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Context: Every diagnosis involves an act of decision making, which requires proper evaluation of information. However, even seemingly objective information can require interpretation, often without our conscious awareness. In this cross‐cutting edge article we describe the phenomenon of leader‐driven information distortion (ID) and its implications for medical education. Information distortion: Recent research indicates that one threat to good decisions is a biased interpretation of information to favour one alternative course of action over another. Once an alternative emerges as a leader during a decision there is a strong tendency to evaluate subsequent information as supporting that option. This can occur when deciding between two competing diagnoses. It is particularly a concern if diagnostic tests provide potentially ambiguous results. This leader‐driven ID is pre‐decisional in nature, in that it develops during a decision and involves the interpretation of information available prior to the final decision or diagnosis, with different interpretations possible depending on whichever alternative is the leader. Studies reveal that the distortion bias is pervasive in decisions, and that awareness of the act of distortion is low in decision makers. Application to medical education: Empirical research has confirmed the presence of leader‐driven ID in hypothetical diagnoses made by physicians. ID creates two threats to medical decisions: First, it can make a diagnosis sticky in that it is resistant to being overturned by contradictory information. Second, it can promote unwarranted certainty in a diagnosis. The outcome may be premature closure, unnecessary testing or incorrect treatment, resulting in delayed or missed diagnoses. Methods: This paper summarises research related to leader‐driven ID in medical and professional decisions and discusses various approaches directed towards reducing ID. A framework and language are provided for thinking about and discussing ID in medical decisions and medical education. Courses of action for mitigating the effects of ID are suggested. Boyle and Purdon review what is known about leader‐driven information distortion, a decision‐bias that can lead physicans to premature closure, unnecessary testing, incorrect treatment, or overconfidence resulting in delayed or missed diagnoses. [ABSTRACT FROM AUTHOR]

Objective To review and quantify the association between endogenous and exogenous testosterone and prostate-specific antigen (PSA) and prostate cancer. Methods Literature searches were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Prospective cohort studies that reported data on the associations between endogenous testosterone and prostate cancer, and placebo-controlled randomized trials of testosterone replacement therapy (TRT) that reported data on PSA and/or prostate cancer cases were retained. Meta-analyses were performed using random-effects models, with tests for publication bias and heterogeneity. Results Twenty estimates were included in a meta-analysis, which produced a summary relative risk (SRR) of prostate cancer for an increase of 5 nmol/L of testosterone of 0.99 (95% confidence interval [CI] 0.96, 1.02) without heterogeneity ( I² = 0%). Based on 26 trials, the overall difference in PSA levels after onset of use of TRT was 0.10 ng/mL (−0.28, 0.48). Results were similar when conducting heterogeneity analyses by mode of administration, region, age at baseline, baseline testosterone, trial duration, type of patients and type of TRT. The SRR of prostate cancer as an adverse effect from 11 TRT trials was 0.87 (95% CI 0.30; 2.50). Results were consistent across studies. Conclusions Prostate cancer appears to be unrelated to endogenous testosterone levels. TRT for symptomatic hypogonadism does not appear to increase PSA levels nor the risk of prostate cancer development. The current data are reassuring, although some caution is essential until multiple studies with longer follow-up are available. [ABSTRACT FROM AUTHOR]

The pattern-recognition pathway plays an important role in infection recognition and immune responses, and previous studies have suggested an association between genetic variation in innate immunity genes and non-Hodgkin lymphoma (NHL). We evaluated NHL risk associated with genetic variation in pattern-recognition genes using data from a case-control study of NHL conducted in Connecticut women. Single nucleotide polymorphisms (SNPs) in 27 pattern-recognition genes were genotyped in 432 Caucasian incident NHL cases and 494 frequency-matched controls. Unconditional logistic regression was used to compute odds ratios (ORs) for NHL and common NHL subtypes in relation to individual SNPs and haplotypes. A gene-based analysis that adjusted for the number of tagSNPs genotyped in each gene showed a significant association with overall NHL for the MBP gene ( P = 0.028), with the diffuse large B-cell lymphoma (DLBCL) subtype for the MASP2 gene ( P = 0.011), and with the follicular lymphoma (FL) subtype for DEFB126 ( P = 0.041). A SNP-based analysis showed that MBP rs8094402 was associated with decreased risks of overall NHL (allele risk OR = 0.72, P-trend = 0.0018), DLBCL (allele risk OR = 0.72, P-trend = 0.036), and FL (allele risk OR = 0.67, P-trend = 0.021), while MASP2 rs12711521 was associated with a decreased risk of DLBCL (allele risk OR = 0.57, P-trend = 0.0042). We also observed an increased risk of FL for DEFB126 rs6054706 (allele risk OR = 1.39, P-trend = 0.033). Our results suggest that genetic variation in pattern-recognition genes is associated with the risk of NHL or specific NHL subtypes, but these preliminary findings require replication in larger studies. Mol. Mutagen. 2013. © 2012 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Study Type - Therapy (data synthesis) Level of Evidence 2b What's known on the subject? and What does the study add? The efficacy of prostate cancer screening using PSA testing is still being debated, with conflicting results in randomized trials. The study shows that, even using the hypothesis most favourable to prostate cancer screening with PSA, the net number of years of life does not favour screening. OBJECTIVE To evaluate the impact of the implementation a prostate-specific antigen (PSA) screening programme using the European Randomized Study of Screening for Prostate Cancer (ERSPC) results and taking into account the impact of prostate biopsy and over-treatment on mortality., MATERIALS AND METHODS We used a model based on the number of years of life gained and lost owing to screening, using data reported in the ERSPC., We conducted a critical evaluation of the ERSPC results and of the Swedish arm of the study., RESULTS Accounting for biopsy-specific mortality and for over-treatment, the balance of number of years of life was negative in the ERSPC study, with an estimated loss of 3.6 years of life per avoided death., The number of years of life becomes positive (real gain) only when fewer than 666 screened individuals are required to avoid one death., We found that in the Swedish arm of the ERSPC there was a biopsy rate of 40% compared with 27% in the ERSPC overall. The over-treatment rate was also greater with 4.1% compared with 3.4% overall., For the last 20 years, there has been a marked difference in prostate cancer-specific mortality between Sweden and the rest of Europe: in 2005, for the age group 65-74 the rate was 140 per 100 000 person years in Sweden and ∼80 per 100 000 for the rest of Europe., CONCLUSION Overall, PSA testing in Europe is associated with a loss in years of life and should thus not be recommended. [ABSTRACT FROM AUTHOR]

ABSTRACT We tested the ability of task conflict to improve the quality of decisions made by four-person groups. In a choice between two entrepreneurial investments, conflict was created by endowing group members with a preference for either one investment or the other. Because the decision was subjective, decision quality was necessarily judged by a process criterion, the reduction in the biased evaluation of new information to support the leading alternative. Groups in which conflict was installed exhibited less bias than individuals, who themselves exhibited less bias than groups without such conflict. Regardless of whether conflict was installed, groups that reached an early consensus exhibited the greatest information bias, while groups that experienced sustained conflict exhibited the least. Before achieving consensus, information bias was not significantly different from zero, but then rose steadily after that agreement. This result identifies one specific mechanism by which conflict can improve the process of group decisions. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The complement system plays an important role in inflammatory and immune responses, and recent evidence has suggested that it may also play a role in lymphomagenesis. We evaluated the association between genetic variation in complement system genes and risk of non-Hodgkin lymphoma (NHL) in a population-based case-control study conducted among women in Connecticut. Tag SNPs in 30 complement genes were genotyped in 432 Caucasian incident cases and 494 frequency-matched controls. A gene-based analysis that adjusted for the number of tag SNPs genotyped in each gene showed a significant association with NHL overall ( P = 0.04) as well as with diffuse large B-cell lymphoma (DLBCL) ( P = 0.01) for the C1RL gene. A SNP-based analysis showed that a C>T base substitution for C1RL rs3813729 (odds ratio (OR)CT = 0.60, 95% confidence interval (CI) = 0.42-0.87, Ptrend = 0.0062) was associated with a decreased risk of overall NHL, as well as for DLBCL (ORCT = 0.39, 95% CI = 0.20-0.73; Ptrend = 0.0034). Additionally, SNPs ( C2 rs497309, A>C and C3 rs344550, G>C) in two complement genes were positively associated with marginal zone lymphoma (MZL) and C1QG was associated with CLL/SLL, but these results were based on a limited number of cases. Our results suggest a potential role of the complement system in susceptibility to NHL; however, our results should be viewed as exploratory and further replication is needed to clarify these preliminary findings. Environ. Mol. Mutagen., 2012. Published 2011 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

Study Type - Disease prevalence (retrospective cohort) Level of Evidence 2b What's known on the subject? and What does the study add? The incidence of bladder cancer has shown a slightly decreasing trend during the past several decades. All published epidemiological studies have trended papillary transitional cell carcinoma (PTCC) and non-papillary transitional cell carcinoma (NPTCC) as one single disease called transitional cell carcinoma (TCC). This study for the first time examined the time trends by PTCC and NPTCC and found that these two histological subtypes presented different temporal trends. The study results support the hypothesis that bladder cancer is a heterogeneous disease and taking disease's heterogeneity into consideration in future epidemiological studies is essential. OBJECTIVE • To test the hypothesis that bladder cancer is a heterogeneous disease. PATIENTS AND METHODS • We examined the temporal trends of bladder cancer by histological subtype and by disease stage and grade using the National Cancer Institute's Surveillance, Epidemiology, and End Results data collected in 1973-2007. RESULTS • The age-adjusted incidence rates of bladder cancer showed a slight decrease from 1973 to 2007 (annual percentage change [APC]=−0.4, P < 0.05). • Although the age-adjusted incidence rates of non-papillary transitional cell carcinoma decreased by about 53% from 7.9 per 100 000 in 1973 to 3.7 per 100 000 in 2007 (APC =−2.2, P < 0.05), the age-adjusted incidence rates of papillary transitional cell carcinoma increased by about 56% from 6.8 per 100 000 in 1973 to 10.6 per 100 000 in 2007 (APC = 0.5, P < 0.05). • Among other rare histological subtypes, except for small cell carcinoma which showed a slightly rising trend, squamous cell carcinoma, adenocarcinoma and others all presented a decreasing trend. • Similar patterns were found for different stages (localized, regional and distant), but a dramatic increasing trend of grade IV was found between 1998 and 2007 when a corresponding decreasing trend was shown for grades I, II and III. CONCLUSION • The results support the hypothesis that bladder cancer is a heterogeneous disease and taking disease heterogeneity into consideration in future epidemiological studies is essential. [ABSTRACT FROM AUTHOR]

The author reflects on the controversy over the efficacy of prostate-specific antigen (PSA) screening. He argues that PSA screening could be used for the detection of disease, however, it did not address whether it could be used for the reduction of prostate cancer mortality rate. He cited four randomized trials that have investigated the efficacy of prostate cancer, in which two of the trials have been longed awaited. The author also discusses the details on the findings of the said trials.

Past research has shown that, to varying degrees, consumers tend to believe price is an indicator of quality, even though there is in fact often very little correlation between objective measures of price and quality (PQ). Moreover, consumers have been observed to be poorly calibrated in their knowledge of precisely which categories exhibit the strongest association between PQ for products. Given the profound changes that have occurred in consumer markets, such as the rise of the Internet and the flood of product quality information now readily available online, the present work seeks to update this line of research. Specifically, it seeks to determine if changes in the marketplace have affected (1) consumers' perceptions of the PQ relationship; and (2) consumers' PQ calibration. Data from two sources were collected and compared: (1) Subjective ratings of the PQ relation for various common products, collected using a questionnaire format in a survey of 313 US consumers; and (2) Objective estimates of the actual PQ association of the same products, gathered from independent third-party information providers who report both prices and rank-ordered quality measures for each. Results indicate that consumers today (1) continue to perceive a modest positive relationship between PQ (more so for durables, less for non-durables); and (2) are modestly calibrated for durable products. But they are much less well calibrated in the realm of non-durables, where consumers expect a positive link between price and quality in precisely those product categories in which the relationship is actually negative. Relative to past research, the calibration of consumers has apparently ‘flipped’ from non-durables to durables today. Potential explanations for this result include (1) the rise of the Internet as an information source for quality ratings of durables; (2) a higher level of perceived risk for durable goods purchases; (3) a greater tendency for durables to exhibit a positive correlation between actual quality and price; and (4) the rising quality level of private label brands, which may render prior price–quality perceptions for non-durables outdated or obsolete. [ABSTRACT FROM AUTHOR]

OBJECTIVE To update trends in kidney cancer mortality in 32 European countries and the European Union (EU) as a whole, as mortality from kidney cancer has increased throughout Europe until the late 1980s or early 1990s, and has tended to stabilise or decline thereafter. METHODS Data from the World Health Organization mortality database over the period 1980–2004 were used to compute age-specific and age-standardized (world standard) rates per 100 000 persons at all ages, and truncated to 35–64 years. RESULTS In men in the EU, mortality rates from kidney cancer peaked at 4.8 per 100 000 in 1990–1994, and declined to 4.1 (−13%) in 2000–2004. In women in the EU, the corresponding values were 2.1 in 1990–1994 and 1.8 (−17%) in 2000–2004. The main decreases were in Scandinavian countries, and other western European countries. In most eastern European countries kidney mortality rates tended to stabilise, even if values remained high, especially in the Czech Republic and Baltic countries. For kidney cancer incidence, there were decreases in rates for both sexes in Sweden throughout the 25-year calendar period considered. In the last 10 years considered, incidence rates decreased or tended to stabilise also in other northern European countries in both sexes, except in the UK. CONCLUSION The present work confirms and further quantifies the recent favourable trends in kidney cancer mortality and (to a lesser degree) in incidence across most European countries. Thus, improvements in diagnosis and treatments cannot largely explain the declines in mortality. Apart from a favourable role of reduced tobacco smoking in men, the interpretation of these trends remains undefined. [ABSTRACT FROM AUTHOR]

OBJECTIVE To evaluate the effectiveness of a well-controlled programme of early detection and treatment of prostate cancer in the population of Tyrol, Austria, where such a programme of early detection and treatment was initiated in 1988 and where prostate-specific antigen (PSA) testing was offered for free to all men aged 45–75 years from 1993. SUBJECTS AND METHODS Comparison of prostate cancer mortality rates in Tyrol and the rest of Austria was accomplished through a generalized additive model. A piecewise linear change-point Poisson regression model was used to compare mortality rates in Tyrol and the rest of Austria. Standardized mortality ratios were calculated with reference to the mortality rates in 1986–1990. RESULTS In all, 86.6% of eligible men have been tested at least once since 1993. Cancer deaths in Tyrol in 2005 were 54% (95% confidence interval [CI] 34–69%) lower than expected compared with 29% (95% CI 22–35%) in the rest of Austria. The decreasing trend in prostate cancer mortality was significantly greater in Tyrol compared with the rest of Austria ( P = 0.001). A significant migration to lower stage disease occurred and radical prostatectomy was associated with low morbidity. CONCLUSIONS In the Tyrol region where treatment is freely available to all patients, where widespread PSA testing and treatment with curative intent occurs, there was a reduction in prostate cancer mortality rates which was significantly greater than the reduction in the rest of Austria. This reduction in prostate cancer mortality is most probably due to early detection, consequent down-staging and effective treatment of prostate cancer. [ABSTRACT FROM AUTHOR]

OBJECTIVE To use a large population-based case-control study to test the association between the common genetic variant rs743572 (−34 T to C), prostate cancer risk and circulating levels of several hormones. SUBJECTS AND METHODS A previous meta-analysis concluded that reported associations between rs743572 in the promoter of CYP17A1 and prostate cancer risk might reflect publication bias, but a few recent studies reported associations with prostate cancer risk and data suggesting that rs743572 is functional. We genotyped 824 prostate cancer cases and 737 population-based controls, and applied unconditional logistic regression to estimate the association between rs743572 and prostate cancer risk. We also used linear regression of transformed testosterone, androstanediol glucuronide, dehydroepiandrosterone sulphate, androstenedione, sex hormone-binding globulin and oestradiol (circulating levels) measured for controls, to estimate the association between these levels and rs743572. The linear models were adjusted for age and laboratory batch. RESULTS Men with different genotypes had similar circulating levels of all the hormones measured (all P < 0.05). In the case-control comparison using unconditional unadjusted logistic regression, the odds ratios (95% confidence interval) for prostate cancer were 1.07 (0.87–1.32) and 0.94 (0.71–1.25) for the dominant and recessive models, respectively, and for the co-dominant model, 1.10 (0.88–1.36) and 0.99 (0.73–1.35) for carriers of one or two copies of the C allele, respectively. There was no evidence of heterogeneity in the odds ratios by tumour stage (all P > 0.3) and grade (all P > 0.3). CONCLUSION The results of the present study are consistent with the conclusions of the previous meta-analysis, and suggest that rs743572 has no role in the risk of prostate cancer for men of Caucasian origin. [ABSTRACT FROM AUTHOR]

We conducted a systematic meta-analysis of observational studies on cigarette smoking and cancer from 1961 to 2003. The aim was to quantify the risk for 13 cancer sites, recognized to be related to tobacco smoking by the International Agency for Research on Cancer (IARC), and to analyze the risk variation for each site in a systematic manner. We extracted data from 254 reports published between 1961 and 2003 (177 case-control studies, 75 cohorts and 2 nested case-control studies) included in the 2004 IARC Monograph on Tobacco Smoke and Involuntary Smoking. The analyses were carried out on 216 studies with reported estimates for 'current' and/or 'former' smokers. We performed sensitivity analysis, and looked for publication and other types of bias. Lung (RR = 8.96; 95% CI: 6.73-12.11), laryngeal (RR = 6.98; 95% CI: 3.14-15.52) and pharyngeal (RR = 6.76; 95% CI: 2.86-15.98) cancers presented the highest relative risks (RRs) for current smokers, followed by upper digestive tract (RR = 3.57; 95% CI: 2.63-4.84) and oral (RR = 3.43; 95% CI: 2.37-4.94) cancers. As expected, pooled RRs for respiratory cancers were greater than the pooled estimates for other sites. The analysis of heterogeneity showed that study type, gender and adjustment for confounding factors significantly influence the RRs estimates and the reliability of the studies. © 2007 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

OBJECTIVE To update trends in bladder cancer mortality in 32 European countries and the European Union (EU) as a whole, as mortality from bladder cancer has been declining in most of Western Europe since the early 1990s, but it has still been increasing in several central and eastern European countries up to the mid 1990s. METHODS We used data from the World Health Organization (WHO) database over the period 1970–2004. Significant changes in mortality rates were identified using join-point regression analysis. RESULTS In the EU overall (27 countries), bladder cancer mortality rates (age-standardized, world standard population) were stable up to the early 1990s at ≈ 7/100 000 men and 1.5/100 000 women, and declined thereafter by ≈ 16% in men and 12% in women, to reach values of 6 and 1.3/100,000, respectively, in the early years of the present decade. Over recent years, most countries showed decreasing trends, except Croatia and Poland in both sexes, Romania in men and Denmark in women. Truncated rates at age 35–64 years were lower in both sexes and trends for men were more favourable, with an overall decrease by >21% during the last decade. Join point regression analysis indicates that, for most countries, the trends were more favourable over recent calendar periods. CONCLUSION The favourable trends in men are partly or largely due to the recent declines in the prevalence of smoking in European men, together with reduced occupational exposure to occupational carcinogens. The decreases in women are more difficult to explain. Better control of urinary tract infections has probably played a role, while the role of diet and other potential urinary tract carcinogens remains undefined. [ABSTRACT FROM AUTHOR]

Controversy exists over the significance of associations between the SRD5A2 (5α-reductase type 2) polymorphisms, A49T and V89L, and risk of prostate cancer. These potentially functional polymorphisms may alter life-long exposure to androgens with subsequent effects on male health and aging. The aim of this study was to examine the association of these variants with prostate cancer risk, plasma hormone levels and androgenetic alopecia. Subjects include 827 cases and 736 controls from an Australian population-based case-control study of prostate cancer. Information on prostate cancer risk factors and patterns of balding were collected. Plasma levels of testosterone, 3α-diol glucuronide (3α-diolG), dehydroepiandrosterone sulfate, androstenedione, sex hormone-binding globulin and estradiol were measured for controls. No associations with the V89L polymorphism were found. Carriers of the rarer A49T A allele were at a 60% higher risk of prostate cancer (OR = 1.60; 95% CI 1.09-2.36; p = 0.02) and 50% lower risk of vertex and frontal balding ( p = 0.03) compared with men homozygous for the more common G allele. Although we found little evidence of association between this variant and plasma levels of 5 measured androgens, circulating 3α-diolG levels were 34% lower in A49T A allele carriers ( p < 0.0001). Our study provides evidence that the SRD5A2 A49T A variant is associated with an increased risk of prostate cancer, lower levels of circulating 3α-diolG and decreased risk of baldness. These findings raise important questions with respect to previous assumptions concerning hormonal influences on prostate cancer risk in ageing males. © 2006 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

In a large epidemiological study, authors investigated the effect of LUTS on quality of life among various cultures. They showed a close association between the two, and that the effect of having moderate symptoms has a similar effect on quality of life as diabetes, hypertension or cancer, and that having severe symptoms had a similar effect as a heart attack or stroke. OBJECTIVES To investigate the effect of lower urinary tract symptoms (LUTS) on quality of life (QoL) and to determine its extent across a variety of cultures, and the confounding effects of self-reported comorbidities and demographics. SUBJECTS AND METHODS Data were obtained from two population-based studies in five cities: UREPIK (Boxmeer, the Netherlands; Auxerre, France; Birmingham, UK; and Seoul, Korea) and the Boston Area Community Health (BACH) study (Boston, USA). UREPIK used stratified random samples of men aged 40–79 years. BACH used a multistage stratified cluster sample to randomly select adults aged 40–79 years. QoL was assessed using a standard Medical Outcomes Study–Short Form 12 (SF-12, mental and physical health component scores); LUTS was assessed using the International Prostate Symptom Score (IPSS). The association between QoL and IPSS, associated illnesses, and lifestyle factors was investigated using weighted regression. RESULTS The UREPIK studied 4800 men aged 40–79 years; BACH recruited 1686 men aged 40–79 years. The prevalence of LUTS, defined as an IPSS of ≥8, varied by city ( P < 0.001), with Auxerre reporting a prevalence (se) of 18.1 (1.2)%, Birmingham 25.6 (1.5)%, Boston 25.1 (1.6)%, Boxmeer 21.2 (1.3)%, and Seoul 19.0 (1.2)%. Overall, this was similar to the reported rate of high blood pressure. Severe LUTS, defined as an IPSS of ≥20, affected ≈ 3.3% of the age group; this was roughly similar to stroke (2.2%), cancer (4.5%), or heart attack (4.5%) and less than half as much as diabetes (8.6%). A 10-point increase in IPSS was associated with a 3.3 (0.3)-point reduction in SF-12 physical health component score, with the same effect in all cities ( P = 0.682 for the interaction test). This was more than the physical health component score reduction caused by cancer, diabetes, or high blood pressure (2 points each), but less than stroke or heart attack (6 points). The comorbidities had no significant impact on SF-12 mental health component score (other than a heart attack, that had a 1.8-point reduction). A 10-point increase in IPSS was associated with a 3.4 (0.6)-point reduction of the mental health component score in the four western cities and a 1.4 (0.3)-point reduction in Seoul. CONCLUSIONS Increasingly severe LUTS is associated with a lower QoL. The effect of moderate LUTS on QoL physical health component score is similar to that of having diabetes, high blood pressure or cancer, while the effect of severe LUTS is similar to a heart attack or stroke. These changes were consistent across cultures. This analysis shows the magnitude and consistency of the effects of LUTS on QoL. While these patients might be seen by several types of practitioners, it is likely that urologists will be in the best position to recognize the true impact of LUTS on a patient’s QoL, to be aware of the effects of therapies for LUTS on QoL, and to ensure that colleagues in other disciplines recognize the importance of these symptoms and their treatment. [ABSTRACT FROM AUTHOR]

The Hungarian Revolution and the military phase of the Suez Crisis occurred virtually contemporaneously in the last week of October and the first week of November 1956. While a great deal of historical research and writing has been done on the two crises individually, there has been relatively little investigation of the interconnection between the two episodes. The interconnections were of particular importance in influencing the Soviet decision to use brutal military force to suppress the Hungarian Revolution and in explaining the depth of bitterness in the rift between Britain and the United States over the Suez Crisis. [ABSTRACT FROM AUTHOR]

To determine the prevalence of female urinary incontinence (UI) and its impact on quality of life.In a Dutch national postal questionnaire survey, 1460 spouses of 1771 men in the town of Boxmeer, age-stratified and randomly selected, were asked to participate. The prevalence of UI in the women was assessed in two ways. First, a total score on a short UI-specific questionnaire differentiated them into three groups, i.e. no symptoms (score 0–2), minimally (3–6) or severely incontinent (7–14). Second, a self-reported UI prevalence was calculated by asking respondents if they ever had urine loss. To conform to the International Continence Society standard definition, spouses were also asked to complete a general (Short Form-12) and lower urinary tract disease-specific quality-of-life questionnaire, and were asked about their need to seek help.The questionnaires were returned by 1071 women (mean age 57 years, range 29–79; response rate 73%); 34% were regarded as minimally and 12% as severely incontinent. The self-reported UI rate was 40%. Disease-specific and general quality of life was significantly lower for women with UI than for those with minimal or no urine loss; 38% of incontinent respondents had consulted a physician for their UI, and among respondents with minimal complaints this was 28%.Up to 46% of the married female population had some degree of UI, and severe UI significantly compromised their quality of life. [ABSTRACT FROM AUTHOR]

This section opens with two meta-analyses, the first into the use of transurethral needle ablation (TUNA) for treating symptomatic BPH and the second into comparative trials between transurethral electrovaporization and TURP. The first of these meta-analyses showed that despite a variety of trial methods, not all were satisfactory. TUNA was effective in improving symptoms and flow rates. The place of this therapy in the treatment of symptomatic BPH is suggested. In the second meta-analysis, methodological shortcomings of the various trials are again discussed. The possible advantages of both of these treatments are described, but the authors suggest that there is a need for future well-designed trials with extended follow-up. This seems to be the ultimate conclusion of a significant number of the meta-analysis into technological treatments for symptomatic BPH. To investigate the short- and long-term effectiveness of transurethral needle ablation (TUNA) of the prostate for clinical benign prostatic hyperplasia (BPH), using a meta-analysis of all clinical studies involving TUNA. Data were extracted from two randomized trials, two non-randomized observational protocols and 10 single-arm studies conducted on TUNA, according to a determined protocol. The meta-analysis was based on the change in the mean score at the end of study from that at baseline. The estimation of the effects from the meta-analysis used a multilevel model including random effects for the studies. In all studies the patients recruited had severe lower urinary tract symptoms and a mean International Prostate Symptom Score (IPSS) of > 20 before treatment. The effect of TUNA was to halve the mean IPSS at 1 year after treatment and, although there was a slight tendency for the IPSS to increase in all arms from year 1 to year 5, this decrease by half was maintained at 5 years. The maximum urinary flow rate (Qmax) also increased by ≈ 70% from baseline to 1 year and in virtually all studies the mean Qmax approached or exceeded 15 mL/s. Although there was a tendency for Qmax to decline slightly over time, the mean Qmax 5 years after treatment was > 50% over baseline. This meta-analysis shows that TUNA is an effective and minimally invasive treatment for men with clinical BPH, even when the symptoms are severe. There is a significant improvement in symptoms and flow rate after 1 year which persists for at least 5 years. TUNA therapy would appear to be an alternative to surgery and an attractive option for men who do not wish to undergo long-term medical therapy, are poor candidates for surgery or are concerned about the side-effects of TURP. [ABSTRACT FROM AUTHOR]