Mild thyroid hormone excess is associated with a decreased physical function in elderly men

Introduction: In the adult, subclinical hyperthyroidism (Shyper) may alter skeletal muscle mass and strength. However, whether these effects are present in elderly subjects is not known. We explored the relationship between mild hyperthyroidism and physical function in a population-based sample of older persons. Methods: In a cross-sectional analysis, calf muscle cross-sectional area (CMA), handgrip strength, nerve conduction velocity (NCV), and Short Physical Performance Battery (SPPB) scores were compared between 364 euthyroid (Eut) and 28 Shyper men as well as between 502 Eut and 39 Shyper women. In a longitudinal analysis, we evaluated the relationship between baseline plasma TSH, FT3 and FT4 and the 3-year change in SPPB score in 304 men and 409 women who were euthyroid at enrolment. Results: At the cross-sectional analysis, Shyper men, but not women, had a significantly (p?=?0.02) lower SPPB score than Eut controls, although with comparable CMA, grip strength and NCV, and were more likely to have poor physical performance (odds ratio?=?2.97, p?<?0.05). Longitudinal analysis showed that in Eut men higher baseline FT4 was significantly (p?=?0.02) predictive of a lower SPPB score at the 3-year follow-up. Conclusion: Even a modest thyroid hormone excess is associated with a reduced physical function in elderly men.     

Attention-deficit/hyperactivity disorder–specific stimulant misuse,mood, anxiety,and stress in college-age women at high risk for or with eating disorders

ABSTRACT

Objective: To examine the misuse of attention-deficit/hyperactivity disorder (ADHD)-specific stimulants in a college population at high risk for or with clinical or subclinical eating disorders. Participants: Four hundred forty-eight college-age women aged 18–25 at high risk for or with a clinical or subclinical eating disorder. Methods: Participants completed assessments of stimulant misuse and psychopathology from September 2009 to June 2010. Results: Greater eating disorder pathology, objective binge eating, purging, eating disorder–related clinical impairment, depressive symptoms, perceived stress, and trait anxiety were associated with an increased likelihood of stimulant misuse. Subjective binge eating, excessive exercise, and dietary restraint were not associated with stimulant misuse. Conclusions: ADHD-specific stimulant misuse is associated with eating disorder and comorbid pathology among individuals at high risk for or with clinical or subclinical eating disorders. Screening for stimulant misuse and eating disorder pathology may improve identification of college-age women who may be engaging in maladaptive behaviors and inform prevention efforts.     

Demographic and Psychological Factors Related to Sexual Desire among Heterosexual Women in a Relationship

This study examined demographic, psychological, and relationship factors that are associated with the experience of sexual desire in women. The contribution of other aspects of sexual function on sexual desire was also investigated. The participants were 741 partnered heterosexual women (mean age = 45.7 years), who completed the Female Sexual Desire Questionnaire online, which evaluated their levels of sexual desire, as well as a range of individual and dyadic variables. For each of the six aspects of sexual desire assessed, the number and frequency of problems in other aspects of women's sexual functioning were the most common predictors. The results demonstrated that sexual desire was lower among older, postmenopausal women and those who had been in their current relationship for a longer period of time. Women who reported that their partner experienced a sexual dysfunction also obtained lower sexual desire scores. These findings demonstrate the strong interrelationship between the different phases of the sexual response cycle for women. Further, they suggest that sexual dysfunction in one partner is likely to be associated with sexual dysfunction in the other partner. The clinical implications of these findings in terms of the treatment for sexual dysfunction among women (and their partners) are discussed.     

Demographic and psychological factors related to sexual desire among heterosexual women in a relationship

This study examined demographic, psychological, and relationship factors that are associated with the experience of sexual desire in women. The contribution of other aspects of sexual function on sexual desire was also investigated. The participants were 741 partnered heterosexual women (mean age?=?45.7 years), who completed the Female Sexual Desire Questionnaire online, which evaluated their levels of sexual desire, as well as a range of individual and dyadic variables. For each of the six aspects of sexual desire assessed, the number and frequency of problems in other aspects of women's sexual functioning were the most common predictors. The results demonstrated that sexual desire was lower among older, postmenopausal women and those who had been in their current relationship for a longer period of time. Women who reported that their partner experienced a sexual dysfunction also obtained lower sexual desire scores. These findings demonstrate the strong interrelationship between the different phases of the sexual response cycle for women. Further, they suggest that sexual dysfunction in one partner is likely to be associated with sexual dysfunction in the other partner. The clinical implications of these findings in terms of the treatment for sexual dysfunction among women (and their partners) are discussed.     

Intersectionality and Black Women’s Health: Making Room for Rurality

Black women have poorer health compared to their White counterparts in a range of health outcomes, including breast cancer, diabetes, HIV/AIDS, and heart disease. The health disparities literature has largely treated women as a monolithic group, assuming that health practices and treatments are equally applicable and effective for all women. This approach, which places too much emphasis on gender, risks masking the unique experiences of various women based on other social categories. This article argues that in order to advance Black women’s health, an intersectionality approach should be incorporated into health research and practice. This approach, however, should go beyond the usual intersection of race and gender to include rurality. The article builds this argument on the fact that Black women living in rural areas have unique experiences that intersect with their gender, race, and class status. Benefits for embracing the intersectionality approach are discussed.     

Not Such Strange Bedfellows After All

Abstract

The irritable bowel syndrome (IBS) is best defined as abdominal pain of greater than three months duration, with or without a change in bowel habits. Barium studies, sedimentation rate, and the lactose tolerance test are usually within normal limits. The underlying physiology includes a predominance of 3 cycles/minute basal electrical rhythm (BER). The abdominal pain is poorly localized and usually intermittent, without a clear relationship to medication. Differential diagnosis should include inflammatory bowel disease, infectious colitis or gastroenteritis, lactose intolerance, gallbladder disease, peptic ulcer disease, pelvic inflammatory disease, ovarian cysts and tumors, and endometriosis. A sedimentation rate is an important part of the diagnostic workup which may or may not include barium studies. Anticholinergics have been shown to alter the abnormal BER of irritable bowel syndrome and have proven to be of use in treating this syndrome. Dietary counseling should include advising the patient to eat slowly and at regular hours, and heat applied to the abdomen in the form of a hot water bag has been useful. “Overprogrammed” individuals with irritable bowel syndrome should be advised to modify their activities as this type of stress may give rise to the symptoms.

“Effect of Estrogen/Progestin Potency on Lipid/Lipoprotein Cholesterol,” PATRICIA WAHL, CAROLYN WALDEN, ROBERT KNOPP, JOANNE HOOVER, ROBERT WALLACE, GERARDO HEISS, and BASH RIFKIND. We studied 374 women taking oral contraceptives, 284 women taking estrogen preparations after menopause, and 1086 women taking no hormones, to determine the relation of plasma lipids and lipoprotein cholesterol concentrations to various types of estrogen/progestin formulations. Premenopausal women using oral contraceptives containing a relatively low dose of estrogen combined with a medium or high dose of progestin (Norlestrin, Ovral, or Demulen) had a 24 per cent higher median concentration of low-density-lipoprotein cholesterol than did those not using hormones (P < 0.05). Women using oral contraceptives that are high in estrogen and low in progestin (Envoid or Oracon) had significantly higher concentrations of high-density-lipoprotein cholesterol than did nonusers; those using Ovral, a low-estrogen and high-progestin formulation, had significantly lower levels of high-density-lipoprotein cholesterol. In postmenopausal women the use of estrogen was associated with concentrations of low-density-lipoprotein cholesterol that were 11 to 19 per cent below the levels in postmenopausal women who did not use hormones. The effects of estrogen-progestin balance on low-density and high-density lipoproteins may underlie the increased incidence of stroke and myocardial infarction in women of childbearing age who take oral contraceptives. (New England Journal of Medicine 1983;308:862–7.)     

Dysfunctional sexual beliefs as vulnerability factors to sexual dysfunction

The differences on sexual beliefs presented by men and women with sexual dysfunction and their sexually functional counterparts were investigated. A total of 488 participants (160 females and 232 males without sexual problems and 47 females and 49 males with a DSM-IV diagnosis of sexual dysfunction) answered the Sexual Dysfunctional Beliefs Questionnaire. Findings showed that, although effects have only reached statistical significance for the female group, both dysfunctional men and women endorsed more sexual dysfunctional beliefs than functional. Women presented significantly more age related beliefs (after menopause women loose their sexual desire, as women age, the pleasure they get from sex decreases) and body image beliefs (women who are not physically attractive cannot be sexually satisfied). Additionally, sexually dysfunctional males presented higher scores (not statistically significant) on 'macho' belief (a real man has sexual intercourse very often) and the beliefs about women satisfaction (the quality of the erection is what most satisfies women). Overall, findings support the idea that sexual beliefs may play a role as vulnerability factors for sexual dysfunction.     

Pituitary radiographic abnormalities and clinical correlates of hypogonadism in elderly males presenting with erectile dysfunction

The prevalence of erectile dysfunction rises rapidly with age and is a frequent complaint presented in clinical practice. Although the etiology of erectile dysfunction is multifactorial, 10-20% of evaluations demonstrate testosterone deficiency. Testosterone deficiency due to secondary hypogonadism increases with age. Despite a higher prevalence of secondary hypogonadism in the elderly, there are no studies addressing hypothalamic-pituitary structural abnormalities in elderly impotent men with testosterone deficiency. We retrospectively reviewed the records of all elderly men who presented for general outpatient evaluation of erectile dysfunction from 1996 to 1999. To obtain a cohort control population, the records of 300 patients without erectile dysfunction were also reviewed. Amongst the erectile dysfunction patients, 225 were found to be testosterone deficient (testosterone < 300 ng/dl). Of these patients, 29 were additionally diagnosed with secondary hypogonadism based on a luteinizing hormone (LH) < 13 mIU/ml. Magnetic resonance imaging (MRI) or computed tomography (CT) imaging was available and reviewed in all patients diagnosed with secondary hypogonadism. Ten per cent of these patients had hypothalamic-pituitary imaging abnormalities. The prevalence of pituitary tumors within our population was not significantly elevated compared to the previous general population studies. Small-vessel white matter disease, hyperlipidemia and history of compression fractures were significantly increased in both univariate and multivariate analysis in the erectile dysfunction group compared with the control cohort. This study does not suggest that the use of hypothalamic-pituitary imaging in the evaluation of impotence in elderly men, in the absence of clinical characteristics of other hormonal loss or sella compression symptoms, will increase diagnosis of structural hypothalamic-pituitary abnormalities over that of the general population. However, the yield may increase with very low testosterone levels. These data suggest that there is an increase in ischemic white matter disease in elderly men with hypogonadism that may reflect microvascular injury to the hypothalamic-pituitary. Furthermore, these data confirm that low testosterone is associated with hyperlipidemia in the elderly. Future studies are required to assess the role of hypogonadism and hyperlipidemia, and to determine if treatment of the hormone deficiency improves the lipid profile.     

Analyzing Roll-Call Voting Tools for Content

Abstract

The roll-call voting tools most frequently used by legislative scholars are not equally useful for all. Roll-call votes selected for traditional measurement tools systematically exclude issues determined to be important to women legislators. Those who study women in politics are unable to employ roll-call voting tools with the assurance that they are using valid measures for their research. After analyzing the content of widely used voting tools and discovering that votes from controversial bills of interest to women were often excluded, I outline suggestions for employing alternative methodological approaches. Further, I add to a growing criticism of roll-call voting statistics by identifying another limitation to their use.     

Emotional Well-Being Factors Associated with Sexual Dysfunction in Adults with Type 1 or Type 2 Diabetes: Results from Diabetes MILES—Australia

Abstract

Objective: Diabetes is a chronic health condition that requires daily self-management activities to prevent or delay the onset of serious long-term complications. The two main types of diabetes are Type 1 (T1D) and Type 2 diabetes (T2D). Although both differ in their etiology, they share similar challenges of self-management of blood glucose levels, which, if are persistently high over time can lead to serious long-term complications. Sexual dysfunction (SD) is a common complication of both types of diabetes and affects both men and women. Although the physical aspects of SD are established, less is known about the emotional factors that may also impact SD in adults with diabetes. This study explored the emotional well-being factors associated with SD among 3,338 men and women with T1D and T2D. Methods: The relationships between self-reported SD and depressive and anxiety symptoms, and diabetes-specific distress, were examined using logistic regression modelling. Results: SD was associated with depressive symptoms (all sub-groups), anxiety (men/T2D; women/T1D/T2D), and diabetes-specific distress (women/T1D/T2D). Diabetes-specific distress was significantly higher in those with T2D who believed their SD was caused by their diabetes. Conclusions: SD impacts both men and women with T1D/T2D and is associated with emotional distress. Evaluation of SD and emotional problems should form part of routine clinical assessment.     

Gonococcal Perihepatitis: Diagnosis and Management in a College Population

Abstract

Although gonococcal perihepatitis is not a common clinical problem, it should be in the differential diagnosis of patients who present with right upper quadrant pain and a subsequent positive gonorrhea culture. With the increasing incidence of venereal disease, more cases of gonococcal perihepatitis are anticipated, and an awareness of its protean manifestations should be known and considered by all health care providers. This is especially true for physicians treating college students, as the sequelae of pelvic infection can be severe tissue injury to the reproductive organs with resultant involuntary infertility.

This paper presents three cases of diagnosed gonococcal perihepatitis in a college population with a complete literature review of this disease entity.     

Pregnancy,the Family,and Work: An Historical Review and Update of Legal Regulations and Organizational Policies and Practices in the United States

In spite, or sometimes because, of extensive employment legislation, women have still not achieved economic equality. Traditionally, pertinent employment legislation either singled women out for less-preferential treatment (treating women very differently from men) or treated them exactly the same as men. Both extremes may be based on the idea that the workplace is essentially male, and women should either be prohibited from entering the workplace, or should accept standards designed around male employees. An historical review of the issue of pregnancy/family leave examines the impact of such gendering. Recent legal developments are described. Finally, additional changes that would help create a more gender-neutral workplace are identified and discussed.     

Systemic lupus erythematosus and hormone replacement therapy

The indications for hormone replacement therapy (HRT) in postmenopausal women is the treatment of climacteric symptoms and the prevention of osteoporosis. Women with systemic lupus erythematosus (SLE) are more likely to have a premature menopause, osteoporosis and cardiovascular disease. HRT can induce SLE flares and cardiovascular or venous thromboembolic events. Therefore it should not be used in women with active disease or those with antiphospholipid (aPL) antibodies. In general, it should be used only for patients without active disease, a history of thrombosis or aPL antibodies. Non-oral administration of estrogen is recommended because of its lesser effect on coagulation. With regard to the progestogen, progesterone or pregnane derivatives are preferred. Otherwise, non-estrogen-based strategies should be used.     

After Breast Cancer: Sexual Functioning of Sexual Minority Survivors

Research on sexual difficulties after cancer has neglected sexual minority women (SMW); for example, lesbian and bisexual women. Clinicians treating these women are therefore at a disadvantage as they lack information about sexual problems in this population. This study tested the hypothesis that SMW with breast cancer have poorer sexual function than SMW without breast cancer, distinguishing partnered from unpartnered women. Using convenience sample recruitment, we conducted a case-control study to compare survivors of breast cancers who are SMW, in other words, cases to controls, that is, SMW without cancer. Anonymous survey data were collected from 85 cases after they had completed active cancer treatment and 85 age- and partner-status matched controls with no history of any cancer. Participants' self-reported sexual frequency and sexual function measured by the Female Sexual Function Index were evaluated. Cases and controls did not differ in risk of sexual dysfunction or the level of overall sexual functioning; however, cases had lower sexual frequency and scored lower on desire and ability to reach orgasm, and higher on pain compared to controls. Results inform clinicians about sexual minority survivors' sexual domains affected by cancer. When discussing sexual problems and therapeutic options, sexual orientation should be ascertained.     

The Incidence of Sexual Dysfunction in Patients Attending Dutch General Practitioners

ABSTRACT

Data on patients with a sexual dysfunction were collected in 45 Dutch general practices between 2003 and 2008. The aim of the study was to determine the incidence of patients with a sexual dysfunction, associated health problems, and related interventions performed by their general practitioners (GPs). The study design was a dynamic cohort study comparing 6 years of data on patients with a sexual dysfunction. Participating GPs were asked to record weekly all consulting patients who presented with a sexual dysfunction. In an additional questionnaire, these problems and associated interventions were specified. Incidence of sexual dysfunctions varied between 132 per 100,000 per year for male patients and 60 per 100,000 per year for female patients. Men mainly consulted a GP for erectile dysfunction, and women mainly consulted a GP for hypoactive sexual desire disorder and dyspareunia. Sexual desire problems were more often associated with comorbid problems such as psychological and relationship problems and medication use than other sexual dysfunctions. Female patients showed more co-occurrence of sexual dysfunction and were more often referred to secondary care services than were male patients. During the period of 2003 to 2008, the help-seeking pattern of men and women consulting their GP for a sexual dysfunction appears to be stable. The presence of comorbid problems indicates that GPs are often dealing with complex multifactorial dynamics. Co-occurrence of sexual dysfunction among women probably resulted in a higher referral rate to secondary care services. Therefore, a gender-sensitive approach and an open mind to differences in sexual identity are needed for counseling in and treatment of sexual dysfunction.     

Crafting the Elastic Self? Gender and Identities in Senior Appointments in Irish Education

This article considers the impact of new managerial reform on the recruitment and retention of women into senior management posts across the Irish education sector. In Ireland as elsewhere, the rhetoric of gender equality permeates new managerial reforms. Yet our data suggest that an emphasis on performativity and an intense commitment to paid work consolidates masculinist management cultures disguised through the ideology of choice. This works to the detriment of women, especially those with caring responsibilities. Drawing on studies of 23 top‐level educational appointments in primary, secondary and higher education, we show how the relentless crafting of an elastic self is required for both those who remain in management positions in education and those who seek them.     

Testosterone therapy in erectile dysfunction

Studies in animals have indicated that the nitric oxide erectile pathway is testosterone-dependent. Castration induces erectile dysfunction and a reduction in nitric oxide synthase-stained nerves in erectile tissue. Furthermore, castration adversely affects penile hemodynamics and smooth muscle content, leading to veno-occlusive dysfunction. Testosterone replenishment reverses these physiological, biochemical and structural changes. Several clinical studies have demonstrated the benefits of a combination of testosterone and sildenafil. A recently published, multicenter study evaluated the safety and efficacy of testosterone gel 1% (Testogel®; Schering AG, Germany/AndroGel®; Solvay Pharmaceuticals) vs. placebo gel in conjunction with sildenafil, in producing an erectile response in hypogonadal men who did not respond to treatment with sildenafil alone for erectile dysfunction. The selection criteria required subjects to have had erectile dysfunction for at least 3 months, to be non-responsive to 100 mg sildenafil and to have low testosterone levels (&lt;?400 ng/dl). The primary efficacy measurement was the mean change from baseline in the Erectile Function domain of the International Index of Erectile Function (IIEF). Secondary outcome measures included the mean change from baseline in the other domains and the total sum of the IIEF. Subjects were randomized to receive either testosterone gel + sildenafil, or placebo gel + sildenafil for 12 weeks. Testosterone therapy with testosterone gel improved the erectile response to sildenafil. Therefore, testosterone therapy may be considered for the treatment of erectile dysfunction in men with low to low-normal testosterone levels, who have failed prior treatment with sildenafil alone. Consequently, it is important to screen for hypogonadism in men who fail PDE5 inhibitors.     

The Relationship Between Weight and Career Payoffs Among Women

The thesis that weight affects women's life chances for reaching high-status, white-collar jobs is tested with survey data gathered from a large aerospace organization (N = 306). It is hypothesized that women who are at or below their desirable weight will have higher incomes and occupational positions than women who are overweight, with human capital variables controlled. It is further hypothesized that weight will be most related to occupational position in male-dominated occupations and in occupations that involve frequent contact outside the firm. Results show that weight is related to income, but only at entry-level professional/managerial occupations. Weight is significantly related to occupational position, especially so in male-dominated occupations. Weight is not more strongly related to occupational position in jobs involving outside contact. Findings are consistent with the interpretation that discrimination based on weight in the general society extends to the inner workings of workplace organizations.     

Testosterone and erectile physiology

The role of testosterone deficiency in sexual dysfunction is an important aspect of aging, because it affects such a large proportion of men over 50 years old. A number of age-related factors can cause sexual dysfunction (in particular erectile dysfunction) and testosterone deficiency, such as chronic illness and multiple medications, and the causative link between hypogonadism and erectile dysfunction is still debated. However, studies in castrated animals have proven that addition of testosterone, and its conversion to dihydrotestosterone, can restore erectile function. It appears that testosterone achieves this by peripheral mechanisms (endothelial dependent and independent) and central mechanisms. Testosterone replacement therapy is therefore effective for erectile dysfunction in men with hypogonadism, with success rates of 35–40%. Testosterone supplementation is also important in men who fail on phosphodiesterase type-5 inhibitors, because a minimum plasma concentration of testosterone is required for the successful restoration of erectile function with these agents. Testosterone gels are now the preferred formulation for testosterone supplementation and they can be highly beneficial in a proportion of men with erectile dysfunction.     

Does Marriage Discourage Female Labor Force Participation? Empirical Evidence from Thailand

Abstract

In labor supply theory, marriage can be one of the obstacles making it less likely for a woman to participate in the labor market. However, the relationship between marriage and a female’s working outside the home can vary according to a country’s stage of economic development. This paper therefore aims to investigate the impact of marital status on labor force participation of women in developing countries by using Thailand as a case study. Using sex ratios at the provincial level as an instrumental variable for marital status gives different results from previous empirical research focusing on developed countries. Married women in a developing country like Thailand are more likely to participate in the labor market and work more hours than are unmarried women, especially those who are younger, less educated, not household heads, and with fewer family members to care for. Therefore, policy recommendations for developing countries should aim to support those young and less educated married (and poor) female workers by including extended maternity leave, flexibility of working hours, and establishment of childcare facilities in the workplace, including child allowances for married women who have children.