Acupuncture for treating overactive bladder in adults.

BACKGROUND: Overactive bladder is a common, long-term symptom complex, which includes frequency of micturition, urgency with or without associated incontinence and nocturia. Around 11% of the population have symptoms, with this figure increasing with age. Symptoms can be linked to social anxiety and adaptive behavioural change. The cost of treating overactive bladder is considerable, with current treatments varying in effectiveness and being associated with side effects. Acupuncture has been suggested as an alternative treatment. OBJECTIVES: To assess the effects of acupuncture for treating overactive bladder in adults, and to summarise the principal findings of relevant economic evaluations. SEARCH METHODS: We searched the Cochrane Incontinence Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (including In-Process, Epub Ahead of Print, Daily), ClinicalTrials.gov and WHO ICTRP (searched 14 May 2022). We also searched the Allied and Complementary Medicine database (AMED) and bibliographic databases where knowledge of the Chinese language was necessary: China National Knowledge Infrastructure (CNKI); Chinese Science and Technology Periodical Database (VIP) and WANFANG (China Online Journals), as well as the reference lists of relevant articles.  SELECTION CRITERIA: We included randomised controlled trials (RCTs), quasi-RCTs and cross-over RCTs assessing the effects of acupuncture for treating overactive bladder in adults. DATA COLLECTION AND ANALYSIS: Four review authors formed pairs to assess study eligibility and extract data. Both pairs used Covidence software to perform screening and data extraction. We assessed risk of bias using Cochrane's risk of bias tool and assessed heterogeneity using the Chi2 testand I2 statistic generated within the meta-analyses. We used a fixed-effect model within the meta-analyses unless there was a moderate or high level of heterogeneity, where we employed a random-effects model. We used the GRADE approach to assess the certainty of evidence. MAIN RESULTS: We included 15 studies involving 1395 participants in this review (14 RCTs and one quasi-RCT). All included studies raised some concerns regarding risk of bias. Blinding of participants to treatment group was only achieved in 20% of studies, we considered blinding of outcome assessors and allocation concealment to be low risk in only 25% of the studies, and random sequence generation to be either unclear or high risk in more than 50% of the studies. Acupuncture versus no treatment One study compared acupuncture to no treatment. The evidence is very uncertain regarding the effect of acupuncture compared to no treatment in curing or improving overactive bladder symptoms and on the number of minor adverse events (both very low-certainty evidence). The study report explicitly stated that no major adverse events occurred. The study did not report on the presence or absence of urinary urgency, episodes of urinary incontinence, daytime urinary frequency or episodes of nocturia. Acupuncture versus sham acupuncture Five studies compared acupuncture with sham acupuncture. The evidence is very uncertain about the effect of acupuncture on curing or improving overactive bladder symptoms compared to sham acupuncture (standardised mean difference (SMD) -0.36, 95% confidence interval (CI) -1.03 to 0.31; 3 studies; 151 participants; I2 = 65%; very low-certainty evidence). All five studies explicitly stated that there were no major adverse events observed during the study. Moderate-certainty evidence suggests that acupuncture probably makes no difference to the incidence of minor adverse events compared to sham acupuncture (risk ratio (RR) 1.28, 95% CI 0.30 to 5.36; 4 studies; 222 participants; I² = 0%). Only one small study reported data for the presence or absence of urgency and for episodes of nocturia. The evidence is of very low certainty for both of these outcomes and in both cases the lower confidence interval is implausible. Moderate-certainty evidence suggests there is probably little or no difference in episodes of urinary incontinence between acupuncture and sham acupuncture (mean difference (MD) 0.55, 95% CI -1.51 to 2.60; 2 studies; 121 participants; I2 = 57%). Two studies recorded data regarding daytime urinary frequency but we could not combine them in a meta-analysis due to differences in methodologies (very low-certainty evidence). Acupuncture versus medication Eleven studies compared acupuncture with medication. Low-certainty evidence suggests that acupuncture may slightly increase how many people's overactive bladder symptoms are cured or improved compared to medication (RR 1.25, 95% CI 1.10 to 1.43; 5 studies; 258 participants; I2 = 19%). Low-certainty evidence suggests that acupuncture may reduce the incidence of minor adverse events when compared to medication (RR 0.34, 95% CI 0.26 to 0.45; 8 studies; 1004 participants; I² = 51%). The evidence is uncertain regarding the effect of acupuncture on the presence or absence of urinary urgency (MD -0.40, 95% CI -0.56 to -0.24; 2 studies; 80 participants; I2 = 0%; very low-certainty evidence) and episodes of urinary incontinence (MD -0.33, 95% CI -2.75 to 2.09; 1 study; 20 participants; very low-certainty evidence) compared to medication. Low-certainty evidence suggests there may be little to no effect of acupuncture compared to medication in terms of daytime urinary frequency (MD 0.73, 95% CI -0.39 to 1.85; 4 studies; 360 participants; I2 = 28%). Acupuncture may slightly reduce the number of nocturia episodes compared to medication (MD -0.50, 95% CI -0.65 to -0.36; 2 studies; 80 participants; I2 = 0%, low-certainty evidence). There were no incidences of major adverse events in any of the included studies. However, major adverse events are rare in acupuncture trials and the numbers included in this review may be insufficient to detect these events. AUTHORS' CONCLUSIONS: The evidence is very uncertain about the effect acupuncture has on cure or improvement of overactive bladder symptoms compared to no treatment. It is uncertain if there is any difference between acupuncture and sham acupuncture in cure or improvement of overactive bladder symptoms. This review provides low-certainty evidence that acupuncture may result in a slight increase in cure or improvement of overactive bladder symptoms when compared with medication and may reduce the incidence of minor adverse events. These conclusions must remain tentative until the completion of larger, higher-quality studies that use relevant, comparable outcomes. Timing and frequency of treatment, point selection, application and long-term follow-up are other areas relevant for research.

COVID-19 vaccine acceptance and hesitancy among primary healthcare workers in Singapore.

BACKGROUND: Factors affecting COVID-19 vaccine acceptance and hesitancy among primary healthcare workers (HCW) remain poorly understood. This study aims to identify factors associated with vaccine acceptance and hesitancy among HCW. METHODS: A multi-centre online cross-sectional survey was performed across 6 primary care clinics from May to June 2021, after completion of staff vaccination exercise. Demographics, profession, years working in healthcare, residential status, presence of chronic medical conditions, self-perceived risk of acquiring COVID-19 and previous influenza vaccination were collected. HCW who accepted vaccine were then asked to rank their top 5 reasons for vaccine acceptance; HCW who were vaccine hesitant had to complete the 15-item 5C scale on psychological antecedents of vaccination. RESULTS: Five hundred fifty seven out of 1182 eligible HCW responded (47.1%). Twenty nine were excluded due to contraindications. Among 528 respondents, vaccine acceptance rate was 94.9% (n = 501). There were no statistically significant differences in COVID-19 vaccine acceptance between sex, age, ethnicity, profession, number of years in healthcare, living alone, presence of chronic diseases, self-perceived risk or previous influenza vaccination. The top 3 reasons for COVID-19 vaccine acceptance ranked by 501 HCW were to protect their family and friends, protect themselves from COVID-19 and due to high risk of acquiring COVID-19 because of their jobs. HCW with suspected or confirmed COVID-19 exposure were 3.4 times more likely to rank 'high risk at work' as one of the top reasons for vaccine acceptance (χ2 = 41.9, p < 0.001, OR = 3.38, 95%C.I. 2.32-4.93). High mean scores of 'Calculation' (5.79) and low scores for 'Constraint' (2.85) for 5C components among vaccine hesitant HCW (n = 27) highlighted that accessibility was not a concern; HCW took time to weigh vaccine benefits and consequences. CONCLUSION: COVID-19 vaccine hesitancy is a minute issue among Singapore primary HCW, having achieved close to 95% acceptance rate. COVID-19 exposure risk influences vaccine acceptance; time is required for HCW to weigh benefits against the risks. Future studies can focus on settings with higher hesitancy rates, and acceptance of booster vaccinations with the emergence of delta and omicron variants.

Factors underlying COVID-19 vaccine and booster hesitancy and refusal, and incentivizing vaccine adoption.

The paper investigates the factors underlying COVID-19 vaccine and booster hesitancy in the United States, and the efficacy of various incentives or disincentives to expand uptake. We use cross-sectional, national survey data on 3,497 U.S. adults collected online from September 10, 2021 to October 20, 2021 through the Qualtrics platform. Results from a multinomial logistic regression reveal that hesitancy and refusal were greatest among those who expressed a lack of trust either in government or in the vaccine's efficacy (hesitancy relative risk ratio, or RRR: 2.86, 95% CI: 2.13-3.83, p<0.001). Hesitancy and refusal were lowest among those who typically get a flu vaccine (hesitancy RRR: 0.28, 95% CI: 0.21-0.36, p<0.001; refusal RRR: 0.08, 95% CI: 0.05-0.13, p<0.001). Similar results hold for the intention to get a booster shot among the fully vaccinated. Monetary rewards (i.e., lottery ticket and gift cards) fared poorly in moving people toward vaccination. In contrast, the prospect of job loss or increased health insurance premiums was found to significantly increase vaccine uptake, by 8.7 percentage points (p<0.001) and 9.4 percentage points (p<0.001), respectively. We also show that the motivations underlying individuals' hesitancy or refusal to get vaccinated vary, which, in turn, suggests that messaging must be refined and directed accordingly. Also, moving forward, it may be fruitful to more deeply study the intriguing possibility that expanding flu vaccine uptake may also enhance willingness to vaccinate in times of pandemics. Last, disincentives such as work-based vaccination mandates that would result in job loss or higher health insurance premiums for those who refuse vaccination should be strongly considered to improve vaccine uptake in the effort to address the common good.

Clinical profiling of subgroups of women with chronic pelvic pain (preprint)

Study question Do subgroups of women with chronic pelvic pain (CPP) report different clinical symptoms and differing impact of pain on their quality of life? Summary answer Clinical profiles of women with CPP show variability of clinical symptoms both within and between subgroups. However, there is an obvious negative impact of pain on the patients’ lives across all subgroups with the comorbid endometriosis and bladder pain symptoms group (EABP) presenting with the higher pain intensities and the lower quality of life. What is known already CPP is a common condition affecting up to 26.6% of women, with many suffering for several years before diagnosis and/or treatment. The clinical presentation of CPP is varied and there are frequently comorbid conditions both within and outside the pelvis. Evidence from the literature show that there is an overlap of symptoms in chronic pain conditions whatever the underlying cause which suggests that chronic pain could be a condition itself. Study design, size, duration The study is part of The Translational Research in Pelvic Pain (TRiPP) project ( https://www.imi-paincare.eu/PROJECT/TRIPP/ ) which is a cross-sectional observational cohort study. The present study includes 769 female participants sampled from two existing endometriosis-focused cohort studies in Oxford, UK and Boston, MA, USA and newly recruited from the Instituto de Biologia Molecular e Celular (IBMC)) in Porto. The participants completed an extensive set of questions derived from standardised WERF EPHect questionnaires. Within this study population we defined a control group (reporting no pelvic pain, no bladder pain syndrome (BPS), and no endometriosis diagnosis, N=230) and four pain groups: endometriosis-associated pain (EAP, N=237), (BPS, N=72), comorbid endometriosis-associated pain and BPS (EABP, N=120), and pelvic pain only (PP, N=127). Participants/materials, setting, methods All participants were women of reproductive age (13-50 years) and were recruited at three different sites: Oxford (University of Oxford), Boston (Boston Center for Endometriosis (BCE)) and Porto (Instituto de Biologia Molecular e Celular (IBMC)). The questionnaire included: demographics; reproductive history; pelvic pain intensity assessed using 10-point numerical rating scales (NRS) for dysmenorrhoea, non-cyclical pain, dyspareunia and bladder pain; medical comorbidities; factors relieving and worsening pain; quality of life assessed using the SF-36 questionnaire; and pain catastrophising. Main results and the role of chance The EAP (Mean:7.37) and EABP (Mean:7.88) groups scored higher on the pain intensity scales for non-cyclical pelvic pain than the PP (Mean:6.82) group (p<0.001) and higher on the dysmenorrhoea scale than both the BPS and PP groups (p<0.001). The EABP (Mean:6.61) and BPS (Mean:6.52) groups had significantly higher bladder pain scores than the EAP (Mean:0.95) and PP (Mean:0.78) (p<0.001). The EABP group also had significantly higher pain scores for dyspareunia (p<0.001), even though more than 50% of participants (who were sexually active) in each of the pain groups reported interrupting and/or avoiding sexual intercourse due to pain in the last 12 months. Exploring the factors reported to worsen or relieve pain found that across the pain groups the three most reported factors for worsening pelvic pain were: stress (23.6%), full bladder/urinating (23.3%) and exercising (20.2%). The most common factors for relieving pelvic pain were: pain medication (31.4%), lying down (31.0%), and use of a heat pad (29.5%). Analysis of the quality-of-life questionnaire (SF-36) subscales revealed significant differences between the study groups across all SF-36 subscales (p<0.001). In line with the pain results the EABP group reported the negative highest impact across all the health measures while the PP group’s profile was closest to the control group’s profile. Significant effects were also observed between the pain groups for pain interference with their work (F(3,209)=9.76, p<0.001) and daily lives (F(3,244)=10.51, p<0.001), with the EABP suffering more compared to the EAP and PP groups (p<0.001). Limitations, reasons for caution Data for this study were derived predominantly from existing cohorts where data have been collected over time and thus different versions of questionnaires have been used. Thus, for some questions only a subgroup may have had an opportunity to complete the measure of interest. Recruitment of participants was impacted due to the COVID-19 pandemic. As a result, sample sizes overall were smaller than originally designed, and our BPS group was predominantly identified from gynaecological rather than urological clinics making it potentially different from other published BPS cohorts. Wider implications of the findings Overall, our results demonstrate the negative impact that chronic pain has on CPP patients’ quality of life and suggests that further exploration of interventions targeting quality of more broadly is important. Furthermore, it demonstrates the importance of dyspareunia in women with CPP, highlighting the need for more research in this area. Importantly, we show significant differences between the sub-groups of CPP suggesting the need for better patient stratification in future clinical studies and trials. However, the marked variability both within and between CPP sub-groups raises the question whether subgrouping on the basis of clinical diagnosis is the most appropriate strategy or whether alternative approaches could be identified allowing prioritisation of treatments better suited to the individual patient. Study funding/competing interest(s) This project has received funding from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement No 777500. This Joint Undertaking receives support from the European Union’s Horizon 2020 research and innovation programme and EFPIA Companies. Financial support was provided by the J. Willard and Alice S. Marriott Foundation for establishment of and baseline data collection within the A2A cohort - from which the Boston-based TRiPP population was sampled. Trial registration number NCT04001244

Diffused bladder wall calcification in a survivor with severe coronavirus disease 2019: A case report.

RATIONALE: Bladder calcification is a rare presentation that was first interpreted to be related to a urea-splitting bacterial infection. Aside from infection, other hypotheses such as schistosomiasis, tuberculosis, cancer, and cytokine-induced inflammatory processes have also been reported. Severe coronavirus disease 2019 (COVID-19) is known for its provoking cytokine storm and uninhibited systematic inflammation, and calcification over the coronary artery or lung has been reported as a long-term complication. PATIENT CONCERNS: We presented a 68 years old man who had persistent lower urinary tract symptoms after recovery from severe COVID-19. No urea-splitting bacteria were identified from urine culture. DIAGNOSIS: Cystoscopy examination revealed diffuse bladder mucosal and submucosa calcification. INTERVENTIONS: Transurethral removal of the mucosal calcification with lithotripsy. OUTCOMES: The patient's lower urinary tract symptoms improved, and stone analysis showed 98% calcium phosphate and 2% calcium oxalate. No newly formed calcifications were found at serial follow-up. CONCLUSION: Diffuse bladder calcification may be a urinary tract sequela of COVID-19 infection. Patients with de novo lower urinary tract symptoms after severe COVID-19 should be further investigated.

Using the integrative model of behavioural prediction to understand COVID-19 vaccine hesitancy behaviour.

The officials realized that the vaccination drive alone would not be  sufficient, but the individual's response towards getting vaccinated needs to be assessed and addressed, especially in India, where the diverse culture could widely affect the population's vaccination behaviour. The study aimed to identify the predictors of vaccine hesitancy behaviour using the health belief model and theory of planned behaviour and understand mediating and moderating influence of knowledge and social support on the relationship between the predictors and vaccine hesitancy behaviours among the Indian population. Data was collected from 1006 samples. Regression analysis was performed to assess the variances exerted on vaccine hesitancy behaviours. Also, SEM AMOS was employed to examine the mediation and moderation effects of knowledge about vaccines and social support. The findings indicated that around 11% of the respondents were hesitant to get vaccinated. The combined models of HBM and TPB provide high predictive power. The analysis also revealed that knowledge about vaccine significantly mediates partially between a few constructs of HBM and TPB concerning hesitancy. This study provides the theoretical framework and suggests that the health belief model and the theory of planned behaviour model could explain the psychological influences of vaccine hesitancy in India.

A pilot study on COVID-19 vaccine hesitancy among healthcare workers in the US.

To explore the attitude towards COVID-19 vaccination among healthcare workers in the US, we surveyed three groups of individuals (essential non-healthcare workers, general healthcare workers, and correctional healthcare workers). We found surprisingly high portions of healthcare workers with COVID-19 vaccine hesitancy/resistance, with 23% of correctional healthcare workers and 17% general healthcare workers (as compared to 12%) refusing to be vaccinated against COVID-19. Multivariate regression models suggest that current season flu vaccination (aOR = 3.34), relying on employer for COVID-19 information (aOR = 3.69), and living in the Midwest (aOR = 5.04) to be strongly associated with COVID-19 vaccine acceptance among essential workers and general healthcare workers. Current season flu vaccination (aOR = 7.52) is also strongly associated with COVID-19 vaccine acceptance among correctional healthcare workers. Potential mechanisms of vaccine hesitancy/resistance among healthcare workers involves low health literacy and employer mistrust. Our findings are highly relevant as we try to reach COVID-19 vaccination goals in the US.

Multisystem inflammatory syndrome in adult with longitudinally extensive transverse myelitis following SARS-CoV-2 vaccination: Case report (preprint)

Introduction: Multisystem inflammatory syndrome in adults (MIS-A) after SARS-CoV-2 infection or vaccination is a known complication. However, longitudinally extensive transverse myelitis (LETM) as a manifestation of MIS-A after SARS-CoV-2 infection or vaccination has not been reported before. Case presentation: 38-year old female, known case of hypothyroidism with history of mild SARS-Cov-2 infection in May 2021 and recent second dose of SARS-CoV-2 vaccination (on 1 st November 2021, COVISHIELD TM Oxford/Astra Zeneca) presented with acute onset progressive flaccid quadriparesis with bowel and bladder involvement since 26 th December 2021. Over next 3 days she developed fever, maculopapular rash , shock, myocarditis, breathlessness, Jaundice, acute kidney injury. Investigations revealed polymorphonuclear leukocytosis, thrombocytopenia, deranged Liver and renal function , severe left ventricular dysfunction. C reactive protein, D-dimer, procalcitonin, Interleukin-6 levels were raised. MRI whole spine revealed LETM from C6 to conus medullaris. Reverse transcriptase polymerase chain reaction for SARS-CoV-2 infection was negative. SARS-CoV-2 antibody titre was raised. Diagnosed as a case of MIS-A with LETM. Managed with ventilatory and ionotropic support, Intravenous Iimmunoglobulin, antibiotics, hemodialysis and intravenous methyl prednisolone and oral steroid. Improved gradually and discharged. Presently patient has grade 5/5 power in both upper limbs and 2/5 power in both lower limbs with improving bowel and bladder control. Conclusions: : This is the first reported case of LETM associated with MIS-A after SARS-CoV-2 infection or vaccination. With wider availability of SARS-CoV-2 vaccination, various side effects are emerging. However as these side effects are rare, SARS-CoV-2 vaccination represents the hope for mankind to overcome this global pandemic.

Key predictors of COVID-19 vaccine hesitancy in Malaysia: An integrated framework.

BACKGROUND: As the vaccination drive against the coronavirus disease (COVID-19) in Malaysia progresses rapidly, the main challenge will gradually shift from procuring and distributing vaccines to ensuring the broadest possible acceptance among all population segments. Therefore, this study used the integrated framework of the health belief model (HBM) and the theory of reasoned action (TRA) to investigate the predictors of intention to receive COVID-19 vaccines in Malaysia. METHODOLOGY: A market research company in Malaysia was engaged to collect data during June 11-20, 2021 using self-administered questionnaires via its online panel, ensuring a nationwide random sample of 804 respondents. A logistic regression was subsequently estimated to determine the significant predictors of vaccination intention. RESULTS: The predictors that significantly affect COVID-19 vaccine hesitancy in Malaysia are age, susceptibility, religious beliefs, attitude, subjective norms, and trust in the vaccine. In particular, those who are more inclined to get vaccinated are older individuals, have a higher perceived risk of infection and social pressure to get vaccinated, have a positive attitude, and have high levels of trust in the vaccine. Individuals' who perceive that their religious beliefs are against vaccination are more likely to exhibit uncertainty toward it. CONCLUSION: This study showed that although a large proportion of respondents indicated that they were willing to be vaccinated against COVID-19, there are concerns about religious barriers and trust in the vaccine that the relevant stakeholders should address. Campaigns should also focus on shaping the nation's attitude toward COVID-19 vaccines, in parallel with encouraging people to use their social influence in helping those in their close circle who are unsure of vaccination to cross the line. These measures will prove to be pertinent as the nation begins to administer booster vaccines to tackle the waning effects of COVID-19 vaccines.

Urologic Oncology Patient Perspectives During COVID-19 Treatment Delays (preprint)

Purpose: The COVID-19 pandemic led to delays in urologic cancer treatment. We sought the patient perspective on these delays. Methods We conducted a mixed methods study with an explanatory-sequential design. Survey findings are presented here. Patients from a Midwestern Comprehensive Cancer Center and the Bladder Cancer Advocacy Network provided demographic and clinical data and responded to statements asking them to characterize their experience of treatment delay, patient-provider communication and coping strategies. We quantified patient distress with an ordinal scale (0-10), based on the National Comprehensive Cancer Network Distress Thermometer (NCCN-DT). Results Forty-four consenting patients responded to the survey. Most were older than 61 years (77%) and male (66%). Their diagnoses included bladder (45%), prostate (30%) and kidney (20%) cancers. Median time since diagnosis was 6 months, 95% had plans for surgical treatment. Dominant reactions to treatment delay included fear that cancer would progress (50%) and relief at avoiding COVID-19 exposure (43%). Most patients reported feeling that their providers acknowledged their emotions (70%), yet 52% did not receive follow up phone calls and only 55% felt continually supported by their providers. Patients’ median distress level was 5/10 with 68% of patients reaching a clinically significant level of distress (≥4). Thematically grouped suggestions for providers included better communication (18%), more personalized support (14%), and better patient education (11%). Conclusion During the COVID-19 pandemic, a high proportion of urologic cancer patients reached a clinically significant level of distress. While they felt concern from providers, they desired more engagement and personalized care.

Determinants of seasonal influenza vaccination hesitancy among healthcare personnel: An integrative review.

AIMS AND OBJECTIVES: To explore the determinants of and behaviour change models for seasonal influenza vaccination compliance among healthcare personnel. BACKGROUND: COVID-19 vaccine hesitancy among healthcare personnel may be better understood by exploring determinants of seasonal influenza vaccine hesitancy. DESIGN: Integrative literature review. METHODS: A systematic search was conducted in accordance with PRISMA guidelines. Six thousand and forty-eight articles were screened. Seventy-eight met inclusion criteria. Due to the heterogeneity of included articles, a narrative synthesis was conducted utilising a conceptual matrix to identify thematic categories. RESULTS: Six thematic categories were identified as influencing HCP SIV compliance: 'perceived vulnerability', 'trust', 'past behaviour', 'professional duty', 'access and convenience' and 'knowledge and experience'. The Health Belief Model (HBM) was the most commonly utilised health behaviour change model within the seasonal influenza vaccination context. Few studies have examined seasonal influenza vaccine acceptance and uptake within the Australian HCP context, particularly involving community care and aged care. CONCLUSIONS: Factors that appear to relate to influenza vaccination compliance among HCP can be grouped according to several thematic categories, and they also appear influential in COVID-19 vaccine uptake. In particular, an emerging focus on 'trust' or the more emotive considerations of decision-making around health-protective behaviours requires further exploration in the context of a pandemic. Efforts to influence these domains to increase compliance, however, are likely to be impeded by a lack of a well-developed and tested behaviour change model. RELEVANCE TO CLINICAL PRACTICE: Healthcare personnel (HCP) face high levels of occupational exposure to seasonal influenza every year. An emerging focus on 'trust' and the more emotive considerations of decision-making around health-protective behaviours requires further exploration in the context of a pandemic.

Impact of COVID-19 pandemic on Functional Urology Practice: A nation-wide survey from Turkey (preprint)

Objective: The Coronavirus pandemic has affected urological practice worldwide. In this study, we aimed to evaluate functional urology practice including outpatient clinic visits, routine examinations, diagnostic procedures and surgical interventions with an online survey. Method We conducted an online survey to evaluate Turkish urologists’ functional urology practices before and during the pandemic. In this survey, we asked questions about the respondents’ place of work, being part of a dedicated pandemic center, involvement with the pandemic and an interest in functional urology. We also examined outpatient clinics, routine examinations, diagnostic methods, and surgical practice before and during the pandemic. Results A total of 152 urologists completed the survey. The majority of the participants, (79.6%) were in tertiary centers. Nearly one-third of respondents (32.2%) stated that more than 50% of their routine practice is related to functional urology. In brief, 80.9% of the participants declared a decrease in the number of outpatient visits for functional urology. 68.4% of the participants declared a decrease in uroflowmetry practice, and 81.3% of had a decrease in urodynamic studies performed. According to respondents, 92.1% stated a decrease in botulinum injections for the bladder, and 93.4% of the participants declared a decrease in anti-incontinence surgery. Eighty-five percent of the participants declared a decrease in prolapse surgery. One-hundred and twenty-eight participants (84.2%) declared a decrease in surgery for benign prostate hyperplasia (BPH). Only 28.9% of the participants responded that they diagnosed their neuro-urology patients as they did prior to the pandemic. Conclusions The daily practice of urology changed, and functional urology was one of the most affected field. The large backlog of functional urology patients is challenging and although conditions, diagnostic tools and surgeries were classed as “benign”, we will have to face the effects of patients’ Quality of life in the near future.

ScRNA-seq discover cell cluster change under OAB: ACE2 expression reveal possible alternation of 2019-nCoV infectious pathway (preprint)

ObjectivePrevious study indicated that bladder cells which express ACE2 were a potential infection route of 2019-nCov. This study observed some differences of bladder cell cluster and their ACE2 expression between OAB mice and healthy mice, indicating the change of infectious possibility and pathway under overactive bladder (OAB) circumstance. Material and methodPubic dataset acquisition was used to get ACE2 expression in normal human bladder and mice bladder (GSE129845). We built up over OAB model and studied the impact on cell typing and ACE2 expression. By way of using single-cell RNA sequencing (scRNA-seq) technique, bladder cell clustering and ACE2 expression in various cell types were measured respectively. ResultIn pubic database (healthy human and mice bladder), ACE2 expression in humans and mice is concentrated in bladder epithelial cells. The disappearance of umbrella cells, a component of bladder epithelial, was found in our OAB model. In the two mouse bladder samples, ACE2 expression of epithelial cells is 34.1%, also the highest of all cell types. ConclusionThe disappearance of umbrella cell may alternate the infection pathway of 2019-nCov and relate to the onset and progression of OAB.