Lower urinary tract symptoms, depressed peak urinary flow rates, enlarged prostates and older age are associated with an increased risk of acute urinary retention in community dwelling men. These findings may help to identify men at increased risk of acute urinary retention in whom closer evaluation may be warranted.

Objective Neuromyelitis optica and its spectrum disorders (NMOSD) are inflammatory demyelinating diseases (IDD) with a specific biomarker, aquaporin-4-IgG. Prior NMO/NMOSD epidemiological studies are limited by lack of aquaporin-4-IgG seroprevalence assessment, absence of population-based USA studies and under-representation of blacks. To overcome these limitations, we sought to compare NMO/NMOSD seroepidemiology across two ethnically divergent populations. Methods We performed a population-based comparative study of the incidence (2003–2011) and prevalence (on December 31, 2011) of NMO/NMOSD and aquaporin-4-IgG seroincidence and seroprevalence (sera collected in 80–84% of IDD) among patients with IDD diagnosis in Olmsted County, USA (82% white [Caucasian]) and Martinique (90% black [Afro-Caribbean]). Aquaporin-4-IgG was measured by M1-isoform-fluorescent-activated-cell-sorting assays. Results The age and sex adjusted incidence (7.3 vs 0.7/1,000,000 person-years [p<0.01]) and prevalence (10 vs 3.9/100,000[p=0.01]) in Martinique exceeded that in Olmsted County. The AQP4-IgG age and sex-adjusted seroincidence (6.5 vs 0.7/1,000,000 person-years [p<0.01]) and seroprevalence (7.9 vs 3.3/100,000[p=0.04]) were also higher in Martinique than Olmsted County. The ethnicity-specific prevalence was similar in Martinique and Olmsted County: 11.5 and 13/100,000 in blacks, and 6.1 and 4.0/100,000 in whites, respectively. NMO/NMOSD represented a higher proportion of IDD in Martinique than Olmsted County (16% vs 1.4%; p<0.01). The onset age (median, 35–37 years) and female:male distribution (8–9:1) were similar across both populations; 60% of prevalent cases were either blind in one eye, dependent on a gait aid or both. Interpretation This study reports the highest prevalence of NMO/NMOSD in any population (10/100,000 in Martinique), estimates it affects 16,000–17,000 in the USA (higher than previous predictions) and demonstrates it disproportionately affects blacks.

The primary treatment for preservation of fertility in women with large fibroids-open myomectomy-is complicated by significant intraoperative bleeding. In a recent survey, over 85% of gynecologists in the United Kingdom reported use of gonadotropin-releasing hormone (GnRH) analogues before myomectomy to reduce operative hemorrhage at myomectomy. In contrast to pretreatment with GnRH analogues, less than 25% of gynecologists of the United Kingdom reported use of tourniquets to myomectomy-associated bleeding. Although evidence for reduction of bleeding by pretreatment with GnRH analogues has been shown in many studies, other studies have found no benefit. In a previous randomized, controlled trial, triple tourniquets (tourniquets applied to the uterine and ovarian vessels) were highly effective to temporarily occlude the uterine blood supply and reduce myomectomy-associated bleeding. This randomized, controlled trial compared the effectiveness of triple tourniquets and preoperative treatment with GnRH analogues in reducing blood loss in a population of 40 women undergoing open myomectomy for symptomatic fibroids. The study subjects were randomized to either 3 months pretreatment with a GnRH analogue or intraoperative application of triple tourniquets. To occlude the uterine blood supply, a number 1 polyglactin suture was threaded through the broad ligament incisions on each side and tied around the cervix above the level of the bladder and size 10 suction catheter tubing was also passed through the incisions and tied around the infundibulopelvic ligaments. Women randomized to tourniquets received no pretreatment. No significant differences between the 2 groups were found in the numbers of fibroids removed or in the total weight of fibroids (P ϭ 0.13). Compared with triple tourniquets, intraoperative blood loss was significantly greater with the GnRH analogue group (GnRH analogues: median 2482 mL, 95% confidence level, 1744 to 3151 vs. tourniquets: mean 640 mL, 95% confidence level, 418 to 881, respectively, P Ͻ 0.001), and significantly more women in the GnRH analogue group required blood transfusion (70% vs. 30%, P Ͻ 0.025). The frequency of postoperative complications was similar among the 2 groups; most were minor. Two women from the tourniquet group sustained major complications that appeared to be unrelated to the use of tourniquets. There was no difference between the 2 groups in the length of the postoperative hospital stay and none of the women in either group was readmitted to hospital in the early postoperative period (Ͻ6 weeks).These data are consistent with previous findings that triple tourniquets are more effective than preoperative treatment with GnRH analogues or other available intraoperative techniques at reducing intraoperative blood loss at open myomectomy. EDITORIAL COMMENT(Open abdominal myomectomy may still be the most effective treatment for large, multiple uterine fibroids. In the study abstracted above, Al-Shabibi et al. from the Royal Free Hospital in London removed an average of 22 fibro...

Serum PSA concentrations can be used to discriminate between men with prostate cancer and those without it among both blacks and whites. Over 40 percent of cases of prostate cancer in black men would not be detected by tests using traditional age-specific reference ranges, which maintain specificity at 95 percent. In this high-risk population, the alternative approach--maintaining sensitivity at 95 percent--may be used with acceptable decrements in specificity.

Objective To describe the prevalence of non-acute conditions among patients seeking healthcare in a defined US population, emphasizing age, sex, and ethnic differences. Methods The Rochester Epidemiology Project (REP) records-linkage system was used to identify all residents of Olmsted County, MN on April 1, 2009 (n=142,377). We then electronically extracted all International Classification of Diseases, ninth revision (ICD-9) codes received by these subjects from any health care provider between January 1, 2005 and December 31, 2009. We grouped ICD-9 codes into Clinical Classification Codes (CCCs), and then into 47 broader disease groups associated with health-related quality of life. Age- and sex-specific prevalence was estimated by dividing the number of individuals within each group by the corresponding age- and sex-specific population. People with multiple codes within a group were counted only once. Results We included a total of 142,377 subjects (53% women). Skin disorders (42.7%), osteoarthritis and joint disorders (33.6%), back problems (23.9%), disorders of lipid metabolism (22.4%), and upper respiratory disease (22.1%; excluding asthma) were the most prevalent disease groups in this population. Eight of the 10 most prevalent disease groups were more common in women; however, disorders of lipid metabolism and hypertension were more common in men. Additionally, the prevalence of seven of these 10 groups increased with advancing age. Prevalence varied also across whites, blacks, and Asians. Conclusion Our findings suggest areas for focused research that may lead to better care delivery and improved population health.

OBJECTIVE To assess the association between erectile dysfunction (ED) and the long-term risk of coronary artery disease (CAD) and the role of age as a modifier of this association. PARTICIPANTS AND METHODS From January 1, 1996, to December 31, 2005, we biennially screened a random sample of 1402 community-dwelling men with regular sexual partners and without known CAD for the presence of ED. Incidence densities of CAD were calculated after age stratification and adjusted for potential confounders by time-dependent Cox proportional hazards models. RESULTS The prevalence of ED was 2% for men aged 40 to 49 years, 6% for men aged 50 to 59 years, 17% for men aged 60 to 69 years, and 39% for men aged 70 years or older. The CAD incidence densities per 1000 person-years for men without ED in each age group were 0.94 (40-49 years), 5.09 (50-59 years), 10.72 (60-69 years), and 23.30 (≥70 years). For men with ED, the incidence densities of CAD for each age group were 48.52 (40-49 years), 27.15 (50-59 years), 23.97 (60-69 years), and 29.63 (≥70 years). CONCLUSION ED and CAD may be differing manifestations of a common underlying vascular pathology. When ED occurs in a younger man, it is associated with a marked increase in the risk of future cardiac events, whereas in older men, ED appears to be of little prognostic importance. Young men with ED may be ideal candidates for cardiovascular risk factor screening and medical intervention.

Objective To describe age and sex patterns of drug prescribing in Olmsted County, MN. Prescription drugs are an important component of health care delivery, yet little is known about the prescribing patterns in the general population. Patients and Methods Population-based drug prescription records for the Olmsted County population in the year 2009 were obtained using the Rochester Epidemiology Project medical records-linkage system (n = 142,377). Drug prescriptions were classified using RxNorm codes and grouped using the National Drug File – Reference Terminology (NDF-RT). Results Overall, 68% of the population received a prescription from at least one drug group, 52% received prescriptions from 2 or more groups, and 21% received prescriptions from 5 or more groups. The most commonly prescribed drug groups in the entire population were penicillins and beta-lactam antimicrobials (17%), antidepressants (13%), opioid analgesics (12%), antilipemic agents (11%), and vaccines/toxoids (11%). However, prescribing patterns differed by age and sex. Vaccines/toxoids, penicillins and beta-lactam antimicrobials, and anti-asthmatic drugs were most commonly prescribed in persons younger than 19 years. Antidepressants and opioid analgesics were most commonly prescribed in young and middle-aged adults. Cardiovascular drugs were most commonly prescribed in older adults. Women received more prescriptions than men for several groups of drugs, in particular for antidepressants. For several groups of drugs, the use increased with advancing age. Conclusion This study provides valuable baseline information for future studies of drug utilization and drug-related outcomes in this population.

No abstract