Age‐related white matter hyperintensities and overactive bladder: a systematic review

© 2023 The Authors. Neurourology and Urodynamics published by Wiley Periodicals LLC. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.Introduction: Age-related white matter hyperintensities (ARWMHs) on brain magnetic resonance imaging have been associated with lower urinary tract symptoms/dysfunction (LUTS/LUTD), namely overactive bladder (OAB) and detrusor overactivity. We aimed to systematically review existing data on the association between ARWMH and LUTS and which clinical tools have been used for this assessment. Materials and methods: We searched PubMed/MEDLINE, Cochrane Library, and clinicaltrials.gov (from 1980 to November 2021) and considered original studies reporting data on ARWMH and LUTS/LUTD in patients of both sexes aged 50 or above. The primary outcome was OAB. We calculated the unadjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) for the outcomes of interest using random-effects models. Results: Fourteen studies were included. LUTS assessment was heterogeneous and mainly based on the use of nonvalidated questionnaires. Urodynamics assessment was reported in five studies. ARWMHs were graded using visual scales in eight studies. Patients with moderate-to-severe ARWMHs were more likely to present with OAB and urgency urinary incontinence (UUI; OR = 1.61; 95% CI: 1.05-2.49, p = 0.03), I2 = 21.3%) when compared to patients with similar age and absent or mild ARWMH. Discussion and conclusions: High-quality data on the association between ARWMH and OAB is scarce. Patients with moderate to severe ARWMH showed higher levels of OAB symptoms, including UUI, when compared to patients with absent or mild ARWMH. The use of standardized tools to assess both ARWMH and OAB in these patients should be encouraged in future research.info:eu-repo/semantics/publishedVersio

Physician-Patient Relationship and its Influence on Health Outcomes

Trabalho Final do Mestrado Integrado em Medicina apresentado à Faculdade de MedicinaRELAÇÃO MÉDICO-DOENTE E INFLUÊNCIA NOS OUTCOMES DE SAÚDE RESUMO A relação médico-doente é um elemento essencial à prática médica, que contribui para a confiança, satisfação e compliance dos doentes. Estão, no entanto, pouco estabelecidas as características e atitudes médicas que contribuem para uma boa relação-médico doente, assim como o impacto direto da qualidade da relação médico-doente nos outcomes de saúde. Aspetos como a comunicação verbal e não-verbal, empatia, inteligência emocional, personalidade e distanciamento social do médico influenciam a relação médico-doente, e o elemento mais decisivo na qualidade da mesma é o médico. A idade, género, constituição física ou grau de literacia dos doentes são também preditores da qualidade da relação. Por último, elementos como o contexto físico ou o tempo dedicado à entrevista podem influenciar as interações médico-doente. A relação e aliança terapêutica podem explicar parte do efeito placebo. Apesar dos resultados encorajadores de intervenções para melhorar a relação médico-doente, estes são ainda escassos, e a preparação dos estudantes de medicina é insuficiente. Os estudos acerca do impacto da relação médico-doente na saúde são escassos, mas apontam para uma melhoria do estado de saúde, qualidade de vida e longevidade quando a relação médico-doente é saudável. Palavras-chave: Relação médico-doente; Aliança terapêutica; Empatia médica; Comunicação médico-doente; Adesão terapêutica; Efeito Placebo. Autor: Filipe Abadesso LopesPHYSICIAN-PATIENT RELATIONSHIP AND ITS INFLUENCE ON HEALTH OUTCOMES ABSTRACT The doctor-patient relationship is an essential element to the medical practice, accounting to patient trust, satisfaction and compliance. However, medical characteristics and attitudes related to a good doctor-patient relationship are yet little established, as well as the direct impact of this relationship in health outcomes. Aspects such as verbal and non-verbal communication and medical empathy, emotional intelligence, personality or social gap between doctor and patient have an impact on the relationship. Moreover, the most decisive element in the quality of the doctor-patient relationship is the doctors’ behavior. Patient age, gender, physical constitution and literacy are also relationship quality predictors. Furthermore, aspects such as physical context or consultation time may be important. The relationship and therapeutic alliance may explain at least part of the “placebo effect”. Despite the good results of interventions to improve doctor-patient relationship, these are still scarce, and the medical schools’ curricula are insufficient. There are only a few studies directly linking doctor-patient relationship to health outcomes, but these point to improved health status, life-quality and lifespan with good doctor-patient relationships. KEY-WORDS: Doctor-patient relationship; Therapeutic alliance; Medical empathy; Doctor-patient communication; Therapeutic compliance; Placebo effect. Author: Filipe Abadesso Lope