Minimum important difference of the ICIQ-UI SF score after self-management of urinary incontinence.

BACKGROUND: This study aimed to evaluate clinically relevant improvement after conservative self-management of urinary incontinence via a mobile app. It further aimed to establish Minimum Important Differences (MIDs) based on the severity and type of urinary incontinence. METHODS: Data was collected in a prospective cohort study that evaluated the freely available app Tät®. The app provided pelvic floor muscle training (PFMT) and life-style advice. Non-pregnant, non-postpartum women (≥ 18 years) who downloaded the app to treat urinary incontinence were included, if they completed the Patient Global Impression of Improvement (PGI-I) question at the 3-month follow-up (n = 1,733). Participants answered the International Consultation on Incontinence Questionnaire (ICIQ-UI SF) at baseline and after 3 months. The score change was analysed for correlation (Spearman) with the PGI-I. We then analysed one-way ANOVAs to determine whether there were significant differences between the groups based on the answers to the PGI-I. The MID was set to the mean change of the group that selected the answer "a little better" to the PGI-I question. RESULTS: The one-way ANOVA showed significant differences between PGI-I groups (p < 0.001). The MID for the general group was set to 1.46 (95% Confidence Interval [CI] 1.26-1.67). In the sub-group analyses, a MID for the group with slight incontinence could not be determined. For the group with moderate severity the MID was determined to be 1.33 (95% CI 1.10-1.57) and for the severe/very severe group it was 3.58 (95% CI 3.08-4.09). Analysis of different types of incontinence showed no difference in MIDs. CONCLUSIONS: The MID for self-management via a mobile app was lower than previously established MIDs, but differed depending on baseline severity. This study shows that MIDs need adjustment for baseline severity and treatment intensity when interpreting clinical trial results. If using MIDs as exact numbers, the study population and the treatment must be comparable.

APP-based treatment of urgency and mixed urinary incontinence in women: factors associated with long-term satisfaction.

PURPOSE: App-based treatment of urgency (UUI) and mixed (MUI) urinary incontinence has proved to be effective. To further improve treatment, it will be beneficial to analyze baseline and treatment-related factors that are associated with satisfaction. METHODS: A secondary analysis was conducted of data from a randomized controlled trial (RCT) assessing an app for UUI or MUI treatment, encompassing 98 women for whom there was long-term treatment satisfaction data. All participants completed a short-term (15 weeks) and a long-term (15 months) follow-up questionnaire after being given access to treatment. The outcome was a 3-item question on current treatment satisfaction at the long-term follow-up. Factors potentially associated with the outcome were analyzed using the chi-square test, Student's t test or logistic regression. RESULTS: At the long-term follow-up, 58% of the women were satisfied with the treatment. The most important baseline variable associated with satisfaction was incontinence-related quality of life (International Consultation on Incontinence Questionnaire (ICIQ) - Lower Urinary Tract Symptoms Quality of Life Module) (OR 0.91, 95% CI 0.58-0.97). Short-term follow-up variables associated with long-term treatment satisfaction were improvement in the ability to endure urgency (OR 4.33, 95% CI 1.43-13.12), and confidence in pelvic floor contraction ability (OR 2.67, 95% CI 1.04-6.82). CONCLUSION: App-based treatment for UUI and MUI may be an alternative first-line treatment that is satisfactory to many women over the long-term. Furthermore, short-term treatment that focuses on improving the ability to endure urgency, and confidence in pelvic floor contraction ability, can also be recommended for long-term satisfaction.

A mobile app as support for pelvic floor muscle training started prior to radical prostatectomy.

Objective: To evaluate the usefulness of a mobile app to support pelvic floor muscle training (PFMT) started prior to radical prostatectomy (RP). Materials and methods: A prospective cohort study conducted in Sweden from June 2018 to February 2021 including men for whom RP was planned within 12 months. Users responded anonymously to questionnaires at baseline, 1 and 3 months. Our primary aim was to evaluate if the app could facilitate PFMT and increase confidence in performing pelvic floor muscle (PFM) contractions correctly. Our second aim was to describe the change in urinary incontinence (UI) after RP, based on the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF). Results: Of the 3043 users at baseline, 388 met the primary inclusion criteria. Of those, 71 (18.3%) were incontinent, predominantly with slight symptoms. The most common type was urge UI, 39/71 (54.9%). Of the 388 users, 159 (41.0%) answered the questionnaire at 1 month, and 131 (33.7%) at 3 months within 89-135 days. Of those 131, 127 (96.9%) indicated that the app facilitated their training 'a lot' or 'somewhat'. Confidence in performing PFM contractions correctly increased from 39.7% at baseline to 74.0% at 1 month and 87.8% at 3 months (p < 0.001). At baseline, 19.8% performed PFM contractions at least daily, which increased to 74.0% at 1 month and 77.9% at 3 months (p < 0.001). At 3 months, 115/131 (87.8%) had undergone RP, 93.6% of which were robot-assisted. Of the 115, 103 (89.6%) were incontinent, and stress UI dominated. The mean ICIQ-UI SF score increased from 1.2 (2.4 SD) at baseline to 9.6 (5.2 SD), p < 0.001, after surgery. Conclusions: The mobile app facilitated pelvic floor muscle training for men who were planned to undergo radical prostatectomy and used the app.

Treatment for problem gambling and counselors' perception of their clinical competence: a national web survey in Sweden.

BACKGROUND: Despite their crucial role in bridging science and practice, not much is known about counselors offering treatment for Problem Gambling (PG). This study maps current treatment, the type of change techniques that are prioritized in treatment and how counselors perceive their clinical competence in their work with PG clients. METHODS: A sample of PG counselors from the healthcare and social services (N = 188, mean age: 49 years, 67% women) completed an online survey. A principal component analysis was conducted to map prioritized types of change techniques, and a multiple regression analysis was carried out to analyze predictors of counselors' role adequacy in their clinical work. RESULTS: There was a large variation in the type of treatments offered for PG (mean 3.6). Cognitive Behavioral Therapy (CBT) and Motivational Interviewing were the most common treatments offered and motivation was rated as the most important type of change technique prioritized in the treatment of PG. A principal component analysis identified four components reflecting different types of change techniques prioritized by the counselors: (1) standard CBT, e.g., gambling cognitions, craving management, and finding alternative activities, (2) assessment of PG, (3) family orientation, i.e., involvement of concerned significant others in treatment, and (4) focus on exposure strategies. Counseling more clients monthly was associated with higher levels of willingness, adequacy and legitimacy in their clinical work with clients with PG. Additionally, offering CBT was a predictor for higher role adequacy and providing counseling on the origins of and consequences of PG. CONCLUSION: There was a large heterogeneity among the treatments offered and what change techniques that were prioritized among the PG counselors. Clinical experience is of importance for developing competence in treating clients with PG. This finding suggests there could be benefits to establishing specialized, more visible treatment units where PG counselors could gain adequate clinical experience, thus increasing clinical competence for treating PG.

How Covid-19 restrictions affected young people's well-being and drinking practices: Analyzing interviews with a socio-material approach.

BACKGROUND: The Covid-19 restrictions - as they made young people's practices in their everyday life visible for reflection and reformation - provide a productive opportunity to study how changing conditions affected young people's well-being and drinking practices. METHODS: The data is based on qualitative interviews with 18- to 24-year-old Swedes (n=33) collected in the Autumn 2021. By drawing on the socio-material approach, the paper traces actants, assemblages and trajectories that moved the participants towards increased or decreased well-being during the lockdown. RESULTS: The Covid-19 restrictions made the participants reorganize their everyday life practices emphatically around the home and communication technologies. The restrictions gave rise to both worsened and improved well-being trajectories. In the worsened well-being trajectories, the pandemic restrictions moved the participants towards loneliness, loss of routines, passivity, physical barriers, self-centered thoughts, negative effects of digital technology, sleep deficit, identity crisis, anxiety, depression, and stress. In the improved well-being trajectories, the Covid-19 restrictions brought about freedom to study from a distance, more time for significant others, oneself and for one's own hobbies, new productive practices at home and a better understanding of what kind of person one is. Both worsened and improved well-being trajectories were related to the aim to perform well, and in them drinking practices either diminished or increased the participants' capacities and competencies for well-being. CONCLUSIONS: The results suggest that material domestic spaces, communication technologies and performance are important actants both for alcohol consumption and well-being among young people. These actants may increase or decrease young people's drinking and well-being depending on what kinds of relations become assembled.

Secrecy, self-blame and risks for social exclusion-Family members' experiences of gambling problems in Japan.

The predominant gambling policy to respond to the adverse consequences of excessive gambling has been the Reno Model, which places the responsibility for gambling-caused problems on gamblers themselves. The newly implemented Japanese gambling policy, which shares basic premises with the Reno Model, focuses on the individual pathology of gamblers. However, this model lacks other critical perspectives: environmental and structural factors. To fully understand the harms caused by gambling; it is important to also pay attention to the negative consequences for affected others. In this brief report, we explore family members' experiences of gambling problems within the specific context of the Japanese gambling policy. Interviews with family members reveal self-stigma of being bad parents which elicits shame and efforts to maintain secrecy, as well as public stigma involving labeling, isolation, risks of status loss, social exclusion and discrimination. The focus on individual pathology in Japanese legislation as well as in public and professional perception, reinforces self-blame, anxiety, and remorse on the part of affected family members. When contrasted with the lived experiences of gamblers' family members, the inconsistencies and unreasonableness of the individual pathology paradigm in Japanese gambling policy become evident. It is necessary to shift the focus of gambling policies from individual to socio-political-cultural factors, investigating how these factors influence gambling-caused harm, especially in the Japanese context.

Sense or sensibility-Ideological dilemmas in gamblers' notions of responsibilities for gambling problems.

The gambling market is a complex field of conflicting stakeholders and interests involving dimensions, such as economy, health, social inequality and morals. The division of responsibility between gamblers, the gambling industry and the regulating state for limiting the harmful effects of this activity, however, are unclear. The aim of this study was to explore how gamblers in the Swedish market attribute responsibility to various actors within the gambling field. Qualitative interviews were conducted with 37 gamblers experiencing extensive gambling problems. Based on a discourse analytical approach, five ideological dilemmas were identified, highlighting the tension between the, often contradictory, values that the participants need to relate to. On the individual level, the gamblers emphasize their own responsibility for their problem, thereby showing accountability in relation to themselves, their significant others and their peers as agents in recovery. On the corporate- and state levels however, the participants argue for a stronger public health approach, where the gambling companies should take further responsibility by living up to the legal regulations and where the state should ensure compliance and safeguard funding for treatment and research. The essential paradox between the individual responsibility discourse of self-regulation and the prevailing medical discourse of the gambler's incapacity for self-control signifies an impossible equation that imposes feelings of guilt and shame upon an individual who is concurrently considered as both responsible and incapable. In order to reduce harm, the gambling industry must be more proactive with coercive external control measures to fulfill the duty of care they claim to adhere to, and the regulating state must ensure its compliance.

"There's a lot of stereotypes going on": A cross-national qualitative analysis of the place of gender in declining youth drinking.

INTRODUCTION: Significant declines in drinking among young people have been recorded in many high-income countries over the past 20 years. This analysis explored the role of gender - which we interpret as socially constructed and relational - to provide insight into whether and how gender might be implicated in declining youth drinking. METHODS: Interview data from four independent qualitative studies from Australia, Denmark, Sweden and the UK (n=194; participants aged 15-19 years) were analysed by researchers in each country following agreement about analytical focus. Findings were collated by the lead author in a process of 'qualitative synthesis' which involved successive rounds of data synthesis and feedback from the broader research team. FINDINGS: Our analysis raised two notable points in relation to the role of gender in declining youth drinking. The first concerned the consistency and vehemence across three of the countries at which drinkers and states of intoxication were pejoratively described in gendered terms (e.g., bitchy, sleazy). The second related to the opportunities non- and light-drinking offered for expressing alternate and desirable configurations of femininities and masculinities. CONCLUSIONS: We identified an intolerance towards regressive constructions of gender that emphasise weakness for women and strength for men and a valorisation of gendered expressions of maturity through controlled drinking. Though subtle differences in gendered drinking practices between and within countries were observed, our findings offer insight into how young people's enactions of gender are embedded in, and evolve alongside, these large declines in youth drinking.

Becoming Safe, Legal, Mature, Moderate, and Self-Reflexive: Trajectories of Drinking and Abstinence among Young People.

In recent years, a vast body of research has investigated trends of declining alcohol consumption among youths. However, the extent to which restrictive-youth approaches towards drinking are maintained into adulthood is unclear. The aim of this study is to explore how young people's relation to alcohol changes over time. Our data are based on longitudinal qualitative in-depth interviews with 28 participants aged 15 to 23 conducted over the course of three years (2017-2019). The study draws on assemblage thinking by analysing to what kinds of heterogeneous elements young people's drinking and abstinence are related and what kinds of transformations they undergo when they get older. Five trajectories were identified as influential. Alcohol was transformed from unsafe to safe assemblages, from illegal to legal drinking assemblages, from performance-orientated to enjoyment-orientated assemblages, and from immature to mature assemblages. These trajectories moved alcohol consumption towards moderate drinking. Moreover, abstinence was transformed from authoritarian assemblages into self-reflexive assemblages. Self-control, responsibility, and performance orientation were important mediators in all five trajectories. As the sober generation grows older, they will likely start to drink at more moderate levels than previous generations.

App-based self-management of urgency and mixed urinary incontinence in women: One-year follow-up.

AIMS: To evaluate the long-term effect of the Tät®II app for treatment of urgency (UUI) and mixed urinary incontinence (MUI). METHODS: Long-term follow-up of a randomized controlled trial, including 123 women ≥18 years old with UUI or MUI, without red-flag symptoms, and ≥2 leakages per week. All participants, regardless of group, had received the intervention, a treatment app, at the long-term follow-up. Long-term data were collected through web-based questionnaires 15 months after participants received the intervention. The app included pelvic floor muscle training, bladder training, psychoeducation, lifestyle advice, an exercise log, reminders, reinforcement messages, and tailored advice. The primary outcome was a change in incontinence symptoms (International Consultation on Incontinence Questionnaire [ICIQ]-Urinary Incontinence Short Form [ICIQ-UI SF]), from baseline to follow-up. Other outcomes were urgency symptoms (ICIQ-Overactive Bladder Module (ICIQ-OAB)), quality of life (ICIQ-Lower Urinary Tract Symptoms Quality of Life Module [ICIQ-LUTSqol]), and improvement (Patient's Global Impression of Improvement [PGI-I]). RESULTS: Of the 123 women, 102 (83%) completed the long-term follow-up. The ICIQ-UI SF mean score improved from 11.5 to 7.6 (mean difference 4.0, 95% CI 3.2-4.7). The ICIQ-OAB improved from 6.7 to 5.5 (mean difference 1.3, 95% CI 0.9-1.6) and the ICIQ-LUTSqol improved from 38.0 to 30.9 (mean difference 7.1, 95% CI 5.7-8.5). Of the 102 women, 74 (73%) reported improvement. CONCLUSIONS: Self-management with the Tät®II app for UUI and MUI had a significant effect across all outcome measures also long-term and might serve as an alternative first-line treatment for these conditions.

Self-management of incontinence using a free mobile app: factors associated with improvement.

BACKGROUND: Pelvic floor muscle training (PFMT) is first-line treatment for urinary incontinence (UI) in women. Self-management via a mobile app is a new cost-effective method for PFMT delivery. This study analyzes factors associated with improvement among app users. METHODS: A pragmatic observational study in a community setting. Upon downloading the app Tät®, users answered questions regarding their age, education, residence, and UI symptoms. After 3 months, users answered follow-up questions regarding symptoms and frequency of training and app usage, and the validated Patient Global Impression of Improvement (PGI-I) questionnaire. Only non-pregnant, non-postpartum adult women with UI who answered the PGI-I questionnaire were included. Multivariate logistic regression was used to analyze possible associations between these factors with any improvement and with great improvement according to the PGI-I. The models were adjusted for age. RESULTS: The study included 2,153 participants who had completed self-management, that is, 11.5% of eligible women who completed the baseline questionnaire. Of these participants, 65.6% reported improvement of UI. Any improvement was associated with age, frequency of PFMT, and app use, accounting for 27.9% of variability (Nagelkerke R2). Lower incontinence severity, frequency of PFMT, and app use were associated with great improvement. CONCLUSION: Self-management of urinary incontinence is easily accessible to many women and improvement rates are comparable with other forms of PFMT. Demographic factors and incontinence severity showed no or incongruent association, whereas regular PFMT and app use predicted any and great improvement. App use showed an additional effect beyond frequency of training.

A Mobile App for Self-management of Urgency and Mixed Urinary Incontinence in Women: Randomized Controlled Trial.

BACKGROUND: Many women experience urgency (UUI) and mixed (MUI) urinary incontinence but commonly hesitate to seek care. Treatment access and self-management for these conditions can be supported through eHealth approaches. OBJECTIVE: This study aimed to investigate the efficacy of the mobile app Tät II for self-management of UUI and MUI in women. METHODS: This randomized controlled trial included women ≥18 years old with UUI or MUI and ≥2 leakages per week. Those with red-flag symptoms were excluded. Participants were recruited via analog and digital advertisements and screened for initial selection through a web-based questionnaire. Data were collected using another questionnaire and a 2-day bladder diary. A telephone interview confirmed the symptom diagnosis. Participants were randomized (1:1) to receive access to a treatment app (including pelvic floor muscle training, bladder training, psychoeducation, lifestyle advice, tailored advice, exercise log, reinforcement messages, and reminders) or an information app (control group), with no external treatment guidance provided. The primary outcome was incontinence symptoms at the 15-week follow-up, measured using the International Consultation on Incontinence Questionnaire (ICIQ)-Urinary Incontinence Short Form (ICIQ-UI SF). Urgency symptoms were assessed using the ICIQ-Overactive Bladder Module (ICIQ-OAB) and quality of life using the ICIQ-Lower Urinary Tract Symptoms Quality of Life Module (ICIQ-LUTSqol). Incontinence episode frequency (IEF) was calculated per bladder diary entries. Improvement was measured using the Patient's Global Impression of Improvement. All outcomes were self-reported. Cure was defined as no leakages per the bladder diary. Intention-to-treat analysis was performed. RESULTS: Between April 2017 and March 2018, 123 women (mean age 58.3, SD 9.6 years) were randomized to the treatment (n=60, 2 lost to follow-up) or information (n=63) group. Of these, 35 (28%) women had UUI, and 88 (72%) had MUI. Mean ICIQ-UI SF score at follow-up was lower in the treatment group than in the information group (estimated difference -3.1, 95% CI -4.8 to -1.3). The estimated between-group difference was -1.8 (95% CI -2.8 to -0.99) for mean ICIQ-OAB score and -6.3 (95% CI -10.5 to -2.1) for the mean ICIQ-LUTSqol score at follow-up. IEF reduction from baseline to follow-up was greater in the treatment group (-10.5, IQR -17.5 to -3.5) than in the information group (P<.001). Improvement was reported by 87% (52/60) of treatment group participants and by 30% (19/63) of information group participants. The cure rate was 32% in the treatment group, and 6% in the information group (odds ratio 5.4, 95% CI 1.9-15.6; P=.002). About 67% (40/60) of the treatment group participants used the app more than thrice a week. CONCLUSIONS: The treatment app was effective for improving urgency and mixed incontinence in women. When self-management is appropriate, this app may be a good alternative to pharmacological treatment or other conservative management, thus increasing access to care. TRIAL REGISTRATION: ClinicalTrials.gov NCT03097549; https://clinicaltrials.gov/ct2/show/NCT03097549.

Real-world effectiveness of app-based treatment for urinary incontinence: a cohort study.

OBJECTIVES: The efficacy of app-based treatment for stress urinary incontinence (SUI) has been demonstrated in a randomised controlled trial (RCT). In this study, we investigate the user characteristics and the effectiveness of the same app when freely available, and compare these results with the RCT. DESIGN: Prospective cohort study. PARTICIPANTS: During a 17-month period, 24 602 non-pregnant, non-postpartum women older than 18 years downloaded the app and responded anonymously to a questionnaire. Of these, 2672 (11%) responded to the 3-month follow-up. INTERVENTION: Three months' use of the app Tät, containing information, a pelvic floor muscle training programme and lifestyle advice. MAIN OUTCOME MEASURES: Change in symptom severity (International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF)) and subjective improvement (Patient Global Impression of Improvement (PGI-I)). RESULTS: Of the respondents, 88% lived in Sweden and 75% (18 384/24 602) were incontinent with a mean age of 45.5 (SD 14.1) years. The UI types, based on symptoms, were SUI (53%), urgency UI (12%), mixed UI (31%) and undefined (4%). The mean ICIQ-UI SF score was 8.2 (SD 4.0) at baseline. The mean ICIQ-UI SF score reduction at follow-up was 1.31 (95% CI: 1.19 to 1.44) with a larger reduction in those with more severe incontinence at baseline (severe/very severe 3.23 (95% CI: 2.85 to 3.61), moderate 1.41 (95% CI: 1.24 to 1.59) and slight 0.24 (95% CI 0.06 to 0.42). When the results were weighted to match the distribution of severity in the RCT, the ICIQ-UI SF score reduction was 2.2 compared with 3.9 in the RCT. Regarding PGI-I, 65% experienced improvement compared with 92% in the RCT. CONCLUSIONS: The app Tät was effective for self-management of UI even in the real world. Although the reduction in incontinence symptoms was less than in the RCT, two-thirds of the users improved. App-based treatment reaches many women without requiring resources from ordinary healthcare services.

Anxiety and depression in women with urinary incontinence using E-health.

INTRODUCTION AND HYPOTHESIS: Previous studies have found high prevalence rates of anxiety and depression in women with urinary incontinence (UI). This study investigates the prevalence in women who had turned to eHealth for treatment of UI and identifies possible factors associated with depression. METHODS: We analyzed data from two randomized controlled trials evaluating eHealth treatment for UI, including 373 women with stress UI (SUI), urgency UI (UUI), or mixed UI (MUI). We used the Hospital Anxiety and Depression Scale (HADS) and defined a score of ≥8 as depression or anxiety. The ICIQ-UI-SF questionnaire was used to score incontinence severity. Logistic regression was used to determine factors associated with depression and anxiety. RESULTS: Women with UUI or MUI were older than women with SUI, mean age 58.3 vs 48.6 years (p = <0.001). Four out of five participating women had a university education. The prevalence of anxiety and depression in women with SUI was 12.4% and 3.2% respectively. In women with MUI/UUI, 13.8% had anxiety and 10.6% had depression. In multivariate analyses, the odds ratio of having depression was 4.2 (95% CI = 1.4-12.3) for women with MUI/UUI compared with SUI when controlling for other risk factors. CONCLUSION: The odds of depression in women with MUI/UUI were increased compared with SUI. The prevalence of anxiety and depression was considerably lower than reported in large cross-sectional surveys. Socioeconomic differences may partly explain this finding, as the use of eHealth still is more common among highly educated women.

'Social health', 'physical health', and well-being: Analysing with bourdieusian concepts the interplay between the practices of heavy drinking and exercise among young people.

BACKGROUND: The article examines the interplay between the practices of heavy drinking and exercise among young people. The comparison helps to clarify why young people are currently drinking less than earlier and how the health-related discourses and activities are modifying young people's heavy drinking practices. METHODS: The data is based on interviews (n = 56) in Sweden among 15-17-year-olds and 18-19-year-olds. By drawing on Pierre Bourdieu's concepts of habitus, field, and capital, we examine what kinds of resources young people accumulate in the fields of heavy drinking and exercise, how these resources carry symbolic value for distinction, and what kind of health-related habitus they imply. RESULTS: The analysis shows that young people's practices in the social spaces of intoxication and exercise are patterned around the 'social health' and 'physical health' approaches and shaped by gendered binaries of masculine dominance. The 'physical health' approach values capable, high-performative, and attractive bodies, whereas the 'social health' approach is oriented towards accumulating social capital. The analysis demonstrates that these approaches affect the interviewees' everyday life practices so that the 'physical health' approach has more power over the 'social health' approach in transforming them. CONCLUSION: As the 'physical health' approach appears to modify young people's practices of drinking to be less oriented to intoxication or away from drinking, this may partly explain why young people are drinking less today than earlier. Compared to drinking, the physical health-related social spaces also seem to provide more powerful arenas within which to bolster one's masculine and feminine habitus. This further suggests that intoxication may have lost its symbolic power among young people as a cool activity signalling autonomy, maturity, and transgression of norms.

Online gambling venues as relational actors in addiction: Applying the actor-network approach to life stories of online gamblers.

BACKGROUND: With the emerging technologies of the Internet and smartphones during the last decades, the gambling environment has undergone a massive transformation. In Sweden, and Europe in general, online gambling has more than doubled since 2007. METHOD: The paper studies online gambling venues (OGVs) as relational actors of addiction. By drawing on the actor-network theory (ANT) and assemblage thinking, we examine how OGVs, as actors in specific networks of attachment, enable the development of gambling addiction and facilitate its continuation. The data consists of life story interviews with 34 online gamblers. RESULTS: Online gambling venues extend the scope of gambling opportunities through space, providing an easy portable 24-hours-a-day access to gambling online and on smartphones. This increases the spatial mobility of gambling to diverse contexts. By linking gambling to more unpredictably evolving patterns of relations, online gambling venues also increase gambling's temporal mobility to intrude in the habitual trajectories of everyday life. By enhancing the gambling mobility through space and time, OGVs simultaneously extend the scope of situations in which gambling may transform from a controlled activity into an addiction. It is then that the actor-networks of gambling infiltrate in the actor-networks of work, domestic life and leisure, and start to feed processes where they are translated to serve the interests of gambling. CONCLUSION: By giving us tools to challenge simplistic and taken-for-granted explanations of gambling addiction and by allowing us to grasp the flux and changing nature of addiction as a relational pattern of heterogeneous contextual attachments, the actor-network theory can help us to understand the complexity and multiplicity of gambling problems. The knowledge on what kinds of contextual attachments in diverse actor-networks enable harmful gambling and sustain unhealthy relations helps practitioners to focus treatment interventions especially on these contextual linkages and their configurations.

Self-management of stress urinary incontinence: effectiveness of two treatment programmes focused on pelvic floor muscle training, one booklet and one Internet-based.

Objectives: In a previous study, self-management of stress urinary incontinence (SUI), via an Internet-based programme or a booklet improved symptoms and quality of life. We wanted to evaluate the effectiveness of these programmes when implemented for free use, as well as to characterize the users. Design: Pragmatic prospective cohort study. Setting and subjects: Information about the Internet programme and the booklet was provided at www.tät.nu and by nurse midwives. Both programmes included a three-month pelvic floor muscle training (PFMT) programme. Questionnaires were used at the start and after three months. Main outcome measures: Characteristics of the participants regarding age and education. Reductions in symptom severity was measured using the validated ICIQ-UI SF. Results: 109 women using the booklet, and 166 women using the Internet-based programme responded to the pre-treatment questionnaire. Of these, 53 (48.6%) in the booklet group and 27 (16.3%) in the Internet group responded to the follow-up. The mean age of booklet users was higher, 59.4 years vs. 54.5 years (p = .005). The proportion of women with post-secondary education was high, 59% in the booklet group and 67% in the Internet group. The mean reduction in the symptom score was 2.6 points (SD 3.4) in the booklet group, and 3.4 (SD 2.9) in the Internet group. These reductions were significant within both groups, with no difference between the groups, and in the same order of magnitude as in the previous randomised controlled study. Conclusion: Two self-management programmes for SUI, one provided as a booklet and one as an Internet-based programme, also rendered clinically relevant improvements when made freely available. KEY POINTS Female stress urinary incontinence can be treated using self-management programmes focused on pelvic floor muscle training. This study evaluates the effect of two different programmes, one provided as a booklet and one Internet-based, when made freely available to the public. •Both programmes rendered clinically relevant improvements, in the same order of magnitude as in the previous randomised controlled study. •Self-management of stress urinary incontinence should be recommended to women that request treatment.

User Experience of an App-Based Treatment for Stress Urinary Incontinence: Qualitative Interview Study.

BACKGROUND: Stress urinary incontinence (SUI) affects 10%-39% of women. Its first-line treatment consists of lifestyle interventions and pelvic floor muscle training (PFMT), which can be performed supervised or unsupervised. Health apps are increasing in number and can be used to improve adherence to treatments. We developed the Tät app, which provides a 3-month treatment program with a focus on PFMT for women with SUI. The app treatment was evaluated in a randomized controlled trial, which demonstrated efficacy for improving incontinence symptoms and quality of life. In this qualitative interview study, we investigated participant experiences of the app-based treatment. OBJECTIVE: This study aimed to explore women's experiences of using an app-based treatment program for SUI. METHODS: This qualitative study is based on telephone interviews with 15 selected women, with a mean age of 47 years, who had used the app in the previous randomized controlled trial. A semistructured interview guide with open-ended questions was used, and the interviews were transcribed verbatim. Data were analyzed according to the grounded theory. RESULTS: The results were grouped into three categories: "Something new!" "Keeping motivation up!" and "Good enough?" A core category, "Enabling my independence," was identified. The participants appreciated having a new and modern way to access a treatment program for SUI. The use of new technology seemed to make incontinence treatment feel more prioritized and less embarrassing for the subjects. The closeness to their mobile phone and app features like reminders and visual graphs helped support and motivate the women to carry through the PFMT. The participants felt confident that they could perform the treatment program on their own, even though they expressed some uncertainty about whether they were doing the pelvic floor muscle contractions correctly. They felt that the app-based treatment increased their self-confidence and enabled them to take responsibility for their treatment. CONCLUSIONS: Use of the app-based treatment program for SUI empowered the women in this study and helped them self-manage their incontinence treatment. They appreciated the app as a new tool for supporting their motivation to carry through a slightly challenging PFMT program. TRIAL REGISTRATION: ClinicalTrials.gov NCT01848938; https://clinicaltrials.gov/ct2/show/NCT01848938 (Archived by WebCite at https://clinicaltrials.gov/ct2/show/NCT01848938).

Gamblers' (mis-)interpretations of Problem Gambling Severity Index items: Ambiguities in qualitative accounts from the Swedish Longitudinal Gambling Study.

The Problem Gambling Severity Index (PGSI) is a screening instrument frequently used to identify risk and problem gambling. Even though the PGSI has good psychometric properties, it still produces a large proportion of misclassifications. AIMS: To explore possible reasons for misclassifications in problem gambling level by analysing previously classified moderate-risk gamblers' answers to the PGSI items, in relation to their own current and past gambling behaviours. METHODS: Semi-structured telephone interviews were conducted with 19 participants reporting no negative consequences from gambling. They were asked the PGSI questions within an eight-year time frame (2008 to 2016). Ambiguous answers to PGSI items were subject to content analysis. RESULTS: Several answers to the PGSI items contained ambiguities and misinterpretations, making it difficult to assess to what extent their answers actually indicated any problematic gambling over time. The item about feelings of guilt generated accounts rather reflecting self-recrimination over wasting money or regretting gambling as a meaningless or immoral activity. The item concerning critique involved mild interpretations such as being ridiculed for buying lottery tickets or getting comments for being boring. Similar accounts were given by the participants irrespective of initial endorsement of the items. Other possible reasons for misclassifications were related to recall bias, language difficulties, selective memory, and a tendency to answer one part of the question without taking the whole question into account. CONCLUSIONS: Answers to the PGSI can contain a variety of meanings based on the respondents' subjective interpretations. Reports of lower levels of harm in the population should thus be interpreted with caution. In clinical settings it is important to combine use of screening instruments with interviews, to be able to better understand gamblers' perceptions of the gambling behaviour and its negative consequences.

Why are young people drinking less than earlier? Identifying and specifying social mechanisms with a pragmatist approach.

Recent surveys have found a strong decrease in alcohol consumption among young people and this trend has been identified in European countries, Australia and North America. Previous research suggests that the decline in alcohol consumption may be explained by changes in parenting style, increased use of social media, changes in gender identities or a health and fitness trend. We use qualitative interviews with drinking and non-drinking young people from Sweden (N = 49) to explore in what way and in what kinds of contexts these explanations may hold true and how they alone or together may explain declining alcohol consumption among young people. By using the pragmatist approach, we pay attention to what kinds of concerns, habits, practices, situations and meanings our interviewees relate to adolescents' low alcohol consumption or decline in drinking. By analyzing these matters, we aim to specify the social mechanisms that have reduced adolescents' drinking. Our paper discovers social mechanisms similar to previous studies but also a few that have previously been overlooked. We propose that the cultural position of drinking may have changed among young people so that drinking has lost its unquestioned symbolic power as a rite of passage into adulthood. There is less peer pressure to drink and more room for competing activities. This opening of a homogeneous drinking culture to the acceptance of differences may function as a social mechanism that increases the success of other social mechanisms to reduce adolescents' drinking. Furthermore, the results of the paper suggest a hypothesis of the early maturation of young people as more individualized, responsible, reflective, and adult-like actors than in earlier generations. Overall, the paper provides hypotheses for future quantitative studies to examine the prevalence and distribution of the identified social mechanisms, as well as recommends directions for developing effective interventions to support young people's healthy lifestyle choices.