Amy B. O'Donnell

Normal, bound and nonbound testosterone levels in normally ageing men: results from the Massachusetts Male Ageing Study

Objective  There is little consensus on what androgen levels are ‘normal’ for healthy, ageing men. Using data from the Massachusetts Male Ageing Study (MMAS), we estimated age‐specific, normal androgen levels for men aged 40–79 years while accounting for health status and behavioural factors known to influence hormone levels.

Intraindividual variation in levels of serum testosterone and other reproductive and adrenal hormones in men.

Background  Estimates of intraindividual variation in hormone levels provide the basis for interpreting hormone measurements clinically and for developing eligibility criteria for trials of hormone replacement therapy. However, reliable systematic estimates of such variation are lacking.

The validity of a single-question self-report of erectile dysfunction : Results from the massachusetts male aging study

OBJECTIVE: To determine how well a single question of self-reported erectile dysfunction compares to a gold standard clinical urologic examination.DESIGN AND SETTING: Clinical validation study nested within the Massachusetts Male Aging Study (MMAS), which is an observational cohort study of aging and health in a population-based random sample of men.MEASUREMENT: During an in-person interview, men were asked to respond to a single-question self-report of erectile dysfunction. A subsample of MMAS participants was then subjected to a clinical urologic examination to obtain a clinical diagnosis of erectile dysfunction.PARTICIPANTS: One hundred thirty-nine men 55 to 85 years of age from the MMAS.RESULTS: Complete data were available from 137 men. Erectile dysfunction (ED) measured by self-report and independent urologic examination were strongly correlated (Spearman r=.80). Receiver operating curve analysis showed that the self-reported ED item accurately predicts the clinician-diagnosed ED (area under the curve [AUC]=0.888). Stratum-specific likelihood ratios (95% confidence intervals) for self-reports predicting the gold standard were: no ED=0.11 (0.06 to 0.22), minimal ED=1.48 (0.67 to 3.26), moderate ED=8.57 (1.21 to 60.65), and complete ED=12.69 (1.81 to 88.79). These data indicate that men diagnosed with ED by urologic examination can be distinguished from men not diagnosed with ED by urologic examination if the respondent self-reported no, moderate, or complete ED.CONCLUSION: Our single-question self-report accurately identifies men with clinically diagnosed ED, and may be useful as a referral screening tool in both research studies and general practice settings.

Testosterone, Sex Hormone–Binding Globulin, and Frailty in Older Men

OBJECTIVES: To determine whether testosterone (T) levels are associated with frailty or its components.

Sources of Variation in Physician Adherence with Clinical Guidelines: Results from a Factorial Experiment

BackgroundHealth services research has documented the magnitude of health care variations. Few studies focus on provider level sources of variation in clinical decision making-for example, which primary care providers are likely to follow clinical guidelines, with which types of patient.ObjectivesTo estimate: (1) the extent of primary care provider adherence to practice guidelines and the unconfounded influence of (2) patient attributes and (3) physician characteristics on adherence with clinical practice guidelines.DesignIn a factorial experiment, primary care providers were shown clinically authentic video vignettes with actors portrayed different “patients” with identical signs of coronary heart disease (CHD). Different types of providers were asked how they would manage the different “patients” with identical CHD symptoms. Measures were taken to protect external validity.ResultsAdherence to some guidelines is high (over 50% of physicians would follow a third of the recommended actions), yet there is low adherence to many of them (less than 20% would follow another third). Female patients are less likely than males to receive 4 of 5 types of physical examination (p < .03); older patients are less likely to be advised to stop smoking (p < .03). Race and SES of patients had no effect on provider adherence to guidelines. A physicians’ level of experience (age) appears to be important with certain patients.ConclusionsPhysician adherence with guidelines varies with different types of “patient” and with the length of clinical experience. With this evidence it is possible to appropriately target interventions to reduce health care variations by improving physician adherence with clinical guidelines.

The Natural History of Symptomatic Androgen Deficiency in Men : Onset, Progression, and Spontaneous Remission

OBJECTIVES: To describe the onset, progression, and remission of symptomatic androgen deficiency (SAD) using longitudinal data from the Massachusetts Male Aging Study (MMAS).

Cortisol levels and measures of body composition in middle‐aged and older men

Introduction  Similarities in the symptomatic expressions of excess adiposity and hypercortisolaemic conditions suggest that elevated glucocorticoid exposure may influence the pathogenesis of obesity. Circulating cortisol levels are not typically elevated in obese subjects, but data from large prospective samples are rare. We undertook an analysis to determine both cross‐sectional and longitudinal associations between body composition and serum cortisol concentrations in a randomly chosen group of 999 community‐dwelling men, aged 40–79 years.

Using Focus Groups to Improve the Validity of Cross-National Survey Research: A Study of Physician Decision Making

In this article, the authors demonstrate how qualitative methods can form a foundation for quantitative research by improving instrument validity, informing the data collection process, and improving cost-effectiveness in a study of physician decision making. To test terminology, applicability, and comprehension of a quantitative questionnaire for doctors in the United States and United Kingdom, each countrys researchers conducted physician focus groups with questions organized around the experiment, including (a) validity of video vignettes of actor “patients,” (b) population accessibility, (c) level of remuneration, (d) appropriate endorsement figure, and (e) question comprehension. Focus group data collected during instrument development and fieldwork planning streamlined processes and achieved cost efficiencies and effectiveness for the overall study. Beyond simply adding a post hoc qualitative component to an already free-standing quantitative methodology, focus groups were used in the study formulation, where the qualitative methodology was integrated into the process of developing a valid survey instrument.

More on the measurement of normal testosterone levels: comments on the Barrett–Connor commentary

© 2005 Blackwell Publishing Ltd, Clinical Endocrinology , 63 , 232–237 women during late pregnancy or in the postpartum period but may be seen at any age or gender. This process generally affects the adenohypophysis and only in 20–30% of the patients is the neurohypophysis involved, which was not the situation here. Second, the patient’s extrapontine myelinolysis was probably secondary to the acute severe hypernatraemia as the patient presented with acute mental status changes. A slow onset of hyperosmolality does not result in myelinolysis because the brain protects against osmotic stress by accumulating electrolytes and organic solutes to ensure isotonicity with respect to serum. Extrapontine myelinolysis has been reported to be associated with severe acute hypernatraemia usually in the presence of other medical problems such as alcoholism (Marchiafava–Bignami), severe burns, hyperglycaemia and disequilibrium syndrome. 3 Extrapontine and pontine myelinolysis frequently coexist and have identical pathological changes 4 in the two anatomical sites. The pathogenic basis is thought to be rapid intracellular brain dehydration resulting in unravelling of the myelin sheath away from the axons. This patient was unusual as there are few published reports of extrapontine myelinolysis caused by central diabetes insipidus resulting in severe acute hypernatraemia in children but not in adults. We also recognize that the rapid rate at which serum sodium correction occurred from hypernatraemia to normonatraemia while she was being resuscitated in the emergency room might have contributed to her clinical situation. However, correction of hypernatraemia has not been reported to be association with myelinolysis. 4 Furthermore, the patient was never hyponatraemic during her hospital course, nor was there evidence of brain oedema in the MRI, indicating that the myelinolysis was likely to be secondary to the acute hypernatraemic state and not due to the electrolyte changes that occurred during resuscitation on admission. It should be emphasized that the common cause of pontine myelinolysis is the rapid reversal of hyponatraemia (rates exceeding 10–15 mmol/l/24 h) producing brain cell shrinkage resulting in neurological damage, and methods to avoid this iatrogenic complication are through a slow correction rate of serum sodium. 4,5