Effect of intervention on decision making of treatment for disease progression,prostate‐specific antigen biochemical failure and prostate cancer death

Background

Patient preference for the choice of treatment modality for prostate cancer has increasingly gained attention.

Objective

To assess the impact of client‐oriented decision on long‐term mortality, disease progression and biochemical failure compared with standard treatment protocol (TP).

Methods

With data from a Finnish multicentre, randomized controlled trial with two arms [104 in the enhanced patient participation (EPP) arm and 106 in the TP arm], disease‐specific and disease‐free survival, biochemical failure with elevated prostate‐specific antigen (PSA) level and disease progression were compared between the two arms using Wilcoxon test and also Cox proportional hazards regression model.

Results

Patients in the EPP arm had a higher risk of death by 37% [HR, 1.37 (0.87–2.17)] compared with those in the TP arm. Patients in the EPP arm were at increased risk of having biochemical failure by 14% [HR, 1.14 (0.72–1.79)] and for having disease progression by 2% [HR, 1.02 (0.61–1.70)] compared with those in the TP arm. All the differences were non‐significant.

Conclusions

Patients actively involved in the choice of treatment had higher risk of prostate cancer death but only slightly increased risk of biochemical failure and clinical disease progression. These findings would provide a good reference when patient autonomy for the choice of treatment modality is addressed.     

Synthesis and Structure–Activity Relationships of N-Benzyl Phenethylamines as 5-HT2A/2C Agonists

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An Analysis of All Applications for Sex Reassignment Surgery in Sweden, 1960–2010: Prevalence,Incidence, and Regrets

Incidence and prevalence of applications in Sweden for legal and surgical sex reassignment were examined over a 50-year period (1960–2010), including the legal and surgical reversal applications. A total of 767 people (289 natal females and 478 natal males) applied for legal and surgical sex reassignment. Out of these, 89 % (252 female-to-males [FM] and 429 male-to-females [MF]) received a new legal gender and underwent sex reassignment surgery (SRS). A total of 25 individuals (7 natal females and 18 natal males), equaling 3.3 %, were denied a new legal gender and SRS. The remaining withdrew their application, were on a waiting list for surgery, or were granted partial treatment. The incidence of applications was calculated and stratified over four periods between 1972 and 2010. The incidence increased significantly from 0.16 to 0.42/100,000/year (FM) and from 0.23 to 0.73/100,000/year (MF). The most pronounced increase occurred after 2000. The proportion of FM individuals 30 years or older at the time of application remained stable around 30 %. In contrast, the proportion of MF individuals 30 years or older increased from 37 % in the first decade to 60 % in the latter three decades. The point prevalence at December 2010 for individuals who applied for a new legal gender was for FM 1:13,120 and for MF 1:7,750. The FM:MF sex ratio fluctuated but was 1:1.66 for the whole study period. There were 15 (5 MF and 10 MF) regret applications corresponding to a 2.2 % regret rate for both sexes. There was a significant decline of regrets over the time period.     

“The psychological skeleton in the closet”: mortality after a sibling’s suicide

Purpose

To study the association between loss of an adult sibling due to suicide and mortality from various causes up to 18 years after bereavement.

Methods

We conducted a follow-up study between 1981 and 2002, based on register data representing the total population of Swedes aged 25–64 years (n = 1,748,069).

Results

An elevated mortality rate from all causes was found among men (RR 1.26; 95 % CI: 1.14–1.40) and women (1.27; 1.11–1.45) who had experienced a sibling’s suicide. The standardized rate ratio of suicide of bereaved to non-bereaved persons was 2.46 (1.86–3.24) among men and 3.25 (2.28–4.65) among women. We also found some indications of an interrelation between sibling suicide and subsequent deaths from external causes other than suicide in men (1.77; 1.34–2.34) and deaths from cardiovascular disease in women (1.37; 0.99–1.91). An elevated all-cause mortality rate was found after the first year of bereavement in men, while bereaved women experienced higher mortality rates during the first 2 years and after 5 years of bereavement.

Conclusions

Our study provides support for adverse health effects among survivors associated with sibling loss due to suicide. Sibling suicides were primarily associated with suicide in bereaved survivors, although there was an increased mortality rate from discordant causes, which strengthens the possibility that the observed associations might not be entirely due to shared genetic causes.     

Type 1 diabetes linked PTPN22 gene polymorphism is associated with the frequency of circulating regulatory T cells

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Effectiveness of Written Dietary Advice for Improving Blood Lipids in Primary Care Adults—A Pragmatic Randomized Controlled Trial (MYDICLIN)

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