Significant differences in the adjusted risk of stress incontinence among Hispanic, white, black and Asian-American women suggest the presence of additional, as yet unrecognized, risk or protective factors for stress incontinence.

Purpose-We compared the prevalence of urinary incontinence by type among white, black, Hispanic and Asian-American women.Materials and Methods-The RRISK is a population based cohort study of 2,109 randomly selected middle-aged and older women. Incontinence and other variables were assessed by self-report questionnaires and in person interviews. Labor and delivery and surgical data were abstracted from medical records archived since 1946. Logistic regression was used to estimate the OR with 95% CIs for incontinence while adjusting for covariates.Results-The age adjusted prevalence of weekly incontinence was highest among Hispanic women, followed by white, black and Asian-American women (36%, 30%, 25% and 19%, respectively, p >0.001). Type of incontinence also differed among groups, with weekly stress incontinence prevalence being 18%, 15%, 8% and 8% (p >0.001), and weekly urge incontinence prevalence being 10%, 9%, 14% and 7% (p >0.001). After adjustment for age, parity, hysterectomy, estrogen use, body mass, menopausal status and diabetes, the risk of stress incontinence remained significantly lower in black (adjusted OR 0.36, 95% CI 0.23-0.57) and Asian-American (adjusted OR 0.54, 95% CI 0.34-0.86) women compared to white women. In contrast, the risk of urge incontinence was similar in black (adjusted OR 1.19, 95% CI 0.79-1.81) and Asian-American (adjusted OR 0.86, 95% CI 0.52-1.43) women compared to white women.Conclusions-Significant differences in the adjusted risk of stress incontinence among Hispanic, white, black and Asian-American women suggest the presence of additional, as yet unrecognized, risk or protective factors for stress incontinence.

Background The ‘Primary HIV Prevention among Pregnant and Lactating Ugandan Women’ (PRIMAL) study aimed to assess the effectiveness of an enhanced HIV counseling intervention for preventing HIV acquisition among HIV-uninfected mothers during pregnancy and throughout the breastfeeding period. Methods We conducted an unblinded randomized control trial between 22 February 2013 and 22 April 2016 to assess the effectiveness of an extended repeat HIV testing and enhanced counseling (ERHTEC) intervention aimed at preventing primary HIV infection among HIV-uninfected pregnant and lactating women in Uganda. HIV-uninfected pregnant women aged 15–49 were enrolled 1:1 individually or in couples together with their partner. Enrolled women and couples were randomized 1:1 to an intervention (ERHTEC) or control (extended repeat HIV testing and standard counseling) group and followed up to 24 months postpartum or six weeks past complete cessation of breastfeeding, whichever came first. Both groups were tested for sexually transmitted infections (STIs) and HIV at enrollment, delivery, 3 and 6 months postpartum and every 6 months thereafter until the end of follow-up. The intervention group received enhanced HIV prevention counseling every 3 months throughout follow-up. The control group received standard counseling at the time of HIV retesting. Both intervention and control couples were offered couple HIV testing and counseling at all study visits. Main outcome measures Frequency of condom use and incidence of HIV, syphilis, gonorrhea, chlamydia and trichomoniasis over follow-up. Results Between February 2013 and April 2014, we enrolled 820 HIV-uninfected pregnant women presenting for antenatal care individually (n = 410) or in couples (n = 410 women and 410 partners) in one urban and one rural public Ugandan hospital. Women’s median age was 24 years (IQR 20–28 years). At baseline, participants did not differ in any socio-demographic, reproductive health, HIV testing history, sexual behavior, medical history or STI status characteristics; 96% (386/402) of couples were tested and counseled for HIV together with their partners at enrolment, 2.1% (7/329) of whom were found to be HIV-infected. Six hundred twenty-five (76%) women completed follow-up as per protocol ( S1 Protocol ). Women were followed for an average of 1.76 years and cumulated 1,439 women-years of follow-up or 81% of the maximum 1,779 women-years of follow-up assuming no dropouts. Men were followed for an average of 1.72 years. The frequency of consistent condom use and the proportion of women who used condoms over the last 3 months or at last vaginal sex increased substantially over follow-up in both arms, but there were no statistically significant differences in increases between the intervention and control arms. During follow-up, on average 42% (range 36%-46%) of couple partners were counseled together. Betwe...

Key Points Question Are adverse pregnancy outcomes independently associated with the development of heart failure among postmenopausal women? Findings In this cohort study including 10 292 Women’s Health Initiative participants, hypertensive disorders of pregnancy were independently associated with incident heart failure, particularly heart failure with preserved ejection fraction, in postmenopausal women. Meaning These findings suggest that hypertensive disorders of pregnancy are sex-specific factors associated with risk of heart failure, particularly heart failure with preserved ejection fraction.

The optoelectronic tweezer assay can distinguish viable from nonviable nonmotile viable sperm with sensitivity comparable to that of the trypan blue assay and equal specificity. Optoelectronic tweezers are a promising means of selecting sperm for intracytoplasmic sperm injection.

regarding the reanalysis of his 2003 JBMR paper.(2) The allegations that the study sponsor withheld data and did not allow all authors full access to the raw data are serious and clearly deserve a detailed response. However, the reanalysis raises a number of issues. We commend the authors for supplementing the smoothed curves with decile analyses but are mystified why Tables 1 and 2 in the response show incident vertebral fracture rates from the risedronate and placebo groups combined, because the decile cut-points for the two treatment groups must differ, and the relationship between change in bone turnover and fracture in the placebo group is not relevant. Even if a statistically significant interaction with treatment group assignment is not found, the decile analyses of the risedronate and placebo groups should be displayed and analyzed separately (as alluded to in the Appendix). Inferences about optimal thresholds and nonlinear relationships, including the statements that critical thresholds were observed at a "CTX reduction of 51%" and at an on-therapy "CTX T-score of 0," may be incorrect if derived from pooled risedronate and placebo group data. This issue is particularly concerning given that, among risedronate-treated women, only 36 suffered a new vertebral fracture.(2) Furthermore, no data are presented to support the statement in the Appendix that on-therapy measurement of bone turnover is "a better measure of future fracture" than short-term changes in bone turnover. As pointed out in the accompanying Editorial, (3) it is unfortunate that the authors of the response did not comment on the observed inconsistencies between their revised N-terminal cross-linking telopeptide of type I collagen (NTX) and Cterminal cross-linking telopeptide of type 1 collagen (CTX) results, nor do they describe any reanalysis of nonspine fracture data. Last, we believe that the results of the revised analyses should be considered in the context of more recent data from larger antiresorptive trials that do not support a nonlinear relationship between short-term changes in bone turnover and subsequent fracture incidence.

Background:Physical activity(PA) has been identified as an effective depression treatment.However, knowledge on how variation in day-to-day PA relates to depression is lacking. Purpose:The purposes of this cross-sectional analysis were to 1) compare overall objectively measured baseline daily steps and duration of moderate to vigorous PA (MVPA) and 2) examine differences in steps and MVPA on days of the week between women with high and low depressive symptoms, enrolled in the mobile phone based physical activity education (mPED) trial.Methods:The Center for Epidemiological Studies Depression Scale was used to categorize low and high depressive symptom groups.We used linear mixed-effects models to examine the associations between steps and MVPA and depression-status both overall and by day of the week,adjusting for selected demographic variables and their interactions with day of the week.Results:275 women were included in the final analysis, of which 217 had low and 58 had high depressive symptoms. We found that day of the week modified the associations of depression with both daily steps and MVPA. Women with high depressive symptoms were characterized by reduced activity at the end of the week (Friday: 832 fewer steps, 95% CI:116 to 1548, p=0.023; 8.9 lower MVPA, 95% CI:2.2 to 15.5, p=0.009), whereas women with low depression showed an increase in physical activity.Conclusions:Day of the week might be an important target for personalization of physical activity interventions. Future work should evaluate potential causes of alterations in daily activity patterns in depression.Trial RegistrationClinicalTrials.gov#:NCTO1280812registered January 21, 2011

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