Habit retraining for the management of urinary incontinence in adults (review)

Background
Habit retraining is toileting assistance given by a caregiver to adults with urinary incontinence. It involves the identification of an incontinent person's natural voiding pattern and the development of an individualised toileting schedule which pre-empts involuntary bladder emptying.

Objectives
To assess the effects of habit retraining for the management of urinary incontinence in adults.

Search strategy
We searched the Cochrane Incontinence Group specialised register (9 May 2002), MEDLINE (January 1966 to February 2004), EMBASE (January 1980 to Week 18-2002), CINAHL (January 1982 to February 2001), PsychINFO (January 1972 to August 2002), Biological Abstracts (January 1980 to December 2000), Current Contents (January 1993 to December 2001) and the reference lists of relevant articles. We also contacted experts in the field, searched relevant websites and hand searched journals and conference
proceedings.

Selection criteria
All randomised or quasi-randomised controlled trials comparing habit retraining delivered either alone or in conjunction with another intervention for urinary incontinence in adults.

Data collection and analysis
Data extraction and quality assessment were undertaken by at least two people working independendy of each other. Any differences were resolved by discussion. The relative risks for dichotomous data were calculated with 95% confidence intervals. Where data were insufficient for a quantitative analysis, a narrative overview was undertaken.

Main results
Three trials with a total of 337 participants met the inclusion criteria, describing habit retraining combined with other approaches compared with usual care. Participants were primarily care-dependent elderly women with concurrent cognitive and/or physical impairment, residing in either a residential aged-care facility or in their own home. Outcomes included incidence and/or severity of urinary incontinence, the prevalences of urinary tract infection, skin rash and skin breakdown, cost and caregiver preparedness, role strain and burden. Caregivers found it difficult to maintain voiding records and to implement the toileting program. A 61% compliance rate was reported in one trial .

There were no statistically significant differences in the incidence and in the volume of incontinence between groups. Within group analyses did however show improvements on these measures. Reductions were also reported for the intervention group in one study for skin rash, skin breakdown and in caregivers' perceptions of their level of stress. Descriptive data on the. intervention suggests that habit retraining is a labour-intense activity. Electronic loggers, used as an adjunct to caregiver-delivered wet/dry checks, were reported as providing more accurate data than that from caregiver conducted wet/dry checks. To date, no analysis of the time and resources associated with these comparisons is available.

Reviewers' conclusions
Data on habit retraining are few and of insufficient quality to provide a firm basis for practice.

Gamblers' habit

The theories used to understand and predict regular non-problem gambling are almost exclusively affective or cognitive-oriented. These include motives, self-esteem, image enhancement and illusions of control over random events. However, gambling is one of the most frequently purchased consumer products, and the frequency of past behavior has traditionally been viewed as “habit” by psychologists and marketers. While habit as the frequency of past behavior has been shown to be a strong predictor of future behavior in gambling, habit offers little additional insight into gambling behavior in that form.

The frequency of past purchasing behavior is an important input to NBD-Dirichlet models that provide an enhanced ability to understand and predict future purchases of frequently purchased consumer package goods. NBD-Dirichlet models have been shown to provide an excellent fit to data for a broad range of frequently purchased goods and services for countries across the world. Applications of the NBD-Dirichlet models to data concerning gambling behavior show that these models consistently provide an even closer fit to the data than with other consumer models tested.

The interpretation of NBD-Dirichlet output can provide more accurate benchmarks than cognitive or affective output to test changes to the gambling environment (e.g., more games, new games, warnings) and to gamblers (e.g., problem gambling). The implications and use of the NBD-Dirichlet statistics for gambling providers and public policy is discussed.

Associations between neighbourhood and household environmental variables and fruit consumption : exploration of mediation by individual cognitions and habit strength in the GLOBE study

Objective The present study examined associations of several home and neighbourhood environmental variables with fruit consumption and explored whether these associations were mediated by variables derived from the Theory of Planned Behaviour (TPB) and by habit strength.

Design Data of the Dutch GLOBE study on household and neighbourhood environment, fruit intake and related factors were used, obtained by self-administered questionnaires (cross-sectional), face-to-face interviews and audits.

Setting The city of Eindhoven in the Netherlands

Subjects Adults (n 333; mean age 58 years, 54 % female).

Results Multiple mediation analyses were conducted using regression analyses to assess the association between environmental variables and fruit consumption, as well as mediation of these associations by TPB variables and by habit strength. Intention, perceived behaviour control, subjective norm and habit strength were associated with fruit intake. None of the neighbourhood environmental variables was directly or indirectly associated with fruit intake. The home environmental variable ‘modelling behaviour by family members’ was indirectly, but not directly, associated with fruit intake. Habit strength and perceived behaviour control explained most of the mediated effect (71·9 %).

Conclusions Modelling behaviour by family members was indirectly associated with fruit intake through habit strength and perceived behaviour control. None of the neighbourhood variables was directly or indirectly, through any of the proposed mediators, associated with adult fruit intake. These findings suggest that future interventions promoting fruit intake should address a combination of the home environment (especially modelling behaviour by family members), TPB variables and habit strength for fruit intake.

Higher education mediating institutions and habit

The aim of this paper is to focus discussion on some philosophical issues that informs discussion of the stabilising dimension of higher education as a mediating institution. Backgrounded habits provide the deep context for developing moral practice and other regarding sentiment in higher education. Understanding higher educational institutions as mediating institutions, as forms of associational life which inculcate habit and the development of mores is an important corrective to the discourse of marketization and neo-liberal reform which otherwise crowds out consideration of the role higher educational institutions play in cultural stabilization and social cohesion. This argument we intend to make in this paper is that the stabilizing and associational function of higher educational institutions is critically important to developing habits and mores which are the key support for a society that can still retain a sense of concern and regard for others. 

Explaining the intention-behaviour gap in gluten-free diet adherence: the moderating roles of habit and perceived behavioural control

Adherence to a strict gluten-free diet is the only treatment for coeliac disease. Nonetheless, many individuals with the disease struggle to achieve and maintain strict adherence. While the theory of planned behaviour is useful for predicting gluten-free diet adherence, an intention-behaviour gap remains. The aim of this study was to investigate the roles of habit and perceived behavioural control in moderating the intention-behaviour relationship in gluten-free diet adherence. A significant three-way interaction was found such that the association between intention and adherence was dependent on both perceived behavioural control and habit. Implications for both theory and intervention design are discussed.

Constipation and diet in a community sample of older Australians

Objective: To estimate the prevalence of constipation and laxative use in a sample of people 65 years and over and examine relationships between usual diet and constipation.
Design: A mailed survey using validated instruments to measure bowel habit and laxative use with follow-up interviews to collect dietary data.
Subjects and setting: Three hundred and thirty people aged 65 years and over living at home in Melbourne were randomly selected from the electoral roll of a federal electorate.
Statistical analysis: Descriptive statistics, frequencies and two sample t-tests were used.
Results: Seventy-nine people responded to the mailed bowel survey and 61 were interviewed to collect food intake data. The proportion of constipated people was approximately one quarter (n = 18). Laxative use in the previous 12 months was reported by a fifth of respondents and in these subjects one in four was not constipated. Analysis of the dietary data revealed that the average number of cereal and vegetable serves consumed per day was similar to the national average but less than recommended by nutrition bodies although fruit intake met these recommendations. Constipated subjects consumed fewer serves from the cereals food group than those who were not constipated (2.9 and 3.5 serves respectively, P = 0.03).
Conclusion: Constipation and laxative use appears to be as common in older Australians as in similar populations overseas. Low intake of cereal foods may be a contributing factor.

The unhallowed art : literature and literary fakes in Australia

The fiction of Peter Carey is peopled by the unhallowed; by ghosts and the ghostly. In Bliss (1981), Carey presents us with the Dantesque trials of an advertising executive after he has a heart attack on his front lawn. In The Unusual Life of Tristan Smith (1994), phantom nations are inhabited by simulacra. In True History of the Kelly Gang (2001), a dead bushranger talks. Carey's My Life as a Fake (2003), the subject of this essay, gives us an apotheosis of this literary habit of bringing the unliving to life. It presents us with the flesh-and-blood, machete-wielding, gladiatorial figure of Bob McCorkle, a poet created as a literary hoax.

Youth publications, generation Y and hopes for the future of newspapers

If readership projections are correct, newspapers in the United States will become niche players by 2010. That is, in about half a decade fewer than half of American adults will read a daily newspaper. This will produce major problems in attracting advertising, the lifeblood of the newspaper business. The biggest decline in readership has occurred among Generation Y - people born between 1977 and 1995. They do not read newspapers to the extent their parents did. They get their news elsewhere, mainly online. As part of a process to attract readers, many of America's major publishers launched a series of youth-focused newspapers in the 18 months to March 2004. The aim was to try to get the elusive 18-24-year-old demographic into the habit of daily reading, hoping that over time they would migrate to more traditional outlets. This paper explores the background to these youth-focused publications, describes the main players and issues involved, and provides a case study of a youth-focused pioneer, the Tribune Company s Red Eye, which is published in Chicago.