Testosterone gel supplementation for men with refractory depression: a randomized,placebo-controlled trial

OBJECTIVE: Testosterone supplementation may produce antidepressant effects in men, but until recently it has required cumbersome parenteral administration. In an 8-week randomized, placebo-controlled trial, the authors administered a testosterone transdermal gel to men aged 30-65 who had refractory depression and low or borderline testosterone levels. METHOD: Of 56 men screened, 24 (42.9%) displayed morning serum total testosterone levels of 350 ng/dl or less (normal range=270-1070). Of these men, 23 entered the study. One responded to an initial 1-week single-blind placebo period, and 22 were subsequently randomly assigned: 12 to 1% testosterone gel, 10 g/day, and 10 to identical-appearing placebo. Each subject continued his existing antidepressant regimen. Ten subjects receiving testosterone and nine receiving placebo completed the 8-week trial. RESULTS: The groups were closely matched on baseline demographic and psychiatric measures. Subjects receiving testosterone gel had significantly greater improvement in scores on the Hamilton Depression Rating Scale than subjects receiving placebo. These changes were noted on both the vegetative and affective subscales of the Hamilton Depression Rating Scale. A significant difference was also found on the Clinical Global Impression severity scale but not the Beck Depression Inventory. One subject assigned to testosterone reported increased difficulty with urination, suggesting an exacerbation of benign prostatic hyperplasia; no other subject reported adverse events apparently attributable to testosterone. CONCLUSIONS: These preliminary findings suggest that testosterone gel may produce antidepressant effects in the large and probably underrecognized population of depressed men with low testosterone levels.     

Outcome of sibling vesicoureteral reflux.

PURPOSE: We determine the efficacy of a prospective screening analysis of an asymptomatic sibling of patients with reflux. MATERIALS AND METHODS: A total of 78 siblings of patients with reflux were evaluated and 40 (51%) had reflux. The resolution rate and necessity for surgical intervention were evaluated. RESULTS: A total of 40 patients had vesicoureteral reflux, including grade I in 12, II in 33, III in 19 and IV in 1. No patient had gross renal scar on ultrasound or renal pelvis dysmorphism on voiding cystourethrogram. Treatment consisted of prophylactic antibiotics in all. One patient required surgical correction for breakthrough urinary tract infection. Followup was available in 31 patients, of whom reflux resolved completely with medical management in 26. Reflux was downgraded in 4 patients. Of the patients in whom reflux resolved completely grades I to II vesicoureteral reflux were in 18, and II to IV in 8. Mean time to resolution was 15.6 months. CONCLUSIONS: The incidence of sibling reflux is significant. However, grade specific time to resolution appears to be decreased compared to primary reflux diagnosed after urinary tract infection. Furthermore, the incidence of renal damage appears to be decreased compared to "traditional" reflux. Although it is reasonable to recommend screening, we suggest that sibling reflux may follow a more benign course.     

The prevalence of major depression or dysthymia among aged Medicare Fee-for-Service beneficiaries

RESEARCH OBJECTIVE: Estimates of the prevalence of major depression vary widely. Current estimates range from 2 to 14 % depending upon the definition and procedure for diagnosis. Further, most estimates are for special populations, either living in selected geographic areas or receiving specific types of medical care. A national survey of Medicare Fee-for-Service (FFS) beneficiaries provides an opportunity to assess the current level of major depression or dysthymia among a diverse population of older Americans. STUDY DESIGN: The Health Outcomes Survey (HOS) was administered to a national random sample of 1,000 Medicare FFS beneficiaries. We used the Mental Component Summary (MCS) measure of the SF-36 to estimate the prevalence of major depression or dysthymia. Logistic regression was used to examine associated factors. RESULTS: The response rate was 61.7%. Using an MCS score of 42 or lower, prevalence of major depression or dysthymia was estimated to be 25% for respondents age 65 years and older. Logistic regression analysis revealed that the likelihood of major depression or dysthymia was associated with years of education (Odds Ratio (OR) = 0.87), difficulties performing activities of daily living (OR = 1.72), and Medicaid enrollment (OR = 2.67). CONCLUSIONS: The results revealed that one-quarter of the respondents reported mental health problems consistent with major depression or dysthymia. This is higher than previously reported. Like previous studies, years of education, physical impairment, and poverty are strong predictors of major depression or dysthymia. The high rate of major depression or dysthymia implies there may be considerable unmet need among elderly Medicare FFS beneficiaries for diagnosing and treating mental illness.     

Self-reported adherence to treatment with mood stabilizers,plasma levels,and psychiatric hospitalization

OBJECTIVE: The authors explored the relationship of adherence to treatment with mood stabilizers (lithium, carbamazepine, and sodium valproate) and plasma levels of these drugs to future psychiatric hospitalizations. METHOD: They prospectively followed 98 patients with mood disorders who were prescribed mood stabilizers. These patients participated in an initial interview and completed a questionnaire regarding their adherence to the medications. Data on their plasma levels of these drugs were taken from assays done in the 3 months before the interview. RESULTS: Six of the 98 patients were not classified as to medication adherence or plasma levels. Twenty-nine (32%) of the remaining patients reported partial adherence to the medication regimen, and 33 (36%) had an index plasma level that was suboptimal. At 18 months, rates of admission to a psychiatric hospital were significantly higher in the 16 partially adherent patients with subtherapeutic plasma levels (N=13, 81%) than in the 46 adherent patients with therapeutic plasma levels (N=4, 9%). However, hospital admission was also more likely in partially adherent patients with therapeutic plasma levels than in adherent patients with subtherapeutic plasma levels. CONCLUSIONS: Adherence to medication regimens may be a proxy measure of other healthy behaviors.     

Muscle dysmorphia: a new syndrome in weightlifters

AUTHOR:e-mail address please Recently more men have reported a desire for larger, more muscular bodies. Muscle dysmorphia (MD) is a new syndrome in which individuals (usually men), although highly muscular, have a pathological belief that they are of very small musculature. As more men are motivated to take up training with weights in order to develop greater musculature, more cases of MD are likely to be encountered. A greater understanding and awareness of the syndrome are therefore needed. Therefore the aim of this study was to investigate perceptions of physical self in male weightlifters, one group with MD (n = 24) and one without (n = 30). Between group comparisons were made using the multidimensional body-self relations questionnaire. The findings confirm the nature of the disorder in that those with MD syndrome have poorer body image and are less happy with their bodies. Moreover, in addition to a desire for greater muscularity, they are very concerned not to gain fat. The results also suggest that future research into perceptions of specific body parts and health is warranted.     

Tax planning strategies for physicians

The development of tax reduction strategies is a critical aspect of both corporate and personal financial planning because taxes represent the largest annual expenditure for the majority of Americans. The categories of tax reduction strategies discussed include charitable-giving techniques, ways to maximize business deductions, shifting income to family members, education tax incentives, retirement planning, and small business tax considerations. One use for these tax savings is the enhancement of a corporation's capabilities to provide services to patients.     

A randomized trial of preexercise stretching for prevention of lower-limb injury

PURPOSE: This study investigated the effect of muscle stretching during warm-up on the risk of exercise-related injury. METHODS: 1538 male army recruits were randomly allocated to stretch or control groups. During the ensuing 12 wk of training, both groups performed active warm-up exercises before physical training sessions. In addition, the stretch group performed one 20-s static stretch under supervision for each of six major leg muscle groups during every warm-up. The control group did not stretch. RESULTS: 333 lower-limb injuries were recorded during the training period, including 214 soft-tissue injuries. There were 158 injuries in the stretch group and 175 in the control group. There was no significant effect of preexercise stretching on all-injuries risk (hazard ratio [HR] = 0.95, 95% CI 0.77-1.18), soft-tissue injury risk (HR = 0.83, 95% CI 0.63-1.09), or bone injury risk (HR = 1.22, 95% CI 0.86-1.76). Fitness (20-m progressive shuttle run test score), age, and enlistment date all significantly predicted injury risk (P < 0.01 for each), but height, weight, and body mass index did not. CONCLUSION: A typical muscle stretching protocol performed during preexercise warm-ups does not produce clinically meaningful reductions in risk of exercise-related injury in army recruits. Fitness may be an important, modifiable risk factor.