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91.
Timothy C. Evans MD PhD ; Keren H. Wick PhD ; Douglas M. Brock PhD ; Douglas C. Schaad PhD ; Ruth Ballweg MPA PA-C 《The Journal of rural health》2006,22(3):212-219
CONTEXT: The physician assistant profession has been moving toward requiring master's degrees for new practitioners, but some argue this could change the face of the discipline. PURPOSE: To see if there is an association between physician assistants' academic degrees and practice in primary care, in rural areas, and with the medically underserved. METHODS: Surveys were sent to 880 graduates of the first 32 University of Washington physician assistant classes through 2000. Respondents noted their academic degree at program entry and the highest degree attained at any time up to the time of survey. Relationships between practice characteristics and academic degree levels were tested by unadjusted odds ratios and logistic regression after controlling for year of graduation and sex. RESULTS: Of the 478 respondents, 54% worked in primary care, about 30% practiced in nonmetropolitan communities, and 42% reported providing care for the medically underserved. Respondents with no degree (33% of total at entry, 24% at survey) were significantly more likely than degree holders to work in primary care and nonmetropolitan areas. Respondents with no degree at program entry were significantly more likely, and those with no degree at the time of the survey were marginally more likely, to self-report work with the medically underserved. CONCLUSION: Respondents with no academic degree are significantly more likely to demonstrate a commitment to primary, rural, and underserved health care. These findings may inform the national debate about the impact of required advanced degrees on the practice patterns of nonphysician providers. 相似文献
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This review discusses treatment options for men with premature ejaculation (PE), a common sexual dysfunction characterized
by short ejaculatory latency, decreased sexual satisfaction, and distress. For a number of reasons, including embarrassment
and the belief that PE is a normal part of aging, that it has no effective treatment, or that it will resolve itself, few
men with PE seek treatment. Although several treatment options exist (eg, behavioral, cognitive, and sex therapy methods;
desensitizing drugs; off-label use of antidepressants, phosphodiesterase type 5 inhibitors, or à-blockers), the majority of
men with PE are not satisfied with their results. New pharmacologic drugs develped specifically for the treatment of PE are
undergoing evaluation in clinical trials. For example, recent clinical research studies have revealed on-demand administration
of one such drug, dapoxetine, which achieved significant improvements in ejaculatory latency, control over ejaculation, and
satisfaction with sexual intercourse. In addition, partners of men who received dapoxetine likewise reported improved satisfaction
with sexual intercourse. Future studies may reveal that integration of pharmacologic drugs with psychologic and/or behavioral
therapy techniques may be the optimal approach to the management of PE. PE is a treatable condition, and new drugs in development
may provide benefits over those available. 相似文献
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Decreases in sex hormone levels with menopause may bring about a number of consequences in women's general health and sexual well-being, especially when levels decline suddenly and prematurely, as in surgical menopause. In addition to the well-established role of estrogens in preserving the biological basis of sexual response, there is emerging evidence that androgens are significant independent determinants affecting sexual desire, activity and satisfaction, as well as mood, energy and other components of women's health. Hypoactive sexual desire disorder (HSDD), a persistent absence of sexual fantasies or thoughts and/or desire for and receptivity to sexual activity that causes personal distress, is experienced by some postmenopausal women. Even though conventional hormone therapy with estrogens or estrogens and progestogens may be effective for vaginal atrophy, increasing vaginal lubrication and reducing dyspareunia, it has not been shown to consistently increase sexual desire or activity and many women with sexual dysfunction remain unresponsive. Several recent, large, phase III studies have shown that the addition of transdermal testosterone to conventional hormone therapy can be helpful in surgically menopausal women presenting with HSDD. After 24 weeks of treatment in these studies, testosterone-treated women experienced significantly greater increases in satisfying sexual activity and sexual desire, and greater decreases in distress, than placebo-treated women. Accurate clinical assessment and individualized management of sexual symptoms are fundamentally important for all menopausal women with HSDD or other sexual problems. 相似文献
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Prostatitis and male infertility are frequent disorders, and the role of prostatitis in male infertility has been under discussion for more than 30 years. Many researchers have shown relevant links between the two. Although a causal relationship has not been definitely demonstrated, increasing evidence shows that chronic prostatitis has a relevant negative impact on male fertility potential, at least in certain subgroups. In the following review, we focus on the present state of knowledge on the role of chronic prostatitis as an etiologic factor in male infertility. 相似文献