of fluid and difficulty, with swallowing after UPPP were reported by 8% and 10%, respectively.Conclusions: The dental-appliance group showed significantly higher success and normalization rates regarding the somnographic variables compared to the UPPP group, but the effectiveness of the dental appliance was partly invalidated by the compliance of 62% at the 4-year follow-up. However, the appliances had few adverse effects on the stomatognathic system an required only moderate adjustments. Use of a dental appliance with regular follow-up can be recommended for long-term treatment of OSA.
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- Walker-Engström, Marie-Louise, et al.
(författare)
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A prospective randomized study comparing two different degrees of mandibular advancement with a dental appliance in treatment of severe obstructive sleep apnea
- 2003
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Ingår i: Sleep and Breathing. - : Springer Science and Business Media LLC. - 1520-9512 .- 1522-1709. ; 7:3, s. 119-130
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Tidskriftsartikel (refereegranskat)abstract
- The objective of this study was to compare the effect of two different degrees of mandibular advancement (MA), 75% versus 50%, on somnographic variables after 6 months of dental appliance treatment in patients with severe obstructive sleep apnea (OSA). A further purpose was to compare the number of adverse events on the stomatognathic system and the effects of dental appliance treatment on the presence of daytime sleepiness.Eighty-six males with severe OSA (apnea index ≥ 20) were randomly allocated to either 75% or 50% MA. Forty patients in the 75% MA group and 37 patients in the 50% MA group completed the 6-month follow-up.The effectiveness of treatment in terms of normalization (apnea index < 5 and apnea/hypopnea index < 10) with 75% MA was 52%, which was significantly higher (p = 0.04) than the 31% achieved with 50% MA. The dental appliance had few adverse events on the stomatognathic system regardless of group, and the number of adverse events did not differ between the two groups. Finally, the mean value of Epworth Sleepiness Scale scores decreased significantly from 11.6 at baseline to 8.0 at follow-up (p < 0.001). No significant difference was observed between the two groups. The results indicate that a dental appliance could be an alternative treatment for some patients with severe OSA.
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- Walker-Engström, Marie-Louise, 1952-
(författare)
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Treatment effects with a mandibular advancement appliance and uvulopalatopharyngoplasty in obstructive sleep apnea -randomised controlled trials-
- 2003
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Enthusiasm for uvulopalatopharyngoplasty (UPPP) in the treatment of mild-to-moderate obstructive sleep apnea syndrome (OSAS) has declined in recent years, partly because of a lower success rate over time and partly because of adverse effects. In more severe cases, the patients are generally treated with nasal continuous positive airway pressure (CPAP). However, many patients do not satisfactorily tolerate CPAP as a result of frequent side-effects. Consequently, there is a need for an alternative treatment. Reports on the beneficial effects of mandibular advancement appliances in the treatment of mild-to-moderate OSA exist in the form of short–term evaluations.One of the aims of the present thesis was to compare treatment effects with a mandibular advancement appliance and UPPP in patients with OSA with follow-up after one and four years. Ninety-five male patients with confirmed mild-to-moderate OSA (apnea index, AI >5 and <25) were randomised to treatment with a dental appliance or UPPP. Sleep studies were performed before and one and four years after intervention. According to the criteria for normalisation (AI<5 and apnea hypopnea index, AHI<10), 78% of the patients in the dental appliance group and 51% of the patients in the UPPP group had normalised after one year (p<0.05). Still after four years of treatment, 63% of the patients in the dental appliance group and 33% of the patients in the UPPP group were normalised. The dental appliance group had a higher normalisation rate than the UPPP group, but the efficacy was partly invalidated by the compliance rate of 62%.Quality of life assessments in the dimensions of vitality, contentment and sleep improved in both groups at the one-year follow-up after treatment. There was no difference between the groups in terms of vitality and sleep. The UPPP group, however, reported a higher degree of contentment than the dental appliance group, even though the somnographic values were superior in the latter group. Another aim was to conduct a randomised study to test the hypothesis that severe OSA patients will benefit from more pronounced mandibular advancement (MA) compared with a shorter advancement. Eighty-six males with severe OSA (AI>20) were randomly allocated to either 75% or 50% MA for a six-month treatment period. Treatment with a more pronounced mandibular advancement yielded a 20% higher normalisation rate than a shorter advancement. A mean normalisation rate of 45% was found for patients in this category with few side-effects, good patient satisfaction and a compliance of 92% after 6 months. The overall conclusion is that dental appliance treatment is effective in patients with mild to moderate OSA and even for patients with severe OSA. The efficacy in terms of normalisation in patients with mild to moderate OSA was higher after the dental appliance treatment with a 50% degree of advancement than after the UPPP treatment. However, severe OSA patients might benefit from more pronounced advancement (75%) compared with a shorter degree of advancement (50%). QOL improved significantly after both dental appliance and UPPP treatment.
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