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OBJECTIVE: To examine the relation between baseline measurements of thyroid function and response to selective serotonin reuptake inhibitors (SSRIs) and to consider the effect of these antidepressants on thyroid hormone levels. METHODS: Nineteen subjects with major depression, but without a history of thyroid treatment or lithium treatment, were treated openly with either sertraline or fluoxetine in a university- affiliated tertiary care hospital. Hamilton Depression Rating Scale (Ham-D) scores were measured before and after treatment. Clinical Global Impressions (CGI) scores were measured at study end. Thyroid data, consisting of values for thyroid-stimulating hormone (TSH), triiodothyronine (T(3), measured by radioimmunoassay [RIA]), thyroxine (T(4), measured by RIA) and free T(4), were collected before and after treatment. Complete thyroid data were available for 17 subjects. Data were collected during 1997-1999. RESULTS: Baseline TSH correlated strongly with response to treatment as measured by change in Ham-D scores (r = 0.64, p = 0.003). Low TSH values correlated with greater improvement in depressive symptoms. Thyroid hormone levels decreased with treatment, but these decreases did not correlate with clinical improvement. CONCLUSION: Baseline thyroid function, as measured by serum TSH, may predict a patient's response to antidepressant treatment with SSRIs. Optimal thyroid function, beyond simply being within the normal laboratory values, may be necessary for an optimal response to antidepressants. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Our objectives were to characterize the stability of pregnancy intention and to examine whether stability is associated with the timing of prenatal care initiation, smoking during pregnancy, and breastfeeding. METHODS: We use a sample of women from the National Longitudinal Survey of Youth (NLSY) for whom information on pregnancy intention was collected both during pregnancy and after delivery. In bivariate analyses we compare outcomes and characteristics of women whose pregnancy intention changed between the prenatal and postpartum periods. With multivariate methods, we analyze the correlates of switching pregnancy intention as well as the association between switching and maternal behaviors. RESULTS: Women whose pregnancy intention changes between the two assessments are similar in marital status and socioeconomic background to those who report both during pregnancy and after delivery that the pregnancy is unintended. Disagreement during pregnancy between the parents' pregnancy intentions is the most important predictor of instability in the mother's pregnancy intention. Effects of unintended pregnancy on the timing of initiation of prenatal care, smoking during pregnancy, and breastfeeding based on reports after delivery are smaller than those based on reports during pregnancy, although differences are not statistically significant. Adverse effects of unintended pregnancy are greater when pregnancies reported by the mother to be unintended at either assessment are combined into a single category for unintended pregnancy. CONCLUSION: Unstable pregnancy intention may be a marker for adverse maternal behaviors related to infant health. [ABSTRACT FROM AUTHOR]

In this paper, we use data from the National Longitudinal Survey of Youth to investigate the empirical link between unintended pregnancy and child health and development. An important contribution of our study is the use of information on siblings to control for unmeasured factors that may confound estimates of the effect of pregnancy intentions on infant and child outcomes. Results from our study indicate that unwanted pregnancy is associated with prenatal and postpartum maternal behaviors that adversely affect infant and child health, but that unwanted pregnancy has little association with birth weight and child cognitive outcomes. Estimates of the association between unwanted pregnancy and maternal behaviors were greatly reduced after controls for unmeasured family background were included in the model. Our results also indicate that there are no significant differences in maternal behaviors or child outcomes between mistimed and wanted pregnancies. [ABSTRACT FROM AUTHOR]

Erectile dysfunction (ED) is the most common sexual problem in men, after premature ejaculation, affecting up to 30 million in the United States. In a society in which sexuality is widely promoted, ED impacts on feelings of self-worth and self-confidence and may impair the quality of life of affected men and their partners. Damage to personal relationships can ensue; and the anger, depression, and anxiety engendered spill over into all aspects of life. Patients are often embarrassed or reluctant to discuss the matter with their primary care practitioners. Unfortunately, many physicians fail to take the opportunity to promote open discussion of sexual dysfunction. They too, may avoid the topic through personal embarrassment. Since the National Institutes of Health (NIH) Consensus Conference on Impotence in 1992, the inadequate level of public and professional understanding of ED has begun to be addressed. As a first step in breaking down the communication barriers between patients and practitioners, it is important that physicians have a thorough understanding of the wide variety of conditions associated with ED and how the different risk factors for ED may be readily identified. This review addresses the diagnosis of ED and identifies diagnostic tests that can be used by primary care physicians to determine the patients most at risk and the treatments most suited to meet the patients' and their partners' goal for therapy. [ABSTRACT FROM AUTHOR]

Context: The professional integrity of scientists is important to society as a whole and particularly to disciplines such as medicine that depend heavily on scientific advances for their progress.Objective: To characterize the professional norms of active scientists and compare them with those of individuals with institutional responsibility for the conduct of research.Design: A mailed survey consisting of 12 scenarios in 4 domains of research ethics. Respondents were asked whether an act was unethical and, if so, the degree to which they considered it unethical and to select responses and punishments for the act.Participants: A total of 924 National Science Foundation research grantees in 1993 or 1994 in molecular or cellular biology and 140 representatives from the researchers' institutions to the US Department of Health and Human Services Office of Research Integrity.Main Outcome Measures: Percentage of respondents considering an act unethical and the mean malfeasance rating on a scale of 1 to 10.Results: A total of 606 research grantees and 91 institutional representatives responded to the survey (response rate of 69% of those who could be contacted). Respondents reported a hierarchy of unethical research behaviors. The mean malfeasance rating was unrelated to the characteristics of the investigator performing the hypothetical act or to its consequences. Fabrication, falsification, and plagiarism received malfeasance ratings higher than 8.6, and virtually all thought they were unethical. Deliberately misleading statements about a paper or failure to give proper attribution received ratings between 7 and 8. Sloppiness, oversights, conflicts of interest, and failure to share were less serious still, receiving malfeasance ratings between 5 and 6. Institutional representatives proposed more and different interventions and punishments than the scientists.Conclusions: Surveyed scientists and institutional representatives had strong and similar norms of professional behavior, but differed in their approaches to an unethical act. INSET: Scenario. [ABSTRACT FROM AUTHOR]

There is little evidence to support the reasons suggested by Hoffman et al. for treating the results based on the NLSYW as outliers. There is even some evidence that might lead one to favor the NLSYW estimates. After some investigation, which of the range of within-family estimates across data sets is most accurate remains unsettled (although exploring differences in cross-sectional estimates from the sisters subsamples seems promising). In addition, we believe there is evidence to support the hypothesis that within-family estimates are upwardly biased because of within-family heterogeneity and endogeneity, but the importance and magnitude of such bias is also an open question. Although we have highlighted here what we believe to be the main points of disagreement between ourselves and Hoffman et al., we hope readers will not lose sight of the areas of agreement between the two studies, which are substantial, or of the empirical support for our key findings that Hoffman et al.'s replication study has provided. To us, the findings of both studies suggest that future research should account empirically for potential biases from (possibly unmeasured) heterogeneity in family background. Because the prevailing beliefs about the consequences of teen childbearing have been based on cross-sectional comparisons that lack detailed family background controls, these beliefs now should be open for reconsideration and should be subjected to reevaluation. Several recent empirical attempts have been made to take heterogeneity or endogeneity bias into account. These studies support this conclusion and caution against drawing causal inferences from existing estimates of the effects of teen births. We continue to recognize the limitations of currently available methods and data for accounting for unobserved heterogeneity and selectivity (e.g., Griliches 1979; Manski 1989). Therefore we encourage the enhancement of data sets and the continued empirical investigation of questions that have been raised about possible biases of sibling estimation and other methodological approaches. We hope that with new rounds of research, advances will continue to further the understanding of these important social processes. Given the difficulty of accounting adequately for selection into teen childbearing across and within populations, and even within families, and given the conflicting within-family estimates, we believe that the size of any "true effects" of teen births on socioeconomic status must be considered an open question. [ABSTRACT FROM AUTHOR]

The article discusses a comment on F.C. Pampel and V.K. Pillai's "Patterns and Determinants of Infant Mortality in Developed Nations, 1950-1975." Pampel and Pillai examined a number of potential determinants of infant mortality rates in a pooled cross-section time series sample of developed nations over the period 1950-1975. In multivariate analyses, they regressed infant mortality rates on the percentage of live births born to mothers below 20 years of age, along with controls for economic, social welfare, and medical care aspects of the countries and time periods considered. Implicit in promoting a policy of delayed fertility is the assumption that the positive association between early fertility and infant mortality is in some sense causal-that is, that the characteristics associated with teen motherhood that lead to excessive infant mortality could be avoided or "outgrown" if those women who actually bear children in their teens were to postpone childbearing until their 20s. In fact, although there is evidence of a general trend in the U.S. toward delayed childbearing, there is also evidence that the disadvantaged in the U. S., particularly poor black Americans, initiate and complete their fertility at young ages. In short, as gross national product increases and fertility declines, the composition of the pool of child bearers changes such that a larger percentage of births are to poor mothers who tend to bear children in their teenage years.

Highlights the discussions during a 1979 symposium on the role of hormonal changes in the diseases of aging and in age-related changes in the function of cells and tissues. Alterations in endocrine function that occur in later life; Relationship of the hormonal changes that occur in postmenopausal women with obesity; Results of a study that determined whether aging men have a fall in androgen levels similar to the postmenopausal decline in estrogen.

Mixed hyperlipidemia is characterized by both elevated total cholesterol and triglycerides. It is estimated to account for 10% to 20% of patients with dyslipidemia. This study assessed the lipid-altering efficacy and tolerability of simvastatin 40 and 80 mg/day as monotherapy. One hundred thirty patients (62 women [48%], 24 [16%] with type 2 diabetes mellitus, mean age 53 years) with mixed hyperlipidemia (baseline low-density lipoprotein [LDL] cholesterol 156 mg/dl [mean], and triglycerides 391 mg/dl [median) were randomized in a multicenter, double-masked, placebo-controlled, 3-period, 22-week, balanced crossover study, and received placebo, and simvastatin 40 and 80 mg/day each for 6 weeks. Compared with placebo, simvastatin produced significant (p <0.01) and dose-dependent changes in all lipid and lipoprotein parameters (LDL cholesterol 2.1%, -28.9%, and -35.5%; triglycerides -3.5%, -27.8%, and -33.0%; high-density lipoprotein cholesterol 3.3%, 13.1%, and 15. 7%; apolipoprotein B 3.8%, -23.1%, and -30.6%; and apolipoprotein A-I 4.0%, 8.2%, and 10.5% with placebo, and simvastatin 40 and 80 mg/day, respectively). The changes were consistent in patients with diabetes mellitus. One patient taking simvastatin 80 mg/day had an asymptomatic and reversible increase in hepatic transaminases 3 times above the upper limit of normal. Simvastatin 40 and 80 mg/day is effective in patients with mixed hyperlipidemia across the entire lipid and lipoprotein profile. The reductions in LDL cholesterol and triglycerides are large, significant, and dose dependent. The increase in high-density lipoprotein cholesterol was greater than that observed in patients with hypercholesterolemia, and appears dose dependent. [ABSTRACT FROM AUTHOR]