Biomedical subjects

Julie L Locher

Publications and source records attributed to Julie L Locher.

14 recordsLinked to original sources

PubMed2006

Global ratings of patient satisfaction and perceptions of improvement with treatment for urinary incontinence: validation of three global patient ratings.

AIMS: To test the validity of three patient global ratings, satisfaction, perception of improvement, and estimated percent improvement, for measuring outcomes of behavioral treatment for urinary incontinence. METHODS: This report is a secondary analysis of data from three randomized controlled trials testing behavioral interventions for incontinence. Participants were 359 community-dwelling women, aged 40-92 years, with stress, urge, or mixed urinary incontinence. All participants received an 8-week program of clinic-based or self-administered behavioral training. Subjective outcomes included a patient satisfaction question (PSQ), global perception of improvement (GPI), and estimated percent improvement (EPI). Convergent validity was tested by examining the relationship between each measure and reduction of incontinence (bladder diary), change on the incontinence impact questionnaire (IIQ), and desire for another treatment. Discriminant validity was explored by examining the relationship of the global ratings to five measures not expected to be related to outcome (age, race, BMI, education level, and change in perceived pain). RESULTS: All three patient global ratings were significantly associated with each other (P < 0.0001), with diary measures of reduction of incontinence episodes (P < 0.0001), and change in the IIQ (P < 0.005), and inversely associated with desire for another treatment (P < 0.0001). All three patient ratings were not significantly associated with age, race, BMI, education level, or change in perceived pain. CONCLUSION: Patient global ratings of satisfaction, perception of improvement, and estimated percent improvement have acceptable convergent and discriminant validity for measuring outcomes in studies of behavioral treatment for urinary incontinence.

Adult↗

PubMed2006

Preoperative biofeedback assisted behavioral training to decrease post-prostatectomy incontinence: a randomized, controlled trial.

PURPOSE: We tested the effectiveness of preoperative biofeedback assisted behavioral training for decreasing the duration and severity of incontinence, and improving quality of life in the 6 months following radical prostatectomy. MATERIALS AND METHODS: We performed a prospective, randomized, controlled trial comparing preoperative behavioral training to usual care. The volunteer sample included 125 men 53 to 68 years old who elected radical prostatectomy for prostate cancer. Patients were stratified according to age and tumor differentiation, and randomized to 1 preoperative session of biofeedback assisted behavioral training plus daily home exercise or a usual care control condition, consisting of simple postoperative instructions to interrupt the urinary stream. The main outcome measurements were duration of incontinence (time to continence), as derived from bladder diaries, incontinence severity (the proportion with severe/continual leakage), pad use, Incontinence Impact Questionnaire, psychological distress (Hopkins Symptom Checklist) and health related quality of life (Medical Outcomes Study Short Form Health Survey). RESULTS: Preoperative behavioral training significantly decreased time to continence (p = 0.03) and the proportion of patients with severe/continual leakage at the 6-month end point (5.9% vs 19.6%, p = 0.04). There were also significant differences between the groups for self-reported urine loss with coughing (22.0% vs 51.1%, p = 0.003), sneezing (26.0% vs 48.9%, p = 0.02) and getting up from lying down (14.0% vs 31.9%, p = 0.04). No differences were found on return to work and usual activities or quality of life measures. CONCLUSIONS: Preoperative behavioral training can hasten the recovery of urine control and decrease the severity of incontinence following radical prostatectomy.

Aged↗

PubMed2006

Ethical issues involving research conducted with homebound older adults.

Conducting research in the home setting with homebound older adults presents distinct ethical and practical challenges that require special consideration. This article describes the methodological issues that make studying homebound older adults especially vulnerable to therapeutic misconception and researcher role conflict and offers practical strategies for researchers to deal with these problems when studying this population. In writing this article, we draw on more than a decade of descriptive and intervention research focusing exclusively on the homebound older population in which the authors have collaborated. Therapeutic misconception and researcher role conflict may occur because of methodological issues related to the recruitment of participants, the "homebound" status of participants, and the home setting as the interview site. Particular care is required on the part of the researcher to address these ethical issues. This may be accomplished especially through clear communication during the informed consent process with participants and in scientific communication with colleagues.

Aged↗

PubMed2006

Patterns and predictors of home health and hospice use by older adults with cancer.

OBJECTIVES: To describe patterns of home health and hospice use by older cancer patients and a comparison group of older persons without cancer. To identify predictors of home care and hospice utilization. DESIGN: Retrospective analysis using the Surveillance, Epidemiology and End Results (SEER)-Medicare Database, a linkage of the SEER Program of the National Cancer Institute (an epidemiological surveillance system of population-based tumor registries) and Medicare Claims. SETTING: The SEER data used in this paper cover a service area that includes approximately 14% of the U.S. population, including the states of Connecticut, Hawaii, Iowa, and New Mexico and the metropolitan areas of Detroit, San Francisco-Oakland, Atlanta, Seattle-Puget Sound, Los Angeles County, and San Jose-Monterey. PARTICIPANTS: Five analytical samples were drawn. The first consisted of all cases with a diagnosis of cancer in 1997 to 1999 who were eligible for services in calendar year 1999 (n=120,072). The second and third were subsamples of these and consisted of cases with a new cancer diagnosis in 1999 (n=46,373) and cases who died in 1999 (n=41,483). The fourth consisted of a comparison sample without cancer (n=160,707). The fifth was a subsample of this and consisted of those who died in 1999 (n=6,639). MEASUREMENTS: Utilization rates of home health and hospice services. RESULTS: Twenty-nine percent of cancer patients used home health services, and 10.7% used hospice services, compared with 7.8% of noncancer patients who used home health and less than 1% who used hospice. Half (51.4%) of cancer patients who used home health did not have cancer listed as an admitting diagnosis for the use of those services. Home health utilization was lowest for unmarried men. CONCLUSION: This is the first study to evaluate community-based home health and hospice utilization by older cancer patients. Future studies must begin to address what constitutes appropriate utilization.

Aged↗

PubMed2006

The relationship between sociodemographic factors and oral health-related quality of life in dentate and edentulous community-dwelling older adults.

OBJECTIVES: To quantify the associations between sociodemographic factors and oral health-related quality of life (OHRQoL) in dentate and edentulous community-dwelling older adults. DESIGN: Cross-sectional study using a 54-item OHRQoL questionnaire. SETTING: Five counties in central Alabama: Jefferson and Tuscaloosa (urban), and Hale, Bibb, and Pickens (rural). PARTICIPANTS: Two hundred eighty-eight participants (Dental Study subjects) aged 65 and older were recruited from participants in the University of Alabama at Birmingham Study of Aging, a longitudinal study of mobility in older African Americans and non-Hispanic whites. MEASUREMENTS: Dental Study subjects were queried on their OHRQoL and sociodemographic status and classified into two categories: dentate and edentulous. Bivariate analyses were used to quantify associations between sociodemographic variables and OHRQoL after excluding participants with severe depression. Variables included age, sex, race, marital status, veteran status, residence, income, education, and transportation difficulties. RESULTS: Dentate and edentulous subjects had similar OHRQoL across age, sex, marital status, veteran status, and residence. Analyses suggested a strong association between OHRQoL and race, education, income, and transportation difficulties in dentate subjects. Sociodemographic factors were less strongly associated with OHRQoL in edentulous participants. CONCLUSION: OHRQoL decrements were prevalent in dentate and edentulous subjects. Of dentate persons, African Americans and those with a 6th-grade education or less, with income less than 16,000 dollars/year, and with transportation difficulties were more likely to have decrements in OHRQoL. In edentulous persons, these associations were not statistically significant or were weaker. These findings suggest differential associations between sociodemographic factors and OHRQoL when stratified according to dentate status.

Black or African American↗

PubMed2005

Social isolation, support, and capital and nutritional risk in an older sample: ethnic and gender differences.

This study examines the relationships that exist between social isolation, support, and capital and nutritional risk in older black and white women and men. The paper reports on 1000 community-dwelling older adults aged 65 and older enrolled in the University of Alabama at Birmingham (UAB) Study of Aging, a longitudinal observational study of mobility among older black and white participants in the USA. Black women were at greatest nutritional risk; and black women and men were the groups most likely to be socially isolated and to possess the least amounts of social support and social capital. For all ethnic-gender groups, greater restriction in independent life-space (an indicator of social isolation) was associated with increased nutritional risk. For black women and white men, not having adequate transportation (also an indicator of social isolation) was associated with increased nutritional risk. Additionally, for black and white women and white men, lower income was associated with increased nutritional risk. For white women only, the perception of a low level of social support was associated with increased nutritional risk. For black men, not being married (an indicator of social support) and not attending religious services regularly, restricting activities for fear of being attacked, and perceived discrimination (indicators of social capital) were associated with increased nutritional risk. Black females had the greatest risk of poor nutritional health, however more indicators of social isolation, support, and capital were associated with nutritional risk for black men. Additionally, the indicators of social support and capital adversely affecting nutritional risk for black men differed from those associated with nutritional risk in other ethnic-gender groups. This research has implications for nutritional policies directed towards older adults.

Aged↗

PubMed2005

The effect of the presence of others on caloric intake in homebound older adults.

BACKGROUND: Undernutrition in homebound older adults is a significant problem. The purpose of this study was to investigate the effect of the presence of others, both within the household and during meals, on caloric intake in homebound older adults. METHODS: In-depth interviews and three 24-hour dietary recalls were obtained from 50 older adults who were receiving home health services. Descriptive statistics were used to characterize participants, and hierarchical linear modeling was performed to evaluate predictors of caloric intake per meal. RESULTS: Participants' mean age was 77. Females composed 65% and African Americans composed 42% of the sample. Analyses are based on 553 meal observations. The majority (84%) of participants consumed all meals for each of the 3 days of data collection; however, they consumed an average of only 1305 calories per day. Hierarchical linear modeling analysis indicated that persons who had others present during meals consumed an average of 114.0 calories more per meal than those who ate alone (p =.009) and that women consumed 76.7 fewer calories per meal than did men (p =.045). The presence of others within the household had no effect on caloric intake. CONCLUSION: This research suggests that a simple and inexpensive way to increase caloric intake in homebound older adults is to make arrangements for family members or caregivers to eat with them.

Aged↗

PubMed2003

Effect of behavioral training with or without pelvic floor electrical stimulation on stress incontinence in women: a randomized controlled trial.

CONTEXT: Pelvic floor electrical stimulation (PFES) has been shown to be effective for stress incontinence. However, its role in a multicomponent behavioral training program has not been defined. OBJECTIVE: To determine if PFES increases efficacy of behavioral training for community-dwelling women with stress incontinence. DESIGN AND SETTING: Prospective randomized controlled trial conducted from October 1, 1995, through May 1, 2001, at a university-based outpatient continence clinic in the United States. PATIENTS: Volunteer sample of 200 ambulatory, nondemented, community-dwelling women aged 40 to 78 years with stress or mixed incontinence with stress as the predominant pattern; stratified by race, type of incontinence (stress only vs mixed), and severity (frequency of episodes). INTERVENTIONS: Patients were randomly assigned to 8 weeks (4 visits) of behavioral training, 8 weeks (4 visits) of the behavioral training plus home PFES, or 8 weeks of self-administered behavioral treatment using a self-help booklet (control condition). MAIN OUTCOME MEASURES: Primary outcome was percentage reduction in the number of incontinent episodes as documented in bladder diaries. Secondary outcomes were patient satisfaction and changes in quality of life. RESULTS: Intention-to-treat analysis showed that incontinence was reduced a mean of 68.6% with behavioral training, 71.9% with behavioral training plus PFES, and 52.5% with the self-help booklet (P =.005). In comparison with the self-help booklet, behavioral training (P =.02) and behavioral training plus PFES (P =.002) were significantly more effective, but they were not significantly different from each other (P =.60). The PFES group had significantly better patient self-perception of outcome (P<.001) and satisfaction with progress (P =.02). Significant improvements were seen across all 3 groups on the Incontinence Impact Questionnaire but with no between-group differences. CONCLUSIONS: Treatment with PFES did not increase effectiveness of a comprehensive behavioral program for women with stress incontinence. A self-help booklet reduced incontinence and improved quality of life but not as much as the clinic-based programs.

Adult↗

PubMed2003

Cadaveric fascia lata sling for stress urinary incontinence: a prospective quality-of-life analysis.

OBJECTIVE: The purpose of this study was to describe the effects of full-length cadaveric fascia lata (CFL) sling on quality-of-life outcomes. STUDY DESIGN: Patients were 102 women (aged 29 to 87 years) who underwent the sling procedure for stress incontinence associated with intrinsic sphincter deficiency. They were followed up at 12, 24, 36, and 48 months with the Incontinence Impact Questionnaire (IIQ-7), Urogenital Distress Inventory (UDI-6), and a patient satisfaction questionnaire. RESULTS: Mean IIQ score declined from 55.1 before surgery to 11.0 at 12 months (P<.001). Mean UDI score declined from 67.1 to 28.0 at 12 months (P<.01). At 12 months, 79.7% of patients reported that leakage was better or much better, and 90.2% reported that they were somewhat or completely satisfied with their progress. Results were maintained throughout the 48-month follow-up period. CONCLUSION: The CFL sling procedure has an enduring beneficial effect on lower urinary tract symptoms and quality of life.

Adult↗

PubMed2003

Urinary incontinence in the 12-month postpartum period.

OBJECTIVE: To describe the prevalence and severity of urinary incontinence in the 12-month postpartum period and to relate this incontinence to several potential risk factors including body mass index, smoking, oral contraceptives, breast-feeding, and pelvic floor muscle exercise. METHODS: Participants were 523 women, aged 14 to 42 years, who had obstetrical deliveries. The women were interviewed in their rooms on postpartum day 2 or 3 and by telephone 6 weeks, 3 months, 6 months, and 12 months postpartum. Chart abstraction was conducted to obtain obstetrical data from the index delivery. RESULTS: At 6 weeks postpartum, 11.36% of women reported some degree of urinary incontinence since the index delivery. Although the rate of incontinence did not change significantly over the postpartum year, frequency of accidents decreased over time. In the generalized estimating equation, postpartum incontinence was significantly associated with seven variables: baseline report of smoking (odds ratio [OR] 2.934; P =.002), incontinence during pregnancy (OR 2.002; P =.007), length of breast-feeding (OR 1.169; P =.023), vaginal delivery (OR 2.360; P =.002), use of forceps (OR 1.870; P =.024), and two time-varying covariates: frequency of urination (OR 1.123; P = <.001) and body mass index (OR 1.055; P =.005). Factors not associated with postpartum incontinence included age, race, education, episiotomy, number of vaginal deliveries, attendance at childbirth preparation classes, and performing pelvic floor muscle exercises during the postpartum period. CONCLUSION: Postpartum incontinence is associated with several risk factors, some of which are potentially modifiable and others that can help target at-risk women for early intervention.

Adolescent↗

PubMed2003

Predictors of outcome in the behavioral treatment of urinary incontinence in women.

OBJECTIVE: To identify predictors of outcome of a multicomponent behavioral training program for urge and stress incontinence in women. METHODS: This report is a secondary analysis of data from three prospective, randomized, clinical trials testing behavioral interventions for urinary incontinence. Participants were a volunteer sample of 258 ambulatory, nondemented, community-dwelling women, aged 40-92 years, with stress, urge, or mixed urinary incontinence. Participants received 8 weeks (four visits) of multicomponent behavioral training in each study. The relationship between a number of variables and treatment success were explored by univariate and multivariable logistic regression analyses. RESULTS: Successful treatment of predominantly urge incontinence (75% reduction of incontinent episodes as recorded on bladder diary) was associated with not wearing any form of protection for incontinence (P = .045; 95% confidence interval [CI] .282, .987). Achieving total continence (100% reduction) was associated with fewer incontinent episodes at baseline (P < .001; 95% CI .138, .557), previous surgery for incontinence (P = .021; 95% CI 1.169, 6.543), and lower education level (P = .022; 95% CI .175, .871). Successful treatment of predominantly stress incontinence (75% reduction) was related to not having previous evaluation or treatment for incontinence (P = .001; 95% CI .026, .415), and fewer incontinent episodes on baseline bladder diary (P = .026; 95% CI .210, .907). Outcomes were not associated with age, race, type of incontinence, or a number of other variables reflecting medical history, obstetric history, medications, pelvic examination, body mass index, urodynamic parameters, or psychological distress. CONCLUSION: Aside from indicators of severity and previous treatment, there were few associations between baseline clinical variables and outcome of behavioral treatment.

Adult↗

PubMed2002

Behavioral training with and without biofeedback in the treatment of urge incontinence in older women: a randomized controlled trial.

CONTEXT: Previous research on urge urinary incontinence has demonstrated that multicomponent behavioral training with biofeedback is safe and effective, yet it has not been established whether biofeedback is an essential component that heightens therapeutic efficacy. OBJECTIVE: To examine the role of biofeedback in a multicomponent behavioral training program for urge incontinence in community-dwelling older women. DESIGN: Prospective, randomized controlled trial conducted from April 1, 1995, to March 30, 2001. SETTING: University-based outpatient continence clinic in the United States. PATIENTS: A volunteer sample of 222 ambulatory, nondemented, community-dwelling women aged 55 to 92 years with urge incontinence or mixed incontinence with urge as the predominant pattern. Patients were stratified by race, type of incontinence (urge only vs mixed), and severity (frequency of accidents). INTERVENTIONS: Patients were randomly assigned to receive 8 weeks (4 visits) of biofeedback-assisted behavioral training (n = 73), 8 weeks (4 visits) of behavioral training without biofeedback (verbal feedback based on vaginal palpation; n = 74), or 8 weeks of self-administered behavioral treatment using a self-help booklet (control condition; n = 75). MAIN OUTCOME MEASURES: Reduction in the number of incontinence episodes as documented in bladder diaries, patients' perceptions and satisfaction, and changes in quality of life. RESULTS: Intention-to-treat analysis showed that behavioral training with biofeedback yielded a mean 63.1% reduction (SD, 42.7%) in incontinence, verbal feedback a mean 69.4% reduction (SD, 32.7%), and the self-help booklet a mean 58.6% reduction (SD, 38.8%). The 3 groups were not significantly different from each other (P =.23). The groups differed significantly regarding patient satisfaction: 75.0% of the biofeedback group, 85.5% of the verbal feedback group, and 55.7% of the self-help booklet group reported being completely satisfied with treatment (P =.001). Significant improvements were seen across all 3 groups on 3 quality-of-life instruments, with no significant between-group differences. CONCLUSIONS: Biofeedback to teach pelvic floor muscle control, verbal feedback based on vaginal palpation, and a self-help booklet in a first-line behavioral training program all achieved comparable improvements in urge incontinence in community-dwelling older women. Patients' perceptions of treatment were significantly better for the 2 behavioral training interventions.

Aged↗

PubMed2002

Urodynamic changes associated with behavioral and drug treatment of urge incontinence in older women.

OBJECTIVES: To describe changes in bladder function and voiding frequency associated with behavioral and drug treatment for urge incontinence and to examine whether these variables mediate the positive effects of treatment on the frequency of incontinence. DESIGN: Randomized, double-blinded, placebo-controlled, clinical trial. Eligible patients were stratified according to type of incontinence (urge only vs mixed urge and stress) and severity of incontinence (frequency of accidents as documented in bladder diary). SETTING: University-based outpatient geriatric medicine clinic. PARTICIPANTS: One hundred five ambulatory, nondemented, community-dwelling women; mean age 67.0 (range 55-91); 98% white, 2% African American. INTERVENTION: Four sessions (over 8 weeks) of biofeedback-assisted behavioral training, drug treatment with individually-titrated oxybutynin chloride, or a placebo control condition. MEASUREMENTS: Two-channel cystometry was performed to determine threshold volumes for first desire to void (FDV), strong desire to void (SDV), bladder capacity, and the volume at which detrusor instability (DI) or leakage occurred, before randomization and after completion of treatment. Two-week bladder diaries were used before and after treatment to document episodes of incontinence and voiding frequency. RESULTS: Bladder capacity increased by 68.9 mL in the oxybutynin group (P <.001) and 17.3 mL in the behavior group and decreased 6.0 mL in the control group. SDV increased 69.9 mL in the oxybutynin group (P <.001), 40.5 in the behavior group (P <.05), and 7.8 mL in the control group. FDV increased by 44.4 mL in the oxybutynin group (P <.001), 18.8 mL in the behavior group, and 8.9 mL in the control group. One of seven patients who presented with DI (12.0%) resolved in the behavior group, seven of eight (87.5%) resolved in the oxybutynin group, and seven of 12 (58.3%) resolved in the control group. These differences were not statistically significant. Voiding frequency was significantly reduced after treatment in both the behavior and the oxybutynin group. Behavioral training resulted in a mean 82.3% reduction in frequency of accidents, oxybutynin (final doses 2.5 mg daily to 5 mg three times a day) resulted in a mean 78.3% reduction, and the control condition resulted in a mean 51.5% reduction (P =.002). Although oxybutynin and behavioral treatment were both effective, and oxybutynin increased SDV and bladder capacity, the structural equation modeling did not demonstrate that the clinical improvement was mediated through the effects of these treatments on urodynamic or voiding frequency measures. CONCLUSIONS: Studies using more-complex urodynamics and studies with larger sample sizes are needed to better characterize changes in bladder function and explore other urodynamic changes that may accompany treatment. In addition, other factors, both physiological and behavioral, need to be explored as mechanisms by which conservative therapies improve urge incontinence.

Age Factors↗

PubMed2002

Effects of age and causal attribution to aging on health-related behaviors associated with urinary incontinence in older women.

PURPOSE: The purpose of this study was to assess the effects of age and patients' attribution of incontinence to aging on health-related behaviors associated with incontinence. DESIGN AND METHODS: Participants in this study were 74 women who either sought treatment for urinary incontinence at a multidisciplinary continence program or volunteered for a randomized clinical trial of behavioral and drug therapy for incontinence. As part of their clinical evaluation, women were interviewed about how they managed their incontinence and their perceptions of what had caused the condition. Self-management of incontinence was defined as behaviors used to cope with incontinence, rather than treat or cure incontinence. Self-treatment was defined as self-implementation of Kegel exercises, and formal treatment was defined as interaction with a health care provider. RESULTS: Over half of the respondents attributed their incontinence to aging. In multivariate analyses, age was associated with self-management of incontinence, but not self-treatment or formal treatment. In contrast, attribution of incontinence to aging was associated with self-management and self-treatment of incontinence. There was also a trend for attribution of incontinence to aging to be associated with formal treatment for incontinence. Women who attributed their incontinence to aging were less likely to have engaged in self-management strategies and to have received a previous evaluation or treatment; but, they were more likely to have engaged in self-treatment for incontinence. When other relevant variables were added to the regression models, perception that incontinence restricted one's activities became the most significant predictor of performing self-management strategies and performing Kegel exercises. IMPLICATIONS: Attribution to aging may be an impediment to seeking treatment. Education to promote understanding of the actual causes and treatment of urinary incontinence may encourage people to seek appropriate intervention. Additionally, whereas attribution to aging is an important factor contributing to health-related behaviors, other factors, such as perception that one's activities are restricted, may play an important role.

Age Factors↗