Psychosocial mechanisms of a behavioral treatment for urinary incontinence of prostate cancer survivors

Abstract

Purpose: We examined underlying psychosocial processes of a behavioral treatment for urinary incontinence (UI) of prostate cancer survivors.

Design: Secondary analysis of data collected from a clinical trial.

Sample: Two hundred forty-four prostate cancer survivors who participated in a clinical trial of behavioral intervention to UI as intervention or control subjects.

Methods: The participants had a 3-month behavioral intervention or usual care and were followed up for an additional 3?months. They were assessed at baseline, 3, and 6?months. Latent growth curve models were performed to examine trajectories of each study variable and relationships among the variables.

Findings: Increasing self-efficacy and social support were significantly and independently associated with more reduction of urinary leakage frequency over time.

Implications for psychosocial oncology: Providing problem-solving skills and social support, including peer support, are essential for empowering patients to reduce UI.     

Comparison of asthma treatment given in addition to inhaled corticosteroids on airway inflammation and responsiveness.

There is increasing evidence that the assessment of eosinophilic airway inflammation using induced sputum and measurement of airway hyperresponsiveness provides additional, clinically important information concerning asthma control. The aim of this study was to directly compare the effects of different treatments on these markers in patients with asthma and persistent symptoms, despite the use of low-dose inhaled corticosteroids. A double-blind four-way crossover study was performed, which compared a 1-month treatment with budesonide 400 mug b.i.d., additional formoterol, additional montelukast and placebo in 49 patients with uncontrolled asthma despite budesonide 100 mug b.i.d., with each treatment separated by a 4-week washout period. The change in sputum eosinophil count with formoterol (2.4 to 3.8% change, 0.6-fold reduction, 95% confidence interval (CI) 0.5-0.9) differed significantly from placebo (2.8 to 2.5% change, 1.1-fold reduction, 95% CI 0.7-1.6) and high-dose budesonide (2.7 to 1.6% change, 1.6-fold reduction, 95% CI 1.2-2.2). The effects of montelukast did not differ from placebo. The changes in methacholine airway responsiveness were small and did not differ between treatments. High-dose budesonide had the broadest range of beneficial effects on other outcomes, including symptom scores, morning peak expiratory flow and forced expiratory volume in one second. In conclusion, treatment given in addition to low-dose inhaled corticosteroids results in modest benefits. Formoterol and high-dose budesonide have contrasting effects on eosinophilic airway inflammation.     

Visual acuity with reversed-contrast charts: I. Theoretical and psychophysical investigations.

When the contrast polarity of a visual acuity chart is reversed by using bright letters on a dark background instead of dark on light, the shape and height of the resolution feature in the retinal image is identical but inverted compared with the normal situation. However, the contrast is different in the two cases because the background light level, which is a dividing factor when contrast is calculated, is much less when only the letters are bright. To the extent that contrast is a limiting factor in visual acuity, reversed-contrast acuity would be expected to be better, and proportionally more so in eyes where light scatter and aberrations widen and flatten the point-spread function. In a careful psychophysical study of Landolt C resolution, the minimum angle of resolution was found to be significantly smaller for white letters on a dark background than for the traditional dark on bright situation.     

Der gesunde Patient mit Hypercholesterin?mie

Eine 71-jährige, gesundheitsbewusste, zu einer Medizinerfamilie gehörige Patientin stellt sich zur Bewertung einer seit 10 Jahren bekannten Cholesterinerhöhung und der an anderer Stelle begonnenen Behandlung mit Mevinacor^® (Lovastatin) vor.Im vorausgegangenen Jahr waren bei vielen Gelegenheiten Gesamtcholesterinkonzentrationen zwischen 289 und 345 mg/dl bestimmt worden. LDL wurde bis auf maximal 261 mg/dl erhöht gefunden, die HDL-Cholesterin-Werte lagen zwischen 40 und 48 mg/dl, die Triglyzeride zwischen 99 und 264 mg/dl.     

Recurrent Access Thrombosis

A substantial fraction of clotted polytetrafluoroethylene (PTFE) grafts undergoing thrombolysis and angioplasty clot again within a few months. Is there a place for routine follow-up fistulograms in these patients, or should we just retreat them as needed? Is there, perhaps, a subgroup that requires special management?