Meng Chih Lee

Prevalence of and attitude toward urinary incontinence in postmenopausal women

To investigate the prevalence of urinary incontinence, and the knowledge, attitudes, and practices of Taiwanese women aged 60 years or older.

Risk factors for urinary incontinence in taiwanese women aged 20-59 years

OBJECTIVE To assess the risk factors for urinary incontinence among Taiwanese women. MATERIALS AND METHODS A sample of 4,549 women was selected using a multistage random sampling protocol. The women selected were interviewed face-to-face by well-trained interviewers. The usual risk factors, which included marital status, age, body mass index, menstrual status, alcohol intake, drug allergy, diabetes mellitus, hypertension and gynecologic events, were evaluated. The factors were assessed by frequency analysis and logistic regression analysis using a significance level of less than 0.05. RESULTS A total of 3,537 women were successfully interviewed, producing a response rate of 77.8% (3,735/4,549). The prevalence of urinary incontinence increased significantly with marriage (21.7%; 95% confidence interval, CI, 20.2-23.2), alcohol intake (24.9%; 95% CI, 19.3-30.5), drug allergy (24.5%; 95% CI, 19.9-29.2), diabetes mellitus (40.3%; 95% CI, 29.3-51.2), hypertension (30.1%; 95% CI, 23.8-36.4), body mass index (odds ratio, 1.05 per unit increase; 95% CI, 1.02-1.09) and a previous gynecologic operation (25.5%; 95% CI, 19.9-31.2). Age was also a risk factor for urinary incontinence (odds ratio, 1.04; 95% CI, 1.03-1.05), but there was no relationship between urinary incontinence and parity, route of delivery, smoking or menstrual status. CONCLUSION There is a high prevalence of urinary incontinence among women who suffer from diabetes or hypertension, or who have undergone a gynecologic operation, in particular hysterectomy. From a public health viewpoint, it is important to promote better health education in order to improve understanding of urinary incontinence and its risk factors and to increase the awareness of the availability of mainstream treatments.

Child growth from birth to 18 months old born after assisted reproductive technology--results of a national birth cohort study.

BACKGROUND Pregnancy conceived by assisted reproductive technology (ART) carries a higher risk of adverse birth outcomes. So far, there have been very few longitudinal studies of the growth of children born after ART. OBJECTIVE The purpose of this study was to explore the determinants of growth of children born after ART. DESIGN, SETTING AND PARTICIPANTS Using data of Wave I (6 months old) and II (18 months old) of the Taiwan Birth Cohort Study (TBCS), a national sample of 21,248 pairs of mothers and their children were included for analysis, including 366 pairs resulting from ART (1.7%). METHODS Data were collected through field interviews with structured questionnaires, and with references to each childs birth certificate and Passport of Well-baby Care. RESULTS Compared to children born with naturally conceived pregnancy, children born after ART had a significantly higher incidences of low birth weight (33.1 vs. 6.9%; p<0.001) and prematurity (42.1 vs. 11.3%; p<0.001). Overall children born after ART had a similar trend of growth in body weight from birth to 18 months old, but did not achieve catch-up of body weight by 18 months old. On the other hand, they had a faster growth and evidence of catch-up in both body height and head circumference from 6 months to 18 months old. Stratified by the birth number, for singleton or twin babies, there was no significant difference in most parameters of growth at birth and up to 18 months old between babies born by ART compared with those born through a natural conception. Analysis using generalized estimating equation modeling showed that multiple pregnancy and breastfeeding as well as having the mother herself as the caregiver in daytime through 18 months old are the negative and positive contributing factors, respectively for both growth and the change of growth with time among children born after ART. CONCLUSION Though exhibiting a higher incidence of low birth weight as well as prematurity, children born with ART enjoyed a similar or faster rate of growth from birth to 18 months old when compared to those children born through naturally conceived pregnancies. While multiple gestation is always a negative contributing factor, continuous breastfeeding and having the mother herself as the caregiver in daytime are positive contributing factors for the growth and/or change of growth for the children born after ART.

Developing and refining the Taiwan Birth Cohort Study (TBCS): Five years of experience

The Taiwan Birth Cohort Study (TBCS) is the first nationwide birth cohort database in Asia designed to establish national norms of childrens development. Several challenges during database development and data analysis were identified. Challenges include sampling methods, instrument development and statistical approach to missing data. The purpose of this paper is to describe the pilot study underpinning the TBCS, testing of the TBCS developmental instrument and the resolution of methodological challenges. Bayesian analysis fill in missing data, three-step regression analysis for the investigation of mediating and moderating effect, the use of structural equation modeling in a large scale investigation, investigating direct and indirect effects, confounding factors and reciprocal relationships in childrens development, and used latent growth model in longitudinal observations are described. The TBCS will provide ongoing longitudinal information regarding the predisposing and maintaining factors affecting the long term outcome of pediatric illnesses.

Risk factors for urinary incontinence in Taiwanese women aged 60 or over

To determine risk factors of urinary incontinence (UI) in Taiwanese women aged 60 or over, face-to-face interviews with 1,517 women, selected by a multistage random method, were completed. The prevalence of UI in this age group was 29.8%. Factors and their prevalence associated with UI were age [odds ratio (OR)=1.04 per year], diabetes mellitus (39.8%, p = 0.002), hypertension (39.5%, p = 0.001), abdominal gynecological surgery (41.4%, p = 0.001), hysterectomy (42.4%, p = 0.003), history of drug allergy (41.3%, p = 0.001), smoking (45.5%, p = 0.010), hormone replacement therapy (41.5%, p = 0.026), and high body mass index (OR = 1.05 per unit). Alcohol consumption and marriage did not increase the risk of UI. UI is a common and costly problem in elderly women. It diminishes the quality of life of the affected women. Of the associated factors that are preventable, modifiable, or controllable, smoking, prior hysterectomy, and obesity may have the greatest impact on the prevalence of UI.

Child developmental screening instrument from six to thirty-six months in Taiwan Birth Cohort Study

BACKGROUND A reliable and valid assessing tool to detect the problem before the child becomes deviant is very important. AIM This study aimed to further test the reliability and validity of developmental screening instrument for follow-up of thirty-six months children in Taiwan. Also, the stability and changes in the development of children from six to thirty-six months were investigated. METHODS A total of 1751 infants were administered the six-month scale, which included levels of Gross and Fine Motor, Language/Communication, and Social ability. At eighteen months, 1267 infants were followed up, and at thirty-six months, 1630 infants were followed up. RESULTS Item analysis showed the thirty-six months scale had a Cronbachs alpha of 0.793. By confirmatory factor analysis, the correlations of the four dimensions in this scale were within the range of 0.38 to 0.61. Structural equation modeling showed that the six month scale could directly predict the eighteen months scale, and the gross motor, language, and social dimensions in the thirty-six months scale. The eighteen-month scale was also predictive of the thirty-six months scale. The six, eighteen and thirty-six-month scales all had acceptable reliability and validity, including content, construct and predictive validity. Additionally, the language development at six months was predictive of the language and social development at thirty-six months. The predictive model showed there were correlations between each dimensions at different ages. CONCLUSIONS This study is the pilot of a large and scientifically robust longitudinal first national birth cohort study in Taiwan, and the findings should provide useful reference for future studies.

Nocturia among women aged 60 or older in Taiwan

Background:  From a public health point of view, it is important to evaluate the prevalence of nocturia and to identify the associated factors for nocturia among the elderly that might impair the quality of life of sufferers. However, those among the Taiwanese female population aged 60 or older are still unclear.

Quality-initiated prophylactic antibiotic use in laparoscopic-assisted vaginal hysterectomy.

Background: An evidence‐based initiation of quality improvement activity for reducing the usage of prophylactic antibiotic in laparoscopic‐assisted vaginal hysterectomy (LAVH) in a tertiary hospital.

RISK FACTORS OF URINARY FREQUENCY AMONG WOMEN AGED 60 AND OLDER IN TAIWAN

OBJECTIVE To assess the associated risk factors for daytime urinary frequency among Taiwanese women aged = 60 years. MATERIALS AND METHODS Daytime urinary frequency, defined by the International Continence Society, and its associated problems were evaluated, and medical history and sociodemographic variables were recorded. A total of 2,410 women were selected by a multistage random sampling method. The factors were assessed by frequency and Pearsons ?2 test using a significance level of < 0.05. RESULTS A total of 621 women of those initially selected in the study died before completion of this study. Face-to-face interviews with 1,521 women were completed, producing a response rate of 85.0% (1,521/1,789 women). The prevalence of daytime urinary frequency was significantly related to body mass index (p = 0.018), diabetes mellitus (p = 0.017), hypertension (p = 0.015), previous drug allergy (p = 0.003), smoking (p = 0.005), hormone therapy (p = 0.019), parity (p = 0.019), and urinary incontinence (p = 0.000). However, there was no association between urinary frequency and previous gynecologic surgery, hysterectomy, alcohol consumption, marital status, childbirth, and age of menopause. CONCLUSION The results of this study showed a relatively high risk of urinary frequency development in patients with urinary incontinence, diabetes mellitus, hypertension, obesity, and smoking that are preventable, modifiable, or controllable. Better quality of health education for these women, drawing their attention to the associated factors, may have an impact on the prevalence of urinary frequency.

Long-term effect of hysterectomy on urinary incontinence in Taiwan

OBJECTIVE To investigate the effect of hysterectomy on urinary incontinence (UI) in Taiwanese women aged 60 or older. MATERIALS AND METHODS A nationwide epidemiologic study was conducted and a total of 2410 women were selected by a multistage random sampling method. Face-to-face interviews with 1517 women were completed. The prevalence of UI by hysterectomy, route of hysterectomy, medical reasons for hysterectomy, and years after hysterectomy were assessed by frequency and Pearsons χ(2) test using a significance level of less than 0.05. RESULTS The prevalence of hysterectomy in Taiwanese women aged 60 or older was 8.83% (134/1,517). Hysterectomy is a risk factor of UI (p=0.003) with the prevalence of UI estimated to be 42.38% (59/134) and that of nonhysterectomy group to be 27.96% (425/1380). Route of hysterectomy (p=0.825), reason for hysterectomy (p=0.060), and how many years after hysterectomy has been performed (p=0.562) were not associated with deteriorating symptoms of UI. CONCLUSION There is a high prevalence of UI among women who have performed hysterectomy, but there is no significant relationship between UI and route of hysterectomy, reason for hysterectomy, including cervical cancer and uterine prolapsed, or year after hysterectomy.