Age- and type-dependent effects of parity on urinary incontinence: the Norwegian EPINCONT study.

OBJECTIVE: To investigate the association between parity and urinary incontinence, including subtypes and severity of incontinence, in an unselected sample, with special emphasis on age as a confounder or effect modifier. METHODS: This was a cross-sectional study (response rate 80%) with 27,900 participating women. Data on parity and urinary leakage, type, frequency, amount, and impact of incontinence were recorded by means of a questionnaire. A validated severity index was used. Relative risks (RR) with nulliparous women as reference were used as an effect measure. RESULTS: Incontinence was reported by 25% of participants. Prevalences among nulliparous women ranged from 8% to 32%, increasing with age. Parity was associated with incontinence, and the first delivery was the most significant. The association was strongest in the age group 20-34 years with RR 2.2 (95% confidence interval [CI] 1.8, 2.6) for primiparous women and 3.3 (2.4, 4.4) for grand multiparous women. A weaker association was found in the age group 35-64 years (RRs between 1.4 and 2.0), whereas no association was found among women over 65 years. For stress incontinence in the age group 20-34 years, the RR was 2.7 (2.0, 3.5) for primiparous women and 4.0 (2.5, 6.4) for grand multiparous women. There was an association with parity also for mixed incontinence, but not for urge incontinence. Severity was not clinically significantly associated with parity. CONCLUSION: Parity is an important risk factor for female urinary incontinence in fertile and peri- and early postmenopausal ages. Only stress and mixed types of incontinence are associated with parity. All effects of parity seem to disappear in older age.

A community-based epidemiological survey of female urinary incontinence: the Norwegian EPINCONT study. Epidemiology of Incontinence in the County of Nord-Trøndelag.

OBJECTIVES: The aim was to assess the prevalence of any urinary leakage in an unselected female population in Norway, and to estimate the prevalence of significant incontinence. METHODS: The EPINCONT Study is part of a large survey (HUNT 2) performed in a county in Norway during 1995-97. Everyone aged 20 years or more was invited. 27,936 (80%) of 34,755 community-dwelling women answered a questionnaire. A validated severity index was used to assess severity. RESULTS: Twenty-five percent of the participating women had urinary leakage. Nearly 7% had significant incontinence, defined as moderate or severe incontinence that was experienced as bothersome. The prevalence of incontinence increased with increasing age. Half of the incontinence was of stress type, 11% had urge and 36% mixed incontinence. CONCLUSIONS: Urinary leakage is highly prevalent. Seven percent have significant incontinence and should be regarded as potential patients.

Direct mailing of consensus recommendations did not alter GPs' knowledge and prescription of oestrogen in the menopause.

OBJECTIVE: To investigate the impact of an information-package (direct mailing) concerning oestrogen therapy, deriving from a consensus conference in 1990, on general practitioners' (GPs') attitudes and knowledge. DESIGN AND SUBJECTS: Controlled randomised study. Two groups of Norwegian GPs. The Intervention group received an information-package consisting of the recommendations from the consensus conference, some headline questions with answers, and a classification of the oestrogens available in Norway, including a table and a graphical presentation of the costs of the different treatments. GPs stated their views on prescribing oestrogen on a five step scale, related to nine short case histories, each containing cues on complaints, smoking, family history suggesting risk for cardiovascular disease, and osteoporosis. MAIN OUTCOME MEASURES: GPs' views on prescribing oestrogen, relation to age, sex, practice type (solo/group) and practice location. RESULTS: The differences in answer distributions between the Intervention (n = 193) and Control (n = 181) groups did not reach statistical significance for any of the nine case histories. The answers indicate a more liberal attitude towards replacement therapy in 1992 compared to a study performed in 1990. The views on contraindications was fundamentally unaltered. CONCLUSION: The study did not reveal any significant effect of direct mailing as means of disseminating consensus conference recommendations to GPs.

[Attitudes of Norwegian general practitioners to prescription of estrogens 1990-92]. / Holdningsendring til forskrivning av østrogen blant norske allmennpraktikere 1990-92.

In order to investigate the attitudes towards the prescription of hormone replacement therapy in menopausal and postmenopausal women, a questionnaire was mailed to two random samples of Norwegian general practitioners. The first sample (n = 340) was investigated in 1990, just before a national consensus conference on the use of oestrogens, the second (n = 240) one year after the conference. Nine short case stories were presented and the doctors indicated their attitudes to oestrogen prescribing in each case. Four items were systematically investigated: climacteric symptoms, smoking, risk of cardiovascular disease and osteoporosis. In general, a restrained attitude towards the prescribing of oestrogen was found. Smoking and a family history of cardiovascular disease reduced the willingness to prescribe. The doctors had more patients on oestrogen treatment in 1992 than in 1990. In general, the answers indicate a more liberal attitude to replacement therapy in 1992, but the pattern of willingness to prescribe remained unchanged. Female physicians showed greater willingness to prescribe oestrogen than their male colleagues did, and were more updated on contraindications.

[Changes in sales of estrogens 1989-1992. Effects of a national consensus conference?]. / Endring i salg av øostrogener 1989-92. Effekter av en nasjonal konsensuskonferanse?

In November 1990 a consensus conference was held in Norway on the use of oestrogens for perimenopausal and postmenopausal complaints, and for preventive purposes. The sales statistics reveal an increase in sales of drugs for hormone replacement therapy after the conference, but the trend had already started before the conference was held. We found the conference had had a statistically significant impact on sales of some of the drugs. We also collected information on marketing campaigns before and after the conference. Only a modest change was found in marketing efforts by the pharmaceutical industry. Presentations in the media were considered to have a strong impact on oestrogen promotion.