Employment status, psychiatric disability and quality of life: comparison of men and women with schizophrenia in Malaysia

This study explores the association between employment opportunities, psychiatric disability and quality of life of male and female patients with schizophrenia. The data were collected from 100 male and 100 female patients and their primary caregivers through personal interviews. The Disability Assessment Schedule and the Quality of Life Interview were used to collect the data. The results of the present study indicate that a large number of both the men and women were unemployed, although they suffered from only mild psychotic symptoms and had no or only minimum psychiatric disability. However, in almost all areas and levels of psychiatric disability, a significantly higher number of men than women were employed. However, the subjective Quality of Life of the employed men was significantly lower than that of the unemployed. Keeping in mind these two results, the present study argues that there is minimal community recognition in Malaysia for the employment potential of people with schizophrenia. The study also argues that policy makers must legislate to create more appropriate workplaces for the mentally ill. People with schizophrenia are entitled to just and fair treatment, and workplaces should be made attractive to them.     

Long-term low-dose dehydroepiandrosterone replacement therapy in aging males with partial androgen deficiency

Dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulfate (DHEAS) age-related withdrawal is very likely to be involved in the aging process and the onset of age-related diseases, giving rise to the question of whether preventing or compensating the decline of these steroids may have endocrine and clinical benefits. The aim of the present trial was to evaluate the endocrine, neuroendocrine and clinical consequences of a long-term (1 year), low-dose (25?mg/day) replacement therapy in a group of aging men who presented the clinical characteristics of partial androgen deficiency (PADAM). Circulating DHEA, DHEAS, androstenedione, total testosterone and free testosterone, dihydrotestosterone (DHT), progesterone, 17-hydroxyprogesterone, allopregnanolone, estrone, estradiol, sex hormone binding globulin (SHBG), cortisol, follicle stimulating hormone (FSH), luteinizing hormone (LH), growth hormone (GH) and insulin-like growth factor 1 (IGF-1) levels were evaluated monthly to assess the endocrine effects of the therapy, while β-endorphin values were used as a marker of the neuroendocrine effects. A Kupperman questionnaire was performed to evaluate the subjective symptoms before and after treatment.

The results showed a great modification of the endocrine profile; with the exception of cortisol levels, which remained unchanged, DHEA, DHEAS, androstenedione, total and free testosterone, DHT, progesterone, 17-hydroxyprogesterone, estrone, estradiol, GH, IGF-1 and β-endorphin levels increased significantly with respect to baseline values, while FSH, LH and SHBG levels showed a significant decrease. The Kupperman score indicated a progressive improvement in mood, fatigue and joint pain.

In conclusion, the present study demonstrates that 25?mg/day of DHEA is able to cause significant changes in the hormonal profile and clinical symptoms and can counteract the age-related decline of endocrine and neuroendocrine functions. Restoring DHEA levels to young adult values seems to benefit the age-related decline in physiological functions but, however promising, placebo-controlled trials are required to confirm these preliminary results.     

An approach to the treatment evaluation of Hodgkin's disease

Hodgkin's disease is a cancer of the lymphatic system. The major feature influencing the type of treatment employed, and the ultimate prognosis, is the stage or extent of disease prior to therapy. This paper is concerned with evaluating the difference in patient progress of two staging procedures. One (pathological staging) procedure is more extensive than the other (clinical staging). The evaluation is carried out by firstly developing a mathematical model of patient progress for pathologically staged patients and then using this model to predict what would have happened to clinically staged patients if they had been treated according to their pathological stage. Comparison of these predictions with actual results suggests that pathologically staged patients appear to remain in disease free survival (remission) following radio-therapy longer than clinically staged patients.