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Urinary frequency [keywords]
- Urinary incontinence in the young woman: treatment plans and options available. [Journal Article]
- Womens Health (Lond Engl) 2014 Mar; 10(2):201-17.
Urinary incontinence is a common and distressing condition, which, although not life-threatening, is known to have a significant effect on quality of life. The incidence of urinary incontinence increases with age and while stress urinary incontinence is more common in younger women, symptoms suggestive of overactive bladder are more common with increasing age. All women complaining of incontinence require simple investigation, and many will benefit from conservative and medical treatments, which may be instituted in primary care. Further investigation in the secondary-care setting should be reserved for those women with refractory or unusual symptoms. The aim of this paper is to review the epidemiology and pathophysiology of common causes of urinary incontinence in younger, premenopausal women, and to review the current algorithms for investigation and management. In addition, treatment paradigms covering conservative, medical and surgical treatment for stress urinary incontinence and overactive bladder will be reviewed.
- Incidence of healthcare associated infection in the surgical ICU of a tertiary care hospital. [Journal Article]
- Med J Armed Forces India 2013 Apr; 69(2):124-9.
Healthcare associated infections (HAI) have taken on a new dimension with outbreaks of increasingly resistant organisms becoming common. Protocol-based infection control practices in the intensive care unit (ICU) are extremely important. Moreover, baseline information of the incidence of HAI helps in planning-specific interventions at infection control.This hospital-based observational study was carried out from Dec 2009 to May 2010 in the 10-bedded surgical intensive care unit of a tertiary care hospital. CDC HAI definitions were used to diagnose HAI.A total of 293 patients were admitted in the ICU. 204 of these were included in the study. 36 of these patients developed HAI with a frequency of 17.6%. The incidence rate (IR) of catheter-related blood stream infections (CRBSI) was 16/1000 Central Venous Catheter (CVC) days [95% C.I. 9-26]. Catheter-associated urinary tract infections (CAUTI) 9/1000 urinary catheter days [95% C.I. 4-18] and ventilator-associated pneumonias (VAP) 32/1000 ventilator days [95% confidence interval 22-45].The HAI rates in our ICU are less than other hospitals in developing countries. The incidence of VAP is comparable to other studies. Institution of an independent formal infection control monitoring and surveillance team to monitor & undertake infection control practices is an inescapable need in service hospitals.
- Sources of variability in biomarker concentrations. [Journal Article]
- J Toxicol Environ Health B Crit Rev 2014; 17(1):45-61.
Human biomonitoring has become a primary tool for chemical exposure characterization in a wide variety of contexts: population monitoring and characterization at a national level, assessment and description of cohort exposures, and individual exposure assessments in the context of epidemiological research into potential adverse health effects of chemical exposures. The accurate use of biomonitoring as an exposure characterization tool requires understanding of factors, apart from external exposure level, that influence variation in biomarker concentrations. This review provides an overview of factors that might influence inter- and intraindividual variation in biomarker concentrations apart from external exposure magnitude. These factors include characteristics of the specific chemical of interest, characteristics of the likely route(s) and frequency of exposure, and physiological characteristics of the biomonitoring matrix (typically, blood or urine). Intraindividual variation in biomarker concentrations may be markedly affected by the relationship between the elimination half-life and the intervals between exposure events, as well as by variation in characteristics of the biomonitored media such as blood lipid content or urinary flow rate. Variation across individuals may occur due to differences in time of sampling relative to exposure events, physiological differences influencing urinary flow or creatinine excretion rates or blood characteristics, and interindividual differences in metabolic rate or other factors influencing the absorption or excretion rate of a compound. Awareness of these factors can assist researchers in improving the design and interpretation of biomonitoring studies.
- Assessment of mycotoxin exposure in the Belgian population using biomarkers: aim, design and methods of the BIOMYCO study. [JOURNAL ARTICLE]
- Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2014 Mar 5.
Abstract Mycotoxins are harmful food contaminants. Currently, human exposure assessment to these toxins is often based on calculations combining mycotoxin occurrence data in food with population data on food consumption. Because of limitations inherent to that approach, biomarkers have been proposed as a suitable alternative whereby a more accurate assessment of exposure at the individual level can be performed. The BIOMYCO study is designed to assess human mycotoxin exposure using urinary biomarkers of exposure. Over the different seasons of 2013 and 2014, morning urine is gathered in a representative part of the Belgian population according to a designed study protocol, whereby 140 children (3-12 years old) and 278 adults (19-65 years old) are selected based on random cluster sampling stratified for sex, age and geographical areas. Every participant completes a food frequency questionnaire to assess the consumption of relevant foodstuffs (n = 43) of both the day before the urine collection and the previous month. Validated multi-toxin LC-MS/MS methods are used to analyse aflatoxins, fumonisins, ochratoxin A, trichothecenes, zearalenone and their metabolites in morning urine. The study protocol is approved by the ethical committee of the Ghent University Hospital. Within this paper, study design and methods are described. The BIOMYCO study is the first study whereby a multi-toxin approach is applied for mycotoxin exposure assessment in adults and children on a large-scale. Moreover, it is the first study that will describe the exposure to an elaborated set of mycotoxins in the Belgian population. In first instance, descriptive analysis will be performed, describing the exposure to mycotoxins for the child and adult group. Exposure of different subgroups will be compared. Furthermore, correlations between the mycotoxin concentrations measured and the food consumption reported will be estimated, to explore whether the mycotoxin exposure could be explained by the consumption of certain foods.
- Comparison of midurethral sling outcomes with and without concomitant prolapse repair. [Journal Article]
- Obstet Gynecol Sci 2014 Jan; 57(1):50-8.
We compared the outcomes of the midurethral sling (MUS) with and without concomitant prolapse repair.We retrospectively reviewed the outcomes of 203 women who underwent MUS at Severance Hospital from January 2009 to April 2012 with and without concomitant prolapse repair. Patients completed the urogenital distress inventory questionnaire preoperatively and postoperatively. The outcomes were assessed by using validated questionnaires and reviewing medical records. McNemar's test, t-test, and multiple logistic regression were used for analysis.We noted that women who underwent MUS alone were more likely to experience urinary frequency (12% vs. 25%, P = 0.045), urgency (6% vs. 24%, P < 0.001), and bladder emptying difficulty (2% vs. 10%, P = 0.029) compared to those who underwent concomitant repair. Women who only MUS were more likely to experience discomfort in the lower abdominal or genital region compared to those who than those who underwent concomitant repair; however, the difference was not significant (5% vs. 11%, P = 0.181). In the MUS only group, maximal cystometric capacity (MCC) was a significant parameter of preoperative and postoperative urinary frequency (P = 0.042; odds ratio, 0.994; P = 0.020; odds ratio, 0.993), whereas the Valsalva leak point pressure (VLPP) was a significant factor of postoperative bladder emptying difficulty (P = 0.047; odds ratio, 0.970).The outcomes did not differ between patients who underwent MUS alone and those with concomitant repair. In the MUS only group, MCC and VLPP were significant urodynamics study parameters related to urinary outcome.
- Caring for Alaska Native prostate cancer survivors in primary care: a survey of Alaska Tribal Health System providers. [Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.]
- Int J Circumpolar Health 2014.:23637.
Little is known about the constraints of optimizing health care for prostate cancer survivors in Alaska primary care.To describe the experiences and attitudes of primary care providers within the Alaska Tribal Health System (ATHS) regarding the care of prostate cancer survivors.In late October 2011, we emailed a 22-item electronic survey to 268 ATHS primary care providers regarding the frequency of Prostate Specific Antigen (PSA) monitoring for a hypothetical prostate cancer survivor; who should be responsible for the patient's life-long prostate cancer surveillance; who should support the patient's emotional and medical needs as a survivor; and providers' level of comfort addressing recurrence monitoring, erectile dysfunction, urinary incontinence, androgen deprivation therapy, and emotional needs. We used simple logistic regression to examine the association between provider characteristics and their responses to the survivorship survey items.Of 221 individuals who were successfully contacted, a total of 114 responded (52% response rate). Most ATHS providers indicated they would order a PSA test every 12 months (69%) and believed that, ideally, the hypothetical patient's primary care provider should be responsible for his life-long prostate cancer surveillance (60%). Most providers reported feeling either "moderately" or "very" comfortable addressing topics such as prostate cancer recurrence (59%), erectile dysfunction (64%), urinary incontinence (63%), and emotional needs (61%) with prostate cancer survivors. These results varied somewhat by provider characteristics including female sex, years in practice, and the number of prostate cancer survivors seen in their practice.These data suggest that most primary care providers in Alaska are poised to assume the care of prostate cancer survivors locally. However, we also found that large minorities of providers do not feel confident in their ability to manage common issues in prostate cancer survivorship, implying that continued access to specialists with more expert knowledge would be beneficial.
- A multicenter randomized controlled trial of tonsillectomy combined with steroid pulse therapy in patients with immunoglobulin A nephropathy. [JOURNAL ARTICLE]
- Nephrol Dial Transplant 2014 Mar 3.
The study aim was, for the first time, to conduct a multicenter randomized controlled trial to evaluate the effect of tonsillectomy in patients with IgA nephropathy (IgAN).Patients with biopsy-proven IgAN, proteinuria and low serum creatinine were randomly allocated to receive tonsillectomy combined with steroid pulses (Group A; n = 33) or steroid pulses alone (Group B; n = 39). The primary end points were urinary protein excretion and the disappearance of proteinuria and/or hematuria.During 12 months from baseline, the percentage decrease in urinary protein excretion was significantly larger in Group A than that in Group B (P < 0.05). However, the frequency of the disappearance of proteinuria, hematuria, or both (clinical remission) at 12 months was not statistically different between the groups. Logistic regression analyses revealed the assigned treatment was a significant, independent factor contributing to the disappearance of proteinuria (odds ratio 2.98, 95% CI 1.01-8.83, P = 0.049), but did not identify an independent factor in achieving the disappearance of hematuria or clinical remission.The results indicate tonsillectomy combined with steroid pulse therapy has no beneficial effect over steroid pulses alone to attenuate hematuria and to increase the incidence of clinical remission. Although the antiproteinuric effect was significantly greater in combined therapy, the difference was marginal, and its impact on the renal functional outcome remains to be clarified.
- Variability in the take-home pathway: Farmworkers and non-farmworkers and their children. [JOURNAL ARTICLE]
- J Expo Sci Environ Epidemiol 2014 Mar 5.
Organophosphate pesticides (OPs) are related to ill health among adults, including farmworkers who are exposed to OPs as part of their regular work. Children of both farmworkers and non-farmworkers in agricultural communities may also be affected by pesticide exposure. Study groups of 100 farmworkers with a referent child (aged 2-6 years) and 100 non-farmworkers with a referent child were recruited to participate in three data collection periods over the course of a year. At each collection, participants provided three urine samples within 5 days, and homes and vehicles were vacuumed to collect pesticide residues in dust. In thinning and harvest seasons, farmworkers and their children had higher dimethyl urinary metabolites than non-farmworkers and their children. During the non-spray season, the urinary metabolites levels decreased among farmworkers to a level comparable to that of non-farmworkers. Farmworkers consistently had higher pesticide residues in their home and vehicle dust. Differences exist between farmworkers and non-farmworkers in urinary metabolites, and the differences extended throughout the agricultural seasons.OP metabolites are seen at much higher levels for farmworkers and their children than for non-farmworkers and their children during agricultural seasons when OPs are in use. These metabolite levels were significantly higher than the nationwide NHANES IV survey and up to 10-fold higher than other rural agricultural studies.Journal of Exposure Science and Environmental Epidemiology advance online publication, 5 March 2014; doi:10.1038/jes.2014.12.
- Interaction between arsenic exposure from drinking water and genetic susceptibility in carotid intima-media thickness in Bangladesh. [JOURNAL ARTICLE]
- Toxicol Appl Pharmacol 2014 Mar 1.
Epidemiologic studies that evaluated genetic susceptibility to the effects of arsenic exposure from drinking water on subclinical atherosclerosis are limited. We conducted a cross-sectional study of 1,078 participants randomly selected from the Health Effects of Arsenic Longitudinal Study in Bangladesh to evaluate whether the association between arsenic exposure and carotid artery intima-medial thickness (cIMT) differs by 207 single-nucleotide polymorphisms (SNPs) in 18 genes related to arsenic metabolism, oxidative stress, inflammation, and endothelial dysfunction. Although not statistically significant after correcting for multiple testing, nine SNPs in APOE, AS3MT, PNP, and TNF genes had a nominally statistically significant interaction with well-water arsenic in cIMT. For instance, the joint presence of a higher level of well-water arsenic (≥ 40.4 μg/L) and the GG genotype of AS3MT rs3740392 was associated with a difference of 40.9 μm (95% CI=14.4, 67.5) in cIMT, much greater than the difference of cIMT associated with the genotype alone (β=-5.1 μm, 95% CI=-31.6, 21.3) or arsenic exposure alone (β=7.2 μm, 95% CI=-3.1, 17.5). The pattern and magnitude of the interactions were similar when urinary arsenic was used as the exposure variable. Additionally, the at-risk genotypes of the AS3MT SNPs were positively related to proportion of monomethylarsonic acid (MMA) in urine, which is indicative of arsenic methylation capacity. The findings provide novel evidence that genetic variants related to arsenic metabolism may play an important role in arsenic-induced subclinical atherosclerosis. Future replication studies in diverse populations are needed to confirm the findings.
- Urinary incontinence in patients with Alzheimer's disease: Relationship between symptom status and urodynamic diagnoses. [JOURNAL ARTICLE]
- Int J Urol 2014 Mar 4.
To assess factors associated with detrusor overactivity in urinary incontinence patients with Alzheimer's disease, and to determine the correlation between the degree of Alzheimer's disease and the presence of detrusor overactivity.A total of 144 Alzheimer's disease patients (48 men, 96 women; aged 56-97 years) with urinary incontinence were enrolled in this protocol. Cognitive testing was carried out using the Mini-Mental State Examination, the Clinical Dementia Rating scale, the Global Deterioration Scale and Barthel's Activities of Daily Living. Urinary incontinence was assessed using a frequency-volume chart and the Incontinence Questionnaire on Urinary Incontinence Short Form. All study participants had a urodynamic study carried out.Based on the Incontinence Questionnaire on Urinary Incontinence Short Form, the most common type of urinary incontinence was urge urinary incontinence followed by enuresis in men, whereas women most commonly complained of urge urinary incontinence followed by stress urinary incontinence. Detrusor overactivity was found in 57.6% of patients (25 men, 58 women) on urodynamic study. No statistical differences were found between those with and without detrusor overactivity in terms of age, sex or duration of education. No significant correlation was found between changes in Incontinence Questionnaire on Urinary Incontinence Short Form scores and those in the Mini-Mental State Examination, Clinical Dementia Rating and Barthel's Activities of Daily Living status. Multiple logistic regression analysis showed the presence of detrusor overactivity could be predicted using Clinical Dementia Rating and Barthel's Activities of Daily Living scores (P < 0.05).The most common type of urinary incontinence in patients with Alzheimer's disease is urge urinary incontinence. Clinical Dementia Rating and Barthel's Activities of Daily Living predict the severity of detrusor overactivity in this patient population.