Cultural Psychology: Beyond East and West.

Research in cultural psychology over the last three decades has revealed the profound influence of culture on cognitive, emotional, and motivational processes shaping individuals into active agents. This article aims to show cultural psychology's promise in three key steps. First, we review four notable cultural dimensions believed to underlie cultural variations: independent versus interdependent self, individualism versus collectivism, tightness versus looseness of social norms, and relational mobility. Second, we examine how ecology and geography shape human activities and give rise to organized systems of cultural practices and meanings, called eco-cultural complexes. In turn, the eco-cultural complex of each zone is instrumental in shaping a wide range of psychological processes, revealing a psychological diversity that extends beyond the scope of the current East-West literature. Finally, we examine some of the non-Western cultural zones present today, including Arab, East Asian, Latin American, and South Asian zones, and discuss how they may have contributed, to varying degrees, to the formation of the contemporary Western cultural zone.

Emotionally expressive interdependence in Latin America: Triangulating through a comparison of three cultural zones.

Evidence suggests that Latin Americans display elevated levels of emotional expressivity and positivity. Here, we tested whether Latin Americans possess a unique form of interdependence called expressive interdependence, characterized by the open expression of positive emotions related to social engagement (e.g., feelings of closeness to others). In Study 1, we compared Latin Americans from Chile and Mexico with European Americans in the United States, a group known to be highly independent. Latin Americans expressed positive socially engaging emotions, particularly in response to negative events affecting others, whereas European Americans favored positive socially disengaging emotions, such as pride, especially in response to personally favorable circumstances. Study 2 replicated these findings with another group of Latin Americans from Colombia and European Americans in the United States. Study 2 also included Japanese in Japan, who expressed positive emotions less than Latin and European Americans. However, Japanese displayed a higher tendency to express negative socially engaging emotions, such as guilt and shame, compared to both groups. Our data demonstrate that emotional expression patterns align with overarching ethos of interdependence in Latin America and Japan and independence among European Americans. However, Latin Americans and Japanese exhibited different styles of interdependence. Latin Americans were expressive of positive socially engaging emotions, whereas Japanese were less expressive overall. Moreover, when Japanese expressed emotions, they emphasized negative socially engaging emotions. Implications for theories of culture and emotion are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

SPIOMET4HEALTH-efficacy, tolerability and safety of lifestyle intervention plus a fixed dose combination of spironolactone, pioglitazone and metformin (SPIOMET) for adolescent girls and young women with polycystic ovary syndrome: study protocol for a multicentre, randomised, double-blind, placebo-controlled, four-arm, parallel-group, phase II clinical trial.

BACKGROUND: Polycystic ovary syndrome (PCOS) is the most prevalent, chronic endocrine-metabolic disorder of adolescents and young women (AYAs), affecting 5-10% of AYAs worldwide. There is no approved pharmacological therapy for PCOS. Standard off-label treatment with oral contraceptives (OCs) reverts neither the underlying pathophysiology nor the associated co-morbidities. Pilot studies have generated new insights into the pathogenesis of PCOS, leading to the development of a new treatment consisting of a fixed, low-dose combination of two so-called insulin sensitisers [pioglitazone (PIO), metformin (MET)] and one mixed anti-androgen and anti-mineralocorticoid also acting as an activator of brown adipose tissue [spironolactone (SPI)], within a single tablet (SPIOMET). The present trial will evaluate the efficacy, tolerability and safety of SPIOMET, on top of lifestyle measures, for the treatment of PCOS in AYAs. METHODS: In this multicentre, randomised, double-blind, placebo-controlled, four-arm, parallel-group, phase II clinical trial, AYAs with PCOS will be recruited from 7 clinical centres across Europe. Intention is to randomise a total of 364 eligible patients into four arms (1:1:1:1): Placebo, PIO, SPI + PIO (SPIO) and SPI + PIO + MET (SPIOMET). Active treatment over 12 months will consist of lifestyle guidance plus the ingestion of one tablet daily (at dinner time); post-treatment follow-up will span 6 months. Primary endpoint is on- and post-treatment ovulation rate. Secondary endpoints are clinical features (hirsutism, menstrual regularity); endocrine-metabolic variables (androgens, lipids, insulin, inflammatory markers); epigenetic markers; imaging data (carotid intima-media thickness, body composition, abdominal fat partitioning, hepatic fat); safety profile; adherence, tolerability and acceptability of the medication; and quality of life in the study participants. Superiority (in this order) of SPIOMET, SPIO and PIO will be tested over placebo, and if present, subsequently the superiority of SPIOMET versus PIO, and if still present, finally versus SPIO. DISCUSSION: The present study will be the first to evaluate-in a randomised, double-blind, placebo-controlled way-the efficacy, tolerability and safety of SPIOMET treatment for early PCOS, on top of a lifestyle intervention. TRIAL REGISTRATION: EudraCT 2021-003177-58. Registered on 22 December 2021. https://www.clinicaltrialsregister.eu/ctr-search/search?query=%092021-003177-58 .

How Spanish speakers express norms using generic person markers.

Language is one powerful vehicle for transmitting norms-a universal feature of society. In English, people use "you" generically (e.g., "You win some you lose some") to express and interpret norms. Here, we examine how norms are conveyed and interpreted in Spanish, a language that-unlike English-has two forms of you (i.e., formal, informal), distinct generic person markers, and pro-drop, allowing for an examination of underlying conceptual tendencies in how the structure of language facilitates the transmission of norms. In Study 1a-b (N = 838) Spanish speakers used informal generic-you and the generic person marker "se" (but not formal-you) to express norms (vs. preferences). In Study 2 (N = 300), formal you, informal you, and impersonal "se" had persuasive force over personal endorsements (e.g., "I"), informing Spanish speaker's interpretation of unfamiliar norms. Our findings add to a growing literature on how subtle linguistic shifts reflect and influence cognitive processes.

Varieties of interdependence and the emergence of the Modern West: Toward the globalizing of psychology.

Cultural psychology-the research field focusing on the mutual constitution of culture and the mind-has made great strides by documenting robust cultural variations in how people think, feel, and act. The cumulative evidence is consistent with the hypothesis that Westerners are independent, whereas those in the rest of the world are interdependent. Although this research traditionally examined North Americans and East Asians, recent research has extended this literature to other non-Western regions. We review this emerging research and describe four distinct forms of interdependence in four non-Western cultural zones. Specifically, interdependence is promoted through (a) conflict avoidance (dominant in much of East Asia), (b) self-assertion for ingroup protection (dominant in Arab regions), (c) expression of emotions that promote interpersonal resonance (dominant in Latin America), and (d) argumentation for conflict resolution (dominant in South Asia). Furthermore, we propose that the Modern West adopted the existing signature features of interdependence in the neighboring cultural zones (notably, self-assertion, emotional expression, and argumentation) and redefined the psychological function and social meaning of these features; instead of promoting interdependence, they became means to achieve independence. This theoretical integration suggests that cultural variation in basic psychological processes emerged over the last several 1,000 years under the influence of ecology, migration, and intergroup relations. The current effort underscores the need to globalize psychological science. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Self-referential processing accounts for cultural variation in self-enhancement versus criticism: An electrocortical investigation.

European Americans are self-enhancing, whereas East Asians are sometimes self-critical. However, the mechanisms underlying this cultural difference remain unclear. Here, we addressed this gap by testing 32 Taiwanese and 32 American young adults, who indicated whether their self-esteem would change in various episodes involving success or failure. We monitored their electroencephalogram (EEG) and assessed upper-alpha band power in response to the outcome information. An increase in upper-alpha power indicates internally directed attention; therefore, it is an index of self-referential processing when assessed during a judgment about the self. As predicted, Americans judged that their self-esteem (but not another's) would increase more after a success than it would decrease after a failure, thereby showing the previously observed self-enhancing pattern. Taiwanese tended to show the opposite pattern, self-criticism. Notably, Americans, but not Taiwanese, showed an increase in upper-alpha band power in response to the self's successes (vs. failures). This bias in the EEG index of self-referential processing predicted the cultural difference in self-enhancement (vs. criticism). The role of self-referential processing in self-enhancement is discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Oscillatory alpha power at rest reveals an independent self: A cross-cultural investigation.

In the current cultural psychology literature, it is commonly assumed that the personal self is cognitively more salient for those with an independent (vs. interdependent) self-construal (SC). So far, however, this assumption remains largely untested. Here, we drew on evidence that resting state alpha power (RSAP) reflects mental processes constituting the personal self, and tested whether RSAP is positively correlated with independent (vs. interdependent) SC. Study 1 tested European Americans and Taiwanese, whereas Study 2 tested European Americans and Japanese (total N = 164). A meta-analysis performed on the combined data confirmed a reliable association between independent (vs. interdependent) SC and RSAP. However, this association was only reliable when participants had their eyes closed. Even though European Americans were consistently more independent than East Asians, RSAP was no greater for European Americans than for East Asians. Our data helps explore a missing link in the theorizing of contemporary cultural psychology.

Racial residential segregation and economic disparity jointly exacerbate COVID-19 fatality in large American cities.

The disproportionately high rates of both infections and deaths among racial and ethnic minorities (especially Blacks and Hispanics) in the United States during the COVID-19 pandemic are consistent with the conclusion that structural inequality can produce lethal consequences. However, the nature of this structural inequality in relation to COVID-19 is poorly understood. Here, we hypothesized that two structural features, racial residential segregation and income inequality, of metropolitan areas in the United States have contributed to health-compromising conditions, which, in turn, have increased COVID-19 fatalities; moreover, that these two features, when combined, may be particularly lethal. To test this hypothesis, we examined the growth rate of confirmed COVID-19 cases and deaths in an early 30-day period of the outbreak in the counties located in each of the 100 largest metropolitan areas in the United States. The growth curves for cases and deaths were steeper in counties located in metropolitan areas where Blacks and Hispanics are residentially segregated from Whites. Moreover, the effect of racial residential segregation was augmented by income inequality within each county. These data strongly suggest that racial and economic disparities have caused a greater death toll during the current pandemic. We draw policy implications for making virus-resilient cities free from such consequences.

Interdependent self-construal predicts reduced sensitivity to norms under pathogen threat: An electrocortical investigation.

Prior evidence suggests that external threat motivates people to monitor norm violations. However, the effect of threat may be attenuated for those high in interdependent self-construal (SC) because this SC affords a sense of protection against the threat. Here, we tested this possibility by priming or not priming young American adults with a pathogen threat. We then had participants read norm-violating or normal behaviors while assessing two electrocortical markers: N400 (indexing the detection of norm violations) and suppression of upper α-band power (indexing vigilance to the violations). In the threat priming condition, interdependent SC predicted decreased responsiveness to norm violations. In the control priming condition, however, interdependent SC predicted increased responsiveness. Our work suggests that interdependent SC may provide a sense of security under threat.

Mandated Bacillus Calmette-Guérin (BCG) vaccination predicts flattened curves for the spread of COVID-19.

Bacillus Calmette-Guérin (BCG) vaccination may reduce the risk of a range of infectious diseases, and if so, it could protect against coronavirus disease 2019 (COVID-19). Here, we compared countries that mandated BCG vaccination until at least 2000 with countries that did not. To minimize any systematic effects of reporting biases, we analyzed the rate of the day-by-day increase in both confirmed cases (134 countries) and deaths (135 countries) in the first 30-day period of country-wise outbreaks. The 30-day window was adjusted to begin at the country-wise onset of the pandemic. Linear mixed models revealed a significant effect of mandated BCG policies on the growth rate of both cases and deaths after controlling for median age, gross domestic product per capita, population density, population size, net migration rate, and various cultural dimensions (e.g., individualism). Our analysis suggests that mandated BCG vaccination can be effective in the fight against COVID-19.

Relational Mobility Predicts Faster Spread of COVID-19: A 39-Country Study.

It has become increasingly clear that COVID-19 is transmitted between individuals. It stands to reason that the spread of the virus depends on sociocultural ecologies that facilitate or inhibit social contact. In particular, the community-level tendency to engage with strangers and freely choose friends, called relational mobility, creates increased opportunities to interact with a larger and more variable range of other people. It may therefore be associated with a faster spread of infectious diseases, including COVID-19. Here, we tested this possibility by analyzing growth curves of confirmed cases of and deaths due to COVID-19 in the first 30 days of the outbreaks in 39 countries. We found that growth was significantly accelerated as a function of a country-wise measure of relational mobility. This relationship was robust either with or without a set of control variables, including demographic variables, reporting bias, testing availability, and cultural dimensions of individualism, tightness, and government efficiency. Policy implications are also discussed.

When norm violations are spontaneously detected: an electrocortical investigation.

One fundamental function of social norms is to promote social coordination. Moreover, greater social coordination may be called for when tight norms govern social relations with others. Hence, the sensitivity to social norm violations may be jointly modulated by relational goals and a belief that the social context is tight (vs loose). We tested this analysis using an electrocortical marker of norm-violation detection (N400). Ninety-one young American adults were subliminally primed with either relational or neutral goals. Then they saw behaviors that were either norm-violating or normal. In the relational priming condition, the norm-violation N400 increased as a function of the perceived tightness of societal norms. In the control priming condition, however, the norm-violation N400 was weak regardless of perceived tightness. Thus, normative tightness was associated with increased neural processing of norm violations only when relational goals were activated. Implications for norm psychology are discussed.

Preservation of fertility in patients with cancer (Review).

Survival rates in oncological patients have been steadily increasing in recent years due to the greater effectiveness of novel oncological treatments, such as radio­ and chemotherapy. However, these treatments impair the reproductive ability of patients, and may cause premature ovarian failure in females and azoospermia in males. Fertility preservation in both female and male oncological patients is nowadays possible and should be integrated as part of the oncological healthcare. The main objective of this review was to describe the different existing options of fertility preservation in patients undergoing gonadotoxic cancer treatments, as well as the differences in success rates that may appear in the different techniques evaluated. Emerging techniques are promising, such as the cryopreservation in orthotopic models of ovarian or testicle tissues, artificial ovaries, or in vitro culture prior to the autotransplantation of cryopreserved tissues. However, oocyte vitrification for female patients and sperm banking for male patients are considered the first line fertility preservation option at the present time for cancer patients undergoing treatment. Certainly, new fertility preservation techniques will continue to develop in the following years. However, despite the growing advances in the subject, optimal counselling from healthcare professionals should always be present.

Culture Embrained: Going Beyond the Nature-Nurture Dichotomy.

Over the past three decades, the cultural psychology literature has established that there is systematic cultural variation in the nature of agency in the domains of cognition, emotion, and motivation. This literature adopted both self-report and performance-based (or behavioral) indicators of these processes, which set the stage for a more recent systematic exploration of cultural influences at the neural and biological level. Moreover, previous work has largely focused on East-West differences, thereby calling for a systematic exploration of other ethnic groups. To address these issues, this article reviews recent work in cultural neuroscience, while paying close attention to Latino Americans-the single most rapidly growing minority group in the United States. We focus on research that has employed neural measures and show that culture has systematic influences on the brain. We also point out that, unlike more traditional self-report or performance-based measures, neural indicators of culture are reliably linked to theoretically relevant individual difference variables such as self-construal and acculturation. Cultural neuroscience offers the framework to go beyond the dichotomy between nature and nurture and to explore how they may dynamically interact.

Estado nutricional de crianças e adolescentes: fatores associados ao excesso de peso e acúmulo de gordura / Nutritional status of children and adolescents: factors associated to overweight and fat accumulation

OBJETIVO: estimar as prevalências e identificar os fatores associados ao estado nutricional de indivíduos de 8 a 17 anos matriculados em escolas de 3 regiões administrativas do município de Vitória. MÉTODO: avaliou-se o estado nutricional de 400 alunos a partir de um estudo transversal. Testou-se a associação entre o sobrepeso e o acúmulo de gordura na cintura com as variáveis: estágio de maturação sexual, nível socioeconômico, número de irmãos, IMC materno e atividade física. Considerou-se em déficit de estatura os indivíduos com índice estatura/idade < -2 escores z do valor mediano da população de referência, em déficit de peso aqueles com Índice de Massa Corporal (IMC) < percentil 5 e com sobrepeso IMC e" percentil 85. Para o perímetro da cintura, adotou-se como parâmetro o percentil e" 90 da população britânica. RESULTADOS: encontrou-se prevalência de 4,0% de déficit de estatura, 4,8% de déficit de peso, 21,3% de sobrepeso e 27,3% de acúmulo de gordura na cintura. No modelo de regressão linear múltipla as variáveis associadas ao sobrepeso foram maturação sexual em estágio inicial e intermediário, IMC materno e"25kg/m² e maior renda. Para acúmulo de gordura na cintura as variáveis associadas foram IMC materno e"25kg/m², maior renda, menores de 14 anos e sedentarismo e"28 horas/semana. CONCLUSÕES: observou-se baixa prevalência de déficit nutricional e elevada de sobrepeso e acúmulo de gordura na cintura, apresentando maior razão de prevalência entre os indivíduos com maior renda, com mães que apresentaram sobrepeso, nos estágios de maturação sexual inicial ou intermediária, menores de 14 anos e sedentários.

OBJECTIVE: To estimate prevalence and identify factors associated with the nutritional status of individuals aged 8 to 17 years old in schools located at 3 administrative regions in the city of Vitória, Brazil. METHODS: The nutritional status of 400 students was assessed based on a cross-sectional study. Association between overweight and fat accumulation around waist was tested considering the variables: sexual maturaten stage, income level, number of siblings, maternal Body Mass Index (BMI) and physical activity. Individuals considered stunting had height-for-age < -2 Z-scores of median value for the reference population; wasting, those with BMI < 5th percentile; overweight, those with BMI e" 85th percentile. Waist circumference was measured under the following parameter: percentile e" 90 of the British population. RESULTS: Prevalence was 4.0% stunting, 4.8% wasting, 21.3% overweight and 27.3% fat accumulation around the waist. In the multiple linear model, variables associated with overweight were the following: initial and intermediate stages of sexual maturaten, maternal BMI > 25kg/m², and high income level. Fat accumulation around the waist was associated to the following variables: maternal BMI >25kg/m², high income level, age < 14, and sedentary > 28 hours/week. CONCLUSIONS: Low prevalence of nutritional deficits and high prevalence of overweight and fat accumulation around the waist were found. Higher prevalence rate occurred among individuals showing the following characteristics: higher income level; overweight mother; within initial and intermediate stages of sexual maturation; bellow 14 years old; sedentary.

Estado nutricional de crianças e adolescentes: fatores associados ao excesso de peso e acúmulo de gordura / Nutritional status of children and adolescents: factors associated to overweight and fat accumulation

OBJETIVO: estimar as prevalências e identificar os fatores associados ao estado nutricional de indivíduos de 8 a 17 anos matriculados em escolas de 3 regiões administrativas do município de Vitória. MÉTODO: avaliou-se o estado nutricional de 400 alunos a partir de um estudo transversal. Testou-se a associação entre o sobrepeso e o acúmulo de gordura na cintura com as variáveis: estágio de maturação sexual, nível socioeconômico, número de irmãos, IMC materno e atividade física. Considerou-se em déficit de estatura os indivíduos com índice estatura/idade < -2 escores z do valor mediano da população de referência, em déficit de peso aqueles com Índice de Massa Corporal (IMC) < percentil 5 e com sobrepeso IMC e" percentil 85. Para o perímetro da cintura, adotou-se como parâmetro o percentil e" 90 da população britânica. RESULTADOS: encontrou-se prevalência de 4,0% de déficit de estatura, 4,8% de déficit de peso, 21,3% de sobrepeso e 27,3% de acúmulo de gordura na cintura. No modelo de regressão linear múltipla as variáveis associadas ao sobrepeso foram maturação sexual em estágio inicial e intermediário, IMC materno e"25kg/m² e maior renda. Para acúmulo de gordura na cintura as variáveis associadas foram IMC materno e"25kg/m², maior renda, menores de 14 anos e sedentarismo e"28 horas/semana. CONCLUSÕES: observou-se baixa prevalência de déficit nutricional e elevada de sobrepeso e acúmulo de gordura na cintura, apresentando maior razão de prevalência entre os indivíduos com maior renda, com mães que apresentaram sobrepeso, nos estágios de maturação sexual inicial ou intermediária, menores de 14 anos e sedentários.(AU)

OBJECTIVE: To estimate prevalence and identify factors associated with the nutritional status of individuals aged 8 to 17 years old in schools located at 3 administrative regions in the city of Vitória, Brazil. METHODS: The nutritional status of 400 students was assessed based on a cross-sectional study. Association between overweight and fat accumulation around waist was tested considering the variables: sexual maturaten stage, income level, number of siblings, maternal Body Mass Index (BMI) and physical activity. Individuals considered stunting had height-for-age < -2 Z-scores of median value for the reference population; wasting, those with BMI < 5th percentile; overweight, those with BMI e" 85th percentile. Waist circumference was measured under the following parameter: percentile e" 90 of the British population. RESULTS: Prevalence was 4.0% stunting, 4.8% wasting, 21.3% overweight and 27.3% fat accumulation around the waist. In the multiple linear model, variables associated with overweight were the following: initial and intermediate stages of sexual maturaten, maternal BMI > 25kg/m², and high income level. Fat accumulation around the waist was associated to the following variables: maternal BMI >25kg/m², high income level, age < 14, and sedentary > 28 hours/week. CONCLUSIONS: Low prevalence of nutritional deficits and high prevalence of overweight and fat accumulation around the waist were found. Higher prevalence rate occurred among individuals showing the following characteristics: higher income level; overweight mother; within initial and intermediate stages of sexual maturation; bellow 14 years old; sedentary.(AU)

Live birth in a woman without ovaries after autograft of frozen-thawed ovarian tissue combined with growth factors.

Currently, cryopreservation of oocytes, embryos and ovarian tissue is considered the basis of fertility preservation programs for women with cancer and other diseases who are rendered sterile by gonadotoxic drugs or radiation.Numerous studies have confirmed that autograft of frozen-thawed ovarian tissue can restore ovarian function and fertility. A total of twenty-two live births have been reported but we still have to consider this technique as experimental. The main problem is that the implant undergoes ischemia until neoangiogenesis is restored, resulting in significant follicular loss.At the moment, there are numerous publications in different medical fields that publish successful experiences with plasma rich in platelets (PRP) in different clinical situations promoting angiogenesis. Thus, we considered the possibility of using it in the field of ovarian autologous transplantation in order to improve the vascularization of the implant and its quality. For this, both thawed ovarian tissue as practiced pockets on the rear side of the broad ligament which have been placed, have been impregnated with PRP. We can say that the implant treated in this way has had a rapid and successful response.We report a special interesting case because this is the first time that this technique is performed successfully in a woman without ovaries combined with growth factors to promote neoangiogenesis. Obviously, the results of the hormonal response come exclusively from the implanted tissue in these special conditions.

Ethinyl estradiol-cyproterone acetate versus low-dose pioglitazone-flutamide-metformin for adolescent girls with androgen excess: divergent effects on CD163, TWEAK receptor, ANGPTL4, and LEPTIN expression in subcutaneous adipose tissue.

OBJECTIVE: The aim was to compare the effects of a traditional therapy (an oral estroprogestagen) to those of a novel treatment (a low-dose combination of generics) in adolescent girls with androgen excess. STUDY DESIGN AND METHODS: In an open-label trial over 1 yr, 34 adolescents (age, 16 yr; body mass index, 23 kg/m2) with hyperinsulinemic androgen excess and without pregnancy risk were randomized to receive daily ethinyl estradiol-cyproterone acetate (EE-CA; Diane 35 Diario) or a low-dose combination of pioglitazone 7.5 mg/d, flutamide 62.5 mg/d, and metformin 850 mg/d (PioFluMet). Markers of androgen excess, C-reactive protein, high molecular weight adiponectin, lipids, carotid intima media thickness, body composition (absorptiometry), abdominal fat partitioning (magnetic resonance imaging), and gene expression in longitudinal biopsies of sc adipose tissue at the abdominal level (RT-PCR) were assessed at baseline and after 1 yr. RESULTS: EE-CA and low-dose PioFluMet reduced androgen excess comparably, but had divergent effects on C-reactive protein, high molecular weight adiponectin, lipids, carotid intima media thickness, lean mass, abdominal and visceral fat, and on the expression of CD163, leptin, TNF-like weak inducer of apoptosis receptor, and angiopoietin-like protein 4, respectively, related to macrophage activation, fat accretion, inflammation, and lipoprotein metabolism in adipose tissue. All these divergences pointed to a healthier condition on low-dose PioFluMet. CONCLUSION: EE-CA and PioFluMet are similarly effective in reversing androgen excess over 1 yr, but low-dose PioFluMet is superior in reversing inflammatory, metabolic, and cardiovascular anomalies that are often associated with androgen excess.

Treatment of androgen excess in adolescent girls: ethinylestradiol-cyproteroneacetate versus low-dose pioglitazone-flutamide-metformin.

OBJECTIVE: The aim was to perform a first comparison between the effects of a classic therapy and those of a novel treatment for androgen excess in adolescent girls. DESIGN AND SETTING: We conducted a randomized, open-labeled trial at a university hospital. PARTICIPANTS: Thirty-four adolescents with hyperinsulinemic androgen excess and without risk of pregnancy participated in the study. INTERVENTIONS: Ethinyl estradiol-cyproterone acetate (EE-CA) vs. a low-dose combination of pioglitazone, flutamide, and metformin (PioFluMet) was administered for 6 months. MAIN OUTCOME MEASURES: We assessed hirsutism and acne scores; androgen excess; fasting insulin, lipid profile, C-reactive protein, high molecular-weight adiponectin, leptin, follistatin; carotid intima-media thickness; body composition (absorptiometry); and abdominal fat partitioning (magnetic resonance imaging). RESULTS: EE-CA and PioFluMet attenuated the androgen excess comparably but had divergent effects on fasting insulinemia; on circulating cholesterol, triglycerides, C-reactive protein, high molecular-weight adiponectin, leptin, and follistatin; on carotid intima-media thickness; on lean mass; and on abdominal, visceral, and hepatic fat, with all these divergences pointing to a healthier condition on low-dose PioFluMet. CONCLUSION: Low-dose PioFluMet compared favorably to EE-CA in adolescents with androgen excess and without pregnancy risk. The efficacy and safety of low-dose PioFluMet remain to be studied over a longer term and in larger cohorts.

Functional traits and the growth-mortality trade-off in tropical trees.

A trade-off between growth and mortality rates characterizes tree species in closed canopy forests. This trade-off is maintained by inherent differences among species and spatial variation in light availability caused by canopy-opening disturbances. We evaluated conditions under which the trade-off is expressed and relationships with four key functional traits for 103 tree species from Barro Colorado Island, Panama. The trade-off is strongest for saplings for growth rates of the fastest growing individuals and mortality rates of the slowest growing individuals (r2 = 0.69), intermediate for saplings for average growth rates and overall mortality rates (r2 = 0.46), and much weaker for large trees (r2 < or = 0.10). This parallels likely levels of spatial variation in light availability, which is greatest for fast- vs. slow-growing saplings and least for large trees with foliage in the forest canopy. Inherent attributes of species contributing to the trade-off include abilities to disperse, acquire resources, grow rapidly, and tolerate shade and other stresses. There is growing interest in the possibility that functional traits might provide insight into such ecological differences and a growing consensus that seed mass (SM), leaf mass per area (LMA), wood density (WD), and maximum height (H(max)) are key traits among forest trees. Seed mass, LMA, WD, and H(max) are predicted to be small for light-demanding species with rapid growth and mortality and large for shade-tolerant species with slow growth and mortality. Six of these trait-demographic rate predictions were realized for saplings; however, with the exception of WD, the relationships were weak (r2 < 0.1 for three and r2 < 0.2 for five of the six remaining relationships). The four traits together explained 43-44% of interspecific variation in species positions on the growth-mortality trade-off; however, WD alone accounted for > 80% of the explained variation and, after WD was included, LMA and H(max) made insignificant contributions. Virtually the full range of values of SM, LMA, and H(max) occurred at all positions on the growth-mortality trade-off. Although WD provides a promising start, a successful trait-based ecology of tropical forest trees will require consideration of additional traits.