The Effect of Antiretroviral Therapy for the Treatment of Human Immunodeficiency Virus (HIV)-1 in Pregnancy on Gestational Weight Gain.

BACKGROUND: Gestational weight gain above Institute of Medicine recommendations is associated with increased risk of pregnancy complications. The goal was to analyze the association between newer HIV antiretroviral regimens (ART) on gestational weight gain. METHODS: A retrospective cohort study of pregnant women with HIV-1 on ART. The primary outcome was incidence of excess gestational weight gain. Treatment effects were estimated by ART regimen type using log-linear models for relative risk (RR), adjusting for prepregnancy BMI and presence of detectable viral load at baseline. RESULTS: Three hundred three pregnant women were included in the analysis. Baseline characteristics, including prepregnancy BMI, viral load at prenatal care entry, and gestational age at delivery were similar by ART, including 53% of the entire cohort had initiated ART before pregnancy (P = nonsignificant). Excess gestational weight gain occurred in 29% of the cohort. Compared with non-integrase strand transfer inhibitor (-INSTI) or tenofovir alafenamide fumarate (TAF)-exposed persons, receipt of INSTI+TAF showed a 1.7-fold increased RR of excess gestational weight gain (95% CI: 1.18-2.68; P < .01), while women who received tenofovir disoproxil fumarate had a 0.64-fold decreased RR (95% CI: .41-.99; P = .047) of excess gestational weight gain. INSTI alone was not significantly associated with excess weight gain in this population. The effect of TAF without INSTI could not be inferred from our data. There was no difference in neonatal, obstetric, or maternal outcomes between the groups. CONCLUSIONS: Pregnant women receiving ART with a combined regimen of INSTI and TAF have increased risk of excess gestational weight gain.

Aquatic Freshwater Vertebrate Models of Epilepsy Pathology: Past Discoveries and Future Directions for Therapeutic Discovery.

Epilepsy is an international public health concern that greatly affects patients' health and lifestyle. About 30% of patients do not respond to available therapies, making new research models important for further drug discovery. Aquatic vertebrates present a promising avenue for improved seizure drug screening and discovery. Zebrafish (Danio rerio) and African clawed frogs (Xenopus laevis and tropicalis) are increasing in popularity for seizure research due to their cost-effective housing and rearing, similar genome to humans, ease of genetic manipulation, and simplicity of drug dosing. These organisms have demonstrated utility in a variety of seizure-induction models including chemical and genetic methods. Past studies with these methods have produced promising data and generated questions for further applications of these models to promote discovery of drug-resistant seizure pathology and lead to effective treatments for these patients.

Lp-PLA2 activity is associated with increased risk of diabetic retinopathy: a longitudinal disease progression study.

AIMS/HYPOTHESIS: The aim of the study was to examine the association between lipoprotein-associated phospholipase A2 (Lp-PLA2) activity levels and incident diabetic retinopathy and change in retinopathy grade. METHODS: This was a cohort study of diabetic participants with serum collected at baseline and routinely collected diabetic retinal screening data. Participants with type 2 diabetes from the GoDARTS (Genetics of Diabetes Audit and Research in Tayside Scotland) cohort were used. This cohort is composed of individuals of white Scottish ancestry from the Tayside region of Scotland. Survival analysis accounting for informative censoring by modelling death as a competing risk was performed for the development of incident diabetic retinopathy from a disease-free state in a 3 year follow-up period (n = 1364) by stratified Lp-PLA2 activity levels (in quartiles). The same analysis was performed for transitions to more severe grades. RESULTS: The hazard of developing incident diabetic retinopathy was 2.08 times higher (95% CI 1.64, 2.63) for the highest quartile of Lp-PLA2 activity compared with the lowest. Higher Lp-PLA2 activity levels were associated with a significantly increased risk for transitions to all grades. The hazards of developing observable (or more severe) and referable (or more severe) retinopathy were 2.82 (95% CI 1.71, 4.65) and 1.87 (95% CI 1.26, 2.77) times higher for the highest quartile of Lp-PLA2 activity compared with the lowest, respectively. CONCLUSIONS/INTERPRETATION: Higher Lp-PLA2 levels are associated with increased risk of death and the development of incident diabetic retinopathy, as well as transitions to more severe grades of diabetic retinopathy. These associations are independent of calculated LDL-cholesterol and other traditional risk factors. Further, this biomarker study shows that the association is temporally sensitive to the proximity of the event to measurement of Lp-PLA2.

Monitoring design for assessing compliance with numeric nutrient standards for rivers and streams using geospatial variables.

Implementation of numeric nutrient standards in Colorado has prompted a need for greater understanding of human impacts on ambient nutrient levels. This study explored the variability of annual nutrient concentrations due to upstream anthropogenic influences and developed a mathematical expression for the number of samples required to estimate median concentrations for standard compliance. A procedure grounded in statistical hypothesis testing was developed to estimate the number of annual samples required at monitoring locations while taking into account the difference between the median concentrations and the water quality standard for a lognormal population. For the Cache La Poudre River in northern Colorado, the relationship between the median and standard deviation of total N (TN) and total P (TP) concentrations and the upstream point and nonpoint concentrations and general hydrologic descriptors was explored using multiple linear regression models. Very strong relationships were evident between the upstream anthropogenic influences and annual medians for TN and TP ( > 0.85, < 0.001) and corresponding standard deviations ( > 0.7, < 0.001). Sample sizes required to demonstrate (non)compliance with the standard depend on the measured water quality conditions. When the median concentration differs from the standard by >20%, few samples are needed to reach a 95% confidence level. When the median is within 20% of the corresponding water quality standard, however, the required sample size increases rapidly, and hundreds of samples may be required.

Twelve Steps to Financial Freedom for Plastic Surgeons.

Financial stress and lack of financial well-being are significant contributors to physician burnout. Many trainees believe little can contribute to developing financial freedom during their training years. However, residency is a pivotal moment in a young attending's life; strategic financial steps taken during this time can lead to a path of financial freedom and well-being for years to come. Methods: We introduce 12 effective financial steps physicians can take at the start of their careers. These essential steps were compiled both anecdotally and from published financial resources such as White Coat Investigator and the Millionaire Next Door. Steps include building your "why," becoming financially educated, eliminating debt, attaining insurance, optimizing contracts, awareness of self-net worth, budgeting, maximizing investment strategies, smart investing, wise spending, K.I.S.S, and creating a personal financial plan. Results: As an example, an IRA is a retirement account set up by you, and to take advantage of the tax benefits, you must have a modified adjusted gross income of less than $124,000 as a single tax filer for 2022. Most physicians are compensated at a rate higher than this; however, there is a legal loophole to take advantage of to allow earners to still contribute to a Roth IRA that is discussed. Conclusions: Financial education is the first step toward a path to financial success in a young physician's life. Implementation of these 12 financial steps early in a physician's career will enrich one's financial freedom and well-being.

Parent Motivational Climate, Sport Enrollment Motives, and Young Athlete Commitment and Enjoyment in Year-Round Swimming.

Parents are known to influence the athlete sport experience through motivational climates. Athletes' perception of motivational climates and their own motives for sport participation influence enjoyment and long-term sport commitment. It is unknown, however, the extent parent motives for initially enrolling their child in a year-round sports program associate with children's sport participation enjoyment and commitment. The purposes of this study were to (a) determine parent motives for enrolling their child (5-8 years) in year-round swimming and (b) explore the relationships of parent motives and motivational climates with child enjoyment and commitment. Parents (n = 40) completed questionnaires on enrollment motives and motivational climate, while children (n = 40) answered questions on enjoyment and commitment. Of the seven motives measured, parents enrolled children in swimming primarily for fitness benefits (M = 4.5, SD = .45) followed by skill mastery (M = 4.31, SD = .48) and fun (M = 4.10, SD = .51) reasons. Findings revealed the fitness motive was moderately, negatively correlated with the success-without-effort facet of a performance climate (r = -.50, p < .01). The fun motive was moderately, positively associated with commitment (r = .43, p < .01). Parent motives for enrolling their child in sport may impact the young child sport experience and long-term sport continuation via motivational climates, enjoyment, and commitment.

Physical function and health-related quality-of-life in a population-based sample.

BACKGROUND. It is of interest to understand whether impaired physical function is associated with health-related quality-of-life (HRQOL). We examined upper and lower body physical function and its relationship with two domains of HRQOL among men. METHODS. We conducted a population-based observational study of musculoskeletal health among Boston, MA residents, the Boston Area Community Health/Bone Survey. Participants were 1219 randomly-selected Black, Hispanic, and White males (30-79 years). Upper body function was measured using hand grip strength, while lower body function was measured by combining a timed walk and a chair stand test. HRQOL was measured using the physical (PCS-12) and mental health (MCS-12) component scores of the SF-12. Multivariate linear regression models were used to estimate the association between poor function and HRQOL. RESULTS. There was a significant association of poor upper body physical function with the MCS-12 (ß coefficient: -4.12, p = 0.003) but not the PCS-12 (ß coefficient: 0.79, p = 0.30) compared to those without poor function. Those with poor lower body physical function had significantly lower PCS-12 scores (ß: -2.95, p = 0.007), compared to those without poor function, but an association was not observed for MCS-12 scores. CONCLUSIONS. Domains of physical function were not consistently related to domains of HRQOL.

Association of sex hormones and C-reactive protein levels in men.

OBJECTIVES: The age-associated decline in sex hormone levels in men is paralleled by an increase in cardiovascular disease and associated risk factors including low grade chronic inflammation. The objective of this analysis was to investigate the association between sex hormone levels and C-reactive protein (CRP) in a population-based sample of men. DESIGN: Population-based, cross-sectional observational survey. PARTICIPANTS: A multistage stratified design was used to recruit a random sample of 2301 racially and ethnically diverse men age 30-79 years. Blood samples were obtained on 1899 men. Analyses were conducted on 1559 men with complete data on CRP and sex hormone levels. MEASUREMENTS: High-sensitivity CRP levels. The association between CRP and sex hormone levels was assessed using multiple linear regression models. RESULTS: An inverse association was observed, in both bivariate and multivariate analyses, between CRP and total testosterone, free testosterone and SHBG levels. These associations remained statistically significant after adjusting for age, body mass index, comorbid conditions and lifestyle factors. A positive trend between oestradiol (total and free) and CRP levels was not statistically significant. CONCLUSIONS: A robust, inverse dose-response correlation between testosterone and SHBG levels with CRP levels provides further evidence of a potential role of androgens in inflammatory processes.

Lean mass, muscle strength, and physical function in a diverse population of men: a population-based cross-sectional study.

BACKGROUND: Age-related declines in lean body mass appear to be more rapid in men than in women but our understanding of muscle mass and function among different subgroups of men and their changes with age is quite limited. The objective of this analysis is to examine racial/ethnic differences and racial/ethnic group-specific cross-sectional age differences in measures of muscle mass, muscle strength, and physical function among men. METHODS: Data were obtained from the Boston Area Community Health/Bone (BACH/Bone) Survey, a population-based, cross-sectional, observational survey. Subjects included 1,157 black, Hispanic, and white randomly-selected Boston men ages 30-79 y. Lean mass was assessed by dual-energy x-ray absorptiometry. Upper extremity (grip) strength was assessed with a hand dynamometer and lower extremity physical function was derived from walk and chair stand tests. Upper extremity strength and lower extremity physical function were also indexed by lean mass and lean mass was indexed by the square of height. RESULTS: Mean age of the sample was 47.5 y. Substantial cross-sectional age differences in grip strength and physical function were consistent across race/ethnicity. Racial/ethnic differences, with and without adjustment for covariates, were evident in all outcomes except grip strength. Racial differences in lean mass did not translate into parallel differences in physical function. For instance, multivariate modeling (with adjustments for age, height, fat mass, self-rated health and physical activity) indicated that whereas total body lean mass was 2.43 kg (approximately 5%) higher in black compared with white men, black men had a physical function score that was approximately 20% lower than white men. CONCLUSIONS: In spite of lower levels of lean mass, the higher levels of physical function observed among white compared with non-white men in this study appear to be broadly consistent with known racial/ethnic differences in outcomes.

Fitness-related benefits: land-based versus aqua-base.

BACKGROUND: It is well documented that individuals participating in land-based aerobic activities receive several fitness-related benefits. Given its virtual weightlessness, thermoregulatory comfort, and ease of movements, aqua-based aerobic activities are commonly perceived as a simpler form of exercise, therefore, lacking the fitness-related benefits equivalent to that of land-based aerobic activities. The purpose of this study was to compare fitness-related benefits between land-based (LAND) versus aqua-based (AQUA) aerobic activity classes within a 15-week period. METHODS: One hundred and fifty-four volunteers participating in LAND (N.=76) and AQUA (N.=78) exercise groups were required to exercise 2 days per week, 50 minutes per day, for 15 weeks. Pre- and post-fitness assessments obtained were body composition, muscular endurance, muscular strength, cardiorespiratory endurance, and flexibility. RESULTS: Mixed ANOVA showed a main effect and interaction for body composition in which, overall, participants decreased more body fat percentage in the land group. A main effect for both muscular strength and muscular endurance was revealed, but no interactions. There were no significant main effects or interactions for neither cardiorespiratory endurance nor flexibility. CONCLUSIONS: Individuals participating in land-based aerobic activities displayed greater decreases in percent body fat when compared to aqua-based aerobic activities, whereas both land- and aqua-based displayed improvements in muscular strength and muscular endurance. There were no changes in cardiorespiratory endurance and flexibility within both groups.

Trichomonas vaginalis in Pregnancy: Patterns and Predictors of Testing, Infection, and Treatment.

OBJECTIVE: To identify factors associated with testing for and diagnosis of trichomoniasis in pregnancy and to describe patterns of treatment and tests of reinfection or persistence. METHODS: We conducted a retrospective cohort study of women who delivered from July 2016 to June 2018 at one institution. Testing for Trichomonas vaginalis infection was done by wet mount microscopy or by nucleic acid amplification testing for routine prenatal testing or symptomatic visits. Poisson regression was used to identify factors associated with testing for trichomoniasis and testing positive in pregnancy. Treatment and re-testing patterns also were assessed. RESULTS: Among 3,265 pregnant women, 2,489 (76%) were tested for T vaginalis infection. Of the total sample, 1,808 (55%) were tested by wet mount microscopy, 1,661 (51%) by nucleic acid amplification testing, and 980 (30%) by both modalities. The sensitivity for microscopy compared with nucleic acid amplification testing was 26%, with a specificity of 99%. Factors associated with increased likelihood of being tested included younger age (adjusted risk ratio [aRR] 0.99, 95% CI 0.99-1.00) and bacterial vaginosis (aRR 1.17, 95% CI 1.01-1.37). Prevalence of trichomoniasis was 15% among those tested by any modality (wet mount or nucleic acid amplification testing). Risk factors for trichomoniasis included younger age (aRR 0.97, P<.01), being of black race (aRR 2.62, P<.01), abnormal vaginal discharge (aRR 1.45, P<.01), and chlamydia during the current pregnancy (aRR 1.70, P<.01). Women diagnosed by microscopy had a shorter time to treatment compared with those diagnosed by nucleic acid amplification testing. Most (75%) women with positive infections had a test of reinfection; 29% of these were positive. Bacterial vaginosis was associated with decreased risk of a positive test of reinfection. CONCLUSION: Although testing for and treatment of trichomoniasis during pregnancy is not routinely recommended, the high burden of infection among some pregnant women demonstrates a need to further understand patterns of T vaginalis testing and infection. Opportunities exist for improving timely treatment of trichomoniasis and test of reinfection.

Prevalence, characteristics, and impact of bloating symptoms in patients with irritable bowel syndrome.

BACKGROUND & AIMS: Bloating symptoms are common in patients with irritable bowel syndrome (IBS) seen in primary care and gastrointestinal clinics. However, the underlying mechanisms of IBS are poorly understood, and there are few data available about the epidemiology of this syndrome or the impact of its symptoms. We investigated the prevalence, characteristics, and impact of bloating symptoms in patients with IBS. METHODS: IBS patients were identified by Rome II criteria in a U.S. population representative web-based survey. Patients were asked about the quality, frequency, and severity of their gastrointestinal symptoms. The impact of these symptoms was investigated by assessing patients' health-related quality of life, utilization of health care, and use of medications. RESULTS: Of the 337 IBS patients in this study, 82.5% (n = 278) reported bloating symptoms, the second most bothersome symptom after abdominal cramping. The symptoms were more prevalent in female patients, 87.4% (n = 209), than in male patients, 70.4% (n = 69) (P < .0001), and in patients with constipation, 88.7% (n = 47), and mixed symptoms, 88.8% (n = 135), than in patients with diarrhea, 72.3% (n = 96), (P = .02 and P < .01, respectively). Bloating symptoms were the third (of 14) most important reason to seek medical care, and more than half of the patients reported regular use of anti-gas medications. Bloating symptoms were associated with decreased energy levels (P = .04), food intake (P < .01), and physical functioning (P = .06). CONCLUSIONS: Bloating symptoms are common in patients with IBS, and their prevalence and relative severity differ on the basis of sex and IBS subtype. Bloating symptoms are associated with a decrease in the quality of life and increases in health care utilization and use of medications.

Menopause-specific questionnaire assessment in US population-based study shows negative impact on health-related quality of life.

OBJECTIVE: To use the Menopause-Specific Quality of Life Questionnaire (MENQOL) to assess the impact of menopausal symptoms on health-related quality of life in a large US population-based study. METHODS: Participants were recruited from the US population through random-digit-dialing and probability sampling. Analyses included 2703 postmenopausal women 40-65 years old in our Menopause Epidemiology Study. Respondents answered a 30-min questionnaire, including the MENQOL. RESULTS: Scores for each domain were: vasomotor: 3.2+/-2.2; psycho-social: 3.3+/-1.8; physical: 3.5+/-1.5; sexual: 2.9+/-2.1. There were significant differences in the MENQOL scores by age, smoking, exercise, education, employment status and BMI. Women aged 60-65 years (p<0.0001), with a bachelor's degree or higher level of education (p<0.0001), who exercised at least 3 days a week (p<0.0001), who had never smoked (p<0.0001), with a body mass index < or =25kg/m(2) (p<0.0001), and who had significantly lower scores indicating better quality of life. Hot flashes affected work (46.0%), social activities (44.4%), leisure activities (47.6%), sleep (82.0%), mood (68.6%), concentration (69.0%), sexual activity (40.9%), total energy level (63.3%) and overall quality of life (69.3%). CONCLUSION: Symptoms experienced during menopause and socio-demographic characteristics affect the quality of life in postmenopausal women. Hot flashes impact the daily activities of most postmenopausal women, especially those with more frequent/severe symptoms. Treatments that safely and effectively treat these symptoms could improve quality of life among postmenopausal women.

Correlates of low testosterone and symptomatic androgen deficiency in a population-based sample.

CONTEXT: Risk factors for low testosterone and symptomatic androgen deficiency (AD) may be modifiable. OBJECTIVE: Our objective was to examine demographic, anthropometric, and medical correlates of low testosterone and symptomatic AD. DESIGN: Data were used from the Boston Area Community Health Survey, an epidemiological study conducted from 2002-2005. SETTING: Data were obtained from a community-based random sample of racially and ethnically diverse men. PATIENTS OR OTHER PARTICIPANTS: Data were available for 1822 men. MAIN OUTCOME MEASURES: Multivariate logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) for associations of covariates with 1) low testosterone and 2) symptomatic AD. The operational definition of low testosterone was serum total testosterone less than 300 ng/dl and free testosterone less than 5 ng/dl; symptomatic AD was defined as the additional presence of symptoms: any of low libido, erectile dysfunction, or osteoporosis or two or more of sleep disturbance, depressed mood, lethargy, or diminished physical performance. RESULTS: Factors associated with low testosterone included age (OR = 1.36; 95% CI= 1.11-1.66, per decade), low per-capita income ($6000 or less per household member vs. more than $30,000; OR = 2.86; 95% CI = 1.39-5.87), and waist circumference (per 10-cm increase; OR = 1.75; 95% CI = 1.45-2.12). Only age (OR = 1.36; 95% CI = 1.04-1.77), waist circumference (OR = 1.88; 95% CI = 1.44-2.47), and health status (OR = 0.21; 95% CI = 0.05-0.92, excellent vs. fair/poor) were associated with our construct of symptomatic AD. Of all variables, waist circumference was the most important contributor in both models. CONCLUSIONS: Waist circumference is a potentially modifiable risk factor for low testosterone and symptomatic AD. Manifestation of symptoms may be a consequence of generally poor health status.

Vulvovaginal atrophy is strongly associated with female sexual dysfunction among sexually active postmenopausal women.

OBJECTIVE: The relationship between vulvovaginal atrophy and female sexual dysfunction is unclear. We investigated this association among sexually active postmenopausal women. DESIGN: The Menopause Epidemiology Study is a cross-sectional, population-based study of women 40 to 65 years old in the United States chosen from a source population selected by random digit dialing and probability sampling. We focused on sexually active postmenopausal women (N = 1,480) for our analyses. Vulvovaginal atrophy was defined as one or more of the following: vaginal dryness, itching, irritation; pain on urination; or pain or bleeding on intercourse. The Arizona Sexual Experience Survey was used to define female sexual dysfunction. Sexual dysfunction subtypes for desire, arousal, and orgasm difficulties were individually scored. We evaluated demographic, behavioral, reproductive history, and medication covariates for effect modification and confounding. Multivariate logistic regression was used to assess the relationship between vulvovaginal atrophy and female sexual dysfunction. RESULTS: The prevalence of vulvovaginal atrophy (57%) and female sexual dysfunction (55%) was high. Women with female sexual dysfunction were 3.84 times more likely to have vulvovaginal atrophy than women without female sexual dysfunction (95% CI: 2.99-4.94). Hot flashes modified the association between vulvovaginal atrophy and desire difficulty. Educational level modified the association between vulvovaginal atrophy and arousal difficulty. Parity modified the association between vulvovaginal atrophy and orgasm difficulty. CONCLUSIONS: This large population-based study provides evidence of an association between vulvovaginal atrophy and overall female sexual dysfunction and its subtypes. Therapies aiming to reduce symptoms of one condition may also relieve symptoms of the other.

Using a ResearchKit Smartphone App to Collect Rheumatoid Arthritis Symptoms From Real-World Participants: Feasibility Study.

BACKGROUND: Using smartphones to enroll, obtain consent, and gather self-reported data from patients has the potential to enhance our understanding of disease burden and quantify physiological impact in the real world. It may also be possible to harness integral smartphone sensors to facilitate remote collection of clinically relevant data. OBJECTIVE: We conducted the Patient Rheumatoid Arthritis Data From the Real World (PARADE) observational study using a customized ResearchKit app with a bring-your-own-device approach. Our objective was to assess the feasibility of using an entirely digital approach (social media and smartphone app) to conduct a real-world observational study of patients with rheumatoid arthritis. METHODS: We conducted this observational study using a customized ResearchKit app with a bring-your-own-device approach. To recruit patients, the PARADE app, designed to guide patients through a series of tasks, was publicized via social media platforms and made available for patients in the United States to download from the Apple App Store. We collected patient-reported data, such as medical history, rheumatoid arthritis-related medications (past and present), and a range of patient-reported outcome measures. We included in the assessment a joint-pain map and a novel objective assessment of wrist range of movement, measured by the smartphone-embedded gyroscope and accelerometer. RESULTS: Within 1 month of recruitment via social media campaigns, 399 participants self-enrolled, self-consented, and provided complete demographic data. Joint pain was the most frequently reported rheumatoid arthritis symptom to bother study participants (344/393, 87.5%). Severe patient-reported wrist pain appeared to be inversely linked with the range of wrist movement measured objectively by the app. At study entry, 292 of 399 participants (73.2%) indicated a preference for participating in a mobile app-based study. The number of participants in the study declined to 45 of 399 (11.3%) at week 12. CONCLUSIONS: Despite the declining number of participants over time, the combination of social media and smartphone app with sensor integration was a feasible and cost-effective approach for the collection of patient-reported data in rheumatoid arthritis. Integral sensors within smartphones can be harnessed to provide novel end points, and the novel wrist range of movement test warrants further clinical validation.

Prevalence of symptomatic androgen deficiency in men.

CONTEXT: Despite recognition that androgen deficiency in men should be defined according to biochemical and clinical criteria, most prevalence estimates are based on low testosterone levels alone. OBJECTIVE: The objective of this study was to examine the association between symptoms of androgen deficiency and low total and calculated free testosterone levels and estimate the prevalence of symptomatic androgen deficiency in men. DESIGN: This study was a population-based, observational survey. PARTICIPANTS: A total of 1,475 Black, Hispanic, and white men, between the ages of 30-79 yr, with complete data on testosterone, SHBG, and symptoms of androgen deficiency, and who are not taking medications that impact sex steroid levels were randomly selected from the Boston Area Community Health Survey. OUTCOME: Outcomes were measured as symptomatic androgen deficiency, defined as low total (<300 ng/dl) and free (<5 ng/dl) testosterone plus presence of low libido, erectile dysfunction, osteoporosis or fracture, or two or more of following symptoms: sleep disturbance, depressed mood, lethargy, or diminished physical performance. RESULTS: Mean age of the sample was 47.3 +/- 12.5 yr. Approximately 24% of subjects had total testosterone less than 300 ng/dl, and 11% of subjects had free testosterone less than 5 ng/dl. Prevalence of symptoms were as follows: low libido (12%), erectile dysfunction (16%), osteoporosis/fracture (1%), and two or more of the nonspecific symptoms (20%). Low testosterone levels were associated with symptoms, but many men with low testosterone levels were asymptomatic (e.g. in men 50+ yr, 47.6%). Crude prevalence of symptomatic androgen deficiency was 5.6% (95% confidence interval: 3.6%, 8.6%), and was not significantly related to race and ethnic group. Prevalence was low in men less than 70 yr (3.1-7.0%) and increased markedly with age to 18.4% among 70 yr olds. Projection of these estimates to the year 2025 suggests that there will be as many as 6.5 million American men ages 30-79 yr with symptomatic androgen deficiency, an increase of 38% from 2000 population estimates. CONCLUSIONS: Prevalence of symptomatic androgen deficiency in men 30 and 79 yr of age is 5.6% and increases substantially with age. The aging of the U.S. male population will cause a large increase in the burden of symptomatic androgen deficiency. Future work should address the clinical significance of low testosterone levels in asymptomatic men.

Healthcare seeking and treatment for menopausal symptoms in the United States.

OBJECTIVES: A population-based study was used to describe healthcare seeking behavior for menopausal symptoms and treatment among women 40-65 years old in the United States. METHODS: Participants were recruited into the Menopause Epidemiology Study from the KnowledgePanel(SM), which is selected by random digit dialing and probability sampling from the US population. From this source, 6201 women 40-65 years old were contacted and 4402 women participated. From the 3135 peri- and postmenopausal women, detailed information was obtained on menopausal symptoms, healthcare seeking, medication usage, and symptom relief from the medication. RESULTS: Many women (60%) reported seeking health care for their menopausal symptoms. More than half of these women sought health care in the past 12 months. Vasomotor symptoms were the most frequently reported menopause symptoms across all races/ethnicities, and the most common symptoms discussed with a health care professional. One-third of the women (34%) used only hormone therapies, 12% used complementary and/or alternative medicines, and 16% used both for treatment of menopausal symptoms. CONCLUSIONS: This study has shown that a large number of women consult healthcare providers for menopausal symptoms, indicating these symptoms are bothersome. Yet, in the United States, there is considerable variation in the symptomatology, healthcare seeking, and use of therapies for menopausal symptoms across cultures. To alleviate these symptoms women have tried alternative treatments as well as hormone therapies, yet many women did not get complete relief of specific symptoms.