The impact of urinary incontinence on multiple health outcomes: an umbrella review of meta-analysis of observational studies.

BACKGROUND AND AIM: We aimed to capture the breadth of health outcomes that have been associated with the presence of Urinary Incontinence (UI) and systematically assess the quality, strength, and credibility of these associations through an umbrella review and integrated meta-analyses. METHODS: We assessed meta-analyses of observational studies based on random-effect summary effect sizes and their p-values, 95% prediction intervals, heterogeneity, small-study effects, and excess significance. We graded the evidence from convincing (Class I) to weak (Class IV). RESULTS AND DISCUSSION: From 3172 articles returned in search of the literature, 9 systematic reviews were included with a total of 41 outcomes. Overall, 37 out of the 41 outcomes reported nominally significant summary results (p < 0.05), with 22 associations surviving the application of a more stringent p-value (p < 10-6). UI was associated with worse scores than controls in female sexual function (Class II), while it was also associated with a higher prevalence of depression (odds ratio [OR] = 1.815; 95% confidence interval [CI]: 1.551-2.124), and anxiety (OR = 1.498; 95% CI: 1.273-1.762) (Class IV). UI was associated with poorer quality of life (QoL), higher rate of mortality (hazard ratio = 2.392; 95% CI: 2.053-2.787) an increase in falls, frailty, pressure ulcers, diabetes, arthritis, and fecal incontinence (Class IV). CONCLUSIONS: UI is associated with female sexual dysfunction, with highly suggestive evidence. However, the evidence of other adverse outcomes including depression, anxiety, poorer QoL, higher mortality, falls, pressure ulcers, diabetes, arthritis, fecal incontinence, and frailty is only weak. A multidimensional approach should be taken in managing UI in the clinical setting.

The role of vitamin D in the prevention of coronavirus disease 2019 infection and mortality.

WHO declared SARS-CoV-2 a global pandemic. The present aim was to propose an hypothesis that there is a potential association between mean levels of vitamin D in various countries with cases and mortality caused by COVID-19. The mean levels of vitamin D for 20 European countries and morbidity and mortality caused by COVID-19 were acquired. Negative correlations between mean levels of vitamin D (average 56 mmol/L, STDEV 10.61) in each country and the number of COVID-19 cases/1 M (mean 295.95, STDEV 298.7, and mortality/1 M (mean 5.96, STDEV 15.13) were observed. Vitamin D levels are severely low in the aging population especially in Spain, Italy and Switzerland. This is also the most vulnerable group of the population in relation to COVID-19. It should be advisable to perform dedicated studies about vitamin D levels in COVID-19 patients with different degrees of disease severity.

Value of DermaCheckup as a novel dedicated digital health solution for teledermatology.

Daily healthcare is becoming increasingly costly and resource-intensive, requiring vast human and financial resources. The primary aim of the present study was to present the initial findings regarding the diagnostic accuracy of a novel telemedicine platform, DermaCheckup, when compared with face-to-face clinical appointments. The secondary aim was to assess whether patient management plans produced via this telemedicine platform differ from those decided upon following a face-to-face dermatological consultation. The difference in time to diagnosis between the tele-dermatology platform and standard care was also assessed. The DermaCheckup teledermatology service was implemented in March, 2020 as the COVID-19 pandemic emerged in the UK. The present study assessed patients who underwent a face-to-face clinical consultation, who, prior to visiting the clinic, used the teledermatology platform; thus, the diagnosis made via teledermatology was able to be compared to that made following standard care. Comparisons were made between diagnosis, process of diagnosis and the time to diagnosis. A total of 29 consecutive patients entering one UK dermatology clinic were included in the study. The COVID-19 pandemic resulted in face-to-face visits being challenging, owing to the risk of transmission of SARS-CoV-2. This limited the number of patients recruited into the study. The DermaCheckup application exhibited a very good level of agreement in terms of diagnosis with traditional face-to-face appointments. In the present study cohort, 93% of the patients could have been managed safely or referred immediately for a biopsy, thus avoiding a visit to the hospital. A substantial important improvement was also observed in the efficiencies that can be potentially achieved; the time to manage a patient decreased between 46-22-fold without considering the waiting time required between the time of organizing an appointment to the actual appointment.