Declining testicular function with age. Hormonal and clinical correlates

Testicular endocrine function and androgen-dependent secondary sexual characteristics were assessed in 283 men 18 to 96 years of age. Mean serum total testosterone levels remained unchanged up to age 70 and declined thereafter. In 29 per cent of the men over 70 years of age total testosterone levels were below the lower limit of normal for young adults, In contrast, mean free or unbound testosterone levels declined after age 50 and were below the lower limit of normal for young adults in 40 per cent of the men over 70 years of age. Serum-luteinizing hormone and follicle-stimulating hormone levels showed a slight but steady rise after age 40 which became more abrupt after age 70. Serum gonadotropin levels were elevated in approximately 60 per cent of the men over 70 years of age.Mean testis length and volume were decreased in 78 per cent and 37 per cent, respectively, of the men over 60 years of age. Facial, pubic and axillary hair were also reduced in amount whereas the prostate was enlarged in 73 per cent of the elderly men. There appeared to be an inverse relationship in older men between testicular size and gonadotropin levels, and a direct relationship between testicular and prostatic sizes.It would appear that some degree of Leydig cell hypofunction commonly begins at around 45 to 50 years of age, becoming more pronounced after age 70. The concomitant elevation in serum gonadotropin levels at this time indicates that this is due to a primary decline in testicular function and is not secondary to pituitary hypofunction.     

Effects of managed care on alcohol and other drug (AOD) treatment

The article represents the proceedings of a symposium at the 2001 RSA Meeting in Montreal, Canada. The organizer/chair was Stephen Magura. The presentations examined: (1) How managed care organization policies may affect enrollees' use of alcohol and other drug (AOD) treatment, by Constance Horgan and associates; (2) The determinants of patients' access to and utilization of AOD treatment in a large health maintenance organization, by Jennifer R. Mertens and Constance Weisner; (3) The impact on treatment access and costs of a statewide carve-out for AOD treatment for Medicaid, by Donald Shepard and associates; and (4) The predictive validity of a new patient assessment technology developed, in part, to better justify AOD treatment in response to the demands of managed care, by Stephen Magura and associates.     

Substance use-related outpatient consultations in specialized health care: an underestimated entity

Background To study the occurrence and documentation of substance use related outpatient visits in specialized health care.
Methods The diagnosis recorded in retrospective discharge data in Tampere University Hospital for 6 years was compared with the prospective data gathered from separately completed forms added during an 8-week period to every outpatient's discharge data. In this form, the relation of substance use and the actual reason for the consultation were specifically elicited.
Results On the basis of diagnoses, retrospectively, 0.4% (6,666 of 1,555,898) of outpatient visits were caused by substance use. In the prospective part of the study, 5.6% of visits (1,401/25,014) were related to substance use. Retrospective study demonstrated 2% prevalence of substance use, whereas prospective study showed 36% substance use–related visits at the emergency room. According to the retrospective discharge data, alcohol-related organ damages were the major reason for substance use–related outpatient visits. In the prospective study, the proportion of acute traumas was most prevalent.
Conclusions Our study indicates that substance use–related visits often remain undetected in specialized health care. Substance use–related visits were underdocumented/undetected in the emergency room. Using a simple separate form could dramatically increase the detection of substance use–related visits.     

不同保健条件下老年2型糖尿病血糖控制及影响因素

目的：比较并分析不同保健条件下老年2型糖尿病（T2DM）血糖控制及影响因素。方法资料随机选择2012年6月—2014年6月该院诊治老年T2DM患者369例,按照患者自身情况及不同保健条件分为对照组和研究组,对照组予慢性疾病管理,研究组予综合管理,记录并分析相关数据。结果两组患者分别给予不同保健条件管理后血糖指标均较实施前发生不同程度改善,其中研究组改善幅度更为显著,且优于对照组实施后,比较差异均具统计学意义（P＜0.05）;研究组影响T2DM的各项因素构成比与研究组比较,差异有统计学意义（P＜0.05）。结论采用综合管理保健模式可有效控制老年T2DM患者血糖指标水平。     

脑血管疾病患者护理中的健康教育价值探讨

目的：探讨健康教育在脑血管疾病患者护理中的应用价值。方法随机选取该院自2013年1月-2014年1月收治的100例脑血管疾病患者为研究对象,将其随机分成观察组与对照组,每组50例。给予两组相同基础治疗与常规护理,并在此基础上给予观察组患者系统健康教育。调查对比两组的治疗依从性、生活质量评分。结果观察组用药、生活方式、门诊随访依从性评分明显大于对照组,两组比较差异有统计学意义(P<0.05)。而护理后两组评分均有所升高,且前后评分比较差异有统计学意义(P<0.05)。且观察组各项评分明显大于对照组,两组比较差异有统计学意义(P<0.05)。结论在给予脑血管疾病患者基础治疗与常规护理的同时,给予其系统性健康教育课有效提高患者对治疗的依从性,提高患者生活质量以及对医护工作的满意度。因此,该护理方法值得临床推广应用。     

医务人员对卫生技术评估的认知分析

为了解医务人员对卫生技术评估的认知,采用现场问卷调查与访谈相结合的方法,对山西省三级综合类医院的医务人员进行调查,从卫生技术评估知晓度、接受培训的意愿、支持意愿、知识获取渠道、期待的职能等方面对结果进行分析,在此基础上指出存在的问题并提出发展建议。     

基于健康体检的居民健康档案

介绍健康体检档案的特点,研究基于健康体检的健康档案数据组织、归集方式,阐述数据项收集标准,介绍健康档案构成,包括受检者基本信息、病史信息、临床物理检查、化验检查、影像检查信息等,最后给出体检信息采集与综合管理系统架购。