1,887 research outputs found

    Psychosexual development in men with congenital hypogonadotropic hypogonadism on long-term treatment: a mixed methods study.

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    INTRODUCTION: Congenital hypogonadotropic hypogonadism (CHH) is a rare, genetic, reproductive endocrine disorder characterized by absent puberty and infertility. Limited information is available on the psychosocial impact of CHH and psychosexual development in these patients. AIM: The aim of this study was to determine the impact of CHH on psychosexual development in men on long-term treatment. METHODS: A sequential mixed methods explanatory design was used. First, an online survey (quantitative) was used to quantify the frequency of psychosexual problems among CHH men. Second, patient focus groups (qualitative) were conducted to explore survey findings in detail and develop a working model to guide potential nursing and interdisciplinary interventions. MAIN OUTCOME MEASURES: Patient characteristics, frequency of body shame, difficulty with intimate relationships, and never having been sexually active were assessed. Additionally, we collected subjective patient-reported outcomes regarding the impact of CHH on psychological/emotional well-being, intimate relationships, and sexual activity. RESULTS: A total of 101 CHH men on long-term treatment (>1 year) were included for the analysis of the online survey (mean age 37 ± 11 years, range 19-66, median 36). Half (52/101, 51%) of the men had been seen at a specialized academic center and 37/101 (37%) reported having had fertility-inducing treatment. A high percentage of CHH men experience psychosexual problems including difficulty with intimate relationships (70%) and body image concerns/body shame (94/101, 93%), and the percentage of men never having been sexually active is five times the rate in a reference group (26% vs. 5.4%, P < 0.001). Focus groups revealed persisting body shame and low self-esteem despite long-term treatment that has lasting impact on psychosexual functioning. CONCLUSIONS: CHH men frequently experience psychosexual problems that pose barriers to intimate relationships and initiating sexual activity. These lingering effects cause significant distress and are not ameliorated by long-term treatment. Psychosexual assessment in CHH men with appropriate psychological support and treatment should be warranted in these patients. Dwyer AA, Quinton R, Pitteloud N, and Morin D. Psychosexual development in men with congenital hypogonadotropic hypogonadism on long-term treatment: A mixed methods study. Sex Med 2015;3:32-41

    Identifying the unmet health needs of patients with congenital hypogonadotropic hypogonadism using a web-based needs assessment: implications for online interventions and peer-to-peer support.

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    BACKGROUND: Patients with rare diseases such as congenital hypogonadotropic hypogonadism (CHH) are dispersed, often challenged to find specialized care and face other health disparities. The internet has the potential to reach a wide audience of rare disease patients and can help connect patients and specialists. Therefore, this study aimed to: (i) determine if web-based platforms could be effectively used to conduct an online needs assessment of dispersed CHH patients; (ii) identify the unmet health and informational needs of CHH patients and (iii) assess patient acceptability regarding patient-centered, web-based interventions to bridge shortfalls in care. METHODS: A sequential mixed-methods design was used: first, an online survey was conducted to evaluate health promoting behavior and identify unmet health and informational needs of CHH men. Subsequently, patient focus groups were held to explore specific patient-identified targets for care and to examine the acceptability of possible online interventions. Descriptive statistics and thematic qualitative analyses were used. RESULTS: 105 male participants completed the online survey (mean age 37 ± 11, range 19-66 years) representing a spectrum of patients across a broad socioeconomic range and all but one subject had adequate healthcare literacy. The survey revealed periods of non-adherence to treatment (34/93, 37%) and gaps in healthcare (36/87, 41%) exceeding one year. Patient focus groups identified lasting psychological effects related to feelings of isolation, shame and body-image concerns. Survey respondents were active internet users, nearly all had sought CHH information online (101/105, 96%), and they rated the internet, healthcare providers, and online community as equally important CHH information sources. Focus group participants were overwhelmingly positive regarding online interventions/support with links to reach expert healthcare providers and for peer-to-peer support. CONCLUSION: The web-based needs assessment was an effective way to reach dispersed CHH patients. These individuals often have long gaps in care and struggle with the psychosocial sequelae of CHH. They are highly motivated internet users seeking information and tapping into online communities and are receptive to novel web-based interventions addressing their unmet needs

    Stable isotopic indicators of population structure and natal habitats of Asian carps threatening to invade the Great Lakes

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    Understanding early-life habitats is crucial for managing non-indigenous large river fishes such as silver carp that are threatening to invade the Great Lakes and may significantly impact economically valuable Great Lakes fisheries. Silver carp inhabiting the upper Illinois River directly below the electrical deterrent barrier (installed on a canal in the Chicago area that connects the Illinois River with Lake Michigan) possess the greatest potential to invade the Great Lakes. However, adult silver carp inhabiting this reach of the Illinois River may have originated from many points throughout the Mississippi River basin (e.g., Illinois River or Middle Mississippi River), and the relative importance of these potential origination locations is unknown. As such, this study was used to identify natal habitats of adult silver carp in the upper portion of the Illinois River. Based on the stable oxygen and stable carbon isotopes of otoliths (earstones) from individual fish, we have determined that silver carp inhabiting the area below the electric barrier originated from within the Illinois River itself, the Middle Mississippi River, and floodplain lakes along the lower Illinois River valley. Because of the geographically widespread points of origin for individual fish, management efforts for eradication or control of silver carp in the upper Illinois River should be directed at a similarly broad geographic scale. While potentially challenging to implement, large-scale removal of silver carp and the closely related bighead carp in the Illinois and Mississippi Rivers could greatly reduce the probability of these species breaching the electrical barriers and entering the Great Lakes

    Beyond hormone replacement: quality of life in women with congenital hypogonadotropic hypogonadism.

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    Little is known about how women with isolated GnRH deficiency cope with their condition. This study aimed to examine the health and informational needs of women with congenital hypogonadotropic hypogonadism (CHH) and evaluate if their experiences differ from women with more common forms of infertility. Cross-sectional, multiple methods study using web-based data collection to reach dispersed rare disease patients. A community-based participatory research framework was employed to develop an online survey and collect quantitative and qualitative data. Adult women diagnosed with CHH who had received at least one year of hormonal treatment completed the Morisky Medication Adherence Scale, Revised Illness Perception Questionnaire and Zung Self-Rating Depression Scale. Information on health care experiences, treatment outcomes and patient-reported challenges were also collected. Women (n = 55) were often diagnosed late (20.7 ± 7.4, range: 10-48 years) and 16/20 patients receiving fertility treatment conceived. Poor adherence was frequently observed (34/55) while more than half (27/49) reported a gap in treatment exceeding a year. Low adherence correlated with depressive symptoms (r = 0.3, P > 0.05). Negative illness perceptions were pervasive and 30/55 exhibited some depressive symptoms - significantly greater than women with common female factor infertility (P < 0.01). Symptoms were underappreciated by providers as only 15 of 55 patients had discussions about psychological services. Women identified isolation, need for information and finding expert care as challenges to living with CHH. Despite being a treatable form of female infertility, the presumable availability of treatment does not necessarily ensure adequate quality of life for women with isolated GnRH deficiency

    Integer polyhedra for program analysis

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    Polyhedra are widely used in model checking and abstract interpretation. Polyhedral analysis is effective when the relationships between variables are linear, but suffers from imprecision when it is necessary to take into account the integrality of the represented space. Imprecision also arises when non-linear constraints occur. Moreover, in terms of tractability, even a space defined by linear constraints can become unmanageable owing to the excessive number of inequalities. Thus it is useful to identify those inequalities whose omission has least impact on the represented space. This paper shows how these issues can be addressed in a novel way by growing the integer hull of the space and approximating the number of integral points within a bounded polyhedron

    Contrasting Population Characteristics of Yellow Bass (Morone mississippiensis) in Two Southern Illinois Reservoirs

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    We investigated two southern Illinois reservoirs with contrasting size structures of yellow bass (Morone mississippiensis) to compare growth, mortality and recruitment patterns. Yellow bass were collected from Crab Orchard and Little Grassy Lakes during April-May 2009 using AC electrofishing. Total length and weight were recorded and sagittal otoliths sectioned and aged by two readers. Increments between otolith annuli were measured and the Weisberg linear growth model was used to assess age and environmental (growth year) effects on individual growth for fish from the two lakes. Von Bertalanffy growth models indicated faster growth and a greater maximum total length for yellow bass in Little Grassy Lake. However, growth of fish in Little Grassy Lake nearly ceased after age 4. The Weisberg model indicated differences in individual growth rate between the two lakes that were consistent across years (age effects were significant but growth year effects and the age-growth year interaction were not). Inter-lake differences in fish growth were present up to age 3. Recruitment was relatively stable in Crab Orchard, with year classes up to age 7 observed. Recruitment was more erratic in Little Grassy, with age 5 being the dominant year class and fish up to age 11 present. Differences in growth and recruitment patterns for yellow bass in these two lakes may be attributed to substantial inter-lake differences in turbidity, morphoedaphic index, or yellow bass density. Maximum age of yellow bass (age 11) was higher than previously reported for this species, likely due to the use of otoliths to age fish rather than scales. This study provides baseline information on age and growth, mortality, recruitment, and size structure of yellow bass that can be compared to data from future studies to elucidate factors influencing population dynamics of this species
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