The validity and reliability of the neurogenic bladder symptom score.

PURPOSE: The neurogenic bladder symptom score is a tool to measure urinary symptoms and consequences in patients with acquired or congenital neurogenic bladder. We describe score validity and reliability. MATERIALS AND METHODS: Exploratory factor analysis was used to assess item variability and subscale structure. Reliability was assessed by the Cronbach α and correlation with retest data. Validity was assessed with a priori hypotheses specifying relationships with the AUASS (American Urological Association symptom score), ICIQ-UI (International Consultation on Incontinence-Urinary Incontinence) and urinary specific quality of life SF-Qualiveen questionnaires, and a self-assessed global bladder problem score. Known groups analysis was used to further assess construct validity. RESULTS: A cohort of 230 patients with spinal cord injury (35%), multiple sclerosis (59%) and congenital neurogenic bladder (6%) were included in study. Factor analysis suggested 3 neurogenic bladder symptom score domains, including incontinence, storage and voiding symptoms, and consequences. Overall internal consistency was high (Cronbach α=0.89). Test-rest reliability was also excellent with an ICC2,1 of 0.91. Validity was demonstrated by the confirmation of hypothesized correlations with the AUASS, ICIQ-UI and SF-Qualiveen, and significant differences in neurogenic bladder symptom score scores among known groups. Patients with a history of seeing a urologist had a significantly higher mean score, as did those with a higher global bladder problem score (22.1 vs 17.1 and 22.1 vs 12.6, respectively, each p<0.001). CONCLUSIONS: The neurogenic bladder symptom score, developed specifically to assess symptoms and consequences associated with neurogenic bladder dysfunction, has appropriate psychometric properties. Depending on the measurement need individual domains may be selected or it can be used as a comprehensive score.

The conceptualization and development of a patient-reported neurogenic bladder symptom score.

BACKGROUND: There is no single patient-reported instrument that was developed specifically to assess symptoms and bladder-related consequences for neurogenic bladder dysfunction. The purpose of this study was to identify and consolidate items for a novel measurement tool for this population. METHODS: Item generation was based on a literature review of existing instruments, open-ended semistructured interviews with patients, and expert opinion. Judgment-based item reduction was performed by a multidisciplinary expert group. The proposed questionnaire was sent to external experts for review. RESULTS: Eight neurogenic quality of life measures and 29 urinary symptom-specific instruments were identified. From these, 266 relevant items were extracted and used in the creation of the new neurogenic symptom score. Qualitative interviews with 16 adult patients with neurogenic bladder dysfunction as a result of spinal cord injury, multiple sclerosis, or spina bifida were completed. Dominant themes included urinary incontinence, urinary tract infections, urgency, and bladder spasms. Using the literature review and interview data, 25 proposed items were reviewed by 12 external experts, and the questions evaluated based on importance on a scale of 1 (not important) to 5 (very important). Retained question domains had high mean importance ratings of 3.1 to 4.3 and good agreement with answer hierarchy. CONCLUSION: The proposed neurogenic bladder symptom score is a novel patient-reported outcome measure. Further work is underway to perform a data-based item reduction and to assess the validity and reliability of this instrument.

Forty-five-year mortality rate as a function of the number and type of psychiatric diagnoses found in a large Danish birth cohort.

OBJECTIVE: Psychiatric comorbidities are common among psychiatric patients and typically associated with poorer clinical prognoses. Subjects of a large Danish birth cohort were used to study the relation between mortality and co-occurring psychiatric diagnoses. METHOD: We searched the Danish Central Psychiatric Research Registry for 8109 birth cohort members aged 45 years. Lifetime psychiatric diagnoses (International Classification of Diseases, Revision 10, group F codes, Mental and Behavioural Disorders, and one Z code) for identified subjects were organized into 14 mutually exclusive diagnostic categories. Mortality rates were examined as a function of number and type of co-occurring diagnoses. RESULTS: Psychiatric outcomes for 1247 subjects were associated with 157 deaths. Early mortality risk in psychiatric patients correlated with the number of diagnostic categories (Wald χ² = 25.0, df = 1, P < 0.001). This global relation was true for anxiety and personality disorders, but not for schizophrenia and substance abuse, which had intrinsically high mortality rates with no comorbidities. CONCLUSIONS: Risk of early mortality among psychiatric patients appears to be a function of both the number and the type of psychiatric diagnoses.

The contribution of parental alcohol use disorders and other psychiatric illness to the risk of alcohol use disorders in the offspring.

BACKGROUND: Few population-based studies have investigated associations between parental history of alcoholism and the risk of alcoholism in offspring. The aim was to investigate in a large cohort the risk of alcohol use disorders (AUD) in the offspring of parents with or without AUD and with or without hospitalization for other psychiatric disorder (OPD). METHODS: Longitudinal birth cohort study included 7,177 men and women born in Copenhagen between October 1959 and December 1961. Cases of AUD were identified in 3 Danish health registers and cases of OPD in the Danish Psychiatric Central Register. Offspring registration with AUD was analyzed in relation to parental registration with AUD and OPD. Covariates were offspring gender and parental social status. RESULTS: Both maternal and paternal registration with AUD significantly predicted offspring risk of AUD (odds ratios 1.96; 95% CI 1.42 to 2.71 and 1.99; 95% CI 1.54 to 2.68, respectively). The association between maternal, but not paternal, OPD and offspring AUD was also significant (odds ratios 1.46; 95% CI 1.15 to 1.86 and 1.26; 95% CI 0.95 to 1.66, respectively). Other predictors were male gender and parental social status. A significant interaction was observed between paternal AUD and offspring gender on offspring AUD, and stratified analyses showed particularly strong associations of both paternal and maternal AUD with offspring AUD in female cohort members. CONCLUSIONS: Parental AUD was associated with an increased risk of offspring AUD independent of other significant predictors, such as gender, parental social status, and parental psychiatric hospitalization with other diagnoses. Furthermore, this association appeared to be stronger among female than male offspring. The results suggest that inherited factors related to alcoholism are at least as important in determining the risk of alcoholism among daughters as among sons.

Effects of premature birth on the risk for alcoholism appear to be greater in males than females.

OBJECTIVE: A large Danish birth cohort was used to test the independent and joint effects of perinatal measures associated with premature birth as predictors of the development of alcoholism in male and female subjects. METHOD: Subjects were born at the Copenhagen University Hospital between 1959 and 1961 (N = 9,125). A comprehensive series of measures was obtained for each of the 8,109 surviving and eligible infants before birth, during birth, shortly after birth, and at 1 year. The adult alcoholism outcome was defined as any ICD-10 F10 diagnosis (Mental and behavioral disorders due to alcohol use) or an equivalent ICD-8 diagnosis found in the Danish Psychiatric Central Research Register or the Municipal Alcohol Clinics of Copenhagen by 2007. RESULTS: Multiple perinatal markers of premature birth independently predicted the development of an alcoholism diagnosis in male (n = 310) but not female (n = 138) subjects. Logistic regression modeling with a global prematurity score, adjusted for social status, maternal smoking, and gender, indicated a significant association of prematurity score for males (p < .02), but not females (p = .51), on the risk of developing an alcohol use disorder. CONCLUSIONS: The results suggest that neurodevelopmental sequelae of premature birth are associated with gender-specific effects on the development of alcoholism in the male baby: small, premature, or growth-delayed male babies appear to be selectively vulnerable to alcoholic drinking years later. The findings implicate neurodevelopmental influences in alcoholism pathophysiology in males and suggest the possibility of distinct, gender-specific pathways in the etiology of severe problem drinking.