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ObjetivoDeterminar, en un período de 5 años, la prevalencia, la incidencia, la remisión, los patrones de cambio de la incontinencia urinaria (IU) y los factores asociados con los cambios en el estatus de continencia.DiseñoEstudio longitudinal prospectivo.EmplazamientoZona Básica de Salud de Cabra (Córdoba).ParticipantesUn total de 827 sujetos seleccionados en 1996 entre 5.139 personas ≥65 años mediante muestreo aleatorio estratificado por grupos de edad y seguidos entre 1996 y 2001.IntervencionesEncuesta domiciliaria.Mediciones.Preguntas sobre detección y severidad de la IU, datos sociodemográficos y valoración funcional. Se analizaron las variables explicativas para la probabilidad de estar vivo y desarrollar IU a los 5 años, respectivamente.ResultadosLa prevalencia de IU fue del 36% en 1996 y del 46% en 2001. La mortalidad fue similar en continentes eincontinentes. El 54,5% de los sujetos continentes en 1996 permaneció igual en 2001. Las tasas de incidencia y remisión alos 5 años fueron del 29 y 15%, respectivamente. En ambos sexos, la incontinencia ligera y moderada evolucionó principalmente hacia grados moderados y severos, mientras que la IU severa permaneció sin cambios en el 40,1%. La autopercepción de salud y la situación funcional son las principales variables queinfluyen tanto en la supervivencia como en la incidencia de IU.ConclusionesLa prevalencia de IU es alta, la incidencia es moderada y la remission espontánea baja. La IU es un problema dinámico y no afecta la mortalidad. Eldeterioro de la movilidad influye fuertemente en la incidencia de IU.ObjectiveTo determine prevalence, incidence and remission rates and change patterns of urinary incontinence (UI) over a 5-year time span.DesignLongitudinal study.LocationBasic Health Zone of Cabra (Córdoba).PatientsA random age-stratified sample of 827 subjects selected from a total of 5139 persons ≥65 years of age and followed up between 1996 and 2001.InterventionsHome interview.MeasurementsQuestions about detection and level of severity of UI, sociodemographic data, and level of functioning. Two logistic regression models were created to identify risk factors for the probability to be alive and to develop UI, respectively.ResultsUI prevalence reached 36% at baseline and 46% five years later. Mortality rates were similar in continent and incontinent subjects. 54.5% of continent subjects in 1996 remained so in 2001. Five-year incidence and remission rates were 29% and 15%, respectively. In both sexes, slight and moderate incontinence mainly progressed to moderate and severe degrees, whereas severe UI remained unchanged in 40.1%. The main risk factors for increased survival and for UI incidence were self-rated health and level of functioning.ConclusionsPrevalence of UI is high, incidence is moderate and remission is low. Urinary incontinence is a dynamic problem and does not affect mortality. Impaired mobility has a strong influence on UI incidence.

OBJECTIVE To determine prevalence, incidence and remission rates and change patterns of urinary incontinence (UI) over a 5-year time span. DESIGN Longitudinal study. LOCATION Basic Health Zone of Cabra (Cordoba). PATIENTS A random age-stratified sample of 827 subjects selected from a total of 5139 persons > or = 65 years of age and followed up between 1996 and 2001. INTERVENTIONS Home interview. MEASUREMENTS Questions about detection and level of severity of UI, sociodemographic data, and level of functioning. Two logistic regression models were created to identify risk factors for the probability to be alive and to develop UI, respectively. RESULTS UI prevalence reached 36% at baseline and 46% five years later. Mortality rates were similar in continent and incontinent subjects. 54.5% of continent subjects in 1996 remained so in 2001. Five-year incidence and remission rates were 29% and 15%, respectively. In both sexes, slight and moderate incontinence mainly progressed to moderate and severe degrees, whereas severe UI remained unchanged in 40.1%. The main risk factors for increased survival and for UI incidence were self-rated health and level of functioning. CONCLUSIONS Prevalence of UI is high, incidence is moderate and remission is low. Urinary incontinence is a dynamic problem and does not affect mortality. Impaired mobility has a strong influence on UI incidence.

ObjetivoConocer la frecuencia con que las personas ancianas con incontinencia urinaria (IU) comunican este problema a los profesionales de atención primaria, las variables asociadas a la no comunicación y los hábitos diagnósticos y terapéuticos de dichos profesionales.DiseñoEstudio transversal.EmplazamientoZona Básica de Salud de Cabra (Córdoba).PacientesUn total de 869 seleccionados entre 5.139 personas de ≥ 65 años mediante muestreo aleatorio estratificado por grupos de edad.IntervencionesEncuesta domiciliaria.MedicionesCuestionario propio con preguntas sobre la comunicación de la incontinencia a los sanitarios y sobre el cribado rutinario y la evaluación diagnóstica y terapéutica de la incontinencia por dichos profesionales. Modelo de regresión logística para identificar los factores explicativos de la búsqueda de ayuda profesional.ResultadosUn 32% de los 330 incontinentes del estudio comunicó su problema a los sanitarios y el 68% restante no lo hizo, porque en su mayoría piensan que la incontinencia tiene escasa importancia y/o que ocurre con la vejez. Los factores explicativos de la comunicación fueron la frecuencia, la duración y el impacto de la incontinencia, y la dependencia en el autocuidado. Los médicos habían investigado rutinariamente la existencia de incontinencia en un 10% de los 827 encuestados. En uno de cada 5 incontinentes el médico no adoptó ninguna medida diagnóstica ni terapéutica.ConclusionesLa búsqueda de ayuda médica para la IU fue escasa y depende de variables relacionadas con la percepción en los cambios de los síntomas. El diagnóstico y el tratamiento que realizan los profesionales es subóptimo. La severidad de la IU condiciona el diagnóstico y el tratamiento.ObjectiveTo investigate the frequency in which aged people who suffers on urinary incontinence (UI) talk about this problem with primary care professionals, variables related to no healthcare-seeking as well as diagnostic and therapeutic habits of these professionals.DesignCross-sectional study.LocationBasic Health Zone of Cabra (Córdoba, Spain).PatientsA random age-stratified sample of 869 patients selected from a total of 5139 persons ≥ 65 years of age.InterventionsHome interview.MeasurementsProper questionnaire with questions about reporting of incontinence to health professionals and the procedures used for routine screening as well as diagnostic and therapeutic assessment of incontinence. A logistic regression model was elaborated to identify explanatory factors for reporting incontinence to healthcare professionals.ResultsOf 330 incontinents, only 32% reported their problem to healthcare professionals. The remaining 68% did not report their incontinence because most thought it was a minor problem and/or part of the ageing process. The explanatory factors for seeking medical help were the frequency, duration and impact of incontinence, and dependence in self-care. Physicians performed routine screening for incontinence in 10% of 827 inquired aged. In 1 out of 5 incontinents, the physician did not take any diagnostic or therapeutic measures.ConclusionsSeeking of UI medical help was very limited and depends on variables related to perception in symptom’s changes. Diagnosis and treatment done by professionals was suboptimal. Severity of UI conditions diagnosis and treatment.

Low expected frequencies in tests associated to log-linear models building are treated with the aim of providing a methodology, useful for nonstatistician users, to analyse multivariate contingency tables. A procedure that reproduces the decisions of a statistical analyst studying a multivariate contingency table and confronted with low expected frequencies is provided, using the Bayesian information criterion to select a variable over which the aggregation should be done, and the entropy of Shannon to decide which categories should be aggregated. Prior opinions and knowledge about the feasibility of aggregation of categories within the context where the data have been collected are included in the system. The procedure has some user friendly techniques oriented to nonstatisticians, and it allowed greater efficiency when there are several multivariate tables to be analysed using some variables that can be included in different log-linear models.

From January 1978 to December 1987 we operated on 135 patients with calcified mitral stenosis. In 60 patients a conservative operation was performed (group I). Nine patients required mitral annuloplasty associated with the commissurotomy. The other 75 patients underwent mitral valve replacement (group II). In 37 patients a mechanical prosthesis was used and in 38 a biologic one. The patients given mitral valve replacement had a more heavily calcified valve than those undergoing a conservative procedure. Twenty-one patients (12 from group I and 13 from group II) required associated tricuspid annuloplasty. The mean follow-up time was 69.1 months (1 months to 10 years). There were no significant differences between the two groups in terms of operative death (0% and 4%, respectively), postoperative functional class, actuarial survival rate at 10 years (84% and 96%, respectively), and probability of freedom from thromboemboli at 10 years (98% and 96%, respectively). However, the probability of freedom from reoperation at 10 years significantly favored the conservative surgery group (84% and 69%, respectively, p less than 0.01). Finally, the probability of freedom from complications at 10 years was also significantly higher in the conservative surgery group (82% and 64%, respectively, p less than 0.005). Because of these results we believe that conservative surgery is, at present, a better alternative than mitral valve replacement for patients with partially calcified mitral stenosis.