Review of health risks of low testosterone and testosterone administration

Hypogonadism is prevalent in older men and testosteronereplacement therapy(TRT) for older hypogonadal men is a promising therapy. However, a number of important clinical concerns over TRT safety remain unsolved due to a lack of large-scale randomized clinical trials directly comparing the health risks of untreated hypogonadism vs long-term use of TRT. Meta-analyses of clinical trials of TRT as of 2010 have identified three major adverse events resulting from TRT: polycythemia, an increase in prostate-related events, and a slight reduction in serum high-density lipoprotein cholesterol. There are other purported health risks but their incidence can be neither confirmed nor denied based on the small number of subjects that have been studied to date. Furthermore, subsequent literature is equivocal with regard to the safety and utility of TRT and this topic has been subject to contentious debate. Since January 2014, the United States Food and Drug Administration has released two official announcements regarding the safety of TRT and clinical monitoring the risks in TRT users. Additionally, the health risks related to the clinical presentation of low or declining testosterone levels not been resolved in the current literature. Because TRT is prescribed in the context of putative risks resulting from reduced testosterone levels, we reviewed the epidemiology and reported risks of low testosterone levels. We also highlight the current information about TRT utilization, the risks most often claimed to be associated with TRT, and current or emerging alternatives to TRT.

Using GIS to Plan Specialty Health Services for Veterans: The Example of Acute Stroke Care

The Department of Veterans Affairs (VA) manages the largest healthcare system under a single management structure in the United States. Providing access to high quality healthcare to the VA’s nearly 9 million enrollees is a mission priority for the Veterans Health Administration (VHA), the arm of the VA that oversees all medical facilities and operations. Geographic Information Systems (GIS) tools enable analysts to construct data-driven recommendations to policy makers for providing the best and most timely healthcare to those individuals who have honorably served their country. This paper illustrates how GIS is being used by the VHA and provides the example of acute stroke care access for Veterans in one Veterans Integrated Service Network (VISN) within the VHA.

Self-efficacy for managing hypertension and comorbid conditions

BACKGROUND Self-efficacy is defined an individual’s belief in completing necessary actions to achieve the desired goal.For individuals with hypertension and other chronic conditions,self-efficacy has been an essential factor to predict adherence to treatment behaviors.AIM To examine self-efficacy for managing chronic conditions in individuals with hypertension.METHODS A total of 1087 individuals with chronic conditions in two groups(hypertension and non-hypertension groups)were selected in this study.The two groups’selfefficacy for managing chronic conditions were investigated using the five domains of patient reported outcomes measurement information system selfefficacy for managing chronic conditions measures(PROMIS-SE);daily activities,emotions,medication and treatment,social interactions,and symptoms.Also,the relationships between self-efficacy and other health-related outcomes for the hypertension group were examined using structural equation modeling.RESULTS Among 1087 participants,437 reported having hypertension.The hypertension and non-hypertension groups were statistically different in self-efficacy for managing daily activities[F(1,598)=5.63,P<0.05].Structural equation modeling indicated that for individuals with hypertension,two domains of PROMIS-SE(managing daily activities and emotions)significantly predict global physical health(P<0.001 and P<0.01 sequentially),and one domain(managing emotions)significantly predicts mental health(P<0.001).Hypertension patients’general quality of life was significantly predicted by global physical health(P<0.001)and mental health(P<0.001).CONCLUSION The hypertension group reported deficits in self-efficacy in managing daily activities as compared to the non-hypertension group.In this hypertension group,self-efficacy functioned as an indirect predictor of general quality of life,mediated by global physical and mental health.