Parent personality traits and problem behavior in adolescence: The mediating role of adolescent personality.

INTRODUCTION: Parental personality traits are predicted to influence offspring outcomes through parenting behavior and offspring personality traits. This study explored whether mother and father personality traits relate to offspring behavior problems in mid-late adolescence METHOD: In total, 3089 Australian adolescents (1576 boys, 1513 girls; Mage = 16.46 ± 0.50 years) and their parents completed questionnaires assessing personality, conduct problems, emotional and social functioning, antisocial and criminal behavior, cigarette smoking and drug use, at a single time-point. RESULTS: After controlling for sociodemographic factors, results showed that problem behaviors in adolescence were most consistently related to mothers' scores on neuroticism and conscientiousness, and fathers' scores on neuroticism. Father personality traits were most important for antisocial and criminal behavior, whereas mother personality traits were most important for social and emotional functioning. Moderation analysis showed that associations between fathers' personality traits and some adolescent outcomes (cigarette smoking and drug use) were stronger for adolescent boys than for adolescent girls. Mediation models further demonstrated that adolescent personality traits mediated associations between parent personality and adolescent outcomes in almost all cases. Indirect effects expressed as a percentage showed that between 1.4% and 33.3% of the variance in the association between parent personality and adolescent outcomes was shared with the corresponding adolescent personality trait. CONCLUSIONS: Overall, the findings of this study provide evidence that traits inherited (directly or indirectly) from parents might have an important role in shaping problem behavior in adolescence.

Psychophysiological effects of slow-paced breathing at six cycles per minute with or without heart rate variability biofeedback.

Heart rate variability (HRV) biofeedback, referring to slow-paced breathing (SPB) realized while visualizing a heart rate, HRV, and/or respiratory signal, has become an adjunct treatment for a large range of psychologic and medical conditions. However, the underlying mechanisms explaining the effectiveness of HRV biofeedback still need to be uncovered. This study aimed to disentangle the specific effects of HRV biofeedback from the effects of SPB realized alone. In total, 112 participants took part in the study. The parameters assessed were emotional (valence, arousal, and control) and perceived stress intensity as self-report variables and the root mean square of the successive differences (RMSSD) as a physiologic variable. A main effect of condition was found for emotional valence only, valence being more positive overall in the SPB-HRVB condition. A main effect of time was observed for all dependent variables. However, no main effects for the condition or time x condition interaction effects were observed. Results showed that for PRE and POST comparisons (referring, respectively, to before and after SPB), both SPB-HRVB and SPB-NoHRVB conditions resulted in a more negative emotional valence, lower emotional arousal, higher emotional control, and higher RMSSD. Future research might investigate psychophysiological differences between SPB-HRVB and SPB-NoHRVB across different time periods (e.g., long-term interventions), and in response to diverse psychophysiological stressors.

Autologous blood patch pleurodesis for prolonged postoperative air leaks.

BACKGROUND: A prolonged air leak (PAL) is the most frequent complication after pulmonary resection. This study aimed to assess the safety and efficacy of autologous blood patch pleurodesis (ABPP) to treat PAL. METHODS: A prospectively maintained database identified patients with a PAL after pulmonary resection for lung cancer between 2015-2019. In this observational cohort study, clinical data were collected to retrospectively compare patients undergoing ABPP to no ABPP in a propensity-matched analysis. Kaplan Meier estimates and Cox models accounting for inverse probability weighting (IPTW) were used to assess the association of ABPP with each outcome. RESULTS: Of the 740 patients undergoing lung resection, 110 (15%) were identified as having a PAL at postoperative day (POD) 5. There was no difference between baseline characteristics among those undergoing ABPP (n=34) versus no ABPP (n=76). Propensity-weighted analysis did not reveal a significant association of ABPP treatment with in-hospital complication (P=0.18), hospital length of stay (LOS) (P=0.13), or post-discharge complication (P=0.13). However, ABPP treatment was associated with a lower risk of hospital readmission [P=0.02, hazard ratio (HR) 0.16] and reoperation for air leak or empyema (P=0.05, HR 0.11). Although not statistically significant, the mean chest tube (CT) removal of 11 days for the ABPP group was less than the no ABPP group (16 days) (P=0.14, HR 1.5-2). Those treated with ABPP were less likely to be discharged with a CT (ABPP 7/34, 21% vs. no ABPP 40/76, 53%). There was no statistical difference in empyema development between groups (ABPP 0/34, 0% vs. no ABPP 4/76, 5%, P=0.39, HR 0.24). CONCLUSIONS: ABPP administration is safe compared to traditional PAL management. In a retrospective propensity-matched analysis, postoperative patients treated with ABPP required less readmission and reoperation for PAL. Larger powered randomized trials may demonstrate the magnitude of benefit from treatment with ABPP.

Extraversion development in childhood, adolescence and adulthood: Testing the role of sport participation in three nationally-representative samples.

This research sought to test whether sport participation relates to the development of trait extraversion across three life phases. Sport participation and extraversion were measured in children aged 10.5 ± 0.5 years (n = 3600), in adolescents aged 14.5 ± 0.5 years (n = 3463), and in adults with a mean age of 49.4 ± 18.0 years (n = 12,280), with corresponding data collected four years earlier. There were small mean-level decreases in extraversion during childhood and adulthood, and a large decrease in extraversion during adolescence. Four-year rank-order stability in extraversion was .58 in childhood, .61 in adolescence and .76 in adulthood. Sport participation was associated with higher extraversion in all three samples. After controlling for sociodemographic factors, children and adolescents who dropped out of sport showed greater decreases in extraversion than those who continued participation in sport. Sport participation was unrelated to mean-level change in extraversion during adulthood. Sport participation was also associated with greater intra-individual stability in extraversion for children, adolescents and adults. There were no significant sex moderation effects for mean-level change or individual-level stability. These findings provide evidence that sport participation might have an important role in trait extraversion stability and change across the lifespan.

Complications after Ravitch versus Nuss repair of pectus excavatum: A Society of Thoracic Surgeons (STS) General Thoracic Surgery Database analysis.

BACKGROUND: There are conflicting reports in the literature comparing outcomes after open Ravitch and minimally invasive Nuss procedures for pectus excavatum repair, and there is relatively little data available comparing the outcomes of these procedures performed by thoracic surgeons. METHODS: The 2010 to 2018 Society of Thoracic Surgeons General Thoracic Surgery Database was queried for patients age 12 or greater undergoing open or minimally invasive repair of pectus excavatum. Patients were stratified by operative approach. Multivariable logistic regression was performed with a composite outcome of 30-day complications. RESULTS: A total of 1,767 patients met inclusion criteria, including 1,017 and 750 patients who underwent minimally invasive pectus repair and open repair, respectively. Open repair patients were more likely to be American Society of Anesthesiologists (ASA) class III or greater (24% vs 14%; P < .001), have a history of prior cardiothoracic surgery (26% vs 14%; P < .001), and require longer operations (median 268 vs 185 minutes; P < .001). Open repair patients were more likely to require greater than 6 days of hospitalization (18% vs 7%; P < .001), undergo transfusion (7% vs 2%; P < .001), and be readmitted (8% vs 5%; P = .004). After adjustment, open repair was not associated with an increased risk of a composite of postoperative complications (odds ratio 0.99, 95% confidence interval 0.67-1.46). This finding persisted after propensity score matching (odds ratio 1.11, 95% confidence interval 0.74-1.67). CONCLUSION: Pectus excavatum repair procedure type was not associated with the risk of postoperative complications after adjustment. Further investigation is necessary to determine the impact of pectus excavatum repair type on recurrence and patient reported outcomes, including satisfaction, quality of life, and pain control.

Bias Against Complex Lung Cancer Surgery.

BACKGROUND: Lung cancer remains a major public health problem. There remain differences in mortality among socioeconomic and racial groups. Using The Society of Thoracic Surgeons General Thoracic Surgery database, we attempted to determine whether there were differences in treatment choices by thoracic surgeons based on patients' race or insurance. METHODS: Using data from 2012 to 2017, we analyzed data from 75,774 patients with a diagnosis of lung cancer for whom complete information on race, insurance, or both was available, and who had undergone a pulmonary resection. We categorized 66,614 operations (87.9%) into standard (lobectomy, bilobectomy, or wedge excision) and 9160 (12.1%) into complex (pneumonectomy, sleeve or bronchoplastic resection, segmentectomy, or Pancoast resection) operations. Univariate and multiple variable logistic regression models were used to assess associations with receipt of a complex operation. RESULTS: Patients with private insurance had a higher incidence of complex operations (14.4%) compared with patients with government insurance (11.6%) (P < .0001). We also found a higher incidence of complex operations in White patients (12.2%) compared with Nonwhite patients (11.3%; P = .0054). On multivariate analysis, patients with private insurance were significantly more likely to have a complex operation (odds ratio = 1.08; P < .03) and Nonwhite patients were less likely to have a complex operation (odds ratio = 0.93; P = .04) respectively. CONCLUSIONS: In this cohort of patients from The Society of Thoracic Surgeons General Thoracic Surgery database, White patients and those with private insurance had a higher incidence of complex operations. Many factors affect the decision to proceed with a complex thoracic surgical operation; type of medical insurance and race may represent 2 of them.

Thinking About Pathomechanisms and Current Treatment of Erectile Dysfunction-"The Stanley Beamish Problem." Review, Recommendations, and Proposals.

INTRODUCTION: Up to 50% of all men over 50 years of age suffer from erectile dysfunction. Since the late 1990s erectile dysfunction has been treated mostly with phosphodiesterase 5 inhibitors (PDE5I). Over the past 20 years, numerous scientific findings on the development of erectile dysfunction have been collected, which have so far received little attention in the treatment of erectile dysfunction. OBJECTIVES: The objectives of this study were to review the existing medical literature on erectile dysfunction regarding physiology, pathophysiology, and especially therapeutic options beyond treatment with PDE5I and to enable a more effective and especially sustainable treatment for erectile dysfunction. METHODS: A literature review was performed by using PubMed from 1985 to 2020 regarding the physiology, pathophysiology, and treatment of erectile dysfunction. RESULTS: Since the end of the 1990s an enormous amount of knowledge has been gained about the physiology/pathophysiology of erection/erectile dysfunction. Based on these findings, numerous physical, drug, and holistic therapeutic options (beyond the application of PDE5I) have been developed for the treatment of erectile dysfunction. However, these are still relatively rarely used in the therapeutic concept of erectile dysfunction today. CONCLUSION: Based on scientific findings of the last 20 years, there are numerous therapeutic approaches, including lifestyle modification, specific pelvic floor exercises, shock wave treatment, and the application of different supplements. The long-term treatment of erectile dysfunction should now go beyond the purely symptomatic use of PDE5I. W-D Beecken, M Kersting, W Kunert, et al. Thinking About Pathomechanisms and Current Treatment of Erectile Dysfunction-"The Stanley Beamish Problem." Review, Recommendations, and Proposals. Sex Med Rev 2021;9:445-463.

A Matched Control Trial of a Mental Health Literacy Intervention for Parents in Community Sports Clubs.

This controlled trial evaluated the effectiveness of a mental health literacy intervention for parents delivered through community sport clubs. In total, 540 parents (321 females, 219 males) of adolescent athletes participated in a brief educational workshop on youth mental health (n = 352) or a community-matched control group (n = 188). Generalised linear mixed models revealed no significant improvements in the intervention group compared to control in the primary mental health literacy outcomes, at 1 month follow-up. However, parents in the intervention group were more likely to seek formal help for themselves, had increased confidence and knowledge to help someone experiencing a mental health disorder, experienced reduced psychological distress, and perceived more support from other parents in their sport club, relative to the control group. Overall, the findings suggest that a brief educational intervention delivered through community sports clubs can positively affect some components of parents' mental health literacy.

Management of Epiphrenic Diverticula and Short-term Outcomes.

Epiphrenic diverticulum is a rare and benign condition with significant surgical morbidity and evolving surgical management. The objective of this study was to analyze short-term clinical outcomes after surgery for epiphrenic diverticula. We conducted a retrospective cohort study in a single tertiary care center of all patients who underwent treatment for epiphrenic esophageal diverticula from June 1990 to December 2016. Data collection included demographics, operative details and short-term outcomes (esophageal leak, other complications, 30-day mortality). In addition, all preoperative imaging was reviewed by an esophageal radiologist in order to describe epiphrenic diverticula characteristics in a uniform and blinded manner. Of the 94 patients in the study, 84 patients were managed with an open surgical approach and 10 with minimally invasive techniques. Median size of diverticula was 5.5 cm and mean height above gastroesophageal junction was 4 cm. A myotomy was completed in 95% of patients and a fundoplication in 58%. The MIS group had a shorter length of stay (4 vs 6 days). Overall complication rate was 27% with an esophageal leak rate of 7% with 60% grade I leaks that sealed with conservative management. Complete resection of the diverticulum, closure of the muscle over the resection, contralateral myotomy, and consideration for partial fundoplication are common strategies utilized to surgically treat patients with epiphrenic diverticulum. Minimally invasive approaches are increasingly utilized.

Personality and Sexual Orientation: New Data and Meta-analysis.

This research explored associations between personality and sexual orientation. In Study 1, we explored whether the Big Five trait dimensions relate to sexual orientation in a nationally representative sample of Australian adults (n = 13,351). Personality differences were observed between those who identified as heterosexual (straight), bisexual, and homosexual (gay/lesbian) on all five measured traits. In Study 2, we conducted an updated systematic review and meta-analysis of personality and sexual orientation. A total of 21 studies (35 independent samples, 262 effect sizes) comprising 377,951 men and women were identified that satisfied inclusion criteria. Results showed that bisexual individuals reported higher levels of openness than homosexual individuals, who in turn, reported higher levels of openness than heterosexual individuals. Bisexual individuals also report lower levels of conscientiousness than both heterosexual and homosexual individuals. Sex moderation effects showed that homosexual men scored higher than heterosexual men on neuroticism, agreeableness and conscientiousness, whereas homosexual women scored lower than heterosexual women on extraversion, agreeableness, and conscientiousness. There was also evidence that personality differences between sexual orientation categories tend to decline with age. These findings align with the gender-shift hypothesis and should be of interest to theorists working in personality science and sexual identity development.

Associations of chronotype, Big Five, and emotional competences with perceived stress in university students.

This study aimed to investigate the associations between individual difference factors (chronotype, Big Five, emotional competences) and perceived stress in French university students. In total, 362 students agreed to take part (Mage = 20.19 ± 1.75 years). Participants completed the Caen Chronotype Questionnaire, Big Five Inventory, the Profile of Emotional Competences, and the Perceived Stress Scale. Results showed that chronotype amplitude (+), eveningness chronotype (+), neuroticism (+), conscientiousness (-), and intrapersonal emotional competences (-) were important for perceived stress. These findings have theoretical and practical implications in terms of identifying students who might benefit most from stress management interventions.

Predictors of Patient-Reported Reflux After Esophagectomy.

BACKGROUND: Patient-reported reflux is among the most common symptoms after esophagectomy. This study aimed to determine predictors of patient-reported reflux and to ascertain whether a preserved pylorus would protect patients from symptomatic reflux. METHODS: A prospective clinical study recorded patient-reported reflux after esophagectomy from August 2015 to July 2018. Eligible patients were at least 6 months from creation of a traditional posterior mediastinal gastric conduit, had completed at least 1 reflux questionnaire, and had the pylorus treated either temporarily (≥100 IU Botox [onabotulinumtoxinA]) or permanently (pyloromyotomy or pyloroplasty). RESULTS: Of the 110 patients meeting inclusion criteria, the median age was 65 years, and 88 of the 110 (80%) were male. Botox was used in 15 (14%) patients, pyloromyotomy in 88 (80%), and pyloroplasty in 7 (6%). A thoracic anastomosis was performed in 78 (71%) patients, and a cervical anastomosis was performed in 32 (29%). Esophagectomy was performed for malignant disease in 105 of 110 (95%), and 78 of 110 (71%) patients were treated with perioperative chemoradiation. Multivariable linear regression analysis revealed that patient-reported reflux was significantly worse in patients with shorter gastric conduit lengths (P = .02) and in patients who did not undergo perioperative chemoradiation (P = .01). No significant difference was found between patients treated with pyloric drainage and those treated with Botox. CONCLUSIONS: The absence of perioperative chemoradiation therapy and a shorter gastric conduit were predictors of patient-reported reflux after esophagectomy. Although few patients had Botox, preservation of the pylorus did not appear to affect patient-reported reflux. Further objective studies are needed to confirm these findings.

Normal variations in personality predict eating behavior, oral health, and partial syndrome bulimia nervosa in adolescent girls.

Eating disorders are among the most prevalent disorders in adolescence and can have negative consequences including poor quality of life, medical complications, and even death. This study addresses whether normal variations in personality relate to eating behavior and eating disorder symptomatology in adolescent girls. Participants were a near-representative sample of Australian adolescent girls (n = 1,676). Three personality traits (neuroticism, extraversion, and conscientiousness) were assessed at age 12 and again at age 14, and self-reported eating and weight management behaviors were assessed at age 14. After controlling for sociodemographic factors, higher levels of conscientiousness at age 12, and increases in conscientiousness between ages 12 and 14, were associated with greater fruit and vegetable consumption, a lower intake of high fat foods and high sugar drinks, less frequent meal skipping, better oral health, and decreased risk of partial syndrome bulimia nervosa at age 14. Higher neuroticism at age 12 was associated with more frequent meal skipping, and increases in neuroticism between ages 12 and 14 were associated with more frequent meal skipping and increased risk of partial syndrome bulimia nervosa at age 14. Extraversion was generally unrelated to eating and weight management behaviors. These findings provide evidence that normal variations in personality are related to eating behavior, oral health, and eating disorder symptoms during midadolescence.

Personality and body dissatisfaction: An updated systematic review with meta-analysis.

This research synthesis explored whether major personality dimensions relate to body dissatisfaction. A comprehensive literature search identified 26 studies (37 independent samples) that met inclusion criteria (364 effect sizes; n = 39,109). Data were analyzed using inverse-variance weighted random effects meta-analysis. Mean effect sizes from 30 individual meta-analyses provided evidence that neuroticism (r = .30), extraversion (r = -.17) and conscientiousness (r = -.16), and to a lesser extent openness (r = -.10) and agreeableness (r = -.08), relate to body dissatisfaction. Effect sizes were smaller in models that controlled for body mass index, with non-significant effects for openness and agreeableness. There was some evidence of publication bias and substantial heterogeneity in computed averages. Random effects meta-regression showed that the association between neuroticism and body dissatisfaction decreased as the sample age increased. Measurement was the most important moderator across personality dimensions, with measures of appearance evaluation and body appreciation often showing smaller associations than other measures of body dissatisfaction. Effect sizes were not moderated by sample sex or world-region. Overall, findings show that higher levels of neuroticism, and lower levels of extraversion and conscientiousness, are associated with a greater risk of body dissatisfaction in men and women irrespective of actual body weight.

Self-regulation in childhood as a predictor of future outcomes: A meta-analytic review.

This meta-analysis explores whether self-regulation in childhood relates to concurrent and subsequent levels of achievement, interpersonal behaviors, mental health, and healthy living. A comprehensive literature search identified 150 studies that met inclusion criteria (745 effect sizes; total n = 215,212). Data were analyzed using inverse-variance weighted random effects meta-analysis. Mean effect sizes from 55 meta-analyses provided evidence that self-regulation relates to 25 discrete outcomes. Results showed that self-regulation in preschool (∼age 4) was positively associated with social competency, school engagement, and academic performance, and negatively associated with internalizing problems, peer victimization, and externalizing problems, in early school years (∼age 8). Self-regulation in early school years was positively related to academic achievement (math and literacy), and negatively related to externalizing problems (aggressive and criminal behavior), depressive symptoms, obesity, cigarette smoking and illicit drug use, in later school years (∼age 13). Results also showed that self-regulation in early school years was negatively related to unemployment, aggressive and criminal behavior, depression and anxiety, obesity, cigarette smoking, alcohol and substance abuse, and symptoms of physical illness in adulthood (∼age 38). Random effects metaregression identified self-regulation measurement as the most important moderator of pooled mean effects, with task-based assessments and teacher-report assessments often showing stronger associations than parent-report assessments. Overall, findings from this meta-analysis provide evidence that self-regulation in childhood can predict achievement, interpersonal behaviors, mental health, and healthy living in later life. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

A Systematic Review of Parent and Caregiver Mental Health Literacy.

This study aimed to systematically review the current body of research on parent and caregiver mental health literacy. Electronic databases were searched in January 2018 with 21 studies meeting inclusion criteria. A narrative synthesis of quantitative and qualitative studies was conducted. Findings across studies suggest that parents and caregivers had limited mental health knowledge. Factors associated with help-seeking included cultural and religious beliefs, financial and knowledge barriers, fear and mistrust of treatment services, and stigma. Notable limitations include non-representative samples, cross-sectional research designs, and use of inconsistent and non-validated study measures. Research would benefit from more diverse samples, an increased focus on prevention, and controlled trials of educational programmes targeting mental health literacy.

Postoperative Opioid Consumption in Thoracic Surgery Patients: How Much Is Actually Used?

BACKGROUND: The objective of this initiative was to perform a prospective, multicenter survey of patients after lung resection to assess the amount of opioid medication consumed and the disposition of unused opioids to inform the development of evidence-based prescribing guidelines. METHODS: Adults undergoing lung resection with either minimally invasive surgery (MIS; n = 108) or thoracotomy (n = 45) were identified prospectively from 3 academic centers (from March 2017 to January 2018) to complete a 28-question telephone survey 21 to 35 days after discharge. Discharge opioids were converted into morphine milligram equivalents (MME) and were compared across patient and surgical details. RESULTS: Of the 153 patients who completed the survey, 89.5% (137) received opioids at discharge with a median prescription of 320 MME (interquartile range [IQR], 225, 450 MME) after MIS and 450 MME (IQR, 300, 600 MME) after thoracotomy (P = .001). Median opioid consumption varied by surgical approach: 90 MME (IQR, 0, 262.5) after MIS and 300 MME (IQR, 50, 382.5 MME) after thoracotomy (P < .001). The majority of patients (73.7%; 101) had residual opioid medication at the time of the survey, and patients after MIS had a relative increase in amount of remaining opioid medication: 58.3% vs 33.3% (P = .05) of the original prescription. Only 5.9% of patients with opioids remaining had properly disposed of them. CONCLUSIONS: Although patients undergoing MIS lung resection used significantly less opioid medication over a shorter duration of time than did patients after thoracotomy, they had relatively more excess opioid prescription. Evidence-based, procedure-specific guidelines with tailored pain regimens should be developed and implemented to reduce the amount of postoperative opioid medication remaining in the community.

Systematic Review and Meta-Analysis of Self-Serving Attribution Biases in the Competitive Context of Organized Sport.

This meta-analysis explored the magnitude of self-serving attribution biases for real-world athletic outcomes. A comprehensive literature search identified 69 studies (160 effect sizes; 10,515 athletes) that were eligible for inclusion. Inverse-variance weighted random-effects meta-analysis showed that sport performers have a tendency to attribute personal success to internal factors and personal failure to external factors (k = 40, standardized mean difference [SMD] = 0.62), a tendency to attribute team success to factors within the team and team failure to factors outside the team (k = 23, SMD = 0.63), and a tendency to claim more personal responsibility for team success and less personal responsibility for team failure (k = 4, SMD = 0.28). There was some publication bias and heterogeneity in computed averages. Random effects meta-regression identified sample sex, performance level, and world-region as important moderators of pooled mean effects. These findings provide a foundation for theoretical development of self-serving tendencies in real-world settings.

American Board of Thoracic Surgery 10-Year Maintenance of Certification Exam Improves and Validates Knowledge Acquisition.

BACKGROUND: Previous "high-stakes" examinations by the American Board of Thoracic Surgery (ABTS) required remote testing, were noneducational, and were not tailored to individual practices. Given the ABTS mission of public safety and diplomate education, the ABTS Maintenance of Certification (MOC) examination was revised in 2015 to improve the educational experience and validate knowledge acquired. METHODS: The ABTS-MOC Committee developed a web-based, secure examination tailored to the specialty-specific practice profile (cardiac, general thoracic, cardiothoracic, congenital) of the individual surgeon. After an initial answer to each question, an educational critique was reviewed before returning to the initial question and logging a second (final) response. Intraexam learning was assessed by comparing scores before and after reading the critique. Diplomate feedback was obtained. RESULTS: A total of 988 diplomates completed the 10-year MOC examination between 2015 and 2017. Substantive learning was demonstrated with an 18%, 17%, 20%, and 9% improvement in cardiac, general thoracic, cardiothoracic, and congenital final scores, respectively. This improvement was most notable among diplomates with the lowest initial scores. Fewer diplomates failed the new exam (<1% vs 2.3%). Diplomate postexam survey highlighted marked improvements in clinical relevance (35% vs 78%), convenience (37% vs 78%), and learning (15% vs 45%). Over 80% acknowledged educational value, and 97% preferred the new format. CONCLUSIONS: The new MOC process demonstrates increased knowledge acquisition through a convenient, secure, web-based practice-focused examination. This approach provides feedback, identifies baseline knowledge gaps for individual diplomates, and validates new knowledge attained.

Physical activity as an adjunct treatment for erectile dysfunction.

Increasing data are available to suggest that physical activity and lifestyle modification in general can benefit erectile function, with effect sizes comparable with established treatment options such as testosterone therapy and phosphodiesterase type 5 inhibitors. Despite this evidence, primary-care physicians are rarely afforded critical information on the underlying mechanisms through which physical activity works as a treatment, severely hampering treatment credibility for both physician and patient. Physical activity is associated with psychological and metabolic adaptations that are compatible with the adaptations required for the treatment of erectile dysfunction (ED). These adaptations include increased expression and activity of nitric oxide synthase, strengthened endothelial function, acute rises in testosterone, decreased stress and anxiety, and improved body image. Use of physical activity as a first-line treatment option for ED is limited, and explicit physical activity guidelines for the treatment of ED are required. Such guidelines should include not only a suggested exercise programme but also guidelines for physician-patient communication that might enhance patient receptivity and therapy continuation. An understanding of how physical activity affects erectile function, as well as its effectiveness in treating ED compared with other established treatments, can benefit urologists and primary-care physicians searching for noninvasive treatment options for men presenting with poor erectile function.