Associations of the lower urinary tract symptoms with the lifestyle, prostate volume, and metabolic syndrome in the elderly males

This study aimed to evaluate the influence of the lifestyle, prostate volume (PV), and metabolic syndrome (MS) on lower urinary tract symptoms (LUTS) in the elderly males. A total of 764 men aged greater than 40 years were enrolled. Their severities of LUTS were assessed by the International Prostate Symptom Score questionnaire, while their MS was diagnosed according to the criteria developed by the National Cholesterol Education Program Adult Treatment Panel III. Lifestyle factors, PV, and components of MS were compared between no/mild and moderate/severe LUTS groups. In univariate analysis, age, cigarette smoking, alcohol consumption, physical activity, and PV significantly correlated with the severity of LUTS, but the presence or any components of MS did not. Results of multivariate analysis showed that aging, cigarette smoking, lack of regular exercise, and larger PV were independent predictors for moderate/severe LUTS. Notably, the risk factors for LUTS was influenced by the presence of MS. PV may play a role in determining the severity of LUTS for men without MS, while physical activity was the critical factor for men with MS. It was suggested that healthy lifestyle would be beneficial to lessen the severity of LUTS in the elderly males.     

Aging, physical activity, and hormones in women--a review

Women experience significant changes in endocrine function during aging. Decreasing levels of anabolic hormones may be associated with musculoskeletal atrophy and decrease in function that is observed in older women and, as a result, there has been an increase in the use of pharmacological hormone therapies. It is difficult to distinguish, however, between physiological changes that are truly age related and those that are associated with lifestyle factors such as physical activity participation. Some research has shown that circulating levels of anabolic hormones such as DHEA(S) and IGF-I in older women are related to physical activity, muscle function, and aerobic power. Exercise-intervention studies have generally shown that increasing age blunts the acute hormonal response to exercise, although this might be explained by a lower exercise intensity in older women. There have been relatively few studies that examine hormonal adaptations to exercise training. Physical activity might have an effect on hormone action as a result of changes in protein carriers and receptors, and future research needs to clarify the effect of age and exercise on these other components of the endocrine system. The value and safety of hormone supplements must be examined, especially when used in combination with an exercise program.     

Patient-perceived effectiveness and impact on quality of life of solifenacin in combination with an α-blocker in men with overactive bladder in Sweden: a non-interventional study

Treating male lower urinary tract symptoms (LUTS) by targeting the prostate would have limited effect on overactive bladder (OAB) symptoms. This study assessed perceived symptoms and quality of life (QoL) of male patients with OAB treated with an α-blocker plus solifenacin in daily clinical practice. Male patients aged ≥40 years were included after the decision was made to initiate treatment with an α-blocker for LUTS plus solifenacin for OAB symptoms. The primary endpoint was change in patient perception of bladder condition (PPBC) questionnaire score over 6?months. Other assessments included the OAB-questionnaire short form (OAB-q SF) and International Prostate Symptom Score (IPSS). Interpretation of the study data was hindered by not meeting the enrollment target and a high dropout rate. In 36 evaluable patients, mean (SD) PPBC score improved from 4.3 (0.93) at baseline (“moderate” to “severe” problems) to 3.5 (1.06) at month 6 (“minor” to “moderate” problems). OAB-q SF scores and total IPSS also improved. In this patient population, treatment with solifenacin and an α-blocker resulted in improvements in male patient perception of their LUTS and QoL, although the results should be interpreted with caution due to the low number of patients with complete data.     

Pelvic organ prolapse: review of the aetiology, presentation, diagnosis and management

Pelvic organ prolapse is a common condition affecting a large number of women. Incidence increases after the menopause. Age, parity and obesity are the most consistently reported risk factors. Many women can be asymptomatic of prolapse but common symptoms include a sensation of a bulge or fullness in the vagina or urinary, bowel or sexual dysfunction. Management depends upon symptoms and the type and grade of the prolapse as well as any associated medical co-morbidities. Management options include expectant, conservative or surgical approaches. Up to 10% of women having a surgical procedure for prolapse will require a second procedure. It is, therefore, important to consider lifestyle modifications such as weight loss and conservative measures including pelvic floor muscle training, topical estrogens and pessaries as initial management options.     

Epidemiology and risk factors of lower urinary tract symptoms/benign prostatic hyperplasia and erectile dysfunction

Benign prostatic hyperplasia (BPH) is very common in aging men and causes lower urinary tract symptoms (LUTS), which decrease health-related quality of life. A number of evidence suggests that other than ageing, modifiable factors, such as increasing prostate volume, obesity, diet, dyslipidemia, hormonal imbalance, hypertension, metabolic syndrome, alcohol, and smoking, also contribute to the development of BPH and/or LUTS. More recently, erectile dysfunction (ED) has been linked to LUTS/BPH as a part of this syndrome, suggesting that patients with BPH or LUTS easily develop ED, and that LUTS/BPH symptoms often coexist with ED. This article focuses on the epidemiology and risk factors of the combined phenotype LUTS/BPH – ED.     

Lower urinary tract symptoms and its potential relation with late-onset hypogonadism

The study of the health status of the aging male takes presently a more integrative approach and it appears that ailments typical of male aging, such as lower urinary tract symptoms (LUTS), (visceral) obesity, metabolic syndrome and erectile failure are significantly interrelated. A common denominator of the above ailments is lower-than-normal testosterone levels occurring in a significant proportion of elderly men. This review addresses the potential connections between LUTS and late-onset hypogonadism. In animal studies there appear to be androgen and estrogen receptors in the urothelium and smooth muscle cells of the urethra and bladder of the rat and rabbit, as well as in the neurons in the autonomic ganglia of the prostatic plexus of the male rat. Upon castration electrically evoked relaxations of the smooth muscle of the prostatic urethra were decreased. There is a Rho-kinase activation/endothelin pathway; possibly involved in the increased smooth muscle activity found in both LUTS/benign prostate hyperplasia. Nitric oxide (NO) appears to have a smooth muscle relaxing effect in the urogenital organs. Studies in humans have convincingly shown that phosphodiestererase inhibitors have a beneficial effect on LUTS. More intervention studies should be undertaken to test the clinical validity of the theoretically plausible interrelationship between LUTS and late-onset hypogonadism.     

Predicting attitudes and behavioural intentions towards social entrepreneurship: the role of servant leadership in young people / Predicción de las actitudes y las intenciones conductuales hacia el emprendimiento social: el papel del liderazgo de servicio en los jóvenes

: Social entrepreneurship (SE) refers to the development of innovative projects whose main aim is not individual profit but the transformation of society. The issue is particularly important for promoting youth development and participation. This research offers insights from two studies designed from a multi-dimensional perspective analysing attitudes and behavioural intentions towards social ventures built upon the constructs of servant leadership and lifestyles. Results of Study 1 indicated that servant leadership is a key predictor of attitudes and behavioural intentions towards social entrepreneurship, while having a violent lifestyle is negatively associated with these attitudes and intentions. Study 2 showed that servant leadership style predicted attitudes towards social entrepreneurship over and above other types of leadership (i.e., transformational, transactional and laissez-faire). These studies demonstrate the importance of considering servant leadership and relational styles as key factors in predicting attitudes and behavioural intentions regarding social and active participation of young people. Limitations of the study and applications to designing interventions aimed at improving attitudes and behavioural intentions towards social entrepreneurship are discussed.     

The effect of testosterone therapy on lower urinary tract symptoms/bladder and sexual functions in men with symptomatic late-onset hypogonadism

Objective.?To prospectively investigate the effect of testosterone therapy on lower urinary tract symptoms (LUTS)/bladder and sexual functions in men with symptomatic late-onset hypogonadism (SLOH).

Methods.?The study included 25 men (age range 38 to 73 years) presented with sexual dysfunction, having SLOH, at a single university hospital. All men received testosterone replacement therapy with transdermal testosterone 50–100 mg gel per day for one year. Urodynamic studies with pressure-flow analysis, measurement of prostate volume, prostate specific antigen (PSA) and free PSA level, International Prostate Symptom Score (IPSS), Aging Male Symptom (AMS) scale and International Index of Erectile Function (IIEF-5) score were recorded in all men before and after one year of the treatment.

Results.?The mean AMS score significantly decreased from 40.4 ± 7.3 to 28.8 ± 5.31 (p = 0.001), and mean IIEF-5 score significantly increased from 8.84 ± 3.76 to 14.36 ± 3.62 (p = 0.001). The mean maximal bladder capacity and compliance significantly increased (p = 0.007 and p = 0.032, respectively), and mean detrusor pressure at Qmax significantly decreased from pre-treatment to post-treatment (p = 0.017).

Conclusion.?This study suggests that in addition to improvement in sexual functions, testosterone therapy may also improve LUTS/bladder functions by increasing bladder capacity and compliance and decreasing detrusor pressure at maximal flow in men with SLOH.     

Posttraumatic stress disorder (PTSD) symptoms among firefighters: Roles of resilience and locus of control

Firefighting is a an extremely stressful occupation that risks exposure to traumatic events as part of the job. Despite this, the literature on stress and trauma pays little attention to this occupation and its generalization to other, high risk occupations. This study examined resilience and work locus of control as predictors of posttraumatic stress disorder (PTSD) symptoms among Nigerian firefighters. Participants were 116 paid, professional firefighters (98 males and 18 females) who completed the Post-Traumatic Stress Disorder Checklist-Civilian Version (PCL-C), Resilience Scale (RS-14), and Work Locus of Control Scale (WLCS) and provided vital demographic information. Multiple regression analysis was used to analyze the data. Results showed that resilience negatively predicted PTSD symptoms such that higher resilience was associated with fewer symptoms of PTSD. Work locus of control was a positive predictor of PTSD symptoms, indicating that externality of control beliefs in the workplace was associated with more PTSD symptoms. Relevant demographic factors especially higher years of service, being a senior firefighter, and higher educational status were associated with lower PTSD symptoms. Findings underscore the potential value of resilience training and implementing behavioral health programs to modify firefighters’ external locus of control beliefs. Interventions should consider resilience and locus of control focused interventions as protective factors for PTSD.     

Rational and behavioural predictors of pre-retirement cash-outs

Given the worldwide concern that individuals are not saving sufficiently for retirement, many governments are taking action to try and rectify this tendency. A key focus area is implementing policies to dissuade individuals from accessing accumulated retirement funds when changing jobs. While traditional economic theories assume that individuals act rationally and make optimal decisions without outside intervention, current policy interventions support behavioural theories of decision-making where sub-optimal choices occur due to limitations in human decision-making. Therefore, interventions are based on the assumption that individuals act irrationally. Despite these interventions, many individuals still access their funds suggesting that current interventions may not be sufficiently aligned with the factors influencing decision making in this environment.The main research objective of this study was to test empirically both rational and behavioural factors that could potentially influence retirement preservation decisions, to determine which factors were the best predictors of whether an individual preserved funds when changing jobs. A research instrument was designed using a combination of existing psychometric measures and customised questions to form an analytical survey. This was used to test the factors that predicted the preservation decisions of a sample of 256 academic and non-academic personnel at a tertiary education institution in South Africa.The study found that behavioural factors play an important role in predicting preservation decisions. In particular, behavioural factors related to bounded rationality, due to the computational complexity of the decision-making environment, emerged as important explanatory variables, indicating that interventions such as decision support and guidance may assist individuals in making optimal decisions.     

Efficacy of newer medications for lower urinary tract symptoms attributed to benign prostatic hyperplasia: a systematic review

We conducted a systematic review to evaluate the efficacy and adverse effects of newer drugs used to treat lower urinary tract symptoms (LUTS). The drugs were either Food and Drug Administration (FDA) approved for benign prostatic hyperplasia (BPH) or not FDA approved for BPH but have been evaluated for treatment of BPH since 2008. We searched bibliographic databases through September 2017. We included randomized controlled trials (RCTs) lasting one month or longer published in English. Outcomes of interest were LUTS assessed by validated measures. Efficacy was interpreted using established thresholds indicating clinical significance that identified the minimal detectable difference. Twenty-three unique, generally short-term, RCTs evaluating over 9000 participants were identified. Alpha-blocker silodosin and phosphodiesterase type 5 inhibitor tadalafil were more effective than placebo in improving LUTS (moderate strength evidence) but these drugs had more adverse effects, including abnormal ejaculation (silodosin). Anticholinergics were only effective versus placebo when combined with an alpha-blocker. Evidence was generally low strength or insufficient for other drugs. Evidence was insufficient to assess long-term efficacy, prevention of symptom progression, need for surgical intervention, or long-term adverse effects. Longer trials are needed to assess the effect of these therapies on response rates using established minimal detectable difference thresholds, disease progression, and harms.     

Marital Status and Self-Rated Health in Rural Inhabitants in Japan: A Cross-Sectional Study

Poor self-rated health is considered to be a predictor of short survival, and self-rated health is associated with several lifestyle and sociodemographic factors. To determine whether marital status is an independent risk factor for poor self-rated health among inhabitants in rural areas, we conducted a cross-sectional survey of inhabitants in Japan. Complete responses were obtained from 10,268 individuals. Self-ratings of mental health, demographics, and symptoms were used to predict self-rated health. Being male; having disease, questionnaire-based physical complaints, and depressive state; having lower levels of education; and being divorced resulted in higher odds (95% confidence interval) for poor self-rated health, presenting 1.41 (1.18–1.69), 10.8 (8.62–13.7), 1.11 (1.09–1.12), 1.11 (1.08–1.13), 1.22 (1.02–1.46), and 1.53 (1.01–2.31), respectively. In contrast, age, friendship, and other marital status such as single or bereaved showed no significant relationship with poor self-rated health. To improve self-rated health among rural inhabitants, attention should be focused on divorced inhabitants, especially men.     

Are urge incontinence and aging risk factors of erectile dysfunction in patients with male lower urinary tract symptoms?

Introduction: Several studies have indicated that erectile dysfunction (ED) patients also suffer from lower urinary tract symptoms (LUTS). We investigated a group of men with LUTS and assessed their sexual function with the aim of being able to predict ED risk factors and introduce ED treatments earlier for this patient group.

Methods: International Prostate Symptom Score (IPSS), Overactive Bladder Symptoms Score (OABSS) and Sexual Health Inventory for Men (SHIM) score were obtained from 236 men with LUTS at their first out-patients visit. Clinical parameters such as body mass index, prostate volume, residual urine volume and prostate specific antigen were also evaluated. The relationship between the SHIM score and other clinical data was analyzed.

Results: According to the SHIM score, ED in men with LUTS was severe 15%, moderate 19%, moderate to mild 28%, mild 17%, normal 7% and data was incomplete in 14%. Based on the results of a multivariate analysis, aging (p?p?=?0.024) were significantly correlated to severe and moderate ED. Furthermore, among OAB symptoms score items, urge urinary incontinence was a risk factor for severe and moderate ED (p?=?0.005).

Conclusion: Aging and OAB (notably urinary urge incontinence) are risk factors for severe and moderate ED in men with LUTS.     

Intergenerational Processes,Attachment and Unexplained Medical Symptoms

Children organise self‐protectively in response to anxiety‐provoking or dangerous parental behaviours. When children's self‐protective responses are extreme and persist over time, they may come to the attention of health professionals in the guise of emotional, behavioural or somatic symptoms. A parallel phenomenon is that harmful parental behaviours may be embedded in the emotional processes of the inter‐generational family unit, reflecting the parents' own experiences of comfort and danger, as well as the particular manner in which these experiences have been integrated into the parents' current functioning. Using a case study of a three‐year‐old girl with medically unexplained urinary retention, the article explores how information about attachment relationships and unresolved parental loss or trauma can inform our understanding of implicit, anxiety‐driven processes within the family, and to facilitate family interventions and symptom alleviation. The case shows that the Dynamic‐Maturational Model of attachment has significant applications in the areas of family therapy theory and practice, psychosomatic medicine and consult‐liaison psychiatry.     

Cognitive behavioural psychotherapy intervention in childhood sexual abuse: identifying new directions from the literature

The short‐ and long‐term consequences of childhood sexual abuse have been extensively reported. However, for many years there has been an absence of psychological conceptual frameworks for understanding and treating abuse trauma symptoms. This paper reviews a number of outcome studies for the treatment of child sexual abuse where a post‐traumatic stress disorder (PTSD) conceptualization was used to plan treatment interventions. The paper concludes that, contrary to some concerns expressed by clinicians, sexually abused children and their non‐abusing carers can signi?cantly bene?t from cognitive behavioural interventions which use reliving and confrontation of the abusive experience. Notwithstanding this, there is a need for further controlled outcome research of cognitive behavioural interventions using reliving techniques to explore how and why these interventions help in reducing abuse‐related PTSD symptoms. Copyright © 2004 John Wiley & Sons, Ltd.     

Implications of the Literature on Equine-Assisted Activities for Use as a Complementary Intervention in Social Work Practice with Children and Adolescents

This article reviews the literature investigating psychosocial benefits of equine-assisted activities (EAA) for children and adolescents with physical, mental, and family challenges. It further analyzes implications for clinical social work practice in the use of EAA as complementary or adjunct interventions with these populations, thus addressing a gap in the literature on population-specific outcomes of EAA. As a contribution to methodology in future research, the conceptual analysis suggests that concurrent examination of complementary interventions across categories of special needs could add to the knowledge base concerning these children’s psychosocial status. Cross-domain investigations could also assess the contribution of each challenge to the status of children with multiple conditions.     

Treatment of postmenopausal vaginal atrophy with 10-μg estradiol vaginal tablets

Postmenopausal estrogen deficiency can lead to symptoms of urogenital atrophy. Individuals with urogenital atrophy have symptoms that include vaginal dryness, vaginal and vulval irritation, vaginal soreness, pain and burning during urination (dysuria), increased vaginal discharge, vaginal odour, vaginal infections, recurrent urinary tract infections, pain associated with sexual activity (dyspareunia) and vaginal bleeding associated with sexual activity. Despite the frequency and effects of vaginal atrophy symptoms, they are often under-reported and, consequently, under-treated. Therefore, care of a menopausal woman should include a physical assessment of vaginal atrophy and a dialogue between the physician and the patient that explores existing symptoms and their effect on vulvovaginal health, sexuality and quality-of-life issues. The development of the ultra-low-dose 10-μg estradiol vaginal tablets is in line with the requirements of regulatory agencies and women's health societies regarding the use of the lowest effective hormonal dose. Because of its effectiveness and safety profiles, in addition to its minimal systemic absorption, the 10-μg estradiol vaginal tablet can offer greater reassurance to health-care providers and postmenopausal women with an annual estradiol administration of only 1.14 mg.     

用大学生身体素质的变化评价大学体育教学质量

运用测试法,对苏北部分高校的大学生体质健康现状进行测试和调查,对学生的身体形态、机能和素质进行比较分析。结果发现:大学生在大学期间的身体素质呈明显的下降趋势,建议进一步加强对大学生的体质了解,提高高校体育课教学和体育辅导的针对性,积极采取有效的教学内容、教学手段、评价机制等,引导和帮助他们科学锻炼,培养健康的生活方式。     

Bloodless management of benign prostatic hyperplasia: medical and minimally invasive treatment options

Benign prostatic hyperplasia (BPH) is a medical condition affecting a wide range of the aging male population resulting in various degrees of lower urinary tract symptoms (LUTS). Today, a variety of medical therapies and minimally invasive BPH treatment modalities are available. Medical therapy includes α₁ blockers, 5α reductase inhibitors and combination therapy. When these options fail, surgery is indicated. Transurethral resection of the prostate (TURP) is still considered the gold standard surgical treatment for BPH. Nevertheless, numerous minimally invasive treatment alternatives are available that are comparable in effectiveness to TURP, with significantly less morbidity. In this article, current treatment options for BPH are reviewed with respect to their indications, long-term safety and efficacy in relieving BPH related LUTS. The selection of the type of BPH treatment should be based on the physician's experience, patient's co-morbidities as well as the prostate size and clinical disease progression.