Shao Tung Chang

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.

Risk factors for nocturia in Taiwanese women aged 20-59 years

OBJECTIVE To assess the risk factors for nocturia among Taiwanese women aged 20-59 years. MATERIALS AND METHODS A random sample of 4,549 women aged 20-59 years was selected by multistage sampling. A total of 3,537 women were interviewed face-to-face by well-trained interviewers and local public health nurses. The definition of lower urinary tract symptoms used is that as defined by the International Continence Society. Variables of sociodemography, medical histories, obstetric and gynecologic histories, and lower urinary tract symptoms were recorded. The factors were assessed by frequency and logistic regression analyses using a significance level of less than 0.05. RESULTS The prevalence of nocturia increased significantly with age (p < 0.001), body mass index (p < 0.001), diabetes mellitus (p = 0.024), hypertension (p = 0.001), previous gynecologic operation (p = 0.003), drug allergy (p = 0.036), and marital status (p = 0.000). However, there was no relationship between nocturia and smoking, alcohol consumption, parity, hysterectomy, menopause or hormone therapy. CONCLUSION Although the answers to the etiology of nocturia are still not all known, nocturia has been associated with various factors, suggesting that multiple approaches are necessary in the treatment of patients with nocturia.

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.

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.

Prevalence of and attitude toward urinary incontinence in Taiwanese women.

Most epidemiological studies of urinary incontinence (UI) have sampled populations composed almost exclusively of white women and they found a prevalence of 9—52%. The purpose of this study was to investigate the prevalence of UI among Taiwanese women aged between 20 and 59 years their knowledge attitude and practices (KAP) regarding UI. In coordination with the National Institute of Family Planning (NIFP) 4549 women from a population of 5.9 million were selected using a multistage random sampling design. Of these 3537 were interviewed by well-trained NIFP interviewers who obtained a response rate of 77.8%. The questionnaire included items on the women’s general background past history lower urinary tract symptoms and KAP regarding UI. (excerpt)

Change-point detection for shifts in control charts using fuzzy shift change-point algorithms

A new fuzzy mechanism is proposed to detect the time of shifts in mean.Knowledge of the distribution and the process parameters is not required.The algorithm is applicable to normal and non-normal processes of phase I and II.The method performs better than traditional methods in accuracy and precision.Efficiency in small shifts detection is helpful for identifying causes fast. Knowing the real time of changes, called change-point, in a process is essential for quickly identifying and removing special causes. Many change-point methods in statistical process control assume the distribution and the in-control parameters of the process known, however, they are rarely known accurately. Small errors accompanied with estimated parameters may lead to unfavorable change-point estimates. In this paper, a new method, called fuzzy shift change-point algorithm, which does not require the knowledge of the distribution nor the parameter of the process, is proposed to detect change-points for shifts in process mean. The fuzzy c-partition concept is embedded into change-point formulation in which any possible collection of change-points is considered as a partitioning of data with a fuzzy membership. These memberships are then transferred into the pseudo memberships of observations belonging to each individual cluster, so the fuzzy c-means clustering can be used to obtain the estimates for shifts. Subsequently, the fuzzy c-means algorithm is used again to obtain new iterates of change-point collection memberships by minimizing an objective function concerning the deviations between observations and the corresponding cluster means. The proposed algorithm is nonparametric and applicable to normal and non-normal processes in both phase I and II. The performance of the proposed fuzzy shift change-point algorithm is discussed in comparison with powerful statistical methods through extensive simulation studies. The results demonstrate the superiority and usefulness of our proposed method.

Hydrodistention plus bladder training versus hydrodistention for the treatment of interstitial cystitis

OBJECTIVE To assess the efficacy of hydrodistention (HD) followed by bladder training (BT) versus HD alone in patients with interstitial cystitis (IC). METHODS A total of 70 patients with IC were included and randomly assigned to two groups: one treated with HD (HD group) and the other treated with HD plus BT (HD plus BT group). Each patient was followed up using a weekly diary for 8 weeks after HD and monthly thereafter for 6 months after HD. Evaluation parameters included age, duration of IC in years, how many doctors visited before treatment, urgency, bladder pain, daytime voided volume per void, nocturnal volume per void, daytime voids per day, and nocturia per day. RESULTS Age, duration of IC in years, doctors visited before treatment, and voiding profiles of patients before treatments between the two groups did not show statistical significance. However, at 24 weeks after HD, the proportions of urgency, and bladder pain of the HD group versus the HD plus BT group were 43.48% versus 10.71% (p = 0.008), and 34.78% versus 14.29% (p = 0.086), respectively. Concurrently, the mean ± standard deviation of daytime voided volume per void, nocturnal volume per void, daytime voids per day, and nocturia per day of the HD group and HD plus BT group are 212.2 ± 114.2 mL and 300.1 ± 90.2 mL (p = 0.005), 276.8 ± 113.0 mL and 360.0 ± 129.6 mL (p = 0.018), 8.2 ± 3.2 and 6.2 ± 1.4 (p = 0.010), and 2.2 ± 1.2 and 1.5 ± 0.7 (p = 0.019), respectively. CONCLUSION HD followed by BT produced a statistically significantly better effect than HD alone in the treatment of patients with IC.

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.

PREVALENCE OF NOCTURIA IN TAIWANESE WOMEN AGED 20-59 YEARS

OBJECTIVE To estimate the prevalence of nocturia in Taiwanese women aged 20-59 years. MATERIALS AND METHODS A random sample of 4,549 women within the age range was selected by a multistage sampling design. Face-to-face visits with 3,537 women were completed by well-trained professional interviewers. Nocturia, according to the definition of the International Continence Society, and its associated problems were evaluated and, concurrently, variables of medical histories and sociodemography were recorded. RESULTS The response rate was 77.8%, and a total of 930 of 3,521 women reported having had nocturia, producing a prevalence of nocturia of 26.4%, with 16 not answering the question about nocturia. For those who had nocturia, 88.9% of the interviewees reported < or = 2 voids per night and 1.6% of these women reported having to void > or = 5 times per night. CONCLUSION Nocturia is a common condition among Taiwanese women, especially among the elderly. Its prevalence is significantly related to age. Treatment of this condition in this patient population can both improve their quality of life and reduce the risk of deterioration in their general state of health.