Discrimination impairs cognitive function in ageing men and women

Background

We sought to assess changes in episodic memory and executive functioning among men and women in the Midlife in the United States (MIDUS) cohort study; and to delineate variations in episodic memory and executive functioning by gender; and to determine the impact of discrimination on longitudinal changes in episodic memory and executive functioning.

Methods

We used data from the MIDUS study - a national probability sample of non-institutionalized, English speaking respondents aged 25-74 living in the 48 contiguous states of the United States. The initial wave in our study (1995) included 4963 non-institutionalized adults aged 32 to 84 (M = 55, SD = 12.4). Dependent variables are episodic memory and executive functioning, assessed with the Brief Test for Cognition. The independent variables were discrimination (lifetime and daily discrimination) variables. Furthermore, we investigated baseline cognition score, race/ethnicity (White, Hispanic, other), education (some college or more vs high school of less), whether or not living with partner, income (per 100% above Federal Poverty Level), unemployed (vs employed), retired (vs employed), physical health (self-reported), vigorous physical activity, depression (continuous scale), anxiety (continuous scale). To assess cognition changes we estimated adjusted linear regression models.

Results

Cross-sectional, work discrimination was associated with cognition in men and women. Longitudinally, adjusting for baseline cognition score, race/ethnicity, education, living situation, income, (un)employed, (not)retired, physical health, vigorous physical activity, depression, and anxiety, we found an association of family strain with cognition changes in high-income men, and an association of daily discrimination with cognition changes in men (Beta 0.01, P-value: 0.001).

Conclusions

Reducing discrimination might be an important measure to support cognitive function in ageing populations.

The impact of social stress and strain on cognitive function in older people

Background

Social stress and strain, especially discrimination and inequality might have an impact on memory and cognitive function. This is a major concern for older individuals, their families, communities and societies. We sought to assess changes in episodic memory (EM) and executive functioning (EF) among men and women in the 'Midlife in the United States' (MIDUS) cohort study, to delineate variations in EM and EF by gender, and to determine the impact of social stress/strain at three levels (family, work, society) on longitudinal changes in EM and EF in men and women.

Methods

We used data from the MIDUS study - a national probability sample of non-institutionalized, English speaking respondents aged 25-74 living in the 48 contiguous states of the United States. The initial wave in our study (1995) included 4963 non-institutionalized adults aged 32 to 84 (M = 55, SD = 12.4). The dependent variables are EM and EF, which were assessed with the Brief Test for Cognition. The independent variables were social stress and discrimination variables at the family/partner level, the work level and the society level, assessed with validated discrimination measures. To assess cognition changes we estimated adjusted linear regression models.

Results

Women report more perceived inequality for their family and more family strain than men across all age groups. After controlling for other explanatory variables, the main effect on cognition for all age groups was found for perceived inequality of one's family opportunities.

Conclusions

Reducing social stress and providing opportunities might be an important measure to support episodic memory and executive functioning in aging populations.

Feed efficiency phenotypes in lambs involve changes in ruminal, colonic, and small-intestine-located microbiota

Several studies have revealed differences in rumen-located microbes between greatly efficient and inefficient animals; however, how the microbiota vary in the hind gastrointestinal tract (GIT) has only been sparsely explored and how they vary in the small intestine remains to be determined. We therefore sampled the microbiota of the duodenum, jejunum, ileum, colon, and colorectally-obtained feces, in addition to the rumen of 12 lambs that, in a residual feed intake trial, were found to be at either extreme of feed efficiency phenotypes. The 16S rRNA gene (V3-V4 region) profiles of all samples were analyzed and revealed unique microbiota in all GIT locations except the jejunum and ileum (ANOSIM > 0.2, < 0.001). Measures of β-diversity revealed greater dissimilarity between more anatomically distant GIT locations (e.g., Rumen-Duodenum, ANOSIM = 0.365, < 0.001; Rumen-Colon, ANOSIM = 1, < 0.001) with the nearest distal region typically more similar than the nearest proximal location. The relative abundances of 13 operational taxonomic units (OTUs) from the duodenum, jejunum, colon, and feces, as well as the rumen, differed between efficient and inefficient animals (Bonferroni corrected, < 0.05), while another 2 OTUs trended toward significance. These OTUs were classified as taxa with known roles in fibrolysis (Fibrobacteres, Ruminococcaceae, and Saccharofermentans) and others that are commonly associated with health (Bifidobacteriaceae, and Christensenellaceae) and dysbiosis (Proteobacteria). Our findings show biospatial delineations of microbiota throughout the GIT and suggest that feed efficiency extends beyond the rumen, transcending these regions, and involves increases in both rumen- and colon-located fibrolytic taxa, increases in bifidobacterial species in the small intestine, and reductions in small intestine and distal GIT-located Proteobacteria.

Recidivous offence in sadistic homosexual pedophile with karyotype 48, XXXY after testicular pulpectomy. A case report

The case of recidivous sexual offender with genetically caused mental retardation and primary hypogonadism (Klinefelter's syndrome with karyotype 48, XXXY) is described. He was examined after sadistic abuse of a boy aged 13 that he had committed 19 years after performed testicular pulpectomy. Plasmatic level of testosterone was found 4x higher than mean level in men after orchidectomy. Histological examination of residual scrotal tissues proved that the source of androgens were hyperplastic nodules of extratesticular Leydig cells.

Serum levels of steroid hormones in men with varicocele and oligospermia as compared to normozoospermic men

In order to assess the contribution of individual steroidogenic organs to over-all steroid biosynthesis, the basal plasma levels of six hormonal steroids, reflecting the function of gonads and adrenals, as well as both gonadotropins and prolactin, have been determined in 63 oligo- and/or asthenozoospermic men with palpable varicocele, confirmed in each case by sonography. The values obtained were compared with the results of a group of age-matched normospermic men without endocrine disorders. Insignificantly lower levels of testosterone accompanied by significantly lower levels of dihydrotestosterone, slightly decreased LH but increased FSH undistinguishable concentrations of cortisol in patients with varicocele were in agreement with previous findings. Higher levels of an exclusively adrenal androgen 11 beta-hydroxyandrostenedione in men with varicocele indicate increased activity of the adrenal cortex. Significantly higher basal levels of 17 alpha-hydroxyprogesterone in the patient group (p < 0.001), so far not unequivocally proved, evidence for suggested decreased enzyme activity of C17-20 lyase in the testis in at least some of men with varicocele.

Clinical case management of revolving door patients - a semi-randomized study

OBJECTIVE

To assess the effectiveness of psychiatric clinical case management.

METHOD

Subjects with at least three admissions in the previous 2 years were randomized into a clinical case management group (CMG; n = 122) and a standard care group (SCG; n = 95). Individuals who refused or were not located were included in a third, non-randomized no-treatment group (NTG; n = 153). Parameters assessed included utilization of in-patient services and psychosocial functioning.

RESULTS

We found no difference between the CMG and the SCG in psychosocial functioning as evaluated by interviewers, and no difference between the three groups in hospitalization. In subjects' self-ratings, the CMG showed slight improvement in psychosocial functioning.

CONCLUSION

Clinical case management did not prove itself superior to standard care in a revolving door population.

Exercise--it's never too late: the strong-for-life program

OBJECTIVES

This investigation determined whether an in-home resistance training program achieved health benefits in older adults with disabilities.

METHODS

A randomized controlled trial compared the effects of assigning 215 older persons to either a home-based resistance exercise training group or a waiting list control group. Assessments were conducted at baseline and at 3 and 6 months following randomization. The program consisted of videotaped exercise routines performed with elastic bands of varying thickness.

RESULTS

High rates of exercise adherence were achieved, with 89% of the recommended exercise sessions performed over 6 months. Relative to controls, subjects who participated in the program achieved statistically significant lower extremity strength improvements of 6% to 12%, a 20% improvement in tandem gait, and a 15% to 18% reduction in physical and overall disability at the 6-month follow-up. No adverse health effects were encountered.

CONCLUSIONS

These findings provide important evidence that home-based resistance exercise programs designed for older persons with disabilities hold promise as an effective public health strategy.

A randomized, controlled trial of a group intervention to reduce fear of falling and associated activity restriction in older adults

A randomized, single-blind controlled trial was conducted to test the efficacy of a community-based group intervention to reduce fear of falling and associated restrictions in activity levels among older adults. A sample of 434 persons age 60+ years, who reported fear of falling and associated activity restriction, was recruited from 40 senior housing sites in the Boston metropolitan area. Data were collected at baseline, and at 6-week, 6-month, and 12-month follow-ups. Compared with contact control subjects, intervention subjects reported increased levels of intended activity (p < .05) and greater mobility control (p < .05) immediately after the intervention. Effects at 12 months included improved social function (p < .05) and mobility range (p < .05). The intervention had immediate but modest beneficial effects that diminished over time in the setting with no booster intervention.

Home-based resistance training: predictors of participation and adherence

This study identified factors associated with exercise participation and adherence in a sample of 102 sedentary, functionally limited, community-dwelling adults aged 60 to 94 years who participated in a home-based resistance training program. Stepwise regression analyses revealed that baseline physical factors (i.e., higher levels of mobility, weaker muscle strength, and fewer numbers of new medical conditions) were associated with higher rates of participation in the home program. Positive attitudes and a sense of control toward exercise, lower levels of confusion and depressive moods, and the development of fewer new medical problems during the program were related to higher levels of adherence to the program. Findings revealed that although physical health variables were the primary indicators of an older person's overall participation in the program, it was the psychological factors that were most important to adherence to this home-based program.

[MESA, TESA, TESE + ICSI: results of the first 50 cases]

During the period between February 1996 and August 1997 51 infertile men were operated. The authors evaluate the results from 47 couples--25 cases of testicular azoospermia and 22 cases of obstructive azoospermia. The mean age of the men in the group was 33 years (22-48 years). The follow-up period is 1-18 months. In 17 cases, microsurgical epididymal sperm aspiration (MESA) was made, in five cases testicular sperm aspiration (TESA) and in 25 men, testicular sperm extraction (TESE) was performed. In the group with testicular azoospermia it proved possible to obtain sperm in 12 of 25 cases, i.e. in 48%. In men with obstructive azoospermia all aspirations were successful, i.e. the yield was 100%. In this group five children were born, seven pregnancies are under way. Thus regardless of the etiology of male infertility 12 of 47 cases, i.e. 25.5% were resolved successfully. When the results of the two groups are differentiated, the outcome is as follows: in the group with testicular azoospermia one child was born and two pregnancies are under way, i.e. 12%, in the group with obstructive azoospermia four children were born and five pregnancies are under way, i.e. 40.9%.

[Microsurgery and micromanipulation in the treatment of male infertility: results of a one-year investigation]

A one-year study of 51 infertile couples, 47 couples evaluated--25 cases of testicular azoospermia and 22 cases of obstructive azoospermia. The mean age of the men in the group is 33 years (22-48 years). The follow-up period is 1-18 months. In 17 instances microsurgical epididymal sperm aspiration--MESA was made, five times testicular sperm aspiration--TESA and in 25 men testicular sperm extraction--TESE was used. In the group with testicular azoospermia it proved possible to obtain sperm in 12/25 cases, i.e. in 48%. In men with obstructive azoospermia all aspirations were successful, i.e. the yield was 100%. In this group five infants were born, another seven pregnancies are under way. Thus regardless of the etiology of male infertility 12/47 cases, i.e. 25.5%, were successfully resolved. When using differentiated evaluation of the two groups the results are as follows: in the group with testicular azoospermia one infant were born and five pregnancies are under way, i.e. 40.9%.

The development of coping resources in adulthood

We examined three community samples to determine whether stressful episodes form a context for the development of coping resources in adulthood. The first study found that 81.9% of a sample of 845 older men reported drawing upon prior experiences in coping with a recent problem. Content analysis revealed that only 22.7% drew upon similar stressful episodes; the rest drew upon problems from work, the military, illnesses, deaths, etc. The second study replicated the earlier findings in 102 men and women, ages 24 to 84, who reported on a recent low point in semistructured interviews. In addition, 75% reported long-term effects, equally split between negative, positive, and mixed effects. Those individuals who perceived advantages from the low point were significantly more likely to report positive long-term effects. The third study replicated the findings from the first two studies in a sample of 941 men and women ages 23 to 62. Path analyses showed that coping strategies differentially predicted perceived positive or negative outcomes, which in turn predicted current mastery and depression levels. While the findings are cross-sectional and causality cannot be inferred, they are nonetheless supportive of the effects of stress and coping on personality.

Evaluation of SHBG test for disclosure of insensitivity to androgens

A laboratory test enabling to reveal and confirm the suspicion on the insensitivity to androgens was evaluated. The test consisted of determination of the decline in plasma level of sex hormone binding globulin (SHBG) on the 7th day after administration of a single dose of testosterone preparation (Testoviron Depot 100, Schering, 2 mg/kg body weight). The upper limit of percentual SHBG decline, below which the patients can be considered normal responders (i.e. subjects without insensitivity to androgens), obtained from the follow up of the time course of SHBG changes after Testoviron application to 6 healthy men, was established as 83.6%. The level of percentual SHBG decline, above which the patients were considered non-responders with impaired peripheral sensitivity to androgens was assessed from the imprecision of immunoradiometric determination of SHBG and amounted 91.9%. The test was used and evaluated in 26 patients with 46 XY karyotype, representing various cases of intersex, gonadal dysgenesis and male hypogonadism, out of which four subjects with clinically confirmed impaired peripheral sensitivity to androgens were discovered. The test however, appeared not to be reliable in cases of very low basal SHBG levels, i.e. below 15 nmol/l.

[A laboratory test for the detection of androgen resistance using sex hormone-binding globulin]

A simple laboratory test for disclosure of peripheral androgen insensitivity has been suggested. The test is based on determination of sex hormone-binding globulin (SHBG) following single administration of testosterone preparation (Testoviron Depot, Schering, 2 mg/kg of body weight). The kinetics of SHBG response to exogenous testosterone was investigated first in a group of 5 healthy male volunteers. The highest highly significant decrease of SHBG level occurred 7th day after drug administration. The method of choice for SHBG determination is an immunoradiometric assay (IRMA). The test was used for a group of 15 children and young people suspected for androgen sensitivity disorder. In all cases, besides SHBG on days 0 and 7 testosterone, dihydrotestosterone and LH were measured, too. In three instances the response was negative: in the case of male Turner syndrome, with very low basal SHBG levels, in one case of confirmed diagnosis of testicular feminization and in the third case of suspected testicular feminization, which has not yet been concluded. In all other patients a significant decrease (in average to 62.8% of the basal level) was in agreement with clinical findings.

A non-computer-dependent prospective review of blood and blood component utilization

The effect that a prospective review of blood and blood component utilization had during a 1-year period at an 850-bed tertiary-care teaching hospital is reported. The review process, which has been in operation for 18 years, is based on institutionally developed usage guidelines for blood, fresh-frozen plasma (FFP), platelets (Plts), and cryoprecipitate (Cryo). The guidelines were developed by the hospital's Transfusion Medicine Committee. The review is initiated by the transfusion service technical personnel when an order is received. Back-up support is provided, as needed, by physicians on the service or by those pathology residents taking off-hour call. They consult with the ordering physician when questions arise as to the appropriateness of an order as it relates to the patient's clinical situation. Screening values used in the initial evaluation of each order are: hematocrit, less than or equal to 27 percent (0.27) for blood; prothrombin time, greater than or equal to 16 seconds, and/or activated partial thromboplastin time, greater than or equal to 60 seconds, for FFP; bleeding time, greater than or equal to 16 minutes and/or a platelet count of 20 to 100 x 10(3) per mm3 (20-100 x 10(9)/L), as related to clinical conditions, for Pits; and fibrinogen less than or equal to 120 mg per dL (1.2 g/L) for Cryo. Also taken into consideration is the stated clinical indication, which is provided when the requisition is submitted. As a result of the prospective review, orders for blood and/or components for 114 patients were canceled, and 51 patients received 207 blood components that were more appropriate for the clinical situation.(ABSTRACT TRUNCATED AT 250 WORDS)

The impact of a patient education program on directed donations

The effect of an informational program in which the benefits and disadvantages of directed donations are discussed directly with the prospective recipient of the blood and/or that patient's family was examined during a 20-month period. Data collected for 27 regional Connecticut hospitals that accept directed donations were compared with similar data for Hartford Hospital, an 885-bed tertiary-care facility. The number of directed-donor units (68) collected by the American Red Cross Blood Services for Hartford Hospital during the study period was comparable to the number (average, 62.3) provided for smaller (301-450 beds) institutions in the state. The percentage that directed-donor units drawn for Hartford Hospital represented of the total number of homologous units provided (0.23%) was less than that for any of the categories of hospitals, by size, in the state. Supplying the patient and/or the patient's family, in a personalized manner, with information concerning the advantages and disadvantages of directed as well as of volunteer donor blood can result in a marked overall reduction in the number of directed donations and also serves to reassure those concerned about blood transfusion.

Castrated men exhibit bone loss: effect of calcitonin treatment on biochemical indices of bone remodeling

To test the hypothesis that the reduction in gonadal function can lead to bone mass loss, a group of 12 men who had undergone bilateral orchidectomy at the age of 28.2 +/- 6.8 yr was evaluated. A progressive loss of the lumbar bone density was observed as a function of time after orchidectomy. Both the biochemical indices of bone resorption (urinary hydroxyproline/creatinine ratio and plasma tartrate-resistant acid phosphatase) and bone formation (serum osteocalcin and bone isoenzyme of alkaline phosphatase) were significantly increased in the patients compared with healthy controls. A positive correlation was found between urinary hydroxyproline excretion and percent change in spinal bone mineral density per yr. Because of this increase in the biochemically indicated bone resorption, nine of the patients were studied again after 1-3 yr and were thereafter treated with intranasal calcitonin. Urinary hydroxyproline excretion normalized after 3 months of treatment, and a significant decrease, but not to normal levels, was also observed in the mean values for the other biochemical indices of bone remodeling. Thus, testosterone deficiency, like estrogen deficiency, is associated with accelerated bone loss. The increase in osteoresorption was partially corrected by calcitonin treatment.

Hormonal changes in tamoxifen treated men with idiopathic oligozoospermia

Three months of tamoxifen treatment of 43 men with idiopathic oligozoospermia, out of which 20 completed the study, resulted in a significant enhancement of sperm motility, but the improvement of sperm parameters was in no relation to the FSH response to short time tamoxifen treatment. There was a significant increase of testosterone, estradiol, LH, FSH, SHBG, 17 alpha-hydroxy-progesterone and also of 11 beta-hydroxyandrostenedione, an androgen of exclusively adrenal origin, during the treatment and (with the exception of the latter), on the first week after discontinuation of the therapy. Significantly elevated testosterone and SHBG concentrations were retained still 9 weeks after finishing of the therapy. The results confirm that tamoxifen treatment provides conditions more favourable for conception and demonstrate that also adrenal steroidogenesis is positively influenced by this antiestrogen.

The vestibular aqueduct in congenital deafness: evaluation by the axial projection

Thirty-two patients with congenital neurosensory hearing loss demonstrated dilatation of the peripheral limb of the vestibular aqueduct as visualized on pluridirectional tomograms. Multiple additional anomalies involving most frequently the cochlea (15 patients) but also the ossicles (three patients) or vestibule (one patient) were associated. The axial-pyramidal (Poschl) projection was of great value in evaluation of the vestibular aqueduct and cochlea. The technique, clinical correlation, and surgical implications are discussed.

Aging opinion survey: a report on instrument development

Attitude instrument development remains a necessary task in aging research, for the eventual explication of attitude-behavior relationships. The present report describes initial development of the Aging Opinion Survey, an instrument based upon a multidimensional view of attitudes towards aging and the elderly. After identifying substantive attitudinal content areas, an initial 120-item pool was constructed, balanced across referent groups and direction of wording. Pilot analysis eliminated sixty items with minimal variances. Administration of the reduced item set to a subsequent sample of 200 gerontological practitioners and students produced four meaningful factors. Poor items were again eliminated and replacements constructed. Another administration (n=226) again produced four meaningful factors, three of which met the criterion of reliability: (1) Stereotypic age decrement, (2) Personal anxiety toward aging, and (3) Social value of the elderly. These scales appeared to reflect peer, personal, and generalized-elderly referents, respectively. Development and refinements of attitudes scales such as the Aging Opinion Survey are necessary elements for proceeding beyond the current theoretical and empirical difficulties in gerontological attitude literature.

[Mouth preparation before radiotherapy for cervicofacial carcinomas. Fluoride prophylaxis against dental lesions (author's transl)]

The use of a 1% fluore gel, for ten minutes every day during the irradiation period and after that twice a week, constitutes an excellent protection for the good teeth located in the Tele-Coblat irradiation area. This will avoid the systematic ablation of the good teeth.

[Invasive carcinoma of the parotid with a double glandular and epidermoid component. One case (author's transl)]

The authors present an observation of epithelial tumor with double composent glandular and epidermoid. The true name is adenosquamous carcinoma. Here, it's a case of parotid Tumor. This tumor is very exceptional and very severe.