Characterizing the cortical pathways underlying visual trigger induced urinary urgency incontinence by functional MRI.

AIMS: Visual triggers have long been recognized clinically to stimulate urgency urinary incontinence (UUI). Current pathophysiology recognizes the importance of cortical control over micturition but there is no standardized methodology for clinicians to study the impact of visual triggers. Our aim was to develop an imaging protocol able to characterize the brain's response to personalized visual triggers, providing a methodology for evaluation on connectivity within the brain in patients with visually triggered urinary urgency. METHODS: A magnetic resonance imaging (MRI) methodology specific for urologic use was developed. A 3T-Elition Scanner was first used to acquire static structural images. These images were then used to define approximately 200 brain regions of interest (ROI) using a validated brain atlas. Then, real-time functional MRI (fMRI) scans were conducted during natural bladder filling, where study subjects were shown randomized block sequences of visual stimuli comprised of both subject-specific trigger images and neutral images. The fMRI scan data were merged to identify key ROI underlying UUI. RESULTS: Dynamic fMRI scans were conducted in 10 subjects, 4 with trigger-induced UUI, 2 with trigger-induced urgency, and 4 with no urgency or leakage to visual triggers. No subjects with UUI history lost continence during imaging, but all four subjects reported sensations of urgency in response to their own subject-specific trigger images. The ROI identified were the periaqueductal gray, anterior cingulate gyrus, pons, and prefrontal cortex. We found increased activity in the prefrontal cortex and limbic system ROI in response to subject-specific visual triggers of UUI. CONCLUSIONS: This information provides proof of principle for further exploration of subject-specific trigger image evaluation using fMRI to explore causation in patients with UUI.

Monitoring spinal cord hemodynamics and tissue oxygenation: a review of the literature with special focus on the near-infrared spectroscopy technique.

STUDY DESIGN: Review. OBJECTIVES: Clinical studies have shown that the hemodynamic management of patients following acute spinal cord injury (SCI) is an important aspect of their treatment for maintaining spinal cord (SC) perfusion and minimizing ischemic secondary injury to the SC. While this highlights the importance of ensuring adequate perfusion and oxygenation to the injured cord, a method for the real-time monitoring of these hemodynamic measures within the SC is lacking. The purpose of this review is to discuss current and potential methods for SC hemodynamic monitoring with special focus on applications using near-infrared spectroscopy (NIRS). METHODS: A literature search using the PubMed database. All peer-reviewed articles on NIRS monitoring of SC published from inception to May 2019 were reviewed. RESULTS: Among 125 papers related to SC hemodynamics monitoring, 26 focused on direct/indirect NIRS monitoring of the SC. DISCUSSION: Current options for continuous, non-invasive, and real-time monitoring of SC hemodynamics are challenging and limited in scope. As a relatively new technique, NIRS has been successfully used for monitoring human cerebral hemodynamics, and has shown promising results in intraoperative assessment of SC hemodynamics in both human and animal models. Although utilizing NIRS to monitor the SC has been validated, applying NIRS clinically following SCI requires further development and investigation. CONCLUSIONS: NIRS is a promising non-invasive technique with the potential to provide real-time monitoring of relevant parameters in the SC. Currently, in its first developmental stages, further clinical and experimental studies are mandatory to ensure the validity and safety of NIRS techniques.

Exploring the relationship between self-reported urinary tract infections to quality of life and associated conditions: insights from the spinal cord injury Community Survey.

STUDY DESIGN: Descriptive study OBJECTIVES: Urinary tract infections (UTIs) are one of the most frequent types of infections following spinal cord injury (SCI). Here we assess the relationship between frequency of UTIs and activity level/overall quality of life (QOL) measures, determine the frequency of temporally associated conditions associated with UTI and identify factors associated with frequent UTIs. SETTING: Canada METHODS: The Spinal Cord Injury Community Survey was developed to assess major dimensions of community living and health outcomes in persons with chronic SCI in Canada. Participants were stratified by self-reported UTI frequency. The relationship between UTI frequency and QOL, health resource utilization, and temporally associated conditions were assessed. Results were analysed with cross tabulations, χ2 tests, and ordinal logistic regression. RESULTS: Overall 73.5% of participants experienced at least one self-reported UTI since the time of injury (mean 18.5 years). Overall QOL was worse with increasing frequency of these events. Those with frequent self-reported UTIs had twice as many hospitalizations and doctors' visits and were limited in financial, vocational and leisure situations, physical health and ability to manage self-care as compared with those with no UTIs. Self-reported UTIs were associated with higher incidence of temporally associated conditions including bowel incontinence, constipation, spasticity, and autonomic dysreflexia. Individuals who were younger and female were more likely to have frequent UTIs and those with constipation and autonomic dysreflexia had worse QOL. CONCLUSIONS: Higher frequency self-reported UTIs is related to poor QOL of individuals with long-term SCI. These findings will be incorporated into SCI UTI surveillance and management guidelines.

Quantification of pelvic floor muscle strength in female urinary incontinence: A systematic review and comparison of contemporary methodologies.

AIMS: There remains no gold standard for quantification of voluntary pelvic floor muscle (PFM) strength, despite international guidelines that recommend PFM assessment in females with urinary incontinence (UI). Methods currently reported for quantification of skeletal muscle strength across disciplines are systematically reviewed and their relevance for clinical and academic use related to the pelvic floor are described. METHODS: A systematic review via Medline, PubMed, CINHAL, and the Cochrane database using key terms for pelvic floor anatomy and function were cross referenced with skeletal muscle strength quantification from 1946 to 2016. Full text peer-reviewed articles in English having female subjects with incontinence were identified. Each study was analyzed for use of controls, type of methodology as direct or indirect measures, benefits, and limitations of the technique. RESULTS: A total of 1586 articles were identified of which 50 met the inclusion criteria. Nine methodologies of determining PFM strength were described including: digital palpation, perineometer, dynamometry, EMG, vaginal cones, ultrasonography, magnetic resonance imaging, urine stream interruption test, and the Colpexin pull test. Thirty-two percent lacked a control group. CONCLUSION: Technical refinements in both direct and indirect instrumentation for PFM strength measurement are allowing for sensitivity. However, the most common methods of quantification remain digital palpation and perineometry; techniques that pose limitations and yield subjective or indirect measures of muscular strength. Dynamometry has potential as an accurate and sensitive tool, but is limited by inability to assess PFM strength during dynamic movements.

Health Care Workers Online YouTube Content Compared to AUA Prevention of Recurrent Urinary Tract Infections in Women Guidelines: An Integrative Review of Quality and Comprehensiveness Analysis.

INTRODUCTION: We document the quality, veracity, and comprehensiveness of recurrent UTI information on YouTube to increase health care workers' (HCWs') awareness of UTI-related content online, and to identify deficits in understanding, clarify misconceptions, and reduce stigmatization risk. METHODS: High-traffic topic search terms were curated by Google Trends to extract 200 videos, of which 45 met inclusion criteria. Five independent reviewers used a standardized questionnaire based on the AUA recurrent UTI guidelines to assess the definition of UTI, marketing content, prophylaxis/prevention strategies, and antibiotic use/stewardship. RESULTS: Incongruent or incomplete guideline UTI definitions were found in 78% (35/45) of videos (K = 0.40), despite 80% (36/45) being authored by HCWs. Forty-two percent (19/45) promoted nonguideline-based hygiene practices; 25% (11/45) advocated front-to-back wiping (K = 0.71). Descriptors identified within the videos included the mention of women with UTI as unclean. Only 55% (25/45) discussed increasing fluid intake (K = 0.59), while 33% (15/45) discussed the use of cranberry supplementation (K = 0.81). CONCLUSIONS: Discussion of hygiene practices which lack a specific guideline statement is particularly evident. Descriptors that characterize women with UTI as "unclean" may create a health equity concern for women experiencing UTIs. These findings should alert HCWs to the scope and emphasis in online education that patients may view to self-educate; both the errors and the issues of equity are problematic. Educational materials on UTI should be based on evidence-based guidelines, such as those by the AUA.

Time to establish an international vaccine candidate pool for potential highly infectious respiratory disease: a community's view.

In counteracting highly infectious and disruptive respiratory diseases such as COVID-19, vaccination remains the primary and safest way to prevent disease, reduce the severity of illness, and save lives. Unfortunately, vaccination is often not the first intervention deployed for a new pandemic, as it takes time to develop and test vaccines, and confirmation of safety requires a period of observation after vaccination to detect potential late-onset vaccine-associated adverse events. In the meantime, nonpharmacologic public health interventions such as mask-wearing and social distancing can provide some degree of protection. As climate change, with its environmental impacts on pathogen evolution and international mobility continue to rise, highly infectious respiratory diseases will likely emerge more frequently and their impact is expected to be substantial. How quickly a safe and efficacious vaccine can be deployed against rising infectious respiratory diseases may be the most important challenge that humanity will face in the near future. While some organizations are engaged in addressing the World Health Organization's "blueprint for priority diseases", the lack of worldwide preparedness, and the uncertainty around universal vaccine availability, remain major concerns. We therefore propose the establishment of an international candidate vaccine pool repository for potential respiratory diseases, supported by multiple stakeholders and countries that contribute facilities, technologies, and other medical and financial resources. The types and categories of candidate vaccines can be determined based on information from previous pandemics and epidemics. Each participant country or region can focus on developing one or a few vaccine types or categories, together covering most if not all possible potential infectious diseases. The safety of these vaccines can be tested using animal models. Information for effective candidates that can be potentially applied to humans will then be shared across all participants. When a new pandemic arises, these pre-selected and tested vaccines can be quickly tested in RCTs for human populations.

'Many voices, one song': a model for an oral health programme as a first step in establishing a health promoting school.

Four health promoting (HP) schools were established in rural communities in Uganda by a joint Ugandan/Canadian university team. The model was based on a successful Canadian health promotion initiative designed to address poor oral health in Aboriginal children in rural and remote communities. Careful situation analysis, orientation of partner schools and collaborative development of educational materials and evaluation methodology preceded implementation. The intervention had three elements: inclusion of health topics by teachers in regular classroom activities; health education delivered by the university team to reinforce key educational concepts; and daily in-school tooth brushing to develop healthy practices. All children entering Grade 1 at four schools were recruited for 4 years; evaluation included year 1 pre-intervention and annual end-of-year data collection of quantitative and qualitative measures. Principal findings at 4 years included: an increase from baseline in the original cohort (n = 600) in those brushing at least once daily (p < 0.05) and before bed (p < 0.05); improved oral health (less 'bad breath', pain and absences for emergency dental treatment); more comprehensive health knowledge. Other positive observations were change in the schools' health culture; children sharing new health knowledge and advocating for health practices learned; and evolution of health promotion activity to address other community-identified issues following success with the initial oral health component. University faculty and students learned from participation in programme delivery and community-based educational opportunities. School-based health promotion using this oral health model was readily accepted, implemented, sustained and evaluated; all communities took ownership, and all schools continue their programmes. Addressing oral health through HP schools is novel in Africa, and several lessons learned are of potential value for similar health promotion initiatives in sub-Saharan Africa.

Videotaped interviews as a medium to enhance cross-cultural programme evaluation.

Evaluation is a required component of interventions. Written data are the predominant source. However, video recording is used in many applications to evaluate a range of encounters and practices. We report assessment of the role of videotaped interviews in programme evaluation. Interviews using a consistent script of open-ended questions were recorded during evaluation of an international child-health promotion programme in Uganda by individuals with basic training and equipment. Participants were a convenience sample of programme team members (six school teachers, and six Ugandan and 12 Canadian health-care trainees) who had completed the annual written evaluation questionnaire. Evaluators reviewed each participant's videotaped interview and questionnaire, content coded the responses against a criterion-based check list, documented how many times factual information was contributed on each question and compared the data. Videos were also assessed for strong positive or negative emotion. Videotaped interviews provided more comprehensive responses than written questionnaires, and were more accurate where mis-comprehension of question meaning occurred. The video interview, unlike the written questionnaire, allowed rephrasing for clarification. The video interview medium enhanced programme evaluation by providing more facts, greater insight into the effects of the interventions and clearer direction for future activity. Hence, video-recorded feedback has great potential value in applied research for comprehensive programme evaluation.

Detection of hypoxia by near-infrared spectroscopy and pulse oximetry: a comparative study.

SIGNIFICANCE: Pulse oximetry is widely used in clinical practice to monitor changes in arterial oxygen saturation (SpO2). However, decreases in SpO2 can be delayed relative to the actual clinical event, and near-infrared spectroscopy (NIRS) may detect alterations in oxygenation earlier than pulse oximetry, as shown in previous cerebral oxygenation monitoring studies. AIM: We aim to compare the response of transcutaneous muscle NIRS measures of the tissue saturation index with pulse oximetry SpO2 during hypoxia. APPROACH: Episodes of acute hypoxia were induced in nine anesthetized Yucatan miniature pigs. A standard pulse oximeter was attached to the ear of the animal, and a transcutaneous NIRS sensor was placed on the hind limb muscle. Hypoxia was induced by detaching the ventilator from the animal and reattaching it once the pulse oximeter reported 70% SpO2. RESULTS: Twenty-four episodes of acute hypoxia were analyzed. Upon the start of hypoxia, the transcutaneous NIRS measures changed in 5.3 ± 0.4 s, whereas the pulse oximetry measures changed in 14.9 ± 1.0 s (p < 0.0001). CONCLUSIONS: Transcutaneous muscle NIRS can detect the effects of hypoxia significantly sooner than pulse oximetry in the Yucatan miniature pig. A transcutaneous NIRS sensor may be used as an earlier detector of oxygen saturation changes in the clinical setting than the standard pulse oximeter.

Standing open magnetic resonance imaging improves detection and staging of pelvic organ prolapse.

INTRODUCTION: The role of imaging in pelvic organ prolapse (POP) assessment is unclear. Open magnetic resonance imaging (MRI) systems have a configuration that allows for imaging women with POP in different positions. Herein, we use a 0.5 Tesla open MRI to obtain supine, seated, and standing images. We then compare these images to evaluate the impact of posture on detection and staging of POP. METHODS: Women presenting with symptoms of POP at a tertiary care university hospital were asked to participate in this prospective cohort study. Symptom scores, POP-Q staging and three-position MRI imaging of the pelvis data were collected. The pubococcygeal line (PCL) was used to quantify within-patient changes in pelvic organ position as defined by: no displacement, <1 cm inferior to the PCL, mild (1-3 cm), moderate (3.1-6 cm), and severe (>6 cm) in the axial and sagittal T2-weighted images. Statistical analysis was completed (T-test; p<0.05 significant). RESULTS: A total of 42 women, age range 40-78 years, participated. There was a significant difference in the mean values associated with anterior prolapse in the supine (0.7±1.8), seated (2.4±3.4), and upright (4.2±1.6) positions (p=0.015). There was a significant difference in the mean values associated with apical prolapse in the supine (0.5±1.5), seated (1.5±1.4), and upright (2.1±1.5) positions (p=0.036). CONCLUSIONS: Our findings suggest that POP is more readily detected and upstaged with standing MRI images as compared to supine and seated positions. The developed two-minute standing MRI protocol may enable clinicians to better assess the extent of POP.

Rating of Pelvic Floor Muscle Training Mobile Applications for Treatment of Urinary Incontinence in Women.

OBJECTIVE: To identify pelvic floor muscle therapy mobile health applications (apps) targeting women with urinary incontinence (UI), and evaluate them in a standardized fashion. METHODS: A systematic search of English language apps on the Canadian App Store (iOS) and Google Play (Android) Store was performed. Eligible apps were evaluated independently by 5 reviewers using the validated Mobile App Rating Scale (MARS) tool. Descriptive characteristics were summarized and MARS subscale and overall quality scores werereported. RESULTS: Of 139 mobile health apps identified, 20 unique apps were included for full review, of which there were 7 iOS only apps, 6 Android only apps, and 7 apps available in both stores. At the time of analysis, most apps had been updated within the last year (60%). Only 1 app had been trialed and verified by evidence in scientific literature. The majority of apps were free to download (80%). The median (interquartile range) MARS overall quality score was 3.7 (0.8) on a 0-5 scale, ranging from 2.7 to 4.1. The highest-rated subscale was "functionality" with a median score of 4.1 (0.6); the lowest-rated was "information" with a median score of 3.4 (0.6). The median MARS subjective quality score was 2.9 (1.0). CONCLUSION: There are both free and paid apps available on-line that deliver pelvic floor muscle therapy programs. Evaluation using the MARS tool identified that many apps are not of high quality, and only 1 was evidence-based and has been trialed clinically. This knowledge is relevant to the choice of apps by both patients and caregivers.

Continuous Optical Monitoring of Spinal Cord Oxygenation and Hemodynamics during the First Seven Days Post-Injury in a Porcine Model of Acute Spinal Cord Injury.

One of the only currently available treatment options to potentially improve neurological recovery after acute spinal cord injury (SCI) is augmentation of mean arterial blood pressure (MAP) to promote blood flow and oxygen delivery to the injured cord. However, to optimize such hemodynamic management, clinicians require a method to monitor the physiological effects of these MAP alterations within the injured cord. Therefore, we investigated the feasibility and effectiveness of using a novel optical sensor, based on near-infrared spectroscopy (NIRS), to monitor real-time spinal cord oxygenation and hemodynamics during the first 7 days post-injury in a porcine model of acute SCI. Six Yucatan miniature pigs underwent a T10 vertebral level contusion-compression injury. Spinal cord oxygenation and hemodynamics were continuously monitored by a minimally invasive custom-made NIRS sensor, and by invasive intraparenchymal (IP) probes to validate the NIRS measures. Episodes of MAP alteration and hypoxia were performed acutely after injury, and at 2 and 7 days post-injury to simulate the types of hemodynamic changes SCI patients experience after injury. The NIRS sensor demonstrated the ability to provide oxygenation and hemodynamic measurements over the 7-day post-SCI period. NIRS measures showed statistically significant correlations with each of the invasive IP measures and MAP changes during episodes of MAP alteration and hypoxia throughout the first week post-injury (p < 0.05). These results indicate that this novel NIRS system can monitor real-time changes in spinal cord oxygenation and hemodynamics over the first 7 days post-injury, and has the ability to detect local tissue changes that are reflective of systemic hemodynamic changes.

Dynamic topographic mapping of the human bladder during voiding using functional near-infrared spectroscopy.

Functional near-infrared spectroscopy (fNIRS) with multichannel instruments and grids of source-detector pairs can map regional change in oxygenation/hemodynamics. Developed for cortical brain mapping, fNIRS technology has relevance in other organs where pathology affects the microcirculation. We describe fNIRS of the human bladder for evaluation of hemodynamic change during voiding. A 5x5-cm grid with two source-detector pairs is placed on the abdomen suprapubically in an asymptomatic male. In four separate trials, after natural bladder filling NIRS-derived changes in oxyhemoglobin (O(2)Hb), deoxyhemoglobin (HHb), and total hemoglobin (tHb) concentration are recorded during voiding (measured via uroflow), using four channels of a four wavelength continuous wave instrument. Graphic and video images (topographic mapping software) are generated. Changes in tHb occur following permission to void that predominantly reflected variation in O(2)Hb; tHb peaks at maximum urine flow then falls to a nadir lasting to uroflow end. Change in fNIRS video color intensity correlates with graphic change in chromophore concentration. Color variations across the mapped area suggest regional hemodynamic variation. fNIRS bladder studies generate reproducible chromophore data consistent with single channel studies, but the dynamic color video and larger tissue area monitored potentially offer new methodology for investigating regional variations in bladder oxygenation and hemodynamics.

Prevalence of impaired glucose tolerance and the components of metabolic syndrome in Canadian Tsimshian Nation youth.

INTRODUCTION: Canadian Aboriginal people have been disproportionately affected by obesity and type 2 diabetes (T2D). Our objective was to determine the prevalence of obesity, glucose intolerance and the components of metabolic syndrome (MetS) in Tsimshian Nation youth living in 3 remote coastal communities. METHODS: A medical history, anthropometric measurements and an oral glucose tolerance test were performed in youth aged 6-18 years. We defined "overweight" by a body mass index (BMI) at the 85th percentile or higher and "obese" by a BMI at the 95th percentile or higher, by age and sex. We used the International Diabetes Federation criteria for MetS. RESULTS: Of the 224 eligible youth, 192 (85%) participated in the study. Nineteen percent were overweight, 26% were obese and 36% had central obesity (waist circumference > or = 90th percentile for age and sex). No new cases of T2D were identified. The prevalence of impaired fasting glucose (IFG 5.6-6.9 mmol/L) and impaired glucose tolerance (IGT 2-hr glucose 7.8-11.0 mmol/L) were 19.3% and 5.2%, respectively. Five of the 10 youth with IGT had a fasting glucose less than 5.6 mmol/L. The prevalence of MetS was 4.7% and increased to 8.3% when pediatric hypertension norms were applied. CONCLUSION: Tsimshian Nation youth have a high prevalence of central obesity, impaired glucose homeostasis and other components of MetS. The oral glucose tolerance test may be a more appropriate screening test to identify IGT in Aboriginal youth.

Prevalence of type 2 diabetes, obesity and the metabolic syndrome among Canadian First Nations children in a remote Pacific coast community.

BACKGROUND: Type 2 diabetes mellitus (T2D) in children and adolescents is a growing public health concern. Although the prevalence of T2D in First Nations children has been documented to be as high as 1% in central Canada, no paediatric data are available for any Aboriginal community in British Columbia (BC). OBJECTIVE: To determine the prevalence of obesity, glucose intolerance and the metabolic syndrome in children living in a remote BC First Nations community. METHODS: Children who were six to 18 years of age and living in the community of Hartley Bay, BC, participated in the study. A medical history, a physical examination and a 2 h oral glucose tolerance test were completed. Overweight was defined as a body mass index between the 85th and 95th percentiles, and obese was defined as a body mass index greater than or equal to the 95th percentile, which were standardized for age and sex. RESULTS: Thirty of 34 children (88%) participated (mean +/- SD age 11.8+/-3.4 years). Ten children (33%) were obese, and five (17%) were overweight. There were seven children (23%) with abnormal glucose tolerance as per the 2007 American Diabetes Association criteria: five with only impaired fasting glucose ([IFG] 5.6 mmol/L to 6.9 mmol/L), one with both IFG and impaired glucose tolerance and one with T2D. However, using the 2008 Canadian Diabetes Association criteria, two children (6.7%) had abnormal glucose tolerance (one with IFG plus impaired glucose tolerance and one with T2D) because no child met the definition for IFG alone (6.1 mmol/L to 6.9 mmol/L). Four children (13%) met the criteria for the metabolic syndrome. CONCLUSIONS: There is a high prevalence of the components of the metabolic syndrome, including overweight, obesity and abnormal glucose tolerance, in the children of this community.

Creation and Initial Validation of a Picture-Based Version of the Limitations of Activity Domain of the SF-36.

Those with limited language comprehension or literacy face problems completing written questionnaires evaluating their health or physical status on which treatment plans are based. This brief report describes how a picture-based version of the 10 items in the limitations of activities section of the short form 36 health survey questionnaire (SF-36) was developed iteratively and then piloted. Study participants were 101 community-living volunteers (58 female and 43 male volunteers aged 18-93 yrs) educated to postsecondary level (52), high school grades 10-12 (44), and grade 9 or less (5). They first completed the picture-based SF-36 LoA and described verbally and in writing what they understood each picture to mean and then completed the English text version of the SF-36 limitations of physical activities domain for comparison assessment. Additional feedback suggested where pictures could be altered to increase information capture. Subjects rated their health as 26.7% excellent, 25.7% very good, 29.8% good, 10.9% fair, and 6.9% poor. Analysis showed strong correlation between text-based SF-36 LoA questions and the picture-based visual score-VSF-36 LoA-(intraclass correlation coefficient = 0.98) with question 10 correlating highest (intraclass correlation coefficient = 0.90) and question 2 lowest (intraclass correlation coefficient = 0.82). The VSF-36 LoA is the first picture-based version of the SF-36; good correlation with the text-based version and global need warrants further development to aid those with limited literacy or language comprehension.

Development of a near-infrared spectroscopy interface able to assess oxygen recovery kinetics in the right and left sides of the pelvic floor.

Near-infrared spectroscopy (NIRS) muscle oxygenation data are relied on in sports medicine. Many women with urinary incontinence (UI) have dysfunctional pelvic floor muscles (PFMs) but their evaluation lacks such measures; a transvaginal NIRS interface would enable the PFM to be interrogated. Paired miniature fiber-optic cables were configured on a rigid foam insert so their emitter detector arrays with an interoptode distance of 20 mm apposed the right and left inner sides of a disposable clear plastic vaginal speculum, and linked to a standard commercial NIRS instrument. Measurement capability was assessed through conduct of three maximum voluntary contractions (MVCs) and one sustained maximum voluntary contraction of the PFM with calculation of HbDiff (½RT), a validated muscle reoxygenation kinetic parameter. In all four asymptomatic controls, mean age 40, mean BMI 21.4, MVCs were associated with changes in PFM oxyhemoglobin (O2Hb), deoxyhemoglobin (HHb) concentration, and their difference (HbDiff) comparable to those in voluntary muscle sports medicine studies. NIRS data during recovery (reoxygenation) allowed calculation of HbDiff (½RT). New techniques are called for to evaluate UI. This NIRS interface warrants further development as the provision of quantitative reoxygenation kinetics offers more comprehensive evaluation of patients with PFM dysfunction.

Associations between sexual satisfaction and function and the severity of lower urinary tract symptoms among men in a rural sub-Saharan African community.

INTRODUCTION: The recognized association between erectile dysfunction (ED) with lower urinary tract symptoms (LUTS) from high-income countries is unreported from Africa. Authentic figures on prevalence of ED and LUTS from Africa are scarce in the literature. This study was conducted to quantify sexual function and satisfaction among Ugandan men in relation to LUTS severity. METHODS: A convenience sample of men participating in a parallel, cross-sectional survey was used. The population, men >55 years living in Sheema district, Uganda, were recruited into two cohorts: those living in the community and those seeking clinic care due to bother from LUTS. This was to ensure inclusion of a full spectrum of LUTS. The instruments were the International Prostate Symptom Score (IPSS) to quantify LUTS and the Epstein Inventory (EI) to assess four measures of sexual functioning. Bivariate analysis compared community and clinic cohort participants, LUTS severity, and each sexual functioning item with two-sample t-tests for means and Chi-square tests of independence for categorical versions. RESULTS: Participants included 415 men (238 community and 177 clinic) at mean age of 67.5 years vs. 62.9 (p=<0.001) with mean IPSS of 9.32 vs. 17.07 (p≤0.001). Lower mean satisfaction with sexual activity and frequency of erections occurred in the clinic cohort (p≤0.001). Overall, all four questions assessing dissatisfaction with sexual function were significantly correlated with worsening LUTS; sexual satisfaction and frequency of sexual drive were also influenced by age and low levels of education. CONCLUSIONS: These are the first data describing the severity relationship between LUTS and ED in African men. Respondents reported dissatisfaction in the past year with the level of their sexual activity, frequency of sexual drive, ability to have erections, and sexual performance that related statistically to the severity of their LUTS.