Marie-Louise Walker-Engström

Quality of life and seeking help in women with urinary incontinence : A population-based study

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.

A Prospective Randomized Study Comparing Two Different Degrees of Mandibular Advancement with a Dental Appliance in Treatment of Severe Obstructive Sleep Apnea

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.

A prospective randomized study of a dental appliance compared with uvulopalatopharyngoplasty in the treatment of obstructive sleep apnoea.

The enthusiasm for uvulopalatopharyngoplasty (UPPP) in the treatment of obstructive sleep apnoea (OSA) has declined in recent years, partly because of a lower success rate over time and partly because of adverse effects. Reports on the beneficial effects of dental appliances exist, but only one prospective randomized study has been published comparing dental appliances with nasal continuous positive airway pressure (CPAP) treatment. No study has been published comparing dental appliance treatment with UPPP. Ninety-five male patients with confirmed OSA, subjective daytime sleepiness and an apnoea index (AI) > 5 were randomized for subsequent treatment with either a dental appliance or UPPP. There were 49 patients in the dental appliance group and 46 in the UPPP group. Thirty-seven patients in the dental appliance group and 43 in the UPPP group completed the 12-month follow-up. The success rate (rate of patients with at least a 50% reduction in AI) for the dental appliance group was 95%, which was significantly higher (p < 0.01) than the 70% success rate for the UPPP group. According to the criteria for OSA (apnoea index > or = 5 or apnoea/hypopnoea index > or = 10), 78% of the dental appliance group and 51% of the UPPP group were normalized after 12 months. The difference between the groups was significant (p < 0.05). These findings suggest that the dental appliance technique is useful in the treatment of mild to moderate OSA.

Reasons why women with long-term urinary incontinence do not seek professional help : a cross-sectional population-based cohort study.

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.

Dental and skeletal changes after 4 years of obstructive sleep apnea treatment with a mandibular advancement device : a prospective, randomized study.

The aim of this prospective, randomized study was to analyze dental and skeletal side effects after 4 years of treating obstructive sleep apnea (OSA) patients with a mandibular advancement device (MAD) compared with uvulopalatopharyngoplasty (UPPP). With the appliance in position, the mandible was advanced 50% of maximum protrusion capacity (ie, 4-6 mm); the vertical opening between the incisal edges was, on average, 3 mm. Thirty patients in the MAD group and 37 in the UPPP group completed the 4-year follow-up. There were no differences between the MAD and the UPPP groups in any of the dental or skeletal variables measured after the 4-year treatment period. In the MAD group, small but statistically significant changes were found: there was a posterior rotation of the mandible (mandibular line [ML]/nasion-sella line [NSL]) (mean 0.5 degrees [95% confidence interval (CI) 0.1-0.8 degrees ]). Correlated to the posterior rotation of the mandible, the distances incision superius ML, incision superius-NSL, and incision inferius-NSL increased by means (95% CI) of 0.7 (0.5-1.2), 0.8 (0.4-1.1), and 1.3 (0.8-1.8) mm, respectively. Overjet and overbite did not change significantly, nor was there a significant change in the mandibular length. The observed changes were considered clinically insignificant because overbite and overjet stayed within normal limits. Only the vertical position of the maxillary incisors in relation to ML changed to the extent that the 95% CI of the mean for the change was outside that of the mean of the change in the UPPP group and measurement error. Treatment of OSA with a dental appliance is probably a lifelong process, and long-term follow-up studies should therefore be undertaken to control both the treatment effect on OSA and the side effects on the masticatory system.

Impact on quality of life of different lower urinary tract symptoms in men measured by means of the SF 36 questionnaire

Objective. To describe how different lower urinary tract symptoms (LUTS) affect the quality of life (QOL) in men. Material and methods. The study included 1008 men aged 40–80 years living in the community of Surahammar, Sweden who had answered a questionnaire concerning stress incontinence, urgency and post-micturition dribbling 12 months earlier. The occurrence and severity/frequency of 12 specific LUTS were assessed using the Danish Prostatic Symptom Score questionnaire. QOL was evaluated using the Short Form 36 (SF-36) questionnaire. Results. Post-micturition dribbling was the most frequently reported symptom (71%) and stress incontinence the least common (11%). Men who experienced urge, stress or “other incontinence” had lower mean scores for all of the eight dimensions measured by the SF-36 than men without such symptoms. Furthermore, men who experienced a moderate/severe degree of weak stream or nocturia reported a poorer QOL for all dimensions compared to men with a mild level of the same symptoms. QOL was found to decrease with increasing age. Men aged 66–80 years with “other incontinence” reported lower mean SF-36 scores for physical functioning, role physical, role emotional, social functioning and body pain than 40–65-year-old men. Conclusions. LUTS in men affect QOL dimensions differently. Storage symptoms appear to reduce QOL more than voiding and post-micturition symptoms. Urinary incontinence affected all eight of the dimensions evaluated. Elderly men with LUTS reported a lower QOL than younger men.

Two different degrees of mandibular advancement with a dental appliance in treatment of patients with mild to moderate obstructive sleep apnea.

The objective of this study was to evaluate the effect of 2 different degrees of mandibular advancement, 50% vs. 75% of maximum protrusive capacity, on somnographic variables after 1 year of dental appliance treatment in patients with mild to moderate obstructive sleep apnea (OSA). A further purpose was to compare the number of adverse events on the stomatognathic system. In a prospective study, 74 male patients were randomly allocated to receive a dental appliance with either 50% (38 patients) or 75% mandibular advancement (36 patients). After 1 year of treatment, 55 patients completed the follow‐up. Somnography was performed to measure treatment effects before and 12 months post‐treatment. The apnea, apnea/hypopnea, and oxygen desaturation indices decreased significantly in both groups after 1 year (P<0.001); however, there were no differences between the groups. Normalization (apnea index <5 and apnea/hypopnea index <10) was observed in 79% in group 50 and in 73% in group 75. Few patients (<5%) reported symptoms from the stomatognathic system except for headache (> once a week), which was reported in one‐third of the patients. Headache was significantly more infrequent after 1 year of treatment in both groups (P<0.001). No serious complications were observed except for 2 patients who reported a painful condition from the temporomandibular joint in either group. In conclusion, mandibular advancement with a dental appliance effectively reduces the sleep‐breathing disorder measured as frequency of apneas, and a pronounced mandibular advancement did not show a greater improvement of the medical problem compared to less advancement for patients with mild to moderate OSA. On the basis of few adverse events in the stomatognathic system or other complications we can recommend dental appliance treatment and, for patients with mild to moderate obstructive sleep apnea, not starting treatment by more than 50% mandibular advancement.

Changes in urinary incontinence and quality of life after four years : a population-based study of women aged 22-50 years

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.