Sexuality Among Middle-Aged and Older Adults With Diagnosed and Undiagnosed Diabetes: A national, population-based study

OBJECTIVE

To describe sexual activity, behavior, and problems among middle-age and older adults by diabetes status.

RESEARCH DESIGN AND METHODS

This was a substudy of 1,993 community-residing adults, aged 57–85 years, from a cross-sectional, nationally representative sample (N = 3,005). In-home interviews, observed medications, and A1C were used to stratify by diagnosed diabetes, undiagnosed diabetes, or no diabetes. Logistic regression was used to model associations between diabetes conditions and sexual characteristics, separately by gender.

RESULTS

The survey response rate was 75.5%. More than 60% of partnered individuals with diagnosed diabetes were sexually active. Women with diagnosed diabetes were less likely than men with diagnosed diabetes (adjusted odds ratio 0.28 [95% CI 0.16–0.49]) and other women (0.63 [0.45–0.87]) to be sexually active. Partnered sexual behaviors did not differ by gender or diabetes status. The prevalence of orgasm problems was similarly elevated among men with diagnosed and undiagnosed diabetes compared with that for other men, but erectile difficulties were elevated only among men with diagnosed diabetes (2.51 [1.53 to 4.14]). Women with undiagnosed diabetes were less likely to have discussed sex with a physician (11%) than women with diagnosed diabetes (19%) and men with undiagnosed (28%) or diagnosed (47%) diabetes.

CONCLUSIONS

Many middle-age and older adults with diabetes are sexually active and engage in sexual behaviors similarly to individuals without diabetes. Women with diabetes were more likely than men to cease all sexual activity. Older women with diabetes are as likely to have sexual problems but are significantly less likely than men to discuss them.Advances in treatment for diabetes have prolonged and improved quality of life for many of the ∼12 million affected individuals aged ≥60 years in the U.S. Clinical guidelines for diabetes care include assessment and treatment of erectile problems in men (1). Sexual problems may be a warning sign of diabetes or a consequence that can lead to depression, lack of adherence to treatment, and strained intimate relationships. In contrast, older women''s sexual issues have been largely overlooked in screening for and treating diabetes (1,2). Failure to recognize and address sexual issues among middle-aged and older adults with diabetes may impair quality of life and adaptation to the disease.Some adults with diabetes maintain sexual relationships throughout their lives (3). Prior studies have focused on the pathophysiological effects of diabetes on male sexual function, primarily erection and sexual desire. The effects of diabetes on women''s sexual functioning are poorly understood and probably multifactorial (2). Sexual problems in adults with diabetes have been associated with age, disease duration, and comorbidity (1). The effects of chronic hyperglycemia, degree of diabetes control, or use of glucose-lowering drugs are less clear (4), in part because individuals with undiagnosed or preclinical diabetes are typically aggregated with control subjects in other studies (1). Psychosocial correlates of sexual problems in individuals with diagnosed diabetes have been found in younger adults. Studies including older adults find associations with depression (1), vulnerability, lifestyle restrictions due to disease management (5), and marital conflict (6).Prior data on sexuality in individuals with diabetes were derived primarily from studies that are small, have not included very old individuals or aggregated individuals ≥65 years, lacked a comparison group, and relied on convenience or other nongeneralizable samples (1,2). Comprehensive, population-based data are needed to further physicians'' understanding of the sexual norms and problems of older adults with diagnosed and undiagnosed diabetes. Virtually nothing is known about sexual function among individuals with undiagnosed diabetes; this information could be relevant for diagnosis, motivation to engage in treatment, and prevention of sexual and nonsexual diabetes-related complications. The National Social Life, Health and Aging Project (NSHAP) provides disease-specific data on the sexual activity, behaviors, and problems of middle-aged and older adults affected by diabetes.     

Gist recall in temporal lobe seizure patients (a study of adaptive memory skills)

This study investigates the capacity of lateralized temporal lobe seizure patients to process and retain complex narrative information, to recall the most important elements of verbal material, and to make effective use of mnemonic strategies during a brief study period to improve performance. Compared to normal controls, both left and right temporal lobe samples recall significantly less information on both immediate and post-study trials. In addition seizure patients, particularly left temporal subjects, engaged in fewer active learning strategies and produced more instances of major distortion. However, despite their reduced efficiency in total recall, seizure patients, like control subjects, do tend to remember a higher proportion of important idea units and a smaller proportion of details. The findings are discussed in relation to previous research which documented memory monitoring failures in temporal lobe seizure patients, and in terms of the development of adaptive memory skills to circumvent memory deficits.     

Elective paratracheal neck dissection for lateral metastases from papillary carcinoma of the thyroid: Is it indicated?

BACKGROUND: Therapeutic paratracheal neck dissection for patients with papillary carcinoma of the thyroid is standard treatment. Its use as an elective procedure is controversial. METHODS: Thirty-seven patients with papillary carcinoma of the thyroid and evidence of positive adenopathy at levels II-V underwent selective neck dissection and elective/therapeutic paratracheal neck dissection. Results of preoperative ultrasonography of the neck were compared with the dissection specimens. RESULTS: Morbidity of the surgical procedure was minimal (1 permanent hypocalcemia). All specimens showed metastases from papillary thyroid carcinoma: 100% (37/37) in the jugular chain of lymphatics and 83.7% (31/37) in the paratracheal region. The rate of occult (negative physical examination and ultrasonography) metastases in the paratracheal region in the presence of metastases in the ipsilateral jugular chain was 83.3% (20/24). CONCLUSION: The high rate of occult metastases in the paratracheal region and the low rate of surgical morbidity speak in favor of elective paratracheal neck dissection in patients with metastatic papillary carcinoma of the thyroid.     

Evaluation of POSSUM and P-POSSUM scoring systems in assessing outcome after laparoscopic colectomy

BACKGROUND: The purpose of this study was to compare the actual and predicted risk-adjusted morbidity and mortality after laparoscopic colectomy (LAC) calculated using both the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) and Portsmouth POSSUM (P-POSSUM) scoring systems. METHODS: All patients who underwent LAC performed by a single surgeon between March 1999 and December 2000 were analysed. The observed morbidity and mortality rates were compared with those predicted by the POSSUM scoring system, and the observed mortality rate with that predicted by P-POSSUM. The operative severity component of the operative score was sequentially decreased from 4 (standard score for open colectomy) to 2, then 1, in an attempt to correct overprediction. RESULTS: Two hundred and fifty-one consecutive patients underwent LAC, with a conversion rate of 8.0 per cent. The morbidity rate (6.8 per cent) was significantly lower than the predicted rates calculated with an operative score of 4 or 2 (12.4 per cent, P < 0.001; 9.6 per cent, P = 0.001), but was fully corrected with an operative score of 1 (7.0 per cent, P = 0.325). The observed mortality rate (0.8 per cent) was significantly different from the expected mortality rates calculated using either uncorrected POSSUM (9.6 per cent, P = 0.001) or P-POSSUM (3.5 per cent, P = 0.001). POSSUM (2.6 per cent, P = 0.007) continued to overpredict mortality but P-POSSUM (1.0 per cent, P = 0.001) accurately predicted mortality with an operative score of 1. CONCLUSION: LAC appeared to be associated with lower morbidity and mortality rates than those predicted by the POSSUM scoring system, and with a lower mortality rate than that predicted using the P-POSSUM system.     

Research Priorities for Healthcare Chaplaincy: Views of U.S. Chaplains

Chaplains in the United States and around the world appear to support an evidence-based practice approach to chaplaincy. While there continues to be strong growth in spiritual care research, several spiritual care researchers have stressed the need for a research agenda for chaplaincy. This study investigated the research priorities of chaplains who completed a survey distributed at four chaplaincy conferences in 2016. A total of 193 chaplains responded, resulting in 499 comments. When compared to the findings of existing literature regarding research priorities for chaplaincy, chaplain’s views of research priorities appear to be very consistent with views of chaplaincy leaders. Both prioritize research on outcomes of spiritual care, the development and testing of the effectiveness of interventions, the development and evaluation of assessment and screening tools and research about key subgroups of patients. The chaplains in the survey however added to the agenda research regarding competencies, education, and certification and research regarding the chaplain and the team.     

Bullous pemphigoid: Etiology,pathogenesis, and inducing factors: Facts and controversies

The term pemphigoids includes a group of autoimmune bullous diseases characterized by subepidermal blistering. Bullous pemphigoid (BP) is not only the most common disorder within the pemphigoid group, but also represents the most frequent autoimmune blistering disease in general.