Purpose Common advice for lower urinary tract symptoms (LUTS) of frequency, urgency and related bother includes elimination of potentially irritating beverages (coffee, tea, alcohol, and carbonated and/or artificially sweetened beverages). The purpose of this study was to determine compliance with standardized instruction to eliminate these potentially irritating beverages, whether LUTS improved after instruction, and if symptoms worsened with partial reintroduction. Design The three-phase fixed sequence design was: 1) baseline, 2) eliminate potentially irritating beverages listed above, and 3) reintroduce at 50% of baseline volume, with a washout period between each 3-day phase. We asked participants to maintain total intake volume by swapping in equal amounts of non-potentially irritating beverages (primarily water). Subjects and Setting The study sample comprised 30 community-dwelling women recruited through newspaper advertisement. Methods Quantification measures included 3-day voiding diaries and detailed beverage intake, and LUTS questionnaires completed during each phase. Results During Phase 2, we found significant reduction in potentially irritating beverages but complete elimination was rare. Despite the protocol demands, total beverage intake was not stable; mean (± standard deviation) daily total intake volume dropped by 6.2±14.9oz (p=0.03) during Phase 2. In Phase 3, the volume of total beverage intake returned to baseline, but intake of potentially irritating beverages also returned to near baseline rather than 50% as requested by protocol. Despite this incomplete adherence to study protocols, women reported reduction in symptoms of urge, inability to delay voiding, and bother during both phases (p≤0.01). The number of voids per day decreased on average by 1.3 and 0.9 voids during phases 2 and 3 respectively (p=0.002 and p=0.035). Conclusions Education to reduce potentially irritating beverages resulted in improvement in LUTS. However, eliminating potentially irritating beverages was difficult to achieve and maintain. Study findings do not allow us to determine if LUTS improvement was attributable to intake of fewer potentially irritating beverages, reduced intake of all beverages, the effect of self-monitoring, or some combination of these factors.

Purpose: To test a novel bladder health tutorial on use of the Knack for overcoming bladder control challenges. The Knack-tutorial is a self-administered vignette-based instructional program on preempting bladder challenges in daily life (urgency, stress-leakage, or urge-leakage) through anticipatory, well-timed pelvic floor muscle contraction at the moment of challenge. Materials and Methods: This is a randomized controlled trial pilot test of 108 women with stress or mixed urinary incontinence. The Knack-tutorial group saw a 15-minute slide show with 10 vignettes portraying use of the Knack in daily life. The slide show format used inserted narrated videos, dubbed and animation enhanced pictures and cartoons, and automatic slide advancement. A control group saw a similarly constructed slide show on incorporating good diet/exercise habits. Outcomes were self-perceived improvement (yes/no, and as 0%-100%) 1 month after viewing the tutorial. Results: We enrolled 123 women, randomizing 64 to Knack-tutorial group and 59 to diet/exercise tutorial group. Eleven and one participant, respectively, did not return. Three did not fill out the self-perceived improvement report. Significant improvement was reported by 71% in the Knack-tutorial group compared to 25% in the diet/exercise group ( p < 0.001). Self-perceived improvement was 21%-22% higher (Model I Est: 21.01, SE: 4.25, p < 0.001) in the Knack-tutorial group. Conclusions: An electronic tutorial viewed independent of a health care provider with vignettes showing Knack application to manage the everyday bladder challenges women face shows benefit of a magnitude that warrants more widespread use and rigorous testing. A professional remake of the intervention is now available (www.myconfidentbladder.com).

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A população do Centro da cidade de São Paulo é marcada pela pobreza e por problemas sociais. Não é diferente no bairro do Bom Retiro, onde um grande número de imigrantes - em especial de países sul-americanos, como Bolívia e Paraguai - trabalha em oficinas de costura. Eles são explorados de tal forma que é possível observar vestígios de trabalho escravo, explicitados pelo fato de muitos trabalharem de forma ilegal em nosso país. Nessa população com alta vulnerabilidade, verifica-se alta frequência de crianças com carências nutricionais, já que o trabalho das mães as impede de cuidar adequadamente dos filhos. Buscou-se solucionar essa situação por meio de um projeto que mediasse as relações entre essa população necessitada e a Unidade Básica de Saúde da região, de forma a criar uma fonte de informação, sob a forma de uma cartilha, para instruir essas mães imigrantes quanto aos seus direitos nas políticas de saúde brasileiras e ao seu papel no desenvolvimento dos filhos, no contexto da participação de alunos da Faculdade de Ciências Médicas da Santa Casa no Programa de Reorientação da Formação Profissional em Saúde (Pró-Saúde).