Impact of smoking on asthma symptoms, healthcare resource use, and quality of life outcomes in adults with persistent asthma

Background Smoking habits of asthmatics are similar to those of the general population. However, little attention has been paid to the associations between smoking and asthma-related outcomes. Objective To evaluate relationships between cigarette smoking, asthma symptoms, and asthma-related resource utilization in subjects with persistent asthma. Method A stratified, random sample of adults from France, Germany, and the UK with persistent asthma were surveyed in 2001 through 2004. Statistical analyses compared asthma symptoms and healthcare resource utilization for cigarette smokers compared with those for non-smokers. Results Analyses included 1109 subjects with persistent asthma symptoms in 2001–2003 and 852 subjects with persistent asthma symptoms in 2004. Using multivariate analysis of data from eligible subjects in 2004 that did not have concomitant chronic obstructive pulmonary disease and adjusting for subjects’ baseline and demographic characteristics, cigarette smokers were more likely to experience nighttime symptoms (OR 1.46, 95% CI 1.07, 1.97 P = 0.015) and were more likely to use healthcare resources than were non-smokers (P ≤ 0.004). Findings were similar in a secondary analysis of subjects ≤55 years of age. Conclusions Cigarette smoking appears to be associated with more asthma symptoms and more ED visits and hospitalizations in adults with persistent asthma.     

北京市某医院456例急性心肌梗死患者五年吸烟及戒烟现状调查

目的 了解急性心肌梗死(AMI)患者吸烟及出院后自主戒烟现状.方法 分析2003年10月至2008年10月北京复兴医院CCU病房所有因首次AMI入院共456例西城区患者的个人资料及吸烟现状.统一对吸烟患者出院后戒烟情况、戒烟失败原因进行电话随访.结果 (1)AMI吸烟患者中以男性为主(96.3%),平均吸烟率为55.9%,其中29～50岁患者吸烟率高达87.5%.(2)正在吸烟的AMI患者平均发病年龄(58.0±12.3)岁,吸烟患者AMI平均发病年龄较戒烟组和从不吸烟组提前约16年.(3)吸烟的AMI患者出院后成功戒烟率为42.5%,不同年龄段对出院后成功戒烟率影响有统计学意义,29～50岁年龄段成功戒烟率最高,而51～65岁患者成功戒烟率最低.(4)自主戒烟失败率为40.9%,戒烟失败的主要原因为习惯性因素、戒断症状、工作压力及同事吸烟影响等.其中51～65岁患者主要受习惯性因素和戒断症状影响.结论 北京市西城区成年AMI患者吸烟率及自主戒烟失败率均较高,吸烟致AMI平均发病年龄明显提前.积极倡导戒烟对减少AMI发病率及改善预后有重要意义.

Abstract：

Objective To explore the smoking and smoking cessation status in patients with acute myocardial infarction.Methods 456 hospitalized patients with acute myocardial infarction in Xicheng district were recorded in CCU ward between October 2003 and October 2008.Personal data and smoking status were collected.The smoking cessation status after discharge was investigated by telephone.Results (1) Patients who smoked were still male-dominated (96.3%).The average smoking rate in male patients was 55.9%,and even as high as 87.5% in patients at 29-50 years of age.(2) The average age in patients who smoked and with acute myocardial infarction was 58.0±12.3 years old,16 years advanced the age compared to the groups who never smoked or after stopped smoking.(3) The successful smoking cessation rate in patients with acute myocardial infarction after discharge was 42.5%,and 29-50 years old group having the highest rate of successful cessation,while the lowest rate seen in 51-65 years old group.(4) The failure rate of smoking cessation was 40.9% with the main reasons as:radical habit on smoking,withdrawal symptoms,stress in work and peer influence etc.The 51-65 year-old group was mainly suffered from habitual factors and withdrawal symptoms.Conclusion The smoking rate and smoking cessation failure rate in adult patients with acute myocardial infarction in Xicheng district in Beijing remained high.The onset age of acute myocardial infarction was significantly in advance among patients who smoked.To actively advocate on smoking cessation was still vital for reducing the occurrence of acute myocardial infarction and to improve the prognosis in patients with myocardial infarction.     

辽宁省五城市卫生医务人员、教师和公务员吸烟状况抽样调查

目的了解卫生医务人员、教师和公务员吸烟、戒烟、被动吸烟、劝阻吸烟现状以及对吸烟危害健康和我国履行《烟草控制框架公约》的认识,为制定控制吸烟干预措施提供依据。方法采用多阶段整群随机抽样方法抽取辽宁省5市2300名卫生医务人员、教师和公务员,采取自填式答卷调查。结果3种人群总吸烟率为33．2％,男性吸烟率为63．2％,女性吸烟率2．5％;公务员吸烟率最高,为38．2％,卫生医务人员吸烟率为33．0％,教师吸烟率为28．4％;3种人群戒烟成功率为13．9％;有66．7％的人在工作场所被动吸烟;74．0％的人没听说过《烟草控制框架公约》。结论辽宁省5市男性卫生医务人员、教师和公务员吸烟率比较高,加强对卫生医务人员、教师和公务员的控烟责任感教育,让他们认识到卫生医务人员、教师和公务员在全社会控烟工作的过程中起着关键性作用。     

The short and long-term impact of the healthy kids initiative on depressed mood in youth living with obesity

PurposeThe purpose of this study is to determine the effect of a free, comprehensive program with social support on depressed mood in youth (aged 11–17 years) living with obesity in a prospective, longitudinal, community-based study.MethodsYouth living with obesity (BMI > 30), residing in three cities in Saskatchewan, Canada, were eligible to participate in a 12-week program designed to facilitate behavioural change with five physical activity sessions a week, one dietary session a week, and one group cognitive behavioural session per week offered by health care professionals. Baseline data were collected on depressed mood (Centre for Epidemiological Studies-Depression 12 or CES-D 12), health-related quality of life (SF-12), and self-esteem (NLSCY) at baseline, 12-weeks, and at 52-weeksResultsOverall, 2598 youth started and 2292 (88.2 %) completed the 12-week program with 1703 (74.3 %) of participants presenting for 52-week follow-up. Depressed mood improved significantly over the course of the program: 79.2 % of participants had depressed mood at the start of the program and this decreased to 64.7 % at the end of 12-weeks; which was an overall relative reduction of 18.4 % (Cohen’s d = 0.94). The mean CES-D 12 score at one-year was significantly lower than the mean baseline score (17.90 compared to 21.11, p < .001). By depressed mood severity, 58.7 % of participants had severe depressed mood at baseline, which reduced to 31.6 % at 12 weeks, and 27.9 % at 52 weeks. Age and maternal occupation were initially significantly associated with depressed mood at 52-week follow-up (unadjusted). However, after binary logistic regression was used to determine the independent risk factors for having depressed mood at 52-week follow up, only older age (OR 1.88, 95 % CI 1.52–2.34, p < .001) was significant.ConclusionThe Healthy Kids Initiative lends more evidence that healthy behavioural interventions can have a positive impact on depressed mood among youth living with obesity.     

Green space and serious psychological distress among adults and teens: A population-based study in California

There has been mounting evidence for the beneficial effect of green space on mental health among adults, but studies on the same topics are lacking for teens in the US. This study aimed to fill in this research gap by utilizing data from California Health Interview Survey (CHIS) 2011–2014. A total of 81,102 households (composed of 4538 teens and 81,102 adults) were retained for main analyses. Surrounding greenness was assessed by the Normalized Difference Vegetation Index (NDVI) within varying buffers of home residence. Survey logistic regressions accounted for sampling weights and design were conducted to examine the effects of greenness on serious psychological distress (SPD), adjusted for major socio-demographic factors, neighborhood socioeconomic status (SES) and co-respondent's psychological distress level within the same household. An inter-quartile increment of NDVI in 350 m buffer predicted decreased odds of SPDs by 36% in teens (OR = 0.64, 95% CI = [0.46, 0.91]). Mediation analyses revealed that this association remained almost unchanged even after adjusting for social cohesion. The NDVI-SPD association of adults was found to be significant only in the older group (OR = 0.81, 95% CI = [0.68, 0.95]). This study is one of the first population-based US studies extending the epidemiological evidence for benefits of green space on mental health from adults to teens.     

中国人群主动吸烟与慢性阻塞性肺病关系的Meta分析

目的 通过meta分析探究中国人群慢性阻塞性肺病（COPD）的危险因素,为制定中国控烟政策及评估中国烟草带来的疾病负担提供必要的参数。方法 在PubMed、Web of science、Embase、中国知网、维普、万方数据库中检索从建库至2021年6月31日发表的所有吸烟相关疾病的中、英文队列或病例对照研究文献,筛选并提取相关信息。 使用Stata 16.0进行meta分析,探究吸烟与慢性阻塞性肺病发病/死亡的关联。结果 最终纳入16篇文献,其中队列研究10篇,病例对照6篇。Meta分析结果显示,吸烟是COPD的重要危险因素,曾吸烟者较不吸烟者COPD患病/死亡风险更大,RR值为2.64（95%CI:1.74～4.00）,其中男性RR为1.74（95%CI:1.44～2.09）,女性RR为4.06（95%CI:2.53～6.52）,女性显著高于男性。亚组分析结果显示,除男性曾吸烟者病例对照研究（RR: 2.22,95%CI:1.68～2.95)和队列研究（RR:1.33,95%CI:1.19～1.49）RR可信区间无交叠,差异有统计学意义外,其他不同类别的各亚组间RR值差异没有统计学意义。结论 虽然与西方国家相比,中国人群RR值偏低,但吸烟仍是COPD的重要危险因素,其中女性较男性危险度更高。为减轻COPD造成的疾病负担,应进一步加强控烟相关措施。同时,作为一篇只针对于中国人群的研究,本篇文献将为制定中国控烟政策及评估中国烟草带来的疾病负担提供相关依据。     

老年人吸烟及戒烟与相关死亡的前瞻性研究

目的：前瞻性探讨男性老年人吸烟及戒烟与烟草有关疾病死亡的相互关系。方法：研究对象为1987年西安市22个军队干休所的全部男性离体干部,共计1268人,基线调查时,388人为不吸烟者,419人为吸烟者,461人为戒烟者。终点指标为全死因和与烟草有关疾病死亡。结果：截止1999年,共观察14163人年,平均随访11年。共死亡299人,943人存活,26人失访。在调整了年龄,血压、体重指数,总胆固醇,甘油三酯、饮酒,体育锻炼和既往病史等因素后,多元Cox生存分析模型显示：既往吸烟与该人群相关死亡的对危险度（95％CI）分别为总死亡1．34（1．02－1．76）、慢性阻塞性肺病（COPD）3．23（0．95－10．91）,肺癌、2．31（0．95－5．61）、冠心病1．60（0．81－3．19）。其死亡危险性随既吸烟量的增多和吸烟年限的延长而升高,存在明确的剂量反应关系。与继续吸烟者相比,戒烟总死亡和冠心病死亡和危险性分别下降56％和93％,但COPD的死亡危险却升高了174％。结论：（1）吸烟是中国男性老年人的主要死因之一,而戒烟降低总死亡和心血管病死亡;（2）戒烟者COPD死亡危险高于继续吸烟者的原因可能与“无病吸烟者作用”和“因病戒烟作用有关。     

The ecological relationship of tobacco smoking to the prevalence of symptoms of asthma and other atopic diseases in children: the International Study of Asthma and Allergies in Childhood (ISAAC)

This study examined the relationship between parental smoking and asthma and other atopic diseases at the ecological level. The prevalence of atopic symptoms in 6–7- and 13–14-year old children was assessed in 91 centres (from 38 countries) and 155 centres (from 56 countries) respectively in the International Study of Asthma and Allergy in Childhood (ISAAC). These symptoms were related to prevalence of tobacco smoking for each country by gender as reported by the World Health Organisation. There was a significant negative association between the prevalence of smoking by men and the prevalence of symptoms of asthma and rhinitis, but not eczema in the 13–14-year age group. There was a significant positive relationship between prevalence of smoking by women and prevalence of wheeze in the last 12 months, but not for any other symptoms in the 13–14-year age group. In the 6–7-year age group, there was a significant negative correlation between prevalence of smoking by men and the prevalence of wheeze causing sleep disturbance and a close to significant negative association at the 5% level with the prevalence of wheeze in the last 12 months and rhinitis. Thus, for the countries that are included in this analysis, countries that have high adult male smoking rates have a lower risk of asthma and rhinitis symptoms in children. It should be stressed that this analysis does not involve information on individual exposures and therefore does not contradict the well-established association of active and passive smoking in individuals with the occurrence of asthma symptoms in the same individuals. Rather, it indicates that this well-established individual-level association does not account for the international differences in asthma prevalence, and that other risk factors for asthma must be responsible for the observed international patterns.     

Psychological distress and chronic obstructive pulmonary disease in the Renfrew and Paisley (MIDSPAN) study

BACKGROUND: This study examined whether psychological distress might be a predictor of chronic obstructive pulmonary disease (COPD). METHOD: The relation between psychological distress at baseline, measured by the general health questionnaire (GHQ), and chronic bronchitis three years later, as measured by the Medical Research Council (MRC) bronchitis questionnaire and forced expiratory flow in one second (FEV(1)), was examined in 1682 men and 2203 women from the Renfrew and Paisley (MIDSPAN) study. The analyses were run on men and women separately and adjustments were made for age, socioeconomic position, and lung function at baseline (FEV(1)). People with chronic diseases at baseline were then excluded to give a "healthy" baseline cohort. The effect of psychological distress on individual components of the MRC bronchitis questionnaire and FEV(1) was also assessed. RESULTS: In multivariate analyses of the whole cohort baseline psychological distress in women was associated with reduced FEV(1) at follow up (OR 1.31 95% CI 1.0 to 1.73) after adjustment. In women, in the healthy cohort, psychological distress was associated with chronic bronchitis (OR 2.00, 95% CI 1.16 to 3.46), symptoms of bronchial infection (OR 2.14, 95% CI 1.44 to 3.19), symptoms of breathlessness (OR 3.02, 95% CI 1.99 to 4.59), and reduced FEV(1) (OR 1.62, 95% CI 1.13 to 2.32). In men psychological distress predicted symptoms of bronchial infection (OR 2.09, 95% CI 1.28 to 3.42). CONCLUSION: This study supports research suggesting that psychological distress is associated with COPD and shows that psychological distress predicts COPD in women. The robustness of the association and the exact mechanism requires further investigation.     

Psychological distress among marginalized women in the outskirts of Beirut: Determinants and association with health perception

The objective of this study was to determine the prevalence of psychological distress (PD) and its determinants in under-privileged women in the outskirts of Beirut, Lebanon. A cross-sectional survey of 1,869 ever-married women aged 15-59 was carried out. PD levels were determined using the 12-item General Health Questionnaire (Appendix). Health status, living conditions, social support, and physical symptoms as reported by women were recorded. Logistic regression was used to test the independent effect of each variable on PD. 46.6% of women had PD. Psychologically distressed women had more children, less education, lower income, less social support, an uncomfortable relationship with their husband, participated in the labor force and were more likely to reside in a predominantly Moslem community. Reporting a health or living problem were significant predictors of PD. The presence of limb, back and stomach pain, and headache were associated with PD. Compared to similar populations in other countries, our sample had a high prevalence of mental distress.     

西安市军队老年人慢性阻塞性肺疾病死亡危险因素的18年队列研究

目的探讨西安市军队男性老年人慢性阻塞性肺病（COPD）死亡危险因素及相互关系。方法研究对象为1987年西安市22个军队下休所的全部男性离休干部，共计1268人。终点指标为全死因和COPD死亡。结果截止2005年6月30日，共观察18766．28人年，平均随访14．35年；死亡491例，748人存活，29人失访。死亡总例数中COPD居第二位，占16．90％；COPD单因素分析：年龄的RR值95％CI为[1．13（1．09～1．17）]、每日吸烟晕[1．04（1．02～1．06）]、吸烟年限[1．03（1．01～1．04）]、负性生活事件[1．81（2．85～6．77）]、既往COPD史[4．39（285～677）]为COPD死亡危险因素；多因素分析结果显示：年龄的RR值95％CI为[1．10（1．06～1．15）]、每日吸烟量[1．03（1．01～1．06）]、既往COPD史[3．07（1．90～4．98）]为COPD死亡危险因素；其死亡危险性随既往吸烟量的增多和吸烟年限的延长而升高，存在明确的剂量反应关系；戒烟者总死亡的危险下降了66．67％。结论队列中COPD死亡居第二位；年龄、每日吸烟量和既往COPD史是COPD死亡的危险因素；戒烟对COPD死亡的影响有待进一步观察。     

小潮气量通气治疗小儿急性呼吸窘迫综合征临床研究

目的 观察小潮气量通气治疗小儿急性呼吸窘迫综合征(ARDS)的疗效.方法 选择本院2008年1月至2011年12月本院PICU收治需支持通气的ARDS患儿44例为研究对象,将患者分为2组,对照组(20例)机械通气采用常规潮气量(10～12 ml/kg);观察组(24例)机械通气采用小潮气量(6～8 ml/kg).上机后观察两组患儿24、48及72 h氧合改善及血气分析等指标变化,分析机械通气并发症及28 d病死率.结果 两组患儿上机前PaO2/FiO2值(104±23.6 vs 112 ±34.7)比较差异无统计学意义(P＞0.05);上机后24、48及72 h PaO2/Fi02、PaCO2两组比较差异均有统计学意义(t≥2.01,P＜0.05;t ≥2.74,P＜0.01);观察组气压伤低于对照组(x2 =6.97,P＜0.01);观察组病死率16.7％(4/24)低于对照组50％(10/20),其差异有统计学意义(x2=5.58,P＜0.05).结论 ARDS患儿采用小潮气量通气,能改善其氧和,且无血液动力学影响,亦可降低机械通气并发症及病死率,其疗效确切,值得临床推广应用.     

Variables associated with fibrinogen in a population-based study: interaction between smoking and age on fibrinogen concentration

The aim of the study was to assess the association between fibrinogen and other cardiovascular risk factors. A cross-sectional population-based study in Gerona (Spain) was designed, 1544 subjects (747 men, 797 women) participated. Anthropometric measurements, blood pressure and blood samples were obtained. Fibrinogen was measured by a coagulometric method. Smoking habits, alcohol consumption and physical activity practice were recorded by questionnaires. Fibrinogen was directly related to age, body mass index (BMI) and female gender and inversely to alcohol and moderate–heavy physical activity practice. Fibrinogen was also higher in men and young women who smoked. In the multivariate analysis, age (regression coefficient (RC): 1.33; standard error (SE): 0.13; unit = 1 year), female gender (RC: 12.24; SE: 3.56) and BMI (RC: 1.83; SE: 0.39; unit = 1 kg/m²) were directly associated with fibrinogen, whereas alcohol (RC: –0.04; SE: 0.01; unit = 1 g/d) was inversely associated. A statistically significant interaction between smoking and age was observed. Age was the strongest variable associated with fibrinogen and modifies the association between smoking and fibrinogen; the magnitude of this association increases with age.     

Estimating health utilities in patients with asthma and COPD: evidence on the performance of EQ-5D and SF-6D

Objective  The objective of this study was to understand systematic differences in utility values derived from the EQ-5D and the SF-6D in two respiratory populations with heterogeneous disease severity. Methods  This study involved secondary analysis of data from two cross-sectional surveys of patients with asthma (N = 228; Hungary) and COPD (N = 176; Sweden). Disease severity was defined according to GINA and GOLD guidelines for asthma and COPD, respectively. EQ-5D and SF-6D scores and their distributional characteristics were compared across the two samples by disease severity level. Results  Within each patient population, mean EQ-5D and SF-6D scores were similar for the overall group and for those with moderate disease. Mean scores varied for patients with mild and severe disease. EQ-5D versus SF-6D scores in the asthma group by severity levels were 0.89 versus 0.80, 0.70 versus 0.73, 0.63 versus 0.64, and 0.51 versus 0.63, respectively. EQ-5D versus SF-6D scores in the COPD group by severity levels were 0.85 versus 0.80, 0.73 versus 0.73, 0.74 versus 0.73, and 0.53 versus 0.62, respectively. Conclusions  Results suggest the EQ-5D and SF-6D do not yield consistent utility values in patients with asthma and COPD due to differences in underlying valuation techniques and the EQ-5D’s limited response options relative to mild disease.     

The natural environment,plant diversity,and adult asthma: A retrospective observational study using the CDC's 500 Cities Project Data

A wealth of evidence links microbial exposure to better human immune function. However, few studies have examined whether exposure to plant diversity is protective of immune diseases, despite the fact that plant leaves support ~10²⁶ bacterial cells. Using the Centers for Disease Control and Prevention's 500 cities project data, we found that a 1-SD increase in exposure to taxonomic plant diversity is associated with a 5.3 (95% CI: 4.2–6.4; p < 0.001) percentage-point decline in Census-tract level adult-asthma rate. In contrast, A 1-SD increase in overall greenness exposure (measured using the normalized difference vegetation index) was associated with a 3.8 (95% CI: 2.9–4.8; p < 0.001) percentage-point increase in adult-asthma rate. Interactions between air pollution and both overall greenness and plant diversity were positive, suggesting that air pollution may potentiate the allergic effects of plant pollen. Results show that the relationship between the natural environment and asthma may be more complex than previously thought, and the combination of air pollution and plant pollen may be a particular risk factor for asthma in adults.     

吸烟对四川省30岁及以上居民慢性阻塞性肺疾病发病风险影响的前瞻性研究

目的 了解四川省≥30岁居民慢性阻塞性肺疾病（COPD）的发病情况，分析吸烟对COPD发病风险的影响。方法 2004-2008年随机抽取四川省彭州市30~79岁人群进行问卷调查、体格检查和肺功能检测，并进行长期随访，确定COPD发病情况。运用Cox比例风险回归模型分析吸烟与COPD的关系。结果 共纳入46 540名研究对象，男性当前吸烟占比为67.31%，女性为8.67%，有3 101名新发COPD，累积发病率为6.66%。控制年龄、性别、职业、婚姻状况、家庭年收入、文化程度、BMI、日均总体力活动水平、当前做饭频率、当前有无排烟装置、被动吸烟暴露频率等因素后，多因素Cox比例风险回归分析显示，与从不吸烟人群相比，当前吸烟、戒烟增加COPD的发病风险，HR值分别为1.42（95%CI：1.29~1.57）和1.34（95%CI：1.16~1.53）。与从不或偶尔吸烟人群相比，日均吸烟量越大，COPD发病风险越高；当前吸烟类型为混吸、开始吸烟类型为混吸增加COPD的发病风险，HR值分别为1.79（95%CI：1.42~2.25）和2.12（95%CI：1.53~2.92）；开始吸烟年龄<18、≥18岁增加COPD的发病风险，HR值分别为1.61（95%CI：1.43~1.82）和1.34（95%CI：1.22~1.48）；吸烟时吸入口腔后即吐出、吸到咽喉部和深吸到肺部增加COPD的发病风险，HR值分别为1.30（95%CI：1.16~1.45）、1.63（95%CI：1.45~1.83）和1.37（95%CI：1.21~1.55）。控制多个混杂因素，校正回归稀释偏倚后，日均吸烟量、开始吸烟年龄和烟吸入部位对COPD发病均有影响，性别差异尤为突出。结论 吸烟增加COPD的发病风险，这种影响与吸烟量、吸烟类型、开始吸烟年龄和烟吸入部位等存在一定关系，控烟应综合考虑吸烟的具体特征，从而预防COPD的发生。     

Prevalence of distress and symptom severity from the lower urinary tract in men: a population-based study with the DAN-PSS questionnaire

Background. Lower urinary tract symptoms (LUTS) are a commonand costly public health issue. The prevalence varies greatlyin published reports. The distress caused by each symptom isimportant to assess the primary care required before therapeuticdecisions or a referral to an urologist are made. Objectives. LUTS are highly prevalent in men, but less is knownregarding the distress caused by each symptom. The aim of thisstudy was to examine symptom severity and different levels ofdistress using the Danish Prostatic Symptom Score (DAN-PSS)questionnaire in men affected by symptoms from the lower urinarytract. Methods. The study included all men aged 41–81 years (n= 504) that, 12 months earlier in a population-based survey,had reported stress incontinence, urgency or post-micturitiondribbling in a postal questionnaire. The DAN-PSS questionnairewas used to measure severity and distress from LUTS. Results. In total, 311 (80%) of the 387 responders who reportedat least one symptom experienced some level of distress. Themost distressing symptom overall was urinary incontinence. Nineof 10 men with storage symptoms (stress, urge and ‘other’urinary incontinence) reported distress even if the symptomoccurred only seldom. Moreover, two-thirds of the men with themost frequent symptom, post-micturition dribbling, characterizedtheir symptom as moderate or severe; the most distressing voidingsymptom was weak stream. In general, LUTS were well tolerated. Conclusion. Urge incontinence was the most distressing LUTSeven when occurring only seldom. The DAN-PSS questionnaire maybe a potentially useful tool for health professionals to identifypatients with pronounced distress from LUTS to offer therapeuticand nursing care on the relevant level. Keywords. DAN-PSS, distress, LUTS, population-based, postal questionnaire.