Urinary incontinence (UI) is a commonly underreported and underdiagnosed condition. The purpose of this trial was to implement and evaluate behavioral management for continence (BMC), an intervention to manage symptoms of UI with older rural women in their homes. Participants were randomized into BMC or a control group, and 178 were followed for between 6 and 24 months. The intervention involved self-monitoring, bladder training, and pelvic muscle exercise with biofeedback. The primary outcome variable-severity of urine loss-was evaluated by pad test. Secondary variables were episodes of urine loss, micturition frequency, voiding interval, quality of life, and subjective report of severity. Urine loss severity at baseline evaluation was not significantly different in the two groups. But using the generalized linear mixed model analysis, at the four follow-ups, severity of urine loss, episodes of urine loss, quality of life, and subjective report of severity were significantly different. At 2 years the BMC group UI severity decreased by 61%; the control group severity increased by 184%. Self-monitoring and bladder training accounted for most of the improvement. The results support the use of simple strategies based on bladder diaries before implementing more complex treatments.

In 1991, the University of Florida College of Medicine established a required primary care preceptorship coordinated by the Area Health Education Center (AHEC) Program for all students in the first semester of medical school. Six years' experience with this course, which is entirely community-based and taught by community physicians, provides evidence of the success of the preceptorship. Over the first six years, 97% of students and 92% of preceptors felt strongly that this was an appropriate and valuable experience for students in the first semester of medical school. All believed that the students were capable of interacting with patients in a meaningful fashion and that the course allowed students to gain confidence as health care providers. The course also reinforced the importance of the basic science curriculum and initiated the process of professional development by affirming students' decisions to pursue a career in medicine. The use of content analysis to further evaluate attitudes and behaviors indicated that the students were highly satisfied with their experience and were active participants in the preceptors' practices. Students' approach to patients as people, rather than cases, was positive, and increased from the first to the last day of the preceptorship. After six years, this preceptorship has been demonstrated to have a positive and meaningful impact on medical student education and development.