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At least 343 records · Page 19Linked to original sources
PubMed2005

Testosterone patch increases sexual activity and desire in surgically menopausal women with hypoactive sexual desire disorder.

CONTEXT: Hypoactive sexual desire disorder (HSDD) is one of the most common sexual problems reported by women, but few studies have been conducted to evaluate treatments for this condition. OBJECTIVE: The objective of this study was to evaluate the efficacy and safety of a testosterone patch in surgically menopausal women with HSDD. DESIGN: The design was a randomized, double-blind, parallel-group, placebo-controlled, 24-wk study (the Intimate SM 1 study). SETTING: The study was performed at private or institutional practices. PATIENTS: The subjects studied were women, aged 26-70 yr, with HSDD after bilateral salpingo-oophorectomy who were receiving concomitant estrogen therapy. Placebo (n = 279) or testosterone 300 microg/d (n = 283) was administered. There were 19 patients who withdrew due to adverse events in the placebo group and 24 in the 300 mug/d testosterone group. INTERVENTION: Testosterone (300 microg/d) or placebo patches were applied twice weekly. MAIN OUTCOME MEASURE(S): The primary end point was the change in the frequency of total satisfying sexual activity at 24 wk. Secondary end points included other sexual functioning end points and safety assessments. RESULTS: At 24 wk, there was an increase from baseline in the frequency of total satisfying sexual activity of 2.10 episodes/4 wk in the testosterone group, which was significantly greater than the change of 0.98 episodes/4 wk in the placebo group (P = 0.0003). The testosterone group also experienced statistically significant improvements in sexual desire and a decrease in distress. The overall safety profile was similar in both treatment groups. CONCLUSION: In the Intimate SM 1 study, the testosterone patch improved sexual function and decreased distress in surgically menopausal women with HSDD and was well tolerated in this trial.

Administration, Cutaneous↗
PubMed2006

Follicle luteinization in hyperandrogenic follicles of polycystic ovary syndrome patients undergoing gonadotropin therapy for in vitro fertilization.

CONTEXT: Polycystic ovary syndrome (PCOS) is a reproductive disorder of ovarian hyperandrogenism and insulin resistance characterized by abnormal luteinization of small follicles. After exposure to GnRH analog/FSH stimulation for in vitro fertilization (IVF), however, it is unclear whether such PCOS follicles remain abnormally luteinized during the resumption of oocyte maturation in vivo. OBJECTIVE: The aim of this study was to determine whether PCOS follicles exposed to GnRH analog/FSH stimulation for IVF show abnormal luteinization. DESIGN: This study was a prospective cohort. SETTING: The setting was an institutional practice. PATIENTS: Eleven PCOS and 30 normoandrogenic ovulatory women were included. INTERVENTION(S): All subjects received GnRH analog/FSH therapy after basal serum hormone determinations. MAIN OUTCOME MEASURE(S): Follicle fluid aspirated at oocyte retrieval from the first follicle of each ovary was assayed for gonadotropins, steroids, insulin, and glucose. LH receptor mRNA expression was determined in granulosa cells of the same follicle. RESULTS: In PCOS patients with basal hyperandrogenemia and hyperinsulinemia, total oocyte number was increased and follicle diameter was decreased, despite normal maximal serum estradiol levels. Within PCOS follicles, progesterone levels were reduced (P < 0.01), despite comparable bioactive LH and insulin levels and granulosa cell LH receptor mRNA expression; estradiol levels were normal, despite diminished FSH availability (P < 0.004). Elevated androstenedione (P < 0.01), testosterone (P < 0.001), and glucose (P < 0.01) levels also occurred. In PCOS follicles containing mature oocytes, however, elevated androgen levels were accompanied by both normal progesterone concentrations and a normal inverse relationship between glucose depletion and lactate accumulation. CONCLUSION: Hyperandrogenic follicles with mature oocytes from PCOS women receiving GnRH analog/recombinant human FSH therapy for IVF show sufficient glucose utilization for normal luteinization.

Adult↗
PubMed2002

Depression associated with Parkinson's disease: clinical features and treatment.

Depression associated with Parkinson's disease (PD) is common and affects 25 to 40% of patients. Recognition of the signs and symptoms of depression associated with PD is essential for clinical practitioners. Treatment of depression in this subset of patients can have a direct and dramatic impact on functional disability and quality of life. A review of the literature concerning depression and depression associated with PD was undertaken, with specific attention given to disease mechanisms, clinical presentation, association with thyroid disease, and the principles of management and treatment. Specific signs and symptoms of depression can be easily identified in patients with PD. Practitioners should be aware of these signs and symptoms when diagnosing and treating depression associated with PD. Practitioners should also be aware of the pros and cons of each treatment option and should choose a therapy appropriate for each individual patient's needs. It is important to identify the features of depression associated with PD in order to render early diagnosis and institute practical and efficacious therapy.

Antidepressive Agents↗
PubMed2003

Queering marriage: an ideographic interrogation of heteronormative subjectivity.

Recent debates on same-sex marriage mark the institution, practice, and concept of marriage as a significant site of power and resistance within American culture. Adopting Michel Foucault's conception of "discipline," this essay examines how marriage discourse reinforces heteronormative power relations through its rhetorical constitution of gay male identity. Supplementing "ideographic" critique with Judith Butler's theory of performative speech acts enables us to better interrogate and resist these operations of power. This essay maps the contemporary scene of heteronormative power and resistance through two rhetorical performances of gay male identity. The marriage debates, in the first instance, demonstrate how a conventional desire for masculine agency influences the heteronormative production of gay male identity. In the second instance, gay male SM [sadomasochism] performs a concept of "relational agency," which potentially resists heteronormativity.

Female↗
PubMed2004

Living and dying in Georgian London's lying-in hospitals.

This article uses previously untapped archival sources to revise the dominant, negative view of London's eighteenth-century maternity hospitals, by reconstructing daily life at the British Lying-in Hospital. Though the hospital in fact helped to support women's work as midwives, its institutional practices altered the experience of childbirth both negatively and positively, which inspired rumors, criticism, and inflammatory published attacks. The article illuminates how two unrecognized events in 1751-the hospital's first epidemiological crisis, and the arrival of a new man-midwife who used instruments-may have become intertwined in the public imagination and helped to shape the terrible reputation of lying-in hospitals, despite their overall positive eighteenth-century record.

Charities↗
PubMed2004

Detection of postpartum depressive symptoms by screening at well-child visits.

OBJECTIVE: To assess 1) the feasibility of universal postpartum depression screening during well-child visits in the first year of life, 2) the prevalence of postpartum depressive symptoms among mothers who attend first-year well-child visits, 3) detection of postpartum depressive symptoms in a pediatric clinic before and after universal screening at each first-year well-child visit, and 4) social work referrals before and after universal screening. METHODS: The practice instituted universal screening for postpartum depressive symptoms during first-year well-child visits using the Edinburgh Postnatal Depression Scale (EPDS). We randomly selected 110 infant medical records before (cohort 1) and 110 after (cohort 2) screening was initiated. Measures included demographics, notation of depression or depressive symptoms in the well-child visit note, and referral for depression. EPDS scores were collected for cohort 2 only. Before-after comparisons were made for detection of depression or depressive symptoms and mental health referrals. RESULTS: The EPDS was included in the medical record in 46% of well-child visits. Eighty-eight percent of these forms were completed. Twenty-one percent of completed EPDS forms had scores > or =10, and 27% of women who completed the EPDS had scores > or =10 sometime during the postpartum year. There was a significant increase in documentation of depressive symptoms with the EPDS after initiation of universal screening (1.6% of visits [cohort 1] vs 8.5% [cohort 2]). Social work referrals for mental health reasons increased significantly (0.2% of visits [cohort 1] to 3.6% [cohort 2]). CONCLUSIONS: Women with high levels of postpartum depressive symptoms are common in an urban population and can be detected at well-child visits throughout the first postpartum year by pediatricians using a standardized screening tool. Because screening for depression during well-child visits is feasible using a standardized screening instrument, pediatricians can play an active role in early detection and referral for postpartum depression.

Adult↗
PubMed1991

The New York Needle Trial: the politics of public health in the age of AIDS.

During the past 5 years, the exchange of sterile needles and syringes for dirty injecting equipment has gained increasing acceptance outside the United States as a potential means of reducing the transmission of the human immunodeficiency virus (HIV) among intravenous drug users. This article describes the controversy over attempts to establish a needle and syringe exchange scheme in New York City between 1985 and 1991. The response to a health crisis is used as an indicator of patterns of social and institutional practice. Advocates of needle exchanges had reached a stalemate with the promoters of law enforcement, and the strategic reformulation of the policy problem in terms of the research process seemed to offer a solution. The article discusses the practical limitations on designing and carrying out a controversial health promotion policy; the use (under constraint) of a restrictive research process to constitute--rather than simply to guide or monitor--public policy; and the potential ethical hazards of health professionals' seeking a polemical recourse to the clinical trial. The efforts to establish a needle exchange in New York thus illustrate more general problems for AIDS prevention.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Individual or social responsibility for premature death? Current controversies in the British debate about health.

This article uses the current controversies in the British debate about health to illustrate the need to theorize, and therefore critically evaluate, the links between medicine and health policies, including health care policies. The medical model of health is deeply embedded in institutional practices in many countries, and while this model has attracted deserved criticism in recent years, an alternative social model, or one that incorporates indispensable aspects of the medical model, has attracted much less attention and requires sustained development. Comparative study of patterns of inequality in health, and especially of the correlation between material deprivation and premature mortality, necessarily reveals causal determinants of both health and ill-health in populations and invites ambitious programs to develop a social model.

Delivery of Health Care↗
PubMed1991

A microbiological hazard in caloric testing.

The use of caloric testing is widespread in hospital audiology departments. This paper describes contamination of the caloric water tanks with the organism Acinetobacter anitratus and the changes in practice instituted to eliminate this risk to patients.

Acinetobacter↗
PubMed1997

Models of disability.

This paper critically reviews medical approaches to the identification and treatment of disability. The medical model locates disability within individuals. By contrast, this paper argues that disability cannot be understood outside its social context. As such, some of the assumptions about normality and difference which underpin traditional approaches to the diagnosis and treatment of disabled people are challenged. If it is accepted that disability is located not solely within the mind or body of an individual, but rather in the relationship between people with particular bodily and intellectual differences and their social environment, then greater focus may be placed on ameliorating disability through changes in social policy, culture and institutional practices.

Persons with Disabilities↗
PubMed2004

Switching antipsychotics in inpatient schizophrenia care: predictors and outcomes.

BACKGROUND: Within a pharmacoepidemiologic study, characteristics of patients with schizophrenia switched from first- to second-generation antipsychotics (FGAs and SGAs, respectively) or to antipsychotic polypharmacy were compared with those of patients maintained on treatment with FGAs. The primary aim was to assess factors associated with antipsychotic switching and to compare disease course with regard to mental state and social functioning. METHOD: Adult inpatients with an ICD-10 diagnosis of schizophrenia or schizoaffective disorder were assessed in 7 psychiatric hospitals. Data were collected between 2001 and 2002. For those patients (N = 847) with an antipsychotic prescription at discharge, t tests and covariance and logistic regression analyses were used to evaluate the relationship between demographic and clinical characteristics and antipsychotic switching. RESULTS: Patients switched from FGAs to SGAs had fewer previous psychiatric admissions, a shorter illness duration, fewer substance disorders, and a higher probability of working in a competitive setting but more pronounced symptoms than those maintained on treatment with FGAs. Mental state and social functioning after case-mix adjustment were more favorable in the group switched to SGA monotherapy but not in those patients administered FGAs and SGAs concurrently at discharge. Logistic regression controlling for demographic and clinical variables revealed that a short disease duration (p <.05), fewer previous psychiatric hospitalizations (p <.01), voluntary admission (p <.05), and pronounced thought disorder (p <.05) were significantly associated with switching from FGAs to SGAs. Hospital differences were also observed. CONCLUSION: Remaining on FGAs or switching to SGAs in schizophrenia care depends strongly on institutional practices in addition to the previous disease course and health care utilization.

Adult↗
PubMed1989

Low-density lipoprotein (LDL) distribution shown by 99mtechnetium-LDL imaging in patients with myeloproliferative diseases.

STUDY OBJECTIVE: To image and identify by noninvasive methods the sites of low-density lipoprotein (LDL) catabolism in patients with myeloproliferative disease in whom chronic hypocholesterolemia was previously reported. STUDY DESIGN: The 99mTechnetium-LDL (Tc-LDL) distribution in patients with myeloproliferative diseases was compared with that in normal subjects. The Tc-LDL distribution was also compared with the distribution and organ uptake of a macrophage-seeking radiotracer. 99mTc-sulfur colloid (Tc-SC). SETTING: Major metropolitan referral center and institutional practice. PATIENTS: Three normal subjects, two patients with polycythemia vera, two with post polycythemia myeloid metaplasia, and one with agnogenic myeloid metaplasia. The patients were being managed with hydroxyurea or phlebotomy. INTERVENTION: Ten mCi of Tc-LDL (homologous) was injected intravenously. MEASUREMENTS AND MAIN RESULTS: Gamma camera images of Tc-LDL biodistribution and organ uptake were obtained 4 hours after injection of the tracer. In normal subjects, the Tc-LDL was predominantly taken up by the liver, with relative nonvisualization of spleen and central or peripheral marrow. Patients with myeloproliferative disease showed marked splenic uptake of Tc-LDL. Peripheral bone marrow uptake extended to the lower tibia in two patients with post-polycythemia myeloid metaplasia. Splenic and bone marrow uptake paralleled that of Tc-SC. Hypercellularity of central and peripheral marrow at the sites of Tc-LDL uptake was confirmed by biopsy specimens. The Tc-LDL uptake, however, was not correlated with collagen fibrosis. CONCLUSIONS: These results indicate that spleen and bone marrow are sites of LDL catabolism in patients with myeloproliferative disease and suggest the role of macrophages in the hypocholesterolemia and accelerated LDL catabolism of myeloproliferative disease.

Adult↗
PubMed1983

Endoparasites of hares (Lepus timidus L. and L. europaeus Pallas) in Finland.

Intestinal and lung parasites of 85 mountain hares (Lepus timidus) and 24 European hares (L. europaeus) were examined. The species of parasites found in both hare species were Trichostrongylus retortaeformis Zeder, 1800; Mosgovoyia pectinata Goeze, 1782 and Protostrongylus pulmonalis Froelich, 1802. Eimeria semisculpta Madsen, 1938 and E. townsendi Carvalho, 1943 were found only in the European hares and Eimeria leporis Nieschulz, 1923 and Dicrocoelium dendriticum Rudolphi, 1819 only in the mountain hares. Ninety-five percent of the mountain hares and 88% of the European hares were infected with parasites. Mountain hares were more commonly infected with P. pulmonalis and D. dendriticum while European hares were more commonly infected with Eimeria spp. and T. retortaeformis. Young mountain hares were more often infected with M. pectinata and adult mountain hares with P. pulmonalis. The management technique of winter-feeding did not increase significantly the percentage of infected animals. Dicrocoelium dendriticum was found only in hares from islands where sheep had grazed during the summers. The absence of cysticerci of Taenia pisiformis Bloch, 1780 in this survey may be a reflection of improved hygiene practices instituted by hunters.

Age Factors↗
PubMedDate not supplied

[Ileoanal reservoir: new concepts and current results].

More than 1,800 ileoanal pouches have been performed at the Mayo Clinic since 1981 and results have been satisfactory in more than 90% of the patients. However, we continue to search for alternatives to improve postoperative results and avoid the complications that currently occur in a minority of patients. During the last two years new concepts and surgical techniques for the construction of the ileoanal reservoir have been described. Herein we present those innovations and compare them to our current institutional practice.

Adenomatous Polyposis Coli↗
PubMed1991

Development of guidelines for the preparation and administration of ribavirin.

Due to numerous inquiries from neonatal professional staff members regarding the potential teratogenic effects of ribavirin, the decision was made to establish institutional guidelines for its safe administration and preparation. The neonatal pharmacist was asked to prepare guidelines from available information in the literature and other institutions' practice standards.

Abnormalities, Drug-Induced↗
PubMedDate not supplied

Developing a merit compensation plan in an academic setting.

UACCMF believes it has created an effective tool to quantify departmental goals and objectives and the faculty's performance in attaining those attributes. Formulating the plan and marketing it to the faculty was time consuming. On several occasions, UACCMF contemplated scrapping the plan but persevered because staff believed it was supported by sound theory. By changing certain details, it won faculty acceptance. Any large change makes people resistant because it involves uncertainties, especially when compensation is affected. Naturally, people view the plan first from their own perspective (How will this affect my pay?) and only later from the department's perspective. Now that a blueprint of department values is established, faculty members have concrete goals on which to focus and some direct control over their salaries.

Academic Medical Centers↗