General Sense Of Well-being Research Articles

Perception of males’ aging symptoms, health and well-being in elderly community-dwelling men is not related to circulating androgen levels

Aging in men is associated with a progressive but variable decline in androgen production. In aging men there is also an increased occurrence of symptoms such as lack of concentration, nervousness, impaired memory, depressive mood, insomnia, lack of energy and general sense of well-being, decreased libido and erectile dysfunction, periodic sweating, bone and joint complaints, reduction of strength and increased adiposity. This ill-defined male climacterium syndrome is often referred to as “andropause”, with the underlying implication that it is at least in part related to (relative) androgen deficiency. Recently an “aging males” symptoms’ (AMS) rating scale was developed aimed at a more systematic description of severity of symptoms related to a clinically defined “male climacteric”. We studied the relationship of male climacteric symptoms as assessed by the AMS with androgen levels and other questionnaires assessing the perception of health and well-being. Serum levels of sex steroids, sex hormone binding globulin and gonadotropins were measured in blood samples of 161 healthy, ambulatory, elderly men, aged 74–89 years who also completed the AMS scale. Mean value of total, free and bioavailable testosterone in this group was 401.6, 6.8 and 151.4 ng/dl, respectively, with 24.7, 32.4 and 52.2% of the values under the normal range for young men. The results of the AMS scores mostly suggested mild psychological and mild to moderate somatovegetative symptoms. However, clear sexual symptoms were reported in 88% of cases. None of the three AMS domain scale scores significantly correlated with testosterone, free testosterone or bioavailable testosterone. Significant correlations were observed between results for the AMS scores and those for other health questionnaires, but none of the subscores for the latter questionnaires correlated with androgen serum levels. In conclusion, the results of this study have shown that, as assessed by the AMS, healthy ambulatory elderly males over 70 had a high perception of sexual symptoms with mild psychological and mild to moderate somatovegetative symptoms. These data failed to support the view that in healthy elderly men, “climacteric symptoms” can predict androgen levels.

LA PLACE DES ANDROGENES CHEZ LA FEMME MENOPAUSEE

After menopause, especially after bilateral oophorectomy, androgens are significantly reduced in blood and this would influence the well-being of the woman. A Female Androgen Deficiency Syndrome has been described and it is logical to add androgens to the classical oestrogen replacement therapy. There are several advantages of such combined treatment including higher bone density, better sexual function, improved mood and general sense of well-being, less depression and enhanced cognitive functioning. Side effects upon lipids are minimal and without any long-term effect on cardiovascular morbidity as long as low dosage is used. It seems that low dose of androgen therapy is a very interesting treatment option for menopausal women but further studies are needed before clinical use is recommended.

Researching Young Children's Perspectives on 'the Troubles' in Northern Ireland

It was not long after the emergence of the present phase of 'the troubles' in Northern Ireland in the late 1960s that concerns began to be expressed about the potentially negative effects that the violence was having on children's development and general sense of well-being. Since the early 1970s, a plethora of research studies have been conducted and published examining a range of different issues from children's overall levels of awareness of the conflict to their patterns of socialisation and moral and emotional development. Such work has been extremely important and has played a central role in drawing attention to and emphasising the plight of children in Northern Ireland. However, while it has certainly increased our understanding of some of the effects of 'the troubles' on children's lives, it has been less successful in drawing out and facilitating children's own perspectives and experiences. This paper outlines some of the reasons for this while also suggesting alternative methodological approaches that are more appropriate for the study of children's perspectives on 'the troubles'. It concludes with a brief discussion of two separate and quite different research studies that I have directed which have attempted to focus on the awareness and attitudes of young children towards 'the troubles' in Northern Ireland.

The Effects of a Multi-Modal Intervention Trial of Light, Exercise, and Vitamins on Women's Mood

ABSTRACT The purpose of this study was to test the efficacy of a tri-modal intervention (LEVITY) to improve women's mood. This eight-week randomized experiment with a placebo-control group targeted women with symptoms of mild to moderate depression. Women in the intervention group were instructed to take a brisk 20-minute outdoor walk at target heart rate of 60% of maximum heart rate, to increase light exposure throughout the day and to take a specific vitamin regimen. Women in the control group took a daily placebo vitamin. The sample consisted of 112 women ages 19–78 who reported mild to moderate depressive symptoms. They were in otherwise good health and were not currently taking any mood-altering medication. Pre- and post-intervention assessment utilized five measures of mood: Center for Epidemiology Studies Depression Scale, Profile of Mood States, Depression-Happiness Scale, Rosenberg Self-Esteem Scale, and the General Well-Being Schedule. Analysis of covariance indicated that the intervention was effective in improving women's overall mood, self-esteem, and general sense of well-being and in decreasing symptoms on two measures of depression. Of particular note, the data from all five outcome measures supported the efficacy of the intervention. In addition, a high level of adherence to the intervention protocol was observed with two-thirds of the women reporting 100% adherence. Study implications suggest that this type of intervention may provide an effective, clinically manageable therapy for mild-to-moderately depressed women who prefer a self-directed approach or who have difficulties with the cost or side-effects of medication or psychotherapy.

The impact of nausea and vomiting on women: a burden of early pregnancy.

Nausea and vomiting are troublesome symptoms occurring in the first trimester of pregnancy. The aim of this study was to describe the impact these symptoms have on women in early pregnancy by interviewing, using a structured questionnaire, 593 pregnant women presenting with nausea and vomiting in the first trimester of pregnancy. The women were asked to complete the Rhodes index of nausea and vomiting and the MOS 36 Short Form Health Survey (SF-36). Symptoms of nausea and vomiting started early in pregnancy. Nausea was the most troublesome symptom experienced by women, both in its duration and intensity. Low scores for the SF-36 were found for all items, particularly physical functioning, energy and social functioning. The women described substantial effects on working, household duties and parenting activities. Findings from this study suggest nausea and vomiting in early pregnancy has a profound impact on women's general sense of well-being and day to day life activities.

Evaluating Aboriginal empowerment programs: the case of Family WellBeing

ObjectiveTo evaluate the effectiveness of a Family WellBeing empowerment course. MethodA range of methods were used, including: theory-driven analysis of literature and project documentation; participant observation; and analysis of course participants' personal narratives against set empowerment criteria. ResultsParticipation in the Family WellBeing course resulted in high levels of personal empowerment. The course enhanced participants' sense of self-worth, resilience, ability to reflect on root causes of problems and problem-solving ability, as well as belief in the mutability of the social environment. They were able to bring about modest, but significant, improvements in their general sense of wellbeing and those of the people around them in ways that were previously impossible. There was no evidence of organisational and community empowerment, such as stronger social networks and systems-level changes. DiscussionThe effectiveness of the Family WellBeing course shows the importance of resourcing Aboriginal people to develop their own programs that address trauma and other issues resulting from settler colonisation. ConclusionsThe study highlights three lessons for the use of empowerment interventions to improve health conditions, particularly among socially disadvantaged groups: 1) A need to adopt an ecological approach that simultaneously addresses empowerment at multiple settings or levels. 2) A need to ensure that such programs reach a critical mass of the target group. 3) Policy-makers and practitioners need to take a longer-term approach to empowerment interventions, including properly resourced longitudinal studies to document and enhance the evidence base for such interventions.

The role of whole organ pancreas transplantation in the treatment of type I diabetes

BACKGROUND AND DEMOGRAPHICS: Clinical course was reviewed for 19 whole organ pancreas transplant recipients at UCLA between 11/14/93 and 5/31/95, 18 of which were simultaneous pancreas kidney transplants and 1 of which was an isolated pancreas after kidney transplant. The initial 4 pancreatic grafts were procured by classical warm dissection techniques while the remaining 15 were procured by rapid en bloc technique. Mean recipient age, duration of diabetes, and daily insulin requirements were 38 years, 25 years, and 45 units, respectively. Bladder drainage of exocrine secretions was used primarily in 18 cases and primary enteric drainage in one. All recipients manifested immediate dialysis and insulin independence. Actuarial patient and graft survival were 100% and 89%, respectively, at a mean follow-up of 396 days (range, 150-660 days). Mean maximal serum amylase on the first postoperative day was 366 U/dL. There were no instances of pancreatic graft vascular thrombosis. Three patients experienced pancreatic leaks (16%), 1 of which resulted in graft loss. Six month posttransplant Hgb A1c was within normal range and significantly lower than pretransplantation values (5.1 vs 10.7, P = 0.002). Mean length of initial hospitalization was 15 days, with 100% of patients requiring at least one read mission. Fifty-eight percent of patients experienced rejection episodes. Ninety-one percent of patients responding to a quality of life survey reported improvement in general sense of well-being after transplantation. It is concluded that high rates of success may be possible with whole organ pancreas transplantation, even in new programs. Rapid en bloc dissection is a safe, expeditious method of pancreas procurement. Successful pancreatic transplantation is associated with freedom from exogenous insulin administration, normalization of glycated hemoglobin, and subjective improvement in quality of life. However, this modality is associated with higher rates of rejection and readmission, and longer duration of hospitalization when compared with isolated kidney transplantation.

TREATMENT OF CHRONIC DISEASES OF THE INNER EAR WITH LOW LEVEL LASER THERAPY (LLLT):

One hundred and thirty-nine patients who presented in a 22 month period were treated with low reactive-level laser therapy LLLT using combined HeNe and infrared diode lasers (632.8 nm, 20 mW and 830 nm 100 mW, respectively) for a variety of chronic complex diseases of the inner ear with such symptoms of tinnitus and vertigo. They received 15 treatments for the purpose of this study. In addition to the laser therapy they were prescribed a daily dose of a plant-based drug (ginkgoflavonglycoside). In response to a post-therapy questionnaire, 77.4% of the patients reported significant overall improvement including their general sense of well-being; 67.7% reported significant improvement in their tinnitus; and 82.5% reported significant improvement of their vertigo. Audiometric tests showed a significant improvement in hearing of around 20 dB over all frequencies in 83% of the patients. Treatment was continued after the trial for those patients with persistent irritating symptoms associated with their inner ear condition, and by the end of two years, all patients were cured. There has been no recurrence in a two-year follow-up. Although some patients reported some exacerbation of their condition (2.2%, general well being, 2.2% in tinnitus but 0% in vertigo), they did not associate this with the laser therapy but rather with individual stress-related problems. Laser therapy is therefore reported in this pilot study as being effective for improvement of well-being, treatment of tinnitus and alleviation of vertigo in a large percentage of chronic inner ear conditions. In addition LLLT was easy to apply, pain-free, noninvasive and had no significant adverse side effects.

Experimental manipulation of cocaine craving by videotaped environmental cues.

Thirteen male patients consecutively admitted to an inpatient drug and alcohol rehabilitation hospital with the primary diagnosis of crack cocaine dependence were shown a 30-minute videotape that included salient environmental cues intended to elicit cocaine craving. The subjects were tested before and after the videotape by the use of a continuous 20-cm analogue visual instrument that asks them to rate their perceived degree of craving, mood, energy, and wellness. Only craving showed a statistically significant change from pretest to posttest. Correlations among the four separate ratings suggest that mood and craving are different dimensions that independently contribute to one's general sense of well-being. This study demonstrates that cocaine craving can be induced in a group setting by presenting certain visual and auditory cues on a video monitor. The procedure of obtaining self-ratings in response to videotaped environmental cues could be easily incorporated into research methods designed to assess pharmacologic efficacy in reducing the intense craving that reinforces addiction.

Sexual Harassment and Prior Sexual Trauma Among African-American and White American Women

This study examined the relationship between sexual harassment in work, educational, and social settings and sexual abuse in childhood and/or adulthood in a stratified community sample of 248 African-American and white American women. The cumulative impact of sexual victimization on women's sense of general well-being was also examined. Those most likely to be sexually harassed in work and social settings were women with contact sexual abuse histories, regardless of ethnicity. The work status of harassers of women with sexual abuse histories differed significantly by ethnic group. Although women with prior sexual abuse experiences from both ethnic groups most frequently reported a response to sexual harassment at work, they least frequently did so in social settings. A history of childhood sexual abuse was more negatively associated with African- American women's well-being than were repeated experiences of sexual violence. Future research should address the implications of ethnic and cultural issues on the cumulative impact of incidents of sexual violence on women of color.

Extended follow-up in 212 long-term allogeneic bone marrow transplant survivors. Issues of quality of life.

A group of 235 allogeneic marrow recipients were contacted at least one year following their BMT to obtain information on their quality of life; 212 (90%) agreed to participate in this survey. A total of 162 adults and 50 pediatric survivors were interviewed during clinic visits (5%) or over the telephone (95%). Changes in productive activity and marital status at the time of interview were studied, as well as the presence of physical symptoms and perception of a general sense of well-being. Older transplant recipients were observed to have a significantly higher incidence of chronic graft-versus-host disease, common colds, and skin changes when compared with pediatric transplant recipients (P < 0.01). Older subjects were also more likely to require any type of regular medication. Younger survivors were rated with a higher Karnofsky performance status and global subjective score. There were no significant differences between patients who received TBI as part of the conditioning regimen and those who did not, with the exception of increased cataract development in pediatric patients receiving TBI (P < 0.008). We conclude that most allogeneic marrow transplant survivors, especially those individuals of younger age at the time of their transplants, are doing well in the domains tested.

The Impact of Diuretic Therapy on Reported Sexual Function

--Thiazide diuretics are the most commonly prescribed antihypertensive agent in the treatment of hypertension. No studies to date have isolated conclusively the effect of diuretic therapy on patient quality of life, and particularly on sexual dysfunction. --We carried out a randomized placebo-controlled trial of the effect of thiazide diuretics on quality of life in mildly hypertensive men between the ages of 35 and 70 years. After a 1-month washout period off diuretic therapy, the men were randomized to a 2-month trial of a thiazide treatment or placebo. At the end of the trial, 176 men completed a confidential self-administered questionnaire assessing aspects of social performance, general well-being, and emotional and physiologic states. --Patients taking diuretics reported significantly greater sexual dysfunction than control subjects, including decreased libido, difficulty in gaining and maintaining an erection, and difficulty with ejaculation. Multivariate analysis suggested that the findings were not mediated by low serum potassium levels or by low blood pressure. Sexual dysfunction was noted more often in the confidential self-report questionnaire than in response to direct questions from clinicians. We found no differences between diuretic and placebo groups in measures of mood, general sense of well-being, ability to work, alertness, and social/recreational activities. --Thiazide diuretic use is associated with male sexual dysfunction but does not appear to adversely affect other aspects of quality of life.

Institutionalization of an elderly family member: Reactions of spouse and nonspouse caregivers

Although a prevalent clinical assumption is that the caregiver well-being improves following patient institutionalization, recent research challenges this assumption. In this article, the impact of patient institutionalization on the well-being of family caregivers is examined. Caregiver reaction, sense of general well-being and level of depression are compared pre- and postinstitutionalization and differences between spouse, adult child, and other caregivers are investigated.

Mood disturbance following increased training in swimmers.

Twelve male swimmers were studied psychologically before, during, and after 10 d of increased training. Daily training distance was increased from 4,000 to 9,000 m.d-1, and intensity was maintained at 94% of VO2max. Three of the swimmers were unable to tolerate the increased training load, and they did the same distance at slower speeds. Swimmers completed the Profile of Mood States, a muscle soreness scale, and a 24-h history each morning prior to the first of two daily training sessions. Changes across days were evaluated statistically with a one-way repeated measures ANOVA. Significant (P less than 0.005) increases occurred in the ratings of exercise intensity, muscle soreness, depression, anger, fatigue, and global mood disturbance, along with a reduction in general sense of well-being. Swimmers were classified as "responders" or "non-responders" on the basis of distress patterns using separate physiological and psychological criteria, and these classifications were performed in a double-blind setting. Close agreement (89%) was achieved between the psychometric and physiological judgments, and the physiological results appear in related papers. It is concluded that significant psychometric changes occur with an intense 10-d training regimen, and these alterations resemble those observed in swimmers exposed to increased training across several months. These findings underscore the potential utility of monitoring mood states in the prevention of staleness.

Pharmacotherapy for Organic Brain Syndrome in Late Life

Evaluation of treatment modalities, including pharmacotherapy, for organic brain syndrome (OBS) has been difficult because of sampling and methodological problems, and comparisons of research studies are all but impossible. In this study, an ergot derivative, a combination of dihydroergocornine mesylate, dihydroergocristine mesylate, and dihydroergokryptine mesylate (Hydergine) was compared with placebo, using a double-blind technique in a sample of nursing home residents with evidence of OBS. An 18-category symptom rating scale was used for periodic assessment over a six-month interval. Comparisons of the two groups of subjects disclosed that the Hydergine-treated group showed statistically significantly more improvement in most of the variables measured, especially during the last three months of treatment. Furthermore, sophisticated analysis revealed that positive changes in cognitive function cannot be accounted for as a mere reflection, or "halo" effect, associated with improved mood and general sense of well-being.

Restoration of Plasma Testosterone Levels in Uremic Men With Clomiphene Citrate

Five men with chronic renal failure and symptoms suggestive to androgen deficiency were treated with clomiphene citrate (Clomid) at a dose of 100 mg/day for a period of 5 to 12 months. The treatment resulted uniformly in increased libido, sexual potency, and a general sense of well-being. Circulating testosterone rose from mean basal value of 223 +/- 164 to 879 +/- 171 ng/dl (SD), representing a mean increment of 290%. Mean serum lutenizing hormone (LH) and follicle-stimulating hormone (FSH) values before treatment were 76 +/- 40 and 143 +/- 85 ng/ml (SD). During treatment, both LH and FSH increased dramatically to 518 +/- 302 and 787 +/- 291 ng/ml (SD), respectively. Both serum gonadotropin values are expressed as ng/ml of LER 907. The effect of clomiphene on spermatogenesis in these subjects was inconclusive as either improvement or deterioration occured. In these five patients, serum prolactin was not related in any way to testicular function as its values were consistently in the normal range throughout the entire study period. Serum total estrogen, however, was elevated in all; the significance of this high circulating estrogen in relation to gonadal dysfunction in uremia is not clear at the present time. However, we found that normalization of circulating androgen was beneficial to our patients and that long-term clomiphene treatment achieved this goal by increasing pituitary gonadotropin secretion and secondarily stimulating testicular hormonogenesis.

The effects of choice and enhanced personal responsibility for the aged: a field experiment in an institutional setting.

A field experiment was conducted to assess the effects of enhanced personal responsibility and choice on a group of nursing home residents. It was expected that the debilitated condition of many of the aged residing in institutional settings is, at least in part, a result of living in a virtually decision-free environment and consequently is potentially reversible. Residents who were in the experimental group were given a communication emphasizing their responsibility for themselves, whereas the communication given to a second group stressed the staff's responsibility for them. In addition, to bolster the communication, the former group was given the freedom to make choices and the responsibility of caring for a plant rather than having decisions made and the plant taken care of for them by the staff, as was the case for the latter group. Questionnaire ratings and behavioral measures showed a significant improvement for the experimental group over the comparison group on alertness, active participation, and a general sense of well-being.

Rheumatoid arthritis with secondary amyloidosis and malabsorption syndrome: Effect of D-penicillamine

Described herein is a case of rheumatoid arthritis with generalised secondary amyloidosis in which the malabsorption syndrome was one of the most prominent features. This appears to be the third such documented case. The malabsorption syndrome was proved by biopsy to be associated with the presence of amyloid deposits in stomach, jejunum and rectum. The patient failed to respond to conventional treatments, and in view of the qualitatively increased macroglobulins it was decided to use d-penicillamine in a dosage of 1.8 gm. per day. Penicillamine therapy appeared to halt the steatorrhoea and to improve the patient's general sense of well-being, without modifying some of the other parameters of malabsorption. There was a marked rise in the haemoglobin level which appeared to be due to more adequate utilisation of iron stores. The serum albumin and gamma globulin returned to more normal levels during the course of treatment. Alpha 2 globulins appeared to return towards normal for a while but concomitantly with an increase in serum urea returned to their past levels. The expected changes in the macroglobulins on immunoelectrophoresis were not observed and the Rose-Waaler test became positive again during the treatment.

Urologic dilemmas resolved by the ileal conduit.

An isolated segment of ileum, its caliber reduced by excising a longitudinal strip from its antimesenteric border, can be used to supplement or replace the ureter in establishing flow from the kidney to the bladder or the skin. Benefits from this ileal-conduit diversion are increasingly evident when the operation is reserved for especially selected patients. In 45 of the present series of 70 patients the underlying disease was benign; 16 patients were less than 25 years old. Eight cases are presented in support of the thesis that success in the use of the ilealconduit operation must be measured in terms of symptomatic relief, general sense of well-being, ability to resume a place in society, and anticipated longevity.

The Tobacco Export of the Upper James River Naval District, 1773-75

T THE golden leaf, tobacco, was long the staple of Virginia's plantation agriculture and the colony's most valuable export. No matter where a discussion started, Virginians could be expected to bring the topic around to tobacco. Burgesses in the Assembly and farmers at crossroad stores spent interminable hours discussing crop conditions and market prospects. The structure and state of the tobacco trade fundamentally affected Virginia's economy, public finance, politics, and general sense of well-being. Tobacco staple acts, planter's petitions about the state of the trade, voluminous and sometimes acrimonious correspondence with English merchants, and the lengthy British customs records all attest the importance of the trade. For many Virginia planters the successful cultivation and marketing of tobacco was at once an economic necessity and a symbol of status and respect within the community. Tobacco was more than an agricultural commodity. Something of the pride of the planter went into his crop. The Virginia economy cannot be studied without reference to tobacco; the study of any facet of Virginia's colonial history will be to some extent enlightened by a proper understanding of the Virginians' role in the tobacco trade. Fortunately for historians, English colonial bureaucrats were methodical record keepers during the hectic years that preceded the Revolution. The Crown's interest in trade was considerable, and the government required regular reports on the volume of trade. The naval officer, in particular, was a Crown official with the responsibility of keeping detailed records