***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES To examine the relationship of urinary incontinence ( UI ) and depressive symptoms ( DS ) in older adults . DESIGN A r and omized , controlled trial to determine the effects of clinical practice guideline implementation on provider attitudes and behavior , and patients ' UI , health status , quality of life , and satisfaction with care . Baseline and endpoint data were collected from patients via computer-assisted telephone interviewing . SETTING Forty-one nonacademic primary care practice s ( PCP ) in North Carolina . PARTICIPANTS A total of 668 community-dwelling adults ( age > 60 ) who had visited the one of the selected PCPs . INTERVENTION PCPs in the intervention group were given instruction in the detection and management of UI , educational material s for providers and patients , office system supports , and academic detailing . MEASUREMENTS The dependent measure was assessed using an eight-item screener for DS . UI ( status , frequency , amount ) , health ( physical , mental ) , and demographic ( age , gender , marital status ) and self-report information about bladder control served as predictors . RESULTS Wilcoxon rank sum tests showed that UI status was associated with moderate to severe DS ( 43 % vs 30 % , P = .05 ) . Multivariate analyses showed that UI status , physical and mental health , and gender were significant predictors of DS . Among UI adults ( n = 230 ) , physical and mental health , life satisfaction , and the perception that UI interfered with daily life were significant predictors of DS . CONCLUSIONS This study provides clear evidence that UI is related to DS in older adults PURPOSE Initial weight loss improves urinary incontinence in overweight and obese women . In this study we examined the longer term effects of a weight loss intervention on urinary incontinence . MATERIAL S AND METHODS Overweight and obese women ( mean + /- SD age 53 + /- 10 years ) with 10 or more urinary incontinence episodes weekly were r and omized to an 18-month behavioral weight loss intervention ( 226 ) or control group ( 112 ) . Outcome measures were collected at 12 and 18 months . RESULTS At baseline women had a mean body mass index of 36 + /- 6 kg/m(2 ) and reported a mean of 24 + /- 18 incontinence episodes weekly . Of the patients 86 % completed 18-month measurements . The percent weight loss in the intervention group averaged 8.0 % , 7.5 % and 5.5 % at 6 , 12 and 18 months , respectively , vs approximately 1.5 % in the control group ( all values p < 0.001 ) . Compared with controls at 12 months the intervention group reported a greater percent reduction in weekly stress urinary incontinence episodes ( 65 % vs 47 % , p < 0.001 ) , and a greater proportion achieved at least a 70 % decrease in weekly total and stress urinary incontinence episodes . At 18 months a greater proportion of women in the weight loss intervention group had more than 70 % improvement in urge incontinence episodes but there were no significant differences between the groups for stress or total urinary incontinence . The intervention group also reported greater satisfaction with changes in urinary incontinence than the control group at 6 , 12 and 18 months . CONCLUSIONS Weight loss intervention reduced the frequency of stress incontinence episodes through 12 months and improved patient satisfaction with changes in incontinence through 18 months . Improving weight loss maintenance may provide longer term benefits for urinary incontinence OBJECTIVES To determine whether a multifaceted intervention based on the Agency for Health Care Policy and Research ( AHCPR ) Clinical Practice Guidelines for Urinary Incontinence would increase primary care physician screening for and management of urinary incontinence ( UI ) . DESIGN Group r and omized trial , conducted from 1996 to 1997 . SETTING Internal medicine and family medicine community practice s. PARTICIPANTS Forty-one primary care practice s , including 57 physicians and their staff and 1,145 patients aged 60 and older . INTERVENTION Twenty of the 41 primary care practice s in North Carolina were r and omized to a composite intervention that included a 3-hour continuing medical education accredited course , training in management of UI , patient educational material s , and on-site physician and office support . The remaining 21 practice s served as " usual care " controls . Telephone surveys of UI status and quality of life were obtained from 1,145 patients before the intervention . At 1 year , patients and physicians were contacted by telephone and mail to determine the effect of the educational intervention . MEASUREMENTS Patients completed telephone surveys to assess screening for UI , UI status , treatment interventions , and quality of life . Physicians completed surveys related to UI treatment and practice patterns . RESULTS Baseline and endpoint telephone surveys were completed by 668 of 1,145 ( 58 % ) of patients , who were cared for by 45 physicians ( 10 internists , 35 family medicine ) .  Physician screening rates for UI were 22 % for those patients who did not report UI . UI was reported by 39.5 % of patients at baseline , of whom 30 % reported being asked about UI by their primary care physician during the study . Rates of assessment and management of existing UI were low in both the control and intervention groups . Additional historical question ing indicated that 54.2 % reported that they had ever undergone assessment , including history , urinalysis , or testing , or had had management of their UI by any physician . CONCLUSION Attempts at increasing screening and management of UI by primary care physicians using the AHCPR st and ardized guidelines using a multifaceted system of educational and logistical support were not successful . These guidelines may not be the best approach to treating UI in the primary care setting OBJECTIVES To report on the responsiveness testing and clinical utility of the 12-item Geriatric Self-Efficacy Index for Urinary Incontinence ( GSE-UI ) . DESIGN Prospect i ve cohort study . SETTING Six urinary incontinence ( UI ) outpatient clinics in Quebec , Canada . PARTICIPANTS Community-dwelling incontinent adults aged 65 and older . MEASUREMENTS The abridged 12-item GSE-UI , measuring older adults ' level of confidence for preventing urine loss , was administered to all new consecutive incontinent patients 1 week before their initial clinic visit , at baseline , and 3 months posttreatment . At follow-up , a positive rating of improvement in UI was ascertained from patients and their physicians using the Patient 's and Clinician 's Global Impression of Improvement scales , respectively . Responsiveness of the GSE-UI was calculated using Guyatt 's change index . Its clinical utility was determined using receiver operating curves . RESULTS Eighty-nine of 228 eligible patients ( 39.0 % ) participated ( mean age 72.6 + 5.8 , range 65 - 90 ) . At 3-month follow-up , 22.5 % of patients were very much better , and 41.6 % were a little or much better . Guyatt 's change index was 2.6 for patients who changed by a clinical ly meaningful amount and 1.5 for patients having experienced any level of improvement . An improvement of 14 points on the 12-item GSE-UI had a sensitivity of 75.1 % and a specificity of 78.2 % for detecting clinical ly meaningful changes in UI status . Mean GSE-UI scores varied according to improvement status ( P<.001 ) and correlated with changes in quality -of-life scores ( r=0.7 , P<.001 ) and reductions in UI episodes ( r=0.4 , P=.004 ) . CONCLUSION The GSE-UI is responsive and clinical ly useful OBJECTIVES To assess whether urinary incontinence ( UI ) and its severity are associated with poor self-rated health in a national sample of community-living older adults and whether this relationship persists after controlling for confounding attributable to functional status , comorbidity , and demographic factors . DESIGN A cross-sectional analysis using multivariate logistic regression . SETTING Subjects were from the 1990 - 1991 National Survey of Self-Care and Aging ( N = 3485 ) , a r and om sampling in geographic clusters of community-dwelling Medicare beneficiaries 65 years of age or older in the contiguous United States . MEASURES The responses to an interviewer-administered question naire regarding urinary incontinence , Basic Activities of Daily Living ( BADL ) , Instrumental Activities of Daily Living ( IADL ) , Mobility Activities of Daily Living ( MADL )  , age , gender , place of residence , race , education , need for proxy response to the survey , and number of medical conditions . RESULTS Unadjusted analysis showed the presence of urinary incontinence to be associated with poor self-rated health ( OR 2.7 , 2.1 - 3.3 ) . With gender , number of comorbid conditions , race , IADL impairment , and interaction terms of incontinence/race and incontinence/IADL in the final model , UI was associated with poor self-rated health in certain subgroups . White subjects with no IADL impairment and mild-moderate incontinence had an OR of 2.0 ( 95 % CI 1.5 - 2.9 ) and those with severe incontinence had an OR of 4.5 ( 95 % CI 2.4 - 8.4 ) of rating their health as poor , whereas those with no IADL impairment and no incontinence were the referent group . For those with a lot of difficulty performing one or more IADL activity , the association of UI and poor self-rated health was weak . For non-white subjects , there was no association , or a very weak association , of UI and poor self-rated health . CONCLUSION In this national sample , urinary incontinence was independently and positively associated with poor self-rated health after adjustment for age , comorbidity , and frailty for most community-dwelling older adults . This association between UI and poor self-rated health was weaker and statistically insignificant when IADL impairment was present or in non-white subjects . Further research is indicated to better underst and the impact of urinary incontinence in specific cultural setting BACKGROUND AND PURPOSE The effects of a home exercise program for persons with chronic peripheral neuropathies ( CPN ) have not been documented . We compared changes in impairment and health-related quality of life ( HRQL ) between exercise and control groups , investigated the relationship between HRQL and measures of impairment , and contrasted the HRQL of individuals with CPN to that previously described for the general population . SUBJECTS Twenty-eight subjects with CPN , aged 23 to 84 years ( mean = 56.2 , SD = 14.9 ) , completed the study . METHODS Impairment measures included average muscle score ( AMS ) , h and grip force , walking time , and forced vital capacity . The HRQL instrument measured the eight scales of the Medical Outcomes Study 36-Item Short-Form Health Survey ( SF-36 ) and the component scales . The exercise group ( n = 14 ) completed a 6-week home exercise program . The control group ( n = 14 ) did not participate in a home exercise program . RESULTS There was an increase in the AMS in the exercise group compared with the control group . No other between-group differences were found . The exercise group improved in scores on the role limitation scales of the SF-36 . The AMS and walking time were moderately correlated with the physical function scale of the SF-36 ( r = .55 and -.62 , respectively ) . The SF-36 scores of individuals with CPN were lower than scores previously described for the general population . CONCLUSION AND DISCUSSION The home exercise program appears to be an important component of the treatment of persons with CPN . Compared with the general population , patients with CPN appear to have a lower HRQL , but some areas appear to improve following a home exercise program OBJECTIVE Diabetes is associated with increased urinary incontinence risk . Weight loss improves incontinence , but exercise may worsen this condition . We examined whether an intensive lifestyle intervention or metformin therapy among overweight pre-diabetic women was associated with a lower prevalence of incontinence . RESEARCH DESIGN AND METHODS We analyzed data from the Diabetes Prevention Program , a r and omized controlled trial in 27 U.S. centers . Of the 1,957 women included in this analysis , 660 ( 34 % ) were r and omized to intensive lifestyle therapy  , 636 ( 32 % ) to metformin  , and 661 ( 34 % ) to placebo with st and ard lifestyle advice . The main outcome measure was incontinence symptoms by frequency and type by a vali date d question naire completed at the end-of-trial visit ( mean 2.9 years ) . RESULTS The prevalence of total ( stress or urge ) weekly incontinence was lower among women in the intensive lifestyle group ( 38.3 % ) than those r and omized to metformin ( 48.1 % ) or placebo ( 45.7 % ) . This difference was most apparent among women with stress incontinence ( 31.3 % for intensive lifestyle group vs. 39.7 % for metformin vs. 36.7 % for placebo , P = 0.006 ) . Changes in weight accounted for most of the protective effect of the intensive lifestyle intervention on stress incontinence . CONCLUSIONS Less-frequent urinary incontinence may be a powerful motivator for women to choose lifestyle modification to prevent diabetes AIMS Few studies have documented the effectiveness of continence promotion programs targeting older in 
    Output:
    
Women reported significant improvement in self-efficacy and incontinence-related quality of life .