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Kan KM, Agrawal G, Brosula R, Venkatapuram P, Chen AL, Zhang CA. Prevalence of pediatric lower urinary tract symptoms in a national claims database of privately insured patients, 2003-2014. Int Urol Nephrol 2024; 56:1785-1793. [PMID: 38289544 DOI: 10.1007/s11255-023-03913-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 12/05/2023] [Indexed: 02/28/2024]
Abstract
BACKGROUND We conducted this study to estimate the prevalence of pediatric lower urinary tract symptoms (pLUTS) in a US privately insured pediatric population who are 6-20 years old by age, sex, race/ethnicity from 2003-2014. This has not been previously described in the literature. METHODS We retrospectively reviewed Optum's de-identified Clinformatics® Data Mart Database between 2003-2014. A pLUTS patient was defined by the presence of ≥ 1 pLUTS-related ICD-9 diagnosis code between the age of 6-20 years. Neurogenic bladder, renal transplant and structural urologic disease diagnoses were excluded. Prevalence by year was calculated as a proportion of pLUTS patients among the total population at risk. Variables reviewed included age, sex, race, geographic region, household factors and clinical comorbidities including attention-deficit/hyperactivity disorder (ADHD), constipation, and sleep apnea. Point of service (POS) was calculated as a proportion of pLUTS-related claims associated with a POS compared to the total claims at all POS in the time period. RESULTS We identified 282,427 unique patients with ≥ 1 claim for pLUTS between the ages of 6-20 years from 2003 to 2014. Average prevalence during this period was 0.92%, increasing from 0.63% in 2003 to 1.13% in 2014. The median age group of patients was 6-10 years. More patients were female (59.80%), white (65.97%), between 6 and 10 years old (52.18%) and resided in the Southern US (44.97%). Within a single household, 81.71% reported ≤ 2 children, and 65.53% reported ≥ 3 adults. 16.88% had a diagnosis of ADHD, 19.49% had a diagnosis of constipation and 3.04% had a diagnosis of sleep apnea. 75% of pLUTS-related claims were recorded in an outpatient setting. CONCLUSIONS Families consistently seek medical care in the outpatient setting for pLUTS. The demographic and clinical characteristics of our cohort reflect prior literature. Future studies can help define temporal relationships between household factors and onset of disease as well as characterize pLUTS-related healthcare resource utilization. Additional work is required in publicly insured populations.
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Affiliation(s)
- Kathleen M Kan
- Department of Urology, Stanford University School of Medicine, 453 Quarry Road, Urology 5656, Palo Alto, CA, 94304, USA.
| | - Gunjan Agrawal
- Flushing Hospital Medical Center, 4500 Parsons Blvd, Flushing, NY, 11533, USA
| | - Raphael Brosula
- Department of Urology, Stanford University School of Medicine, 453 Quarry Road, Urology 5656, Palo Alto, CA, 94304, USA
| | - Pranaya Venkatapuram
- Department of Urology, Stanford University School of Medicine, 453 Quarry Road, Urology 5656, Palo Alto, CA, 94304, USA
| | - Abby L Chen
- Department of Urology, Stanford University School of Medicine, 453 Quarry Road, Urology 5656, Palo Alto, CA, 94304, USA
| | - Chiyuan A Zhang
- Department of Urology, Stanford University School of Medicine, 453 Quarry Road, Urology 5656, Palo Alto, CA, 94304, USA
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Cunningham SD, Lindberg S, Joinson C, Shoham D, Chu H, Newman D, Epperson N, Brubaker L, Low L, Camenga DR, Yvette LaCoursiere D, Meister M, Kenton K, Sutcliffe S, Markland AD, Gahagan S, Coyne-Beasley T, Berry A. Association Between Maternal Depression and Lower Urinary Tract Symptoms in Their Primary School-Age Daughters: A Birth Cohort Study. J Wound Ostomy Continence Nurs 2024; 51:53-60. [PMID: 38215298 PMCID: PMC10794027 DOI: 10.1097/won.0000000000001039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
PURPOSE Although maternal depression is associated with adverse outcomes in women and children, its relationship with lower urinary tract symptoms (LUTS) in offspring is less well-characterized. We examined the association between prenatal and postpartum maternal depression and LUTS in primary school-age daughters. DESIGN Observational cohort study. SUBJECTS AND SETTING The sample comprised 7148 mother-daughter dyads from the Avon Longitudinal Study of Parents and Children. METHOD Mothers completed questionnaires about depressive symptoms at 18 and 32 weeks' gestation and 21 months postpartum and their children's LUTS (urinary urgency, nocturia, and daytime and nighttime wetting) at 6, 7, and 9 years of age. Multivariable logistic regression models were used to estimate the association between maternal depression and LUTS in daughters. RESULTS Compared to daughters of mothers without depression, those born to mothers with prenatal and postpartum depression had higher odds of LUTS, including urinary urgency (adjusted odds ratio [aOR] range = 1.99-2.50) and nocturia (aOR range = 1.67-1.97) at 6, 7, and 9 years of age. Additionally, daughters born to mothers with prenatal and postpartum depression had higher odds of daytime wetting (aOR range = 1.81-1.99) and nighttime wetting (aOR range = 1.63-1.95) at 6 and 7 years of age. Less consistent associations were observed for depression limited to the prenatal or postpartum periods only. CONCLUSIONS Exposure to maternal depression in the prenatal and postpartum periods was associated with an increased likelihood of LUTS in daughters. This association may be an important opportunity for childhood LUTS prevention. Prevention strategies should reflect an understanding of potential biological and environmental mechanisms through which maternal depression may influence childhood LUTS.
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Affiliation(s)
- Shayna D. Cunningham
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT
| | - Sarah Lindberg
- Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN
| | - Carol Joinson
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, England
| | - David Shoham
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN
| | - Haitao Chu
- Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN
| | - Diane Newman
- Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Neill Epperson
- Department of Psychiatry, University of Colorado, Aurora, CO
| | - Linda Brubaker
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, San Diego, CA
| | - Lisa Low
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI
| | - Deepa R. Camenga
- Department of Pediatrics, Yale School of Medicine, New Haven, CT
| | - D. Yvette LaCoursiere
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, San Diego, CA
| | - Melanie Meister
- Department of Obstetrics and Gynecology, University of Kansas, Kansas City, KS
| | - Kimberly Kenton
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Siobhan Sutcliffe
- Division of Public Health Sciences, Department of Surgery, and the Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO
| | - Alayne D. Markland
- Department of Medicine and the Birmingham/Atlanta Geriatrics Research Education and Clinical Center, University of Alabama at Birmingham, Birmingham, AL
| | - Sheila Gahagan
- Department of Pediatrics, University of California San Diego, La Jolla, CA
| | - Tamera Coyne-Beasley
- Departments of Pediatrics and Internal Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Amanda Berry
- Division of Urology, Children’s Hospital of Philadelphia, Philadelphia, PA
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Cho YJ, Shin B, Lee SH, Park S, Kim YK, Kim JJ, Kim E. Altered Urine Microbiome in Male Children and Adolescents with Attention-Deficit Hyperactivity Disorder. Microorganisms 2023; 11:2063. [PMID: 37630623 PMCID: PMC10458914 DOI: 10.3390/microorganisms11082063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/26/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023] Open
Abstract
While interest in developing the human microbiome as a biomarker for attention-deficit hyperactivity disorder (ADHD) is increasing, there has been limited exploration in utilizing urine samples. In this study, we analysed urine microbiome profiles by extracting 16S ribosomal DNA from purified bacteria-derived extracellular membrane vesicles obtained from urine samples. Sequencing libraries were constructed by amplifying V3-V4 hypervariable regions sequenced using Illumina MiSeq. Profiles of male Korean children and adolescents with ADHD (n = 33) were compared with healthy sex-matched controls (n = 39). Statistically controlling for age, we found decreased alpha diversity in the urine bacteria of the ADHD group, as evidenced by reduced Shannon and Simpson indices (p < 0.05), and significant differences in beta diversity between the two groups (p < 0.001). The phyla Firmicutes and Actinobacteriota, as well as the genera Ralstonia and Afipia, were relatively more abundant in the ADHD group. The phylum Proteobacteria and the genera Corynebacterium and Peptoniphilus were more abundant in the control group. Notably, the genus Afipia exhibited significant correlations with the Child Behavior Checklist Attention Problems score and DSM-oriented ADHD subscale. This study is the first to propose the urine microbiome as a potential biomarker for pediatric ADHD.
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Affiliation(s)
- Yoon Jae Cho
- Department of Psychiatry, College of Medicine, Yonsei University, Seoul 06273, Republic of Korea
| | - Bokyoung Shin
- Department of Psychiatry, College of Medicine, Yonsei University, Seoul 06273, Republic of Korea
| | - Sung-Ha Lee
- Center for Happiness Studies, Seoul National University, Seoul 08826, Republic of Korea
| | - Sangmin Park
- Interdisciplinary Program in Neuroscience, Seoul National University, Seoul 08826, Republic of Korea
| | | | - Jae-Jin Kim
- Department of Psychiatry, College of Medicine, Yonsei University, Seoul 06273, Republic of Korea
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
| | - Eunjoo Kim
- Department of Psychiatry, College of Medicine, Yonsei University, Seoul 06273, Republic of Korea
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
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Kan KM, Agrawal G, Brosula R, Venkatapuram P, Chen AL, Zhang CA. Prevalence of pediatric lower urinary tract symptoms in a US population seeking medical care, 2003- 2014. RESEARCH SQUARE 2023:rs.3.rs-2883579. [PMID: 37333169 PMCID: PMC10275036 DOI: 10.21203/rs.3.rs-2883579/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Background We conducted this study to estimate the prevalence of pediatric lower urinary tract symptoms (pLUTS) in a US privately-insured pediatric population who are 18 years of age or older by age, sex, race/ethnicity from 2003-2014. This has not been previously described in the literature. Methods We retrospectively reviewed Optum's de-identifed Clinformatics® Data Mart Database database between 2003-2014. A pLUTS patient was defined by the presence of ≥ 1 pLUTS-related ICD-9 diagnosis code between the age of 6-20 years. Neurogenic bladder, renal transplant and structural urologic disease diagnoses were excluded. Prevalence by year was calculated as a proportion of pLUTS patients among the total population at risk. Variables reviewed included age, sex, race, geographic region, household factors and clinical comorbidities including attention-deficit/hyperactivity disorder (ADHD), constipation, and sleep apnea. Point of service (POS) was calculated as a proportion of pLUTS-related claims associated with a POS compared to the total claims at all POS in the time period. Results We identified 282,427 unique patients with ≥ 1 claim for pLUTS between the ages of 6-20 years from 2003-2014. Average prevalence during this period was 0.92%, increasing from 0.63% in 2003 to 1.13% in 2014. Mean age was 12.15 years. More patients were female (59.80%), white (65.97%), between 6-10 years old (52.18%) and resided in the Southern US (44.97%). Within a single household, 81.71% reported ≤ 2 children, and 65.53% reported ≥ 3 adults. 16.88% had a diagnosis of ADHD, 19.49% had a diagnosis of constipation and 3.04% had a diagnosis of sleep apnea. 75% of pLUTS-related claims were recorded in an outpatient setting. Conclusions Families consistently seek medical care in the outpatient setting for pLUTS. The demographic and clinical characteristics of our cohort reflect prior literature. Future studies can help define temporal relationships between household factors and onset of disease as well as characterize pLUTS-related healthcare resource utilization. Additional work is required in publicly-insured populations.
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Attention-Deficit/Hyperactivity Disorder Is Associated With Increased Rates of Childhood Infectious Diseases: A Population-Based Case-Control Study. J Am Acad Child Adolesc Psychiatry 2023; 62:253-260.e1. [PMID: 36007815 DOI: 10.1016/j.jaac.2022.06.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 05/30/2022] [Accepted: 08/15/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Infectious diseases (IDs) pose a heavy burden on children. An association between pediatric attention-deficit/hyperactivity disorder (ADHD) and specific IDs has been documented. Our objective was to test the possibility that ADHD is associated with increased likelihood for pediatric IDs at large. METHOD A population-based case-control study was conducted using Electronic Medical Records (EMRs) of a national Health Maintenance Organization, Leumit Health Services (LHS). ICD-9/10 criteria were used for all diagnoses. The study population consisted of all children and adolescents (aged 5-18 years), members of LHS between January 1, 2006-June 30, 2021. Case patients met International Classification of Diseases (ICD-9/10) criteria for ADHD. Controls included randomly selected persons without ADHD (2:1 ratio), matched individually by demographic indices. The EMRs retrieved 3 exposure categories: pediatric ID, anti-infective medications use, and number of physician visits. The study was approved by the review board of Shamir Medical Center and the Research Committee of LHS. RESULTS Cases patients comprised 18,756 participants, with a mean age of 8.3 ± 2.6 years and a male/female ratio of 63%:37%. Matched controls comprised 37,512 participants, with a mean age of 8.3 ± 2.6 years and a male/female ratio of 63%:37%. Demographic variables were similar between the groups. The rates of all IDs were significantly higher in participants with ADHD than in controls and were not restricted to a single body system, including acute respiratory infection (OR = 1.4, 95% CI = 1.3-1.4, p < .001), acute gastroenteritis (OR = 1.3,95% CI 1.3-1.4, p < .001), salmonellosis (OR = 2.8, 95% CI = 2.3-3.5, p < .001), and urinary tract infection (OR = 1.3, 95% CI = 1.2-1.4, p < .001). All anti-infective agents were prescribed significantly more often to children with ADHD. There were significantly higher rates of physician visits for participants with ADHD. CONCLUSION Study findings suggest an association between ID and pediatric ADHD Health care providers should be aware of this potential association. CLINICAL TRIAL REGISTRATION INFORMATION The Health and Economic Impact of Treated and Untreated ADHD; https://www.shamir.org/; 005-18-LEU.
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Liu X, Zhang G. Functional urination or defecation disorders may be warning signs of attention-deficit/hyperactivity disorder among children in rural China. J Affect Disord 2022; 316:63-70. [PMID: 35981625 DOI: 10.1016/j.jad.2022.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 07/19/2022] [Accepted: 08/12/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study was designed to investigate the prevalence of attention-deficit/hyperactivity disorder (ADHD) and its association with functional urination and defecation disorders among children in rural China. METHODS A cross-sectional study was conducted with children aged 6-18 in rural schools in southwest China using a survey questionnaire. The Swanson, Nolan, and Pelham Questionnaire-IV (SNAP-IV) was used to measure ADHD symptoms, and standardized questions about urination and defecation were used to measure lower urinary tract symptoms (LUTS) and functional defecation disorders (FDDs). The association of ADHD with LUTS and FDDs was analyzed by matched logistic regression after propensity score matching was performed to minimize the influence of potential confounders, including demographic characteristics. RESULTS A total of 17,279 participants were included in the analyses. The prevalence of ADHD was 2 % mainly among boys before age 12, after which it showed a decreasing trend with age, resulting in a concomitant reduction in gender differences. The risk of ADHD was positively associated with the presence of enuresis, holding maneuvers, intermittency, and encopresis, with encopresis having the strongest association (P = 0.001). The presence of holding maneuvers, intermittency, excessive volitional stool retention, and encopresis were associated with a higher risk of ADHD at 6-15 years-old, with intermittency exhibiting an increasingly positive association with ADHD risk across ages 6-15. CONCLUSIONS ADHD was associated with LUTS and FDDs, which highlights that functional urination and/or defecation disorders could serve as warning signs for ADHD that should trigger screening, especially in relatively backward regions with little ADHD awareness.
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Affiliation(s)
- Xiaorui Liu
- Department of Neurology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Gaofu Zhang
- Department of Nephrology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China.
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Favorito LA. International Brazilian Journal of Urology reached the Biggest Impact Factor of its history - 1.541. Int Braz J Urol 2021; 47:918-920. [PMID: 34260172 PMCID: PMC8321451 DOI: 10.1590/s1677-5538.ibju.2021.05.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Luciano A Favorito
- Unidade de Pesquisa Urogenital - Universidade Estadual do Rio de Janeiro - Uerj, Rio de Janeiro, RJ, Brasil.,Serviço de Urologia, Hospital Federal da Lagoa, Rio de Janeiro, RJ, Brasil
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Combs AJ. Editorial Comment: Association between Attention Deficit Hyperactivity Disorder and lower urinary tract symptoms in children: do they mean what we presume them to be? Int Braz J Urol 2021; 47:979-981. [PMID: 34260174 PMCID: PMC8321445 DOI: 10.1590/s1677-5538.ibju.2020.0978.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 05/25/2021] [Indexed: 11/21/2022] Open
Affiliation(s)
- Andrew J Combs
- Pediatric Urodynamics in Urology, Weill Cornell Medicine, New York, NY, USA
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