Relationship between chronic nasal and respiratory symptoms in patients with COPD

The relationship between the upper and lower airways in chronic obstructive pulmonary disease (COPD) is unknown. We examined the prevalence of chronic nasal symptoms and the correlation with lower respiratory symptoms and parameters of severity of COPD such as exacerbation frequency and spirometry. 61 COPD patients from the East London COPD cohort were studied. [Mean (SD) age 70 (6.96) years, FEV1 0.98 (0.38) l, FVC 2.45 (0.72) l, FEV1%Pred 37.0 (12.3), and 47.6 (31.8) smoking pack years, 14 current smokers, 36 males]. COPD patients had a high prevalence of nasal symptoms (75%), more than half reporting nasal discharge (52.5%) and sneezing (45.9%). Associations were found between nasal score and daily sputum production (P = 0.005) and post-nasal drip and sputum production (P = 0.046) with a trend to increased nasal symptoms in frequent exacerbators compared to infrequent exacerbators. No significant relationship was found between nasal symptoms and FEV1 or any other lower respiratory airway symptom. Associations between nasal and respiratory symptoms were found suggesting that there is a relationship between the upper and lower airway in COPD.     

Association between depressive symptoms and sleep disturbances in community-dwelling older men

OBJECTIVES: To examine the association between depressive symptoms and subjective and objective measures of sleep in community-dwelling older men.
DESIGN: Cross-sectional.
SETTING: Six U.S. clinical centers.
PARTICIPANTS: Three thousand fifty-one men aged 67 and older.
MEASUREMENTS: Depressive symptoms assessed using the 15-item Geriatric Depression Scale and categorized as 0 to 2 (normal, referent group), 3 to 5 (some depressive symptoms), and 6 to 15 (depressed); objective sleep measures ascertained using wrist actigraphy (mean duration 5.2 nights); and subjective sleep measures assessed using the Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale.
RESULTS: There was a strong multivariable-adjusted association between level of depressive symptoms and subjective sleep disturbances ( P -trend <.001). For example, the odds of reporting poor sleep quality were 3.7 times (95% confidence interval (CI)=2.5–5.3) higher for depressed men as for normal men, and 2.1 times (95% CI=1.7–2.6) higher for men with some depressive symptoms. For objectively measured sleep disturbances, men with more depressive symptoms had greater odds of sleep latency of 1 hour or more ( P -trend=.006). There was no association between level of depressive symptoms and sleep efficiency, awakening after sleep onset, multiple long-wake episodes, or total sleep time. Excluding 384 men taking antidepressants, benzodiazepines, or other anxiolytic or hypnotics did not alter the results.
CONCLUSION: Depressive symptoms have a strong, graded association with subjective sleep disturbances and are moderately associated with objectively measured prolonged sleep latency. Future studies should address temporality of depression and sleep disturbances.     

Predictors of depressive symptoms in patients with COPD and health impact

While depression is a common co-morbid condition among patients with COPD, little is known about predictors or health impact of depression among these patients. To address these gaps in knowledge we conducted a cross-sectional survey of 207 patients with COPD cared for in a network of primary care clinics affiliated with an urban academic health center. A standardized questionnaire was used to measure demographic characteristics, smoking status, co-morbid medical conditions, current medications, self-efficacy, social support, illness intrusiveness, and self-reported health care utilization during the previous 6 months. Depressive symptoms were assessed using the Centers for Epidemiologic Studies-Depression scale. Overall, the prevalence of moderate to high levels of depressive symptoms was 60.4%. In a multivariate analysis independent predictors of depressive symptoms were being a former smoker (OR = 0.41 (95% CI 0.19-0.89)), higher self-efficacy (OR = 0.42 (0.28-0.64)), higher social support (OR = 0.72 (0.52-0.99)), and higher perceived illness intrusiveness (OR = 1.05 (1.02-1.08)). Depressive symptoms were associated with increased physician visits, emergency room visits, and hospitalizations for lung disease. In conclusion, depressive symptoms are common among patients with COPD and associated with an increase in healthcare utilization. These findings suggest that the identification of risk factors for depressive symptoms (e.g., continued smoking) may increase detection and improve management of depression and health outcomes among patients with COPD.     

Relationship between exercise capacity and depressive symptoms in community-dwelling older adults

BackgroundDepressive symptoms cannot be ignored when exercise intervention is performed. The purpose of this study was to clarify the association between depressive symptoms and exercise capacity in community-dwelling older adults.MethodsIn this cross-sectional study, we analyzed 110 community-dwelling older adults (mean age [standard deviation] = 70.7 [4.0] years old; women: 55 %). Depressive symptoms were measured using a Japanese version of the Geriatric Depression Scale. We evaluated exercise capacity by measuring distance (2MWD) during a 2-minute walk test. Linear regression models were applied to analyze the association between 2MWD and depressive symptoms.ResultsThe results suggest that depressive symptoms are associated with low 2MWD (beta = −5.87, 95 % confidence interval = −11.18 to −0.57, p < 0.05) even after adjusting for age, gender, Body Mass Index, cigarette smoking, alcohol consumption, pain severity, and the number of comorbidities.ConclusionsThe results indicated that depressive symptoms are associated with decreased exercise capacity in older adults.     

Relationship between respiratory symptoms and medical treatment in exacerbations of COPD.

Exacerbations of chronic obstructive pulmonary disease (COPD) can be defined symptomatically or by healthcare contacts, yet the relationship between these events is unknown. Data were collected during a 1-yr study of the budesonide/formoterol combination in COPD patients, where exacerbations, defined by increases in treatment, were compared with daily records of respiratory symptoms, rescue medication use and peak expiratory flow (PEF). The relationship between changes in these variables and the medical event was examined using different modelling approaches. Data from the first exacerbation treated with oral corticosteroids and/or antibiotics and/or hospitalisation (event based) were available in 468 patients. Patients exacerbating were significantly more breathless and more likely to report cough than healthy patients, but did not differ in baseline spirometry. Exacerbations defined by changes in individual symptoms were only weakly related to event-based exacerbations; however, defined with 63% of such events being predicted from symptom changes. Changes in rescue medication use or PEF were poor predictors of event-based exacerbations. The mean peak change in symptoms was closely related to the onset of therapy. In conclusion, event-based exacerbations are a valid way of identifying acute symptom change in a chronic obstructive pulmonary disease population. However, daily symptom monitoring is too variable using the current diary cards to make individual management decisions.     

Relationship between the living-alone period and depressive symptoms among the elderly

ObjectiveThe study aims to understand the relationship between the living-alone period and depressive symptoms among the elderly in South Korea.MethodsThe study obtained data on the elderly over 65 years old from the 2006 to 2019 Korea Welfare Panel Study. Generalized estimating equation (GEE) analysis was performed to understand changes in depressive symptoms over periods of living alone. Additional subgroup analysis of age and gender was conducted to observe differences.ResultsA total 568 (19% of the study samples) elderly transitioned from living with others into a living-alone state. Males and females showed a significant increase in depressive symptoms as they started to live alone, which gradually decreased with prolonged periods of living alone. The result of the GEE analysis demonstrated high odds of depressive symptoms during the first (OR = 1.857; 95% CI: 1.492–2.310), second (OR = 1.414; 95% CI: 1.127–1.774), and third (OR = 1.413; 95% CI: 1.105–1.808) years of living alone compared with living with others. Regarding additional subgroup analysis, the female and old–old groups showed high odds of depressive symptoms in the first 3 years of living alone, whereas the male and young–old groups showed high odds for the first year only.ConclusionsThe study provides valuable insights into the relationship between the living-alone period and depressive symptoms among the elderly. Future research using the living-alone period on various social factors are recommended.     

Screening for depressive symptoms in an online sample of men who have sex with men

Depression is a debilitating disorder and relatively high rates have been reported in studies of men who have sex with men (MSM). This study was undertaken to assess the utility of screening for, and characteristics associated with, depressive symptoms in an online survey of MSM. In 2003-2004, an online cross-sectional study was conducted among 2,964 MSM from the US and Canada. Using the two-item Patient Health Questionnaire (PHQ-2), 18% of the study participants screened positive for depressive symptoms within the past three months. Characteristics associated with a positive PHQ-2 screen for depressive symptoms in multivariate analysis included: having less than a high school or college degree; being single (not having a primary male partner) or being married to a woman; being HIV-positive; and not having recent sex. Additionally, among men who screened positive on the PHQ-2, predictors of not having treatment from a mental health provider in the past year were: low education; being black/African American/Canadian or Hispanic; and having no primary care provider. The Internet is a viable medium to reach and screen men at-risk for depression. Future work is needed for online outreach and connection to offline assessment as well as intervention.     

Osteoporosis in men with hyperprolactinemic hypogonadism

To ascertain the effects of chronic hyperprolactinemia and testosterone deficiency on skeletal integrity in men, we measured forearm bone density and hormone concentrations in 18 men aged 30 to 79 who had prolactin-secreting pituitary tumors. We also measured vertebral bone density in 12 of the men. Patients with hyperprolactinemia had significant decreases in both forearm (p less than 0.001) and vertebral bone density (p = 0.003) compared with age-matched controls. Cortical osteopenia was significantly related to the duration of hyperprolactinemia (p less than 0.01) but not to the absolute levels of prolactin or androgens. Seven patients had longitudinal follow-up measurements of forearm bone density. Normalization of serum levels of prolactin or testosterone was associated with an increase in forearm bone density (p less than 0.05). These data show that chronic hyperprolactinemia and testosterone deficiency in men have deleterious and previously unrecognized extragonadal effects that may be alleviated after normalization of hormone concentrations.     

甲状腺功能异常与男性性腺功能减退症

甲状腺在维持性腺功能方面起着极为重要的作用.甲状腺功能异常可引起性激素结合球蛋白及性激素水平的变化,进而对男性性功能产生危害,尤其在性激素水平、睾丸功能和性行为方面.当甲状腺功能恢复正常时,性激素及性功能异常即可显著改善.     

Osteoporosis in men with idiopathic hypogonadotropic hypogonadism

To assess the effect of testosterone deficiency on skeletal integrity in men, we determined bone density in 23 hypogonadal men with isolated gonadotropin-releasing hormone deficiency and compared those values with ones from controls. Cortical bone density, as assessed by single-photon absorptiometry of the nondominant radius, ranged from 0.57 to 0.86 g/cm2 (mean +/- SE, 0.71 +/- 0.02) in patients with fused epiphyses and from 0.57 to 0.67 g/cm2 (mean, 0.61 +/- 0.01) in patients with open epiphyses, both of which were significantly (p less than 0.001) lower than normal. Spinal trabecular bone density, as assessed by computed tomography, was similarly decreased (p less than 0.0001) and ranged from 42 to 177 mg K2HPO4/cm3 (mean, 112 +/- 7). Cortical bone density was at least 2 SD below normal in 16 of 23 men, and 8 men had spinal bone densities below the fracture threshold of 80 to 100 mg K2HPO4/cm3. Osteopenia was equally severe in men with immature and mature bone ages, suggesting that abnormal bone development plays an important role in the osteopenia of men with idiopathic hypogonadotropic hypogonadism.     

Prevalence and associated factors of depressive and anxiety symptoms among HIV-infected men who have sex with men in China

HIV-positive men who have sex with men (HIVMSM) face severe stigma and high levels of stressors, and have high prevalence of mental health problems (e.g., depression and anxiety). Very few studies explored the role of positive psychological factors on mental health problems among HIVMSM. The present study investigated the prevalence of two mental health problems (anxiety and depression), and their associated protective (gratitude) and risk (enacted HIV-related stigma, and perceived stress) factors among HIVMSM in China. A cross-sectional survey was conducted among 321 HIVMSM in Chengdu, China, by using a structured questionnaire. Over half (55.8%) of the participants showed probable mild to severe depression (as assessed by the Center of Epidemiologic Studies Depression scale); 53.3% showed probable anxiety (as assessed by the General Anxiety Disorder scale). Adjusted logistic regression models revealed that gratitude (adjusted odds ratio (ORa?=?0.90, 95% confidence intervals (95% CI)?=?0.86–0.94) was found to be protective, whilst perceived stress (ORa?=?1.17, 95% CI?=?1.12–1.22) and enacted stigma (ORa?=?7.72, 95% CI?=?2.27–26.25) were risk factors of depression. Gratitude (ORa?=?0.95, 95% CI?=?0.91–0.99) was also found to be protective whilst perceived stress (ORa?=?1.19, 95% CI?=?1.14–1.24) was a risk factor of anxiety. Gratitude did not moderate the associations found between related factors and poor mental health. It is warranted to promote mental health among HIVMSM, as depression/anxiety was highly prevalent. Such interventions should consider enhancement of gratitude, reduction of stress, and removal of enacted stigma as potential strategies, as such factors were significantly associated with depression/anxiety among HIVMSM.     

REM-related sleep-disordered breathing is associated with depressive symptoms in men but not in women

Purpose

The purposes of the present study are to determine the prevalence and demographic features of rapid eye movement (REM)-related sleep-disordered breathing (SDB) in Korean adults with newly diagnosed obstructive sleep apnea (OSA) and determine if REM-related SDB is associated with depressive symptoms and health-related quality of life (HRQoL) in OSA patients.

Methods

In this cross-sectional study, we evaluated 1281 OSA adults who were consecutively recruited. REM-related SDB was defined as an overall apnea-hypopnea index (AHI) ≥5, an AHI_NREM <15, and AHI_REM to AHI_NREM ratio of >2. The Epworth Sleepiness Scale (ESS), Beck Depression Inventory (BDI), and Medical Outcomes Study Short-Form Health survey (SF-36) were used to evaluate all patients. Multiple regression analyses were performed to determine the associations between REM-related SDB and clinical outcomes.

Results

The prevalence of REM-related SDB was 18 % in this study. REM-related SDB was more commonly observed in patients with mild or moderate OSA (p < 0.001) and women (p < 0.001). The linear regression analysis showed that the presence of REM-related SDB was significantly associated with higher BDI scores, but only in men. AHI_REM was positively associated with the BDI scores, but only in men with REM-related SDB. There were no differences in ESS and SF-36 scores between patients with and without REM-related SDB.

Conclusions

Patients with REM-related SDB account for 18 % of Korean OSA adults. REM-related SDB was associated with depressive symptoms, but only in men. AHI_REM is positively related to the degree of depressive symptoms in men with REM-related SDB.

     

Androgen replacement in men with hypogonadism and erectile dysfunction

The prevalence of hypogonadism and erectile dysfunction (ED) increases with age. Hypogonadism also is frequently associated with decreased libido and ED. Testosterone replacement therapy for hypogonadal ED is effective in restoring sexual desire and erectile function, especially in younger and healthy men. It appears to be less effective in older men with comorbid diseases that may cause ED. Therapy should be individualized, considered carefully, and closely monitored because of potential risks, especially in older men. The FDA has approved several testosterone delivery systems. These include a buccal testosterone tablet, intramuscular injections, transdermal and subcutaneous forms. There also are several promising experimental androgens under investigation including non-steroidal selective androgen receptor modulators (SARMs).     

Erectile dysfunction and hypogonadism among men with HIV

Erectile dysfunction (ED) and hypogonadism are increasingly recognized conditions, however, the prevalence and etiologies of these conditions among HIV-infected men remain unclear. We studied 300 HIV-infected men who completed standardized questionnaires regarding sexual function and hypogonadal symptoms. An early morning testosterone test was performed; patients with a low serum testosterone level (defined by <300 ng/dL), underwent additional blood tests to determine the etiology of the hypogonadism. The participants' mean age was 39 years (range, 19-72); 61% were Caucasian; 24%, African American; 9%, Hispanic; and 5% other. Participants had been HIV-positive for a mean of 9 years (range, 0.5-20) with a mean CD4 count of 522 cells/mm(3) (range, 1-1531). Sixty percent were receiving antiretroviral therapy. ED was reported by 61.4%; of those with ED, 32% did not have a rigid enough erection for penetration, and 46% were unable to sustain an erection for the completion of intercourse. In the multivariate analysis, increasing age (odds ratio [OR] 1.4 for a 5-year increment, p < 0.001) and depression (OR 2.64, p < 0.0001) were associated with ED. A higher current CD4 count was protective (OR 0.80 for each 100 cells/mm(3), p = 0.004). Only 25% of patients with ED had utilized a phosphodiesterase-5-inhibitor for treatment. Seventeen percent of the 300 men were hypogonadal; there was no correlation between hypogonadism and ED. Increasing age and a higher body mass index (BMI) were positively associated with hypogonadism, while smoking was negatively associated (OR 0.44, p = 0.02). All patients with low testosterone had secondary hypogonadism. There was no association between ED or hypogonadism with the current, past, or cumulative use of HIV medications.     

Alpha-subunit secretion in men with idiopathic hypogonadotropic hypogonadism

We studied the regulation of glycoprotein hormone alpha-subunit secretion in four men with idiopathic hypogonadotropic hypogonadism due to presumed GnRH deficiency. Immunoreactive alpha-subunit was present at low but usually detectable levels in blood samples drawn at 10- to 20-min intervals for 12-24 h; however, no characteristic pattern of pulsatile alpha-subunit secretion was found. Serum from each man was examined by gel filtration chromatography. Each sample tested contained an immunoreactive alpha-subunit peak with a slightly lower elution volume than [125I]hCG alpha, as we had previously found in serum from normal men. To determine if this peak represented TSH alpha, two men were treated with 0.3 mg L-T4 daily for 7-14 days. Serum TSH levels decreased to less than 1.5 mU/L, and neither TSH nor alpha-subunit levels increased after the iv administration of 500 micrograms TRH. An alpha-subunit peak that eluted before [125I]hCG alpha was again found in the serum of T4-treated men. We conclude that glycoprotein hormone alpha-subunit is present in the serum of men with idiopathic hypogonadotropic hypogonadism in whom TSH secretion is completely suppressed by L-T4. The gonadotrophs represent the most likely source of this alpha-subunit. The finding of more normal alpha-subunit than LH secretion in these men indicates that the production of the gonadotropin subunits is differentially regulated in man and supports the hypothesis that factors in addition to GnRH regulate alpha-subunit gene expression.     

Production rates of cortisol in men with hypogonadism

Healthy men have a larger endogenous cortisol production rate (PR) than healthy women. To investigate whether this sex-specific difference is maintained in men with low serum testosterone concentrations the endogenous PRs (2 pm to 6 pm) of testosterone, dihydrotestosterone (DHT), and cortisol were simultaneously determined in 10 hypogonadal men. As expected, hypogonadal men were characterized by subnormal PRs of testosterone (19.6 +/- 5.7 microg/h; normal, 180 to 346 microg/h) and of DHT (1.6 +/- 1.1 microg/h; normal, 11 to 20 microg/h). In hypogonadal patients with an intact pituitary-adrenal axis (n = 8), plasma concentrations (7.3 +/- 1.8 microg/dL), metabolic clearance rates (MCRs) (10.0 +/- 4.6 L/h), and endogenous PRs (0.6 +/- 0.2 mg/h) of cortisol were comparable to those seen in eugonadal men. Hence, the sex-specific difference in endogenous cortisol PRs does not depend on the prevailing serum concentrations and on the endogenous PRs of testosterone.