Perspective of Dutch healthcare professionals on care for female urinary incontinence:A mixed-methods study

Introduction and hypothesis : Health care professionals (HCP) can reveal practical recommendations to improve processes and address challenges in the care of women with urinary incontinence (UI) in the Netherlands.Methods : We conducted an exploratory, sequential, mixed-methods study among HCPs, using the outcomes of six focus group sessions (30 HCPs) to inform a subsequent survey. HCPs included general practitioners (GPs), practice assistants (PAs), pelvic physiotherapists (PPTs), and urologists and gynecologists (UGs).Results : The main themes arising from the six focus group sessions (with 6 GPs, 7 PAs, 6 (resident) UGs, 8 PPTs, and 7 PPTs) were “identification of UI,” “current state of care,” and “guiding patients through the healthcare system.” The survey respondents included 351 PAs, 124 GPs, 75 PPTs, and 183 UGs. Of these 741 respondents, 72.8% (strongly) agreed that the identification of UI in general practice required improvement and 60% confirmed the need for further education on this topic. Most HCPs (83.1%) found it useful to offer women a patient information leaflet when buying incontinence products, but less useful to ask about UI routinely in specific scenarios, and most (75%) agreed that a multidisciplinary guideline could improve healthcare. Interestingly, 86% of PPTs and 21% of UGs advocated referral to a PPT before referral to a specialist, while 87% of PPTs wanted primary care services to offer a UI consultation hour and 36% of the GPs (strongly) disagreed.Conclusion : Poor UI identification in primary care and a lack of patient guidance through the health care system hamper continence care provision

Dithiocarbamates Induce Craniofacial Abnormalities and Downregulate sox9a during Zebrafish Development

Dithiocarbamates (DTCs) have a wide variety of applications in diverse fields ranging from agriculture to medicine. DTCs are teratogenic to vertebrates but the mechanisms by which they exert these effects are poorly understood. Here, we show that low nanomolar exposure to three DTCs, tetraethylthiuram (thiram), tetramethylthiuram (disulfiram), and sodium metam (metam), leads to craniofacial abnormalities in developing zebrafish embryos that are reminiscent of DTC-induced abnormalities found in higher vertebrates. In order to better understand the molecular events underlying DTC teratogenesis, we exposed embryonic zebrafish (PAC2) cells to thiram and disulfiram and measured changes in gene expression with microarrays. We found differential expression of 166 genes that were specific for exposure to DTCs and identified a network of genes related to connective tissue development and function. Additionally, we found eight downregulated genes related to transforming growth factor β-1 (TGF-β1) signaling, including an essential transcription factor for zebrafish craniofacial development, SRY-box-containing gene 9a (sox9a). Finally, we show that sox9a expression is perturbed in the ceratobranchial arches of DTC-exposed zebrafish, suggesting that this is an important event in the development of DTC-induced craniofacial abnormalities. Together, we provide evidence for a novel teratogenic endpoint and a molecular basis for a better understanding of DTC-induced teratogenesis in vertebrates. © The Author 2010. Published by Oxford University Press on behalf of the Society of Toxicology. All rights reserved