Symptoms of urinary incontinence and pelvic organ prolapse and physical performance in middle-aged women from Northeast Brazil: a cross-sectional study.

BACKGROUND: Reproductive history and urogynecological disorders have been associated with limitations in physical function. However, little is known about the relationship between symptoms of urinary incontinence and pelvic organ prolapse, and physical performance. Therefore, the purpose of this study was to examine whether symptoms of urinary incontinence and pelvic organ prolapse are independently associated factors with indicators of lower physical performance in middle-aged women from Northeast Brazil. METHODS: This is a cross-sectional study of 381 women between 40 to 65 years old living in Parnamirim, Northeast Brazil. Physical performance was assessed by gait speed, chair stand and standing balance tests. Urinary incontinence and pelvic organ prolapse were self-reported. Multiple linear regression analyses were performed to model the effect of self-reported urinary incontinence and pelvic organ prolapse on each physical performance measure, adjusted for covariates (age, family income, education, body mass index, parity). RESULTS: In the analysis adjusted for confounders, women reporting urinary incontinence spent, on average, half a second longer to perform the chair stand test (ß = 0.505 95% CI: 0.034: 0.976). Those reporting pelvic organ prolapse shortened the balance time with eyes open by 2.5 s on average (ß = - 2.556; CI: - 4.769: - 0.343). CONCLUSIONS: Symptoms of pelvic organ prolapse and urinary incontinence are associated to worse physical performance in middle-aged women. These seemingly small changes in physical performance levels are of clinical importance, since these conditions may influence women's physical ability, with implications for other tasks important to daily functioning and should be addressed by health policies targeting women's health and functionality.

Training and nutritional components of PMTCT programmes associated with improved intrapartum quality of care in Mali and Senegal.

OBJECTIVE: Scale-up of prevention of mother-to-child transmission (PMTCT) of HIV programmes in sub-Saharan Africa has stimulated interest to assess whether these programmes can indirectly affect other health priorities. This study assesses whether PMTCT programmes, or components of these programmes, are associated with better obstetrical quality of care and how PMTCT may reinforce existing maternal health programmes. DESIGN: Cross-sectional analysis of data from a cluster-randomized trial called QUARITE. SETTING: Mali and Senegal, West Africa. PARTICIPANTS: Thirty-one referral hospitals and 612 obstetrical patients. INTERVENTION: The exposure of interest was PMTCT measured with a scale containing 10 components describing different prongs of a hospital PMTCT programme. Other variables of interest included: presence of a quality of care improvement programme, hospital resources and patient demographic characteristics. MAIN OUTCOME MEASURE: Obstetrical quality of care measured through a validated chart abstraction tool. RESULTS: Of 45 points, the mean hospital PMTCT score was 26.1 (SD: 6.7). Total PMTCT score was not significantly associated with quality of care, but programme component scores were. After adjustment for known predictors of quality of care, staff training in PMTCT (P = 0.03) and complementary nutritional services (P = 0.03) were significantly associated with better quality obstetrical care. A point increase in scores for either of these components was associated with 40% greater odds of good obstetrical care. CONCLUSIONS: PMTCT training and nutritional components are significantly associated with better quality intrapartum care. Health professionals' training in maternal healthcare and PMTCT could be combined to improve the quality of obstetric care in the region.

Emergency obstetrical complications in a rural African setting (Kayes, Mali): the link between travel time and in-hospital maternal mortality.

The West African country of Mali implemented referral systems to increase spatial access to emergency obstetrical care and lower maternal mortality. We test the hypothesis that spatial access- proxied by travel time during the rainy and dry seasons- is associated with in-hospital maternal mortality. Effect modification by caesarean section is explored. All women treated for emergency obstetrical complications at the referral hospital in Kayes, Mali were considered eligible for study. First, we conducted descriptive analyses of all emergency obstetrical complications treated at the referral hospital between 2005 and 2007. We calculated case fatality rates by obstetric diagnosis and travel time. Key informant interviews provided travel times. Medical registers provided clinical and demographic data. Second, a matched case-control study assessed the independent effect of travel time on maternal mortality. Stratification was used to explore effect modification by caesarean section. Case fatality rates increased with increasing travel time to the hospital. After controlling for age, diagnosis, and date of arrival, a travel time of four or more hours was significantly associated with in-hospital maternal mortality (OR: 3.83; CI: 1.31-11.27). Travel times between 2 and 4 h were associated with increased odds of maternal mortality (OR 1.88), but the relationship was not significant. The effect of travel time on maternal mortality appears to be modified by caesarean section. Poor spatial access contributes to maternal mortality even in women who reach a health facility. Improving spatial access will help women arrive at the hospital in time to be treated effectively.

Relationship between maximal respiratory pressures and multiple childbearing in Brazilian middle-aged and older women: A cross-sectional community-based study.

OBJECTIVE: Previous studies show that multiparity and a number of chronic conditions are correlated among women. Also, low respiratory muscle strength has been associated to adverse health outcomes such as chronic lung disease and early mortality. This study aimed to investigate associations between the number of lifetime pregnancies and maximal inspiratory/expiratory pressures. METHODS: In a cross-sectional study, 204 women ages 41-80 years-old, from the rural community of Santa Cruz, Brazil, provided data regarding demographics, socioeconomic characteristics, health behaviors, and number of lifetime pregnancies (≤3, 4-6 or ≥7). Maximal respiratory pressures were measured with a digital manometer. Multiple linear regression analysis was used to examine the association of multiple childbearing on maximal respiratory pressures. RESULTS: Of the participants, 44.1% had ≤3 pregnancies, 30.4% had 4-6 pregnancies and 25.5% had >7 pregnancies. In the unadjusted analyses, maximal inspiratory and expiratory pressures varied significantly according to multiple childbearing categories. After adjustment, the values remained statistically significant only for maximal expiratory pressure. Compared to women with ≤3 lifetime pregnancies, those who had ≥7 pregnancies had significantly lower maximal expiratory pressure values (ß = -18.07, p = 0.01). CONCLUSION: Multiple childbearing appears to be negatively associated with maximal respiratory pressures; women with a higher number of lifetime pregnancies had lower values of maximal respiratory pressures when compared to those with fewer pregnancies. This association may be due to biomechanical changes in the respiratory muscles promoted by multiple lifetime pregnancies. This finding indicates a need to motivate women, from the prenatal to postpartum period, to safely exercise their respiratory muscles, including abdominal muscle exercises as well as respiratory muscle training.

Frailty and life course violence: The international mobility in aging study.

OBJECTIVE: To estimate the prevalence of frailty in older adults in the IMIAS population, to examine associations between lifelong domestic violence and frailty and possible pathways to explain these associations. METHODS: A cross-sectional study with 2002 men and women in the International Mobility in Aging Study, aged between 65 and 74 years old living in five cities of Tirana (Albania), Natal (Brazil), Kingston and Saint-Hyacinthe (Canada), and Manizales (Colombia). Domestic physical and psychological violence by family and intimate partner was assessed by the Hurt, Insult, Threaten and Scream (HITS) scale. Fried's phenotype was adopted to define frailty. Logistic regressions were fitted to estimate between frailty and lifelong violence. Mediation analyses using the Preacher and Hayes method was used to examine potential health pathways. RESULTS: Frailty prevalence varies across cities, being lowest in Saint-Hyacinthe and Kingston, and highest in women in Natal. Women had a higher prevalence in Tirana and Natal. Adjusting for age, sex, education and research city, those reporting childhood physical abuse (CPA) had higher odds of frailty (OR = 1.68; 95% CI: 1.01; 2.78); those who had been exposed to psychological violence by their intimate partner had also higher odds of frailty (OR = 2.07; 95% CI: 1.37; 3.12). CPA effect on frailty was totally mediated by chronic conditions and depression symptoms. Effects of psychological violence by intimate partner were partially mediated by chronic conditions and depression symptoms. CONCLUSIONS: Childhood physical abuse and psychological violence during adulthood leave marks on life trajectory, being conducive to adverse health outcomes and frailty in old age.