Prevalencia de incontinencia urinaria y vejiga hiperactiva en la población española: Resultados del estudio EPICC

doi:10.1016/S0210-4806(09)74117-8

Actas Urológicas Españolas

Volume 33, Issue 2, 2009, Pages 159-166

https://doi.org/10.1016/S0210-4806(09)74117-8 Get rights and content

Resumen

Introducción

A pesar del creciente interés que despiertan en nuestro país la Incontinencia Urinaria (IU), la enuresis nocturna y la Vejiga Hiperactiva (VH), no existe ningún estudio epidemiológico que evalúe la prevalencia de estas patologías en los diferentes grupos sobre los que se asientan, de la población general de España.

Pacientes y método

Estudio epidemiológico, observacional, multicéntrico y de ámbito nacional. Se recogieron datos, a través de encuestas en 5 áreas representativas de todo el ámbito nacional y en cuatro grupos de la población: 1) Mujeres, laboralmente activas (entre 25 y 64 años); 2) Varones, laboralmente activos (entre 50 y 64 años); 3) Niños en enseñanza primaria (entre 6 y 11 años); y 4) Personas mayores de 65 años institucionalizadas con nivel cognitivo conservado. La encuesta a población adulta y ancianos incluía dos partes: 1) variables socio-demográficas y antecedentes de la historia clínica; y 2) sobre síntomas de VH e IU. La encuesta a niños incluía variables socio-demográficas y sobre ingesta de líquidos y control de la orina.

Resultados

El porcentaje de respuesta en los diferentes grupos del estudio osciló entre el 79,7% y el 98%. La prevalencia de VH y de IU aisladas en mujeres laboralmente activas fue de 2,69% y 4,01% respectivamente; en varones fue de 3,55% y 0,56%; en personas de más de 65 años fue de 9,14% y 15,16%. En conjunto el 9,94% (95% IC= 8,9–11,04) de las mujeres estudiadas padecían una o las dos patologías, porcentaje que fue de 5,14% (95% IC= 3,89–6,63) para varones y de 53,71% (95% IC= 50,56–56,85) para personas de más de 65 años. La prevalencia de enuresis nocturna en niños fue de 7,82% (95% IC= 6,62–9,17).

Conclusión

La prevalencia de VH y/o IU en España se acerca al 10% en mujeres entre 25 y 64 años, está alrededor del 5% en varones entre 50 y 65 años y es superior al 50% en personas de más de 65 años de ambos sexos; la prevalencia de enuresis nocturna en niños entre 6 y 11 años está alrededor del 8%.

Background

Despite the growing interest on Urinary Incontinence (UI) in our country, nocturnal enuresis and Overactive Bladder (OAB), there are no epidemiologic studies on the prevalence of these health problems in the different affected groups of the general population.

Patients and methods

This is an epidemiologic, observational, multicentre and national study. Data were collected by means of personal interviews in 5 representative areas from Spain and in 4 groups of population: 1) working women (25- 64 years old); 2) working men (50-64 years old); 3) children attending primary school (6-11 years old); and 4) elderly institutionalized subjects (over 65 years old) with no mental impairment. The Interview addressed to adult population included two parts: 1) socio-demographic variables and clinical history; and 2) data about OAB and UI symptoms. The Interview addressed to children included socio-demographic variables and questions about liquid intake and urine control.

Results

Percentage of answer to interview in the different groups varied between 79.7% and 98%. Prevalence of isolate OAB and UI in working women were 2.69% and 4.01% respectively; in men were 3.55% and 0.56%; in elderly were 9.14% and 15.16%. In total, 9.94% (95%CI = 8.9–11.04) of the women under study suffer one or both health problems; this percentage was 5.14% (95% CI= 3.89–6.63) in men and 53.71% (95% CI= 50.56–56.85) in elderly. Prevalence of nocturnal enuresis in children was 7.82% (95% CI= 6.62–9.17).

Conclusions

Prevalence of OAB and/or UI in Spain is near 10% of women between 25 and 64 years, is around 5% in men between 50 and 64 years and it is over 50% in persons over 65 years; prevalence of nocturnal enuresis in children between 6 and 11 years is around 8%.

Referencias (36)

E. Martínez Agulló
Terminología de la función del tracto urinario inferior
Actas Urol Esp
(2005)
K.S. Coyne et al.
The impact of urinary urgency and frequency on health-related quality of life in overactive bladder: results from a national community survey
Value Health
(2004)
M.J. Modroño Freire et al.
[Study of the prevalence of urinary incontinence in women from 18 to 65 and its influence on their quality of life]
Aten Primaria
(2004)
A.J. Huang et al.
Urinary incontinence and pelvic floor dysfunction in Asian-American women
Am J Obstet Gynecol
(2006)
C. Teloken et al.
Overactive bladder: prevalence and implications in Brazil
Eur Urol
(2006)
J.G. Wen et al.
An epidemiological study of primary nocturnal enuresis in Chinese children and adolescents
Eur Urol
(2006)
P.M. Espuña
[Urinary incontinence in women]
Med Clin (Barc
(2003)
S. Hunskaar et al.
The prevalence of urinary incontinence in women in four European countries
BJU Int
(2004)
R. Botlero et al.
Prevalence and incidence of urinary incontinence in women: review of the literature and investigation of methodological issues
Int J Urol
(2008)
S.L. Tennstedt et al.
Prevalence of and risk factors for urine leakage in a racially and ethnically diverse population of adults: the Boston Area Community Health (BACH
Am J Epidemiol
(2008)

A.C. Diokno et al.

Prevalence of urinary incontinence in community dwelling men: a cross sectional nationwide epidemiological survey

Int Urol Nephrol

(2007)

J.T. Anger et al.

Urologic Diseases of America Project, The prevalence of urinary incontinence among community dwelling men: results from the National Health and Nutrition Examination survey

J Urol

(2006)

D.V. Espino et al.

Prevalence and severity of urinary incontinence in elderly Mexican-American women

J Am Geriatr Soc

(2003)

V.A. Minassian et al.

Urinary incontinence in women: variation in prevalence estimates and risk factors

Obstet Gynecol

(2008)

Y. Dooley et al.

Urinary incontinence prevalence: results from the National Health and Nutrition Examination Survey

J Urol

(2008)

K.S. Kinchen et al.

The prevalence, burden, and treatment of urinary incontinence among women in a managed care plan

J Womens Health (Larchmt

(2007)

J.T. Anger et al.

Urologic Diseases of America Project. The prevalence of urinary incontinence among community dwelling adult women: results from the National Health and Nutrition Examination Survey

J Urol

(2006)

N. Fultz et al.

management and impact of urinary incontinence in the workplace

Occup Med (Lond

(2005)

Cited by (79)

The association between physical activity and urinary incontinence among adults residing in Spain
2023, Science and Sports
To explore the association between physical activity (PA) and urinary incontinence (UI) in Spain.
Cross-sectional data from the Spanish National Health Survey 2017 were analyzed. The International Physical Activity Questionnaire (IPAQ) short form was used to measure level of PA (exposure), and sufficient PA corresponded to at least 600 MET-minutes/week. UI (outcome) was self-reported in response to the question “Have you ever been diagnosed with UI?”. Multivariable logistic regression was used to assess associations overall, by sex, and by age group (15–40, 41–64, 65–69 years). Logistic regression models were adjusted for sex (except sex-stratified analyses), age, marital status, education, smoking, alcohol, obesity, hypertension, diabetes, osteoarthritis, chronic back pain, injury, asthma, thyroid dysfunction, depression, and anxiety.
This study included 17,777 participants [48.0% of males; mean (SD) age 45.8 (14.1) years]. The prevalence of sufficient PA and UI was 69.8% and 2.4%, respectively. After adjustment for potential confounders, doing at least 600 MET-minutes/week of PA was negatively associated with UI [odds ratio (OR) = 0.67; 95%CI = 0.55–0.83]. This finding was corroborated in women (OR = 0.62; 95%CI = 0.48–0.80), participants aged 15–40 years (OR = 0.40; 95%CI = 0.20–0.79) and those aged 41–64 years (OR = 0.71; 95%CI = 0.55–0.93), but not in men (OR = 0.81; 95%CI = 0.57–1.16) and those age 65–69 years (OR = 0.72; 95%CI = 0.47–1.09).
Participation in PA is negatively associated with UI. Although further research is needed to explore the direction of this association, PA should be promoted in people with UI, especially in women and young and middle-aged adults.
Explorer l’association entre activité physique (AP) et incontinence urinaire (IU) chez des adultes en Espagne.
Les données transversales de l’Enquête Nationale Espagnole sur la Santé de 2017 ont été analysées. L’International Physical Activity Questionnaire (IPAQ) a été utilisé pour mesurer le niveau d’AP (variable indépendante), et une AP suffisante correspondait à un équivalent métabolique d’au moins 600 minutes par semaine. L’IU (variable dépendante) était renseignée par les participants avec la question « Avez-vous déjà reçu un diagnostic d’IU ? ». Une régression logistique multivariée a par la suite été utilisée pour étudier l’association entre AP et IU dans l’ensemble de l’échantillon, par sexe et par groupe d’âge (15–40 ans, 41–64 ans et 65–69 ans). Les modèles de régression logistique étaient ajustés pour le sexe (à l’exception des analyses stratifiées sur le sexe), l’âge, le statut marital, l’éducation, le tabagisme, l’alcool, l’obésité, l’hypertension, le diabète, l’arthrose, les rachialgies chroniques, les traumatismes physiques, l’asthme, les troubles thyroïdiens, la dépression, et l’anxiété.
Cette étude a inclus 17 777 participants [48,0 % d’hommes ; âge moyen (ET) 45,8 (14,1) ans]. La prévalence d’une AP suffisante et d’une IU était respectivement de 69,8 % et de 2,4 %. Après ajustement sur l’ensemble des variables de contrôle, une AP suffisante était négativement associée à la présence d’une IU [rapport de cotes (RC) = 0,67; intervalle de confiance (IC) à 95 % = 0,55–0,83]. Ce résultat a été corroboré chez les femmes (RC = 0,62 ; IC à 95 % = 0,48–0,80), les participants âgés de 15–40 ans (RC = 0,40 ; IC à 95 % = 0,20–0,79) et ceux âgés de 41–64 ans (RC = 0,71 ; IC à 95 % = 0,55–0,93), mais pas chez les hommes (RC = 0,81 ; IC à 95 % = 0,57–1,16) et les participants âgés de 65–69 ans (RC = 0,72 ; IC à 95 % = 0,47–1,09).
Une AP suffisante est négativement associée à la présence d’une IU. Bien que des études supplémentaires soient nécessaires pour explorer la direction de cette association, une AP correspondant à un équivalent métabolique d’au moins 600 minutes par semaine devrait être promue chez les personnes avec une IU, en particulier chez les femmes et les adultes jeunes et d’âge moyen.
Influence of constipation on enuresis
2021, Anales de Pediatria
Clásicamente se ha considerado el estreñimiento como un factor de riesgo de la enuresis, aunque cada vez hay más publicaciones que reportan una prevalencia de estreñimiento similar en enuréticos y no enuréticos.
Determinar la influencia del estreñimiento en la enuresis monosintomática y la no monosintomática y conocer la prevalencia de las 3 entidades así como de disfunciones del trato urinario inferior y disfunción vesicointestinal en la población.
Estudio observacional transversal de prevalencia sobre una muestra representativa de la población gallega de niños y niñas escolarizados de 5 a 9 años. Se realizó una encuesta en los colegios sobre hábitos miccionales e intestinales que incluía las preguntas del cuestionario Paediatric Lower Urinary Tract Scoring System (PLUTSS) de diagnóstico y graduación de las disfunciones del tracto urinario inferior. Se consideró la enuresis según los criterios de la Sociedad Internacional para la Continencia en Niños (ICSS), y si además asociaba sintomatología diurna, se clasificó como enuresis no monosintomática. El estreñimiento se valoró de acuerdo con los criterios Roma III y la escala de heces de Bristol adaptados.
Se incluyeron 772 encuestas en el estudio. La prevalencia de estreñimiento fue del 20%, la de enuresis del 9,1% (enuresis monosintomática 62,9% y no monosintomática 37,1%) y la de disfunción vesicointestinal del 5,2%. Observamos que el estreñimiento no influye en la presencia de enuresis monosintomática, pero sí en la enuresis no monosintomática y las disfunciones del trato urinario inferior, donde constituye un importante factor de riesgo.
Es fundamental el diagnóstico diferencial entre enuresis monosintomática y no monosintomática en la valoración inicial de un paciente enurético, ya que el manejo terapéutico y las características de ambas entidades son diferentes, constituyendo el estreñimiento un factor de riesgo solamente en el caso de las enuresis no monosintomáticas.
Constipation has classically been considered as a risk factor of enuresis, although there are increasingly more publications that report a similar prevalence of constipation in both enuretics and non-enuretics.
To determine the influence of constipation in monosymptomatic and non-monosymptomatic enuresis, and to find out the prevalence of the three disorders, as well the lower urinary tract dysfunction and bladder-bowel dysfunction in the population.
A cross-sectional observational prevalence study on a representative population sample of 5 to 9 year-old school boys and girls of Galicia, Spain. A questionnaire was completed in the schools on urinary and bowel habits, which included questions from the Paediatric Lower Urinary Tract Scoring System (PLUTSS) diagnostic questionnaire and grading of the lower urinary tract dysfunctions. The enuresis was diagnosed using the International Children's Continence Society (ICSS), and if it was also associated with diurnal symptoms, it was also classified as non-monosymptomatic enuresis. The constipation was evaluated using the Rome III criteria and the adapted Bristol stool scale.
A total of 772 questionnaires were included in the study. The prevalence of constipation was 20% and that of enuresis was 9.1% (62.9% monosymptomatic enuresis and 37.1% non-monosymptomatic), with the prevalence of bladder-bowel dysfunction being 5.2%. It was observed that constipation had no influence on the presence of monosymptomatic enuresis, but it did have an influence on non-monosymptomatic enuresis and lower urinary tract dysfunctions, where it was a significant risk factor.
The differential diagnosis between monosymptomatic and non-monosymptomatic enuresis is essential in the initial evaluation of the patient with enuresis, since the therapeutic management and the characteristics of both disorders are different, with constipation only being a risk factor in cases of non-monosymptomatic enuresis.
Urinary and fecal incontinence in patients with advanced ovarian cancer treated with CRS + HIPEC
2021, Surgical Oncology
Citation Excerpt :
Furthermore, 15% of the patients had both associated dysfunctions (urinary and fecal incontinence). The urinary incontinence rates in our series are close to the upper limit reported in other studies referring to the population of our environment (Spanish population) [16]. In Spain and the United States, up to 40% of women in the general population have some type of urinary incontinence [17–19].
The objective of this work was to analyze the long-term prevalence of urinary and fecal incontinence and their impact on quality of life in patients with advanced and recurrent ovarian cancer treated with cytoreductive surgery and hyperthermic intraoperative intraperitoneal chemotherapy (CRS + HIPEC).
This cross-sectional study included a series of patients with advanced and recurrent ovarian cancer treated by CRS + HIPEC, with a disease-free period of at least 12 months after the procedure. Urinary incontinence was evaluated using the International Consultation on Incontinence Questionnaire – Short Form (ICIQ-SF), fecal incontinence using the Wexner test and the Fecal Incontinence Quality of Life (FIQL) questionnaire and global quality of life using the Short Form 36 (SF-36) survey.
A total of 64 patients were included in the study, with a median age of 55 years (range 28–78). The urinary incontinence rate was 45% and the fecal incontinence rate was 20%. Up to 14% of the patients presented both types of incontinence. The presence of urinary or fecal incontinence generated a significant negative impact on quality of life in relation to patients without incontinence.
Urinary and fecal incontinence is frequent in the follow-up of ovarian cancer patients treated with CRS + HIPEC. Reconsidering the approach to the pelvis without peritoneal metastases in the peritoneum could modify the incidence of these pelvic floor dysfunctions.
Percutaneous tibial nerve stimulation in urge urinary incontinence: A prospective study
2020, Rehabilitacion
Evaluar la eficacia de la estimulación percutánea del nervio tibial y su efectividad mantenida en el tiempo en la incontinencia urinaria de urgencia.
Se efectuó un diseño longitudinal observacional prospectivo sin grupo control, cuyos sujetos fueron los pacientes con incontinencia urinaria de urgencia que cumplían los criterios de inclusión y exclusión. Se realizaron 12 sesiones de estimulación percutánea del nervio tibial mediante electroacupuntura. Los datos de la situación basal y postratamiento fueron recogidos mediante historias clínicas y se les evaluó tiempo después mediante entrevista telefónica. Se registraron variables sociodemográficas, tiempo hasta entrevista, cuestionarios Sandvick e ICIQ-SF, frecuencia miccional diurna, nocturia, material absorbente y uso de tratamiento farmacológico. Se realizó análisis descriptivo de las variables y se analizó la evolución de los pacientes mediante modelos mixtos lineales generalizados, utilizando el paquete estadístico SPSS v. 25.
Treinta y dos mujeres con 58,69 ± 8,96 años. Todas las variables mejoraron tras el tratamiento significativamente: Sandvick 4,38 puntos (IC 95%: 2,68-6,08, p < 0,001), ICIQ-SF 8,55 puntos (IC 95%: 5,89-11,22, p < 0,001), frecuencia miccional diurna 2,10 puntos (IC 95%: 1,04-3,16, p < 0,001) y nocturia 1,31 puntos (IC 95%: 0,58-2,04, p < 0,001). Sin embargo, en entrevista tras 16,34 ± 9,72 meses después del tratamiento, empeoraron ligeramente sin alcanzar los valores basales.
La estimulación percutánea del nervio tibial mediante electroacupuntura es eficaz para el tratamiento de la incontinencia urinaria de urgencia. Aunque su efecto disminuye con el tiempo, la mejoría respecto de la situación basal se mantiene durante el periodo de seguimiento.
To assess the efficacy of percutaneous tibial nerve stimulation and its effectiveness over time in urge urinary incontinence.
We performed a longitudinal, observational, prospective study without a control group that included patients diagnosed with urge urinary incontinence who met the inclusion/exclusion criteria. Patients were treated with 12 sessions of percutaneous tibial nerve stimulation by electroacupuncture. Baseline and post-treatment data were collected from medical records. Patients were assessed by a telephone interview after the treatment. The variables studied were sociodemographic variables, time until interview, the Sandvick and ICIQ-SF questionnaires, daytime urinary frequency, night-time urinary frequency, use of absorbent material and drug treatment. A descriptive analysis of the variables was performed and patient outcomes were analysed with generalised linear mixed models by SPSS v. 25 statistics software.
A total of 32 women were included (mean age 58.69 ± 8.96). All variables significantly improved after treatment: Sandvick by 4.38 points (95% CI: 2.68-6.08, P < .001), ICIQ-SF by 8.55 points (95% CI: 5.89-11.22, P < .001), daytime urinary frequency by 2.10 points (95% CI: 1.04-3.16, P < .001) and night-time urinary frequency by 1.31 points (95%CI: 0.58-2.04, P < .001). However, 16.34 ± 9.72 months after treatment, these improvements diminished but without reaching baseline levels.
Percutaneous tibial nerve stimulation by electroacupuncture is effective for the treatment of urge urinary incontinence. Although its effect diminishes over time, the improvement over the baseline situation is maintained during the follow-up period.
Cognitive function assessment in elderly patients with overactive bladder treated with transdermal oxybutynin
2019, Actas Urologicas Espanolas
Los pacientes mayores con vejiga hiperactiva bajo tratamiento antimuscarínico son especialmente susceptibles al deterioro cognitivo. El objetivo fue evaluar los cambios a corto plazo en la función cognitiva de pacientes de edad avanzada con vejiga hiperactiva tratados con oxibutinina transdérmica.
Estudio observacional retrospectivo multicéntrico en pacientes entre 65 y 80 años de edad, con vejiga hiperactiva, que reciben tratamiento con oxibutinina transdérmica. Antes y después de un mes de tratamiento, se evaluó la función cognitiva mediante el test de alteración de memoria y el test del dibujo del reloj, los cambios en los síntomas con cuestionarios validados, la percepción del paciente ante su respuesta al tratamiento utilizando la escala de beneficio del tratamiento y la adherencia al tratamiento con el test de Morisky-Green modificado.
De 85 pacientes elegibles, 70 completaron la evaluación (promedio de edad: 71,4 ± 4,5; IMC: 28,7 ± 3,1 kg/m²). No se observó deterioro cognitivo tras un mes de tratamiento con oxibutinina transdérmica: Test de alteración de memoria (+1 punto; IC 95%: 0-1,5), test del dibujo del reloj (0 puntos; IC 95%: 0-0). Se observó una mejoría estadísticamente significativa (p < 0,001) en todos los síntomas de almacenamiento urinario, excepto en la incontinencia de esfuerzo. Hubo una mejora en el cuestionario de autoevaluación de control de la vejiga (grado de los síntomas: −2,27; IC 95%: −2,8, −1,7; p < 0,001; grado de molestias: −2,73; IC 95%: −3,3, −2,1; p < 0,001). El 70% de los pacientes informaron una condición de vejiga estable o mejorada según el cuestionario de Percepción de la Condición de la Vejiga del Paciente. El 72,8% de los pacientes informó que sus problemas urinarios habían mejorado o mejorado notablemente con un 84,3% de adherencia al tratamiento.
No se observó deterioro cognitivo en pacientes de edad avanzada tras de un mes de tratamiento con oxibutinina transdérmica. Los síntomas de incontinencia urinaria mejoraron y hubo una adecuada adherencia al tratamiento.
Older patients with overactive bladder under antimuscarinic treatment are especially susceptible to cognitive impairment. The aim was to assess short term changes in cognitive function in elderly patients with overactive bladder treated with transdermal oxybutynin.
Observational, retrospective, multicentre study in patients with overactive bladder aged 65-80 years undergoing treatment with transdermal oxybutynin. Before and after one month of treatment, cognitive function using the Memory Alteration Test and Clock-Drawing Test, changes in symptoms with validated questionnaires, patient perception of treatment response using Treatment Benefit Scale and treatment adherence with the modified Morisky-Green test, were assessed.
From 85 eligible patients, 70 completed the assessment (mean age: 71.4 ± 4.5; BMI: 28.7 ± 3.1 kg/m2). No cognitive impairment was observed after one month with transdermal oxybutynin: Memory Alteration Test (+1 point; 95%CI: 0.0-1.5), Clock-Drawing Test (0 points; 95%CI: 0.0-0.0). A statistically significant improvement (P < .001) was observed in all urinary storage symptoms, except stress urinary incontinence. There was an improvement in the Bladder Control Self-Assessment Questionnaire (symptom score: −2.27; 95%CI: −2.8, −1.7; P < .001; bother score: −2.73; 95%CI: −3.3, −2.1; P < .001). 70% of patients reported either a stable or improved bladder condition according to the Patient Perception of Bladder Condition questionnaire. 72.8% of patients reported that their urinary problems had improved or greatly improved with an 84.3% treatment adherence.
No cognitive impairment was observed in elderly patients after one month of treatment with transdermal oxybutynin; urinary urgency symptoms improved and there was adequate treatment adherence.
Overactive bladder
2018, FMC Formacion Medica Continuada en Atencion Primaria

View all citing articles on Scopus

View full text

Prevalencia de incontinencia urinaria y vejiga hiperactiva en la población española: Resultados del estudio EPICCPrevalence of urinary incontinence and oberactive bladder in spanish population: results from EPICC study

Resumen

Introducción

Pacientes y método

Resultados

Conclusión

Background

Patients and methods

Results

Conclusions

Actas Urol Esp

Value Health

Aten Primaria

Am J Obstet Gynecol

Eur Urol

Eur Urol

[Urinary incontinence in women]

Med Clin (Barc

The prevalence of urinary incontinence in women in four European countries

BJU Int

Prevalence and incidence of urinary incontinence in women: review of the literature and investigation of methodological issues

Int J Urol

Prevalence of and risk factors for urine leakage in a racially and ethnically diverse population of adults: the Boston Area Community Health (BACH

Am J Epidemiol

Prevalence of urinary incontinence in community dwelling men: a cross sectional nationwide epidemiological survey

Int Urol Nephrol

Urologic Diseases of America Project, The prevalence of urinary incontinence among community dwelling men: results from the National Health and Nutrition Examination survey

J Urol

Prevalence and severity of urinary incontinence in elderly Mexican-American women

J Am Geriatr Soc

Urinary incontinence in women: variation in prevalence estimates and risk factors

Obstet Gynecol

Urinary incontinence prevalence: results from the National Health and Nutrition Examination Survey

J Urol

The prevalence, burden, and treatment of urinary incontinence among women in a managed care plan

J Womens Health (Larchmt

Urologic Diseases of America Project. The prevalence of urinary incontinence among community dwelling adult women: results from the National Health and Nutrition Examination Survey

J Urol

management and impact of urinary incontinence in the workplace

Occup Med (Lond