Reviewer's report 
 Prevalence of Urinary Incontinence in Andorra: Impact on Womens Health. Title: 
Authors: 
avellanet m.a merce PhD ( saas.rhb@andorra.ad )
Dr fiter m.f meritxell MD ( mfv@andorra.ad )
coll m.c margarida MD ( alaycoll@myp.ad )
 2  8 Dec 2002 Version: Date: 
 Dr Mary Palmer Reviewer: 
 A paper whose findings are important to those with closely related research Level of interest: 
interests 
 Unable to decide on acceptance or rejection until the authors have Advice on publication: 
responded to the compulsory revisions 
Prevalence of urinary incontinence (UI) in women is an important and timely topic. Some of your 
references are old and I included at the end of my review a list of some references that may be of 
interest to you. My major concern with this paper focuses on the definitions for urinary incontinence. I 
strongly urge the use of the ICS definition. 
Discretionary revision: 
1. Since space is not an issue for this journal, I suggest you publishing your questionnaire as an 
appendix to your paper. Your research questions are relevant. I suggest you organize your Results 
and Discussion sections according to each research question. 
Compulsory revision: 
1. What was our response rate (you gave the numerator but no denominator)? Your conclusion in 
the abstract should deal with all 4 research questions. Since you asked questions about BMI, childbirth, child weight at birth etc, I would like to see your Results discuss the effect (even if there 
was none) of these factors on UI. 
2. What is the relationship between level of education and social status? Could one serve as a proxy 
for the other? What statistical tests were used? It would seem that logistic regression would help to 
answer the question about socio-demographic factors and it would help you to tease out the impact 
of age (which may be a confounding variable). 
3. Would it be possible to include a table (or if not a table than some information in the text) on the 
key characteristics of the female Andorran population and compare them to the sample 
characteristics? 
4. The issue of bothersomeness is fascinating. Your findings are consistent with those of some of 
the studies listed at the end of this review. The issue of fear of reporting to health care providers, 
stigma associated with being incontinent, viewing it as a non- modifiable non-medial problem has 
been reported elsewhere. Your report further confirms that there appears to be a paradox in how 
women think about incontinence. 
5. I don't understand how women were categorized as "low, middle and upper" class. Please provide 
information to give context to your findings. 
6. Tables are too 'busy", please streamline to include only pertinent information and providing the 
results of statistical analyses would be helpful too. 
7. Figure 3 do you mean >64? Are results in figures statistically significant? 
8. In the second paragraph under the section "Prevalence in relation to age" do you mean figure 3 
instead of as reported figure 2? 
9. Some phrases and sentences are awkwardly stated. Editing is needed throughout the paper. 
10. Some references used were dated. These are some references the authors may want to consult 
with their revisions. These are offered only as 'for your information' only. 
**** (gives the new ICS definition of urinary incontinence) 
Abrams, P., Cardozo, L., Fall, M., Griffiths, D., Rosiers, P., Ulmsten, U., et al. (2002). The 
standardization of terminology of lower urinary tract function: Report from the Standardisation 
Sub-Committee of the International Continence Society. Neurourology and Urodynamics, 21, 
167-178. 
Kuh D, Cardozo L, Hardy R. Urinary incontinence in middle aged women: childhood enuresis and 
other lifetime risk factors in a British prospective cohort. Epidemiology Community Health 
1999;53:453. 
Chiarelli P, Brown W, McElduff P. Leaking urine: prevalence and associated factors in Australian 
women. Neurology and Urodynamics 1999;18:567. 
Palmer MH. Fitzgerald S, Berry SJ, Hart K. Urinary incontinence in working women: An exploratory 
study. Women and Health 1999;29:67. 
Palmer, M. & Fitzgerald, S. Urinary incontinence in working women: A comparison study. Journal of 
Gender based Medicine and Women's Health (in press). 
Fitzgerald S, Palmer MH, Kirkland VL, Robinson L. The impact of urinary incontinence in working 
women: a study in production facility. Women and Health 2002:35(1):1. 
Reymert J, Hunskaar S. Why do only a minority of perimenopausal women with urinary incontinence 
consult a doctor? Scan J Prim Health Care 1994;12:180. 
Swinthinbank LV, Abrams P. A detailed description, by age, of lower urinary tract symptoms in a 
group of community-dwelling women. BJU International 2000;85 Suppl 2:19. 
Moller LA, Lose G, Jorgensen T. The prevalence and bothersomeness of lower urinary tract 
symptoms in women 40-60 years of age. Acta Obstet Gynecol Scand 2000;79:298. 
Nygaard IE, Thompson FL, Svengalis SL, Albright JP. Urinary incontinence in elite nulliparous 
athletes. Obstet and Gynecol 1994;84:183. 
Davis GD, Goodman M. Stress urinary incontinence in nulliparous female soldiers in airborne 
infantry training. J Pelvic Surg 1996;2:68. 
Fultz NH, Herzog AR. Prevalence of urinary incontinence in middle-aged and older women. J of 
Aging and Health 2000;12:459. 
Competing interests: 
None declared.