Cognitive function evaluation in premenstrual syndrome during the follicular and luteal phases using near-infrared spectroscopy.

Background: Many adult females experience periodic mental and physical symptoms associated with premenstrual syndrome (PMS). Diagnosis of PMS is generally based on self-reported symptoms over several menstrual cycles, but there are concerns about its accuracy and duration. It is well known that decreased cognitive function is one of the symptoms of PMS. Near-infrared spectroscopy (NIRS) is one of the methods for imaging brain activity, similar to magnetic resonance imaging (MRI), electroencephalography (EEG), and positron emission tomography (PET). NIRS has been used to assess cognitive function decline demonstrated by decline in brain activity. However, to the best of our knowledge, there have been no report characterizing brain activity pattern in females with PMS during the luteal and follicular phases separately. Objective: We aimed to characterize the cognitive function of females with PMS during the follicular and luteal phases using NIRS. Methods: The level of brain activity in the prefrontal cortex was detected with NIRS while PMS women were performing cognitive tasks. NIRS detected brain activity by measuring the oxy-hemoglobin and deoxy-hemoglobin levels. Participants were females between the ages of 20 and 25 with PMS (n = 11) and without PMS (n = 11). During the participants' follicular and luteal phases, the participants were asked to perform the cognitive task; an N-back task (0-, 1-, and 2-back tasks), which is widely used for assessing cognitive function. We also calculated the oxyhemoglobin integral value during the N-back task using the NIRS signal; this value represented the total amount of change in cerebral oxyhemoglobin and the brain activation level. Results: The correct response rate on the 2-back task was significantly lower during both the follicular and luteal phases in females with PMS compared to that in females without PMS (P = 0.01; P = 0.02, during the follicular and luteal phases, respectively). During the luteal phase, brain activation was significantly lower in participants with PMS than in that in females without PMS (P = 0.04). In addition, during the luteal phase, the participants with PMS also had higher negative mood than those without PMS. Conclusion: The cognitive decline during the luteal phase in participants with PMS was detected by NIRS with significant differences from participants without PMS. The difference was observed only during the luteal phase, not in the follicular phase and were related to the increase in negative mood. These results may provide an objective method for diagnosing PMS based on brain activity. We believe that the use of instruments (e.g., NIRS, MRI, EEG … etc.) to detect cognitive function decline will lead to rapid and reliable diagnosis of PMS and premenstrual dysphoric disorder.

Development of primary design guidelines for supportive underwear to elevate the bladder neck in women based on finite element analysis of the pelvis.

The use of supportive underwear has been applied for preventing stress urinary incontinence (SUI) which is caused by descent of the bladder neck due to weakness in the pelvic floor muscles, because it is known that SUI can be improved by elevating the descended bladder neck. However, appropriate approaches to the underwear design are still being explored. In order to establish an appropriate first-order design strategy for supportive underwear, clarifying the relationship between the pressure from the underwear and the amount of elevation of the bladder neck is necessary. We constructed a finite element model of the pelvis based on magnetic resonance images of a subject in an upright position, experimentally explored Young's modulus of the soft tissue and analyzed the amount of elevation of the bladder neck when changing the combination of applied pressures from the underwear. The position of the bladder neck relatively elevated when the pressure in the region from the abdomen to the pubis decreased and when the pressure in the region from the perineum to the coccyx increased, suggesting an appropriate design for the supportive underwear.

Effects of wearing supportive underwear versus pelvic floor muscle training or no treatment in women with symptoms of stress urinary incontinence: an assessor-blinded randomized control trial.

INTRODUCTION AND HYPOTHESIS: In our previous single-arm pilot study, we reported that ready-made supportive underwear (shaper) was effective in elevating the bladder neck and reducing urinary incontinence (UI) symptoms. The aim of this study was to determine the effects of wearing a shaper compared with pelvic floor muscle training (PFMT) at home using a training compact disc with music, or no treatment, in an assessor-blinded randomized control trial, on reducing UI symptoms. METHODS: Participants aged 30-59 years with symptoms of stress urinary incontinence were randomly assigned to three groups: the shaper group, PFMT group, and no treatment group. The UI episodes/week and the Japanese version of the International Consultation on Incontinence Questionnaire Short-Form were compared between the baseline and the 6th or 12th week of the intervention period. RESULTS: Eighty-nine women who completed the 12-week intervention period were analyzed. After the 12-week intervention period, the improvement rate in UI symptoms (ratio of the case number in which the UI episodes/week decreased at least 50% from the baseline) was 73.3% (22/30 women) in the shaper group, 74.2% (23/31 women) in the PFMT group, and 25.0% (7/28 women) in the no treatment group. The improvement rate in UI symptoms in the shaper and PFMT groups was significantly higher than that in the no treatment group (both P < 0.001). CONCLUSIONS: Wearing supportive underwear (shaper) was almost as effective as PFMT at home in reducing UI symptoms.

Prevalence and Risk Factors of Urinary Incontinence and Overactive Bladder in Japanese Women.

OBJECTIVES: The prevalence of storage symptoms, including stress urinary incontinence (SUI) and overactive bladder (OAB), is high in women worldwide. In Japan, there have been few large-scale epidemiological surveys of lower urinary tract symptoms (LUTS), and the risk factors for these symptoms are unclear. The aim of this study was to explore the prevalence and risk factors of storage symptoms in Japanese women. METHODS: A cross-sectional Internet survey was conducted in Japan. Five thousand women aged 20-79 years were selected to answer demographic questionnaires, Japanese version of International Consultation on Incontinence Questionnaire-Short Form, and the Overactive Bladder Symptom Score (OABSS) pertaining to their symptoms in the previous month. Descriptive statistics were used to evaluate the prevalence of storage symptoms. Logistic regression analysis was performed to determine risk factors for SUI and OAB. RESULTS: The answers from 4804 women (average age, 40.4 years) were analyzed. The prevalence of SUI was 16.7% (SUI, 13.0%; mixed urinary incontinence, 3.7%). The prevalence of OAB diagnosed on OABSS was 8.1%. The prevalence of SUI and OAB symptoms increased with age, and 68.0% of women had one or more storage symptoms. Age ≥40 years, body mass index ≥25 kg/m2 , and constipation were common risk factors for SUI and OAB. Childbirth was an additional risk factor for SUI. CONCLUSIONS: The prevalence of storage symptoms in Japanese women was high, and risk factors associated with these symptoms were similar to those reported in studies in other countries.

Single-Arm Pilot Study to Determine the Effectiveness of the Support Power of Underwear in Elevating the Bladder Neck and Reducing Symptoms of Stress Urinary Incontinence in Women.

OBJECTIVES: To verify the effectiveness of support power of underwear (the shaper) to elevate bladder neck and to reduce symptoms of stress urinary incontinence (SUI). METHODS: This was a single-arm pilot study conducted in Japan by using the shaper (SLIM-up-Pants with Style Science, Wacoal Corporation, Kyoto, Japan). The bladder neck position in a sitting posture was recorded using an open-configuration magnetic resonance system and then compared between parous women with SUI, without and with the shaper. Women wore the shaper during the daytime for 12 weeks, followed by one week during which they did not wear the shaper. The symptoms of urinary incontinence (UI) were assessed based on the 1-h pad test, the Japanese version of the International Consultation Incontinence Questionnaire-Short Form, and the incontinence diary. RESULTS: Forty-five Japanese women with SUI, aged between 27 and 65 years, were included. When the shaper was worn, the bladder neck was found to be significantly elevated by 11.5 mm (median; P < 0.05/6 = 0.008). After 12 weeks, all symptoms of UI decreased significantly (P < 0.05/3 = 0.016), and the bladder neck was further elevated by 4.7 mm (median; P < 0.001) even when not wearing the shaper. In addition, after one week of not wearing the shaper, the bladder neck position remained elevated and symptoms of UI did not recur immediately. CONCLUSION: The shaper was considered to be effective in elevating the bladder neck and reducing symptoms of UI.

Impact of dietary folate intake on depressive symptoms in young women of reproductive age.

INTRODUCTION: Folate deficiencies may be linked to depressive disorders among persons suffering from neurological and psychiatric problems. The purpose of the present study was to evaluate the impact of dietary folate intake on depressive symptoms in young Japanese women of reproductive age. METHODS: The study was conducted in Japan in 2009 with 141 Japanese women aged 18 to 28 years. A Japanese version of the Center for Epidemiologic Studies Depression (CES-D) scale was used to screen for depressive symptoms. Dietary intake was investigated by a diet history questionnaire. Nonfasting blood samples were collected from the women to measure folate and homocysteine levels. RESULTS: The proportion of women with lower folate intake (< 240 µg/d) was significantly higher in the women with CES-D scores greater than or equal to 19 when compared with the folate levels in those with CES-D scores less than 19 (75.0% vs 43.6%, respectively; P < .001). Logistic regression analysis revealed significant associations between CES-D scores greater than or equal to 19, low folate intake, and low vitamin B(6) intake when adjusted for age, living status, smoking, and body mass index. Adequate folate intake of more than the recommended dietary allowance (RDA) level of 240 µg per day was independently related to a decreased risk of depression (adjusted odds ratio 0.22; 95% confidence interval, 0.11-0.56; P < .001). DISCUSSION: Multiple logistic regression analysis revealed a reduced incidence of depression in women whose intake of folate exceeded the RDA of 240 µg per day. This finding suggests that dietary folate intake may be causally related to depressive symptoms in women of reproductive age. If results of studies powered to determine causal relationships are similarly positive, folate supplementation could reduce the incidence of depression.