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Introduction: The number of preventive care guidelines is rapidly increasing. It is unknown whether the number of guideline-recommended preventive services is associated with utilization.Methods: The authors used Poisson regression of 390,778 person-years of electronic medical records data from 2008 to 2015, in 80,773 individuals aged 50-75 years. Analyses considered eligibility for 11 preventive services most closely associated with guidelines: tobacco cessation; control of obesity, hypertension, lipids, or blood glucose; influenza vaccination; and screening for breast, cervical, or colorectal cancers, abdominal aortic aneurysm, or osteoporosis. The outcome was the rate of preventive care utilization over the following year. Results were adjusted for demographics and stratified by the number of disease risk factors (smoking, obesity, hypertension, hyperlipidemia, diabetes). Data were collected in 2016 and analyzed in 2017.Results: Preventive care utilization was lower when the number of guideline-recommended preventive services was higher. The adjusted rate of preventive care utilization decreased from 38.67 per 100 (95% CI=38.16, 39.18) in patients eligible for one guideline-recommended service to 31.59 per 100 (95% CI=31.29, 31.89) in patients eligible for two services and 25.43 per 100 (95% CI=24.68, 26.18) in patients eligible for six or more services (p-trend<0.001). Results were robust to disease risk factors and observed for all but two services (tobacco cessation, obesity reduction). However, for any given number of guideline-recommended services, patients with more disease risk factors had higher utilization rates.Conclusions: The rate of preventive care utilization was lower when the number of guideline-recommended services was higher. Prioritizing recommendations might improve utilization of high-value services. [ABSTRACT FROM AUTHOR]

Introduction: Approximately 30% of adults consume sugar-sweetened beverages (SSBs) daily, many at fast food restaurants. Researchers examined fast food purchases to better understand which consumers order SSBs, particularly large SSBs.Methods: Fast food customers in New York City and New Jersey provided receipts and participated in a survey during 2013-2014 (N=11,614). Logistic regression analyses predicted three outcomes: ordering no beverage or a non-SSB, a small/medium SSB, or a large SSB. Among respondents who ordered a beverage (n=3,775), additional analyses predicted number of beverage calories and odds of ordering an SSB. Covariates included demographic and behavioral factors.Results: Respondents aged 18-29 years were 88% more likely to order a large SSB than a non-SSB or no beverage, as compared with respondents aged ≥50 years (p<0.001). Among respondents who purchased a beverage, respondents ordered more beverage calories with a large combination meal (+85.13 kcal, p=0.001) or if the restaurant had a large cup size >30 ounces (+36.07 kcal, p=0.001). Hispanic and Asian respondents were less likely to order a large SSB (AOR=0.49 and 0.52, respectively, both p≤0.026) than non-Hispanic white respondents. Odds of ordering a large SSB were higher for respondents who ate in the restaurant (AOR=1.66, p<0.001) or stated that they chose beverage based on price (AOR=2.02, p<0.001).Conclusions: Young adults and customers of restaurants with a larger cup size were more likely to purchase SSBs, and their beverage calories increased with meal size. Increased understanding of these factors is an important step toward limiting unhealthy SSB consumption. [ABSTRACT FROM AUTHOR]

Background: To induce consumers to purchase healthier foods and beverages, some policymakers have suggested special taxes or labels on unhealthy products. The potential of such policies is unknown. Purpose: In a controlled field experiment, researchers tested whether consumers were more likely to purchase healthy products under such policies. Methods: From October to December 2011, researchers opened a store at a large hospital that sold a variety of healthier and less-healthy foods and beverages. Purchases (N=3680) were analyzed under five conditions: a baseline with no special labeling or taxation, a 30% tax, highlighting the phrase “less healthy” on the price tag, and combinations of taxation and labeling. Purchases were analyzed in January–July 2012, at the single-item and transaction levels. Results: There was no significant difference between the various taxation conditions. Consumers were 11 percentage points more likely to purchase a healthier item under a 30% tax (95% CI=7%, 16%, p<0.001) and 6 percentage points more likely under labeling (95% CI=0%, 12%, p=0.04). By product type, consumers switched away from the purchase of less-healthy food under taxation (9 percentage point decrease, p<0.001) and into healthier beverages (6 percentage point increase, p=0.001); there were no effects for labeling. Conditions were associated with the purchase of 11–14 fewer calories (9%–11% in relative terms) and 2 fewer grams of sugar. Results remained significant controlling for all items purchased in a single transaction. Conclusions: Taxation may induce consumers to purchase healthier foods and beverages. However, it is unclear whether the 15%–20% tax rates proposed in public policy discussions would be more effective than labeling products as less healthy. [Copyright &y& Elsevier]

Objective: To provide insights into the long-term impact of radical retro-pubic prostatectomy (ORRP) on lower urinary tract symptoms (LUTS) which are age and prostate dependent and adversely impact quality of life.Methods: 1995 men undergoing ORRP enrolled in a prospective longitudinal outcomes study. The American Urological Association Symptom Index was self-administered before ORRP and at predetermined time-points after surgery. A multivariate generalized linear model was used to evaluate the association of time since ORRP with American Urological Association symptom score (AUASS). McNemar's test and paired sample t-tests were used to assess whether the proportion of men with clinically significant LUTS (CSLUTS) defined by an AUASS >7 or mean AUASS differed significantly between the time-dependent assessments, respectively.Results: The 15-year mean adjusted AUASS was similar to baseline (7.00 vs 6.85, P = .66). Throughout the 15 years of follow-up, the proportion of men with CSLUTS was lower than baseline with the exception of the 3 month and 15 year assessments. Among men with baseline clinically insignificant LUTS (CILUTS), the mean adjusted AUASS at 15 years was significantly greater than baseline (6.09 vs 3.19, P < .001). Among men with baseline CSLUTS, ORRP led to a significant decrease in mean adjusted AUASS between baseline and 15 years (13.26 vs 8.67, P < .001).Conclusion: ORRP favorably affects the long-term natural history of LUTS. The long-term economic and quality of life benefits of ORRP on LUTS should inform the risks and benefits of RP for treatment of localized prostate cancer. [ABSTRACT FROM AUTHOR]

Objective To determine the association between baseline factors, post-treatment factors, and long-term satisfaction after radical prostatectomy (RP). Methods Between January 2000 and March 2009, 1425 men who underwent RP by a single surgeon were enrolled in an institutional review board–approved, prospective, longitudinal outcomes study. Baseline characteristics and post-treatment functional and oncologic outcomes were captured through 2013. Patient survey responses from 875 (61.4%) of these men were used to evaluate satisfaction with treatment outcome and treatment decision. Results Overall, 88.2% and 91.0% men were satisfied to very satisfied with treatment outcome and treatment decision, respectively. Baseline sexual function was associated with satisfaction with both treatment outcome (adjusted odds ratio [aOR] = 1.40; 95% confidence interval [CI], 1.01-1.93) and treatment decision (aOR = 1.47; 95% CI, 1.08-2.01). Among post-treatment factors, higher University of California, Los Angeles Prostate Cancer Sexual Function (aOR = 2.95; 95% CI, 2.06-4.22), University of California, Los Angeles Prostate Cancer Urinary Function (aOR = 2.38; 95% CI, 1.66-3.40), and lower urinary tract symptom scores (aOR = 1.91; 95% CI, 1.19-3.06) were predictors of satisfaction with outcome. Bother due to incontinence and sexual dysfunction, and perception of cure were independent predictors of both satisfaction with treatment outcome and treatment decision. Conclusion Nearly 90% of men are satisfied with both their treatment outcome and treatment decision after open RP. Improving long-term satisfaction after RP requires efforts to provide realistic expectations and improve functional outcomes. [ABSTRACT FROM AUTHOR]

Abstract: Background: The long-term impact of radical prostatectomy (RP) on sexual function (SF) and erectile function (EF) has important implications related to the risk-to-benefit ratio of this treatment. Objective: To determine the long-term effect of RP on male SF and EF over 10 yr of follow-up. Design, setting, and participants: This was a prospective, longitudinal outcomes study in 1836 men following RP at a university hospital. Men were invited to complete the University of California, Los Angeles, Prostate Cancer Index SF survey at baseline, 3, 6, 12, 24, 96, and 120 mo postoperatively and a survey at 4 and 7 yr postoperatively assessing global changes in their EF over the preceding 2 yr. Intervention: All men underwent open RP. Outcome measurements and statistical analysis: Multiple, generalized linear regression models were used to evaluate the association between time following RP and SF and EF scores controlling for age, prostate-specific antigen, Gleason scores, stage, nerve sparing, race, and marital status. Results and limitations: After an expected initial decline, time-dependent improvements in SF and EF were observed through 2 yr postoperatively. Overall, SF and EF were both generally stable between 2 and 10 yr following RP. The subgroups of younger men and men with better preoperative function were more likely to maintain their EF and SF through 10 yr following RP. The primary limitation is the potential bias attributable to nonresponders. Conclusions: The recovery of EF can extend well beyond 2 yr. There is a significant association between younger age and better preoperative function and the likelihood of experiencing improvements beyond 2 yr. Assessing the comparative effectiveness of treatment options for localized prostate cancer must examine SF beyond 2 yr to account for delayed treatment effects and the natural history of SF in the aging male population. [Copyright &y& Elsevier]

Abstract: Background: Urinary incontinence is a common short-term complication of radical prostatectomy (RP). Little is known about the long-term impact of RP on continence. Objective: To elucidate the long-term progression of continence after RP. Design, setting, and participants: From October 2000 through September 2012, 1788 men undergoing open RP for clinically localized prostate cancer by a single surgeon at an urban tertiary care center prospectively signed consent to be followed before RP and at 3, 6, 12, 24, 96, and 120 mo after RP. A consecutive sampling method was used and all men were included in this study. Intervention: Men underwent open RP. Outcome measurements and statistical analysis: Regression models controlled for preoperative University of California, Los Angeles–Prostate Cancer Index urinary function score (UCLA-PCI-UFS), age, prostate-specific antigen level, Gleason score, stage, nerve-sparing status, race, and marital status were used to evaluate the association of time since RP with two dependent variables: UCLA-PCI-UFS and continence status. Results and limitation: The mean UCLA-PCI-UFS declined between 2 yr and 8 yr (83.8 vs 81.8; p =0.007) and marginally between 8 yr and 10 yr (81.8 vs 79.6; p =0.036) after RP, whereas continence rate did not significantly change during these intervals. Men ≥60 yr old experienced a decline in mean UCLA-PCI-UFS between 2 yr and 8 yr (p =0.002) and a marginal decline in continence rate between 2 yr and 10 yr (p =0.047), whereas these variables did not change significantly in men <60 yr old. These outcomes are for an experienced surgeon, so caution should be exercised in generalizing these results. Conclusions: Between 2 yr and 10 yr after RP, there were slight decreases in mean UCLA-PCI-UFS and continence rates in this study. Men aged <60 yr had better long-term outcomes. These results provide realistic long-term continence expectations for men undergoing RP. [Copyright &y& Elsevier]

Objective: To assess the impact of the American Urological Association (AUA) guidelines advocating partial nephrectomy for T1 tumors guidelines on the likelihood of undergoing partial nephrectomy. Materials and Methods: We analyzed the Nationwide Inpatient Sample (NIS), a dataset encompassing 20% of all United States inpatient hospitalizations, from 2007 through 2010. Our dependent variable was receipt of radical vs partial nephrectomy (55.50, 55.51, 55.52, and 55.54 vs 55.4) for a renal mass (International Classification of Disease, 9th Revision [ICD-9] code 189.0). The independent variable of interest was time of surgery (before or after the establishment of AUA guidelines); covariates included a diagnosis of chronic kidney disease (CKD), overall comorbidity, age, race, gender, geographic region, income, and hospital characteristics. Bivariate and multivariable adjusted logistic regression was used to determine the association between receipt of partial nephrectomy and time of guideline establishment. Results: We identified 26,165 patients with renal tumors who underwent surgery. Before the guidelines, 4031 patients (27%) underwent partial nephrectomy compared to 3559 (32%) after. On multivariable analysis, undergoing surgery after the establishment of guidelines (odds ratio [OR] 1.20, 95% confidence interval [CI] 1.08-1.32, P <.01) was an independent predictor of partial nephrectomy. Other factors associated with partial nephrectomy were urban location, surgery at a teaching hospital, large hospital bed size, Northeast location, and Black race. Female gender and CKD were not associated with partial nephrectomy. Conclusion: Although adoption of partial nephrectomy increased after establishment of new guidelines on renal masses, partial nephrectomy remains an underutilized procedure. Future research must focus on barriers to adoption of partial nephrectomy and how to overcome them. [Copyright &y& Elsevier]