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).     

‘Wishing to go it alone’: the complicated interplay of independence,interdependence and agency

Some individuals with disabilities for whom verbal speech is not reliable use facilitated communication to express thoughts and ideas. While they may require intensive physical support initially, the goal is independent typing. However, this emphasis on fading support and independence bears consideration. We utilize a Disability Studies lens to frame practices around independence and the complicated interplay between interdependence, agency and voice. Based on qualitative analysis of communication training sessions, we present four findings: the complexity of the message versus fading of physical support, the emotional dimensions of independence, the facilitator’s navigation of multiple roles, and the importance of facilitating agency. We also share implications of reframing independence and facilitating agency for the communication training process.     

Alienation in the United States: Uniform or Group-Specific Change?

“Alienation,” in the sense of disenchantment with core institutions of society, increased after the mid-1960s. Most accounts hold that the rise in alienation was uniform across all groups. This paper evaluates the hypothesis of uniform change using data from the Harris Polls. We find evidence of both short-term and long-term shifts in patterns of alienation. Blacks and low-income people are less alienated under Democratic than under Republican administrations. Over the long term, increases in alienation have been larger among women and people without a college degree.

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.     

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.     

Regulation of technology adoption when individuals pursue multiple utility

Should regulatory approaches to technology adoption in U.S. agriculture be command and control in character, or use economic incentives? This paper addresses this question while testing the “I and We” multiple utility model and suggesting socioeconomic theory as a conceptual framework. Results show that one perhaps cannot understand farmer response to regulation without considering norms. Introducing the “We-utility” notion into the standard “I-utility” model adds explanatory power. Government's regulatory role needs to be shifted to first providing the impetus for action and then to helping in the evolution of norms, no matter which approach is used. The proposed socioeconomic theory goes beyond standard microeconomics by including both the idea of norms and that of positive freedoms, and thus introducing ethical considerations into economic analysis.