Prevalence and impact of vasomotor symptoms due to menopause among women in Brazil, Canada, Mexico, and Nordic Europe: a cross-sectional survey.

OBJECTIVE: This study investigated the prevalence and impact of moderate to severe vasomotor symptoms (VMS), related treatment patterns, and experiences in women. METHODS: The primary objective was to assess the prevalence of moderate to severe menopause-related VMS among postmenopausal women aged 40 to 65 years in Brazil, Canada, Mexico, and four Nordic European countries (Denmark, Finland, Norway, and Sweden) using an online survey. Secondary objectives assessed impact of VMS among perimenopausal and postmenopausal women with moderate to severe VMS using the Menopause-Specific Quality of Life questionnaire, Work Productivity and Activity Impairment questionnaire, Patient-Reported Outcomes Measurement Information System sleep disturbances assessment, and questions regarding treatment patterns and attitudes toward symptoms and available treatments. RESULTS: Among 12,268 postmenopausal women, the prevalence of moderate to severe VMS was about 15.6% and was highest in Brazil (36.2%) and lowest in Nordic Europe (11.6%). Secondary analyses, conducted among 2,176 perimenopausal and postmenopausal women, showed that VMS affected quality of life across all domains measured and impaired work activities by as much as 30%. Greater symptom severity negatively affected sleep. Many women sought medical advice, but most (1,238 [56.9%]) were not receiving treatment for their VMS. The majority (>70%) considered menopause to be a natural part of aging. Those treated with prescription hormone therapy and nonhormone medications reported some safety/efficacy concerns. CONCLUSIONS: Among women from seven countries, moderate to severe menopause-related VMS were widespread, varied by region, and largely impaired quality of life, productivity, and/or sleep.

Additive Nonlinear Functional Concurrent Model.

We propose a flexible regression model to study the association between a functional response and multiple functional covariates that are observed on the same domain. Specifically, we relate the mean of the current response to current values of the covariates by a sum of smooth unknown bivariate functions, where each of the functions depends on the current value of the covariate and the time point itself. In this framework, we develop estimation methodology that accommodates realistic scenarios where the covariates are sampled with or without error on a sparse and irregular design, and prediction that accounts for unknown model correlation structure. We also discuss the problem of testing the null hypothesis that the covariate has no association with the response. The proposed methods are evaluated numerically through simulations and two real data applications.

Additive Function-on-Function Regression.

We study additive function-on-function regression where the mean response at a particular time point depends on the time point itself, as well as the entire covariate trajectory. We develop a computationally efficient estimation methodology based on a novel combination of spline bases with an eigenbasis to represent the trivariate kernel function. We discuss prediction of a new response trajectory, propose an inference procedure that accounts for total variability in the predicted response curves, and construct pointwise prediction intervals. The estimation/inferential procedure accommodates realistic scenarios, such as correlated error structure as well as sparse and/or irregular designs. We investigate our methodology in finite sample size through simulations and two real data applications. Supplementary Material for this article is available online.

Avoiding complications: surgery for ischemic priapism.

Ischemic, or low-flow, priapism is among the most common and challenging urologic emergencies. Management of recurrent or refractory ischemic priapism is even more challenging, with increasing levels of risk for both the patient and the urologist. The goal of this commentary is to condense a career of experience (TF Lue) in the management of ischemic priapism into a concise, practical clinical tool for the reader. We will describe our current algorithm for the treatment of ischemic priapism in addition to detailing how we arrived at these recommendations. We will also describe why we believe that the presented approach is the best available approach and why we have turned away from alternative procedures.