Men Of Mature Age Research Articles

Age-related features of somatometric parameters of Yakut men according to Heath–Carter

The aim of the study was to identify the features of the somatometric parameters of Yakut men in the youthful and second period of adulthood according to Heath–Carter.Material and methods. 167 young men and 41 men of the second period of mature age of the Yakut nationality were examined. The examination included anthropometric measurements and bioimpedance analysis of the body BMI and waist-to-hip ratio were calculated. Somatotyping according to Heath–Carter was carried out on the basis of ecto-, meso- and endomorphic scores, which are included in the bioimpedancemetry protocol. Statistical processing of the obtained data was carried out using the SPSS 17.0 application package. The normality of the distribution of parameters was determined by the Kolmogorov–Smirnov criterion. Mean (M) and standard deviation (SD) were calculated, and intergroup differences were assessed using Student's t-test.Results. The study revealed age differences in terms of length, weight and body composition. Significantly large values of body length, relative parameters of skeletal muscle mass and active cell mass were found in young men. Mature men had significantly higher body weight values, absolute and relative indicators of fat mass, absolute values of active cell mass. According to BMI, overweight was detected in 6.6%, obesity - in 3.0% of young men. Among men of mature age, overweight was determined in 54.2%, obesity - in 27.0%. A high index of the ratio of waist circumference to hip circumference was found in 4.8% of boys and 58.5% of men. The distribution of somatotypes according to Heath-Carter revealed that young men in 100% of cases had a mesectomorphic somatotype. In mature men, the mesectomorphic type was also the predominant somatotype (95.8%). In 4.2% of men of mature age, a balanced ectomorphic type was determined. The absence of variability in body types suggests that the mesectomorphic somatotype is the most adapted to living in the extreme natural and climatic conditions of Yakutia.

Bioimpedance and clinical features of psoriasis vulgaris in men of mature age (the 2nd period)

Bioimpedance and clinical features of psoriasis vulgaris in men of mature age (the 2nd period)

ПРЕДСТАВЛЕНИЯ МУЖЧИН ЗРЕЛОГО ВОЗРАСТА О СУПРУЖЕСКОЙ СЕМЬЕ

The relevance of the empirical study lies in the applied psychodiagnostic issue of studying how marriage affects maturation of men and gender-specific aspects of viewing the structure and functions of the family in the modern society. Despite the large amount of research carried out in the field of personality and age characteristics of men within the framework of developmental and gender psychology, the role of the parental family in the personality development of men and their vision of marriage have been understudied. The purpose of the study is to investigate how marriage is viewed by men of mature age. The author performed a critical review of theoretical approaches to identification of personality charac-teristics of men at mature age, their troubles, family functions and roles. In order to study men’s attitude to different aspects of family life, the authors used the method of psychological measurement (questionnaire “Role expectations and claims in marriage”) and the method of mathematical statistics (Mann-Whitney U test). After analysis of the obtained results, statistically significant differences were found in the views of men of different age groups. Moral and emotional partner support as well as personal identification with the partner are the most important according to the men of 25–34 years old, while for men aged 35–42 parenting is of high priority.

Прогнозування перебігу гіпоандрогенії в хлопців-підлітків

The most pathological conditions that adversely affect the reproductive function in men of mature age is formed precisely in adolescence as a result from hypoandrogenism (HA), - a decrease in the production of male sex hormones (androgens) below the age norm. Therefore, the ability to predict the course of HA in adolescent boys allows to prevent serious health problems in the future. Purpose - to determine significant prognostic criteria for adverse course of HA in adolescent boys with delayed sexual development. Materials and methods. Were examined 157 boys 14-17 years old with signs of androgen deficiency, the degree of which was based on the assessment of total testosterone (TT). The levels of gonadotropic hormones, estradiol, their ratios were studied by enzyme-linked immunosorbent assay, and the content of thyroid-stimulating hormone and free thyroxine, their ratio was determined. The lipid spectrum of blood was studied. On the basis of X-rays of the non-dominant hand and wrist determined bone age and ossification deficiency. Сonditionally unfavorable course of HA was formed in adolescent boys with severe androgen deficiency (HA 3 degree) at the level of total testosterone <4 nmol/l. Favorable course of HA was considered to be the presence of clinical signs of hypoandrogenism in adolescents with normal TT, levels more than 12 nmol/l (HA 0 degree). Results. Based on the study was identified the most informative features and calculated their prognostic coefficient. It is proved that significant informative signs of HA in adolescent boys are such as body mass index abnormalities, bone age deficit, levels and ratios of gonadotropic hormones, estradiol values and testosterone / estradiol, testosterone / luteinizing hormone ratios, thyroid stimulating hormone / free thyroxine, changes in lipid profile. To the most prognostically significant negative prognostic criteria for adverse HA in adolescent boys are excess body weight by body mass index level, significant deficit of bone age (more than 3 years), decreased luteinizing hormone levels, decreased luteinizing hormone / follicle stimulating hormone ratio, hyperestrogenism, pronounced androgenic-estrogenic disbalance, the presence of minimal thyroid dysfunction, disorders of the lipid profile. Conclusions. The developed prognostic criteria for adolescent boys with HA will make it possible to predict the further course of the disease (in the early stages of its formation pathology), what will carry out timely treatment and rehabilitation measures in adolescent boys, and this will help to improve their health. Teens with HA, who show prognostically unfavorable signs, need more careful dispensary observation of an endocrinologist. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

БИОФИЗИЧЕСКИЕ ПАРАМЕТРЫ ОРГАНИЗМА МУЖЧИН-ЯКУТОВ ЗРЕЛОГО ВОЗРАСТА

Statistical data indicate a high level of morbidity in the main classes of diseases and mortality among the male population of older age groups, which requires a comprehensive study. The purpose of this study was to determine the biophysical parameters of the body in mature Yakut men. A total of 41 men of the first and second periods of adulthood, workers and employees of various enterprises of Yakutsk were examined. An anthropometric and bioimpedancmetric examination was carried out. The overall dimensions of the body (length and body weight), waist circumference and hip circumference were measured, BMI and the ratio of waist circumference to hip circumference were calculated. Bioimpedance measurement was carried out using the analyzer of body composition and balance of water sectors of the body ABC – 01 “Medass”. Statistical analysis of the data obtained was carried out using the SPSS 17.0 software package. An anthropometric survey revealed that according to the BMI, most men are overweight and obese, according to the ratio of waist circumference to hip circumference a larger proportion of the surveyed men have visceral obesity. Bioelectric indicators and parameters of the component composition of the body were established. In men of mature age, higher relative indicators of fat mass, extracellular fluid and reduced values of musculoskeletal mass were revealed in comparison with similar parameters of Yakut young males.

The Effect of Regular Physical Activity on Platelet Activity in Men of Mature Age

The Effect of Regular Physical Activity on Platelet Activity in Men of Mature Age

Decisão clínica compartilhada diante dos riscos do rastreamento do câncer de próstata

Introdução: Evidências atuais apontam para desiquilíbrio entre os benefícios e danos com a prática do rastreamento do câncer de próstata, podendo provocar consideráveis riscos à saúde dos homens. Tal afirmativa fundamentou a recomendação do Ministério da Saúde sobre não estimular a realização dessa prática e a necessidade de discutir todas as implicações desses exames quando o homem solicitar sua realização. Objetivo: Analisar a percepção e experiências de homens e médicos/as sobre a tomada de decisão compartilhada para o rastreamento do câncer de próstata no Brasil. Método: Foi realizado um estudo qualitativo e exploratório, a partir de um grupo focal com homens na maturidade da idade (média: 51 anos) e entrevistas semiestruturadas com médicos/as de unidades básicas de saúde, de diferentes estados do Brasil. Abordagem analítica qualitativa, cujos dados foram categorizados pela análise de conteúdo. Resultados: Identificou-se desconhecimento dos homens sobre os possíveis danos relacionados ao rastreamento desse câncer, além de barreiras de cunho pessoal, cultural e na organização do processo de trabalho, que demonstraram dificultar à comunicação clínica durante a consulta na atenção primária à saúde (APS). De outra parte, os homens referem desejo de maior participação nas escolhas sobre sua saúde, mencionando a internet como uma ferramenta frequentemente utilizada para diminuir a disparidade de conhecimento na relação clínica. Os achados também apresentam estratégias utilizadas pelos médicos/as, como recursos gráficos e ferramentas de comunicação, que ajudam a incluir diferentes perfis de homens na tomada de decisão. Conclusão: A investigação demonstrou que, embora haja avanços em relação ao debate de possíveis implicações danosas do rastreamento do câncer de próstata e exemplos de abordagens inclusivas, essa prática ainda não está consolidada no Brasil, revelando a necessidade de incentivar a participação do homem nas decisões que influenciam diretamente sua qualidade de vida e bem-estar. Dessa forma, há a necessidade de investir em estratégias que facilitem a comunicação médico/paciente e ampliem o debate sobre as possíveis implicações do rastreamento entre os profissionais inseridos na APS e na população.

Prevalence of ischemic heart disease depending on factors of psychoemotional stress among men of mature age (epidemiological study)

To establish associations of the prevalence of ischemic heart disease (IHD) and factors of psychoemotional stress in men of the open urban population in the age group 4564 years after two decades of life. A cross-sectional epidemiological study using a model of the city of Tyumen was conducted on a representative sample of the population among males of mature age (4564 years). Based on standard epidemiological methods, IHD was established according to strict epidemiological criteria definite IHD. The study of the factors of psycho-emotional stress (depression, hostility, life exhaustion) was carried out according to the algorithms of the World Health Organization program MONICA-psychosocial. When calculating the odds ratio for the development of IHD, a low level of psycho-emotional stress factors was regarded as the absence of a sign, a combination of medium and high levels as a presence. The prevalence of ischemic heart disease in the open population (on the model of Tyumen) according to strict epidemiological criteria in men aged 4554 years was 8.2%, at the age of 5564 years 19.2%, a predominance of painless form of ischemic heart disease was revealed. According to the levels of factors of psychoemotional stress in mature men, mainly the average level of depression and life exhaustion, a high level of hostility were established. In men of an open population (on the model of Tyumen), depending on the psychoemotional stress, a high risk of developing a certain coronary heart disease was established in the age categories 4554 and 5564 years old in the presence of depression, at the age of 5564 years in the presence of hostility or life exhaustion. Consequently, the data obtained indicate the importance of further studying the factors of psychoemotional stress in men of mature age in Siberian populations, their relationships with conventional risk factors for coronary artery disease, as well as the advisability of preventive measures aimed at weakening the influence of not only conventional risk factors, but also factors of psycho-emotional stress. among the Russian population.

Физкультурно-спортивные предпочтения работников нефтегазодобывающих предприятий: поведенческие и биологические факторы

The relevance of this study is due to the need to optimize the physical activity of workers engaged in heavy physical labor, which is impossible without taking into account their physical culture and sports preferences. The aim of the study was to identify the physical culture and sports preferences of employees of oil and gas production enterprises, as well as factors that characterize the features of their motor behavior and body functioning. To analyze the subjects' physical culture and sports preferences and features of physical activity, a survey was conducted; the Attitude to Competitive Physical Culture and Sports Activities questionnaire was used; the heart rate variability was studied using the hardware and software complex “Omega”. The significance of the difference in the characteristics in the compared groups was verified using the Mann-Whitney U-test. The study involved 49 men of mature age who are engaged in professional activities at oil and gas production enterprises, using out-of-hours means of physical culture and sports of a recreational or sports orientation. The subjects were differentiated based on their physical culture and sports preferences, depending on the manifestation of rivalry in them: 1) with individual rivalry (n1=19); 2) with team rivalry (n2=15); 3) with avoiding open rivalry (n3=15). All the men who prefer martial arts did sports in the past or continue to do sports in the present. Of those who prefer team sports, this is 80%, and of those who avoid open competition, preferring individual running, recreational walking or strength training, this is 54%. All representatives of the first group systematically engage in physical culture and sports. Thirty-three per cent of men who prefer activities without rivalry and seven per cent of men doing team sports do sports from time to time. Subjective readiness to participate in physical culture and sports events is more evident in men who prefer martial arts. To a lesser extent, men from the third group are ready to participate in events with the manifestation of maximum physical capabilities. The indicator that characterizes the interest in knowledge in the field of physical culture and sports, as well as the activity of attracting other people to participate in competitions, prevails among men who prefer martial arts. The most optimal indicators of the activity of regulatory systems are observed in men who prefer team sports. In subjects who engage in martial arts in their free time, the indicators of the autonomic regulation of the heart are also within the normal range, but closer to the border that characterizes the transition from the vegetative balance to the predominance of the sympathetic department. In the representatives of the third group who refuse open competition and prefer individual activities, there is a more pronounced tension of the regulatory systems. The results obtained should be taken into account when developing corporate programs to optimize the physical activity of employees of oil and gas producing enterprises.

Changes in testicular tissue in obstructive azoospermia with an increase in the duration of the disease

To understand the infertility development it is important to study how individual components of the connective complexes of Sertoli’s cells are formed and developed in order to allow not only individual cells, but also entire syncytia of germ cells to migrate from the basal to the adluminal compartment of the spermatic epithelium, without causing loss of permeability. Testicular tissue changes in azoospermia with an increase in the duration of the disease and the prognosis of the possibility of conception are of particular interest. The aim. To reveal changes in the testicular tissue on azoospermia with an increase in the duration of the disease. Materials and methods: to achieve the aim, a pathomorphological study was carried out. The material for the study was testicular biopsies of patients aged 26-45 years with a diagnosis of obstructive azoospermia (OA). The material was divided into three groups: group 1, control: healthy fertile men; group 2 (study group): men of mature age (26–45 y. o.) with a clinical diagnosis of OA up to 5 years of duration. Group 3 (study group): men of mature age (30–45 y. o.) with a clinical diagnosis of OA up to 10 years of duration. The preparations were studied macroscopically, microscopically, morphometrically and immunohistochemically. Results and discussion. Healthy spermatogenesis was typical for all control group samples. In group 2 (disease up to 5 years from the previous conception) there were three spermatogenesis samples out of eight. There were focal processes of fibrosis and hyalinosis, with focal proliferation of interstitial tissue. In the the group of men with OA lasting up to ten years from the previous conception, the absence of healthy spermatogenesis in all cases was noted. Conclusions.1. In the group of men with OA lasting up to five years from the previous conception there were violations of spermatogenesis, a decrease in the transport of biologically active substances through the blood-testicular barrier. The latter leads to degenerative processes in the germ cells.2. In the group of men with OA lasting up to ten years from the previous conception, there was a pronounced deterioration in spermatogenesis, the transition of OA to NOA with increased duration of the pathological process. The latter significantly worsens the prognosis of the disease course and significantly reduces the possibility of conception.

STRUCTURAL AND FUNCTIONAL CHANGES IN THE PROSTATE GLAND OF MEN OF OLDER AGE AT SUFFERING INGUINAL HERNIA

The research of structural and functional parameters of the prostate gland and the state of hemodynamics in it in case of testicular diseases are important for andrology, urology and gerontology, as even insignificant deviations of these parameters has negatively affect on the reproductive function and performance of male. Despite the considerable number of publications that relating to the prostate gland, their analysis shows that the structural and functional features of the blood vessels and tissue elements of this organ, in the conditions of inguinal hernia, is remained beyond the attention of researchers. However, the contents of a hernial sac in these conditions leads to chronic testicular hypoxia because of the contents of the hernial sac exerts the constant or periodic pressure on the testicular blood vessels, in particular on the wide and thin-walled testicular veins. Venous stagnation in the testicle violates thermoregulation, which is an important factor for the normal course of spermatogenesis and production of testosterone in interstitial endocrinocytes, and the prostate gland is the target for this hormone. Increase the concentration of testosterone in the blood leads to atrophy of the secretory epithelium of the lobules prostate gland and the development of connective tissue in it. Ultrasound and color ultrasound transrectal angiography of the prostate gland has been conducted in men of mature age (first period) with the inguinal hernia lasting of 3-5 years and has been showed a significant increase in peak blood flow (6,34±0,52) cm/sec and up to (2,42±0,31) cm/sec of diastolic blood flow compared to (19,32±3,28) cm/sec and (5,90±0,28) cm/sec on average in control group of male. These hemodynamic disorders were accompanied by an increase of up to (26,5 ± 1,7) cm3 of volume and up to (27,8 ± 1,6) g of mass of the prostate gland, which is markedly larger in comparison with the control. Such changes in parameters are due to the growth of connective tissue elements with a decrease of glandular parenchyma, the ratio between which is 56% versus 46%.

Low-Frequency Fatigue at Different Muscle Length Following Intermittent Eccentric Drop Jumps in 12—14 Year-Old Boys

Low frequency fatigue (LFF) in 12—14 year-old adolescent boys (n = 10) doing 75 eccentric jumps performed every20 s from a platform 80 cm high was investigated.Thus the aim of this study was to find out if LFF manifests itself in the muscles of boys aged 12—14 years doing 75 dropjumps performed every 20 s at angles of 90˚ and 135˚ from a platform 80 cm high. The results of the research have shownthat doing 75 eccentric jumps performed every 20 s calls forth LFF in the muscles of boys that is particularly strong anddisappears more slowly at a shorter length of the muscle exercised. Thus, the hypothesis as to the sarcomeric origin ofLFF in the muscles of boys and men has been confirmed. Besides, the muscles of men of mature age are more resistantto LFF than those of boys. This fact, as well as a more acute pain brought about in the muscles of boys, indicates thatthe muscles of boys are less resistant to mechanical damage than those of men of mature age.It is maintained that as a result of the eccentric exercise performed, some portion of the weak sarcomeres gets tornand then the strong sarcomeres, i.e. the ones that develop contraction force have to work at a shorter muscle length.When muscle contraction length is short the sensitiveness of miofibrillas to Ca 2+ decreases. It is rather unexpectedthough that 24 h after the end of the exercise the force developed by electrostimulation at low frequencies (20 Hz) issmaller (p < 0.05), as compared to the initial force registered at a shorter muscle length. Since after the exercise therewas also a decrease in the force developed at a shorter muscle length in particular, the sarcomeres are believed tohave been damaged during eccentric exercise.Keywords: electrical stimulation, force, age, muscle damage, stretch-shortening exercise.

Comparative Characteristic of the Maxillary Dental Arch Width Indicators Variability in Men with Different Craniotypes

The study of of dental arches morphology is relevant for the improvement and development of new diagnostic and surgical methods. The aim is to make a comparative evaluation of the dental arches width on the upper jaw in mature aged men with physiological occlusion depending on the craniotype. Material and methods. The morphometric parameters of the maxillary dental arches’ width have been studied. The work was performed on 172 preparations of mature aged male skulls with physiological occlusion of teeth. The cranial index was defined as the ratio of the transverse dimension of neurocranium to its longitudinal dimension. When examining dental arches, the main points were set on the medial and distal corners of the tooth crowns from the vestibular and palatal sides. The width of the maxillary dental arch was measured between canines, premolars and molars. Results. The values of the width indices of both the vestibular and palatal sides of the maxillary dental arches at all levels of measurement prevail in the brachycranial type of the skull. The indicators of the maxillary dental arches width in mesocranes are more then those in dolichocranes only at canines and the first premolars. At the second premolars and molars, the difference in the average statistical parameters of the width of the dental arches was not observed. Conclusions. The width of maxillary dental arches in men of mature age depends on craniotype. The new data obtained as a result of the research, supplement and expand the information on the studied parameters, both in theoretical and clinical aspects.

Seasonal optimality of high intensity physical activity for men of mature age

Aim. To study and compare the seasonal response of men’s cardiovascular system to physical activity of high intensity with average annual rates. Determine the optimal seasons for the intensification of occupations by physical activity of high intensity.Material. The study was attended by men aged 40-55 years old (n=18), leading a healthy lifestyle. All men do not have chronic illnesses. All men have the experience of independent occupations of high intensity physical activity. Men live in the south of Ukraine. For 12 months, daily (after a night sleep) the body weight, heart rate, and arterial pressure were recorded. Calculated: body mass index, cardiovascular system tension. Physical activity was measured by bioresigners Basis B1, Peak.Results. In winter, the overall physical activity of men was significantly lower (by 11.37%) than the average annual. Physical activity of high intensity was lower by 21.61%. In summer, the time of men’s employment has significantly decreased (by 4.11%) for the average annual. In autumn period, the total physical activity was significantly higher (4.73%) than the average annual.Conclusions. It was determined that the physical activity of high intensity during all seasons positively affects the physical condition of men. It reduces the tension of the cardiovascular system. It is advisable to predict the summer season as the most optimal for the intensification of the physical activity of high intensity of mature age men.

К вопросу о функциональной морфологии семенных пузырьков в постнатальном онтогенезе

Functional morphology of seminal vesicles, received on autopsy from 70 men 20-89 years old, with the absence of pathology of urogenital system organs. The material was divided into groups with 10-years periodicity. Kruskal-Wallis test was used compare data from different age groups and parts of seminal vesicles. The data obtained reflect the dynamics of the macro-microscopic parameters of the seminal vesicles and their main duct in postnatal ontogenesis. Individual fluctuations of studied parameters are most pronounced in men of mature age. From the age of 60-69 years both the maximum and minimum values of the individual parameters of seminal vesicles’ microstructure start to decrease. The identified age-related changes of seminal vesicles’ structure in norm must be considered in medical practice for assessing organ biopsies.

The structural and functional state of hemomicrocirculatory bed and parenchyma of the testis in varicocele

Varicose veins of the spermatic cord and testis membranes play a key role in the development of male infertility. Aim. To study the structural features of the bloodstream and testicular parenchyma in terms of varicose veins of the spermatic cord and testis membranes. Meyhods and results. In 23 testicular preparations taken from men of mature age convoluted seminiferous tubules diameter, number of cells of spermatogenic epithelium and interstitial endocrinocytes nuclei volume were studied using macro- and microscopic morphometric methods. It was established that in varicocele testis volume, diameter of convoluted seminiferous tubules and interstitial endocrinocytes nuclei volume significantly reduced. Conclusion. This indicates the presence of circulatory hypoxia of testicles, which leads to a decrease in the volume of interstitial endocrinocytes nuclei by 31%, thereby reducing their functional properties.

The Ukrainian men's way of life as a factor, which leads to risk of chronic disease and premature mortality

The unsatisfactory state of health of masculine population in Ukraine acquires especially sharp character and differs in a permanent tendency to worsening. Principal reasons of premature death rate of men remain to be chronic noninfectious diseases. The article investigates the influence of lifestyle factors on the probability of development of chronic non-communicable diseases at mature age. Given the central role of lifestyle in the development of this disease, there is a need to improve the effectiveness of attracting people to a healthy lifestyle. Personal identification and social conditions get great importance that may contribute to increased motivation of men of mature age to a healthy lifestyle.

The influence of the recreative beach volleyball training on mature aged men organism in sanatorium conditions

The influence of the recreative beach volleyball training on mature aged men organism in sanatorium conditions

The hormonal function of human gonads and adrenals at various age

Results of radioimmunoassay of the adrenal and sex hormones and their precursors in the peripheral blood of men of different age groups are presented. The measurements were carried out in men of mature age of the two periods (22 to 35 years of age. I period, and 36 to 60. II period), elderly subjects aged 61 to 74, senile ones aged 75 to 90, and in long-livers aged 91 to 112. The content of the principal adaptive hormone, hydrocortisone, and its immediate precursor 11-deoxyhydrocortisone was found to be virtually the same in all age groups. At the same time, the levels of other precursors – pregnanediole, 17-hydroxypregnanediole and 17-hydroxyprogesterone progressively reduce with age. An inverse correlation can be traced between the level of the principal adrenal androgen, dehydroepiandrosterone, and the age of the examined men. In contrast to testosterone, the content of 5alfa-dehydrotestosterone is reliably reduced in elderly age and remains at this level in the subsequent years.

Female Nursing of Male Insane

The question of the adaptability or suitability of the method of female nursing of male patients in asylums, which is the all but universal practice in general hospitals, if not exactly what might be termed a “burning” question, has been forced into unexpected prominence during the present crisis of affairs. The military and naval requirements of a great country fighting not merely for a great ideal, but for, if perhaps the less noble, certainly the more urgent and so to say personal object of maintaining its own existence, necessitated the raising—and at very short notice—of our two great services to their maximum strength, and, therefore, a demand on the male population of the British Empire of such magnitude as has never been experienced before. This demand has, as we know, been promptly and liberally responded to, and by no class of men perhaps more readily than those serving on an asylum staff, over 3,000 of whom, as shown in the Journal of October last, have joined the colours. Such a drain on the at no time very ample nursing resources of these institutions could not fail to cause very serious inconvenience. The shortage occasioned had in some way or other to be compensated for, if even to only a limited extent. In some cases men of mature age have been employed to replace those who have left, but these are probably not procurable in any great numbers owing to the demand for middle-aged men for munitions and other work connected with the war, and also for doing the enormous amount of business—trade, agriculture, etc.—which must be carried on throughout the country generally. Consequently, resort to the employment of women as substitutes for male nurses has had in many instances to be adopted.