Adding to the controversy: Pitfalls in the diagnosis of testosterone deficiency syndromes with questionnaires and biochemistry

Purpose. To determine the value of available questionnaires used for the diagnosis of testosterone deficiency syndromes (TDS) by correlating their ratings with a panel of hormonal determinations in a male population.

Materials and methods. Participants completed the ADAM questionnaire and underwent biochemical evaluation at the local site. Assessments determined entry into Group A (symptomatic) or Group B (non-symptomatic). After stratification, subjects provided a morning sample of blood, completed the Aging Male Survey (AMS) and the newly developed Canadian Society for the Study of the Aging Male (CSAM-Q) questionnaires. Serum aliquots were analysed at a central lab for 8 putative markers commonly associated with symptomatic testosterone deficiency associated with aging: total testosterone (T); bioavailable T (BT); dehydroepiandrosterone sulphate (DHEA-S); sex-hormone binding globulin (SHBG); luteinizing hormone (LH), prolactin (PRL); thyroid-stimulating hormone (TSH) and insulin-like growth factor-1 (IGF-1).

Results. 92 men were screened; of these 59 (mean age of 58 ± 11 years) completed the study, 30 (51%) scored positively (mean 61.5 years) to the ADAM while 29 (49%) did not (mean 54.1 years). For the AMS the weight of the three domains (psychological, somato-vegetative and sexual) was significantly greater in Group A (p < 0.001) than in Group B. Equally, for the CAS questionnaire, the scores for the variables energy, global performance, frequency of intercourse, mood and quality of sleep were lower in Group A than in their asymptomatic counterparts (p < 0.001). The domain of memory assessment within the CSSAM-Q was not discriminatory. ADAM and AMS are self-administered and completed within 10 minutes. CSSAM-Q is more time consuming, requires an investigator to administer, and memory domain is biased in favour of specific professional training.

No difference was found between the two groups in 6 of 8 biochemical tests. However, significant lower values (p < 0.001) were found for DHEA-S and IGF-1 in the symptomatic group as compared with the non-symptomatic cohort.

Conclusions. This study confirms that newer, more complex tools perform similarly to the simpler ADAM questionnaire. The lack of correlation between the clinical picture and the most commonly used biochemical confirmatory tests, again, clearly points to the paramount importance of the clinical evaluation. An emphasis and reliance on serum T alone hinders the clinician's ability to manage testosterone deficiency syndromes (TDS).     

Roadmap to recovery: Reporting on a research taskforce supporting Indigenous responses to COVID‐19 in Australia

In April 2020 a Group of Eight Taskforce was convened, consisting of over 100 researchers, to provide independent, research‐based recommendations to the Commonwealth Government on a “Roadmap to Recovery” from COVID‐19. The report covered issues ranging from pandemic control and relaxation of social distancing measures, to well‐being and special considerations for vulnerable populations. Our work focused on the critical needs of Aboriginal and Torres Strait Islander communities; this paper presents an overview of our recommendations to the Roadmap report. In addressing the global challenges posed by pandemics for citizens around the world, Indigenous people are recognised as highly vulnerable. At the time of writing Australia's First Nations Peoples have been largely spared from COVID‐19 in comparison to other Indigenous populations globally. Our recommendations emphasise self‐determination and equitable needs‐based funding to support Indigenous communities to recover from COVID‐19, addressing persistent overcrowded housing, and a focus on workforce, especially for regional and remote communities. These latter two issues have been highlighted as major issues of risk for Indigenous communities in Australia It remains to be seen how governments across Australia take up these recommendations to support Indigenous peoples' health and healing journey through yet another, potentially catastrophic, health crisis.     

Gender and jockography: post-feminism and resistance in female sports autobiographies

While research consistently shows news media’s devaluation of female athletes, “the jockography,” or sports autobiography, is one form of widely-consumed media through which female athletes can construct their own representation. However, there has been little consideration of the genre. This essay addresses this gap by analyzing how thirty women’s jockographies published since 1992 rhetorically construct female athletic identity and sports practice. It finds that most athletes, regardless of their sport or racial or class background, constitute their identities and participation in ways that reinforce post-feminist notions of upward mobility and heterosexual femininity while failing to confront inequalities affecting women in sport. Nevertheless, a few recent jockographies challenge normalizing discourses, asking readers to recognize differences between women and confront inequities shaping their athletic experiences.     

“Feeling Warmth and Close to Her”: Communication and Resilience Reflected in Turning Points in Positive Adult Stepchild–Stepparent Relationships

With the goal of understanding the development of positive stepchild–stepparent relationships, the researchers focused on turning points characterizing the interaction of adult stepchildren who have a positive bond with a stepparent. Engaging a relational turning points perspective, 38 stepchildren (males and females, ages 25 to 52 years old) who reported a positive stepparent relationship were interviewed, generating 269 turning points which were categorized into 15 turning point types and coded by valence. Turning points occurring most frequently were: prosocial actions, quality time, conflict/disagreement, changes in household/family composition, and rituals. Findings are discussed, including implications for developing and enacting resilient and positive stepchild–stepparent relationships and future directions for researchers wanting to focus on positive family interaction.     

Career Counseling With Persons Living With HIV: An Ecological Approach

Advances in medical treatment have greatly extended the life span and quality of life of persons living with HIV, with the nature of the disease evolving from causing an early death to chronic, manageable illness. Career counselors will increasingly be called upon to assist persons living with HIV. This article provides an overview of HIV disease and of career‐related issues unique to persons living with HIV. Career counseling interventions are discussed from an ecological perspective.     

Contraceptive Method Choice Among Youth in the United States: The Importance of Relationship Context

We examine the relationship characteristics associated with contraceptive method choice within young people’s nonmarital sexual relationships, using data from retrospective relationship histories available in the third wave (2001–2002) of the National Longitudinal Study of Adolescent Health. Data-reduction techniques produce a detailed multidimensional characterization of relationship commitment for nonmarital sexual relationships. We then use multilevel analysis to estimate associations between two key relationship characteristics—relationship commitment and couple heterogamy—and the type of contraceptive method used at last sexual intercourse within each relationship. Results indicate that for a given individual, contraceptive method choice varies across relationships as a function of these characteristics, even after we account for important individual and family characteristics and prior relationship experiences.     

The Public Finance Implications of Private Pensions: An Analysis with Special Reference to the United Kingdom

In an effort to take the costs of pensions "off the books", many have advocated giving a greater role to funded benefits, privately provided. However, where governments have adopted such an approach, they have both mandated contributions to the private schemes and sought, in the interests of consumer protection, to regulate them. Moreover, in many cases, either explicitly or implicitly, they have made some guarantees about the benefits that will be received. This paper, which makes special reference to plans and debates in the United Kingdom, argues that governments have, therefore, taken on some contingent liabilities, and that these liabilities have public finance implications. Even with privatization, not all the costs of pensions will be "off budget".     

Conversion to Islam: Narratives of Awakening,Continuity, and Return

Previous research utilizing conversion narratives to understand how and why people convert has been troubled by the “accuracy” of the accounts. This study of Muslim converts in the United States sidesteps this problem by turning the focus away from the causes, motives, and drivers of conversion and placing it instead on the form or structure of their conversion narratives. More specifically, it foregrounds the subjective process of making sense of one's conversion story through the employment of formulaic narrative structures. Findings suggest that when accounting for their conversion to Islam, these respondents employed three different narrative structures: stories of awakening, continuity, and return. Although these stories vary in meaningful ways, each provides a different perspective on how conversion to Islam can be conceptualized and expressed narratively. The discussion centers on the similarities and differences between these stories in order to more fully articulate and distinguish their underlying premises. I conclude by considering how each of these stories are used by converts to convey the authenticity of their Muslim identities.     

Cluster designs to assess the prevalence of acute malnutrition by lot quality assurance sampling: a validation study by computer simulation

Summary.  Traditional lot quality assurance sampling (LQAS) methods require simple random sampling to guarantee valid results. However, cluster sampling has been proposed to reduce the number of random starting points. This study uses simulations to examine the classification error of two such designs, a 67×3 (67 clusters of three observations) and a 33×6 (33 clusters of six observations) sampling scheme to assess the prevalence of global acute malnutrition (GAM). Further, we explore the use of a 67×3 sequential sampling scheme for LQAS classification of GAM prevalence. Results indicate that, for independent clusters with moderate intracluster correlation for the GAM outcome, the three sampling designs maintain approximate validity for LQAS analysis. Sequential sampling can substantially reduce the average sample size that is required for data collection. The presence of intercluster correlation can impact dramatically the classification error that is associated with LQAS analysis.     

‘I Was Quite Amazed’: Donor Conception and Parent–Child Relationships from the Child's Perspective

Donor conception and parent–child relationships were explored from the child's perspective. At ages 7 and 10, interview data were obtained from children in 31 donor insemination, 28 egg donation and 51 natural conception families. Children were also administered the MacArthur Story Stem Battery and a family map. Children in all family types reported close and affectionate relationships with their parents, irrespective of the lack of a genetic link between the parent and the child. Of those children who were aware of their donor conception at age 10, most demonstrated an understanding of, and had positive feelings about their donor conception.