Background Testosterone supplementation has been shown to increase muscle mass and strength in healthy older men. The safety and efficacy of testosterone treatment in older men who have limitations in mobility have not been studied. Methods Community-dwelling men, 65 years of age or older, with limitations in mobility and a total serum testosterone level of 100 to 350 ng per deciliter (3.5 to 12.1 nmol per liter) or a free serum testosterone level of less than 50 pg per milliliter (173 pmol per liter) were randomly assigned to receive placebo gel or testosterone gel, to be applied daily for 6 months. Adverse events were categorized with the use of the Medical Dictionary for Regulatory Activities classification. The data and safety monitoring board recommended that the trial be discontinued early because there was a significantly higher rate of adverse cardiovascular events in the testosterone group than in the placebo group. Results A total of 209 men (mean age, 74 years) were enrolled at the time the trial was terminated. At baseline, there was a high prevalence of hypertension, diabetes, hyperlipidemia, and obesity among the participants. During the course of the study, the testosterone group had higher rates of cardiac, respiratory, and dermatologic events than did the placebo group. A total of 23 subjects in the testosterone group, as compared with 5 in the placebo group, had cardiovascular-related adverse events. The relative risk of a cardiovascular-related adverse event remained constant throughout the 6-month treatment period. As compared with the placebo group, the testosterone group had significantly greater improvements in leg-press and chest-press strength and in stair climbing while carrying a load. Conclusions In this population of older men with limitations in mobility and a high prevalence of chronic disease, the application of a testosterone gel was associated with an increased risk of cardiovascular adverse events. The small size of the trial and the unique population prevent broader inferences from being made about the safety of testosterone therapy.

Testosterone administration in older men with mobility limitation was associated with patient-important improvements in muscle strength and stair-climbing power. Improvements in muscle strength and only some physical function measures should be weighed against the risk of adverse events in this population.

Isolated myeloid sarcoma (MS) is a rare extramedullary presentation of acute myeloid leukemia (AML). Little is known about MS outcomes due to its rarity. A population-based analysis of MS using the Survival, Epidemiology, and End Results (SEER) database was performed. We identified 345 patients, aged 15 or older, diagnosed with isolated MS between 1973 and 2010. Overall survival (OS) was calculated and compared between MS and non-MS AML using the log-rank test. Survival was also evaluated based upon the primary site of disease presentation. The 3-year survival rate for MS (0.319; 95% confidence interval [CI]: 0.267-0.371) was greater than for non-MS AML (0.172; 95% CI: 0.168-0.175). There was variation in survival based on the site of involvement. The survival rates for isolated MS involving the pelvis/genitourinary organs, eyes/gonads and gastrointestinal mucosa appeared to be slightly improved when compared to primary sites of soft tissues, lymphatic/hematopoietic tissues or nervous system.

The aging of the population is a worldwide phenomenon. The prevalence of diabetes rises with increasing age, so the personal and financial costs of diabetes in the aging population have become significant burdens. In 2012, 104 billion (59%) of the estimated $176 billion in United States healthcare expenditures attributable to diabetes were utilized by patients older than 65 years of age [American Diabetes Association (1)]. With improvement in diabetes management and better glycemic control in the general population, there is an increase in the prevalence of hypoglycemia, which is the complication of the treatment of diabetes. Older adults with diabetes have a higher risk for hypoglycemia due to altered adaptive physiologic responses to low glucose levels. These patients also have comorbidities, such as cognitive and functional loss, that interfere with prompt identification and/or appropriate treatment of hypoglycemia. Older adults who suffer from hypoglycemia also have increased risk for falls, fall-related fractures, seizures and comas and exacerbation of chronic conditions, such as cognitive dysfunction and cardiac events. Thus, hypoglycemia in the older adult must be proactively avoided to decrease significant morbidity and mortality. Education of the patients and caregivers is important in prevention and treatment of hypoglycemia. In this article, we discuss the important aspects and unique challenges pertaining to hypoglycemia in older population. We also highlight the risks, consequences and prevention and management strategies for hypoglycemia that can be used by healthcare providers caring for older populations.

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BACKGROUND AND OBJECTIVES: Previous research has demonstrated associations between maternal experience of intimate partner violence (IPV) and a range of adverse outcomes among women and their young children. However, few studies have examined the associations between maternal experience of IPV and early child development (ECD) outcomes in low- and middle-income countries (LMIC). Our objectives in this study were to examine the association between IPV victimization and ECD and assess whether the association was mediated by maternal and paternal stimulation. METHODS: We combined cross-sectional data from the Demographic and Health Surveys for 15 202 households representing mothers and fathers of children aged 36 to 59 months in 11 LMIC. We used multivariable linear regression models to estimate the association between IPV victimization in the year preceding the survey and ECD, which we measured using the Early Child Development Index. We used path analysis to determine if the association between IPV victimization and ECD was mediated through maternal and paternal stimulation. RESULTS: After adjusting for sociodemographic variables, IPV victimization was negatively associated with ECD (β = −.11; 95% confidence interval = −.15 to −.07). Path analysis indicated that the direct association between IPV victimization and ECD was partially and independently mediated through maternal and paternal stimulation. CONCLUSIONS: Interventions that include components to prevent IPV may be effective for improving ECD in LMIC.

BackgroundBirth registration, and the possession of a birth certificate as proof of registration, has long been recognized as a fundamental human right. Data from a functioning civil registration and vital statistics (CRVS) system allows governments to benefit from accurate and universal data on birth and death rates. However, access to birth certificates remains challenging and unequal in many low and middle-income countries. This paper examines wealth, urban/rural and gender inequalities in birth certificate coverage.MethodsWe analyzed nationally representative household surveys from 94 countries between 2000 and 2014 using Demographic Health Surveys and Multiple Indicator Cluster Surveys. Birth certificate coverage among children under five was examined at the national and regional level. Absolute measures of inequality were used to measure inequalities in birth certificate coverage by wealth quintile, urban/rural residence and sex of the child.ResultsOver four million children were included in the analysis. Birth certificate coverage was over 90% in 29 countries and below 50% in 36 countries, indicating that more than half the children under five surveyed in these countries did not have a birth certificate. Eastern & Southern Africa had the lowest average birth certificate coverage (26.9%) with important variability among countries. Significant wealth inequalities in birth certificate coverage were observed in 74 countries and in most UNICEF regions, and urban/rural inequalities were present in 60 countries. Differences in birth certificate coverage between girls and boys tended to be small.ConclusionsWe show that wealth and urban/rural inequalities in birth certificate coverage persist in most low and middle income countries, including countries where national birth certificate coverage is between 60 and 80%. Weak CRVS systems, particularly in South Asia and Africa lead rural and poor children to be systematically excluded from the benefits tied to a birth certificate, and prevent these children from being counted in national health data. Greater funding and attention is needed to strengthen CRVS systems and equity analyses should inform such efforts, especially as data needs for the Sustainable Development Goals expand. Monitoring disaggregated data on birth certificate coverage is essential to reducing inequalities in who is counted and registered. Strengthening CRVS systems can enable a child’s right to identity, improve health data and promote equity.Electronic supplementary materialThe online version of this article (doi:10.1186/s12939-017-0635-6) contains supplementary material, which is available to authorized users.

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