Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 4 uppsatser.

Bakgrund   Icke-maligna prostataförändringar är ett utbrett samhällsproblem och en vanlig anledning till att människor söker sjukvård. Prostatit och benign prostatahyperplasi är två icke-maligna förändringar som kan te sig på olika sätt och kan orsaka lidande hos de drabbade, ofta genom ”lower urinary tract symptoms” och smärta som är vanliga symtom. Att lindra lidande är vårdens uppgift och en sjuksköterskas ansvar.     Syfte Syftet med denna litteraturöversikt var att belysa hur det är att leva med en icke-malign prostataförändring.    Metod  Metoden som användes var icke-systematisk litteraturöversikt där 18 artiklar analyserades.    Resultat Resultatet efter att ha analyserat de inkluderad studierna visade att icke-maligna prostataförändringar kan ha inverkan på samliv och relationer, ge upphov till känslor av skam, rädsla och oro, att det finns faktorer som kan vara mer eller mindre gynnsamma vid dessa tillstånd samt att det finns rum för förbättring vid mötet med sjukvården.   Slutsats Resultatet i denna litteraturöversikt visar på att leva med icke-maligna prostataförändringar och symtomen de ger upphov till kan ha en tydlig inverkan på drabbade personers liv och livskvalitet i ett flertal aspekter / Background Non-malignant prostatic conditions are a prevalent problem in society and a common reason as to why people seek medical care. Prostatitis and benign prostatic hyperplasia are two examples of non-malignant conditions that can appear in different ways and that could cause the afflicted person suffering, oftentimes through symptoms like pain and lower urinary tract symptoms. Alleviating suffering is an undertaking of health-care professionals’ and a nurse’s responsibility.     Aim The aim of this literature review was to illuminate what it is like to live with a non-malignant prostatic condition.    Method Non-systematic literature review where 18 articles were analyzed.     Results The results of the included and analyzed studies show that non-malignant prostatic conditions can influence intimate relationships, cause feelings of shame, fear and worry, that there are factors that can be more or less favourable in relation to these conditions and that there is room for improvement in the meeting with healthcare professionals.    Conclusions The results in this non-systematic literature review show that living with non-malignant prostatic conditions, and the symptoms they cause, can have a significant influence on the affected persons’ lives and quality of life in several aspects.

The overall aim of this thesis was to evaluate methods for urinary catheter handling in patients undergoing hip surgery. The intention was to gain knowledge in order to provide optimal and cost- effective care regarding urinary catheterisation in this group of patients. In Study I , 45 of the 86 catheterised patients (52%) contracted nosocomial urinary tract infections (UTIs). Diabetes was a risk factor for developing UTI, and cloxacillin as a perioperative antibiotic prophylaxis seemed to offer a certain protection. Study II was a randomised controlled trial on the effect of clamping (n = 55) or not (n = 58) of the indwelling urinary catheter before removal. No significant differences were found between the groups with respect to time to normal bladder function, need for recatheterisation, or length of hospital stay. Study III was a randomised controlled trial among patients with hip fracture and hip arthroplasty, in which the patients were randomised to intermittent (n = 85) or indwelling (n = 85) urinary catheterisation. No significant differences in nosocomial UTIs (9% vs. 12%) or cost-effectiveness were shown. The patients in the intermittent group regained normal bladder function significantly sooner after surgery. Fourteen percent of the patients in the intermittent group did not need any catheterisation. In Study IV , 30 patients were interviewed about their experiences of bladder emptying and urinary catheterisation. The patients’ views were described through the main category ‘An issue but of varying impact’. Both bladder emptying through micturition and bladder emptying through catheterisation were described as convenient, but also as uncomfortable and an intrusion on dignity. The patients were aware of risks and complications of urinary catheterisation. In conclusion, this thesis indicates that UTI is common in hip surgery patients. Clamping of indwelling catheters seems not necessary. There is no preference for either intermittent or indwelling urinary catheterisation according to the results of this thesis, either for the development of nosocomial UTI or, for cost-effectiveness, or from the patient perspective. Nurses should be aware that catheterisation might make the patients feel exposed, and it is essential that their practice reflect the best available evidence.

Master of Science / Department of Industrial & Manufacturing Systems Engineering / Malgorzata Rys / Catheter associated urinary tract infections (CAUTIs) are a source of concern in the healthcare industry because they occur more frequently than other healthcare associated infections and the rates of CAUTI have not improved in recent years. The use of urinary catheters is common among patients; between 15 and 25 percent of all hospital patients will use a urinary catheter at some point during their hospitalization (CDC, 2016). The prevalence of urinary catheters in hospitalized patients and high CAUTI occurrence rates led to the application of human factors engineering to develop a tool to help hospitals reduce CAUTI rates. Human reliability analysis techniques are methods used by human factors engineers to quantify the probability of human error in a system. A human error during a catheter insertion has the opportunity to introduce bacteria into the patient’s system and cause a CAUTI; therefore, human reliability analysis techniques can be applied to catheter insertions to determine the likelihood of a human error. A comparison of three human reliability analysis techniques led to the selection of the Cognitive Reliability and Error Analysis Method (CREAM). To predict a patient’s probability of developing a CAUTI, the human error probability found from CREAM is incorporated with several health factors that affect the patient’s risk of developing CAUTI. These health factors include gender, duration, diabetes, and a patient’s use of antibiotics, and were incorporated with the probability of human error using fuzzy logic. Membership functions were developed for each of the health factors and the probability of human error, and the centroid defuzzification method is used to find a crisp value for the probability of a patient developing CAUTI. Hospitals that implement this tool can choose risk levels for CAUTI that places the patient into one of three zones: green, yellow, or red. The placement into the zones depends on the probability of developing a CAUTI. The tool also provides specific best practice interventions for each of the zones.

<p>Urinary tract infections (UTIs) are typically caused by bacteria that colonize different regions of the urinary tract, mainly the bladder and the kidney. Approximately 25% of women that suffer from UTIs experience a recurrent infection within 6 months of the initial bout, making UTIs a serious economic burden resulting in more than 10 million hospital visits and $3.5 billion in healthcare costs in the United States alone. Type-1 fimbriated Uropathogenic E. coli (UPEC) is the major causative agent of UTIs, accounting for almost 90 % of bacterial UTIs. The unique ability of UPEC to bind and invade the superficial bladder epithelium allows the bacteria to persist inside epithelial niches and survive antibiotic treatment. Persistent, intracellular UPEC are retained in the bladder epithelium for long periods, making them a source of recurrent UTIs. Hence, the ability of UPEC to persist in the bladder is a matter of major health and economic concern, making studies exploring the underlying mechanism of UPEC persistence highly relevant. </p><p>In my thesis, I will describe how intracellular Uropathogenic E.coli (UPEC) evade host defense mechanisms in the superficial bladder epithelium. I will also describe some of the unique traits of persistent UPEC and explore strategies to induce their clearance from the bladder. I have discovered that the UPEC virulence factor Alpha-hemolysin (HlyA) plays a key role in the survival and persistence of UPEC in the superficial bladder epithelium. In-vitro and in-vivo studies comparing intracellular survival of wild type (WT) and hemolysin deficient UPEC suggested that HlyA is vital for UPEC persistence in the superficial bladder epithelium. Further in-vitro studies revealed that hemolysin helped UPEC persist intracellularly by evading the bacterial expulsion actions of the bladder cells and remarkably, this virulence factor also helped bacteria avoid t degradation in lysosomes. </p><p>To elucidate the mechanistic basis for how hemolysin promotes UPEC persistence in the urothelium, we initially focused on how hemolysin facilitates the evasion of UPEC expulsion from bladder cells. We found that upon entry, UPEC were encased in “exocytic vesicles” but as a result of HlyA expression these bacteria escaped these vesicles and entered the cytosol. Consequently, these bacteria were able to avoid expulsion by the cellular export machinery. </p><p>Since bacteria found in the cytosol of host cells are typically recognized by the cellular autophagy pathway and transported to the lysosomes where they are degraded, we explored why this was not the case here. We observed that although cytosolic HlyA expressing UPEC were recognized and encased by the autophagy system and transported to lysosomes, the bacteria appeared to avoid degradation in these normally degradative compartments. A closer examination of the bacteria containing lysosomes revealed that they lacked V-ATPase. V-ATPase is a well-known proton pump essential for the acidification of mammalian intracellular degradative compartments, allowing for the proper functioning of degradative proteases. The absence of V-ATPase appeared to be due to hemolysin mediated alteration of the bladder cell F-actin network. From these studies, it is clear that UPEC hemolysin facilitates UPEC persistence in the superficial bladder epithelium by helping bacteria avoid expulsion by the exocytic machinery of the cell and at the same time enabling the bacteria avoid degradation when the bacteria are shuttled into the lysosomes. </p><p>Interestingly even though UPEC appear to avoid elimination from the bladder cell their ability to multiple in bladder cells seem limited.. Indeed, our in-vitro and in-vivo experiments reveal that UPEC survive in superficial bladder epithelium for extended periods of time without a significantly change in CFU numbers. Indeed, we observed these bacteria appeared quiescent in nature. This observation was supported by the observation that UPEC genetically unable to enter a quiescence phase exhibited limited ability to persist in bladder cells in vitro and in vivo, in the mouse bladder. </p><p>The studies elucidated in this thesis reveal how UPEC toxin, Alpha-hemolysin plays a significant role in promoting UPEC persistence via the modulation of the vesicular compartmentalization of UPEC at two different stages of the infection in the superficial bladder epithelium. These results highlight the importance of UPEC Alpha-hemolysin as an essential determinant of UPEC persistence in the urinary bladder.</p> / Dissertation

Thesis advisor: Katherine Hutchinson / Lower urinary tract (LUTS) storage symptoms, including overactive bladder (OAB) and urinary incontinence (UI), are common conditions among women with significant health and economic consequences. Much of the existing literature on LUTS focuses on older, often postmenopausal women, and there is limited research available about prevalence, incidence and severity of LUTS in young women. For many young women in the United States, the period from the late teens through early twenties coincides with the period of emerging adulthood and college enrollment. The unique factors influencing women at this stage of development may be influential in understanding prevalence and correlates of OAB and UI later in the life-course. The purpose of this cross-sectional descriptive survey-based study was to explore and describe the experience of urinary storage symptoms, specifically OAB and UI, among female undergraduate college students, and to identify associated factors. Qualtrics online platform was used to create and distribute the survey to a sample of 1,800 female college undergraduate students at a private Catholic university in the northeast. Two instruments previously used to assess LUTS, the ICIQ-FLUTS and LUTS Tool, were combined into the Urinary Symptoms Scale with a one-week recall. Twelve items assessed LUTS storage symptoms of OAB and UI. The final sample consisted of 456 female undergraduate college students with a mean age of 20.3-years-old. The sample was predominantly White non-Hispanic. Most commonly reported symptoms included urgency (47.6%), frequency (52.6%), urinary incontinence (21.3%), stress urinary incontinence (28.8%), and urge urinary incontinence (16.4%). Total severity scores were low and highly skewed towards the lower range (M = 3.31; SD = 3.91). Participants with symptoms, most commonly reported experiencing symptoms rarely or sometimes during the past week. Perceived bother from urinary symptoms mean scores were low (M = 1.77) but extended the full range on a 0 to 10 scale. In this study, perceived bother from urinary symptoms as well as perceived impact of urinary symptoms on activities of daily life (ADLs) were significantly associated with care-seeking and use of self-management strategies. Interestingly, LUTS storage symptom severity was not significantly associated with care-seeking, but it was related to use of self-management strategies in this population. Perception of overall health, history of constipation/IBS, sexual activity, delayed toileting behaviors, and premature toileting behaviors were significant in multivariate analyses when controlling for other factors. Further research on the relationship of these factors and LUTS storage symptoms is needed. This study represented a first step in understanding college women’s experiences with LUTS storage symptoms and identifying the unique personal, behavioral and environmental factors associated with LUTS. The study found that OAB and UI symptoms are common among female college undergraduates. In addition, a number of personal and behavioral factors were found to be associated with LUTS storage symptoms. Given that many health-related behaviors established during college years may persist later in adulthood, identifying experiences and influences of young women’s LUTS storage symptoms is important in informing future research and practice recommendations. / Thesis (PhD) — Boston College, 2018. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Para avaliar as fibras elásticas na junção vésico-uretral de ratos, em diferentes faixas etárias, realizou-se estudos histológicos, microscopia elêtronica e histomorfometria. O estudo histológico do sistema de fibras elásticas mostrou a presença dos três tipos de fibras elásticas, em todas as faixas etárias, a microscopia eletrônica de transmissão, mostrou as diferenças ultra-estruturais entre as fibras elásticas. A avaliação histomerfométrica revelou diminuição na densidade linear das fibras elásticas e oxitalânicas e aumento na das elaunínicas. Na junção vésico-uretral de animais velhos, há uma queda nas propriedades de elasticidade, recuo elástico e ancoragem, que são compensadas pelas fibras elaunínicas. O processo de envelhecimento das fibras elásticas na junção vésico-uretral não contribui sozinha e diretamente no estado de incontinência urinária, mas compensa e dá suporte a muscular, devido ao aumento das fibras elaunínicas, o que torna o sistema elástico na junção vésico-uretral indiretamente responsável pela manutenção da continência urinária. / To evaluate the elastic fibers in the junctio vesico-urethral of the rat, in different age groups, was accomplished studies histologics, electron microcopy and histomorphometrics. Study histologic showed the presence of the three types elastic fibers in all the studied age groups, electron microcopy showed the ultra-structural differences amoung elastic fibers. Histomorphometric studies revealed a decrease the linear density of the mature elastic fibers and oxytalans and an increase elaunin. In the junction vesico-urethral of the old animals there is a fall the properties elastic, elastic recoil and achorage, but they are compensated by elaunins. Processs aging of the elastic system in this place doesn?t contribute alone or directly in urinary incontinence, but it is indirectly responsible for the maintenance urinary continence.

Properties of Escherichia coli considered to be of importance in overcoming host defence mechanisms against urinary tract infection (OTI) were investigated. These were: 1) 0 and H serotype 2) K antigen content 3) Sensitivity to the bactericidal activity of human serum 4) Haemolysin production 5) Fimbriae production 6) Fermentation of sucrose, salicin and dulcitol 7) Sensitivity to serine, spermine and urea 8) Growth requirements 9) Mucinase production Ecoli strains isolated from normal subjects and patients attending the Nephrourological Clinic at St. Bartholomew's Hospital because of known or suspected UTI, were studied. Strains isolated from urines more frequently belonged to 0 serogroups 2,4,6,8,18ab and 75, had high K antigen titres, were haemolytic and fimbriate, and fermented salicin than periurethral strains from normal subjects. These findings support the concept of "special pathogenicity", that certain strains are more invasive for the urinary tract than others. Strains rich in these "pathogenic properties" were rarely isolated from normal subjects but were significantly more frequently isolated from periurethral swabs of patients. Periurethral strains from symptomatic, abacteriuric (urethral syndrome) patients were similar to those from bacteriuric patients when they were between infections. Previous work has not implicated bacteria in the aetiology of most cases of this disease and this finding remains unexplained. Strains isolated from the upper tracts of patients undergoing localisation tests more frequently exhibited pathogenic properties than those isolated from only the lower tract, and this was considered to reflect the superior ability of these strains to reach the upper tract or better combat host defence mechanisms.

"Bacterial infections persist as a public threat due to the ease by which bacteria adapt to commonly used antibiotics. In addition, bacteria on surfaces develop protective communities called biofilms that hinder the ability of antibiotics to completely eliminate the pathogens. The rapid development of bacterial resistance to antibiotics has made pharmaceutical companies reluctant to fund new antibiotics research. Hence, novel approaches to prevent and treat infections are needed. The development of infections can be divided into three steps: adhesion, invasion and multiplication. Antibiotics target at the latter two step and are prone to bacterial resistance as passive strategies. Bacterial adhesion to host cells/implanted medical devices is the first step leading to following invasion and multiplication. However, fundamental understanding of bacterial adhesion process is still lacking. The current studies are aimed to systematically investigate biological interactions between pathogenic bacteria and host cell, proteins and biomaterials with both macro and micro scale approaches. The macro scale methods include bacterial adhesion assay, viability studies, and thermodynamic modeling. The micro scale methods include direct adhesion force measurements, ultra surface visualization via atomic force microscopy (AFM) and surface structure modeling. Our work combines experiments and modeling aimed at understanding the initial steps of the bacterial adhesion process, focusing on two case studies: 1) Mechanisms by which cranberry can prevent urinary tract infections through interfering with bacterial adhesion; and 2) Design of anti-adhesive and antimicrobial coatings for biomaterials. We make direct adhesion force measurements between bacteria and substrates with an atomic force microscope (AFM), and combine such experiments with thermodynamic calculations, in order to develop a set of tools that allows for the prediction of whether bacteria will attach to a given surface. These fundamental investigations of the bacterial adhesion process help elucidate the underlying mechanisms behind bacterial adhesion, thus leading to improved clinical outcomes for a number of biomedical applications. "