月经失调的检查与治疗

月经是女性生殖功能成熟的标志之一,也是妇女健康状况的重要标志之一。月经失调既可以是下丘脑──垂体──卵巢轴功能障碍的表现,也可以是全身功能状态异常的反映。诊断时应详细了解病史,结合B超、诊断性刮宫等检查方法。青春期功血以调整月经周期和促进排卵为主;更年期功血以调整月经周期和手术治疗为主。     

The Family Unpredictability Scale: Reliability and Validity

We developed the Family Unpredictability Scale (FUS) to better understand the factors that underlie the presence and consequences of family dysfunction. Familial unpredictability is defined as a lack of consistency in family behaviors and regulatory systems. Family researchers and therapists generated and evaluated items, which were self‐administered by married parents who had children aged 2 to 18 (N= 314 ). Principal‐components analysis yielded four subscales (discipline, nurturance, meals, and money; 22 items total) that were internally consistent; confirmatory factor analysis based on a separate subsample yielded an adequate preliminary representation of this factor structure. The FUS related significantly to known measures of family and individual functioning but not to social desirability. The present study provides preliminary reliability, construct validity, and concurrent validity for this new multidimensional, self‐report assessment of family unpredictability. Research and clinical implications are discussed.     

Factors Associated with Sexual Dysfunction Symptoms among Veterans who Have Experienced Military Sexual Trauma

Although military sexual trauma (MST) has been found to be associated with sexual dysfunction (SD), there is limited information about the demographic, health, and traumatic experience factors related to SD symptoms among veterans who have experienced MST. The current study surveyed a national sample of 2,002 U.S. veterans who had screened positive for MST. Relationship status, overall health, and antidepressant use were significantly related to the presence of SD symptoms. Analyses examining SD types demonstrated that different factors may contribute to different SD symptoms. Potential implications of these findings for clinical practice and sexual health research among veterans are discussed.     

Increased visceral adiposity index associated with sexual dysfunction in men

Objective: Visceral adipose index (VAI) is a novel parameter for the evaluation of visceral obesity. As we know that obesity is a risk factor for erectile dysfunction (ED). So, in this study, we compared the VAI levels between the men with ED and without ED.

Materials and method: A total of 177 men were included in the study. Ninety-five men with ED and 82 men without ED (control). All men were evaluated for ED by Index of Erectile Function-5 items (IIEF-5). VAI levels were calculated using body mass index, high density lipoprotein and tryglyceride levels.

Results: Mean age was 53.5 (38–69) in men who have ED and 53.1 (34–69) in control. The men with ED had higher body mass index (BMI), triglyceride (TG) levels, higher waist circumference (WC) and lower high-density lipoprotein-cholesterol (HDL-C) levels. Mean VAI level was 5.18?±?2.50 in study group and 3.47?±?1.76 in control goup, respectively. VAI levels were statistically higher in men with ED (p?Discussion: The simplicity of WC and BMI measurement and TG and HDL assessment, make VAI an easily applicable index for the evaluation of visceral fat dysfunction. VAI can be useful index for the evaluation and calculation of erectile dysfunction risk.     

Sildenafil versus continuous positive airway pressure for erectile dysfunction in men with obstructive sleep apnea: a meta-analysis

Objective.?To evaluate the effectiveness of sildenafil versus continuous positive airway pressure (CPAP) for patients with erectile dysfunction (ED) and obstructive sleep apnea (OSA).

Methods.?This is a meta-analysis of a randomized controlled trial. The main outcome measures for effectiveness were the percentage of successful intercourse attempts, International Index of Erectile Function (IIEF) domain scores (erectile function, EF) and the satisfaction levels of the patients and their partners with the treatment for ED.

Results.?Two randomized controlled trials totaling 70 patients were included. Meta-analysis results are as follows: after 12 weeks of treatment, patients under sildenafil demonstrated a significant advantage over under CPAP in terms of the percentage of successful intercourse attempts [OR?=?3.24, 95% CI (2.37–4.43)], EF scores [WMD?=?3.57, 95%CI (1.68–5.45)], and the satisfaction levels of the patients and their partners with the treatment for ED [OR?=?3.56, 95% CI (1.27–9.98)].

Conclusion.?Current clinical studies might confirm that both therapeutic methods were safe and effective, but sildenafil was superior to CPAP in the treatment of ED in men with OSA. We conclude that new therapeutic agents or a combination of the two methods should be studied further.     

Alcohol and Drug Use,and Sources of Stress

ABSTRACT

The purposes of this survey were to assess the prevalence of self-reported chemical use, concerns regarding coworker and family members' chemical use, and issues relating to life stress. A total of 2,567 faculty, staff, and administrators from a medium-sized, eastern, land-grant institution responded to a 20 item survey. Results indicated that tobacco was the most frequendy used chemical followed by alcohol. Participants were most concerned both about coworkers drinking and family member's drinking. Respondents also reported significant concerns regarding coworker's drug use. Applications for prevention, intervention and programming are discussed. Suggestions for future research are also provided.     

Original immunophenotype of blood endothelial progenitor cells and microparticles in patients with isolated arterial erectile dysfunction and late onset hypogonadism: effects of androgen replacement therapy

Objective.?Blood endothelial progenitor cells (EPCs) and endothelial microparticles (EMPs) have been proposed as markers of endothelial dysfunction. Aim of this study was to evaluate an original immunophenotype of EPCs and EMPs in patients with isolated arterial erectile dysfunction (ED) and late onset hypogonadism (LOH) before and after androgen replacement therapy.

Materials and methods.?Fifty patients (50–64 years) with ED and LOH were selected. EPC (CD45_neg/CD34_pos/CD144_pos) and EMP (CD45_neg/CD34_neg/CD144_pos) blood concentrations were evaluated by flow cytometry. Thirty patients received androgen replacement therapy (Tostrex® ProStrakan) for 6 months (group A), other 20 patients not received androgen therapy for the contraindications in their clinical history (group B).

Results.?After 6 months, group B showed IIEF-5 score, peak systolic velocity and acceleration time significantly worse than group A; in addition EPCs and EMPs were significantly higher in group B compared to group A.

Conclusions.?Patients with isolated arterial ED and LOH not treated with androgen therapy showed worst vascular parameters measured by penile Doppler and higher EPCs and EMPs compared to treated hypogonadal patients, hence, LOH appears to be an additional vascular risk factor, and these markers may be considered as predictors of cavernous artery disease. Finally, androgen therapy improves endothelial dysfunction.     

What motivates internal whistleblowing? A typology adapted to the French context

Transparency and ethics are nowadays often cited as a way to remedy various difficulties faced by companies. However, whistleblowing employees who are an example of this are potentially confronted with silence or reprisals. The researchers have sought to apprehend the reasons pushing to whistleblow but the motivations are complex. Although some studies have tried to create profiles of whistleblowers, they have been led in cultural and legislative contexts where the whistleblower may be internal or external to the company, act out of revenge, or be financially rewarded for the information reported, none of which the Sapin II law in France permits. Using a qualitative method based on ten life narratives from French employees who have whistleblown, our article seeks to understand their primary motivations for taking this action. The research will first present the French definition of a whistleblower and the motivations identified in the Anglo-Saxon context from which most studies originate. Following the detailed presentation of the methodology, we will explain the typology of four profiles obtained from the analysis of our results and discuss similarities/differences with the Anglo-Saxon work. In a context where many organizations are promoting the establishment of a genuine ethical and democratic spirit, this typology will aim to identify the arguments that can be used upstream to encourage the process. It can also be used as a tool for training managers and employees to better understand whistleblowing, explaining to them that it is part of a predominantly positive approach, thereby limiting reprisals and stimulating the feedback on dysfunctions within the organization.     

RigiScan data under long-term testosterone therapy: improving long-term blood circulation of penile arteries,penile length and girth,erectile function,and nocturnal penile tumescence and duration

Background: Late-onset hypogonadism (LOH) presents with low serum testosterone (TT) levels and sexual and nonsexual symptoms. Erectile dysfunction affects a man’s self-esteem and as a result partner relationship and quality of life.

Objectives: To investigate the andrological clinical profile outcomes of testosterone therapy (TTh) in men (n?=?88) with symptomatic LOH complaints and symptoms.

Main outcome measures: Erectile function was assessed using the International Index of Erectile Function-5 questionnaire at baseline and at 6 and 12 months of TTh. In addition, penile length was measured at baseline and 12 months. We also evaluated nocturnal penile tumescence (NPT, using RigiScan) and blood flow of cavernous arteries (penile Doppler ultrasonography) at baseline and 12 months of TT.

Materials and methods: Eighty-eight LOH men (M_age 51.1 years) with erectile dysfunction, all with serum TT?<10.4?nmol/L before TTh. Patients received intramuscular long-acting testosterone undecanoate for 12 months.

Results: Following TTh, in all patients, serum TT levels were restored within 3 months to normal levels. Compared with baseline values, erectile function significantly improved at 6 (mean score increase 1.95) and 12 months (mean score increase 2.16). No significant changes in penile length were observed. NPT significantly improved at 12 months in terms of both the frequency (mean increase 1.27 times) and duration of rigidity (mean increase 5.12?min). As regards the blood flow of the cavernous arteries, we observed a significant improvement (decrease of 1.16?cm/s) and end diastolic velocity of the penile arteries.

Conclusion: TTh in men with LOH resulted in improvement of the erectile function, NPT, and to some extent the blood flow of the cavernous arteries.