Prevalence of comorbid psychiatric illness and its impact on symptom perception,quality of life,and functional status in women with urinary incontinence

Objective: The purpose of this study was to determine the prevalence and impact of major depression and panic disorder in women with urinary incontinence. Study Design: Participants were 218 consecutive women with urinary incontinence over a 14-month period. Major depression and panic disorder diagnoses, symptom perception, incontinence-specific quality of life, functional status, and urinary incontinence type were assessed. Results: The overall prevalence of major depression and panic disorder was 16% and 7%, respectively. In a comparison to patients with stress urinary incontinence, the odds of having major depression were 9.2 for patients with urge and 13.5 for patients with mixed urinary incontinence. Although clinically similar to patients who did not have depression, patients with depression rated their urinary incontinence as significantly more severe and had greater quality of life and functional status impairment. Conclusion: Current major depression and panic disorder are highly prevalent in women with urinary incontinence. Patients with urge and mixed urinary incontinence are significantly more likely to have coexistent psychiatric illness. Comorbid major depression significantly impacts a patient's urinary incontinence symptom reporting, incontinence-specific quality of life, and functional status. (Am J Obstet Gynecol 2002;187:80-7.)     

Correlation between bone mineral density and plasma lipids in Taiwan

Many studies showed that depression is correlated with osteoporosis, while others showed that low cholesterol level is also related to depression. However, these relationships still remain controversial. Since the bone mineral density (BMD) is related to depression and depression is related to hypocholesterolemia, there might exist a correlation between BMD and plasma cholesterol levels. To prove this, we enrolled 5000 individuals, 2170 males, and 2830 females, who had health check-ups at a private clinic between 1998 and 1999. They were divided into three groups. Group 1 was composed of male subjects; Group 2, female subjects; and Group 3, females aged over 50 to exclude pre-menopausal females. Each subject had a routine physical examination, fasting blood drawing, BMD measured by dual energy x-ray absorptiometry (DEXA) over the wrist, and was given a questionnaire to answer. Between Groups 1 and 2, the females were significantly younger, had higher body mass index (BMI), total cholesterol (TC), high density lipoprotein cholesterol (HDLC), low density lipoprotein cholesterol (LDLC), and platelet, but lower BMD, fasting plasma glucose (FPG), triglycerides (TG), hemoglobin (Hgb), and white blood cell (WBC) count. As for Groups 1 and 3, all the aforementioned findings still remained the same except that the systolic blood pressure (SBP) was higher and diastolic blood pressure (DBP) was lower in Group 3. Our results showed that BMD is negatively related to age in males. In females, it is negatively correlated with age, FPG, PPG, SBP, DBP, TC, LDLC, TG, and Hgb, but positively related to BMI and platelet. However, for females in Group 3, BMD is only negatively related to age, FPG, SBP, and TG but positively related to BMI. Stepwise multiple regression analysis showed that the BMD is negatively related to age but positively related to BMI in both males and females. In Group 3, BMD is negatively related to age and FPG but positively related BMI. In conclusion, no correlation exists between BMD and cholesterol. This implies that the depression is not significantly related to cholesterol and/or BMD. This might be due to various confounding factors, which could affect their relationships. The negative correlation between BMD and FPG is only observed in females older than 50 years. Further studies are needed to clarify these relationships.     

Integrated approach to teaching and testing in histology with real and virtual imaging

The University of Iowa College of Medicine histology teaching laboratory incorporates extensive Web- and computer-based teaching modalities, including the Virtual Microscope (VM), as emerging learning aids in histology and pathology laboratory instruction. We report here our experience in offering a multiple resource-based approach to laboratory instruction while retaining the opportunity and requirement of examining actual microscopic slide preparations with the microscope. Acceptance of this approach has been high among our students and faculty, and performance levels established over years of teaching histology by traditional means have been maintained.     

Research report: learning styles of biomedical engineering students

Examining students learning styles can yield information useful to the design of learning activities, courses, and curricula. A variety of measures have been used to characterize learning styles, but the literature contains little information specific to biomedical engineering (BMEN) students. We, therefore, utilized Felders Index of Learning Styles to investigate the learning style preferences of BMEN students at Tulane University. Tulane BMEN students preferred to receive information visually (preferred by 88% of the student sample) rather than verbally, focus on sensory information (55%) instead of intuitive information, process information actively (66%) instead of reflectively, and understand information globally (59%) rather than sequentially. These preferences varied between cohorts (freshman, sophomore, etc.) and a significantly higher percentage of female students preferred active and sensing learning styles. Compared to other engineering student populations, our sample of Tulane BMEN students contained the highest percentage of students preferring the global learning style. Whether this is a general trend for all BMEN students or a trait specific to Tulane engineers requires further investigation. Regardless, this study confirms the existence of a range of learning styles within biomedical engineering students, and provides motivation for instructors to consider how well their teaching style engages multiple learning styles. © 2002 Biomedical Engineering Society. PAC2002: 8780-y, 0140-d     

Impaired developmental competence of oocytes in adult prenatally androgenized female rhesus monkeys undergoing gonadotropin stimulation for in vitro fertilization

To determine whether prenatal T propionate exposure beginning gestational d 40-44 (early-treated) or 100-115 (late-treated) affects oocyte competence, five early-treated and five late-treated prenatally androgenized and five normal monkeys underwent recombinant human FSH injections with oocyte-retrieval after hCG administration. Serum FSH, LH, estradiol (E(2)), progesterone (P(4)), androstenedione (A(4)), T, and dihydrotestosterone were measured basally, during gonadotropin stimulation and at oocyte-retrieval; fasting serum glucose and insulin also were determined basally and at oocyte-retrieval. Follicle fluid sex steroids were analyzed. Oocyte number, nuclear maturity, and fertilization were comparable among female groups, but the percentage of zygotes developing into blastocysts was reduced in early-treated prenatally androgenized females. The intrafollicular P(4)/E(2) ratio was significantly elevated in early-treated prenatally androgenized females, whereas intrafollicular P(4)/A(4) and T/A(4) ratios were significantly increased in all prenatally androgenized females. Early-treated prenatally androgenized females demonstrated persistent LH hypersecretion. They also were unable to suppress circulating insulin levels during gonadotropin stimulation. Circulating sex steroid levels and serum P(4)/E(2), P(4)/A(4), and E(2)/androgen ratios were similar in all females. Early prenatal androgenization in monkeys receiving gonadotropins impairs oocyte developmental competence and seems to induce premature follicle differentiation in the presence of LH hypersecretion and relative insulin excess.     

Modified ultrafiltration postextracorporeal membrane oxygenation

Modified ultrafiltration (MUF) has been widely used for the removal of extracellular water in the immediate postcardiopulmonary bypass (CPB) period. The reported benefits of this technique are improved hematological status and hemodynamic stability post-CPB, as well as a decrease in blood utilization during the operation. MUF has also been associated with improved pulmonary status along with enhanced myocardial performance. With these benefits in mind, we have explored the possible advantages of using MUF following extracorporeal membrane oxygenation (ECMO). The theoretical advantages of using MUF post-ECMO are the reduction of blood use prior to removal from ECMO for optimization of hemoglobin levels, improved pulmonary compliance decreasing the duration of ventilatory support, improved myocardial function, as well as the other reported benefits described with MUF post-CPB. This report communicates the technique used to perform MUF post-ECMO, as well as a simple MUF circuit design for use in the intensive care unit setting.     

The relationship between National Heart,Lung, and Blood Institute Weight Guidelines and concurrent medical costs in a manufacturing population

PURPOSE: To explore the relationship between the 1998 National Heart, Lung, and Blood Institute (NHLBI) weight guidelines and concurrent medical costs. DESIGN: Cross-sectional study. SETTING: In a nationwide manufacturing corporation (General Motors Corporation). SUBJECTS: A total of 177,971 employees, retirees, and their adult dependents who were enrolled in Indemnity/PPO health insurance plan during the years 1996 and 1997 and completed one health risk appraisal (HRA) in the same period. MEASURES: The participants were categorized into six weight groups according to the NHLBI 1998 guidelines (body mass index [BMI] < 18.5, 18.5-24.9, 25-29.9, 30-34.9, 35-39.9, > or = 40 kg/m2). The height and weight data were collected by self-reported values on an HRA or biometric screening completed during 1996 to 1997. To represent the typical medical costs in a given group, the median, instead of mean, medical charges were used in this article. The annual median medical charges (including drug charges) for years 1996 and 1997 were compared among the six weight groups by using Wilcoxon rank sum tests. The differences in median charges were also tested between the normal weight group and the other five groups for each of the 10 gender-age subgroups (five age groups: 19-44, 45-54, 55-64, 65-74, 75+). RESULTS: Overall median medical costs were consistent with the NHLBI weight guidelines. The normal-weight group costs the least and both underweight and overweight-obesity groups cost more. The median medical costs of the six weight groups were $3184, $2225, $2388, $2801, $3182, and $3753, respectively, with statistical differences existing between any two groups of the last five categories. The underweight groups, especially in females, were not consistent with the guidelines in the two young groups (ages 19-44 and 45-54). An inconsistent relationship between medical costs and BMI groups was seen in the oldest males (age 75+). CONCLUSIONS: The six weight groups defined by the 1998 NHLBI guidelines are consistent with concurrent medical costs. Except for the underweight group (BMI < 18.5 kg/m2), medical costs gradually increased with BMI. Given that the prevalence of obesity continues to increase in western countries, effective weight control programs would help avoid a substantial amount of medical costs associated with overweight/obesity and related diseases.     

Pattern of medical charges after quitting smoking among those with and without arthritis, allergies, or back pain

PURPOSE: To examine the time frame of changes in medical charges after smoking cessation among (1) those with arthritis, allergies, or back pain and (2) those with none of these chronic conditions. DESIGN: Cross-sectional study using smoking status determined in 1996 and 4-year average medical charges measured from 1996 to 1999. SETTING: Nationwide manufacturing corporation (General Motors Corporation). SUBJECTS: A total of 20,332 employees and spouses who completed a health risk appraisal in 1996 were younger than 64 years, were enrolled in indemnity or preferred provider organization health insurance plans during 1996 to 1999, and self-reported no preexisting primary diseases. MEASURES: Participants were categorized according to 1996 self-reported smoking status into six subgroups: current smokers, former smokers by years since cessation (0-4, 5-9, 10-14, and > or = 15 years), and never smokers. Average annual medical charges (1996-1999) among those with chronic conditions (arthritis, allergies, or back pain; N = 11,921) or without chronic conditions (N = 8411) were examined independently. Never smokers in each group were compared to respective smoker and former smoker subgroups. RESULTS: Current smokers and former smokers without chronic conditions who quit fewer than 5 years earlier had higher medical charges compared with never smokers ($2613 and $3356 vs. $2203, respectively). Among those with chronic conditions, current smokers, former smokers who quit 0 to 4 years ago, and former smokers who quit 5 to 9 years ago had higher medical charges than never smokers ($4208, $4027, and $4050 vs. $3108, respectively). CONCLUSIONS: It took approximately 5 years for former smokers without chronic conditions and nearly 10 years for former smokers with chronic conditions to reduce their medical charges to levels close to their respective never smokers. Health promotion practitioners and other decision makers should consider the impact of chronic conditions on the course of medical savings when implementing smoking cessation programs at the worksite.