Background:Because it is unclear whether lower urinary tract symptoms (LUTS) are associated with cardiovascular disease (CVD) in the Japanese population, we explored the association in general ...Japanese men aged 55–75 years.Methods and Results:The cross-sectional study included male participants who had both national health checkup data and the International Prostate Symptom Score (IPSS) in the same calendar year between 2009 and 2017. LUTS severity was evaluated by IPSS. A robust Poisson regression model was used to assess the association between LUTS severity and the composite CVD outcome coronary artery disease (CAD), stroke, or atrial fibrillation (AF) and each component of the composite outcome. Prevalence ratio (PR) was adjusted for conventional cardiovascular risk factors. Of 16,781 male participants (mean age, 67±5 years), mild LUTS were observed in 9,243 (55.1%); moderate, 6,445 (38.4%); and severe, 1,093 (6.5%). Compared with the mild LUTS group, moderate LUTS PR 1.18, 95% confidence interval (CI) 1.10–1.25, P<0.001 and severe LUTS (PR 1.38, 95% CI 1.24–1.53, P<0.001) were significantly associated with a higher prevalence of CVD. LUTS severity was associated with higher prevalence of CAD and stroke, but not AF.Conclusions:The severity of LUTS was associated with a higher prevalence of CVD, especially CAD and stroke, independent of conventional CVD risk factors.
Purpose of Review
The rising suicide rate in the USA will not be reversed without improved risk assessment and prevention practices. To date, the best method for clinicians to assess a patient’s risk ...for suicide is screening for past suicide attempts in the patient and their family. However, neuroimaging, genomic, and biochemical studies have generated a body of findings that allow description of an initial heuristic biological model for suicidal behavior that may have predictive value.
Recent Findings
We review studies from the past 3 years examining potential biological predictors of suicide attempt behavior. We divide findings into two major categories: (1) structural and functional brain imaging findings and (2) biochemical and genomic findings encompassing several systems, including major neurotransmitters (serotonin, catecholamines, GABA, and glutamate), the hypothalamic pituitary adrenal (HPA) axis, the inflammasome, lipids, and neuroplasticity.
Summary
The biomarkers that appear promising for assessing suicide risk in clinical settings include indices of serotonergic function, inflammation, neuronal plasticity, and lipids.
Objective: Negative symptoms largely account for poor outcome in psychotic disorders but remain difficult to treat. A cognitive-behavioral approach to these symptoms showed promise in chronic ...schizophrenia patients. We explored whether a combination of group and individual treatment focused on social activation (CBTsa) could benefit patients recently diagnosed with a psychotic disorder. Method: A single-blind randomized controlled trial enrolled 99 participants recently diagnosed with schizophrenia or a related disorder that received treatment as usual (TAU; n = 50), or TAU plus CBTsa (n = 49). Negative symptoms (Brief Negative Symptom Scale) and social withdrawal (Positive and Negative Syndrome Scale) were primary outcomes. Secondary outcome measures included dysfunctional beliefs (Dysfunctional Attitudes Scale-Defeatist Performance Attitude), stigma Internalized Stigma of Mental Illness Scale (ISMIS), and symptom severity and functioning as measured with the Global Assessment of Functioning (GAF). Outcomes were compared directly posttreatment and at follow-up (6 months posttreatment). Results: Intention-to-treat analyses showed significant improvement in GAF symptoms (p = .02, d = 0.36) and a decrease in negative symptoms on trend level (p = .08, d = −0.29) in CBTsa compared to TAU at posttreatment. These group differences were no longer apparent at 6 months follow-up. Social withdrawal and negative symptoms improved over time in both conditions. Conclusions: The current trial showed small positive effects on symptom severity posttreatment but did not demonstrate maintenance of longer-term effects in favor of the CBTsa group. Findings suggest that the treatment duration may have been too short to change dysfunctional beliefs, a potentially important maintaining factor of negative symptom severity. Longer intervention periods in later, more stable stages of the illness when intensive standard treatment has tapered off may yield more beneficial effects.
What is the public health significance of this article?
This study suggests that a cognitive-behavioral approach aimed at social activation might be beneficial in accelerating the initial reduction of negative symptoms in patients recently diagnosed with a psychotic disorder. However, to archive sustained treatment effects, and target defeatist beliefs, additional treatment with a longer intervention period may be necessary.
Objective: Given the strong association between a history of childhood maltreatment and somatic symptoms, identification of therapeutically modifiable intervention targets is warranted. Alexithymia, ...or difficulty identifying and describing emotions, may be playing an important role. The present study examined contributions of alexithymia and childhood maltreatment as related to somatic symptoms. Method: Participants (N = 447) completed measures of childhood maltreatment, alexithymia, and somatic symptoms. Two three-step hierarchical linear regressions were conducted to examine the unique contribution of alexithymia after accounting for demographic characteristics and childhood maltreatment. The first regression utilized total scores, and the second explored five domains of childhood maltreatment, a trauma validity index, and three domains of alexithymia. Results: In the first linear regression, childhood maltreatment and alexithymia were significantly associated with higher somatic symptoms. In the second linear regression, childhood maltreatment and alexithymia both significantly added to the model; however, only emotional abuse was significantly associated with somatic symptoms. Conclusions: In line with previous research, childhood maltreatment and alexithymia are associated with somatic symptoms. Given specific domains of alexithymia were nonsignificant in this relationship, it appears no single aspect of alexithymia is of greater importance. Future research should examine these associations longitudinally, as improving alexithymia may help improve outcomes in individuals with childhood maltreatment history experiencing somatic symptoms.
Clinical Impact Statement
Many individuals who have experienced childhood maltreatment report somatic symptoms. Both have been associated with alexithymia, the inability to identify or describe emotions. Understanding which types of maltreatment or alexithymia contribute most to somatic symptoms is less clear. This study examined how specific types of childhood maltreatment and alexithymia relate to somatic symptoms. Overall childhood maltreatment and alexithymia were related to greater somatic symptoms and when specific types were examined, only emotional abuse was associated with somatic symptoms. These findings indicate individuals with a history of emotional abuse in particular experience increased somatic symptoms, as do those with alexithymia.
Purpose
This study aimed to clarify associations between and changes over time in lower urinary tract symptoms (LUTS) and quality of life (QOL) in cancer patients after a total prostatectomy.
Methods
...The subjects were cancer patients who had undergone total prostatectomy and had participated in non-randomized controlled trials, cohort studies, or case-control studies with outcomes of changes over time in LUTS or QOL. Fourteen studies were included for systematic review and meta-analysis.
Results
Compared to preoperatively, the International Prostate Symptom Score (IPSS)—a LUTS indicator—yielded the following, 3 months after operation (MD 95% confidence interval, CI = −0.27 −2.22 to 1.68,
p
= .7855), 6 months after operation (MD 95% CI = −2.12 −3.04 to −1.20,
p
< .0001), and 12 months after operation (MD 95% CI = −2.27 −2.63 to −1.92,
p
< .0001), demonstrating significant decrease and, therefore, improvement of symptoms after 6 months. International Prostate Symptom Score—Quality of Life (IPSS-QOL), a QOL indicator, was significantly reduced at 12 months after surgery, indicating improved QOL (MD 95% CI = −0.49 −0.87 to −0.11,
p
= .0107), but there was heterogeneity between different studies (
I
2
= 89.19%). A cumulative meta-analysis showed a tendency for greater improvements in IPSS-QOL at 12 months after surgery, the older the mean age and the higher the mean pre-surgery IPSS. Factors of age, prostate volume, and pre-surgery IPSS were related to postoperative LUTS; exacerbation of both urinary incontinence and urinary tract obstruction was related to QOL.
Conclusion
While LUTS improves over time after total prostatectomy, it takes 6 to 12 months after surgery. As there is an association between LUTS and QOL, support to promote self-management of LUTS is important.
Military veterans report high rates of psychiatric and physical health symptoms that may be amenable to mindfulness-based interventions (MBIs). Inconsistent prior findings and questions of fit ...between MBIs and military culture highlight the need for a systematic evaluation of this literature.
To quantify the efficacy and acceptability of MBIs for military veterans.
We searched five databases (MEDLINE/PubMed, CINAHL, Scopus, Web of Science, PsycINFO) from inception to October 16th, 2019.
Randomized controlled trials (RCTs) testing MBIs in military veterans.
Twenty studies (k = 16 unique comparisons, N = 898) were included. At post-treatment, MBIs were superior to non-specific controls (e.g., waitlist, attentional placebos) on measures of posttraumatic stress disorder (PTSD), depression, general psychological symptoms (i.e., aggregated across symptom domains), quality of life / functioning, and mindfulness (Hedges' gs = 0.32 to 0.80), but not physical health. At follow-up (mean length = 3.19 months), MBIs continued to outperform non-specific controls on general psychological symptoms, but not PTSD. MBIs were superior to specific active controls (i.e., other therapies) at post-treatment on measures of PTSD and general psychological symptoms (gs = 0.19 to 0.25). Participants randomized to MBIs showed higher rates of attrition than those randomized to control interventions (odds ratio = 1.98). Several models were not robust to tests of publication bias. Study quality and risk of bias assessment indicated several areas of concern.
MBIs may improve psychological symptoms and quality of life / functioning in veterans. Questionable acceptability and few high-quality studies support the need for rigorous RCTs, potentially adapted to veterans.
•Mindfulness-based interventions (MBIs) produce psychological benefits in veterans.•MBIs may slightly outperform other active interventions.•Veterans are more likely to drop out of MBIs than active control conditions.•Large-scale randomized trials with follow-up assessment are needed.
Lower urinary tract symptoms (LUTS) are reported to affect over half of all adults, and they are associated with significantly impaired quality of life (QOL). We performed a population-based study to ...evaluate the overall prevalence and impact of LUTS including overactive bladder (OAB) in adults aged ≥40 years in China.Adults aged ≥40 years were eligible to participate in this internet-based survey, provided that they had the ability to access the internet, to use a computer and to read the local language. The survey contained questions relating to International Continence Society (ICS) symptom definitions, the International Prostate Symptom Score (IPSS) and the Overactive Bladder Symptom Score (OABSS). The primary study objective was to determine the prevalence of LUTS using the ICS 2002 symptom definition.Among the 4136 respondents, 2080 (50.3%) were men and 1347 (32.6%) were aged ≥60 years. LUTS prevalence according to ICS criteria was 60.3% in men and 57.7% in women. All 3 ICS symptom groups (voiding, storage, and postmicturition) were present in 22.8% of women and 24.2% of men, making this the most common combination of ICS symptom groups. The most bothersome symptoms were terminal dribble and nocturia. According to IPSS scores, 32.9% of participants had at least moderate symptoms. The prevalence of OAB was 23.9%. The presence of LUTS-particularly all 3 ICS symptom groups-was associated with reduced sexual QOL in women, reduced satisfaction with erectile function in men, higher anxiety and depression scores, and reduced health-related QOL (physical health and mental health domains). The overall percentage of participants with LUTS visiting healthcare professionals for urinary symptoms was 38%.In conclusion, LUTS affect the majority of adults aged ≥40 years in China, and prevalence increases with increasing age. LUTS are associated with impaired QOL and mental health, but fewer than half of individuals in China with LUTS seek healthcare for their symptoms. There is therefore a need to improve awareness and treatment of the condition.ClinicalTrials.gov identifier: NCT02618421.
Tobacco users with mental health conditions are a vulnerable population in tobacco research, yet few studies have evaluated the association of depressive and anxiety symptoms with multiple tobacco ...product (MTP) use among young adult electronic cigarette (ENDS) users.
Cross-sectional survey data on U.S. young adult past 30-day ENDS users (N = 2348) were collected via Amazon MTurk from May-July 2019. Binary logistic regressions evaluated the association of tobacco use pattern (exclusive ENDS use, ENDS + one other tobacco product OTP; dual use, ENDS + two or more OTPs poly-use) with depressive (PHQ-9) and anxiety (GAD-7) symptoms. Among MTP users (n = 1736), we evaluated the association of ENDS use relative to OTP use and same-day MTP use with depressive and anxiety symptoms.
The sample included 26% exclusive ENDS, 27% dual, and 47% poly-users. We observed a gradient-relationship for depressive and anxiety symptoms: poly-users had greater odds of depressive and anxiety symptoms compared to dual users (aOR = 1.86 95%CI:1.50-2.30 and aOR = 1.61 95%CI:1.30-2.01, respectively), and dual users had greater odds of depressive and anxiety symptoms compared to exclusive ENDS users (aOR = 1.42 95%CI:1.11-1.81 and aOR = 1.56 95%CI:1.20-2.02, respectively). MTP users who used ENDS more often than OTPs (vs. less often than OTPs) had greater odds of depressive (aOR = 1.38 95%CI:1.06-1.80) and anxiety (aOR = 1.37 95%CI:1.04-1.79) symptoms.
The majority of young adult past 30-day ENDS users in this sample reported OTP use. Future research on MTP use should distinguish between dual and poly-use. Tobacco prevention efforts for young adults with mental health symptoms are needed.
Clinicians should not only know how many patients will benefit from alpha-blocker therapy but should also be able to identify who will benefit. We studied the changes in patient symptoms following ...alpha-blocker therapy and the predictors of symptom improvement in clinical practice.
This was a single-arm, open-label observational cohort study with a 6-week follow-up.
Twenty-two pharmacies in the Netherlands.
Patients were eligible for inclusion if they attended a pharmacy with a new prescription for an alpha-blocker from a general practitioner or urologist.
Outcomes were assessed using the International Prostate Symptom Score (IPSS), Overactive Bladder Questionnaire Short Form (OAB-q SF), and Patient Global Impression of Improvement (PGI-I). Demographic, disease-related, and drug-related information were collected to identify predictors of symptom improvement. These predictors were then assessed by logistic and linear regression analyses of both the original data set and an imputed data set that accounted for the missing variables.
During the study, 37% of patients with lower urinary tract symptoms perceived clear symptomatic improvement based on the results of the PGI-I. Improvement was more likely in those who still used alpha-blockers at the end of the 6-week study period and in those who used multiple medications. Although symptom scores decreased significantly on the IPSS and OAB-q SF, the only predictor of change was the pretreatment symptom severity.
Approximately one-third of our cohort perceived symptom improvement on alpha-blocker therapy. However, we identified no clear predictors of who might benefit from alpha-blocker treatment, indicating that alpha-blockers should still be prescribed on a trial basis.
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