Predictive value of low testosterone concentrations regarding coronary heart disease and mortality in men and women - evidence from the FINRISK97 study.

INTRODUCTION: The relevance of low testosterone concentrations for incident coronary heart disease (CHD) and mortality has been discussed in various studies. Here, we evaluate the predictive value of low baseline testosterone levels in a large population-based cohort. METHODS: We measured the serum levels of testosterone in 7671 subjects (3710 male, 3961 female) of the population-based FINRISK97 study. RESULTS: The median follow-up (FU) was 13.8 years. During the FU, a total of 779 deaths from any cause, and 395 incident CHD events were recorded. The age-adjusted baseline testosterone levels were similar in subjects suffering incident events during FU and those without incident events during FU (men: 15.80 vs. 17.01 nmol L-1 ; P = 0.69, women: 1.14 vs. 1.15 nmol L-1 ; P = 0.92). Weak correlations of testosterone levels were found with smoking (R = 0.09; P < 0.001), HDL cholesterol levels (R = 0.22, P < 0.001), systolic blood pressure (R = -0.05; P = 0.011), BMI (R = -0.23; P < 0.001) and waist-hip-ratio (R = -0.21; P < 0.001) in men, and with eGFR (R = -0.05; P = 0.009) in women. Kaplan-Meier analyses did not reveal a positive association of testosterone levels with incident CHD or mortality. Accordingly, also in Cox regression analyses, testosterone levels were not predictive for incident CHD or mortality - neither in men (HR 1.02 [95%CI: 0.70-1.51]; P = 0.79 for lowest versus highest quarter regarding CHD and HR 1.06 [95%CI: 0.80-1.39]; P = 0.67 regarding mortality), nor in women (HR 1.13 [95%CI: 0.69-1.85]; P = 0.56 for lowest versus highest quarter regarding CHD and HR 0.99 [95%CI: 0.71-1.39]; P = 0.80 regarding mortality). CONCLUSIONS: Low levels of testosterone are not predictive regarding future CHD or mortality - neither in men, nor in women.

Psychiatric Genetics in Child Custody Proceedings: Ethical, Legal, and Social Issues.

This paper considers the ethical, legal, and social issues raised by the prospect of increasing use of psychiatric genetic data in child custody litigation. Although genetic tests cannot currently confirm a parent or child's psychiatric diagnosis, it is likely that as relevant findings emerge, they will be introduced in family courts to challenge parental capacity. Here, we draw on three projected, but plausible, scenarios for obtaining psychiatric data about parents -- imposed genetic testing, access to medical records, and genetic theft -- then consider the use of psychiatric genetic data of children, to highlight the issues that judges, child custody evaluators, and clinicians who may provide treatment for parents or children with mental health issues will need to consider. These include: genetic privacy, stigma, genetic surveillance, and judicial and health professionals' bias. We argue that the unchecked introduction of psychiatric genetic data may have a detrimental effect on the administration of justice. In particular, the article highlights the risk that the (mis)use of psychiatric genetic data in custody disputes would 1) exacerbate stigma and treatment-avoidance among parents and incentivize privacy violations to pressure parents to relinquish parental rights; 2) disproportionately affect poor parents and single mothers of color involved with Child Protective Services; and 3) detract attention from social and environmental factors impacting mental health to the detriment of the families involved. Awareness of these issues and an understanding of the meaning of genomic data by judges and custody evaluators will be pivotal in ensuring that justice is served.

Ultrastructural alterations in the liver and intestine of carp Cyprinus carpio induced orally by ultra-low doses of endosulfan.

In order to elucidate the importance of food-borne chemical contamination in fish, cytological and ultrastructural alterations in hepatocytes and enterocytes of common carp Cyprinus carpio L. exposed for 5 wk to 0.5 microgram endosulfan (6,7,8,9,10,10-hexachloro-1,5,5a,6,9a-hexahydro-6,9-methano-2,4,3-benzo- dioxyanthiepin-3-oxide) kg-1 food dry weight, equivalent to an ultra-low dosis of 15 ng kg-1 fish d-1, were investigated by means of light and electron microscopy. Observations on liver alterations were quantified by morphometric analysis. Livers show enlargement of the nucleolus, increase in number and size of both Golgi fields and rough endoplasmic reticulum (ER) lamellae, as well as proliferation of peroxisomes and lysosomes. Taken together, these alterations represent the morphological equivalent of a general stimulation of hepatic metabolism. Proliferation of the smooth ER is indicative of the onset of biotransformation processes under the influence of food-borne endosulfan. Further pathological processes in the liver were evident by glycogen and lipid depletion, invasion of phagocytic macrophages, and accumulation of myelinated bodies in endothelial cells of hepatic sinusoids. In the intestinal tract, exposure to endosulfan is associated with a complete lack of chylomicrons in the epithelial lining, which indicates disturbance of intestinal absorption. The reaction of the gut epithelium also included considerable distension of the intercellular space and an elevated number of lysosomal inclusions in enterocytes. An increased rate of mucous cell precursors was detectable, and macrophages were numerous. Results are consistent with endosulfan resorption by the intestinal epithelium and the coexistence of gut and liver ultrastructural changes at extremely low doses. Thus, the substantiation of pathological alterations in organs sequentially in contact with toxicants appears useful as a biomarker of pollutant exposure and effect. With regard to a chemical spill into the Rhine river at Basel, Switzerland, in November 1986, endosulfan, as a component of the mixture of toxic substances, may well have contributed to the overall toxicity of the chemicals released during the accident and the subsequent fish kill, less as a toxicant in itself than as a stimulant for the toxicity of other xenobiotics.

Compensation in the year 2000: pay for performance?

Notes the attempts by many companies today to identify innovative compensation strategies that are directly linked to improving organizational performance. Observes that there are many approaches to incentive compensation such as cash bonuses, stock purchase and profit sharing. Examines the individual and group incentive concepts that reward performance based on predetermined organizational goals and metrics, several behavioural theories that can be associated with reward and compensation, and convergent and divergent views and conclusions from the business community.

The laying on of health: personality patterns of psychic healers.

Twenty-six psychic healers who claimed to heal by way of touch were studied with psychological tests to see whether they had personality characteristics in common. The consistencies they showed could be conceptualized in a way that sheds light on the nature of all healing.

Dermatitis artefacta. Case reports.

Patients who seek care for foot problems may present to the podiatrist with concurrent problems, such as anxiety, depression, phobias, personality disorders, and psychoses. These may or may not have any direct relationship to the pathogenesis of the foot problem. The podiatrist may learn of the presence of an emotional problem directly from the patient or from a family member. In many cases, the patient may be unaware or deny the presence of an emotional problem, leaving the podiatric physician in the dark about the patient's mental health state or its implications for the management of the skin problem. In a review of the psychosomatic aspects of dermatology, Koblenzer offered a working classification of the psychodermatoses. This is helpful to the podiatrist in recognizing those dermatologic disease states in which the various aspects of the individual participate in the disease, signs and symptoms of the disease, and the potential psychological value of the disease for the patient. It is also helpful to the podiatrist for recognizing those dermatoses in which psychiatric consultation may be useful so that recognition, treatment, improvement, and perhaps cure may be effected quickly.

Evils in the private practice of psychotherapy.

The private, and especially solo, practice of psychotherapy often poses conflicts of interest between patient and therapist, which, because of the field's ambiguities and equivocal guidelines, may tend to be resolved in favor of the therapist and to the detriment of the treatment. The author delineates these potential conflicts so that awareness and training can minimize their pernicious effects.

The relationship between assessment and psychotherapy.

The many arguments, pro and con, about the usefulness and roles of diagnosis in general, and a psychological test battery in particular, can be settled only with reference to particular tests, a particular tester, particular patients, with reference to particular questions, in a particular context. Psychologists need to establish the usefulness of tests in cost-effective ways and demonstrate how tests provide a means of studying the mind. It follows that all psychotherapists should be able to use the tests, as all physiologists should be able to use a microscope. The rule of thumb that therapists should not give tests to their patients is unnecessary, though it is preferable that the tests be given early in the relationship, and that patients have the opportunity to explore their reactions to the procedure. To maximize the usefulness of tests given by someone who is not the patient's therapist, the test report should be designed as a means of persuasion toward therapeutic action more than a passive report of findings. An outline for test report writing is suggested. Finally, the use of tests helps elucidate the many factors that contribute to change through psychotherapy.

Allopurinol kinetics and bioavailability. Intravenous, oral and rectal administration.

Six normal, healthy adult males received a single dose of allopurinol intravenously, orally in the form of a commercial tablet, and rectally in the form of an extemperaneously prepared suppository (either in a cocoa butter or in polyethylene glycol base). Plasma allopurinol and oxipurinol concentrations were measured over a period of at least 60 h. The following mean (+/- SD) values were obtained from the intravenous allopurinol experiment: clearance, 9.62 +/- 3.49 ml . kg-1 . min-1; Vd, 1.61 +/- 0.74 l/kg; t1/2, 1.62 h. Oxipurinol had a mean t1/2 of 16.90 h. The absolute systemic bioavailability of the oral tablet was 67% +/- 23%, while the allopurinol rectal suppositories produced no measurable plasma concentrations of allopurinol or oxipurinol in any of the subjects. Current use of rectal dosage forms as an adjunct in cancer chemotherapy should therefore be re-examined.

Managerial/organizational stress: identification of factors and symptoms.

Stress is a factor built into complex organizations and people are psychologically vulnerable to its power. It cannot be eliminated but must be managed lest its costly, counterproductive results remain unchecked.