scholarly journals SAT-047 Adoption of an Age Adjusted Testosterone Reference Range Reduces Referrals to Endocrine Clinic and New Prescriptions of Testosterone

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Charlotte Dewdney ◽  
Heidi Mendoza ◽  
Rosemary Clark ◽  
Sandra MacRury ◽  
Rod Harvey ◽  
...  
Keyword(s):  
Lower Limit ◽  
Reference Range ◽  
Age Groups ◽  
Male Hypogonadism ◽  
Reference Ranges ◽  
Endocrine Society ◽  
Testosterone Levels ◽  
Referral Criteria ◽  
Before And After ◽  
The Impact

Abstract Testosterone levels decline with age. However, until recently well defined harmonised age and/or obesity (BMI <30kg/m2) adjusted reference ranges did not exist.1 There is also a lack of international consensus on whether an age adjusted reference range (RR) should be used to define the syndrome of hypogonadism in men. Our local referral guideline suggests referral to endocrinology is appropriate if morning testosterone is <9.4nmol/L similar to the Endocrine Society Clinical Practice Guideline.2 In mid 2018 our laboratory adopted the published all men age adjusted RR1. We sought to; i) investigate clinic referrals before and after adoption of the all men age adjusted RR and, ii) to model the impact on referrals and prescription of testosterone replacement therapy (TRT) had we adopted either the lower limit of either all men or non-obese age adjusted RR as our referral criteria. Despite similar numbers of testosterone levels being measured in the laboratory, referrals to endocrine clinic for investigation of male hypogonadism fell by 52% (n=101 vs 48) in the one year following the introduction of the new age adjusted RR, with a corresponding reduction in prescriptions for testosterone. Mean testosterone concentration (6.7±2.5 vs 6.4±3.9nmol/L [mean±SD], NS), and age (51±13.9 vs 50±17.9 years, NS) of individuals referred were similar before and after the change of RR. Of the 101 patients referred for investigation of hypogonadism prior to the new RR mean testosterone concentrations were 8.5±4.5, 7.3±4.1, 6.8±3.6, 6.7±2.1 & 6.6±1.6nmol/L, with 39, 71, 39, 40 & 17% of the 87 patients seen in clinic being prescribed TRT in age groups 19-39 (n=28), 40-49 (n=7), 50-59 (n=33), 60-69 (n=20) &70-79 (n=6) respectively, excluding those with a history of anabolic steroid use or Klinefelter’s syndrome. Mean BMI was 30.9±4.4kg/m2, which was similar between age groups. Had the lower limit of normal of the all men testosterone RR been employed as our referral criteria in the preceding year, 23.8% (24/101) of referrals would not have met referral criteria, and 26.2% (n=11/42) of those receiving a prescription would potentially not have received a trial of TRT. In contrast, had the non-obese age adjusted RR had been adopted for all men 13.9% (14/101) of referrals would not have met referral criteria and, of those prescribed testosterone, 2.4% (n= 1/42) would not have received a trial of TRT. In conclusion, adoption of the all men age adjusted RR for testosterone has been associated with a significant fall in referrals for investigation of male hypogonadism. However, modelling of historical clinic data would suggest that some non-obese individuals miss out on a therapeutic trial of TRT, especially if the all men, rather than non-obese, age adjusted RR is adopted. Reference: (1) Travison et al, J Clin Endocrinol Metab, 2017,102(4):1161-1173, (2) Bhasin S et al,. J Clin Endocrinol Metab. March 2018;103(5):1715-1744.

Effects of Age and Health on the Euthyroid Reference Ranges for Serum Free Thyroxine and Free Triiodothyronine

1985 ◽  
Vol 24 (02) ◽  
pp. 57-65 ◽  
Author(s):  
J. E. M. Midgley ◽  
K. R. Gruner
Keyword(s):  
Lower Limit ◽  
Healthy Subjects ◽  
Thyroid Dysfunction ◽  
Reference Range ◽  
Free Thyroxine ◽  
Reference Ranges ◽  
Free Triiodothyronine ◽  
Serum Free ◽  
Young Subjects ◽  
Age Range

SummaryAge-related trends in serum free thyroxine (FT4) and free triiodothyronine (FT3) concentrations were measured in 7248 euthyroid subjects (age-range 3 months to 106 years). 5700 were patients referred to hospitals for investigation of suspected thyroid dysfunction, but who were diagnosed euthyroid. 1548 were healthy blood donors (age-range 18-63 years) with no indication of thyroid dysfunction. FT4 concentrations were little affected by the age, the sex or the state of health of the subjects in either group. Serum FT3 concentrations were significantly affected by both age and health factors. The upper limit of the euthyroid reference range for young subjects up to 15 years was about 20% higher (10.4 pmol/1) than for adult subjects older than 25 years (8.8 pmol/1). The change in the upper limits typical of young subjects to that typical of adults occurred steadily over the decade 15–25 years. After this age, little further change occurred, especially in healthy subjects. Additionally, the lower limit of the euthyroid range for FT3 was extended by the inclusion in the reference group of patients referred to hospitals. Compared with the lower limit of the FT3 range for healthy subjects (5 pmol/1), the corresponding limit for referred subjects (young or adult) was 3.5–3.8 pmol/1. Broadening of the FT3 reference range was probably brought about by a significant number of patients in the hospital-referred group with the “1OW-T3 syndrome” of mild non-thyroidal illness. Accordingly, FT3 was inferior to FT4 in the discrimination of hypothyroidism, as FT4 was unaffected by this phenomenon. Effects of age and non-thyroidal illness on serum FT3 concentrations require great care when selecting subjects for a laboratory euthyroid reference range typical of the routine workload. Constraints on the choice of subjects for FT4 reference ranges are less stringent.

scholarly journals A prospective, observational clinical trial on the impact of COVID-19-related national lockdown on thyroid hormone in young males

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Giulia Brigante ◽  
Giorgia Spaggiari ◽  
Barbara Rossi ◽  
Antonio Granata ◽  
Manuela Simoni ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Serum Levels ◽  
Stressful Event ◽  
Italian Population ◽  
Reference Ranges ◽  
Endocrine Regulation ◽  
Before And After ◽  
Hpt Axis ◽  
The Impact

AbstractTrying to manage the dramatic coronavirus disease 2019 (COVID-19) infection spread, many countries imposed national lockdown, radically changing the routinely life of humans worldwide. We hypothesized that both the pandemic per se and the consequent socio-psychological sequelae could constitute stressors for Italian population, potentially affecting the endocrine system. This study was designed to describe the effect of lockdown-related stress on the hypothalamic-pituitary-thyroid (HPT) axis in a cohort of young men. A prospective, observational clinical trial was carried out, including patients attending the male infertility outpatient clinic before and after the national lockdown for COVID-19 pandemic. The study provided a baseline visit performed before and a follow-up visit after the lockdown in 2020. During the follow-up visit, hormonal measurements, lifestyle habits and work management were recorded. Thirty-one male subjects were enrolled (mean age: 31.6 ± 6.0 years). TSH significantly decreased after lockdown (p = 0.015), whereas no significant changes were observed in the testosterone, luteinising hormone, follicle-stimulating hormone, estradiol and prolactin serum levels. No patient showed TSH serum levels above or below reference ranges, neither before nor after lockdown. Interestingly, TSH variation after lockdown was dependent on the working habit change during lockdown (p = 0.042). We described for the first time a TSH reduction after a stressful event in a prospective way, evaluating the HPT axis in the same population, before and after the national lockdown. This result reinforces the possible interconnection between psychological consequences of a stressful event and the endocrine regulation.

scholarly journals Plasma mineral (selenium, zinc or copper) concentrations in the general pregnant population, adjusted for supplement intake, in relation to thyroid function

2020 ◽  
Vol 125 (1) ◽  
pp. 71-78
Author(s):  
Victor Pop ◽  
Johannes Krabbe ◽  
Wolfgang Maret ◽  
Margaret Rayman
Keyword(s):  
Thyroid Function ◽  
Reference Range ◽  
First Trimester ◽  
Future Research ◽  
Thyroid Peroxidase ◽  
Reference Ranges ◽  
Lower Plasma ◽  
The Mean ◽  
The Impact ◽  
Supplement Intake

AbstractThe present study reports on first-trimester reference ranges of plasma mineral Se/Zn/Cu concentration in relation to free thyroxine (FT4), thyrotropin (TSH) and thyroid peroxidase antibodies (TPO-Ab), assessed at 12 weeks’ gestation in 2041 pregnant women, including 544 women not taking supplements containing Se/Zn/Cu. The reference range (2·5th–97·5th percentiles) in these 544 women was 0·72–1·25 µmol/l for Se, 17·15–35·98 µmol/l for Cu and 9·57–16·41 µmol/l for Zn. These women had significantly lower mean plasma Se concentration (0·94 (sd 0·12) µmol/l) than those (n 1479) taking Se/Zn/Cu supplements (1·03 (sd 0·14) µmol/l; P < 0·001), while the mean Cu (26·25 µmol/l) and Zn (12·55 µmol/l) concentrations were almost identical in these sub-groups. Women with hypothyroxinaemia (FT4 below reference range with normal TSH) had significantly lower plasma Zn concentrations than euthyroid women. After adjusting for covariates including supplement intake, plasma Se (negatively), Zn and Cu (positively) concentrations were significantly related to logFT4; Se and Cu (but not Zn) were positively and significantly related to logTSH. Women taking additional Se/Zn/Cu supplements were 1·46 (95 % CI 1·09, 2·04) times less likely to have elevated titres of TPO-Ab at 12 weeks of gestation. We conclude that first-trimester Se reference ranges are influenced by Se-supplement intake, while Cu and Zn ranges are not. Plasma mineral Se/Zn/Cu concentrations are associated with thyroid FT4 and TSH concentrations. Se/Zn/Cu supplement intake affects TPO-Ab status. Future research should focus on the impact of trace mineral status during gestation on thyroid function.

Impact of copayment elimination on annual and biennial screening mammography utilization among rural U.S. women.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 6503-6503
Author(s):  
Jeffrey M. Peppercorn ◽  
Stephanie B. Wheeler ◽  
Kevin Houck ◽  
Bercedis Peterson ◽  
Victor Villagra ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Rural Women ◽  
Age Groups ◽  
Screening Mammography ◽  
Prior History ◽  
Insurance Claims ◽  
Financial Barriers ◽  
Before And After ◽  
Insurance Claims Data ◽  
The Impact

6503 Background: Early detection of breast cancer through mammography screening leads to earlier stage at diagnosis and improved survival. Previous research has shown that rural American women are less likely to receive screening mammography compared to their urban counterparts. Copayments for mammography are a potential barrier to screening, and elimination of copayments may improve screening rates. We examined annual (aSMU) and biennial (bSMU) screening mammography utilization and the impact of copayment elimination among rural U.S. women. Methods: Using the insurance claims database of the National Rural Electric Cooperative Association (NRECA), which insures over 100,000 electrical workers and their families nationally, we identified all women ages 40 to 64 with no prior history of invasive breast cancer or DCIS (based on ICD-9 codes) and captured claims for aSMU and bSMU between 1999 and 2009. Changes in screening over time were assessed for the periods before and after NRECA elimination of copayments for screening mammography in January, 2006. Chi-squared tests were used to compare aSMU and bSMU rates by age group. All p-values are two-sided. Results: During this time period, over 20,000 women ages 40 to 64 received health insurance through NRECA each year. From 1999 to 2009, aSMU increased from 38.1% to 49.5%, while bSMU increased from 57.2% to 68.1%. Screening increased significantly following elimination of copayments in 2006 (p = 0.0004). Specifically, for the period 2006-2007 compared to 2004-2005, the percentage of women undergoing at least biennial screening increased from 60.9 to 68.8% (p < 0.0001), with absolute differences in screening by age ranging from an increase of 5.3% among women 40-45, to 10% among women 60 – 64. Conclusions: Evaluation of insurance claims data from rural US populations reveals that a large percentage of rural women ages 40 to 64 do not undergo even biennial breast cancer screening. Elimination of copayments improves both annual and biennial screening rates in all age groups, but does not eliminate all barriers. Further investigation is ongoing to understand financial and non-financial barriers to screening and attitudes towards current screening recommendations.

scholarly journals Digit Ratio (2D:4D), Aggression, and Testosterone in Men Exposed to an Aggressive Video Stimulus

2013 ◽  
Vol 11 (5) ◽  
pp. 147470491301100 ◽  
Author(s):  
Liam P. Kilduff ◽  
Renato N. Hopp ◽  
Christian J. Cook ◽  
Blair T. Crewther ◽  
John T. Manning
Keyword(s):  
Negative Correlation ◽  
Free Testosterone ◽  
Digit Ratio ◽  
Testosterone Levels ◽  
Prenatal Testosterone ◽  
Before And After ◽  
Video Stimulus ◽  
The Difference ◽  
And Control ◽  
The Impact

The relative lengths of the 2nd and 4th digits (2D:4D) is a negative biomarker for prenatal testosterone, and low 2D:4D may be associated with aggression. However, the evidence for a 2D:4D-aggression association is mixed. Here we test the hypothesis that 2D:4D is robustly linked to aggression in “challenge” situations in which testosterone is increased. Participants were exposed to an aggressive video and a control video. Aggression was measured after each video and salivary free testosterone levels before and after each video. Compared to the control video, the aggressive video was associated with raised aggression responses and a marginally significant increase in testosterone. Left 2D:4D was negatively correlated with aggression after the aggressive video and the strength of the correlation was higher in those participants who showed the greatest increases in testosterone. Left 2D:4D was also negatively correlated to the difference between aggression scores in the aggressive and control conditions. The control video did not influence testosterone concentrations and there were no associations between 2D:4D and aggression. We conclude that 2D:4D moderates the impact of an aggressive stimulus on aggression, such that an increase in testosterone resulting from a “challenge” is associated with a negative correlation between 2D:4D and aggression.

scholarly journals Before and After the Pandemic: Alcohol Consumption and Related Problems in Argentina

2021 ◽  
Vol 55 (1) ◽  
pp. e1444
Author(s):  
Karina Conde ◽  
Paula Victoria Gimenez ◽  
Tomás Salomón ◽  
Raquel Inés Peltzer ◽  
Sebastián Laspiur ◽  
...  
Keyword(s):  
Alcohol Consumption ◽  
Latin American ◽  
Online Survey ◽  
Age Groups ◽  
Heavy Episodic Drinking ◽  
Alcoholic Beverages ◽  
Before And After ◽  
The Impact ◽  
New Evidence ◽  
Alcohol Related Problems

The impact of the COVID-19 pandemic and isolation measures on alcohol consumption remains unknown among Latin-American countries. This paper characterizes differences in alcohol consumption and related problems before and after the pandemic among Argentinians from different genders, age groups, income levels, and behaviors regarding the acquisition of alcoholic beverages. Through an online survey 1446 participants were assessed regarding four alcohol consumption dimensions (frequency, quantity, heavy episodic drinking -HED- and alcohol-related problems) three months prior and after the first cases in the country and subsequent lockdown measures. Overall, participants reported small reductions for usual consumption and moderate ones for HED and related problems. As expected, very high reductions were found for those underage (14 to 18 years), and young adults (19 to 24 years). Those who had an increase in income after the pandemic did not report changes in consumption, while those whose income remained equal or lowered reported reductions. Those who did not report special behaviors to acquire alcohol (e.g. pre-stocking) informed decreases in consumption compared to those who did. This study provides new evidence on the impact of environmental factors in public health, suggesting restricted access to alcohol generates a significant decrease in alcohol consumption and related problems.

scholarly journals Sex differences in psychotropic and analgesic drug use before and after initiating treatment with acetylcholinesterase inhibitors

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0243804
Author(s):  
Anne Sverdrup Efjestad ◽  
Hege Ihle-Hansen ◽  
Vidar Hjellvik ◽  
Knut Engedal ◽  
Hege Salvesen Blix
Keyword(s):  
Age Groups ◽  
Acetylcholinesterase Inhibitors ◽  
Prescription Database ◽  
Prescription Pattern ◽  
Before And After ◽  
Norwegian Prescription Database ◽  
Total Prescription ◽  
A Prospective Study ◽  
The Impact

Background/aims The aim was to explore the impact of sex on prevalence, patterns and trends in the prescription of psychotropics and analgesics in users of acetylcholinesterase inhibitors (AChEIs), before and after AChEI initiation, compared to the general population. Methods A prospective study applying data from the Norwegian Prescription Database (NorPD) in the period 2004–2016. Prescription of antidepressants, antipsychotics, analgesics including opioids, benzodiazepines and z-hypnotics in persistent AChEI users was studied in a follow-up period from four years before to two years after AChEI initiation in men and women of four age groups: 37–64, 65–72, 73–80 and 81–88 years. Results Use of antidepressants, antipsychotics and weaker analgesics increased in both sexes during the follow-up period in 11.764 persistent AChEI users. Women with pre-dementia and dementia stages of AD showed a prescription pattern with more use of psychotropics and opioids than men, except for antipsychotics. Conclusion Female sex showed to have a significant influence on the prescriptions of psychotropics and analgesics in AD patients in a pre-dementia and dementia stage. The exception is for antipsychotics, that men used more than women. The prescription pattern showed a higher extent of polypharmacy of psychotropics and/or opioids in women than in men. The total prescription pattern of analgesics could indicate an undertreatment of pain in pre-dementia and dementia stages, most pronounced in men.

Study of the Total Serum Concentration of Serrum Ionized Magnesium in Children and Adolescents from Sibiu Area

2019 ◽  
Vol 69 (12) ◽  
pp. 3389-3392 ◽  
Author(s):  
Elisabeta Antonescu ◽  
Gabriela Bota ◽  
Bogdan Serb ◽  
Diter Atasie ◽  
Cristina Dahm Tataru ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Reference Range ◽  
Serum Magnesium ◽  
Age Groups ◽  
Reference Intervals ◽  
Magnesium Concentration ◽  
Total Serum ◽  
Reference Ranges ◽  
Insulin Metabolism ◽  
The Difference

Magnesium is an essential nutrient for the living organisms and plays an important part in the prevention and treatment of many diseases. It is an enzymatic cofactor for more than 300 reactions. Magnesium is essential for regulating blood pressure, muscle contraction, cardiac excitability, insulin metabolism, vasomotor tonus. Studying the way in which serum magnesium concentration varies in children and adolescents in the Sibiu area according to the reference intervals we especially set for this area. The study is a retrospective one, using approximately 4900 data from the archives of the Medical Analysis Laboratory within the Sibiu Pediatric Clinical Hospital. Serum magnesium was dosed using the Konelab Prime 30i analyser. The data from the literature was used to compare the results. The reference ranges obtained in the current study were similar to the literature studied. The percentage of patients with magnesium concentration outside the reference ranges was roughly equal for all age groups. The difference was between 1 month and 2 year-old children with very few deviations from the reference range. The results of our study reflect more accurately the real reference range for the population in the Sibiu area, helping clinicians to establish a diagnosis as quickly and accurate as possible. These results were not significantly different from the literature studied.

The impact of SIGN glaucoma guidelines on false-positive referrals from community optometrists in Central Scotland

2018 ◽  
Vol 103 (3) ◽  
pp. 369-373 ◽  
Author(s):  
Samantha Sii ◽  
Ahmad Nasser ◽  
Cheng Yi Loo ◽  
Catherine Croghan ◽  
Alan Rotchford ◽  
...  
Keyword(s):  
Corneal Thickness ◽  
Secondary Outcome ◽  
Visual Field Defects ◽  
Referral Criteria ◽  
Discharge Rates ◽  
Before And After ◽  
Group 2 ◽  
The Uk ◽  
The Impact

BackgroundSince the introduction of National Institute for Health and Care Excellence glaucoma guidelines 2009, the number of referrals from community optometrists to hospital eye services has increased across the UK, resulting in increase in first visit discharge rates (FVDRs).AimTo assess the impact of Scottish Intercollegiate Guidelines Network (SIGN) 144 on quality of referrals from community optometrists.MethodologyA retrospective study of patient records who attended as new adult glaucoma referrals to clinics in Princess Alexandra Eye Pavilion, Edinburgh, and in Greater Glasgow and Clyde, was carried out across October–November 2014 (group 1) and September–October 2016 (group 2), before and after the introduction of SIGN 144. The primary outcome of this study is FVDRs. A secondary outcome is the extent of compliance to referral recommendations by SIGN guidelines.ResultsThree hundred and twelve and 325 patients were included in groups 1 and 2, respectively. There was a significant decline in FVDRs between these two periods from 29.2% to 19.2%. (p=0.004) (OR 0.58 (95%CI 0.40 to 0.84)). Post-SIGN guidelines, 87% of referrals were compliant to SIGN referral criteria while 13% remained non-compliant. The main reasons for non-compliance were no repeatable visual field defects (42.0%) and referrals due to high intraocular pressure were either not repeated or not interpreted in the context of age and central corneal thickness (36.8%).ConclusionPatients referred after the introduction of SIGN guidelines were 33.5% less likely to be discharged at the first visit. Although compliance to most recommendations in SIGN guidelines has improved, there is still a need to improve adherence to referral criteria

scholarly journals Firearm legislation reform in the European Union: impact on firearm availability, firearm suicide and homicide rates in Austria

2007 ◽  
Vol 191 (3) ◽  
pp. 253-257 ◽  
Author(s):  
Nestor D. Kapusta ◽  
Elmar Etzersdorfer ◽  
Christoph Krall ◽  
Gernot Sonneck
Keyword(s):  
Age Groups ◽  
Law Reform ◽  
The European Union ◽  
Firearm Availability ◽  
Before And After ◽  
Firearm Suicide ◽  
Prevention Programmes ◽  
Using Data ◽  
Union Impact ◽  
The Impact

BackgroundThe availability of firearms in homes and at aggregate levels is a risk factor for suicide and homicide. One method of reducing access to suicidal means is the restriction of firearm availability through more stringent legislation.AimsTo evaluate the impact of firearm legislation reform on firearm suicides and homicides as well as on the availability of firearms in Austria.MethodOfficial statistics on suicides, firearm homicides and firearm licences issued from 1985 to 2005 were examined. To assess the effect of the new firearm law, enacted in 1997, linear regression and Poisson regressions were performed using data from before and after the law reform.ResultsThe rate of firearm suicides among some age groups, percentage of firearm suicides, as well as the rate of firearm homicides and the rate of firearm licences, significantly decreased after a more stringent firearm law had been implemented.ConclusionsOur findings provide evidence that the introduction of restrictive firearm legislation effectively reduced the rates of firearm suicide and homicide. The decline in firearm-related deaths seems to have been mediated by the legal restriction of firearm availability. Restrictive firearm legislation should be an integral part of national suicide prevention programmes in countries with high firearm suicide rates.

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