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Diabetic microalbuminuria, which predisposes to the irreversible macroproteinuria and terminal renal failure, has been shown to be reversible by stringent metabolic control. In this study, using logistic regression, 23 patients with insulin-dependent diabetes mellitus were evaluated. Basing on the reported biochemical changes in patients with diabetes mellitus, the relationship between microalbuminuria and serum biochemistries was assessed. Four biochemical parameters were shown to be significantly related to the amount of microalbuminuria and microproteinuria. The microalbuminuria as assayed by rocket immunoelectrophoresis is closely correlated with the microproteinuria as measured by the Coomassie dye binding method and both have a significant relationship with plasma creatinine, bicarbonate, albumin and globulin as assessed by the Minitab computer program and the Biomedical Data Package--Logistic Regression computer program. The relationship with bicarbonate and creatinine can be due to a decrease in glomerular filtration rate associated with more advanced microproteinuria. The relationship with albumin and globulin is the result of impaired albumin synthesis by the liver in diabetes mellitus. From these data, two simple equations which can provide a relative risk factor with rough quantitative assessment for microproteinuria and microalbuminuria are derived. Thus, from these four parameters available from relatively simple blood biochemistries, assessment can be made of the severity of coexisting diabetic proteinuria. The measurement of the latter is not readily available and is more costly and tedious. This assessment together with the finding of a decrease in albumin, slight increase in creatinine and decrease in bicarbonate associated with the more severe microalbuminuria can be used to alert the diabetologist in implementing tighter metabolic control and other interventional methods before irreversible macroproteinuria develops.
In an exploratory study of 1031 persons observed to progress from normotension to essential hypertension and 1031 matched subjects who remained normotensive, the initial leukocyte count (WBC) was found to be related to the development of hypertension, with risk increased 40% (95% confidence interval 12-82%) in persons in the highest as compared to the lowest quartile of WBC. This relationship proved to be largely independent of body mass index, body fat distribution, alcohol and tobacco consumption, and parental history of hypertension. An increased WBC may reflect greater sympathetic tone or may directly increase peripheral vascular resistance by impeding circulation through small blood vessels. If confirmed, this study adds another condition to the growing list for which the WBC is predictive. This simple, cheap test should be considered for inclusion in prospective epidemiological studies of many different diseases.
OBJECTIVES: To compare the prevalence and severity of lower urinary tract symptoms (LUTS) in Japanese men and women and to analyze the impact on bother in an age-stratified manner. METHODS: A consecutive series of 2328 men (mean age 49.5 years) and 1735 women (mean age 48.3 years) who underwent multiphasic health screening at our institution completed the self-administered International Prostate Symptom Score (IPSS) questionnaire with quality-of-life (QOL) assessment. RESULTS: A significant age-related increase in the IPSSs and QOL scores was observed in both sexes. Age-stratified analysis showed that the total IPSS, voiding symptoms, and QOL score were significantly greater in men than in women, and the storage symptoms were not significantly different between both sexes. The percentage with moderate to severe symptoms (IPSS 8 or greater) among those younger than 40, 40 to 49, 50 to 59, 60 to 69, and 70 years old or older was 7.9%, 12.0%, 23.7%, 32.0%, and 48.7%, respectively, in men and 6.5%, 8.3%, 12.1%, 13.8%, and 31.8%, respectively, in women. Within each category of the severity of IPSS, the distribution of the QOL score was very similar in both sexes, showing no sex difference in the impact of LUTS on bother. CONCLUSIONS: These data showed a similar age-related development of LUTS in both sexes, except that voiding symptoms were more prevalent among men. The impact of LUTS on bother was also comparable between men and women.
OBJECTIVES: To assess the age-stratified prevalence of erectile dysfunction (ED) and how lower urinary tract symptoms (LUTS) are associated with ED, and to estimate the correlates of ED among Japanese men. METHODS: A self-administered questionnaire of the International Prostate Symptom Score and the abridged 5-item version of the International Index of Erectile Function were given to 3189 noninstitutionalized men during a multiphasic health screening. The data from 2084 men who provided complete responses to the questionnaire were analyzed. RESULTS: The prevalence of moderate to severe ED increased from 13.4% among those younger than 40 years to 20.6%, 39.9%, and 63.1% among those aged 40 to 49, 50 to 59, and 60 years or older, respectively. Most were dissatisfied with their sex life regardless of age. The severity of ED was significantly associated with moderate to severe International Prostate Symptom Scores (age-adjusted odds ratio 1.52), specifically in the urgency (1.75) and nocturia (1.36) domains, and for those with diabetes mellitus (2.54) and coronary artery disease (8.04). CONCLUSIONS: ED is highly prevalent among Japanese men with LUTS and is significantly associated with the severity of LUTS after controlling for age. This significant aspect of life for men of all ages should be taken into account when treating patients with LUTS.
OBJECTIVES: To assess whether urinary incontinence and its severity are associated with the International Prostate Symptom Score (IPSS) in Japanese women using linguistically validated questionnaires. METHODS: Using a self-administered questionnaire of the IPSS and the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), lower urinary tract symptoms were evaluated in a consecutive series of 1634 women (mean age 48.1 years) who underwent multiphasic health screening at our institution. Ordinal logistic regression analysis was applied, with age, ICIQ-SF, and continence status as the explanatory variable and IPSS severity as the response variable. RESULTS: All scores, including the IPSS (with its voiding and storage symptom scores) and the ICIQ-SF, were significantly greater for the incontinent than the continent women and for those with urge and mixed incontinence than those with stress incontinence. Including all women, IPSS severity was significantly associated with age (odds ratio [OR] 1.03), ICIQ-SF (OR 1.22), and urge (OR 2.79) and mixed (OR 3.54) incontinence, but not with stress incontinence. Among women with stress incontinence, however, the IPSS severity was significantly associated with the ICIQ-SF (OR 1.21), but not with age. CONCLUSIONS: Not only continence status, but also its severity (ICIQ-SF score), has a significant impact on IPSS. We, therefore, must be cautious about interpreting the epidemiologic data on female lower urinary tract symptoms without simultaneous quantitative assessment of urinary incontinence with a validated instrument.
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Behavior that develops in phases may exhibit distinctively different rates of change in one time period than in others. In this article, a mixed-effects model for a response that displays identifiable regimes is reviewed. An interesting component of the model is the change point. In substantive terms, the change point is the time when development switches from one phase to another. In a mixed-effects model, the change point can be a random coefficient. This possibility allows individuals to make the transition from one phase to another at different ages or after different lengths of time in treatment. Two examples are reviewed in detail, both of which can be estimated with software that is widely available.
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International research has demonstrated significant shortcomings in the health of adults with intellectual disability (ID). Because general practitioners (GPs) are the main providers of primary healthcare for this population, strategies to improve general practice care are an important aspect of rectifying these shortcomings. The present pilot study aimed to determine the effect of various interventions on health maintenance activities and to assess their acceptability to GPs, with a view to informing larger scale studies. The GPs were recruited through an earlier questionnaire-based postal survey. The GPs identified all their adult patients with ID, then obtained consent for participation from three patients randomly selected by the investigators. The GPs completed two self-evaluation forms and case note audits 12 months apart, read a synopsis of the relevant literature provided by the researchers, and completed a comprehensive health assessment (CHA) of their three patients. Forty-five GPs agreed to participate in the CHA programme (CHAP), and 15 completed the project. Thirty-eight patients completed the project. The number of patient-GP dyads who completed the project was too small to demonstrate statistically significant changes in health issues over time. The GPs found that the synopsis of the literature was the best intervention for increasing knowledge and was also the most practical to use in general practice. The CHAP was the intervention that prompted the most action from the GP which would not have been undertaken otherwise. The CHAP appeared to provide a superior review process compared to the other interventions used in the present study. The numbers of health maintenance activities found to be overdue and the number of health issues detected as a result of the process were considerable. The CHAP served as a communication tool and an educative instrument, providing a basis for future studies and strategies to improve the general practice care of adults with ID.