De novo urethral hypermobility at 6 months after first delivery as a risk factor for stress urinary incontinence 12 years postpartum.

OBJECTIVE: The aim of the study was to analyze the association between de novo urethral hypermobility 6 months postpartum and stress urinary incontinence (SUI) symptoms at 6 months and 12 years after first delivery. Risk factors associated with the development of postnatal urethral hypermobility were also examined. METHODS: A longitudinal cohort study was conducted on primigravid women, after excluding those with UI before pregnancy and/or urethral hypermobility (rotational angle ≥30°) at term. At 6 months postpartum, SUI was assessed based on symptoms and introital ultrasound performed to measure rotational angle (difference between urethro-pelvic angle at rest and at maximum Valsalva). Twelve years after delivery, women were sent a questionnaire including SUI assessment and questions on parity, current age, and body mass index. Continuous variables were compared using student's t-test and qualitative variables using chi-squared tests. A logistic regression model was constructed including variables that reached statistical significance (P < 0.05) in the univariate analysis. RESULTS: Of the 314 women who completed the 6-month follow-up, 265 (84.4%) were successfully contacted and completed the questionnaire at 12 years and these formed the study group. In 127 women (47.9%), de novo urethral hypermobility had developed by 6 months postpartum. There was no association between urethral hypermobility and SUI symptoms 6 months postpartum (OR: 1.17; 95% CI: 0.59-2.33). Twelve years after delivery, however, SUI was reported by 110 women overall (41.5%) and nearly half of the women who developed postnatal urethral hypermobility (61/127, 48.0%). CONCLUSION: De novo urethral hypermobility 6 months postpartum constitutes a risk factor for SUI 12 years later.

Quality of life in patients with nonvalvular atrial fibrillation treated with oral anticoagulants.

OBJECTIVES: Health-related quality of life (HRQL) is a key factor in making anticoagulant treatment decisions. The objective of this study was to assess the HRQL of patients with nonvalvular atrial fibrillation by treatment type: direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs). METHODS: We carried out a cross-sectional observational study with clinical practice data, gathering demographic and clinical variables. HRQL was measured using the 5-level 5-dimension EuroQol questionnaire (EQ-5D-5L). Differences between the study groups in HRQL as measured by the EQ-5D-5L were analyzed using two-part multivariate regression models. First, using logistic regression, the adjusted probability, p(x), of having perfect health was estimated in each subgroup. Secondly, generalized linear models were used to estimate mean disutility values, w(x), in a population that does not have perfect health, i.e. utility less than 1 or 1-w(x). RESULTS: We recruited 333 patients, of whom 126 were on DOACs and 207 on VKAs. A significant difference was observed in the EQ-5D-5L anxiety/depression dimension, with a higher percentage of patients classified in the 'no problems' category in the DOAC group. The same type of analysis did not identify significant differences in any of the other dimensions (mobility, self-care, usual activities or pain/discomfort). DISCUSSION: In the multivariate model, utility was significantly higher in the DOAC group than in the VKA group, although the difference was small (0.0121). This difference is attributable to patients on DOACs having less anxiety/depression. CONCLUSION: Patients treated with DOACs report a slightly better quality of life than those treated with VKAs.

Risk factors associated with stress urinary incontinence 12 years after first delivery.

INTRODUCTION AND HYPOTHESIS: This study was aimed at investigating risk factors involved in stress urinary incontinence (SUI) 12 years after first delivery. We also evaluated cumulative incidence, severity, and impact on quality of life (QoL) of SUI. We hypothesized that changes during the first pregnancy might be associated with SUI long after delivery. METHODS: A longitudinal cohort study was undertaken including primigravid women who delivered in our hospital during 2007. SUI was assessed following definitions of the International Continence Society. Severity was evaluated using the Incontinence Severity Index and impact on QoL with the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form. Comparisons between continuous variables were performed using Student's t test and between qualitative variables using Chi-squared tests. A logistic regression model was constructed including variables that reached statistical significance (p < 0.05) in the univariate analysis. RESULTS: During the inclusion period, 479 pregnant women were interviewed, 381 attended the 6-month follow-up, and 318 completed the questionnaires 12 years after and formed the study group. The cumulative incidence of SUI at 6 months and 12 years postpartum was 14.2% and 39.6% respectively. Generally, SUI severity was slight (73.0%) or moderate (28.9%) and its impact on QoL was low. Pregnancy SUI (OR: 2.14; 95% CI: 1.29-3.55) was independently associated with SUI 12 years postpartum. CONCLUSION: The cumulative incidence of SUI increases markedly from 6 months to 12 years postpartum, being slight or moderate in severity and having a low impact on QoL in most cases. Developing SUI during pregnancy doubled the risk of SUI 12 years postpartum.

Tromboc@t Working Group recommendations for management in patients receiving direct oral anticoagulants. / Recomendaciones del Grupo Catalán de Trombosis (Tromboc@t Working Group) para el tratamiento de los pacientes que reciben anticoagulantes orales directos.

BACKGROUND AND OBJECTIVES: In recent years, direct oral anticoagulants (DOACs) have become an alternative to vitamin K antagonists (VKA) for the prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation (NVAF) as well as for prevention and treatment of deep venous thrombosis. Pivotal trials have demonstrated non-inferiority and potential superiority compared to warfarin, which increases the options of anticoagulant treatment. In our setting, the Anticoagulant Treatment Units (ATUs) and Primary Care Centres (PCCs) play an important role in the education, follow-up, adherence control and management in special situations of anticoagulated patients. These considerations have motivated us to elaborate the present consensus document that aims to establish clear recommendations that incorporate the findings of scientific research into clinical practice to improve the quality of care in the field of anticoagulation. MATERIAL AND METHODS: A group of experts from the Catalan Thrombosis Group (TROMBOC@T) reviewed all published literature from 2009 to 2016, in order to provide recommendations based on clinical evidence. RESULTS: As a result of the project, a set of practical recommendations have been established that will facilitate treatment, education, follow-up and management in special situations of anticoagulated patients with ACODs. CONCLUSIONS: Progressive increase in the use of DOACs calls for measures to establish and homogenise clinical management guidelines for patients anticoagulated with DOACs in ATUs and PCCs.