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OBJECTIVE To evaluate the prevalence and severity of urinary incontinence (UI) in women who participate in CrossFit classes compared with women who participate in non-CrossFit group fitness classes. METHODS The authors conducted a cross-sectional study of women who participate in either CrossFit or non-CrossFit group fitness classes using an online survey. Participants provided demographic information and completed the Incontinence Severity Index and Urinary Distress Inventory. Participants were recruited from local CrossFit and non-CrossFit gyms, online via social media, and an electronic CrossFit Newsletter. Associated comorbidities, exercises associated with UI, and coping mechanisms for urinary leakage were also assessed. RESULTS Four hundred twenty-three women meeting inclusion criteria completed the survey, including 322 CrossFit participants and 101 non-CrossFit participants. We found that CrossFit participants were older than non-CrossFit participants and more likely to self-identify as non-Hispanic white. CrossFit participants more commonly reported UI (84% vs 48%, P =

To evaluate the prevalence and severity of urinary incontinence (UI) in women who participate in CrossFit classes compared with women who participate in non-CrossFit group fitness classes.The authors conducted a cross-sectional study of women who participate in either CrossFit or non-CrossFit group fitness classes using an online survey. Participants provided demographic information and completed the Incontinence Severity Index and Urinary Distress Inventory. Participants were recruited from local CrossFit and non-CrossFit gyms, online via social media, and an electronic CrossFit Newsletter. Associated comorbidities, exercises associated with UI, and coping mechanisms for urinary leakage were also assessed.Four hundred twenty-three women meeting inclusion criteria completed the survey, including 322 CrossFit participants and 101 non-CrossFit participants. We found that CrossFit participants were older than non-CrossFit participants and more likely to self-identify as non-Hispanic white. CrossFit participants more commonly reported UI (84% vs 48%, P =0.001), higher severity of UI (Urinary Distress Inventory score: 20.8 vs 12.5, P0.001), and specifically more stress UI (73% vs 47%, P0.001). Weightlifting and jumping movements were the most common exercises associated with UI in CrossFit participants. Age and participation in CrossFit are significant and independent predictors of UI.More than 80% of CrossFit participants reported UI and half of these reported moderate-severe UI, as compared with women who participate in non-CrossFit classes, less than half of whom reported UI with a small minority reporting moderate-severe UI. Exercises most associated with UI were jumping and weightlifting.

Background: This study addresses the strength of associations between trichotillomania (TTM) and other DSM-IV Axis I conditions in a large sample (n = 2606) enriched for familial obsessive-compulsive disorder (OCD), to inform TTM classification. Methods: We identified participants with TTM in the Johns Hopkins OCD Family Study (153 families) and the OCD Collaborative Genetics Study, a six-site genetic linkage study of OCD (487 families). We used logistic regression (with generalized estimating equations) to assess the strength of associations between TTM and other DSM-IV disorders. Results: TTM had excess comorbidity with a number of conditions from different DSM-IV chapters, including tic disorders, alcohol dependence, mood disorders, anxiety disorders, impulse-control disorders, and bulimia nervosa. However, association strengths (odds ratios) were highest for kleptomania (6.6), pyromania (5.8), OCD (5.6), skin picking disorder (4.4), bulimia nervosa (3.5), and pathological nail biting (3.4). Conclusions: TTM is comorbid with a number of psychiatric conditions besides OCD, and it is strongly associated with other conditions involving impaired impulse control. Though DSM-5 includes TTM as an OCD-related disorder, its comorbidity pattern also emphasizes the impulsive, appetitive aspects of this condition that may be relevant to classification. Keywords: Comorbidity, classification, Impulse-control disorder, Obsessive-compulsive disorder, Trichotillomania

Objective The aim of this study was to identify smartphone Kegel and pelvic floor exercise applications (apps) and identify those with superior functionality, features, and accuracy. Methods We identified a complete list of Kegel and pelvic floor exercise applications by searching iTunes and Google Play stores for "pelvic floor," "pelvic floor exercises," "Kegel," and "Kegel exercises." We used a modified APPLICATIONS scoring system to evaluate all identified apps. Results We identified 120 apps related to Kegel exercises. Apps unrelated to the pelvic floor, unavailable in English, or duplicated on a separate platform were excluded from the analysis, leaving 90 unique apps. After a preliminary review, we excluded an additional 58 apps that were nonfunctional, required a biofeedback device, or intended for pregnant women. The final 32 apps included 15 paid and 17 free apps. Paid apps had higher rates of privacy features than free apps (80% vs 53%), used more images and figures (53% vs 41%), and were more likely to cite primary literature in their descriptions (33% vs 29%). Paid apps were also more likely to have tech support available (73% vs 53%). Overall score, however, was almost identical between the groups, with paid apps averaging 9.93 and free apps 9.41. The highest rated free and paid app both received a score of 12, consisting of Kegel Trainer and Kegel Trainer Pro, respectively. Conclusion The quality of the apps is markedly variable in both the paid and unpaid applications. Using the APPLICATIONS scoring system, the apps were very similar in overall quality and value.

Background Ovarian mature cystic teratomas (MCTs) rarely transform to primary primitive neuroectodermal tumors. This case report offers evidence that MCTs might have undetected microfoci of malignant neural tumors. Case We describe the case of a 12-year-old girl who presented with right-sided abdominal pain and distention. Intraoperative findings revealed a right ovarian MCT. However, pathology showed a 0.5-cm focus of malignant neural tumor within the 11-cm MCT. Summary and Conclusion This patient will need close follow-up with a multidisciplinary team because the clinical implications of this transformation has yet to be defined.