Madeleine M.K. Donaldson

The association of diet and other lifestyle factors with overactive bladder and stress incontinence: a longitudinal study in women

To investigate the role of diet and other lifestyle factors in the incidence of overactive bladder and stress incontinence in women. Studies have suggested relationships between different aspects of lifestyle and symptoms of urinary incontinence, but there is a lack of firm evidence about their role in its cause.

Storage symptoms of the bladder: prevalence, incidence and need for services in the UK.

To establish valid and reliable prevalence and incidence rates for urinary incontinence and storage disorder, and estimate the extent of healthcare need and requirement for the UK.

Evaluation of a hip fracture risk score for assessing elderly women: the Melton Osteoporotic Fracture (MOF) study.

Abstract: Risk assessment for osteoporotic fracture within a primary care context, in old age, has received little attention. We aimed to develop such a risk score and assess its feasibility and validity. This was a 100% population-based, prospective cohort study, with a minimum 51/2 year follow-up among women aged 70 years and over, set in a large single general practice in Melton Mowbray, Leicestershire, UK. The main outcome measures were hip fracture, death and migration. Baseline measures included calcaneal broadband ultrasound attenuation (BUA), reported falls, balance, previous fracture history, medical problems, visual acuity, foot problems, body size, lifestyle factors and cognitive impairment. Seventy percent of the sample (1289) participated, including those in residential accommodation. Independent predictors of hip fracture over 3 years were low weight, kyphosis, poor circulation in the foot, epilepsy, short-term use of steroids and poor trunk maneuver. Using the highest tertile, a risk score based on these variables identified 84% (95% CI: 70% to 98%) of the hip fractures with a specificity of 68% (95% CI: 65% to 71%). BUA did not independently predict hip fracture in women of this age group. This study shows that a combination of readily obtained risk factors can identify elderly women who will sustain a hip fracture in the next 3 years more accurately than bone measurements alone in younger women. It also suggests that a risk score approach to universal assessment in the elderly is a feasible proposition in the primary care setting.

The association of diet and other lifestyle factors with the onset of overactive bladder: a longitudinal study in men

OBJECTIVE To investigate associations between diet and non-dietary lifestyle factors and the onset of overactive bladder (OAB) in men. SUBJECTS Random sample of community-dwelling men aged 40 years plus. DESIGN AND METHODS Baseline data on urinary symptoms and diet were collected from 5454 men using a postal questionnaire and a food-frequency questionnaire. Follow-up data on urinary symptoms were collected from 4887 men in a postal survey one year later. Logistic regression analysis was used to investigate diet and lifestyle factors associated with onset of OAB in the men without OAB at baseline. RESULTS There was a highly significant negative association between beer intake at baseline and subsequent OAB onset (P=0.001), with reduced risk at all levels of intake compared with those who seldom/never drank beer. Adjustment for total alcohol intake (g ethanol day(-1)) reduced the significance of the association (P=0.02). None of the food groups studied was associated with OAB onset, with the possible exception of potatoes (P=0.05), which showed an increased risk of onset at the highest level of consumption. Physical activity, smoking and obesity were not significantly associated. CONCLUSIONS While most diet and lifestyle factors were not associated with OAB onset, the evidence from this prospective longitudinal study suggests that beer may have a protective role in the development of OAB. This could be due to a non-alcoholic ingredient as well as the alcohol content.

Etiology of overactive bladder: a diet and lifestyle model for diabetes and obesity in older women.

To evaluate a coherent, evidence‐based hypothesis that specific modifiable lifestyle factors implicated in the development of diabetes and associated obesity are related to the onset of OAB.

Long term follow-up of a randomised controlled trial of services for urinary symptoms

BackgroundGiven the extent and priority of urinary symptoms there is little evidence available to inform service provision in relation to the long term effects of interventions. This study aims to determine the long term (6 year) clinical effectiveness and costs of a new continence nurse led service compared to standard care for urinary symptoms.MethodsA long term follow-up study of a 2-arm, non-blinded randomised controlled trial that recruited from a community based population between 1998-2000 in Leicestershire and Rutland UK was undertaken. 3746 men and women aged 40 years and over were followed up from the original trial. The continence nurse practitioner (CNP) intervention comprised a continence service provided by specially trained nurses delivering evidence-based interventions using pre-determined care pathways. The standard care (SC) arm comprised access to existing primary care including General Practitioner and continence advisory services in the area. Primary outcome: Improvement in one or more symptom. Secondary outcomes included: a) Leicester Impact scale; b) patient perception of problem; c) number of symptoms alleviated and cost-effectiveness; all were recorded at long term follow-up (average 6 years) post-randomisation.ResultsOverall at long-term follow-up (average 6 years) significantly more individuals in the CNP group (72%) had improved (i.e had fewer symptoms) compared to those in the SC group (67%) (difference of 5% 95% (CI = 0.6 to 9;p = 0.02)).ConclusionThe differences in outcome between the two randomised groups shown immediately post treatment had decreased by half in terms of symptom improvement at long term follow-up. Although the difference was statistically significant, the clinical significance may not be, although the direction of the difference favoured the new CNP service.

RE: “PREVALENCE OF AND RISK FACTORS FOR URINE LEAKAGE IN A RACIALLY AND ETHNICALLY DIVERSE POPULATION OF ADULTS: THE BOSTON AREA COMMUNITY HEALTH (BACH) SURVEY”

Wewelcome the recent paper from the Boston Area Community Health (BACH) Survey (1) on the prevalence and risk factors for urinary incontinence in an ethnically diverse population of adults. In his invited commentary, Thom (2) stated that the association with coronary heart disease had not been reported previously as a risk factor for urinary incontinence. However, we would like to draw your attention to our study of comorbid factors in relation to the urinary symptom syndromes, overactive bladder and stress urinary incontinence. This cohort study investigated the associations of a range of comorbid indicators for hypothetical mechanisms, including diabetic, ischemic, neurogenic, myogenic, and immunologic, using a large (>12,500) representative sample of women in the United Kingdom aged 40 years or more (3). We demonstrated a cross-sectional relation for coronary heart disease (myocardial infarction and angina) with the outcomes of stress urinary incontinence and overactive bladder, as well as a prospective association with overactive bladder incident at 1-year follow-up. This is consistent with the findings of Tennstedt et al. (1), suggesting that evidence is building for a relation between heart disease and incontinence. We also note the lack of association found with lifestyle factors. This is inconsistent with findings in our prospective studies in men (4) and women (5) and other studies that have shown associations with, for example, physical activity (6–8). One likely reason for this inconsistency is that, within the causal chain, lifestyle factors act before comorbidities. Therefore, inclusion of both within the current analysis is likely to underestimate any genuine lifestyle associations and to bias the results in favor of comorbid associations. For the purposes of comparing consistency, it would be preferable to see the results of a univariate age-adjusted analysis from the BACH Study, as well as the multivariate analysis, which depends on the particular confounding factors included in the model. Interactions between lifestyle factors may also distort the factors identified by using logistic regression and could usefully be checked by including interaction terms. We look forward to seeing the prospective results from this interesting study.