Identifying the most reliable and valid bladder health screening tool: a systematic review

<p><b>Purpose:</b> Lower urinary tract symptoms are common in advancing age and a major cause of disability through avoidance of activity and social engagement. This systematic review aimed to identify the most valid and reliable brief screening tool for these symptoms or bladder problems, to incorporate into a health promotion programme for older adults to facilitate discussion about self-management.</p> <p><b>Method:</b> Review eligibility criteria included studies published between 1990 and November 2018, reporting the validity, reliability and/or acceptability of bladder health screening tools. Six electronic databases were searched.</p> <p><b>Results:</b> Twenty-two studies were included. Three screening tools met the criteria: International Prostate Symptom Score (IPSS); International Consultation on Incontinence Questionnaire Urinary Incontinence Short-Form; Bladder Control Self-Assessment Questionnaire (B-SAQ). Test–retest reliability for total scores of the IPSS and International Consultation on Incontinence Questionnaire Urinary Incontinence Short-Form was acceptable. All three questionnaires showed evidence of acceptable levels of internal consistency and of convergent validity.</p> <p><b>Conclusion:</b> Having favourable psychometric scores compared to the B-SAQ and for ease of use and trustworthiness of a simple questionnaire, the IPSS and International Consultation on Incontinence Questionnaire Urinary Incontinence Short-Form met the criteria for recommendation for raising awareness and bladder health promoting interventions to reduce associated disability.Implications for Rehabilitation</p><p>Lower urinary tract symptoms are common in advancing age and a major cause of disability through avoidance of activity and social engagement.</p><p>Lower urinary tract symptoms can be prevented or improved through self-management strategies.</p><p>Help-seeking levels for lower urinary tract symptoms is low but could be improved through continence promotion interventions.</p><p>The International Prostate Symptom Score and the International Consultation on Incontinence Questionnaire – Urinary Incontinence Short Form are bladder health screening questionnaires which would be appropriate to use as part of a continence promotion intervention to help prompt discussions and raise awareness and subsequently improve symptoms and associated disability.</p><p></p> <p>Lower urinary tract symptoms are common in advancing age and a major cause of disability through avoidance of activity and social engagement.</p> <p>Lower urinary tract symptoms can be prevented or improved through self-management strategies.</p> <p>Help-seeking levels for lower urinary tract symptoms is low but could be improved through continence promotion interventions.</p> <p>The International Prostate Symptom Score and the International Consultation on Incontinence Questionnaire – Urinary Incontinence Short Form are bladder health screening questionnaires which would be appropriate to use as part of a continence promotion intervention to help prompt discussions and raise awareness and subsequently improve symptoms and associated disability.</p

Stimulation of the tibial nerve: a protocol for a multicentred randomised controlled trial for urinary problems associated with Parkinson’s disease—STARTUP

Introduction Parkinson’s disease is the second most common chronic neurodegenerative condition with bladder dysfunction affecting up to 71%. Symptoms affect quality of life and include urgency, frequency, hesitancy, nocturia and incontinence. Addressing urinary dysfunction is one of the top 10 priority research areas identified by the James Lind Alliance and Parkinson’s UK. Objectives Conduct a randomised controlled trial (RCT) targeting people with Parkinson’s disease (PwP) who have self-reported problematic lower urinary tract symptoms, investigating the effectiveness of transcutaneous tibial nerve stimulation (TTNS) compared with sham TTNS. Implement a standardised training approach and package for the correct application of TTNS. Conduct a cost-effectiveness analysis of TTNS compared with sham TTNS. Methods and analysis An RCT of 6 weeks with twice weekly TTNS or sham TTNS. Participants will be recruited in 12 National Health Service neurology/movement disorder services, using a web-based randomisation system, and will be shown how to apply TTNS or sham TTNS. Participants will receive a weekly telephone call from the researchers during the intervention period. The trial has two coprimary outcome measures: International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form and the International Prostate Symptom Score. Secondary outcomes include a 3-day bladder diary, quality of life, acceptability and fidelity and health economic evaluation. Outcomes will be measured at 0, 6 and 12 weeks. A sample size of 208 randomised in equal numbers to the two arms will provide 90% power to detect a clinically important difference of 2.52 points on the Internatioanl Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) and of 3 points in the International Prostate Symptom Score total score at 12 weeks at 5% significance level, based on an SD of 4.7 in each arm and 20% attrition at 6 weeks. Analysis will be by intention to treat and pre defined in a statistical analysis plan Ethics and dissemination East of Scotland Research Ethics Service (EoSRES), 18/ES00042, obtained on 10 May 2018. The trial will allow us to determine effectiveness, safety, cost and acceptability of TTNS for bladder dysfunction in PWP. Results will be published in open access journals; lay reports will be posted to all participants and presented at conferences. Trial registration number ISRCTN12437878; Pre-results

An acoustic sensor transmitter for in situ assessment of water quality and fish behaviour during chemical treatment of a parasite-infected river system : tag design and practical use

publishedVersio

Effectiveness and cost-effectiveness of basic versus biofeedback-mediated intensive pelvic floor muscle training for female stress or mixed urinary incontinence: protocol for the OPAL randomised trial

This is the final version. Available on open access from BMJ Publishing Group via the DOI in this recordIntroduction Accidental urine leakage is a distressing problem that affects around one in three women. The main types of urinary incontinence (UI) are stress, urgency and mixed, with stress being most common. Current UK guidelines recommend that women with UI are offered at least 3 months of pelvic floor muscle training (PFMT). There is evidence that PFMT is effective in treating UI, however it is not clear how intensively women have to exercise to give the maximum sustained improvement in symptoms, and how we enable women to achieve this. Biofeedback is an adjunct to PFMT that may help women exercise more intensively for longer, and thus may improve continence outcomes when compared with PFMT alone. A Cochrane review was inconclusive about the benefit of biofeedback, indicating the need for further evidence. Methods and analysis This multicentre randomised controlled trial will compare the effectiveness and cost-effectiveness of PFMT versus biofeedback-mediated PFMT for women with stress UI or mixed UI. The primary outcome is UI severity at 24 months after randomisation. The primary economic outcome measure is incremental cost per quality-adjusted life-year at 24 months. Six hundred women from UK community, outpatient and primary care settings will be randomised and followed up via questionnaires, diaries and pelvic floor assessment. All participants are offered six PFMT appointments over 16 weeks. The use of clinic and home biofeedback is added to PFMT for participants in the biofeedback group. Group allocation could not be masked from participants and healthcare staff. An intention-to-treat analysis of the primary outcome will estimate the mean difference between the trial groups at 24 months using a general linear mixed model adjusting for minimisation covariates and other important prognostic covariates, including the baseline score. Ethics and dissemination Approval granted by the West of Scotland Research Ethics Committee 4 (16/LO/0990). Written informed consent will be obtained from participants by the local research team. Serious adverse events will be reported to the data monitoring and ethics committee, the ethics committee and trial centres as required. A Standard Protocol Items: Recommendations for Interventional Trials checklist and figure are available for this protocol. The results will be published in international journals and included in the relevant Cochrane review. Trial registration number ISRCTN57746448; Pre-results.National Institute for Health Research (NIHR

Proglacial icings as indicators of glacier thermal regime : ice thickness changes and icing occurrence in Svalbard

Proglacial icings (also known as naled or aufeis) are frequently observed in the forefields of polar glaciers. Their formation has been ascribed to the refreezing of upwelling groundwater that has originated from subglacial melt, and thus the presence of icings has been used as evidence of polythermal glacier regime. We provide an updated analysis of icing occurrence in Svalbard and test the utility of icings as an indicator of thermal regime by comparing icing presence with: (1) mean glacier thickness, as a proxy for present thermal regime; and (2) evidence of past surge activity, which is an indicator of past thermal regime. A total of 279 icings were identified from TopoSvalbard imagery covering the period 2008-2012, of which 143 corresponded to icings identified by Bukowska-Jania and Szafraniec (2005) from aerial photographs from 1990. Only 46% of icings observed in 2008-2012 were found to occur at glaciers with thicknesses consistent with a polythermal regime, meaning a large proportion were associated with glaciers predicted to be of a cold or transitional thermal regime. As a result, icing presence alone may be an unsuitable indicator of glacier regime. We further found that, of the 279 glaciers with icings, 63% of cold-based glaciers and 64% of transitional glaciers were associated with evidence of surge activity. We therefore suggest that proglacial icing formation in Svalbard may reflect historical (rather than present) thermal regime, and that icings possibly originate from groundwater effusion from subglacial taliks that persist for decades following glacier thinning and associated regime change

ATP-Sensitive Potassium Channel-Deficient Mice Show Hyperphagia but Are Resistant to Obesity

BackgroundThe hypothalamus, the center for body weight regulation, can sense changes in blood glucose level based on ATP-sensitive potassium (KATP) channels in the hypothalamic neurons. We hypothesized that a lack of glucose sensing in the hypothalamus affects the regulations of appetite and body weight.MethodsTo evaluate this hypothesis, the responses to glucose loading and high fat feeding for eight weeks were compared in Kir6.2 knock-out (KO) mice and control C57BL/6 mice, because Kir6.2 is a key component of the KATP channel.ResultsThe hypothalamic neuropeptide Y (NPY) analyzed one hour after glucose injection was suppressed in C57BL/6 mice, but not in Kir6.2 KO mice, suggesting a blunted hypothalamic response to glucose in Kir6.2 KO mice. The hypothalamic NPY expression at a fed state was elevated in Kir6.2 KO mice and was accompanied with hyperphagia. However, the retroperitoneal fat mass was markedly decreased in Kir6.2 KO mice compared to that in C57BL/6 mice. Moreover, the body weight and visceral fat following eight weeks of high fat feeding in Kir6.2 KO mice were not significantly different from those in control diet-fed Kir6.2 KO mice, while body weight and visceral fat mass were elevated due to high fat feeding in C57BL/6 mice.ConclusionThese results suggested that Kir6.2 KO mice showed a blunted hypothalamic response to glucose loading and elevated hypothalamic NPY expression accompanied with hyperphagia, while visceral fat mass was decreased, suggesting resistance to diet-induced obesity. Further study is needed to explain this phenomenon

Effectiveness of pelvic floor muscle training with and without electromyographic biofeedback for urinary incontinence in women: multicentre randomised controlled trial

This is the final version. Available on open access from BMJ Publishing Group via the DOI in this recordObjective To assess the effectiveness of pelvic floor muscle training (PFMT) plus electromyographic biofeedback or PFMT alone for stress or mixed urinary incontinence in women. Design Parallel group randomised controlled trial. Setting 23 community and secondary care centres providing continence care in Scotland and England. Participants 600 women aged 18 and older, newly presenting with stress or mixed urinary incontinence between February 2014 and July 2016: 300 were randomised to PFMT plus electromyographic biofeedback and 300 to PFMT alone. Interventions Participants in both groups were offered six appointments with a continence therapist over 16 weeks. Participants in the biofeedback PFMT group received supervised PFMT and a home PFMT programme, incorporating electromyographic biofeedback during clinic appointments and at home. The PFMT group received supervised PFMT and a home PFMT programme. PFMT programmes were progressed over the appointments. Main outcome measures The primary outcome was self-reported severity of urinary incontinence (International Consultation on Incontinence Questionnaire-urinary incontinence short form (ICIQ-UI SF), range 0 to 21, higher scores indicating greater severity) at 24 months. Secondary outcomes were cure or improvement, other pelvic floor symptoms, condition specific quality of life, women’s perception of improvement, pelvic floor muscle function, uptake of other urinary incontinence treatment, PFMT self-efficacy, adherence, intervention costs, and quality adjusted life years. Results Mean ICIQ-UI SF scores at 24 months were 8.2 (SD 5.1, n=225) in the biofeedback PFMT group and 8.5 (SD 4.9, n=235) in the PFMT group (mean difference −0.09, 95% confidence interval −0.92 to 0.75, P=0.84). Biofeedback PFMT had similar costs (mean difference £121 ($154; €133), −£409 to £651, P=0.64) and quality adjusted life years (−0.04, −0.12 to 0.04, P=0.28) to PFMT. 48 participants reported an adverse event: for 23 this was related or possibly related to the interventions. Conclusions At 24 months no evidence was found of any important difference in severity of urinary incontinence between PFMT plus electromyographic biofeedback and PFMT alone groups. Routine use of electromyographic biofeedback with PFMT should not be recommended. Other ways of maximising the effects of PFMT should be investigated.National Institute for Health Research (NIHR

A Comparison of Major Arable Production Systems: An Agronomic, Environmental and Ecological Evaluation

One of the primary challenges of our time is develop sustainable farming systems that can feed the world with minimal environmental impact. Some studies argue that organic farming systems are best because these have minimal impact on the environment and are positive for biodiversity. Others argue that no-tillage systems are better because such systems save energy and preserve soil structure and quality. A third group argues that conventional farming systems are best because yield per hectare is highest. However, so far, systematic comparisons of major arable production systems are rare and often it is difficult to compare the advantages and disadvantages of farming systems in a systematic way due to differences in soil/site characteristics and management. Here we present data of the Swiss Farming Systems and Tillage Experiment (FAST), a long term experiment where the main European arable production systems (organic and conventional farming, reduced tillage and no tillage, each system with different cover crop treatments) are being compared using a factorial replicated design. A multidisciplinary team of researchers from various disciplines and organizations analysed this experiment. We show the advantages and disadvantages of the various production systems and present data on plant yield, life cycle analysis, global warming potential, soil quality, plant root microbiomes and above and below ground biodiversity. Our results demonstrate that: i) plant yield was highest in the conventional systems, ii) soil biodiversity and above ground diversity tended to be higher in organic production systems, iii) soil erosion was lowest in the absence of tillage and in organic production systems, iv) the positive effects of cover crops were highest in organic production systems and increased with reduced land use intensity, v) the global warming potential of organic farming systems was lower compared to conventional systems, and vi) root and plant microbiome varied between the farming systems with the occurrence of indicator species that were specific for individual farming practices. In a next step we compared the results of this experiment with observations from a large farmers network (60 fields) in Switzerland (see abstract by Büchi et al.) where organic, conventional and conservation agriculture were compared. The results of our trial (e.g. yield and environmental performance of the different farming systems) were largely in agreement with those observed in the farmers network. Overall, our results indicate that no farming system is best and the choice of the “best” production system depends on economic, ecological and environmental priorities