Molly C. Dougherty

Dietary caffeine, fluid intake and urinary incontinence in older rural women.

Abstract: Forty-one women completed the first phase (self-monitoring) of the Behavioral Management for Continence (BMC) intervention, while working with a nurse during home visits to reduce involuntary urine loss as part of the parent study involving older, rural women living at home. A decrease in dietary caffeine intake and an increase in fluid intake were most frequently recommended. The relationship between a decrease in the amount of dietary caffeine consumed and fewer daytime episodes of involuntary urine loss approached significance –P = 0.0744 – whereas an increase in the average amount of fluid intake was significantly related to an increase in the average volume of urine voided –P = 0.0479 – and not to involuntary urine loss.

An Instrument to Assess the Dynamic Characteristics of the Circumvaginal Musculature

This report describes an intravaginal balloon device (IVBD) and an improved method for measuring the dynamic characteristics of circumvaginal muscle (CVM) contractions. The IVBD measurement system may be used in research on womens health problems related to the pelvic floor musculature. The system is independent of examiner judgment and variability, and measurement conditions are carefully controlled. In an initial trial using the device with 20 volunteers, aged 22 to 58 years, the maximal pressure developed during strong CVM contractions was measured with the subjects supine. Subjects were asked to repeat the contraction while they contracted abdominal muscles. The length of time a submaximal contraction could be held was also measured. Test-retest reliability, determined by repeating each experiment, revealed significant correlation in maximal pressure attained, r = .85, p < .03. A t test demonstrated no significant difference between the variables with and without the use of abdominal muscles, indicating the contraction of abdominal muscles did not affect intravaginal pressure when assessed with the IVBD. A weak correlation between length of time a submaximal contraction could be held and age of subject was found, r = -.44, p < .06, but no pressure variable was correlated with age or parity, a possible effect of the small sample in this study.

Blinding in peer review: the preferences of reviewers for nursing journals

AIM This paper is a report of a study to assess the beliefs and preferences of reviewers for nursing journals about blinding of authors to reviewers, reviewers to authors, neither or both. BACKGROUND Blinding of author and reviewer names in the manuscript review process has been of interest to nursing editors, but reports that are based on data rather than simply opinion concern the editorial practices of biomedical rather than nursing journals. There has been no study of nursing journal reviewer beliefs and preferences related to blinding. METHOD A descriptive web-based survey was conducted. The sample included 1675 anonymous reviewers, recruited through 52 editors of nursing journals from their review panels. Data were collected in 2007. FINDINGS Double-blinding of reviews was the most common method reported. Ninety per cent of respondents reported that the papers they received to review did not include author names. When author names were blinded, 62% of reviewers could not identify the authors of papers; another 17% could identify authors < or =10% of the time. Double-blinding was the method preferred by 93.6% of reviewers, although some identified some advantages to an unblinded open review process. CONCLUSION Nursing journal reviewers are generally very satisfied with double-blinding and believe it contributes to the quality of papers published. Editors or editorial boards interested in a more open review process could consider alternatives such as offering authors and reviewers the option to unblind themselves. Simply announcing that the review process will henceforth be unblinded would probably lead to loss of reviewers.

Development and testing of the circumvaginal muscles rating scale.

The purpose of this research was to develop an instrument for clinical assessment of the circumvaginal muscles (CVM), to test the reliability of the instrument, and to correlate sample characteristics with this instrument. The 9-point CVM Rating Scale is based on four components: pressure, duration, muscle ribbing, and position of the examiners finger during examination. Reliability of the CVM Rating Scale was ascertained by use of interrater and test-retest reliability. Interrater reliability was tested on two separate occasions, N = 10, rho = 0.6, p less than .04; N = 10, rho = 0.7, p less than .05. A test-retest sequence was conducted 10 days apart, N = 10, rho = 0.9, p less than .003. Results from these tests indicated that the CVM Rating Scale is a reliable instrument for assessing CVM. A convenience sample of 30 women, aged 18-37, in good general health was tested, using the CVM Rating Scale. Women with a history of pelvic floor reconstructive surgery were excluded. A significant positive correlation between self-reported orgasm and the CVM Rating Scale total scores was found, chi 2 = 7.5, p less than .02. No significant correlations were found between age, race, parity, episiotomy, or self-reported Kegel exercises and the CVM Rating Scale total scores. The scale is a cost-effective, time-efficient, systematic assessment, accessible in clinical settings.

The effect of exercise on the circumvaginal muscles in postpartum women

The effect of exercise on pressure developed by the circumvaginal muscles (CVM) in postpartum women was studied. The CVM assessment system described earlier by Dougherty, Abrams, and McKey used an intravaginal balloon device (IVBD) developed from an impression and model of the vagina. The system (IVBD, pressure transducer and strip chart recorder) provided permanent CVM pressure tracings with high test-re-test reliability (n = 16; r = .85) for maximum pressure (MP). The hypothesis in the research reported here was that exercise with and without an IVBD, when compared to no exercise, would result in significantly higher MP and pressure over time (POT). Forty-five healthy PP volunteers were randomly assigned to a 10-minute per day home training program, for six weeks. The baseline and six-week assessments consisted of CVM pressure tracings during contraction. Dependent variables were MP (highest pressure attained) and POT (area under the pressure curve). Although no significant differences were found between the home training groups, greater improvement was found in the exercise groups. Variability within subjects partly accounts for the results. Pressure changes before and after pregnancy and before and after CVM exercise are demonstrated in a case study. The findings support the use of CVM exercise in the postpartum.

Menopausal status associated with increased inhibition of blood coagulation

Postmenopausal women receiving estrogen replacement therapy (ERT) are not as prone to inappropriate venous and arterial thrombosis as are younger women taking oral contraceptives. To establish whether menopausal status per se has any effect on the coagulation-fibrinolytic system normal premenopausal women (mean age 29 years) were compared with younger (mean age 23) and older (mean age 51) surgically menopausal women and a group of naturally postmenopausal women (mean age 53). The results show that in postmenopausal women, irrespective of age or type, the shift is away from clot formatiuon and toward clot inhibition and fibrinolysis as determined by static in vitro analysis. This was characterized by statistically significant increases in antithrombin III antigen, alpha 1-antitrypsin antigen, and plasminogen activity. These changes may help to explain in part why ERT does not appear to cause increased thrombosis in older women.

Race Differences in the Health of Elders who Live Alone

This investigation was initiated to determine whether older African Americans who live alone are in poorer health than their White counterparts who live under the same circumstances. Data on 5 measures of health were collected in telephone interviews with a stratified random sample of community-dwelling elders (n = 1,189). Analysis of weighted data indicate that there were fewer differences in health by race among older persons who lived alone compared to elders who lived with others. Where racial differences in health did exist among older adults who lived alone, the differences could only sometimes be accounted for by population composition factors that are known to influence health.

Lipids and lipoproteins in women after oophorectomy and the response to oestrogen therapy

Summary. The short‐term effects of different types and doses of oestrogen on serum lipids and lipoproteins were studied in 35 oophorectomized women. After 3 months treatment, serum cholesterol levels were unaffected by 1 and 2mg of micronized l7bT‐oestradiol or 0.625 and l.25mg of conjugated equine oestrogens. Triglyceride levels were significantly elevated after treatment with l.25mg of conjugated oestrogens. A trend towards a higher relative proportion of high‐density lipoproteins and a lower relative proportion of low‐density lipoproteins was observed for all four oestrogen regimens, however, statistical significance was not achieved. The proportion of very‐low‐density lipoprotein was unaffected by oestrogen treatment. The age of the oophorectomized women was found to have no effect on either the direction or magnitude of the lipid or lipoprotein responses to oestrogen. Using FSH depression as an index, 1 .25 mg of conjugated oestrogens was found to be the most potent of the four oestrogen regimens tested. Therefore, with respect to lipid balance, little additional clinical benefit is achieved by using a more potent regimen and the risk of adverse side effects may be increased.

Current status of research on pelvic muscle strengthening techniques

In the past 15 years, research on the effect of pelvic muscle exercise on urinary stress incontinence has contributed substantially to the understanding of the function of the pelvic muscles and the role of pelvic muscle exercise in management of stress urinary incontinence. This literature review addresses pelvic muscle function, pelvic muscle exercise, pelvic muscle exercise training protocols and training aids, changes that result from pelvic muscle exercise, and long-term outcomes of pelvic muscle exercise. Emphasis is placed on results or research that may be used by the clinician with women who experience stress urinary incontinence.

African American Beliefs About Diabetes

In this presentation, a diabetes explanatory model of rural, African American adults at high risk for diabetes is described. Kleinman’s explanatory model of illness was used as the organizing framework. African American men and women (N = 42), between the ages of 18 and 51, participated. Participants described their knowledge and beliefs about diabetes, preventing diabetes, and whether diabetes could be cured or controlled. A common explanatory model of diabetes was not shared among the participants, and gender and age differences were apparent. Common themes included diabetes “running in families,” “eating too much sugar,” and “not taking care of yourself” as causes of diabetes. Weight and physical activity or exercise were not seen as contributing to the development of diabetes. Participants were not sure if diabetes could be prevented. These results provide information to address primary prevention of diabetes in this at-risk group.