A Focused Addiction Curriculum and Its Impact on Student Knowledge, Attitudes, and Confidence in the Treatment of Patients with Substance Use.

BACKGROUND: Assessment of attitudes towards addiction in medical students has largely gone unexplored. This study examines the impact of a supplemental substance use disorder curriculum in the psychiatry clerkship on medical student attitudes towards addiction. METHODS: The curriculum was only administered to students at one clerkship site. Subsequently, medical students were surveyed across all sites regarding their attitudes towards addiction. RESULTS: The survey response rate was 37.5% (N = 75/200), with 25 (33%) completing the supplemental addiction curriculum. In bivariate analysis, medical students receiving the curriculum were more likely to express confidence in managing patients with alcohol and opiate use disorders (T = 2.01, p = 0.05) and were more knowledgeable about Alcoholics Anonymous (AA) as a treatment option available to patients (T = 2.27, p = 0.03). CONCLUSIONS: A supplemental addiction curriculum can improve medical student confidence in managing substance-using patients as well as improve knowledge of AA.

Testosterone therapy in women with gynecological and sexual disorders: a triumph of clinical endocrinology from 1938 to 2008.

INTRODUCTION: Although the term "medicalization" has been used by some to describe contemporary testosterone use in women with sexual disorders and testosterone deficiency syndrome, testosterone therapy for women with various gynecological and sexual disorders has been practiced since the late 1930s. AIM: The study aimed to perform a historical review of testosterone use in women with sexual and gynecological disorders. This review is necessary to bridge important knowledge gaps in the clinical use of testosterone in women with sexual health concerns and to provoke new thoughts and understanding of the multidisciplinary role of testosterone in women's overall health. METHODS: Review of medical literature on androgen therapy in women was carried out from 1938 through 2008. RESULTS: Approximately 70 years ago, clinicians from various disciplines relied on personal experience and clinical observations for outcome assessment of testosterone therapy in women. These early reports on testosterone use in women with sexual medical problems served as a foundation for the development of contemporary approaches and subsequent testosterone treatment regimens. Testosterone use was reported for sexual dysfunction, abnormal uterine bleeding, dysmenorrhea, menopausal symptoms, chronic mastitis and lactation, and benign and malignant tumors of the breast, uterus, and ovaries. CONCLUSIONS: Health-care professionals engaged in the management of women's health issues have observed the benefits of androgen therapy throughout much of the 20th century. Despite this clinical use of testosterone in women for more than seven decades, contemporary testosterone therapy in women is hotly debated, misunderstood, and often misrepresented in the medical community.

Obesity and erectile dysfunction: is androgen deficiency the common link?

Obesity is associated with increased risk of erectile dysfunction (ED); however, the underlying causes of ED in obese individuals remain poorly defined. The aim of this review is to discuss the evidence available on the relationship between obesity and ED. A search of published studies in PubMed from 1970 through 2009 was conducted, and relevant articles were evaluated and discussed. Visceral obesity is a public health threat, and is associated with increased risk of diabetes, vascular disease, endothelial dysfunction, and ED. Plasma testosterone levels are reduced in obesity, further contributing to an increased risk of vascular pathology in obesity. The recognition of the relationship between obesity, reduced testosterone levels, and ED has paved the way for new approaches to manage and treat obese, hypogonadal patients with ED. Obesity profoundly and adversely impacts overall health and, in particular, vascular health, by increasing proinflammatory factors, altering endothelial function and the androgen endocrine milieu, thus increasing the risk of ED.

Mechanisms of obesity and related pathologies: androgen deficiency and endothelial dysfunction may be the link between obesity and erectile dysfunction.

Obesity is associated with a high prevalence of erectile dysfunction; however, the pathophysiological link between obesity and erectile dysfunction remains poorly understood. In this minireview, we have attempted to evaluate the existing literature pertaining to obesity and erectile dysfunction to determine whether a common pathophysiological link exists. Visceral obesity is associated with increased inflammatory responses, which contribute to endothelial dysfunction. Furthermore, obesity is also associated with reduced plasma testosterone levels, which contributes to hypogonadism and increases the risk of vascular pathology. Endothelial dysfunction and androgen deficiency have previously been linked to the pathophysiological mechanisms of erectile dysfunction. The underlying pathophysiological mechanisms of endothelial dysfunction and testosterone deficiency include penile vascular insufficiency as a result of the loss of nitric oxide synthase expression and activity and the loss of tissue compliance, resulting in reduced hemodynamic properties. Recent progress in the field of sexual medicine has recognized the impact of vascular disease and hypogonadism on the management of patients with erectile dysfunction. We suggest that visceral obesity, a component of the metabolic syndrome, adversely affects endothelial function and testosterone levels, contributing to hypogandism and erectile dysfunction. Thus, clinical screening for the risk of erectile dysfunction in obese patients should include the assessment of waist circumference, testosterone levels, body mass index and physical inactivity.

The dark side of testosterone deficiency: III. Cardiovascular disease.

A considerable body of evidence exists suggesting that androgen deficiency contributes to the onset, progression, or both of cardiovascular disease (CVD). The aim of this review is to evaluate the relationships between testosterone (T) deficiency and risk factors of CVD and to discuss the implications of androgen deficiency in men with cardiovascular risk factors. The relationship between androgen deficiency and endothelial function, lipid profiles, inflammatory responses, altered vascular smooth muscle reactivity, and hypertension are discussed with regard to CVD. A comprehensive literature search was carried out with the use of Pub Med from 1980 through 2009, and relevant articles pertinent to androgen deficiency and vascular disease were evaluated and discussed. Low T, whether attributed to hypogonadism or androgen deprivation therapy, in men with prostate carcinoma, produces adverse effects on cardiovascular health. Androgen deficiency is associated with increased levels of total cholesterol, low-density lipoprotein, increased production of proinflammatory factors, and increased thickness of the arterial wall and contributes to endothelial dysfunction. Testosterone supplementation restores arterial vasoreactivity; reduces proinflammatory cytokines, total cholesterol, and triglyceride levels; and improves endothelial function but also might reduce high-density lipoprotein levels. Testosterone is an anabolic hormone with a wide range of beneficial effects on men's health. The therapeutic role of T in men's health, however, remains a hotly debated issue for a number of reasons, including the purported risk of prostate cancer. In view of the emerging evidence suggesting that androgen deficiency is a risk factor for CVD, androgen replacement therapy could potentially reduce CVD risk in hypogonadal men. It should be emphasized, however, that androgen replacement therapy should be done with very thorough and careful monitoring for prostate diseases.