IMPORTANCE Pelvic floor disorders (eg, urinary incontinence), which affect approximately 25% of women in the United States, are associated with childbirth. However, little is known about the course and progression of pelvic floor disorders over time. OBJECTIVE To describe the incidence of pelvic floor disorders after childbirth and identify maternal and obstetrical characteristics associated with patterns of incidence 1 to 2 decades after delivery. DESIGN, SETTING, AND PARTICIPANTS Women were recruited from a community hospital for this cohort study 5 to 10 years after their first delivery and followed up annually for up to 9 years. Recruitment was based on mode of delivery; delivery groups were matched for age and years since first delivery. Of 4072 eligible women, 1528 enrolled between October 2008 and December 2013. Annual follow-up continued through April 2017. EXPOSURES Participants were categorized into the following mode of delivery groups: cesarean birth (cesarean deliveries only), spontaneous vaginal birth (Ն1 spontaneous vaginal delivery and no operative vaginal deliveries), or operative vaginal birth (Ն1 operative vaginal delivery). MAIN OUTCOMES AND MEASURES Stress urinary incontinence (SUI), overactive bladder (OAB), and anal incontinence (AI), defined using validated threshold scores from the Epidemiology of Prolapse and Incontinence Questionnaire, and pelvic organ prolapse (POP), measured using the Pelvic Organ Prolapse Quantification Examination. Cumulative incidences, by delivery group, were estimated using parametric methods. Hazard ratios, by exposure, were estimated using semiparametric models. RESULTS Among 1528 women (778 in the cesarean birth group, 565 in the spontaneous vaginal birth group, and 185 in the operative vaginal birth group), the median age at first delivery was 30.6 years, 1092 women (72%) were multiparous at enrollment (2887 total deliveries), and the median age at enrollment was 38.3 years. During a median follow-up of 5.1 years (7804 person-visits), there were 138 cases of SUI, 117 cases of OAB, 168 cases of AI, and 153 cases of POP. For spontaneous vaginal delivery (reference), the 15-year cumulative incidences of pelvic floor disorders after first delivery were as follows: SUI, 34.3% (95% CI, 29.9%-38.6%); OAB, 21.8% (95% CI, 17.8%-25.7%); AI, 30.6% (95% CI, 26.4%-34.9%), and POP, 30.0% (95% CI, 25.1%-34.9%). Compared with spontaneous vaginal delivery, cesarean delivery was associated with significantly lower hazard of SUI (adjusted hazard ratio [aHR], 0.46 [95% CI, 0.32-0.67]), OAB (aHR, 0.51 [95% CI, 0.34-0.76]), and POP (aHR, 0.28 [95% CI, 0.19-0.42]), while operative vaginal delivery was associated with significantly higher hazard of AI (aHR, 1.75 [95% CI, 1.14-2.68]) and POP (aHR, 1.88 [95% CI, 1.28-2.78]). Stratifying by delivery mode, the hazard ratios for POP, relative to a genital hiatus size less than or equal to 2.5 cm, were 3.0 (95% CI, 1.7-5.3) for a genital hiatus size of 3 cm and 9.0 (95% CI, 5.5-14.8) for a genital hiatus size greater than or equal to 3.5 ...

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Outcomes from this large RCT will provide the first robust evidence of the effect of service brokerage on health service utilisation and health outcomes for ex-prisoners.

Large wildfires that burn through the ''forest-residential intermix'' are complex events with a variety of social impacts. This study looks at three northern Arizona community clusters directly affected by the 2002 Rodeo-Chediski fire. Our analysis suggests that the fire event led to both the emergence of cohesion and conflict in the study area. Community cohesion was evident as residents ''pulled together'' to rebuild their communities. Examples of cohesion included managers of local businesses staying during evacuation to provide for the needs of firefighters, providing shelter and cleanup help for burned-out neighbors, and the emergence of locally based assistance groups. Several types of conflict rooted in blaming and distribution of firefighting and disaster assistance resources were found: cultural, local versus federal, community versus community, intracommunity, and environmental. We suggest that these responses are most usefully understood using the lenses of social psychology (attribution theory) together with sociology (structuration theory). Issues and dynamics that resulted in controversy or were seen as locally constraining and those that resulted in cohesion tended to relate to specific local impacts and how outsider actions were either consonant or dissonant with the application of local knowledge, local autonomy, and locally desirable outcomes.

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ABSTRACT. Prompted by a series of increasingly destructive, expensive, and highly visible wildfire crises in human communities across the globe, a robust body of scholarship has emerged to theorize, conceptualize, and measure community-level resilience to wildfires. To date, however, insufficient consideration has been given to wildfire resilience as a process of adaptive governance mediated by institutions at multiple scales. Here we explore the possibilities for addressing this gap through an analysis of wildfire resilience among wildland-urban interface communities in the western region of the United States. We re-engage important but overlooked components of social-ecological system resilience by situating rural communities within their state-to national-level institutional contexts; we then analyze two communities in Nevada and New Mexico in terms of their institutional settings and responses to recent wildfire events. We frame our analysis around the concepts of scale matching, linking within and across scales, and institutional flexibility.

The lack of knowledge regarding social diversity in the Wildland Urban Interface (WUI) or an in-depth understanding of the ways people living there interact to address common problems is concerning, perhaps even dangerous, given that community action is necessary for successful wildland fire preparedness and natural resource management activities. In this article, we lay out the knowledge and preliminary case study evidence needed to begin systematically documenting the differing levels and types of adaptive capacity WUI communities have for addressing collective problems such as wildland fire hazard. In order to achieve this end, we draw from two theoretical perspectives encompassing humans' interactions with their environment, including (1) Kenneth Wilkinson's interactional approach to community, (2) and certain elements of place literature. We also present case study research on wildfire protection planning in two drastically different California communities to illustrate how social diversity influences adaptive capacity to deal with hazards such as wildland fire. These perspectives promote an image of the WUI not as a monolithic entity but a complex mosaic of communities with different needs and existing capacities for wildland fire and natural resource management.