Quality of life assessment in men and women with urinary incontinence

PURPOSE: The literature on assessment of quality of life from 1993 to 2001 was reviewed to evaluate and compare existing measures through their psychometric value and make adequate recommendations on their clinical use and future research. MATERIALS AND METHODS: We selected quality of life articles and abstracts from Current Content 1996 to 1997 and MEDLINE 1993 to 1996 for our first report presented at the first consultation on incontinence in Monaco in 1998. This report was then updated up to September 2001 using the same strategy. We made our recommendations based on our clinical and research experience with these tools. RESULTS: Several quality of life generic or disease specific questionnaires have been published for male and female urinary incontinence. However, their psychometric value is far from uniform and for most of them responsiveness is weak or has never been reported. CONCLUSIONS: Few quality of life questionnaires are at an advanced enough stage of development to be applied in clinical practice. However, even with these questionnaires more study remains to be done to make them shorter, sometimes even more specific and easier to use in different populations.     

Elevated serum parathormone level after "concise parathyroidectomy" for primary sporadic hyperparathyroidism

BACKGROUND: Cure after parathyroid exploration is traditionally assessed by serum calcium concentration 6 months postoperatively. Postoperative normocalcemic elevation of serum parathormone (PTH) level has been described but is of unclear significance. METHODS: In a 6-year prospective study of outcomes in 380 patients undergoing initial parathyroidectomy for primary sporadic hyperparathyroidism, we measured intact serum PTH and calcium levels at more than 5 months. Those with normocalcemic high PTH levels were begun on oral calcium + vitamin supplements and monitored. RESULTS: At more than 5 months postoperatively, normocalcemic elevation in serum PTH level occurred in 28% of patients, was more common after resection of double adenomas (P =.01), and predated the onset of recurrent hypercalcemia in 3 of 3 patients with unrecognized multiglandular disease. Although delayed treatment with calcium and vitamin supplements produced no clear benefit, patients who took such supplements from the date of surgery were much less likely to have an elevated serum PTH level more than 5 months later (P =.0005). CONCLUSIONS: After successful parathyroid surgery, compensatory normocalcemic elevation in serum PTH level is frequent and may arise from dietary deficiency. Monitored supplemental intake of calcium and vitamin D appears to prevent or to normalize the condition in most patients. Patients with normocalcemic elevation in serum PTH level should receive evaluation for dietary deficiencies as well as follow-up for possible residual disease.     

Successful retransplantation after renal allograft loss to polyoma virus interstitial nephritis

BACKGROUND: Although polyoma virus infection is being increasingly recognized as a cause of renal allograft dysfunction and failure, the risk of polyoma recurrence in a subsequent transplant is unknown. We present the first reported case of successful retransplantation after polyoma virus-induced renal allograft loss. CASE REPORT: A 40-year-old Caucasian woman received a cadaveric kidney transplant. Baseline immunosuppression included corticosteroids, mycophenolate mofetil, and tacrolimus. Her post-transplant clinical course was complicated by an early acute rejection episode on posttransplant day (PTD) 6, that warranted treatment with OKT3. A biopsy performed on PTD 154 to evaluate a rise in creatinine revealed polyoma virus interstitial nephritis. Despite reduction in immunosuppression, the renal function progressively worsened and dialysis was initiated by PTD 160, followed by transplant nephrectomy on PTD 184. Four months later, she received a living related kidney from her sister. Immunosuppression was initiated with prednisone, azathioprine, and tacrolimus. She had immediate graft function with a decrease in serum creatinine from 12.8 to 1.1 mg/dl. Three and one-half years after her second renal transplant, her allograft functions well, with a serum creatinine of 1 mg/dl. Both quantitative and qualitative assays of blood and urine (by PCR) remain negative for BK virus, indicating the absence of virus reactivation. CONCLUSION: Judicious retransplantation should be considered as a therapeutic option in the management of polyoma virus induced graft failure. Previous graft loss secondary to polyoma virus infection is not a contraindication to retransplantation.     

International expert workshop on the analysis of the economic and public health impacts of air pollution: workshop summary

Forty-nine experts from 18 industrial and developing countries met on 6 September 2001 in Garmisch-Partenkirchen, Germany, to discuss the economic and public health impacts of air pollution, particularly with respect to assessing the public health benefits from technologies and policies that reduce greenhouse gas (GHG) emissions. Such measures would provide immediate public health benefits, such as reduced premature mortality and chronic morbidity, through improved local air quality. These mitigation strategies also allow long-term goals--for example, reducing the buildup of GHG emissions--to be achieved alongside short-term aims, such as immediate improvements in air quality, and therefore benefits to public health. The workshop aimed to foster research partnerships by improving collaboration and communication among various agencies and researchers; providing a forum for presentations by sponsoring agencies and researchers regarding research efforts and agency activities; identifying key issues, knowledge gaps, methodological shortcomings, and research needs; and recommending activities and initiatives for research, collaboration, and communication. This workshop summary briefly describes presentations made by workshop participants and the conclusions of three separate working groups: economics, benefits transfer, and policy; indoor air quality issues and susceptible populations; and development and transfer of dose-response relationships and exposure models in developing countries. Several common themes emerged from the working group sessions and subsequent discussion. Key recommendations include the need for improved communication and extended collaboration, guidance and support for researchers, advances in methods, and resource support for data collection, assessment, and research.     

Soy-based formulae and infant growth and development: a review

Soy-based infant formulae, initially developed for infants who were lactose intolerant or allergic to cow's milk-based formulae, now account for >25% of the infant formulae sold in the United States. Formulations have changed over the years to improve digestibility, the stability and availability of minerals, and protein quality. Recent concerns have been raised regarding the phytoestrogenic isoflavone content of soy-based formulae. A systematic review of the literature was conducted to evaluate various measures of infant health and development in clinical studies comparing modern soy-based formulae with other diets and to document areas in which further research seems warranted. Results suggest that modern soy-based formulae support normal growth and nutritional status in healthy term infants in y 1 of life. However, there are very limited data on sexual and reproductive development or outcomes such as immune function, visual acuity/cognitive development and thyroid function. Available data do not provide evidence of meaningful differences in timing of maturation, sexual development or fertility in adolescents or adults. Nonetheless, given evidence suggesting that early exposure to soy and/or isoflavones might have long-term effects, further research following infants fed soy-based formulae into adulthood is warranted.     

Seasonal variations in injury rates during US Army Basic Combat Training

OBJECTIVES: Previous literature suggests that injury rates during physical activity may be higher in the summer than in the fall or winter, possibly due to the greater amount or intensity of physical activity in the summer. This study examined seasonal differences in injury incidence during US Army Basic Combat Training, where physical activity was similar at all times of the year. METHODS: Four independent groups of subjects (total n = 1543 men and 1025 women) were investigated, two training in the summer and two training in the fall. Injury data were obtained from a retrospective review of the subjects' medical records at the conclusion of the 8 week training program. RESULTS: For men, the corrected relative risk of suffering an injury or a time loss injury in the summer was, respectively, 2.0 [95% confidence interval (CI) = 1.7-2.4] and 2.5 (95% CI = 1.9-3.0) times higher than in the fall. For women, the corrected relative risk of suffering an injury or time-loss injury in the summer was, respectively, 1.4 (95% CI = 1.3-1.6) and 1.7 (95% CI = 1.5-2.0) times higher than in the fall. These risks were essentially unchanged after adjustment for subject physical characteristics (age, stature, body mass, body mass index) and physical fitness (push-ups, sit-ups and 2 mile run), indicating that the summer season was an injury risk factor independent of these variables. Linear correlations (r-values) between maximal daily temperature and injury incidence ranged from 0.92 to 0.97, indicating a strong relationship between these two variables. CONCLUSIONS: These data suggest that injury incidence among physically active individuals is higher in the summer than in the fall and that environmental temperature may provide a partial explanation for this finding.     

A comparison of household lead exposure assessment methods in an old,urban community

The accurate assessment of lead hazards within the household is critical to the prevention of lead exposure to children living in urban communities. Although dust wipes are currently accepted as the best method of assessing lead hazards, questionnaires and visual inspections are also used. This study evaluates the level of agreement among these three methods of assessment using a sample of 126 women living in old, urban houses. The level of agreement was assessed using the kappa statistic, which adjusts for chance agreement. Overall, the kappa results for both the participant's assessment (questionnaire) and the visual inspector's assessment were low, indicating only slight to moderate agreement with the dust lead wipe levels. Kappas were higher and more consistent for the visual inspector's assessment than for the participant's assessment. These results indicate that visual inspections and participant questionnaires may provide less accurate information regarding lead hazards within the household than dust wipes. Because lead hazard recognition is important in the prevention of lead exposure in children, our data suggest that emphasis should be placed on the measurement of dust lead levels directly in assessing household lead hazards, possibly by teaching women in high-risk neighborhoods to take dust samples themselves.