J Gerontol A Biol Sci Med Sci. 2002 Sep;57(9):M583-7.
Vitamin B(12) deficiency and incontinence: is there an association?
Endo JO, Chen S, Potter JF, Ranno AE, Asadullah S, Lahiri P.
Section of Geriatrics and Gerontology, Department of Internal Medicine, University of Nebraska-Lincoln. Mason District Hospital, Havana, Illinois, USA.
BACKGROUND: This study investigated the relationship between B(12) (cobalamin) levels and incontinence in older outpatients using secondary data analysis. METHODS: Between 1991 and 1999, there were 929 patients (258 men and 671 women) for whom urinary incontinence (UI), fecal incontinence (FI), and B(12) were prospectively recorded. Covariates included race, gender, age, medications, Mini-Mental State Examination, modified illness rating, and instrumental activities of daily living (IADLs). RESULTS: Some form of incontinence (UI or FI or both) was found in 41% of subjects, isolated UI in 34%, double incontinence (DI) in 12%, and isolated FI in 4%. Having UI increased the risk of also having FI (p <.0001). Serum B(12) levels of 300 pg/ml or less were not predictive of isolated UI or isolated FI. However, in logistic regression, DI was predicted by B(12) (odds ratio [OR] = 2.113, p =.0094), IADLs (OR = 0.810, p <.0001), cathartics/laxative use (OR = 1.902, p =.126), and diuretic use (OR = 2.226, p =.006). Considering isolated UI in women, higher IADLs reduced risk of UI (OR = 0.956, p =.002), while diuretics (OR = 1.481, p =.041) and antihistamines (OR = 1.909, p =.046) both increased risk of UI. In men, only use of anticonvulsant medications (OR = 4.529, p =.023) increased risk of isolated UI. Greater physical illness in both genders increased risk of isolated FI (OR = 1.204, p =.006). CONCLUSIONS: These findings suggest that serum B(12) at levels of 300 pg/ml or less are not associated with isolated UI or isolated FI but may play a role in DI. A possible association of low B(12) levels with DI is intriguing because of the implications for treatment and prevention. More
J Clin Nurs. 2002 Sep;11(5):603-12.
Older people seeking solutions to constipation: the laxative mire.
Annells M, Koch T.
MP Annells Research, Adelaide, Australia.
This article reports an extensive descriptive survey of 90 older people (65+ years) living in the community who sought through in-depth, semistructured interviews to explore their experiences and responses to constipation. The composite story of these older people is that seeking a solution to constipation may be fraught with great difficulty. Most commonly tried are laxatives, yet laxative use can be like a mire. The older people tend to be uncertain of which way to turn to avoid getting stuck in a murky conglomeration of laxative options. The imperative for self-management of constipation is strong amongst most of the older people and the process in which they engage when seeking for a solution is discussed. There is an evident frustrating lack of readily identifiable and accessible services and information that could help them navigate successfully through or around this mire. "Through the mire" would be the appropriate use of suitable laxatives with minimal side-effects. "Around the mire" would be the gaining of useful solutions other than laxative use. Solutions may be strategies to prevent constipation or to treat constipation. The needs of these older people seeking solutions to constipation are grouped into two main categories: provision of accessible, empathetic and useful advice about affordable solution choices, and accessibility to solutions, including laxatives, where evidence-based knowledge informs selection or prescription of the solution. Eight major recommendations, including research suggestions, are offered for consideration.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12201887&dopt=Abstract constipation laxative
Arch Latinoam Nutr. 2002 Mar;52(1):20-8.
[Effects of secretory and osmotic diarrhea on rats intestinal function and morphology]
[Article in Spanish]
de Lima de Mon M, Cioccia AM, Gonzalez E, Hevia P.
Escuela de Medicina Luis Razetti, Universidad Central de Venezuela (UCV), Laboratorio de Nutricion Universidad Simon Bolivar, Venezuela.
In order to compare intestinal morphology and function, diarrhea was produced in rats using laxatives in the diet. The 14 day study included two groups of rats with diarrhea (osmotic or secretory), two groups without diarrhea but with a degree of malnutrition which was similar to that seen in the rats with diarrhea (malnourished without diarrhea) and a well-nourished group (control). The inclusion of laxatives(lactose or bisoxatin acetate) cause a reduction in food intake, diarrhea an malnutrition. It also caused a reduction in dietary protein and fat digestibility which was proportional to the severity of diarrhea and more pronounced in secretory diarrhea. In the malnourished rats without diarrhea, malnutrition did not affect their absorptive function. Both in the rats with secretory and osmotic diarrhea an intestinal hypertrophy was observed. This hypertrophy was proportional to the severity of diarrhea and independent of its aetiology. In the intestines of the rats with both types of diarrhea there was inflammation, a greater number of mitotic figures but the flattening of the villi seen in the malnourished rats without diarrhea was not seen. In osmotic diarrhea there was, in addition, a patchy damage of the surface of the jejunal mucosa and an increment in the number of goblet cells, indicating a more severe intestinal deterioration. Since despite this greater deterioration, these rats absorbed more protein and fat we concluded that the alterations in intestinal morphology seen in this study was not predictive of intestinal function. The study also showed that diarrhea had a trophic effect on the intestine which did not occur in malnourished rats wit
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