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Burns RT, Arnold PJ, Song L, Moss KL, Powell CR. An analysis of urodynamic parameters in diabetic and nondiabetic women. Neurourol Urodyn 2024. [PMID: 38808694 DOI: 10.1002/nau.25510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/02/2024] [Accepted: 05/17/2024] [Indexed: 05/30/2024]
Abstract
OBJECTIVES Diabetes is highly prevalent worldwide, with an estimated 536 million living with diabetes in 2021, and that number projected to increase to 783 million by 2045. Diabetic bladder dysfunction is thought to affect up to 60%-90% of individuals with diabetes and can significantly impact quality of life. Despite the prevalence of diabetic bladder dysfunction, the exact pathophysiological mechanism, and resulting clinical presentation, remains debated. Our objective was to compare urodynamic parameters between diabetic and nondiabetic women, assessing the impact of various markers of diabetes severity on bladder function. METHODS A retrospective chart review was conducted on female patients aged 18 and above who underwent urodynamic studies at a single tertiary care university hospital system from 2014 to 2020. Patients were categorized based on diabetes status, and diabetes severity including duration of disease, hemoglobin A1c levels, insulin dependence, and markers of end-organ dysfunction. Urodynamic variables, including compliance, bladder voided efficiency, bladder contractility index, postvoid residual, maximum flow rate, capacity, voided volume, and detrusor overactivity, were assessed by two independent reviewers. Statistical analyses were performed to assess the impact of diabetes and diabetic severity on urodynamic parameters. RESULTS A total of 652 female patients were included in the study, of which, 152 (23.3%) had diabetes, with an average duration of diagnosis of 82.3 months. Diabetic women were older and had higher body mass index compared to nondiabetic women. Diabetic retinopathy and neuropathy were present in 18% and 54.6% of diabetic patients, respectively. Significant differences in urodynamic parameters were observed between diabetic and nondiabetic women, with diabetic women showing higher rates of detrusor overactivity (p = 0.01), particularly associated with increasing BMI (p = 0.03). However, classic markers of diabetes severity including duration, as well as markers of end-organ damage, showed mixed associations with urodynamic changes. CONCLUSIONS Despite the prevalence of diabetic bladder dysfunction and its impact on patient quality of life, the exact mechanisms and clinical presentation remain elusive. Our study highlights the significant differences in urodynamic parameters between diabetic and nondiabetic women, emphasizing the need for further research into the relationship between diabetes and diabetic bladder dysfunction.
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Affiliation(s)
- Ramzy T Burns
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Peter J Arnold
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Leo Song
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Kevin L Moss
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Charles R Powell
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Xiang SY, He HC, Liu Y, Yu BJ, Mai SY, Li MY, Yan XY, Huang XH. Care Needs of Older Adults With Urinary Incontinence: A Cross-Sectional Study. J Gerontol Nurs 2024; 50:43-49. [PMID: 38691116 DOI: 10.3928/00989134-20240416-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
PURPOSE To explore care requirements of older adults with urinary incontinence (UI) and contributing factors. METHOD This cross-sectional study used the Older Adults Urinary Incontinence Care Needs Inventory to survey participants with UI in three large-scale tertiary hospitals located in Guangzhou City, China, from January 2023 to November 2023. Statistical analyses, including analysis of variance, t tests, correlation analyses, and linear regression models, were conducted to assess factors influencing participants' care needs. RESULTS A total of 530 older adults with UI participated in the survey and mean standardized score for overall care needs was 78.65 (SD = 5.01), with mean scores for each dimension ranging from 70.88 (SD = 10.55) for social participation needs to 82.45 (SD = 7.11) for health education needs. Factors that were found to influence incontinence care needs in older adults included age, literacy level, number of leaks, and type of disease (F = 37.07, adjusted R2 = 0.290, p < 0.001). CONCLUSION Comprehensive care for older adults with UI, encompassing physiological, psychological, and social aspects, is crucial. It is essential to tailor care to individual needs and characteristics, taking into account factors, such as age and education, to ensure effective care. [Journal of Gerontological Nursing, 50(5), 43-49.].
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Sugai K, Sasaki J, Wada Y, Shimizu N, Ishikawa T, Yanagi K, Hashimoto T, Tanaka A, Suwanai H, Suzuki R, Odawara M. Predictive patterns of lower urinary tract symptoms and bacteriuria in adults with type 2 diabetes. Diabetol Int 2024; 15:253-261. [PMID: 38524941 PMCID: PMC10959893 DOI: 10.1007/s13340-023-00687-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/11/2023] [Indexed: 03/26/2024]
Abstract
Background Numerous studies demonstrated the risk factors for urological complications in patients with diabetes before sodium-glucose co-transporter 2 inhibitor (SGLT2i) became commercially available. This study aimed to comprehensively investigate urological characteristics in patients with type 2 diabetes (T2DM) after SGLT2i became commercially available. Methods We examined 63 outpatients with T2DM suspected of bacteriuria based on urinary sediment examinations. Urine cultures were performed, and lower urinary tract symptoms (LUTS) were assessed via questionnaires. Patients with bacteriuria were assessed using ultrasonography to measure post-void residual volume (PVR). Utilizing demographic and laboratory data, a random forest algorithm predicted LUTS, bacteriuria, and symptomatic bacteriuria (SB). Results Thirty-two patients had LUTS and 31 had bacteriuria. High-density lipoprotein cholesterol level was crucial in predicting LUTS, while age was crucial in predicting bacteriuria. In predicting SB among patients with bacteriuria, creatinine level and estimated glomerular filtration rate were crucial. Our models had high predictive accuracy for LUTS (area under the curve [AUC] = 0.846), followed by bacteriuria (AUC = 0.770) and SB (AUC = 0.938) in receiver operating characteristic curve analysis. These predictors were previously reported as risk factors for urological complications. Although SGLT2i use was not an important predictor in our study, all SGLT2i users with bacteriuria had SB and exhibited higher PVR compared to non-SGLT2i users with bacteriuria. Conclusion This study's random forest model highlighted distinct essential predictors for each urological condition. The predictors were consistent before and after SGLT2i became commercially available. Supplementary Information The online version contains supplementary material available at 10.1007/s13340-023-00687-1.
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Affiliation(s)
- Keiji Sugai
- Department of General Internal Medicine, Toda Chuo General Hospital, 1-19-3 Honcho, Toda, Saitama 335-0023 Japan
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-Ku, Tokyo, 160-0023 Japan
| | - Junko Sasaki
- Department of General Internal Medicine, Toda Chuo General Hospital, 1-19-3 Honcho, Toda, Saitama 335-0023 Japan
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-Ku, Tokyo, 160-0023 Japan
| | - Yuki Wada
- Department of General Internal Medicine, Toda Chuo General Hospital, 1-19-3 Honcho, Toda, Saitama 335-0023 Japan
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-Ku, Tokyo, 160-0023 Japan
| | - Norihiro Shimizu
- Department of General Internal Medicine, Toda Chuo General Hospital, 1-19-3 Honcho, Toda, Saitama 335-0023 Japan
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-Ku, Tokyo, 160-0023 Japan
| | - Takuya Ishikawa
- Department of General Internal Medicine, Toda Chuo General Hospital, 1-19-3 Honcho, Toda, Saitama 335-0023 Japan
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-Ku, Tokyo, 160-0023 Japan
| | - Ketchu Yanagi
- Department of General Internal Medicine, Toda Chuo General Hospital, 1-19-3 Honcho, Toda, Saitama 335-0023 Japan
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-Ku, Tokyo, 160-0023 Japan
| | - Takeshi Hashimoto
- Department of Urology, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-Ku, Tokyo, 160-0023 Japan
| | - Akihiko Tanaka
- Department of General Internal Medicine, Toda Chuo General Hospital, 1-19-3 Honcho, Toda, Saitama 335-0023 Japan
| | - Hirotsugu Suwanai
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-Ku, Tokyo, 160-0023 Japan
| | - Ryo Suzuki
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-Ku, Tokyo, 160-0023 Japan
| | - Masato Odawara
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-Ku, Tokyo, 160-0023 Japan
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Su CC, Yang CY, Lin PC, Hwang JS, Liao CH, Lin YK, Liao YM. Sleep quality mediates the relationship between lower urinary tract symptoms and health-related quality of life in women with type-II diabetes. J Adv Nurs 2023; 79:2316-2327. [PMID: 36779456 DOI: 10.1111/jan.15582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 12/08/2022] [Accepted: 01/20/2023] [Indexed: 02/14/2023]
Abstract
AIM To examine the mediating effect of sleep quality on the relationship between lower urinary tract symptoms and health-related quality of life in women with type-II diabetes. DESIGN A cross-sectional study. METHODS A study questionnaire comprising three valid instruments was used to obtain data about lower urinary tract symptoms, sleep quality and physical and mental component summary health-related quality of life between July 2017 and December 2018 (n = 343). Pearson's correlation coefficients were estimated initially to examine the relationships between the three variables. Multiple regression models were tested using a regression-based approach Hayes PROCESS macro for SPSS to examine the significance of proposed mediation effects. RESULTS Most participants experienced at least one urinary symptom (n = 268, 78.1%). The total number of types of lower urinary tract symptoms experienced by participants was significantly inversely correlated with physical and mental component summary health-related quality of life, and sleep quality. Participants' sleep quality was significantly correlated with physical and mental component summary health-related quality of life. The relationships of lower urinary tract symptoms with physical and mental component summary health-related quality of life were, respectively, fully and partially mediated by sleep quality. CONCLUSION Sleep quality played a mediating role on the relationship between lower urinary tract symptoms and health-related quality of life. Our findings could lead to improvements of diabetes care in nursing and healthcare practices. IMPACT Understanding the role of sleep quality in the adverse effects of lower urinary tract symptoms on health-related quality of life contributes to the development and delivery of appropriate strategies to promote optimal health-related quality of life. We recommended including assessments of lower urinary tract symptoms, sleep and health-related quality of life in routine diabetes management. Nurses and healthcare professionals should concurrently reduce lower urinary tract symptoms and improve sleep to achieve this population's optimal health-related quality of life. PATIENTS OR PUBLIC CONTRIBUTION We recruited a sample of older women with type-II diabetes at the endocrinology and metabolism outpatient departments of two hospitals. Study participants provided responses on the study questionnaires. The two hospitals provided needed supports (e.g., height/weight scales, suitable places for interview) during the data collection process.
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Affiliation(s)
- Ching-Chieh Su
- Department of Endocrinology, Cardinal Tien Hospital, New Taipei City, Taiwan, ROC.,Dr. Su Diabetes Clinic, New Taipei City, Taiwan, ROC
| | - Chiu-Yueh Yang
- Department of Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei City, Taiwan, ROC
| | - Pi-Chu Lin
- Department of Nursing & Graduate Institute of Nursing, Asia University, Taichung, Taiwan, ROC
| | - Jawl-Shan Hwang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital-Linkou, Taoyuan City, Taiwan, ROC.,College of Medicine, Chang Gung University, Taoyuan City, Taiwan, ROC
| | - Chun-Hou Liao
- Department of Urology, Department of Surgery, Cardinal Tien Hospital, New Taipei City, Taiwan, ROC.,College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan, ROC
| | - Yen-Kuang Lin
- Graduate Institute of Athletics and Coaching Science, National Taiwan Sport University, Taoyuan, Taiwan, ROC
| | - Yuan-Mei Liao
- Institute of Clinical Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei City, Taiwan, ROC
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Hughes FM, Odom MR, Cervantes A, Purves J. Inflammation triggered by the NLRP3 inflammasome is a critical driver of diabetic bladder dysfunction. Front Physiol 2022; 13:920487. [PMID: 36505062 PMCID: PMC9733912 DOI: 10.3389/fphys.2022.920487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 11/09/2022] [Indexed: 11/26/2022] Open
Abstract
Diabetes is a rapidly expanding epidemic projected to affect as many as 1 in 3 Americans by 2050. This disease is characterized by devastating complications brought about high glucose and metabolic derangement. The most common of these complications is diabetic bladder dysfunction (DBD) and estimates suggest that 50-80% of patients experience this disorder. Unfortunately, the Epidemiology of Diabetes Interventions and Complications Study suggests that strict glucose control does not decrease ones risk for incontinence, although it does decrease the risk of other complications such as retinopathy, nephropathy and neuropathy. Thus, there is a significant unmet need to better understand DBD in order to develop targeted therapies to alleviate patient suffering. Recently, the research community has come to understand that diabetes produces a systemic state of low-level inflammation known as meta-inflammation and attention has focused on a role for the sterile inflammation-inducing structure known as the NLRP3 inflammasome. In this review, we will examine the evidence that NLRP3 plays a central role in inducing DBD and driving its progression towards an underactive phenotype.
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Affiliation(s)
- Francis M. Hughes
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC, United States
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Zhu Y, Zhu Z, Chen J. Risk factors associated with the progression of overactive bladder among patients with type 2 diabetes. Int J Clin Pract 2019; 73:e13395. [PMID: 31332892 PMCID: PMC6851595 DOI: 10.1111/ijcp.13395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 06/20/2019] [Accepted: 07/18/2019] [Indexed: 01/19/2023] Open
Abstract
AIM To investigate the risk factors specific to diabetes mellitus that influence the progression of overactive bladder in Chinese population. METHODS A total of 457 patients who were diagnosed with overactive bladder and diabetes mellitus at the Department of Endocrinology and Urinary Surgery Center of Zhejiang University Jinhua Hospital were enrolled from July 2015 to July 2018. Patients were assessed using a questionnaire and then divided into two groups according to the severity score: mild overactive bladder group and the moderate-severe overactive bladder group. Logistic analysis was performed to evaluate the risk factors associated with the progression of overactive bladder in diabetic patients. RESULT Among the 457 patients with diabetes mellitus and overactive bladder, there was a significant difference in the severity of overactive bladder, age, diabetes duration, symptomatic diabetic peripheral neuropathy as well as ankle reflex (P < .05) between the two groups. Moreover, multivariate analysis revealed that age (OR: 1.59, P = .036), duration of diabetes (OR: 1.41, P = .049) and symptomatic diabetic peripheral neuropathy (OR: 2.39, P = .012) were independent risk factors for the progression of overactive bladder. CONCLUSION In Chinese diabetic patients, overactive bladder progression is closely related with the severity of diabetes mellitus. Age, diabetic duration and symptomatic diabetic peripheral neuropathy are independent predictors of the severity of overactive bladder. Patients with symptomatic diabetic peripheral neuropathy are at risk of overactive bladder.
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Affiliation(s)
- Yiyi Zhu
- Department of EndocrinologySir Run Run Shaw HospitalZhejiang University School of MedicineHangzhouChina
| | - Zaisheng Zhu
- Department of UrologyJinhua HospitalZhejiang University School of MedicineJinhuaChina
| | - Jiajun Chen
- Department of UrologyJinhua HospitalZhejiang University School of MedicineJinhuaChina
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Overactive Bladder in Diabetes Mellitus. CURRENT BLADDER DYSFUNCTION REPORTS 2019. [DOI: 10.1007/s11884-019-00532-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Ding H, Zhang P, Li N, Liu Y, Wang P. The phosphodiesterase type 4 inhibitor roflumilast suppresses inflammation to improve diabetic bladder dysfunction rats. Int Urol Nephrol 2018; 51:253-260. [PMID: 30474782 DOI: 10.1007/s11255-018-2038-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 11/19/2018] [Indexed: 12/12/2022]
Abstract
PURPOSE To demonstrate that phosphodiesterase type 4 (PDE4) inhibitors could potentially treat diabetic bladder dysfunction (DBD) through modulation of the systemic inflammatory response. METHODS In this 6-week study, 60 female Sprague-Dawley rats were divided into three groups: (i) vehicle-treated control rats; (ii) vehicle-treated streptozocin (STZ)-injected rats; and (iii) roflumilast-treated STZ-injected rats. Oral roflumilast (5 mg/kg/day) was administered during the last 4 weeks of STZ injection to induce diabetes in the test group. At 6 weeks, a urodynamic study was performed in each group. The expression of nuclear factor kappa B (NF-κB), tumor necrosis factor-alpha (TNF-α), interleukin (IL)-6, and IL-1β in detrusor smooth muscle (DSM) was analyzed using quantitative reverse transcription-polymerase chain reaction and Western blotting. RESULTS A significant decrease in bodyweight and significant increases in bladder weight and blood glucose level were observed in the diabetic rats and were not ameliorated by roflumilast treatment. Cystometry showed the increased bladder capacity, voiding volume, residual urine volume, and voiding interval in the diabetic rats and the prevention of these changes by roflumilast. These changes were accompanied by significantly enhanced expression of NF-κB, TNF-α, IL-6, and IL-1β in DSM tissue from diabetic rats. Furthermore, roflumilast attenuated the expression of inflammatory factors in DSM tissue. CONCLUSIONS Oral treatment with roflumilast in diabetic rats improves bladder function and inhibits the expression of inflammatory factors in DSM tissue, indicating that PDE4 is a potential therapeutic target for DBD.
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Affiliation(s)
- Honglin Ding
- Department of Urology, Fourth Affiliated Hospital, China Medical University, 4 Chongshan East Road, Shenyang, Liaoning, China.,Department of Urology, Affiliated Hospital, Chifeng University, 42 Wangfu Street, Chifeng, Neimeng, China
| | - Peng Zhang
- Department of General Surgery, Shenyang 242 Hospital, 3 Leshan Road, Shenyang, Liaoning, China
| | - Ning Li
- Department of Urology, Fourth Affiliated Hospital, China Medical University, 4 Chongshan East Road, Shenyang, Liaoning, China.
| | - Yili Liu
- Department of Urology, Fourth Affiliated Hospital, China Medical University, 4 Chongshan East Road, Shenyang, Liaoning, China
| | - Ping Wang
- Department of Urology, Fourth Affiliated Hospital, China Medical University, 4 Chongshan East Road, Shenyang, Liaoning, China
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Xu D, Huang L, Gao J, Li J, Wang X, Wang K. Effects of an education program on toileting behaviors and bladder symptoms in overactive bladder patients with type 2 diabetes: A randomized clinical trial. Int J Nurs Stud 2018; 87:131-139. [PMID: 30096579 DOI: 10.1016/j.ijnurstu.2018.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/22/2018] [Accepted: 07/02/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Overactive bladder is more common in patients with type 2 diabetes than in those without diabetes. Many patients with diabetes adopt unhealthy toileting behaviors to empty their bladder that may contribute to the onset or worsening of overactive bladder. OBJECTIVE To investigate whether an education program targeting toileting behaviors is effective for helping overactive bladder patients with type 2 diabetes in terms of adopting healthy toileting behaviors, improving bladder symptoms, and enhancing quality of life. DESIGN The study was a parallel, pragmatic, open-label randomized trial. SETTINGS The trial was conducted in a hospital-based endocrinology outpatient department in Jinan, China. PARTICIPANTS A total of 104 patients were randomly assigned to a 6-week education program or a control group. METHODS Primary outcomes included toileting behaviors and bladder symptoms, including dry/wet overactive bladder and severity of urgency. Secondary outcomes were overactive bladder-specific and general quality of life. The patients were reassessed on the outcome variables at the end of the intervention and at 3 months and 6 months following the intervention. The analysis followed the intent-to-treat principle. To account for the longitudinal data with repeated measures, group comparisons for continuous outcomes were evaluated using linear mixed models. Group differences in binary outcomes were examined using mixed-effects logit models. RESULTS Compared with the control group, the education program group showed significant changes in three unhealthy toileting behaviors: premature voiding (-0.7, p < 0.001), place preference for voiding (-0.5, p = 0.007), and delayed voiding (-0.2, p = 0.011). The program significantly relieved the bladder symptoms (-2.2, p < 0.001) and decreased the probability of having wet overactive bladder (-0.3, p < 0.001) and the severity of urgency (-0.4, p < 0.001). It also significantly improved the overactive bladder-specific quality of life by 10.8 points (p = 0.001). Regarding patients' general quality of life, the physical aspect was enhanced by 3.0 points (p = 0.049); however, no effect on the mental well-being aspect was observed. CONCLUSIONS Among overactive bladder patients with type 2 diabetes, the 6-week education program targeting toileting behaviors resulted in the adoption of healthy toileting behaviors, relief of bladder symptoms and improvement in quality of life in the 6 months following the intervention compared with routine care alone. The education program was highly successful and may represent an effective, acceptable, feasible, and safe intervention for improving bladder health and quality of life during diabetes care, given that the toileting behavioral changes were maintained during the 6-month follow-up period.
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Affiliation(s)
- Dongjuan Xu
- School of Nursing, Shandong University, Jinan, Shandong Province, China; School of Nursing, Purdue University, West Lafayette, IN, United States
| | - Liqun Huang
- School of Nursing, Shandong University, Jinan, Shandong Province, China
| | - Jie Gao
- School of Nursing, Shandong University, Jinan, Shandong Province, China
| | - Jingjing Li
- School of Nursing, Shandong University, Jinan, Shandong Province, China; Department of Surgical Nursing, Ningbo College of Health Science, Ningbo, Zhejiang Province, China
| | - Xiaojuan Wang
- School of Nursing, Shandong University, Jinan, Shandong Province, China; School of Nursing, Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China
| | - Kefang Wang
- School of Nursing, Shandong University, Jinan, Shandong Province, China.
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Xu D, Zhao M, Huang L, Wang K. Overactive bladder symptom severity, bother, help-seeking behavior, and quality of life in patients with type 2 diabetes: a path analysis. Health Qual Life Outcomes 2018; 16:1. [PMID: 29291738 PMCID: PMC5749008 DOI: 10.1186/s12955-017-0829-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 12/14/2017] [Indexed: 02/05/2023] Open
Abstract
Background This study aimed to investigate the relationships among overactive bladder (OAB) symptom severity, bother, help-seeking behavior, and quality of life (QOL) in patients with type 2 diabetes. Methods A total of 127 diabetic patients, aged at least 18 years, with overactive bladder from a hospital in Shandong Province, China, were recruited for this study. Symptom severity, bother, and quality of life were assessed using the Overactive Bladder Symptom Score (OABSS), Patient Perception of Bladder Condition (PPBC), and Overactive Bladder Questionnaire Short Form (OAB-q SF), respectively. Help-seeking behavior was assessed by asking patients whether they consulted health care professionals or received treatment for their bladder problems. A two-step path analysis was performed to analyze the data. Results OAB symptom severity was directly associated with lower levels of QOL, and the strength of this association was no longer significant when taking bother and help-seeking behavior into account. Bother increased with OAB symptom severity, and patients with bothersome OAB tended to have lower levels of QOL. Moreover, bother increased help-seeking behavior; however, patients who sought help tended to have lower levels of QOL. Conclusions Our findings highlight the role of bother and help-seeking behavior in the relationship between OAB symptom severity and QOL. To improve a patient’s QOL, health care providers should focus not only on symptom bother but also on dysfunctional help-seeking patterns.
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Affiliation(s)
- Dongjuan Xu
- School of Nursing, Shandong University, No. 44, Wenhua Xi Road, Jinan, Shandong, 250012, People's Republic of China.,School of Nursing, Purdue University, West Lafayette, Indiana, 47907, USA
| | - Meng Zhao
- School of Nursing, Shandong University, No. 44, Wenhua Xi Road, Jinan, Shandong, 250012, People's Republic of China
| | - Liqun Huang
- School of Nursing, Shandong University, No. 44, Wenhua Xi Road, Jinan, Shandong, 250012, People's Republic of China
| | - Kefang Wang
- School of Nursing, Shandong University, No. 44, Wenhua Xi Road, Jinan, Shandong, 250012, People's Republic of China.
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Yang N, Ashton J, Gorczyca E, Kasapis S. In-vitro starch hydrolysis of chitosan incorporating whey protein and wheat starch composite gels. Heliyon 2017; 3:e00421. [PMID: 29159316 PMCID: PMC5680984 DOI: 10.1016/j.heliyon.2017.e00421] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 09/15/2017] [Accepted: 09/26/2017] [Indexed: 12/05/2022] Open
Abstract
The study examined the influence of chitosan, incorporated into whey protein and wheat starch thermo gels, on the in-vitro hydrolysis of the polysaccharide. Gels were subjected to the following external conditions containing α-amylase at constant incubation temperature of 37 °C: In the first procedure, they were immersed in phosphate buffer (0.05 M) and maintained at pH 6.9 throughout the entire digestion. In the second instance, they were introduced into a salt solution, with pH and total volume adjusted at times in sync with the human gastrointestinal tract. Results indicate that low and medium molecular weight chitosan, in combination with whey protein, were effective at enhancing the protective barrier against starch degradation. Less maltose was liberated from gels containing medium molecular weight chitosan, as opposed to the low molecular weight counterpart, and results compare favorably with the outcome of the in-vitro digestion of binary whey protein and wheat starch composites.
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Affiliation(s)
- Natasha Yang
- School of Science, RMIT University, City Campus, Melbourne, Vic 3001, Australia
| | - John Ashton
- Sanitarium Development and Innovation, Sanitarium Health Food Company, Cooranbong, NSW 2265, Australia
| | - Elisabeth Gorczyca
- School of Science, RMIT University, City Campus, Melbourne, Vic 3001, Australia
| | - Stefan Kasapis
- School of Science, RMIT University, City Campus, Melbourne, Vic 3001, Australia
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