The rocky and semi-arid terrain of northeastern Brazil, dotted with small cities and rural communities, represents a formidable barrier not only to travel, but to conducting quality health research. Now, Office of Public Health Studies researchers at the University of Hawaiʻi at Mānoa are partnering with Brazilian epidemiologists to reach out to college students in Brazil seeking to improve health programs in this hard-to-reach and economically disadvantaged region.

The students are being taught to administer health surveys, interview study participants, collect epidemiological data in the field and write research articles for publication in peer-reviewed journals, according to a published paper in the Journal of Global Health.

“These students want to learn how to conduct epidemiological research so that they can improve the health programs of their community and we want to support them in doing this,” said Catherine Pirkle, UH Mānoa assistant professor.

In one project, training modules conveyed how to properly collect data on body measurements and take samples for laboratory analyses in pregnant women. In another, students were taught how to recruit pregnant women for a study and provided tips on how to conduct systematic interviews to address women’s health and factors that might contribute to the high rate of teen pregnancy in the region.

“We chose to focus on adolescent pregnancy because doing research on this topic requires a solid understanding of the social, economic and psychological motivations of community members—and all of these ideas are at the core of what we do as public health researchers,” said Pirkle.

Associate Professor Tetine Sentell added that exposing the students to international training was an important objective. Four students from northeastern Brazil visited UH Mānoa to learn how to draft scientific manuscripts for submission to public health journals. So far, three have been published.

“These students are interested in graduate school and academic careers, so we wanted to support their academic development,” said Sentell. “We’re hoping to help them build a thriving research community and to provide new opportunities to support health in this region.”

As women age, their ability to get around affects their quality of life. A new study shows that older women’s physical functioning declines more rapidly if they develop urinary incontinence, according to public health researchers at the University of Hawaiʻi at Mānoa.

Catherine Pirkle and Yan Yan Wu, both assistant professors in the Office of Public Health Studies in the Myron B. Thompson School of Social Work, collaborated with researchers in Brazil, Colombia and Canada to recruit approximately 900 women in their sixties and seventies from those three countries plus Albania. About 25 percent of women over age 60 experience urinary incontinence.

Study participants completed a short test of physical functioning, which included measuring the speed of their usual walking pace, checking their balance and testing how fast they could stand up from a chair. The women also completed a questionnaire about their health, which included a query about whether they had experienced any leakage of urine in the past week. After two years, the women repeated the physical functioning test.

Pirkle said the researchers were surprised by how much physical function had decreased over a two-year period in women who had reported experiencing urine leakage at the study’s start.

“The loss of physical function in this group was quite large and happened very rapidly,” said Pirkle. “We know that, as women age, they tend to experience more functional limitations and disability than men do. But the reasons for this gender gap are not clear.”

Cycle of incontinence and decreasing physical activity

Wu said one supposition is that women who experience incontinence start to engage in less physical activity out of fear of losing urine. This could lead to a vicious cycle, as a reduction in physical activity leads to worsening incontinence and overall health.

But it’s possible that other factors, such as giving birth to many children, may contribute to both urinary incontinence and a physical performance decline. Pirkle and Wu said the next step for the research team is to look at whether women’s reproductive lives, such as the number of children they have and their history of gynecological or obstetric problems, influence their risk of incontinence, as well as other health outcomes of importance to older women.

The study was published in the September 2018 Journal of Aging and Health. Pirkle and Wu’s collaborators on the study include Luana Caroline de Assunção Cortez Corrêa and Saionara Maria Aires da Câmara of the Federal University of Rio Grande do Norte in Brazil; Afshin Vafaei of Lakehead University in Canada; and Carmen-Lucia Curcio of Universidad de Caldas in Colombia.

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