Lower Proportion Of Men Research Articles

High-Intensity Statin Prescribing Following Acute Coronary Syndrome at Wellington Hospital

Background: Statins form an integral part of secondary prevention of myocardial ischaemia. There is widespread consensus regarding a preference for high-intensity therapy from the outset [1Stone N.J. et al.ACC/AHA Blood Cholesterol Guideline 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adult.Circulation. 2013; (2013; 01)Google Scholar, 2Schwartz G.G. et al.Effects of Atorvastatin on Early Recurrent Ischemic Events in Acute Coronary Syndromes: The MIRACL Study: A Randomized Controlled Trial.JAMA. 2001; 285 (4): 1711-1718Crossref PubMed Google Scholar]. Despite this, there remains a reluctance to prescribe higher, guideline doses of statins on discharge following acute coronary syndrome (ACS). Methods: We performed an audit of admission and discharge statin prescribing in all patients admitted to Wellington cardiology department with ACS over a 2-week period. This was followed by a departmental educational intervention and the effect was re-examined in a further 2-week re-audit. Statin intensity was specified based on published LDL-C lowering potency [[3]Weng T.-C. Yang Y.-H.K. Lin S.-J. Tai S.-H. A systematic review and meta-analysis on the therapeutic equivalence of statins.Journal of Clinical Pharmacy and Therapeutics. 2010; 35: 139-151Crossref PubMed Scopus (273) Google Scholar]. Low intensity: atorvastatin 10 mg, simvastatin 10-20 mg, pravastatin 20-40 mg. Moderate intensity: atorvastatin 20-40 mg, simvastatin 40-80 mg, pravastatin 80 mg, rosuvastatin 5-10 mg. High intensity: atorvastatin 80 mg, rosuvastatin 20-40 mg. The specific statin and dose selected were by physician preference. Results: 66 patients were identified pre-intervention and 70 post-intervention. The pre-interventional group was older (65 vs 60 years p = 0.02) and contained a lower proportion of men (71% vs 85% p = 0.03). There was no difference in statin intensity on admission between pre and post interventional groups, and only 8% overall were on high intensity therapy. There was a significant increase in the prescription of high intensity statin therapy post intervention. Conclusion: We found low rates of guideline, high intensity statin prescribing following acute coronary syndromes. After a simple educational intervention this was significantly improved.

Drug treatment patterns for the management of men with lower urinary tract symptoms associated with benign prostatic hyperplasia who have both storage and voiding symptoms: a study using the health improvement network UK primary care data

Background:Real-world data on the pharmacological management of men who have lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) are limited.Objective:To characterize men with LUTS/BPH who had both storage and voiding symptoms and to evaluate treatment patterns in UK primary care.Design, setting and participants:This was an observational study of men aged ≥45 years with a diagnosis, symptoms or therapies indicative of LUTS/BPH with both storage and voiding components. These men were identified from the large Health Improvement Network (THIN) database between 1 January 2004 and 30 September 2011.Outcome measurements and statistical analysis:Drug prescriptions and switching/discontinuation patterns for α1-blockers and antimuscarinics.Results and limitations:We identified 8694 men with a median age of 66.0 (interquartile range [IQR], 59.0–74.0) years. Most (7850; 90.3%) received an α1-blocker, and 2167 (24.9%) received antimuscarinic therapy over a median of 2.1 years. The most commonly prescribed α1-blocker was tamsulosin (81.8%); most frequent antimuscarinics were tolterodine (41.0%), oxybutynin (37.2%) and solifenacin (35.7%). Concomitant prescription of α1-blocker and antimuscarinic therapy (within 30 days of each other) was received by 1160 men (14.8% of α1-blocker-treated men). Of α1-blocker recipients, 3024 (38.5%) discontinued during follow-up, while 1149 (53.0%) discontinued antimuscarinic therapy. Of 2167 men who received an antimuscarinic, 476 (22.0%) switched to another antimuscarinic. Of the three most commonly prescribed antimuscarinics, solifenacin had the lowest proportions of discontinuations (43.0%) and switches (15.3%), and the longest median duration of therapy (90 days, IQR 30–300). General practice consultations accounted for most resource use (5307.9 per 1000 patient-years).Conclusions:This study presents real-world management of men with LUTS/BPH who have both storage and voiding symptoms. The low proportion of men who received concomitant α1-blocker and antimuscarinic therapy suggests that some patients are sub-optimally treated in routine clinical practice.

Lymphocytes telomere length in centenarians and centenarians’ offspring

Introduction.–Women live longer but experience poorer health and disability more frequently than men. Our multicenter populationbased study aims to evaluate gender-differences in the functional status of the oldest old, considering the influence of some life-style factors. Methods.– We enrolled institutionalized and community-dwelling Italian centenarians. We conducted structured face-to-face interviews and applied the following scales: Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), Mini Mental Status Examination (MMSE), Norton Scale andGeriatric Depression Scale (GDS). Results.– 152 centenarians (32 men, 124 women) were recruited. Men showed higher ADL, IADL and Norton mean scores than women (3.66 versus 2.39/6; 4.75 versus 2.75/16; 16.38 versus 14.05/20). Severe cognitive impairment predominantly affected women: 64.5% women versus 43.7% men had MMSE score less than 19/30. Although men were more frequently ex-smokers, they showed some protective life-style factors, such as older mean age at widowhood (87 versus 68 years), 12.5% of men but no woman were still married and all men versus 60.4% of women had had an occupation during life. A lower proportion of men showed symptoms of depression by GDS (17.6% versus 46.5%) with a later onset age (99 versus 83 years). No gender-difference was detected both in self-reported health and in attitude towards life: 58.8% men and 47.7% women reported very good/good health and declared to be optimistic. Key conclusions.– Centenarian men, although fewer in number, were healthier than females and seemed to display a favourable set of life-style factors contributing to reach longevity in better status.

Gender-differences in centenarians: Health status and life-style

Introduction.–Women live longer but experience poorer health and disability more frequently than men. Our multicenter populationbased study aims to evaluate gender-differences in the functional status of the oldest old, considering the influence of some life-style factors. Methods.– We enrolled institutionalized and community-dwelling Italian centenarians. We conducted structured face-to-face interviews and applied the following scales: Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), Mini Mental Status Examination (MMSE), Norton Scale andGeriatric Depression Scale (GDS). Results.– 152 centenarians (32 men, 124 women) were recruited. Men showed higher ADL, IADL and Norton mean scores than women (3.66 versus 2.39/6; 4.75 versus 2.75/16; 16.38 versus 14.05/20). Severe cognitive impairment predominantly affected women: 64.5% women versus 43.7% men had MMSE score less than 19/30. Although men were more frequently ex-smokers, they showed some protective life-style factors, such as older mean age at widowhood (87 versus 68 years), 12.5% of men but no woman were still married and all men versus 60.4% of women had had an occupation during life. A lower proportion of men showed symptoms of depression by GDS (17.6% versus 46.5%) with a later onset age (99 versus 83 years). No gender-difference was detected both in self-reported health and in attitude towards life: 58.8% men and 47.7% women reported very good/good health and declared to be optimistic. Key conclusions.– Centenarian men, although fewer in number, were healthier than females and seemed to display a favourable set of life-style factors contributing to reach longevity in better status.

Anemia is Associated with Bone Mineral Density in Chronic Obstructive Pulmonary Disease

Objective: Patients with chronic obstructive pulmonary disease (COPD) often suffer from systemic co-morbidities, including anemia. However, anemia is related to multiple outcomes in COPD and in other chronic diseases, but it's impact is underestimated in COPD. The objective of the present study was to relate anemia in patients with COPD with disease-related outcomes, systemic inflammation and COPD related co-morbidities. Methods: Data of 321 patients with COPD admitted for pulmonary rehabilitation were analysed. Besides general characteristics, lung function, body composition, arterial gases and plasma haemoglobin concentration, disease-related outcomes (health-related quality of life by St. George's Respiratory Questionnaire, 6-minute walking distance, mMRC dyspnea scale, and BODE index), systemic inflammation (C-reactive protein (CRP)) and self-reported and objectified co-morbidities (low muscle mass, osteoporosis, renal failure, risk for undernutrition) were taken into account. Results: First, 20% of the patients were anemic, and 8% was polycythemic. Polycythemic patients had a lower proportion of men and a lower proportion of low muscle mass compared to the other groups. Anemic patients had higher plasma CRP levels and lower total body bone mineral density compared to the other groups. There was no difference in disease-related outcomes or other co-morbidities in the patients with and without anemia. Even after adjustment for confounders, anemia was an independent determinant for higher CRP levels and lower bone mineral density. Conclusion: Anemia is frequently present in patients with COPD and there is evidence that it is associated with lower whole body bone mineral density.

HIV Counseling and Testing in an Urban Reproductive Primary Health Clinic in South Africa

This letter to the editor focuses on the gender differences for HIV counseling and testing in South Africa. It describes the profile of men and women testing positive for HIV at an urban reproductive health facility in Durban and explains the methods and results of the study.

The growth and age-related origins of bone fragility in men.

At any age, a lower proportion of men than women sustain fractures because fewer men have the structural determinants of bone strength below a critical level where loads exceed bone strength. During aging, bone size increases more in men than in women by means of periosteal apposition, which increases the sex difference in bone size established during growth. Volumetric bone mineral density (BMD) at the spine is similar in young men and women. It decreases less in men, not because trabecular bone loss is less than in women, but rather because periosteal apposition is greater in men than in women. At the hip, volumetric BMD decreases similarly in men and women because greater periosteal apposition in men is matched by greater endosteal bone loss. Volumetric BMD is similarly reduced in elderly men and women. Trabecular architecture is less disrupted and cortical porosity is less in men than in women. Men with fractures have reduced bone size and reduced volumetric BMD owing to growth and age-related factors; both will need to be studied to understand the structural basis of bone fragility in old age.

Modelling inter-provincial migration in Burkina Faso, West Africa: the role of socio-demographic and environmental factors

This study analyses the factors that cause inter-provincial migrations in an African context (Burkina Faso, West Africa), focusing specifically on the role of environmental factors in driving large migration flows in ecologically marginal regions. It uses statistical methods for modelling migration data to assess the relative importance of socio-demographic and biophysical variables. The former included the percentage of the population who are male, literacy and economic activity rates, and the presence of a resettlement policy. The latter included measures of land degradation, land availability and climatic variability, which vary considerably between different regions of the country. The results demonstrate that, as expected, demographic and socio-economic characteristics of Provinces were associated with migration patterns, and that environmental variables were also significant. However, the contribution of environmental variables in the explanation of migration was slightly lower than for the socio-demographic variables. The results show that inter-provincial migrations in Burkina Faso are influenced by high literacy and economic activity rates at the origin and destination, a high proportion of men at the origin, a low proportion of men at the destination, as well as by unfavourable conditions concerning rainfall variability, land degradation and land availability at the origin, and favourable conditions at the destination for these variables.

Self-reports of physical, sexual and emotional abuse in an alcoholism treatment sample.

There is a growing appreciation that emotional, physical and sexual abuse events are frequently part of the life histories of individuals in treatment for alcohol disorders. The present study examines reports of lifetime abuse in a clinical trial for treatment of alcohol dependency. Data were obtained from baseline assessments conducted with participants (N = 1,726; 1,307 men) entering Project MATCH, a multisite clinical trial conducted at nine geographically dispersed research sites. Differences on a broad range of participant characteristics were examined by gender and by reported abuse type. More than half (59%) of the participants reported lifetime abuse. Women were more likely (77%) to report abuse than were men (54%). A lower proportion of men than women (6% vs 31%) reported experiencing both physical and sexual abuse. Gender differences were found on the majority of psychosocial measures. Comparisons of the psychosocial measures by abuse type generally indicated that participants without abuse histories had better functioning than did participants reporting abuse. The high frequency of lifetime abuse in this geographically dispersed sample underscores the necessity for including assessment of emotional, physical and sexual abuse with alcoholism treatment seeking populations. Participants reporting such events may require other treatment in addition to that for alcohol dependency.