Background: Previous studies of lower urinary tract symptoms (LUTS) have focused on men, with few studies including minority populations. The Boston Area Community Health (BACH) Survey is designed to study the prevalence and impact of LUTS among both men and women in a racially, ethnically, and socioeconomically diverse population. Methods:The BACH Survey used a stratified 2-stage cluster design to randomly sample 5506 adults aged 30 to 79 from the city of Boston, Mass (2301 men, 3205 women, 1770 blacks, 1877 Hispanics, and 1859 whites). Data were obtained using interviewer and selfadministered questionnaires. The presence of LUTS was defined as an American Urological Association symptom index score of 8 or above. Quality of life was assessed using the Medical Outcomes Study 12-Item Short Form Survey (SF-12), and a measure of bother was based on the interference of urinary symptoms with various activities. Analyses were weighted to the Boston population using SUDAAN version 9.0 statistical software. Results:The overall prevalence of LUTS was 18.7% and increased with age (10.5% at age 30-39 years to 25.5% at age 70-79 years) but did not differ by sex or race/ ethnicity. Quality of life was significantly reduced among those with LUTS, as measured by the bother of symptoms and the SF-12 component scores. Prevalence of prescription medication use for urinary symptoms was low even among participants with LUTS, with more than 90% of participants reporting no medication use. Conclusions:In this population-based, racially and ethnically diverse random sample, LUTS were common among both men and women and increased substantially with age. Lower urinary tract symptoms had a negative impact on quality of life across age, sex, and race/ethnic groups.The BACH Survey is a population-based, random sample epidemiologic survey of a broad range of urologic symptoms. The study design is a stratified, 2-stage cluster sample. A total of 5506 men and women were recruited (2301 men, 3205 women,

The prevalence of foot and ankle disorders was determined in a community-based, multiethnic (non-Hispanic White, African American, and Puerto Rican) random sample of 784 community-dwelling adults aged 65 or more years in 2001-2002 in Springfield, Massachusetts. Overall, the five most common conditions were toenail disorders (74.9%), lesser toe deformities (60.0%), corns and calluses (58.2%), bunions (37.1%), and signs of fungal infection, cracks/fissures, or maceration between toes (36.3%); 30.9% had some tenderness to palpation of the foot or ankle, and 14.9% had ankle joint pain on most days in the past 4 weeks. Toenail conditions, fungal symptoms, and ulcers or lacerations were more common in men, while bunions and corns and calluses were more common in women (p < 0.001). Significant racial/ethnic differences, independent of education or gender, were found for the prevalence of most toe deformities and flat feet, as well as for corns and calluses, fungal signs, edema, ankle joint pain, tenderness to palpation, and sensory loss. Foot and ankle disorders are common in these older adults. Examination of their prevalence in different segments of the community may inform future studies to determine etiology and means of prevention.

Nocturia is common and associated with decreased quality of life. When planning treatment, clinicians should consider causes of nocturia outside of the lower urinary tract.

Most epidemiologic studies of urine leakage in the United States report on women and White populations. In this study, the authors determined the prevalence of urine leakage across genders and racial/ethnic groups in a population-based sample of 5,506 adults aged 30-79 years and identified factors related to leakage within genders and racial/ethnic groups. The prevalence of weekly urine leakage was 8% overall, 10.4% in women, and 5.3% in men. White women (11.7%) were more likely than Black (9.4%) and Hispanic (7.3%) women to report weekly leakage and to report stress-type (35.4% vs. 9.4% and 14.5%, respectively) and urge-type (13.4% vs. 3.3% and 10.8%, respectively) leakage. Rates and leakage types for men did not vary by race/ethnicity. For women, central obesity, asthma, and arthritis increased the odds of weekly leakage. For men, the odds of leakage increased for Blacks and Whites at ages 50 and 60 years, respectively, and for Hispanics of higher social class. For both genders, various comorbid conditions, including heart disease, asthma, and depression, increased the odds of leakage in varying racial/ethnic groups. The authors conclude that types of and risk factors for urine leakage vary by gender and racial/ethnic group.

Objectives: To describe the Boston Area Community Health (BACH) survey, a National Institutes of Health [en]supported epidemiological study of symptoms suggestive of the following urologic conditions: urinary incontinence, benign prostatic hyperplasia, interstitial cystitis, chronic pelvic pain of bladder origin, prostatitis, hypogonadism, erectile dysfunction, and female sexual dysfunction.Methods: BACH used a two-stage stratified cluster design to recruit a community-based random sample of 5506, divided between males (2301) and females (3205), three racial/ethnic groups (black, Hispanic, and white), and four age groups (30[en]39, 40[en]49, 50[en]59, 60[en]79 yr). Validated questionnaires were used to collect information on urologic symptoms, comorbidities, prescribed and over-the-counter medications, reproductive history, quality of life, health care utilization, physical activity, depressive symptoms, interpersonal stress, smoking, alcohol use, fluid intake, nutrition, menopausal status, sexual activity, abuse, anthropometrics (measured height, weight, hip and waist circumference, pulse rate, blood pressure), and sociodemographics including country of origin, marital status, employment status, and income. Blood samples were collected from 68% of all subjects. Results:A large representative community-based sample was successfully recruited to provide both cross-sectional and eventually longitudinal data to address important urologic questions.Conclusions: BACH has features distinguishing it from most other epidemiological studies in urology. It uses a random community-based sample of people who are racially/ethnically diverse and includes a broad age range (30[en]79 yr). It includes both males and females The study focuses on symptoms rather than variably defined disease conditions, it is multidisciplinary, and it is designed to become longitudinal. KeywordsEpidemiology; Survey sampling; Symptom research; Urology The concept of a urologic icebergIn 1963 epidemiologist John Last introduced the concept of "the illness iceberg" to describe how diseases are distributed in the community [1]. Some problems are never presented to a doctor and never receive a diagnosis, and others are presented but not accurately diagnosed: Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.Take Home Message The Boston Area Community Health Study, a random sample (n = 5506) of females and males, aged 30[en]79 years, equally divided across race/ethnic groups, is estimating the true prevalence, correlates, and impact of symptoms suggestive of eight urologic conditions. NIH Public Access NIH-...

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OBJECTIVESTo investigate the effect of lower urinary tract symptoms (LUTS) on quality of life (QoL) and to determine its extent across a variety of cultures, and the confounding effects of self-reported comorbidities and demographics. SUBJECTS AND METHODSData were obtained from two populationbased studies in five cities: UREPIK (Boxmeer, the Netherlands; Auxerre, France; Birmingham, UK; and Seoul, Korea) and the Boston Area Community Health (BACH) study (Boston, USA). UREPIK used stratified random samples of men aged 40-79 years. BACH used a multistage stratified cluster sample to randomly select adults aged 40-79 years. QoL was assessed using a standard Medical Outcomes Study-Short Form 12 (SF-12, mental and physical health component scores); LUTS was assessed using the International Prostate Symptom Score (IPSS). The association between QoL and IPSS, associated illnesses, and lifestyle factors was investigated using weighted regression. RESULTSThe UREPIK studied 4800 men aged 40-79 years; BACH recruited 1686 men aged 40-79 years. The prevalence of LUTS, defined as an IPSS of ≥ 8, varied by city ( P < 0.001), with Auxerre reporting a prevalence ( SE ) of 18.1 (1.2)%, Birmingham 25.6 (1.5)%, Boston 25.1 (1.6)%, Boxmeer 21.2 (1.3)%, and Seoul 19.0 (1.2)%. Overall, this was similar to the In a large epidemiological study, authors investigated the effect of LUTS on quality of life among various cultures. They showed a close association between the two, and that the effect of having moderate symptoms has a similar effect on quality of life as diabetes, hypertension or cancer, and that having severe symptoms had a similar effect as a heart attack or stroke.

Objectives The objectives of this study were to: 1) investigate the relationship between LUTS as defined by the American Urologic Association Symptom Index (AUA-SI) and the metabolic syndrome (MetS); and 2) determine the relationship between individual symptoms comprising the AUA-SI and MetS. Methods The Boston Area Community Health (BACH) Survey used a two-stage cluster design to recruit a random sample of 2,301 men age 30-79. Analyses were conducted on 1,899 men who provided blood samples. Urologic symptoms comprising the American Urological Association symptom index were included in the analysis. MetS was defined using a modification of the Adult Treatment Panel (ATP) III guidelines. The association between LUTS and MetS was assessed using odds ratios and 95% confidence intervals estimated using logistic regression models. Results Increased odds of MetS were observed among men with mild to severe symptoms (AUA-SI 2-35) compared to men with an AUA-SI score of 0 or 1 (multivariate Odds Ratio (OR)=1.68, 95% confidence interval (CI): 1.21, 2.35). A statistically significant association was observed between MetS and voiding symptom score ≥5 (multivariate adjusted OR=1.73, 95%CI: 1.06, 2.80) but not for storage symptom score ≥4 (multivariate adjusted OR=0.94, 95%CI: 0.66, 1.33). Increased odds of MetS were observed even with mild symptoms, primarily for incomplete emptying, intermittency, and nocturia. These associations were observed primarily among younger men (age<60 years) and were null among older men (age≥60 years). Conclusions The observed association between urologic symptoms and MetS provides further evidence of common underlying factors between LUTS and chronic conditions outside the urinary tract.