Clomiphene citrate: A potential alternative for testosterone therapy in hypogonadal males.

BACKGROUND: Hypogonadism is a worldwide problem among men causing sexual, physical and mental problems. Testosterone therapy is the first-choice treatment for male hypogonadism, with several side effects, that is, subfertility. Clomiphene citrate (CC) is an alternative off-label therapy for a certain group of hypogonadal males, especially for those with an active or future child wish. There is scarce literature in usage of CC for men with hypogonadism. The aim of this retrospective study was to evaluate the effectiveness and safety of CC for hypogonadal males. METHODS: In this single-centre study, men treated with CC for hypogonadism were evaluated retrospectively. Primary outcome was hormonal evaluation including total testosterone (TT), free testosterone (FT), luteinizing hormone (LH) and follicle stimulating hormone (FSH). Secondary outcomes were hypogonadal symptoms, metabolic and lipid parameters, haemoglobin (Hb), haematocrit (Ht), prostate specific antigen (PSA), side effects, the effect of a trial without medication and potential predictors for biochemical and clinical response. RESULTS: In total, 153 hypogonadal men were treated with CC. Mean TT, FT, LH and FSH increased during treatment. TT increased from 9 to 16 nmol/L, with a biochemical increase in 89% of the patients. In patients who continued CC treatment, an increased level of TT persisted after 8 years of treatment. With CC treatment, 74% of the patients experienced hypogonadal symptom improvement. LH at the lower normal range before CC treatment was predictive for better TT response. During CC therapy, few side effects were reported and no clinical important changes in PSA, Hb and Ht were found. CONCLUSION: Clomiphene citrate is an effective therapy on short and long term, improving both clinical symptoms and biochemical markers of male hypogonadism with few side effects and good safety aspects.

N-glycosylation of infectious bronchitis virus M41 spike determines receptor specificity.

Infection of chicken coronavirus infectious bronchitis virus (IBV) is initiated by binding of the viral heavily N-glycosylated attachment protein spike to the alpha-2,3-linked sialic acid receptor Neu5Ac. Previously, we have shown that N-glycosylation of recombinantly expressed receptor binding domain (RBD) of the spike of IBV-M41 is of critical importance for binding to chicken trachea tissue. Here we investigated the role of N-glycosylation of the RBD on receptor specificity and virus replication in the context of the virus particle. Using our reverse genetics system we were able to generate recombinant IBVs for nine-out-of-ten individual N-glycosylation mutants. In vitro growth kinetics of these viruses were comparable to the virus containing the wild-type M41-S1. Furthermore, Neu5Ac binding by the recombinant viruses containing single N-glycosylation site knock-out mutations matched the Neu5Ac binding observed with the recombinant RBDs. Five N-glycosylation mutants lost the ability to bind Neu5Ac and gained binding to a different, yet unknown, sialylated glycan receptor on host cells. These results demonstrate that N-glycosylation of IBV is a determinant for receptor specificity.

Principles for designing and delivering psychosocial and mental healthcare.

The development of the UK's military policy includes the potential for military organisations to deploy in support of humanitarian aid operations. This paper offers an overview of the risks to people's mental health of their exposure to emergencies, major incidents, disasters, terrorism, displacement, postconflict environments in which humanitarian aid is delivered, and deployments to conflict zones. It summarises the psychosocial approach recommended by many contemporary researchers and practitioners. It differentiates the extremely common experience of distress from the mental disorders that people who are affected may develop and introduces the construct of psychosocial resilience. The authors recognise the importance of trajectories of response in separating people who are distressed and require psychosocial care from those who require mental healthcare. Finally, this paper summarises a strategic approach to designing, planning and providing psychosocial and mental healthcare, provides a model of care and outlines the principles for early psychosocial interventions that do not require training in mental healthcare to deliver them.

Deployment guidelines for diplomats: current policy and practice.

BACKGROUND: Diplomatic organizations routinely send staff to high-threat postings (HTPs) and consequentially have moral and legal obligations to protect their health as far as is reasonably practicable. AIMS: To carry out an international survey of diplomatic organizations that send personnel to HTPs to establish how they deal practically with their obligations to protect the mental health of their staff. METHODS: An online anonymous survey about their organizations' policies relating to HTPs completed by international diplomatic organizations. RESULTS: Fourteen of 30 organizations approached completed the questionnaire, with a response rate of 47%. Deployment length varied: no minimum (15%), a minimum of 2 years (39%) and a maximum of 2 (31%), 3 (15%) or 4 years (31%); one organization did not state any maximum. HTP and low-threat postings had the same policies in 46% of organizations. Additional care and support (66%), additional preparation (50%), enhanced leave (33%) and additional physical and mental health assessments were informally adopted to address psychosocial risks of deployment to HTPs. CONCLUSIONS: There was little consensus on policies and practice for HTP deployment. We suggest that formal, consistently written guidelines, based on available quality evidence, and associated training and quality assurance should be formulated to make international practice more consistent and equitable.

Systematic review: deployment length and the mental health of diplomats.

BACKGROUND: While there has been considerable research into the psychosocial consequences of tour length for military personnel, this subject has not been studied in other occupational groups who also deploy staff to high-threat areas. AIMS: To carry out a comprehensive review of relevant published literature to inform diplomatic organizations that deploy staff in high-threat postings (HTPs). METHODS: We searched appropriate scientific databases for studies relevant to deployment length, mental health and well-being for diplomats. A systematic review related to military personnel was found and used as the foundation for the literature review. Other relevant papers identified by the search have also been included. RESULTS: The majority of identified papers had examined military personnel. Results suggested that longer deployments were associated with poorer mental health including post-traumatic stress disorder, depression and alcohol problems and this was most likely to be a function of increased exposure to potentially traumatic events. Exceeding a threshold of 6-12 months within a 3 year period, for military personnel, appeared to elevate the risk of psychosocial problems. Furthermore, diplomats deploying on their first HTP, and those whose tour length is altered after deployment, could be especially vulnerable. CONCLUSIONS: While further research of this topic is required, this review provides an evidence-based insight into the increased risks of developing mental health problems when deployed to HTPs. This information is relevant to generating policies, which may reduce the impacts of adverse psychosocial effects on diplomatic staff and their families.

A theoretical model for smoking prevention studies in preteen children.

The age of the onset of smoking is on a continual decline, with the prime age of tobacco use initiation being 12-14 years. A weakness of the limited research conducted on smoking prevention programs designed for preteen children (ages 10-12) is a well-defined theoretical basis. A theoretical perspective is needed in order to make a meaningful transition from empirical analysis to application of knowledge. Bandura's Social Cognitive Theory (1977, 1986), the Theory of Reasoned Action (Ajzen & Fishbein, 1980), and other literature linking various concepts to smoking behaviors in preteens were used to develop a model that may be useful for smoking prevention studies in preteen children.

Back pain: a case study.

Musculoskeletal complaints, especially back pain without trauma, are frequent health problems seen by nurse practitioners in community emergency centers and office settings. Back pain can be a symptom of serious health problems. This article presents the case of a Caucasian male in his early sixties who reported sudden onset of back pain after pushing a heavy object. Careful clinical assessment led the nurse practitioner with the collaborating physician to pursue diagnostic tests, which revealed thoracic and abdominal aortic aneurysms.

Perception of threat and subjective well-being in low-risk and high-risk pregnant women.

The article reports a study examining the relationship between perceived threat and subjective well-being (positive and negative affect) in pregnant women. Subjects were multiparas classified as having low-risk or high-risk pregnancies and receiving prenatal care from private obstetricians. High-risk women were using home uterine activity monitoring and receiving nursing contact by telephone and home visit. By means of repeated measure analysis of variance, significant risk group differences were found in negative affect and degree of perceived threat. The event of the high-risk pregnancy appeared to be stressful to the high-risk group, with high-risk pregnant women indicating more negative emotions. Based on the findings of this study, interventions to assist women in managing stress should be focused on the second trimester. A balance between personal support and technologic intervention is necessary.

Intervening with prenatal crack cocaine users.

Nurses in primary care, maternal child health, and community health practice settings are in a unique position to intervene with clients who are prenatal crack cocaine users. Clinical assessment is considered in both the context of the pregnancy and the crack cocaine use. A synthesis model of intervention related to both the pregnancy and the drug use are outlined to support a healthy baby and a healthy recovery.

Role play. Providing care to children and their families in the emergency center.

The collaborative model has many benefits for children and families, physicians, nurses, staff, and NPs. The model of care can be structured to charge lower fees for nonacute problems, thereby saving money. Various studies have reported savings of 20% to 38% in the cost of visits when patients were seen by NPs instead of physicians (Salkever, Skinner, Steinwach, & Katz, 1982). With appropriate triaging, waiting time may be reduced for children and families with nonacute problems. Perhaps the most important benefit is the teaching that the NP is able to provide for families in terms of managing particular health problems, safety needs, and preventive interventions and maintenance of wellness for children.

[The optimization of the use of economic resources for vaccination against hepatitis B in professionals in the health area]. / Otimização do emprego de recursos econômicos para vacinação contra hepatite B em profissionais da área de saúde.

In order to optimize the employment of financial resources to be allocated for hepatitis B vaccination programs involving health care workers, two different aspects were studied: the need of a pre-vaccination screening and the efficacy of low-doses schedules of HBV vaccine by the intradermal (ID) route. The economical analysis (a cost-minimization study) showed that when the prevalence of immune individuals is higher than 11% it is more cost-effective to perform pre-vaccination screening. This situation was observed in the employees group. For students and doctors vaccination without screening was the best approach. Regarding the schedules, 3 doses of HBV vaccine by the intramuscular (IM) route (group A) were compared to first dose by the ID route and second and third doses by the IM route (group B) and to first and second doses by the ID route and the last dose by the IM route (group C). After the third dose, soroconversion rates in groups A and B (92% and 93%, respectively) and geometric mean titers of antiHBs (1278 UI/L and 789.6 UI/L) were similar, and both were different from group A (p < 0.05), showing that alternative vaccination schedules may be cost-effective.

Comparison of three different schedules of vaccination against hepatitis B in health care workers.

Health care workers (HCW) are a group at risk for hepatitis B virus (HBV) infection; as a result, vaccination is recommended. However, elevated cost of the vaccination schedule is one of the limiting factors to this approach. Our aim in this study was to evaluate alternative schedules for vaccination against hepatitis B, in order to obtain safe immunization with reduced costs. We studied 300 HCW, randomized to be submitted to one of three vaccination schedules against hepatitis B: Group A--three doses of 20 micrograms i.m. (n = 103); Group B--first dose i.d. (2 micrograms), second and third doses i.m. (20 micrograms) (n = 97); Group C--first and second doses i.d. (2 micrograms), third dose i.m. (20 micrograms) (n = 100). All individuals received recombinant vaccine at 0, 1 and 6 months. After the first dose, there was no difference among the three schedules, either in terms of anamnestic response or in seroconversion rate. After the second dose, there was statistical difference among the three schedules (A > B > C), in terms of seroconversion rates. After the third dose, seroconversion rates were 92.2% in Group A and 92.8% in group B; geometric mean titers (GMT) in Group B (789.6 UI l-1) were similar to group A (1248.0 UI l-1). Group C presented a seroconversion rate of 78% and a GMT of 323.0 UI l-1, both statistically inferior to other schedules. We concluded that the schedule applied in Group B had similar results when compared to schedule A, with estimated savings of 30% in vaccine costs.(ABSTRACT TRUNCATED AT 250 WORDS)

The relationship of illness longevity and relapse with self-perception, cancer stressors, anxiety, and coping strategies in children with cancer.

A descriptive, correlational design was used to investigate the relationship of the longevity of the cancer experience and the presence of a relapse to the child's self-perception, cancer stressors, anxiety, and use of coping strategies. The 44 children included in this study were 6 1/2 to 13 1/2 years of age. Fifteen of the children had experienced a relapse of the disease either on or off therapy. The longevity of the cancer treatment and the presence of a relapse were negatively associated with the child's self-perception. Trait anxiety was positively associated with duration of the cancer experience and with the presence of a relapse. Longevity of the cancer experience and the presence of a relapse may be factors that signal the need for interventions designed to enhance the child's self-perception throughout treatment. Because children in this study who reported lower self-perception and higher trait anxiety levels also reported experiencing more cancer stressors, nursing efforts to develop innovative strategies designed to enhance patients' feelings of self-worth and decrease their anxiety may prove to be important contributions to the care of children receiving treatment for cancer.

Cancer stressors and protective factors: predictors of stress experienced during treatment for childhood cancer.

Perceptions of cancer stressors and protective factors are predictors of stress experienced during treatment for childhood cancer were assessed in this study. Cancer stressors were the type of treatment received during two clinic visits and the child's perception of the cancer experience. Protective factors were self-perception, coping strategies, perceived social support, and family environment. The child's responses to stressors were assessed by epinephrine, norepinephrine, and cortisol levels of urine, and measures of state anxiety. Forty-four children between 6 1/2 and 13 1/2 years of age receiving treatment for cancer were evaluated during two clinic visits. Epinephrine was elevated for children during both clinic visits, while norepinephrine and cortisol remained normal. Stepwise multiple regression analyses revealed that the family environment and global self-worth were the best predictors of epinephrine levels, while social support from friends predicted norepinephrine levels. The family environment and social support from teachers predicted state anxiety.

Life change events and coping behaviors in families of children with cancer.

This study investigated life change events and coping behaviors in families of children with cancer compared with those who have physically healthy children. The sample consisted of 21 families with a child with cancer and 17 families with physically healthy children. All the children in the study were 6 to 12 years of age. Parents from each group completed items from the Family Inventory of Life Events and Changes and the Family Crisis Oriented Evaluation Scales. These tools evaluate stressful life change events experienced by families within a 12-month period and coping behaviors used by families during difficult situations. Families with a child who has cancer experienced significantly more stressful life change events (t = 2.15, P = 0.04) than those with physically healthy children. There were no significant differences (t = 0.23, P = 0.82) in the coping behaviors that were used by the two groups. The results provided a clearer understanding of stressful life change events that impact families with a child with cancer.

Health practices and anxiety in low-income, high and low-risk pregnant women.

OBJECTIVE: To evaluate anxiety and health-protective and health-promoting behaviors in low- and high-risk, low-income pregnant women. DESIGN: Nonrandomized descriptive study. SETTING: Low- and high-risk prenatal clinics at a tertiary-care center. PARTICIPANTS: Sixty-five black and white low-income women between 20 and 41 weeks of pregnancy. MAIN OUTCOME MEASURES: Anxiety and health-promoting behavior. RESULTS: No significant differences were found in anxiety levels. A significant difference was found between the two groups in overall Health-Promoting Lifestyle Profile (HPLP) scores. Women in the low-risk group scored higher on all HPLP subscales, with significant differences on self-actualization and health responsibility. CONCLUSION: Findings support the need for nurses to assess high-risk pregnant women for their health practices during pregnancy. Although a major focus on nursing care during pregnancy is teaching the promotion of health, only limited research exists on the effectiveness of such interventions.