The influence of comorbidities on the aging males’ symptoms scale in patients with erectile dysfunction

Objectives: To investigate if certain common age-related comorbidities are related with a positive aging males’ symptoms (AMS) test outcome.

Methods: This was a multicentric, transversal, observational study carried out in a male population with erectile dysfunction. Comorbidities and testosterone levels were registered. The relationship between comorbidities, testosterone levels, and the AMS test outcomes was studied using the global score and the sub-scale score components.

Results: The study included 1112 patients. In the multivariate analysis the global score strongly correlated with TT?p?Conclusion: Although the AMS test is related to low levels of testosterone, it is also of some limited use for diagnosing hypogonadism because it has low specificity and is influenced by pathologies that are frequent during ageing.     

A new ‘aging males’ symptoms' rating scale

Unlike in women, where instruments are available to measure the severity of symptoms, standardized instruments are lacking for aging males. However, a new ‘aging males’ symptoms' (AMS) rating scale has been developed in the present study, as well as reference values.

A total of 116 medically well-characterized males (aged over 40 years) were recruited to complete a questionnaire of symptoms, the prevalence of which commonly changes with increasing age. Factor analysis was used to establish the raw scale and to identify the dimensions of the scale. This raw scale was applied to a large representative population sample of 992 German males, to establish reference values for the severity of symptoms in males over 40 years.

Three dimensions of symptoms were identified in the patient group: a psychological, a somatovegetative and a sexual factor, that explained 51.6% of the total variance. Reference values of the three dimensions were defined to be used in daily practice. The severity of symptoms assessed using the AMS scale was found to be related to the clinically defined ‘male climacteric’ in the patient group.

The AMS scale is a new and valuable tool for assessing aging males' symptomsc and can be easily used in practice.     

A reliability generalization meta-analysis of coefficient alpha and test–retest coefficient for the aging males’ symptoms (AMS) scale

Purpose: The aging males’ symptoms (AMS) scale is an instrument used to determine the health-related quality of life in adult and elderly men. The purpose of this study was to synthesize internal consistency (Cronbach’s alpha) and test–retest reliability for the AMS scale and its three subscales.

Methods: Of the 123 studies reviewed, 12 provided alpha coefficients which were then used in the meta-analyses of internal consistency. Seven of the 12 included studies provided test–retest coefficients, and these were used in the meta-analyses of test–retest reliability.

Results: The AMS scale had excellent internal consistency [α?=?0.89 (95% CI 0.88–0.90)]; the mean alpha estimates across the AMS subscales ranged from 0.79 to 0.82. The AMS scale also had good test–retest reliability [r?=?0.85 (95% CI 0.82–0.88]; the test–retest reliability coefficients of the AMS subscales ranged from 0.76 to 0.83. There was significant heterogeneity among the included studies.

Conclusions: The AMS scale and the three subscales had fairly good internal consistency and test–retest reliability. Future psychometric studies of the AMS scale should report important characteristics of the participants, details of item scores, and test–retest reliability.     

The impact of age,BMI and sex hormone on aging males’ symptoms and the international index of erectile function scores

Objective: To analyze the impact of age, BMI and sex hormone on aging males’ symptoms (AMS) and the 5-item version of the international index of erectile function (IIEF-5) scores in middle-aged and elderly Chinese men.

Methods: A population-based cross-sectional study was conducted in Jiashan County. A total of 969 men, aged between 40 and 80 years old, were admitted. Physical examination and the sex hormones were measured, and AMS and IIEF-5 scores were assessed.

Results: The oneway ANOVA analysis indicated older age groups had higher AMS total-scores, somatic and sexual sub-scores, and lower IIEF5 scores (all p?r_pairwise) analyses showed the significant associations between AMS and age or sex hormone (cFT, Bio-T, SHBG, and LH) levels, and similar for IIEF5. However, when age was adjusted, the correlation coefficients (r_partial) weakened, and correlation significance disappeared, except LH (for AMS: r_partial?=?0.096, p?=?.009; for IIEF-5: r_partial?= ?0.140, p?=?.001). Multiple linear regressions confirmed the influence of increased age and LH on the AMS and IIEF5 scores.

Conclusion: CFT, Bio-T and SHBG failed to yield any additional predicting information when age was adjusted. To improve the male reproductive health, future research should pay more attention on aging-related comorbidities and how to improve general wellness.     

Could gonadal and adrenal androgen deficiencies contribute to the depressive symptoms in men with systolic heart failure?

Background: Testosterone (TT) and dehydroepiandrosterone sulphate (DHEAS) are neurosteroids and their deficiencies constitute the hormone risk factors promoting the development of depression in elderly otherwise healthy men. We investigated the link between hypogonadism and depression in accordance with age and concomitant diseases in men with systolic HF using the novel scale previously dedicated for elderly population.

Methods: We analysed the prevalence of depression and severity of depressive symptoms in population of 226 men with systolic HF (40–80 years) compared to 379 healthy peers. The severity of depression was assessed using the Polish long version of Geriatric Depression Scale (GDS).

Results: In men aged 40–59 years the severity of depressive symptoms was greater in NYHA classes III–IV compared to NYHA classes I–II and reference group. In men aged 60–80 years depressive symptoms were more severe in NYHA class III-IV compared to controls (all p?≤?0.001). In multivariate logistic regression model in men aged 40–59 years advanced NYHA class was associated with higher prevalence of mild depression (OR?=?2.14, 95%CI: 1.07–4.29) and chronic obstructive pulmonary disease (COPD) with higher prevalence of severe depression (OR?=?69.1, 95%CI: 2.11–2264.3). In men aged 60–80 years advanced NYHA class and TT deficiency were related to higher prevalence of mild depression (respectively: OR?=?2.9, 95%CI: 1.3–6.4; OR?=?3.6, 95%CI: 1.2–10.63).

Conclusion: TT deficiency, COPD and advanced NYHA class were associated with higher prevalence of depression in men with systolic HF.     

Are the Aging Male’s Symptoms (AMS) scale and the Androgen Deficiency in the Aging Male (ADAM) questionnaire suitable for the screening of late-onset hypogonadism in aging Chinese men?

Abstract

The Aging Male’s Symptoms (AMS) scale and the Androgen Deficiency in the Aging Male (ADAM) questionnaire have been widely used for screening men suspected of late-onset hypogonadism (LOH). We evaluated the consistency of the two questionnaires with sex hormone levels. A total of 985 men completed the two questionnaires, as well as an analysis of the serum levels of total testosterone (TT), bioavailable testosterone (BT), luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol (E2), prolactin (PRL) and sex hormone-binding globulin (SHBG). No correlation was observed between any hormone level and the psychological or somatic section of the AMS score, whereas the sexual section was correlated with the levels of FT, LH, FSH, SHBG and BT. Significant correlations were observed between the result of the two questionnaires and these hormone levels. When LOH was defined as TT?<?300?ng/dl and FT?<?5?ng/dl, the sensitivity and specificity of the AMS scale were 54.0% and 41.2% compared with 78.7% and 14.8% for the ADAM questionnaire. Several sex hormone levels correlated with the two questionnaires, but neither of these questionnaires had sufficient sensitivity and specificity. It is necessary to provide a new questionnaire applicable to the Chinese population to screening LOH.     

Breaking the silence: parentally suicide-bereaved youths’ self-disclosure on the internet and the social responses of others related to stigma

‘Suicide stigma’ contributes to the silencing of parental suicide within family and social networks. This article departs from a narrative theoretical framework on grief and identity to analyse suicide-bereaved youths ‘breaking the silence’ through self-disclosure in self-initiated chat threads on the Internet, which is their way of actively seeking social support, telling of their experiences and opening up space for a renegotiation of the meanings around suicide. The article investigates which narrative frameworks for the interpretation of suicide are operating in these contexts, and whether and, if so, how stigma is reproduced or counteracted. Two frameworks are identified: ‘Who is to blame for suicide?’; and ‘What caused the suicide?’. The former is utilized by the newly bereaved chat-initiators, who attribute blame for suicide to the parent and/or themselves in accordance with stigmatizing discourses. These are reproduced in the responses first and foremost of the non-suicide-bereaved, who construct a dichotomy between the deceased parent as ‘perpetrator’ and the child as ‘victim’ in order to relieve blame. A lack of contact with other suicide-bereaved youths can reinforce feelings of otherness. Identities, however, can potentially be de-stigmatized by the meanings drawn from the latter framework.     

How to help the aging male? Current approaches to hypogonadism in primary care

Hypogonadism is a common condition which occurs more frequently in older men. It is characterized by low testosterone (T) and is associated with symptoms which are often nonspecific. A key symptom is low libido, but it can also be associated with erectile dysfunction, reduced muscle mass and strength, increased body fat, reduced bone mineral density and osteoporosis, reduced vitality, and depressed mood. Hypogonadism is linked with a variety of comorbid conditions including erectile dysfunction, metabolic syndrome, diabetes, obesity, and osteoporosis. However, the condition is often underdiagnosed. T supplementation in hypogonadism is associated with a range of benefits including improved sexual function, increased lean body mass and/or reduced fat mass, and improved bone mineral density. A variety of T supplementation formulations are available. Although there is no evidence of increased risk of initiating prostate cancer with T supplementation, it is contraindicated in men with prostate cancer. It is important that primary care physicians are aware of both the signs and symptoms of hypogonadism, the monitoring and testing that is required and the merits and advantages of the various T preparations to ensure optimal management of the condition with a treatment approach that best suits patients’ needs.     

Is Swedish pension reform the right medicine for aging Europe?

Following the Second World War, the idea of the life course with distinct periods of education, work, and retirement became popular as a result of the alliance of interests of unions and management, with politicians seizing the opportunity to accommodate them. These "social partners" implemented benefit rules and created practices for using old age and disability to ease the exit of older workers. Although justifiable at the time, now those rules and practices hinder individual and employer incentives to invest in human capital and work environments that enable older workers to remain in the workforce. The article argues that the workforce environment of the coming half-century, which is relevant for persons born around 2000, is much different from that a hundred years earlier, which determined the opportunities for people born around 1900. People are healthier and live much longer and work environments are friendlier. The article argues that it is no longer justifiable to subsidize exit from the workforce around the age of 60 for healthy workers, especially in view of the coming labor shortage in Europe. It also argues that the introduction of the principles of the Swedish NDC pension reform in Europe would provide possibilities for flexible exit from the workforce and remove impediments to labor mobility in Europe, which are embedded in many of Europe's present pension arrangements.     

‘Resistance: Which Way the Future?’ A dual-screen installation related to the theme of disability and eugenics

This paper reports the part findings of an evaluation of a dual-screen installation entitled ‘Resistance: Which Way the Future?’ by the writer and director Liz Crow. Central to the installation is the experience of disabled people during the Holocaust period, the values underpinning this neglected period of history and how this relates to understanding the experiences of disabled people today. Simultaneously, this paper raises issue with a previous comment which suggested that disabled people and eugenics are a form of ‘emotive rhetoric’. On the contrary, this paper asserts that the link between eugenics and disability cannot be overstated, and is a significant moment in history where the lived experiences of disabled people – people described as having ‘learning difficulties’, surviving artefacts, and recorded testimonies – have still yet to be explored.     

Endothelial progenitor cell therapy for atherosclerosis: the philosopher's stone for an aging population?

Much of the increased risk for atherosclerosis progression with age may be a result of age-related declines in the capacity of precursor cells to repair damage in the arterial endothelium. To estimate the impact of progenitor cell therapy for atherosclerosis on cardiovascular disease (CVD) mortality, life expectancy, and survival, as compared with the lifetime control of conventional risk factors, we modeled the health effects of bone marrow-derived endothelial progenitor cell therapy using data from the 1950 to 1996 follow-up of the Framingham Heart Study. To model cardiovascular disease mortality, we assumed that progenitor cell therapy was applied at age 30, with the effect assumed to be a 10-year delay in atherosclerosis progression. Age projections were constructed analytically using the stochastic process model for risk factor dynamics and mortality and microsimulation techniques. We considered three types of interventions: (i) keeping risk factors within selected limits to model current clinical recommendations; (ii) an age shift of 10 years to model the effects of progenitor cell therapy; and (iii) elimination of a competing risk (such as cancer). Our study suggests that progenitor cell therapy might increase life expectancy in the population as much as the complete elimination of cancer (in females, an additional 3.67 versus 3.37 years; in males, an additional 5.94 versus 2.86 years, respectively).     

Returns to scale in food preparation and the Deaton–Paxson puzzle

We consider returns to scale in food preparation as a potential resolution of a puzzle raised by Deaton and Paxson (Journal of Political Economy, 106(5), 897–930, 1998). We clarify the conditions under which returns to scale in food preparation can resolve the puzzle. The key requirement is that foods are heterogeneous in time costs. We then show that detailed food expenditure and time use data are consistent with larger households shifting to more time intensive foods.     

Beneficiaries’ aspirations to permanent employment within the South African Working for Water Programme

The South African Working for Water (WfW) programme is a short-term public works programme (PWP) focused on clearing invasive alien plants, while training and empowering the marginalised poor to find employment. Furthermore, it aims to develop independent, entrepreneurial contractors who should ‘exit’ from the programme into the broader labour market. However, evidence indicates that many beneficiaries have become financially dependent on this employment, and find it difficult to search for alternatives. Understanding the reasons for this dependence from the perspective of the beneficiaries of this PWP is crucial to align such projects to the actual needs of the beneficiaries, but these have not yet been considered from a sociological perspective. This article reports on data collected, through face-to-face interviews, on WfW beneficiaries’ aspirations to permanent employment in four projects in the Winelands and Overberg districts of the Western Cape. It presents the novel finding that the social structures within projects themselves seem to create a need to remain in the WfW programme. In addition, a misalignment between these projects’ implementation and beneficiaries’ aspirations to financial stability (associated with permanent employment in WfW) is highlighted. The authors argue that WfW should respond to these aspirations, rather than pursue the ostensibly unrealistic aim of creating independent entrepreneurs. Finally, the implications of these findings for PWPs globally, and their concerns regarding the inadvertent creation of beneficiary dependence, are outlined.     

Caring for the Fetus to Protect the Born Child?

This article analyzes the circumstances under which physicians have sought court orders to force pregnant women to comply with unwanted obstetrical interventions. It argues that pregnant women have moral obligations to care for their fetuses, not because the fetus has rights, but because the fetus becomes the born child, and children are vulnerable and in need of care. While the overwhelming majority of women are willing to make significant personal sacrifices in the interest of having a healthy baby, sometimes it is difficult for pregnant women to comply with treatment recommendations due to intervening variables beyond their control. Utilization of the court system to coerce unwanted treatment raises serious ethical and legal problems.     

Correlates of chronic disease and patient–provider discussions among middle-aged and older adult males: Implications for successful aging and sexuality

We use data from the Massachusetts Male Aging Study to approximate the total current knowledge about prostate cancer and to evaluate the relative contributions of various risk factors. The sum total of current knowledge is assessed using the area under the receiver operating characteristic curve (AUROC) and by the Hosmer-Lemeshow statistic in a logistic regression model that includes 30 risk factors identified in the literature that are available in the data set. Relative contributions are measured using the adjusted generalized R² (AR²). To measure relative contributions, we group risk factors with similar etiology and then remove groups and compare the AR² attained without each group to the AR² with all variables included. The overall model fits adequately. The A UROC is 0.788, relatively far from its default value of 0.5, and the Hosmer-Lemeshow statistic has a p value of 0.926. We conclude that, while some knowledge about prostate cancer has been accumulated, there are still more risk factors yet unsuspected. The relative importance analysis shows that immutable factors (i.e. age, genotype) contribute 42%, dietary factors 30%, other lifestyle factors 15%, and endocrinological factors 11%. We recommend that age and other unchanging factors should be the primary focus of screening and risk evaluation and that future interventions should center on nutritional behavior.     

‘To lie down to death for days’

On 20 October 2000, the longest and most deadly hunger strike in modern history began in prisons throughout Turkey. Organized as a response to the government's plans to develop and construct new so-called ‘F-type’ prisons – in which prisoners are isolated from one another, from legal advocates and from family members – the strike was also intended to challenge several recently-enacted ‘anti-terrorism’ policies that have resulted in thousands of arrests. In a country where political prisoners make up roughly one-sixth of the total prison population, and where a long history of prison torture has been criticized by a wide range of outside human rights groups, the hunger strike sees little chance of achieving its goals: convincing government officials to repeal the official legislation and to reconsider its shift to the F-type prison system. Nonetheless, the Strike has continued for well over two years, and has claimed at least 107 lives. This essay is intended to explore the political effects and performative value of a mode of resistance (1) founded on the eventual death of many, if not all, of its practitioners and (2) ineffective in eventuating its desired changes. By definition, hunger striking is an unsustainable form of resistance; and yet, the Turkish strikers have continued to fast far longer than anticipated, and seem to be willing and able to continue indefinitely. How are cultural meanings and political currencies of Hunger Striking reformulated in such a radically changed temporal context? In a practice that so dramatically fuses the subject and object of state violence into a single body (and at the behest of such a maligned community), what kind of political subject is produced, and how is her/his relationship to the state redefined? And finally, how might political efficacy be redefined in the case of the Turkish strike, and by the performative value of various attempts to represent the strike in the context of European assimilation?