Contexts of urgency may go beyond emotion.

Introduction: Urgency has been defined as the tendency towards rash speech and behavior in the context of emotion. Measures of Urgency have been found to have robust predictive power for psychopathologies and problematic behaviors. In the current study, we question whether emotions are unique drivers of urgency, or if emotions are potent exemplars of contexts that lead to rash speech and behavior. The Emotion Specific model and the Broader Contexts model correspond with these two conceptualizations of urgency, and they frame our pre-registered hypotheses. Methods: Participants from two well-powered samples (n = 600,n = 588) completed 9 modified items from the Urgency and Positive Urgency scales to assess rash responses in each of four contexts - "Upset," "Excited," "Tired," and "Hungry" - and a fifth "In General" set. After data cleaning, we used principal components analysis to construct a unidimensional, 4-item set that was applied to capture impulsive behavior across the five contexts. Results: We found that this research tool, called the Contexts of Impulsive Behaviors (CIBS), replicated in the second dataset, and it had adequate internal reliability in both samples. Although the Emotion Specific model was supported by the fact that the Upset context had a greater mean and greater variance than the Tired and Hungry contexts, most results supported the Broader Contexts model. That is, CIBS contexts were highly intercorrelated, and bivariate correlations with psychopathology were not significantly different across contexts. In partial correlations, effects of the Upset and Excited contexts were partially or fully statistically mediated by the Tired and Hungry contexts. Discussion: These findings suggest that emotions are potent contexts for impulsive behaviors. At the same time, those with high urgency are vulnerable to impulsivity in other contexts, such as fatigue and hunger, that challenge the regulatory functions of the prefrontal cortex. Limitations, future directions, and clinical implications are discussed.

Low caregiver health literacy is associated with non-urgent pediatric emergency department use.

OBJECTIVE: Caregivers with low health literacy are more likely to overestimate illness severity and have poor adherence with health-promoting behaviors. Our primary objective was to relate caregiver health literacy to the urgency of emergency department (ED) utilization. The secondary objective was to explore the relationship between social and demographic characteristics, health literacy, and urgency of ED use. METHODS: This sub-study was a descriptive cross-sectional survey with health record review. Data were collected from ten Canadian pediatric EDs. Study variables included demographics, visit details, and the Newest Vital Sign measurement of health literacy. ED visits were classified as urgent or non-urgent based on the resource utilization method. RESULTS: The response rate was 97.6% (n = 2005). Mean (SD) caregiver age was 37.0 (7.7) years, 74.3% (n = 1950) were mothers, 72.6% (n = 1953) spoke English as a primary language, 51.0% (n = 1946) had a university degree, and 45.1% (n = 1699) had a household income greater than $100,000. The mean (SD) age of the children was 5.9 (5.0) years and 48.1% (n = 1956) were female. 43.7% (n = 1957) of caregivers had low health literacy. Being a caregiver with a child < 2 years old [aOR 1.83 (1.35, 2.48)] and low health literacy [aOR 1.56 (1.18, 2.05)] were associated with greater non-urgent pediatric ED use. Interprovincial variation was evident: Quebec caregivers were less likely to use the pediatric ED for non-urgent presentations compared to Alberta, while those in Nova Scotia, Manitoba, British Columbia, and Ontario were more likely compared to Alberta. CONCLUSION: Almost half of caregivers presenting to Canadian pediatric EDs have low health literacy, which may limit their ability to make appropriate healthcare decisions for their children. Low caregiver health literacy is a modifiable factor associated with increased non-urgent ED utilization. Efforts to address this may positively influence ED utilization.

RéSUMé: OBJECTIF: Les soignants ayant une faible littératie en santé sont plus susceptibles de surestimer la gravité de la maladie et d'avoir un manque d'adhésion aux comportements favorisant la santé. Notre objectif principal était de faire le lien entre la littératie en santé des soignants et l'urgence d'utiliser les services d'urgence (SU). L'objectif secondaire était d'explorer la relation entre les caractéristiques sociales et démographiques, la littératie en santé et l'urgence de l'utilisation du traitement. MéTHODES: Cette sous-étude était une enquête transversale descriptive avec examen du dossier de santé. Les données ont été recueillies auprès de dix ED pédiatriques canadiens. Les variables étudiées comprenaient la démographie, les détails des visites et la mesure du dernier signe vital de la littératie en santé. Les visites de DS ont été classées en urgence ou non selon la méthode d'utilisation des ressources. RéSULTATS: Le taux de réponse était de 97,6 % (n=2005). L'âge moyen des aidants naturels était de 37,0 (7,7) ans, 74,3 % (n=1950) étaient des mères, 72,6 % (n=1953) parlaient l'anglais comme langue principale, 51,0 % (n=1946) avaient un diplôme universitaire et 45,1 % (n=1699) avaient un revenu familial supérieur à 100 000 $. L'âge moyen (SD) des enfants était de 5,9 (5,0) ans et 48,1 % (n=1956) étaient des femmes. 43,7 % (n=1957) des aidants avaient une faible littératie en santé. Le fait d'être un aidant naturel avec un enfant de moins de 2 ans [aOR 1,83 (1,35, 2,48)] et une faible littératie en santé [aOR 1,56 (1,18, 2,05)] étaient associés à une utilisation plus importante de l'ES pédiatrique non urgente. La variation interprovinciale était évidente : les aidants naturels du Québec étaient moins susceptibles d'utiliser le DE pédiatrique pour des présentations non urgentes comparativement à l'Alberta, tandis que ceux de la Nouvelle-Écosse, du Manitoba, de la Colombie-Britannique et de l'Ontario étaient plus susceptibles d'utiliser le DE pédiatrique pour des présentations non urgentes. CONCLUSION: Près de la moitié des aidants naturels qui se présentent aux ÉE pédiatriques au Canada ont une faible littératie en santé, ce qui peut limiter leur capacité à prendre les décisions appropriées en matière de soins de santé pour leurs enfants. Le faible niveau de connaissances en santé des aidants est un facteur modifiable associé à une utilisation accrue de l'ES non urgente. Les efforts déployés pour remédier à cette situation peuvent influencer positivement l'utilisation de la DE.

Reliability and Validity of the New Urgency Classification Model for Acute Medical Care in Dutch Nursing Home Setting.

OBJECTIVE: To validate an Urgency Classification Model developed for telephone triage in Dutch nursing homes. DESIGN: Retrospective observational study. SETTING AND PARTICIPANTS: Retrospective analysis of triage data of nursing home residents in a medical service organization, active in 40 nursing homes across the Netherlands. METHODS: An Urgency Classification Model for nursing home care was developed through a collaborative cocreation session by modifying existing acute medical care delivery models. All inquiries to central triage personnel during regular working hours between April 1 and April 30, 2022, were retrospectively categorized according to the new Urgency Classification Model ("urgency," consisting of 6 levels from U0 to U5; and "goals of care and treatment limitations," consisting of 4 options) by 2 independent physicians to evaluate the reliability using Cohen's kappa. To ascertain validity, the categorized data were juxtaposed with the executed treatment plan as documented in the patient records. RESULTS: Of 387 inquiries, consensus between assessors using the Urgency Classification Model was reached upon initial independent classification of urgency in 77.0% (n = 298, Cohen's kappa 0.654) of cases and in 77.3% (n = 299, Cohen's kappa 0.649) of goals of care and treatment limitations classification, representing substantial interrater reliability. A strong positive correlation was found between the urgency identified through the Urgency Classification Model and the observed urgency in the executed treatment, rs = 0.662, P < .001; the same urgency was given in 71.5% (n = 276) of all inquiries. Overtriage (meaning the model classified the inquiry as more urgent than the executed treatment plan) occurred in 9.8% (n = 38) and undertriage in 18.7% (n = 72). CONCLUSION AND IMPLICATIONS: The new Urgency Classification Model is a valid and reliable classification tool for implementation within its intended target population. Universal and comprehensive implementation is expected to lead to more appropriate care delivery, while realizing integration with the acute medical care frameworks already in place.

Rates of Acute Brain Injury Among Severely Hypertensive Patients Seen in the Emergency Department.

Background: Identifying patients with acute brain injury among patients who present to the Emergency Department (ED) with severe hypertension can be challenging. We explored rates of brain injury in a cohort of ED patients with severe hypertension in whom acute target-organ damage was or was not initially suspected. Methods: We conducted a retrospective chart-review study at two different hospitals within the same urban health system. Consecutive adult patients seen from 10/1/2020 to 5/1/2022 with a systolic blood pressure ≥180 mmHg or diastolic blood pressure ≥120 mmHg were included. Results: A total of 972 patients met our eligibility criteria. The average age was 59 years (SD: 16.5), 454 (46.7%) were women, and 582 (59.9%) were non-White. A total of 186/972 (19.1%) patients were initially thought to have acute target-organ damage in the ED with 97/186 (52.2%) diagnosed with stroke or TIA. The remaining 786/972 (80.9%) patients were not initially diagnosed with target-organ damage (hypertensive urgency [HU]). Of the 786 patients with HU, a head CT was obtained in 216/786 (27.7%) and brain MRI in 74/786 (9.4%). Of the HU patients with a brain MRI, 23/74 (31.1%) had acute abnormalities; most abnormalities on brain MRI (17/23 [73.9%]) were not seen on preceding head CT. Conclusions: In a multicenter study of ED patients, nearly 1 in 5 patients though to have HU who eventually underwent brain MRI had unexpected acute neurological findings, though brain MR was obtained in only 9%.

Positive and Negative Pathways Linking Depressive Symptoms to Problematic Alcohol Use Among Argentinian College Students: An Examination of Positive and Negative Urgency Traits and Internal Drinking Motives.

Growing evidence suggests the tendency to act rashly under positive and negative emotions and affect-related drinking motives connect symptoms of mood disorders with alcohol-related problems. However, studies examining this sequence are scarce in Latin-American samples. The present study evaluated, in Argentinian college students (n = 403; 68.2% women; Mage = 21.03 ± 4.90), a sequential model of symptoms of depression, urgency traits, internal drinking motives, and problematic alcohol use. Path analysis was conducted to examine the direct and indirect associations between symptoms of depression and problematic alcohol use (heavy episodic drinking and alcohol-related negative consequences) via positive and negative urgency traits and internal drinking motives. Findings revealed indirect associations from depressive symptoms to problematic alcohol use via urgency traits and drinking motives (e.g. depression symptoms→positive [negative] urgency→enhancement [coping]→drinking problems). This suggests that students who experience more symptoms of depression may be more likely to react to these experiences of negative affect by engaging in heavy drinking episodes and encounter more alcohol-related problems. This seems to stem from a higher propensity to act rashly during intense emotional experiences and a greater motivation to drink as a means of regulating their mood. Future interventions aimed at preventing or reducing problematic alcohol use (especially among Argentinian young adults) might consider targeting these specific impulsivity traits as well as affect-related drinking motivations.

Investigating looming tactile takeover requests with various levels of urgency in automated vehicles.

Designing an effective takeover request (TOR) in conditionally automated vehicles is crucial to ensure driving safety when the system reaches its limit. In our study, we aimed to investigate the effects of looming tactile TORs (whose urgency is dynamically mapped to the situation's criticality as the vehicle approaches the upcoming obstacle) on takeover performance and subjective experience compared with conventional non-looming TORs (several tactile pulses with consistent inter-pulse intervals). In addition, the impact of the TOR urgency level (with urgency levels matched or unmatched to the situation's criticality) was considered. A total of 30 participants were recruited for this study. They were first asked to map the urgency of tactile signals to the criticality of takeover situations with various times to collision according to the recorded video clips. The looming TORs were constructed based on these mapping results. Then, a simulated driving experiment, employing a within-subject design, was conducted to explore the effects of the tactile TOR type (looming vs. non-looming) and urgency level (less urgency vs. matched urgency vs. greater urgency) on takeover performance and drivers' subjective experience. The results showed that the looming TOR can lead to a shorter takeover time and less maximum lateral acceleration compared with the non-looming TOR. Drivers also rated the looming TOR as more useful. Therefore, the looming TOR has great application potential for enhancing driving safety in automated vehicles. In addition, we found that as the TOR's level of urgency increased, the takeover time decreased. However, the TOR with an urgency level matched to the situation's criticality received higher usefulness and satisfaction ratings, suggesting that there was an important trade-off between the advantage of high-urgency TORs in speeding up driver responses and its cost of a poor experience. The findings of our study shed some light on the design and implementation of the takeover warning system for related practitioners.

Burden of Bowel Urgency in Patients With Ulcerative Colitis and Crohn's Disease: A Real-World Global Study.

Background: Bowel urgency is a highly disruptive and bothersome symptom experienced by patients with inflammatory bowel diseases (IBD), (ulcerative colitis [UC], and Crohn's disease [CD]). However, the burden of bowel urgency among patients with varying experiences in targeted treatment has not been consistently assessed. This real-world study explored the clinical and health-related quality of life burden of bowel urgency among patients with IBD with differing treatment experiences. Methods: This cross-sectional survey included gastroenterologists and their patients with IBD across France, Germany, Italy, Spain, the United Kingdom, and the United States treated for over 3 months. Physicians provided patient demographics, clinical characteristics, and treatment history. Patients reported their health-related quality of life and work productivity. Patients with UC and CD were analyzed separately and stratified into 3 groups: Targeted therapy naïve, those receiving their first-line targeted therapy, and targeted therapy experienced. Results: This study found that 17%-26% of UC and 13%-17% of CD patients experienced persistent bowel urgency, irrespective of receiving conventional or targeted therapy. Moreover, patients with bowel urgency experienced an increased clinical and health-related quality of life burden compared to patients without bowel urgency, which physicians most commonly regarded as one of the most difficult symptoms to treat, with the burden remaining substantial irrespective of their treatment experience. Conclusions: Despite several current treatment options, new therapeutic strategies are necessary to provide relief from bowel urgency, one of the most challenging symptoms for people living with IBD.

Association of Smoking Status and Pack Year History With Urinary Urgency Symptoms.

BACKGROUND AND OBJECTIVES: Overactive bladder and its hallmark symptom, urgency, are thought to be multifactorial in pathogenesis. Smoking is a particularly important risk factor to understand because it is modifiable; studies evaluating an association between smoking and urgency have been inconclusive. We therefore sought to rigorously assess the relationship between smoking and urgency in terms of both a temporal and quantitative pack year history of smoking while controlling for other possible confounding factors. METHODS: Community-based adult women were recruited using the ResearchMatch website to participate in an online survey of bladder health which included questions to assess urgency symptoms, medical comorbidities, and detailed smoking history. Smoking history was studied as the independent variable in three different formulations: smoking status (never vs. former vs. current), continuous pack year history, and categorical pack year history. The outcomes studied included urgency (any urgency in the past 7 days), moderate urgency (urgency at least half the time), and urgency urinary incontinence (UUI). Chi-square tests were performed to detect associations between smoking and these outcomes, and multivariate regression was then performed to control for possible confounders and to help determine the comparative influence of temporality versus quantity of smoking history. RESULTS: In 1720 women who completed the questionnaire, current smoking status was associated with a 23% increase in the risk of experiencing urgency (RR 1.23) and a 78% increase in the risk of experiencing moderate urgency (RR 1.78) relative to never smokers. The risk of experiencing UUI was 40% higher (RR 1.40). Lifetime pack year history was also significantly associated with urgency outcomes, although only in smokers/former smokers who had a 20+ pack year history (RR 1.15, 1.60, and 1.25 for urgency, moderate urgency, and UUI, respectively). The presence of former smoking history was not significantly associated with urgency outcomes, even when controlling for cumulative pack years. CONCLUSIONS: This analysis of a large cross-sectional database of women suggests a strong, consistent link between current smoking status and urinary urgency and UUI. By contrast, no increased risk of urgency was attributed to former smoking status. Analysis of pack year history suggests a dose-response relationship wherein ≥ 20 pack years was significantly associated with a higher risk of all urgency outcomes. In models controlling for pack year history, the association of current smoking with urgency remained significant and former smoking remained nonsignificant. Taken together, this supports greater attention being given to the contribution of current smoking to urgency symptoms, and to the need for further longitudinal work to determine if smoking cessation can be a strategy to treat urgency.

Fecal urgency and incontinence in inflammatory bowel disease perceived by physician and patient: Results from the Swiss fecal urgency survey.

INTRODUCTION: Although increasingly appreciated, little is known about the prevalence of fecal urgency, fecal incontinence and differences between patients' and physicians' perception in inflammatory bowel disease (IBD). METHODS: We performed an online patient and physician survey to evaluate the assessment, prevalence and impact of fecal urgency and incontinence in IBD. RESULTS: A total of 593 patients (44.0% ulcerative colitis (UC), 53.5% Crohn's disease (CD), 2.2% indeterminate colitis, 2 not specified) completed the survey (65.8% females, mean age 47.1 years). Fecal urgency was often reported (UC: 98.5%, CD: 96.2%) and was prevalent even during remission (UC: 65.9%, CD: 68.5%). Fecal urgency considerably impacted daily activities (visual analog scale [VAS] 5, IQR 3-8). Yet, 22.8% of patients have never discussed fecal urgency with their physicians. Fecal incontinence was experienced by 44.7% of patients and 7.9% on a weekly basis. Diapers/pads were required at least once a month in 20.4% of patients. However, 29.7% of patients never talked with their physician about fecal incontinence. UC was an independent predictor for the presence of moderate-severe fecal urgency (OR 1.65, 95% CI 1.13-2.41) and fecal incontinence (OR 1.77, 95% CI 1.22-2.59). All physicians claimed to regularly inquire about fecal urgency and incontinence. However, the impact of these symptoms on daily activities was overestimated compared with the patient feedback (median VAS 8 vs. 5, p = 0.0113, and 9 vs. 5, p = 0.0187). CONCLUSIONS: Fecal urgency and incontinence are burdensome symptoms in IBD, with a similar prevalence in UC and CD. A mismatch was found between the physician and patient perception. These symptoms should be addressed during outpatient visits.

Laparoscopic management of large colonic lipoma with atypical presentation: A case report.

Colonic lipomas (CL) are a rare condition that typically causes symptoms in only a minority of patients. When large lipomas occur, they often necessitate extensive surgery, which carries significant risks. CASE PRESENTATION: We present a case of a female patient who experienced abdominal pain and urinary urgency due to a large, 80 % obstructive lipoma in the descending colon. On abdominal Computed tomography scan, a 3.8 cm lesion with fatty density and no solid components was identified. Given its benign nature, our approach aimed to preserve the colon. This involved performing laparoscopic excision of the lipoma after marking the base of the mass with a methylene blue dye few hours prior to surgery. The patient recovered well postoperatively, with an excellent outcome, and was discharged home on the third day after surgery. DISCUSSION: Colonic lipomas are a rare finding in the gastro-intestinal tract, they are benign in nature and can cause a variety of symptoms. The diagnostic pathway can be challenging due to the broad presentation and the variable onset of symptoms. Using multiple imaging modalities (invasive and non-invasive methods) can help narrow down the diagnosis and facilitate the treatment course. CONCLUSION: Our review of literature indicated that Descending Colon lipoma is rare. With nonspecific symptoms imaging modalities such as computed tomography was used in conjunction with Colonoscopy to further delineate origin and pathology. The treatment depends on the patient's condition as well as the size and position of the tumor.

Implementation of a clinical pathway for the evaluation of asymptomatic hypertension in the emergency department.

INTRODUCTION: According to the guidelines of the American Heart Association and American College of Emergency Physicians, respectively, there is no indication for immediate lowering of asymptomatic hypertension in the Emergency Department (ED), and no requirement for routine diagnostic testing in these patients. Despite this, asymptomatic hypertension represents a recurring source of referrals for ED evaluation from other healthcare settings, or from patient self-referral, with significant practice variation in the evaluation and treatment of this complaint. METHODS: This is a pre-post study of a pathway to standardize care of patients presenting to a tertiary academic Veteran's Health Administration ED with asymptomatic hypertension. Inclusion criteria were patients with ICD10 codes of hypertension who were confirmed via chart review to have sought care for a complaint of elevated blood pressure readings from 2018 to 2022, with the pathway having been implementing in 2022. Patients were excluded if they had symptoms of possible end organ pathology due to hypertension, such as chest pain, headache, or shortness of breath, or if they were reproductive age women who had not undergone a sterilization procedure. The primary outcome was major adverse cardiovascular event within 30 days of ED visit. Secondary outcomes included: diagnostic tests performed, administration of antihypertensives in the ED, and length of stay. Descriptive statistics and statistical analysis were performed. RESULTS: There were a total of 295 unique patients and 324 patient encounters that met the inclusion/exclusion criteria, with 46 encounters that took place after pathway implementation. There were no major adverse cardiovascular events either before or after pathway implementation. Chest radiographs were reduced from 10 % to 0 % (p = 0.005) after pathway respectively. There were also declines in laboratory testing, EKGs, and administration of oral antihypertensives, but these differences were not statistically significant. At no point did any diagnostic testing identify any previously undiagnosed medical conditions. There were no instances of intravenous hypertensives being given after pathway implementation. Despite the reductions in diagnostic testing, there was no change in ED length of stay for patients with asymptomatic hypertension. CONCLUSION: Our findings redemonstrate that patients presenting to the ED with asymptomatic hypertension are at low risk for short-term complications of hypertension, and that diagnostic testing is low yield in this population. While we were able to achieve reductions in unnecessary testing, further work is needed to educate clinicians and improve adherence to evidence based principles when caring for these patients.

GEMA-Na and MELD 3.0 severity scores to address sex disparities for accessing liver transplantation: a nationwide retrospective cohort study.

Background: The Gender-Equity Model for liver Allocation corrected by serum sodium (GEMA-Na) and the Model for End-stage Liver Disease 3.0 (MELD 3.0) could amend sex disparities for accessing liver transplantation (LT). We aimed to assess these inequities in Spain and to compare the performance of GEMA-Na and MELD 3.0. Methods: Nationwide cohort study including adult patients listed for a first elective LT (January 2016-December 2021). The primary outcome was mortality or delisting for sickness within the first 90 days. Independent predictors of the primary outcome were evaluated using multivariate Cox's regression with adjusted relative risks (RR) and 95% confidence intervals (95% CI). The discrimination of GEMA-Na and MELD 3.0was assessed using Harrell c-statistics (Hc). Findings: The study included 6071 patients (4697 men and 1374 women). Mortality or delisting for clinical deterioration occurred in 286 patients at 90 days (4.7%). Women had reduced access to LT (83.7% vs. 85.9%; p = 0.037) and increased risk of mortality or delisting for sickness at 90 days (adjusted RR = 1.57 [95% CI 1.09-2.28]; p = 0.017). Female sex remained as an independent risk factor when using MELD or MELD-Na but lost its significance in the presence of GEMA-Na or MELD 3.0. Among patients included for reasons other than tumours (n = 3606; 59.4%), GEMA-Na had Hc = 0.753 (95% CI 0.715-0.792), which was higher than MELD 3.0 (Hc = 0.726 [95% CI 0.686-0.767; p = 0.001), showing both models adequate calibration. Interpretation: GEMA-Na and MELD 3.0 might correct sex disparities for accessing LT, but GEMA-Na provides more accurate predictions of waiting list outcomes and could be considered the standard of care for waiting list prioritization. Funding: Instituto de Salud Carlos III, Agencia Estatal de Investigación (Spain), and European Union.

Proposal of a Modified Classification of Hypertensive Crises: Urgency, Impending Emergency, and Emergency.

Systemic arterial hypertension (HTN) is the main cause of morbidity and mortality, and HTN crises contribute significantly to an unfavourable clinical course. For decades, HTN crises have been dichotomized into hypertensive emergency (HTN-E) and hypertensive urgency (HTN-U). The main difference between the two is the presence of acute hypertension-mediated organ damage (HMOD) - if HMOD is present, HTN crisis is HTN-E; if not, it is HTN-U. Patients with HTN-E are in a life-threatening situation. They are hospitalized and receive antihypertensive drugs intravenously (IV). On the other hand, patients with HTN-U are usually not hospitalized and receive their antihypertensives orally. We suggest a modification of the current risk stratification scheme for patients with HTN crises. The new category would be the intermediate risk group, more precisely the 'impending HTN-E' group, with a higher risk in comparison to HTN-U and a lower risk than HTN-E. 'Impending HMOD' means that HMOD has not occurred (yet), and the prognosis is, therefore, better than in patients with ongoing HMOD. There are three main reasons to classify patients as having impending HTN-E: excessively elevated BP, high-risk comorbidities, and ongoing bleeding/high bleeding risk. Their combinations are probable. This approach may enable us to prevent some HTNEs by avoiding acute HMOD using a timely blood pressure treatment. This treatment should be prompt but controlled.

Female urinary incontinence in China after 15 years' efforts: Results from large-scale nationwide surveys.

Urinary incontinence (UI) is a disease that quietly yet seriously impacts women's health and represents a global health burden that is often neglected. This study aims to systematically assess the prevalence and dynamics of female UI in China, and can inform further policies and have international implications. This study used three nationwide investigations: A national cross-sectional survey in 2021; another nationwide cross-sectional survey in 2006; and data regarding the institutions and physicians providing pelvic floor rehabilitation services from 2005 to 2019. The weighted prevalence of female UI and its subtypes, including stress UI (SUI), urgency UI (UUI), and mixed UI (MUI), were estimated as primary outcomes. Knowledge, attitude and care-seeking behaviors of UI were evaluated. It was found that the weighted prevalence of female UI was 16.0 % (95% CI, 13.3 %-19.1%) with SUI remaining the predominant subtype (7.0%) in 2021, followed by MUI (6.5%) and UUI (1.9%). The estimated absolute number of Chinese adult women with UI was 85.8 million in 2021. 52.7% (95% CI, 45.9%-59.4 %) of women were aware that UI was a medical condition, and only 10.1% of women with UI sought health care. After 15 years of development, there were 8400 pelvic floor rehabilitation institutions and nearly 10,000 relevant physicians in China-they were found to be associated with UI prevalence. The UI prevalence in China was significantly lower in 2021 compared to that in 2006. Despite the achievement, UI remains a public health problem, especially given China's fast aging and three-child policy. More innovations, especially those that can facilitate care seeking, are needed to address this prevalent yet treatable condition.

Pornography use, problematic pornography use, impulsivity, and sensation seeking: a meta-analysis.

BACKGROUND: While some individuals engage in recreational pornography use (PU), others may develop an uncontrolled pattern of use termed problematic pornography use (PPU). PPU is characterized by persistent, excessive, or compulsive engagement with pornographic content, despite distress and adverse consequences. Impulsivity has been identified as a factor associated with PU and PPU. AIM: The present meta-analysis aims to sum up the existing research on the relationship between impulsivity and PU/PPU and investigate whether age and gender could moderate this relationship. METHODS: A keyword-based systematic literature search was performed to identify articles that assessed PU/PPU and impulsivity. Extracted correlations were converted into Fisher's Z. Meta-regression analyses were also performed. Publication bias was assessed by Egger's regression intercept. OUTCOMES: Outcomes included general impulsivity and its dimensions (ie, negative and positive urgency, lack of premeditation and perseverance), sensation seeking, PU, and PPU. RESULTS: Meta-analytic results of the random effects model showed a significant positive correlation between impulsivity as total score and PU (n = 1504, k = 4, Fisher's Z = 0.21, P < .001) and PPU (n = 20174, k = 13, Fisher's Z = 0.17, P < .001). Significant and positive associations were also found between sensation seeking and PU (n = 11707, k = 11, Fisher's Z = 0.14, P < .001) and PPU (n = 20152, k = 9, Fisher's Z = 0.06, P < .001). Concerning the relationship between PPU and different dimensions of impulsivity, almost all the associations were significant and positive. The dimension of positive urgency and attentional and nonplanning impulsivity showed the strongest association. Age (ß = -0.50, Q = 101.26, df = 11, P < .001) and gender (female = 1; ß = -0.46, Q = 102.54, df = 12, P < .001) moderated the association between general impulsivity and PPU. No risk of publication bias emerged. CLINICAL IMPLICATIONS: Prevention programs of PPU should focus on impulsivity and certain key dimensions (eg, positive urgency, attentional and nonplanning impulsivity) and be tailored to individual impulsivity profiles, considering age and gender differences. STRENGTHS AND LIMITATIONS: The primary strength of this meta-analysis is that it considers various conceptualizations of impulsivity. However, the results are to be interpreted with caution since >30% of relevant studies had to be excluded because information could not be gathered from the study authors. CONCLUSION: These results suggest that general impulsivity is linked to PU and PPU and that specific dimensions of impulsivity (ie, attentional impulsivity, nonplanning impulsivity, and positive urgency) can serve as risk factors for PPU.

Efficacy, Satisfaction, and Compliance: Insights from 15 Years of Botulinum Toxin Use for Female Urgency Urinary Incontinence.

Urgency urinary incontinence (UUI) refractory to medical treatment poses significant challenges despite advancements. This study evaluates the efficacy of intravesical botulinum toxin for UUI and identifies factors influencing treatment outcomes. Among 368 women receiving botulinum toxin injections, 74.5% achieved a complete discontinuation of pad usage. Predictors of efficacy included lower pre-treatment pad usage and the absence of prior sling placement. Patients often required repeat injections (60.3%), with younger age and satisfaction correlating with treatment repetition. The interval between injections averaged 18 months, influenced by logistical challenges and patient preferences. Despite concerns about diminishing efficacy, subjective perceptions did not align with objective findings. Limitations include retrospective analysis and heterogeneous clinical records. In conclusion, intravesical botulinum toxin is effective for UUI, with pre-treatment pad usage and sling placement history influencing outcomes and patient characteristics influencing treatment repetition.

A sense of urgency: Trait impulsivity in co-occurring bipolar and alcohol use disorder.

BACKGROUND: Bipolar disorder (BD) and alcohol use disorder (AUD) often co-occur, with BD + AUD characterized by higher levels of impulsivity relative to either disorder alone. Emotional facets of impulsivity (e.g., "urgency," measured by the UPPS-P), however, remain underexplored in this population and could have distinct associations with clinical correlates. METHODS: This cross-sectional study used a two-by-two (BDxAD) factorial design, including groups with BD + AD (n = 28), BD (n = 29), AD (n = 28), and healthy controls (HC) (n = 27), to identify between-group differences among the five subscales of the UPPS-P. Associations of UPPS-P subscales with Barratt Impulsiveness Scale (BIS) total scores and clinical variables of interest were also examined. RESULTS: BD + AD had the highest scores for every UPPS-P subscale but Sensation Seeking, with the Positive and Negative Urgency subscales having the largest main effects for both BD and AD. BIS-11 total scores were most correlated with the urgency subscales of the UPPS-P. Negative Urgency was found to be uniquely relevant to clinical measures in the BD + AD group. Rapid cycling was associated with both urgency subscales and BIS-11 scores, and the Alcohol Dependence Scale was most correlated with the Premeditation subscale. LIMITATIONS: Cross sectional design and predominantly white sample. CONCLUSIONS: Unlike the BIS-11, UPPS-P is able to distinguish emotional from nonemotional facets of impulsivity, something especially relevant to people with co-occurring BD + AD, where fluid emotionality is a key part of symptom presentation. For this reason, the UPPS-P should be utilized in future studies and clinical settings measuring trait impulsivity in this population.

Posterior Tibial Nerve Stimulation With versus Without Mirabegron: A Randomized Controlled Trial.

INTRODUCTION AND HYPOTHESIS: To compare change in urgency urinary incontinence episodes (UUIEs) in women undergoing posterior tibial nerve stimulation (PTNS) plus mirabegron versus PTNS plus placebo for the treatment of refractory urgency urinary incontinence (UUI). The primary hypothesis was that combination therapy is superior to monotherapy. METHODS: A randomized controlled trial was performed in individuals identifying as female aged ≥ 18 years with UUI symptoms refractory to second-line treatment or who could not tolerate antimuscarinic medications. Both participants and providers were blinded to medication treatment allocation. Participants were randomized (1:1) to PTNS plus mirabegron or PTNS plus placebo. Participants completed a 3-day bladder diary prior to and after 12-week treatment. Validated symptom distress and impact questionnaires were obtained pre- and post-treatment. The primary outcome was change in mean number of UUIEs on a 3-day bladder diary pre- versus post-treatment between arms. Primary and secondary outcomes were analyzed via sample t tests. RESULTS: Fifty-four subjects were randomized, mean ± SD baseline age 56.2±15.6 years and body mass index 35.0±9.4 (kg/m2); no differences were noted in any clinical-demographic characteristics. There was a significant difference between arms in mean pre- to post-treatment UUIEs, 9.4±3.9, mirabegron versus 5.3±5.5, placebo (p=0.007). Significant differences were found pre- compared with post-treatment in urinary frequency, Overactive Bladder Questionnaire Short Form Symptom Bother and Symptom Health-Related Quality of Life scores. CONCLUSIONS: In subjects undergoing PTNS treatment for refractory UUI and OAB-wet symptoms, the addition of a ß-3 agonist produced significant improvement in both objective and subjective overactive bladder symptom outcomes compared with PTNS plus placebo.

Do peri-operative changes in voiding function and pelvic organ mobility predict improvement in urgency urinary incontinence following prolapse surgery?

OBJECTIVES: To evaluate whether peri-operative changes in voiding function, pelvic organ descent and urethral mobility predict improvement in urgency urinary incontinence (UUI) following prolapse surgery. METHODS: A retrospective study of women undergoing prolapse surgery without a history of or without a concomitant anti-incontinence surgery at a tertiary unit between 2005 and 2019. All patients underwent a pre- and post-operative standardised interview, POP-Q examination, uroflowmetry and 4D translabial ultrasound. Post processing of ultrasound volume data was performed to assess pelvic organ descent and functional urethral anatomy. RESULTS: The datasets of 123 women were analysed. Mean follow-up was 5.5 months (SD 3.2). Mean age was 61 years (SD 11.7). UUI was reported by 68 before and 44 after operation (p = 0.001 for the reduction). Among those with pre-operative UUI, 34 reported cure of UUI, 20 improvement, 9 no change and 5 worsened UUI after their operation. De novo UUI was reported in 11. Fifty-seven women reported voiding dysfunction before and 32 after operation (p = 0.09 for the reduction). Abnormal uroflowmetry was noted in 63 women before and 37 after operation (p = 0.003 for change). On binary logistic regression, improved/cured UUI was associated with improved subjective voiding function (p = 0.003) and reduced residual urine volume (p = 0.02), but not with peri-operative changes in pelvic organ descent or functional urethral anatomy. CONCLUSION: Prolapse surgery resulted in short- to medium- term improvement in UUI. This was associated with subjective improvement in voiding function and with a reduction in post-void residual urine volume. SUMMARY: Prolapse surgery was associated with improvement in UUI which in turn was associated with subjectively improved voiding and reduced residual urine volume.