Randomized, placebo-controlled trial of the cognitive effect, safety, and tolerability of oral extended-release oxybutynin in cognitively impaired nursing home residents with urge urinary incontinence

OBJECTIVES: Determine the cognitive effect, safety, and tolerability of oral extended-release oxybutynin in cognitively impaired older nursing home residents with urge urinary incontinence.
DESIGN: Randomized, double-blinded, placebo-controlled trial.
SETTING: Twelve skilled nursing homes.
PARTICIPANTS: Fifty women aged 65 and older with urge incontinence and cognitive impairment.
INTERVENTION: Four-week treatment with once-daily oral extended-release oxybutynin 5 mg or placebo.
MEASUREMENTS: Withdrawal rates and delirium or change in cognition from baseline at 1, 3, 7, 14, 21, and 28 days after starting treatment using the Confusion Assessment Method (CAM), Mini-Mental State Examination (MMSE), and Severe Impairment Battery (SIB). The Brief Agitation Rating Scale, adverse events, falls incidence, and serum anticholinergic activity change with treatment were also assessed.
RESULTS: Participants' mean age ±standard deviation was 88.6±6.2, and MMSE baseline score was 14.5±4.3. Ninety-six percent of subjects receiving oxybutynin (n=26) and 92% receiving placebo (n=24) completed treatment ( P =.50). The differences in mean change in CAM score from baseline to all time points were equivalent between the oxybutynin and placebo groups. Delirium did not occur in either group. One participant receiving oxybutynin was withdrawn because of urinary retention, which resolved without treatment. Mild adverse events occurred in 38.5% of participants receiving oxybutynin and 37.5% receiving placebo ( P =.94).
CONCLUSION: Short-term treatment using oral extended-release oxybutynin 5 mg once daily was safe and well tolerated, with no delirium, in older female nursing home participants with mild to severe dementia. Future research should investigate different dosages and long-term treatment.     

高龄老年住院患者老年综合征特点分析

目的探讨高龄老年住院患者的老年综合征特点。 方法选取新疆维吾尔自治区人民医院2017年6月至2018年5月收治的老年患者235例,其中80～95岁患者117例（高龄老年组）,65～79岁患者118例（普通老年组）,比较两组患者的老年综合征特点。组间计量资料的比较采用t检验,计数资料的比较采用χ²检验,影响因素分析采用二元Logistic回归分析。 结果两组患者的一般资料具有可比性（P>0.05）;高龄老年组患者认知障碍、尿失禁、视觉障碍、听力损失、步态平衡障碍及肌少症的发生率明显高于普通老年组患者（χ²=12.254、6.871、10.647、24.634、6.749、41.979,P<0.05）。Logistic回归分析分析发现,高龄老年组患者随着年龄的增加,其认知障碍、尿失禁、视觉障碍、听力损失、步态平衡障碍及肌少症的发生率也随之增高（P<0.05）;女性尿失禁患病率更高（P<0.05）;男性步态平衡障碍和肌少症患病率更高（P≤0.01）;少数民族肌少症患病率更高（P<0.05）;非糖尿病患者尿失禁患病率更高（P<0.05）,糖尿病患者步态平衡障碍和肌少症患病率更高（P≤0.01）;冠心病患者步态平衡障碍患病率更高（P<0.05）;其他疾病仍可影响患者步态平衡障碍和肌少症的患病率（P<0.05或0.01）。 结论不同年龄段老年患者的老年综合征不同,且高龄老年患者更易罹患老年综合征,应根据其患病特点评估制定适宜的治疗方案。     

Etiology and predictors of urinary incontinence and its effect on quality of life

Aim: Urinary incontinence associated with dementia can result in medical comorbidities. We aimed to determine the prevalence of urinary incontinence and to identify the etiology and factors associated with urinary incontinence in dementia patients. Methods: Patients with an Mini‐Mental State Examination (MMSE) score of more than 10, attending the memory clinic were recruited. Basic demographic data, types and duration of dementia, use of cholinesterase inhibitor and other drugs with anticholinergic effects, carer stress and presence of urinary incontinence in the previous 6 months were recorded. Urodynamic studies were carried out in those patients with urinary incontinence. Results: One hundred and forty‐four subjects with a mean age of 78 years (standard deviation 6.8) were included. Forty‐eight (33.3%) had urinary incontinence. There was no statistically significant difference between continent and incontinent groups regarding age, MMSE, duration of dementia, use of cholinesterase inhibitor and of drugs with anticholinergic effects. Presence of nocturia of more than twice per night (odds ratio [OR] 4, 95% confidence interval [CI] 1.7, 9.2), use of walking aids (OR 2.6, 95% CI 1.1, 5.9) and male sex (OR 1.36, 95% CI 1.1, 5.2) were independent predictors of urinary incontinence. Urodynamic studies showed that 21 subjects had detrusor overactivity, 13 had bladder outlet obstruction, two with low compliance bladder, two with small bladder capacity, four with detrusor hyperactivity and impaired contractility. Conclusion: Urinary incontinence commonly occurs in dementia subjects. Poor mobility and presence of nocturia increase the risk of urinary incontinence. Correction of the possible reversible factors may help to reduce the prevalence of urinary incontinence in patients with dementia and reduce carer stress.     

Is there an association between fecal incontinence and lower urinary dysfunction?

BACKGROUND: Urinary and fecal incontinence in females are both common and distressing conditions. Because common pathophysiologic mechanisms have been described, an association between the two would be expected. The aim of this study was to determine whether patients with lower urinary tract dysfunction have concomitant fecal incontinence when compared with age and gender matched community controls and, second, to determine whether they have predisposing factors that have led to lower urinary tract symptoms and concomitant fecal incontinence. METHODS: A case-control study was performed by means of detailed questionnaire and review of investigation results. One thousand consecutive females presenting for urodynamic investigation of lower urinary tract dysfunction, were compared with 148 age and gender matched community controls. RESULTS: Frequent fecal incontinence was significantly more prevalent among all cases than among community controls (5vs. 0.72 percent,P=0.023). Occasional fecal incontinence was also more prevalent (24.6vs. 8.4 percent,P<0.001). Fecal incontinence was not significantly more prevalent among females with genuine stress incontinence (5.1 percent) when compared with females with detrusor instability (3.8 percent) or any other urodynamic diagnosis. Symptoms of fecal urgency and fecal urge incontinence were significantly more prevalent among those with a urodynamic diagnosis of detrusor instability or sensory urgency than among females with other urodynamic diagnoses or community controls. Multivariate analysis comparing cases with fecal incontinence with other cases and also with community controls did not indicate that individual obstetric factors contributed significantly to the occurrence of fecal incontinence in these patients. CONCLUSIONS: There is an association between genuine stress incontinence, lower urinary tract dysfunction, and symptoms of fecal incontinence, but the exact mechanism of injury related to childbirth trauma is questioned.Supported by a research grant from the ANZAC Health and Medical Research Foundation.Presented in part at the Annual Meeting of the Royal Australian College of Surgeons, Sydney, May, 8 to 10, 1997, and the International Urogynaecology Association Meeting, Buenos Aires, September 20 to 24, 1998.     

Association of initial tuberculin sensitivity, age and sex with the incidence of tuberculosis in south India: a 15-year follow-up.

OBJECTIVE: To determine the association of initial tuberculin sensitivity, age and sex with the development of tuberculosis. METHODS: A 15-year follow-up of 280000 subjects in south India, where new cases of tuberculosis were detected mainly by periodic population surveys. Life-table technique was employed to estimate tuberculosis incidence and disease risk in survivors. The independent effect of tuberculin sensitivity, sex and age at intake was determined using Cox's proportional hazard model. RESULTS: Taking subjects with reaction size 0-7 mm to 3 IU PPD-S as reference group, the adjusted relative risk (RR) for developing culture-positive tuberculosis was 1.1, 1.9, 2.9, 3.6 and 3.3 for those with indurations of 8-11, 12-15, 16-19, 20-24 and > or = 25 mm (P < 0.01). Considering subjects aged 0-4 years as reference group, the adjusted RR for the other groups increased from 1.7 to 10.8 (P < 0.01). Males had a substantially higher incidence (adjusted RR 3.0, P < 0.001). The risk of culture-positive tuberculosis over 15 years in survivors was 3.3% (5.0% in males and 1.6% in females), and increased substantially with tuberculin sensitivity at intake. In those with > or = 12 mm at intake, the approximate lifetime risk was 6.1% (8.6% in males and 3.1% in females). CONCLUSION: The incidence of tuberculosis increased steadily with tuberculin sensitivity to PPD-S and age at intake. Males had a significantly higher risk than females in every PPD-S group and the overall risk was three-fold higher.     

Subcortical vascular lesions predict functional recovery after rehabilitation in patients with L-dopa refractory parkinsonism

OBJECTIVES: To identify predictors of functional recovery after an intensive rehabilitation training in patients with gait disturbances and refractory parkinsonism. DESIGN: Observational study. SETTING: A hospital geriatric rehabilitation department ("Ancelle della Carità" hospital of Cremona). PARTICIPANTS: Thirty-eight subjects (mean age+/-standard deviation of 78.9+/-6.5; 66% women) with gait disturbances and L-dopa refractory parkinsonism consecutively admitted to a rehabilitation unit within 6 months were recruited. Exclusion criteria were obvious musculoskeletal disorders (severe leg arthritis, hemiparesis, recent stroke), recent surgery, delirium, physical impairment from other identifiable causes, and missing computed tomography (CT) scan. All subjects received an intensive standardized rehabilitative program including conventional physical therapy and specific gait training. MEASUREMENTS: The outcome measure of the rehabilitation training was the gain between admission and discharge on the Unified Parkinson Disease Rating Scale (delta-UPDRS). The following potential predictors were assessed using comprehensive geriatric assessment: physical health (Charlson Comorbidity Index, number of drugs), cognitive performance (Mini-Mental State Examination (MMSE)), functional status (Tinetti scale), depressive symptoms (Geriatric Depression Scale), nutritional status (serum albumin and body mass index), and subcortical cerebrovascular load (four classes of increasing severity based on diffuse leukoariosis, patchy lesions of the white matter, and lacunas on CT scan). Multivariate logistic regression with fixed adjustment for age, cognitive performance, and UPDRS on admission and stepwise selection of variables were used to identify independent predictors. RESULTS: Patients were divided into two groups of equal size based on the delta-UPDRS (high and low functional recovery: delta-UPDRS >8 and 相似文献   

Urinary complaints in nondisabled elderly people with age-related white matter changes: the Leukoaraiosis And DISability (LADIS) Study

OBJECTIVES: To investigate, in a cohort of nondisabled elderly people, the association between urinary complaints and severity of age‐related white matter changes (ARWMC). DESIGN: Cross‐sectional data analysis from a longitudinal multinational study. SETTING: The Leukoaraiosis And DISability Study, assessing ARWMC as an independent predictor of the transition from functional autonomy to disability in elderly subjects. PARTICIPANTS: Six hundred thirty‐nine subjects (288 men, 351 women, mean age 74.1±5.0) with magnetic resonance imaging (MRI)‐detected ARWMC of different severity. MEASUREMENTS: ARWMC severity was graded on MRI as mild, moderate, and severe (Fazekas scale). MRI assessment also included ARWMC volumetric analysis and the count of infarcts. Urinary complaints (nocturia, urinary frequency, urgency, incontinence) were recorded based on subjects' answers to four questions. RESULTS: In comparing the three ARWMC severity groups, there was a significant difference only in prevalence of urgency, with 16% of subjects in the mild severity group, 17% in the moderate severity group, and 25% in the severe group (P=.03). Adjusting for age, sex, lacunar and nonlacunar infarcts, diabetes mellitus, and use of diuretics, severe ARWMC retained an independent effect in the association with urinary urgency (odds ratio=1.74, 95% confidence interval=1.04–2.90, severe vs mild group). Subjects with urinary urgency also had higher ARWMC volumes (25.2, vs 20.4 mm³ in those without urinary urgency; P<.001). Urgency was confirmed to be associated with the severe degree of ARWMC, irrespective of complaints of memory, gait disturbances, or history of depression. CONCLUSION: In a cohort of nondisabled elderly people, severe ARWMC were associated with urinary urgency, independent of other potential confounders and vascular lesions of the brain.     

Urinary incontinence in Belgium; prevalence, correlates and psychosocial consequences

This article describes the prevalence of urinary incontinence in the Belgian population and assesses factors associated with urinary incontinence. The significance of urinary incontinence as a public health problem is evaluated through its psychosocial consequences. The data comes from the participants of the 1997 national health survey in Belgium, 15 years and older, (n = 7266). The presence and frequency of the urinary incontinence was estimated through self-reporting using a standard questionnaire. The prevalence of urinary incontinence in the population was 1.4% in men and 4.6% in women ranging from less than 1% under the age of 25 years to 13% in males and 21% in females aged 75 years and older. The prevalence in women was higher in all age groups. The prevalence of frequent incontinence (at least once a week) was 0.8% in males and 2.4% in females. Over the age of 75 years 9.8% of the males and 7.9% of the females reported weekly incontinence. Factors associated with the incontinence were physical limitations, comorbidity, having a prostate problem or uterine prolapse, being obese. Further, the prevalence of urinary incontinence was higher in women reporting chronic urinary infection and with a sedentary lifestyle. The prevalence of subjective ill-health, of mental ill-health, of a low appreciation of social contacts and of a low functional content of social contacts was higher in subjects with urinary incontinence. Urinary incontinence is common in both men and women, especially in older ages. Urinary incontinence is associated with other health problems. The substantial psychosocial consequences of urinary incontinence stress the need for more public health and medical attention.     

Recurrent falls and its risk factors among older men living in the veterans retirement communities: A cross-sectional study

AimTo evaluate the prevalence of recurrent falls and their risk factors among older men living in the Veterans Homes in Taiwan.MethodsThis cross-sectional study enrolled 871 residents and all participants received the comprehensive geriatric assessment, including Barthel Index, Mini-Mental Status Examination (MMSE), Geriatric Depression Scale-5 questions (GDS-5), Mini-Nutrition Assessment Short Form (MNA-SF), the status of urinary incontinence, stool incontinence, polypharmacy, past history of falls, multimorbidity, and medication history.ResultsOverall, 871 subjects (mean age: 85.5 ± 5.2 years, all males) participated in this study, whereas 222(25.5%) of them had experienced falls in the past year, and 91 were recurrent fallers. Comparisons between non-fallers, single fallers and recurrent fallers disclosed that they were significantly different in the following characteristics: diabetes mellitus, chronic kidney disease, coronary artery disease, Charlson Comorbidity Index (CCI), Barthel Index, GDS-5, MNA-SF, polypharmacy, use of hypnotics, urinary incontinence, and stool incontinence (P for trend all <0.05). Multiple regression analysis identified that GDS-5 was significantly associated with single falls and recurrent falls (OR 1.256, 95% CI 1.094–1.441, P = 0.001 for single fallers; OR 1.480, 95% CI 1.269–1.727, P < 0.001 for recurrent fallers). Besides, urinary incontinence was the independently associated with recurrent fallers only (OR 2.369, 95% CI 1.449–3.817, P < 0.001), but not single fallers.ConclusionUrinary incontinence and depressive symptoms were independent associated factors for falls among older men living in the retirement communities. However, urinary incontinence was associated with recurrent falls, but not single falls. Intervention study is needed to reduce recurrent falls through management of urinary incontinence.     

Prevalence and severity of urinary incontinence in elderly Mexican-American women

OBJECTIVES: To measure prevalence and characteristics of urinary incontinence in older Mexican-American women. DESIGN: Cross-sectional analysis of a longitudinal survey of a representative sample of older Mexican Americans. SETTING: Five southwestern states in the United States. PARTICIPANTS: A total of 1589 Mexican-American women, aged 65 and older who were part of the Hispanic Established Population for the Epidemiologic Study of the Elderly. MEASUREMENTS: Self-reported psychosocial, demographic, and health variables; self-reported history of symptoms of urinary incontinence. RESULTS: Two hundred thirty-nine (15%) of the 1589 Mexican-American women reported having urinary incontinence. Almost 33% reported urge incontinence symptoms, 10% reported stress incontinence symptoms, and 42% had symptoms suggestive of mixed incontinence. Thirty-five percent of subjects reported incontinence episodes with moderate to large amounts of urine loss, and 15% reported that their urinary symptoms kept them from engaging in social activities. Age and body mass index were risk factors for incontinence (P=.02 and P=.03, respectively). CONCLUSION: This is the first community-based survey examining rates of urinary incontinence in Mexican-American women. The prevalence of urinary incontinence may be lower in older Mexican-American women than in the general population. They may also have a higher percentage of urge as opposed to stress incontinence symptoms and may suffer from moderate to large volumes of urine loss associated with their incontinence episodes.     

Combined behavioral and drug therapy for urge incontinence in older women

OBJECTIVE: The purpose of this study was to examine the effects of combining behavioral treatment and drug treatment for urge incontinence in community-dwelling older women. DESIGN: Modified crossover design (extension of a randomized clinical trial). Eligible subjects were stratified according to type and severity of incontinence and randomized to behavioral treatment, drug treatment, or a control condition (placebo). Subjects not totally continent or not satisfied after 8 weeks of a single treatment were offered the opportunity to cross over into combined therapy. SETTING: A university-based outpatient geriatric medicine clinic. PARTICIPANTS: Subjects in the clinical trial were 197 ambulatory, nondemented, community-dwelling women (age 55 years or older) with persistent urge urinary incontinence. Thirty-five subjects participated in combined treatment. INTERVENTION: One group of subjects received four sessions (over 8 weeks) of biofeedback-assisted behavioral training followed by 8 weeks of behavioral training combined with drug therapy (oxybutynin chloride individually titrated from 2.5 mg to 15 mg daily). The second group received drug therapy first, followed by 8 weeks of drug therapy combined with behavioral training. MEASUREMENTS: Bladder diaries completed by subjects before and after each treatment phase were used to calculate change in the frequency of incontinent episodes. RESULTS: Eight subjects (12.7%) crossed from behavioral treatment alone to combined behavioral and drug therapy. Additional benefit was seen in improvement from a mean 57.5% reduction of incontinence with single therapy to a mean 88.5% reduction of incontinence with combined therapy (P = .034). Twenty-seven subjects (41.5%) crossed from drug therapy alone to combined drug and behavioral treatment. They also showed additional improvement, from a mean 72.7% reduction of incontinence with single therapy to a mean 84.3% reduction of incontinence with combined therapy (P = .001). CONCLUSIONS: This study shows that combining drug and behavioral therapy in a stepped program can produce added benefit for patients with urge incontinence.     

脑白质高信号对帕金森病运动症状和认知损害的影响

目的探讨脑白质高信号(WMH)对帕金森病(PD)运动症状和认知损害的影响。方法回顾性纳入315例PD患者,根据Fazekas量表评分分为轻度WMH组191例,中度WMH组74例,重度WMH组50例。收集脑血管病相关危险因素,Hoehn-Yahr(H-Y)分级、世界运动障碍协会统一帕金森病评定量表第三部分(MDS-UPDRSⅢ)总分及震颤、强直、运动迟缓、步态姿势异常评分评估运动症状,用简易智能状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)评估认知功能,用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评估情绪,用3T MRI及Fazekas量表评估WMH程度,用Spearman相关和多元线性回归分析。结果 3组年龄、起病年龄、病程、MMSE和MoCA评分比较,有统计学差异(P<0.05,P<0.01)。3组H-Y分级、MDS-UPDRSⅢ总分、震颤、强直、运动迟缓、步态姿势异常、HAMA、HAMD评分及体位性低血压比例比较,无统计学差异(P>0.05)。多元线性回归分析校正年龄、病程、起病年龄、MoCA、同型半胱氨酸、缺血性脑卒中、高血压、吸烟、性别、体质量指数和心脏病等因素后,WMH与MMSE仍显著相关(β=-0.183,95%CI:-0.134^-0.007,P=0.029)。脑室旁WMH(r=-0.246,P=0.000;r=-0.235,P=0.000)和深部WMH(r=-0.192,P=0.001;r=-0.187,P=0.001)与MMSE和MoCA呈显著负相关。WMH与PD运动症状不相关(P>0.05)。结论 WMH对PD认知损害影响明显,临床需警惕PD伴发WMH,脑血管病二级预防可能对PD患者认知减退有潜在预防作用。     

Gastric cancer incidence and mortality in Zhuanghe, China, between 2005 and 2010

AIM: To investigate the incidence and mortality of gastric cancer (GC) in Zhuanghe region, northeast China and the influencing factors for their changing trends.METHODS: All new cancer cases and deaths registered from 2005 to 2010 in Zhuanghe County were reviewed. The annual GC cases, constituent ratio, crude rates, age-standardized rates, their sex and age distribution and temporal trends were assessed. The method of annual percentage change (APC) was used to estimate the trends of GC.RESULTS: Altogether 2634 new cases of GC and 1722 related deaths were registered, which accounted for 21.04% and 19.13% of all cancer-related incidence and deaths, respectively. The age-standardized incidence rate steadily decreased from 57.48 in 2005 to 44.53 in 2010 per 10⁵ males, and from 18.13 to 14.70 per 10⁵ females, resulting in a APC of -5.81% for males and -2.89% for females over the entire period. The magnitude of APC in GC mortality amounted to -11.09% and -15.23%, respectively, as the age-standardized mortality rate steadily decreased from 42.08 in 2005 to 23.71 in 2010 per 10⁵ males, and from 23.86 to 10.78 per 10⁵ females. Females had a significantly lower incidence (a male/female ratio 2.80, P < 0.001) and mortality (a male/female ratio 2.30, P < 0.001). In both genders, the peak incidence and mortality occurred in the 80-84 years age group. The age-standardized mortality/incidence ratio also decreased from the peak of 0.73 in 2005 to 0.53 in 2010 for males, and from 1.32 to 0.73 for females.CONCLUSION: Encouraging declines of incidence and mortality of GC were observed in Zhuanghe region between 2005 and 2010, possibly due to the economic development and efficient GC control strategies.     

An analysis of esophageal cancer incidence in Cixian county from 1974 to 1996

AIM: To describe the incidence of esophageal cancer (EC)in Cixian, a county of Hebei province during 1974-1996. Weanalyzed the sex and age characteristics as well as thegeographic distribution of EC, in order to determine theimpact so that methods of preventing and controlling EC inCixian can be put in place.METHODS: Since the early 1970s, the cancer registrysystem has been established, which collects the cancerincidence in Cixian county. The malignant tumors were codedaccording to International Classification of Disease IX (ICD-9). All the data were checked and analyzed using EPIINFO.RESULTS: The trend of the incidence rate of EC from 1974to 1996 had declined, (229.9/100 000 vs 178.5/100 000, Oddsratio= 1.47, 95 % CI: 1.32～1.63, X2=52.89. trend X2=26.54,P＜0.001). The incidence rate of males declined significantly(281.81/100 000 vs 157.96/100 000, Odds ratio=1.61, 95 %CI: 1.41～1.84, X2=47.85. Trend X2=44.86, P＜0.001),whereas, the females remained steady (157.96/100 000 vs133.41/100 000, odds ratio=1.28, 95 % CI:1.17～1.49,X2=9.26. trend X2=2.69, P＞0.05). Male average annualincidence rate was 142.80/100 000 and the female's was95.18/100 000. The sex ratio (males to females) was 1.50:1.The incidence rate was increasing along with the age. As tothe geographic distribution, the incidence rate in mountainousareas and hilly areas showed a significantly declining trend(mountainous areas, trend X2=149.93, P＜0.001; hilly areas,trend X2=42.70, P＜0.001). The incidence rate of EC in plainareas had increased (trend X2=22.39, P＜0.001).CONCLUSION: The incidence rate of EC in Cixian countyshows a trend and has declined after two decades, especiallyin mountainous area. But compared to other regions in theworld, Cixian county still had a high incidence rate of EC.     

Kombinierte Stuhl- und Harninkontinenz

Background: Double (urinary and fecal) incontinence is relatively common in the elderly. 6% of men and 9.5% of women over 50 years suffer from combined urinary and fecal incontinence. 50% of males and 60% of females with fecal incontinence have concurrent urinary incontinence. The high rate of concurrence of urinary and fecal incontinence is due to an almost identical innervation of the urinary bladder and the rectum and the close vicinity and partial identity of the muscular sphincter mechanisms. Classification: There are two causal entities of double incontinence: 1. neurogenic disorders, 2. pelvic floor dysfunction. Neurogenic disorders can be classified in central and peripheral nervous lesions. Pelvic floor dysfunction can be due to nerve injury or direct muscular lesions. According to the International Continence Society, urinary incontinence is classified into five categories: 1. stress incontinence, 2. urge incontinence, 3. reflex incontinence, 4. overflow incontinence, 5. extraurethral incontinence. With respect to anal incontinence, the first four groups are important. Diagnosis: The diagnostic evaluation comprises meticulous history, physical examination including neuro-urological status, rectal and in females standardized pelvic examination, urinalysis, sonography of the kidneys and bladder after voiding (postvoid residual urine). In women, a transrectal ultrasound of the bladder, urethra and the pelvic floor is important and can replace lateral cystourethrography. In complex cases, dynamic NMR imaging is helpful. Functional investigations include urodynamic studies with uroflowmetry, filling and voiding cystometry and urethral pressure profiles and rectomanometry. Conclusion: For optimal therapy of double incontinence, an interdisciplinary approach is necessary.     

Effects of exercise treatment with or without heat and steam generating sheet on urine loss in community‐dwelling Japanese elderly women with urinary incontinence

Aim: To determine the effects of exercise treatment with or without heat and steam generating sheet (HSGS) on reducing urine loss in community‐dwelling elderly women with urinary incontinence (UI). Methods: One hundred and forty‐seven community‐dwelling women aged 70 years and older with stress, urge and mixed UI were randomly assigned to exercise + HSGS (n = 37), exercise only (n = 37), HSGS only (n = 37) or an education group (n = 36). Exercise + HSGS, and exercise groups received exercise training twice a week for 3 months. When the HSGS was placed on the lower back, the temperature of the skin surface rose to 38–40°C and it continued to generate heat and steam for over 5 h. The HSGS group used one sheet per day continuously for 3 months. Urine loss and fitness data were collected at baseline and after intervention. Results: The intervention groups showed significant improvements in muscle strength and walking speed compared to the education group. Exercise and HSGS showed urine loss cure rates of 54.1%, exercise 34.3% and HSGS 21.6% after treatment; whereas, the education group (2.9%) showed no significant improvement (χ²=21.89, P < 0.001). Combining the HSGS to the exercise intervention showed a 61.5% cure rate for stress UI, 50.0% urge UI and 40.0% mixed UI. Conclusion: This data suggests that exercise treatment with HSGS is more effective for treating urine loss regardless of UI type. The HSGS can be used as a supplementary treatment method to enhance the effects of exercise on women with urge, mixed and stress UI. Geriatr Gerontol Int 2011; 11: 452–459.     

Comparison of bowel patterns in hispanics and non-Hispanic whites

Survey questionnaires can be used to characterize normal bowel habits and the prevalence of bowel dysfunction. To determine whether ethnic and sex-related differences in bowel patterns exist between Hispanics and non-Hispanic whites, we conducted a survey of a nonpatient population in El Paso, on the U.S.-Mexico border. A forced-choice, self-report questionnaire was distributed to 1014 subjects and returned by 1000. Data from the 905 Hispanic and non-Hispanic white subjects were compared. Stool frequency was analyzed by multiple linear regression, and bowl dysfunction variables were analyzed by stepwise logistic regression, in ethnic and sex groups. Data were also analyzed controlling for age, socioeconomic status, dietary factors, and use of laxatives. There was a significant sex difference in mean number of stools per week reported (P<0.0001): Hispanic males greater than Hispanic females (8.6 vs 7.5) and non-Hispanic white males greater than non-Hispanic white females (9.3 vs 7.2). The frequency of irritable bowel syndrome-type symptoms was greater in females than males (23.4% vs 9.6%,P<0.001) and was less in Hispanics than non-Hispanic whites (16.9% vs 21.8%,P<0.05), but a significant ethnic difference was not found after controlling for covariates. Additionally, females reported more alternating bowel pattern (44.0% vs 28.5%,P<0.001) and constipation (25.5% vs 12.4%,P<0.01) than males, and non-Hispanic white females more abdominal pain than the other subgroups (P<0.05). Ethnic differences in dietary factors that may be relevant to bowel function were identified. This survey of a biethnic nonpatient population shows that, for both Hispanic as well as non-Hispanic whites, males have a greater stool frequency than females and there are sex differences in the prevalence of bowel dysfunction. Hispanics did not differ from non-Hispanic whites in stool frequency, while the finding of an ethnic difference in the prevalence of irritable bowel syndrome requires further study for clarification.     

The epidemiology of urinary incontinence in older women: incidence, progression, and remission

OBJECTIVES: To examine the epidemiology of urinary incontinence (UI) in older women.
DESIGN: Prospective study.
SETTING: Nurses' Health Study.
PARTICIPANTS: Incidence of UI was determined in 23,792 women aged 54 to 79 without UI at baseline. Progression or remission of UI was determined in 28,813 women with UI at least monthly at baseline.
MEASUREMENTS: UI was ascertained according to questionnaires in 2000 and 2002. Rates of incident UI and progression or remission of prevalent UI were calculated. Logistic regression was used to estimate relative risks of UI associated with risk factors.
RESULTS: In women with no urine leakage at baseline, 9.2% reported leakage at least monthly after 2 years. For women with leakage at least weekly, the incidence was 3.6%; of these cases, stress UI had the highest incidence, followed by mixed and urge UI. Relationships between UI and age differed for stress UI, which decreased with age (relative risk (RR)=0.63, 95% confidence interval (CI)=0.43–0.92 for aged 70–79 vs 54–59), and urge and mixed UI, which increased with age (RR=2.28, 95% CI=1.09–4.75 and RR=2.11, 95% CI=1.24–3.61, respectively). For prevalent UI in 2000, 32.1% of subjects with leakage once a month progressed to leakage at least once a week over follow-up. Only 8.9% with frequent leakage in 2000 reported improvement to monthly leakage or less, with 2.0% having complete remission.
CONCLUSION: The incidence of UI is high in older women, and progression from occasional to frequent leaking is common. Urge UI, for which there are limited effective treatments, increases with age, thus research on UI prevention in older women is particularly important.     

社区老年人轻度认知功能障碍患病调查

目的了解社区老年人轻度认知功能障碍（MCI）的患病率及危险因素。方法采用整群随机抽样的方法对上海市黄浦区年龄≥60岁的老年人进行现况问卷调查及临床医师评定。调查问卷包括一般人口学资料、简易精神状况量表（MMSE）、蒙特利尔认知评估表（MoCA）;临床医师评定包括照料者询问、现病史、既往史、体检、日常生活量表（ADL）、总体退化量表（GDS）、临床痴呆评定量表（CDR）、Hachinski缺血指数量表测评,并由精神科医师进行最后诊断。结果调查300人,确诊为MCI者67例,患病率为22．3％;不同性别、年龄段、文化程度、职业及运动与否、有无业余爱好、饮茶与否的老年人,其MCI患病率差异均有统计学意义（P〈0.01）。结论女性、高龄、低文化水平、不运动等患MCI的危险性增加。