Are Hand Preference and Sexual Orientation Possible Predicting Factors for Finasteride Adverse Effects in Male Androgenic Alopecia?

Sexual side effects of finasteride seem to be redoubtable, being encountered not only during therapy but also after treatment cessation. Consequently, any possible clinical/paraclinical elements that might predict these adverse effects would be useful in the selection of a therapeutic strategy for male androgenic alopecia. Previous published studies show that some compounds that interfere with sexual hormones can decrease sexual activation and response, according to hand preference (as reported for finasteride and tamoxifen) and according to sexual orientation (as noted for bicalutamide). Our preliminary published data and the arguments presented here suggest that these two individual parameters might be used by dermatologists in the therapeutic approach of male androgenic alopecia, so as to alert specific subsets of men, prior to treatment, of the potential increased risk for developing adverse effects to finasteride

The management of pulmonary tuberculosis in the Border sub-region, 1983

In order to study the management of pulmonary tuberculosis among black and coloured adults in the Border region of South Africa in 1983, a historical inception cohort representative of tuberculosis hospitals and local authority health services was followed up over 15 months to assess how efficiently the national responsibility is discharged in a region. About 75% of patients were sputum-positive, and 81% were judged to have had active pulmonary tuberculosis. The mean service delay after radiography was about 1~ weeks. About 26% of patients were treated with a rifampicin regimen, 50% were frequent attenders and 41% completed treatment, although about 21% were still being treated after 15 months. There was a deficiency of laboratory information for diagnosis and monitoring of response to treatment. Periodic cohort evaluation and improvement of diagnostic efficiency, of peripheral use of laboratories, and of spending on community service infrastructure are essential for closing the gap between policies and implementation

The building design process: an investigation into productivity

In this study the role of the architect is investigated in the light of findings in the fields of sociology, psychology and organizational behaviour. The objective is to make recommendations as to how the expanding role of the modern architect can be accompanied by improved performance, especially in his substantive role of building design. Initially the organizational and procedural context of the building design activity is defined as the meaning and importance of productivity in this activity explained. The centrality of the human creative process as an input in design is then established and it is shown that the organizational environments within which designers work have a direct influence on their capacity and their motivation to engage in the creative process. The structure of project organizations in the building industry is then investigated and is shown to be quite different from the situation as it is assumed to be by the architectural profession as a whole. It is demonstrated that, due to changes in technology and increased expectations in society, project organizations(which constitute the primary organizational environment for architects) are increasingly characterized by groups in which members simultaneously compete and co-operate in the initial stages of project procurement. Research on decision-making groups, particularly those in complex interwoven organizations, is reviewed and the nature and importance of the task known as project management explained. A comparison of this task with the work content of the non-design role assumed by architects under the traditional, hierarchic form of project organization reveals that it requires thought and action at much higher levels and an increased ability to manage human Interaction. The response by the architectural profession is then studied. It is shown that, despite previous indications that the competence and integrity of members of the profession may be compromised by enlargement of the role of the architect, little hesitancy has been shown by the profession in accepting, concurrently, both design and project management responsibilities. It is shown, in addition, that the acceptance of this dual responsibility has been accompanied by a deterioration in the performance of members of the architectural profession. A review of educational and control strategies employed by the professional institutes in an attempt to remedy this situation indicates that these strategies possess severe limitations and disadvantages. An analysis of the reasons for the deterioration in the performance of architects - using two broad approaches in the study of leadership – indicates that the present deficiencies in both the competence and integrity of members of the architectural profession arise from the simultaneous assumption of content (design) and process (management) roles by the bulk of the profession. An evaluation of attempts made to structure the profession it three levels, that of the internal organization of the architectural practice, that of the total professional group and that of the project organization as a whole, indicates that the most promising of these attempts, namely the latter, is constrained by the institutional framework of the architectural profession. Criteria for a new framework are isolated and the structure of the legal profession, which is sub-divided very much along the lines suggested by leadership research, is analysed to establish to what degree it meets these criteria. It is concluded that, despite some disadvantages with regard to flexibility, the division of this profession into two Interdependent sub-professions meets many of the criteria set up for the architectural profession. The thesis which emerges from this study is that a division of the architectural profession into two interrelated sub-sections, along the lines of the legal profession, is necessary if the performance of architects is to be enhanced, especially in their fundamental role of building design. In conclusion, a brief review of the implications of this thesis with respect to its implementation in practice and its effect on education are studied. In addition, directions for further research are indicated

Which lipid measurement should we monitor? An analysis of the LIPID study

OBJECTIVES: To evaluate the optimal lipid to measure in monitoring patients, we assessed three factors that influence the choice of monitoring tests: (1) clinical validity; (2) responsiveness to therapy changes and (3) the size of the long-term ‘signal-to-noise’ ratio. DESIGN: Longitudinal analyses of repeated lipid measurement over 5 years. SETTING: Subsidiary analysis of a Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) study—a clinical trial in Australia, New Zealand and Finland. PARTICIPANTS: 9014 patients aged 31–75 years with previous acute coronary syndromes. INTERVENTIONS: Patients were randomly assigned to 40 mg daily pravastatin or placebo. PRIMARY AND SECONDARY OUTCOME MEASURES: We used data on serial lipid measurements—at randomisation, 6 months and 12 months, and then annually to 5 years—of total cholesterol; low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol and their ratios; triglycerides; and apolipoproteins A and B and their ratio and their ability to predict coronary events. RESULTS: All the lipid measures were statistically significantly associated with future coronary events, but the associations between each of the three ratio measures (total or LDL cholesterol to HDL cholesterol, and apolipoprotein B to apolipoprotein A1) and the time to a coronary event were better than those for any of the single lipid measures. The two cholesterol ratios also ranked highly for the long-term signal-to-noise ratios. However, LDL cholesterol and non-HDL cholesterol showed the most responsiveness to treatment change. CONCLUSIONS: Lipid monitoring is increasingly common, but current guidelines vary. No single measure was best on all three criteria. Total cholesterol did not rank highly on any single criterion. However, measurements based on cholesterol subfractions—non-HDL cholesterol (total cholesterol minus HDL cholesterol) and the two ratios—appeared superior to total cholesterol or any of the apolipoprotein options. Guidelines should consider using non-HDL cholesterol or a ratio measure for initial treatment decisions and subsequent monitoring

Early CRT monitoring using time-domain optical coherence tomography does not add to visual acuity for predicting visual loss in patients with central retinal vein occlusion treated with intravitreal ranibizumab:A secondary analysis of trial data

Our primary purpose was to assess the clinical (predictive) validity of central retinal thickness (CRT) and best corrected visual acuity (BCVA) at 1 week and 1 month after starting treatment with ranibizumab for central retinal vein occlusion. The authors also assessed detectability of response to treatment

Colorectal cancer screening: Why immunochemical fecal occult blood tests may be the best option

Abstract Background:There are many test options available for colorectal cancer screening. The choice of test relates to the objectives of those offering or considering screening. Discussion:While all screening programs aim to detect disease early in order to improve the length and/or quality of life for the individual, some organizations and individuals prefer screening tests that offer the opportunity for cancer prevention. Others favor maximizing participation or the opportunity for shared decision-making, including discussion of information on test quality and availability. We propose three additional objectives for screening: minimizing harms, optimizing economic efficiency and maximizing equity of access to screening. Summary:Applying these objectives to colorectal cancer screening, we advocate the use of immunochemical FOBTs as the preferred screening strategy, as it satisfies all three of these important objectives. Keywords:Screening objectives, Colorectal cancer, Fecal occult blood testing, Harm minimization, Equity, Economic efficiency, Prevention, Participatio

Monitoring adherence to drug treatment by using change in cholesterol concentration: Secondary analysis of trial data

Objective: To estimate the accuracy of monitoring cholesterol concentration for detecting non-adherence to lipid lowering treatment. Design: Secondary analysis of data on cholesterol concentration in the LIPID (long term intervention with pravastatin in ischaemic disease) study by using three measures of non-adherence: discontinuation of treatment, allocation to placebo arm, less than 80% of pills taken. Setting: Randomised placebo controlled trial in Australia and New Zealand. Participants: 9014 patients with previous coronary heart disease. Interventions: Pravastatin 40 mg or placebo daily. Main outcome measures: Sensitivity, specificity, area under the receiver operating characteristics (ROC) curve, post-test probability. Results: Monitoring of cholesterol concentration had modest ability for detecting complete non-adherence. One year after the start of treatment, half (1957/3937) of the non-adherent patients and 6% (253/3944) of adherent patients had a rise in concentration of low density lipoprotein cholesterol. Accuracy was reasonable (area under the curve 0.89). Cholesterol monitoring, however, had weak ability for detecting partial non-adherence. One year after the start of treatment,16%(34/213) of partially adherent and 4% (155/3585) of fully adherent patients had a rise in concentration of low density lipoprotein cholesterol. Accuracy was poor (area under the curve 0.65). For typical pre-test probabilities of non-adherence ranging from low (25%) to high (75%), the post-test probabilities indicate continuing uncertainty after lipid testing. A patient with no change in low density lipoprotein cholesterol concentration has a post-test probability of being completely non-adherent of between 67% and 95% and a post-test probability of being partially non-adherent of between 48% and 89%. A patient with a decrease in concentration of 1.0 mmol/L has a post-test probability of being completely non-adherent of between 7% and 40% and a post-test probability of being partially non-adherent of between 21% and 71%. Conclusions: Monitoring concentration of low density lipoprotein (or total) cholesterol has modest ability to detect complete non-adherence or non-persistence with pravastatin treatment and weak ability to detect partial non-adherence. Results of monitoring should be considered as no more than an adjunct to careful discussion with patients about adherence

Patients' perspectives of long-term follow-up for localised cutaneous melanoma

Background Little is known about the value of long-term follow-up for localised cutaneous melanoma from the patients' perspective. This study aimed to explore the benefits and potential downsides of follow-up; feelings about changes to frequency of follow-up, and patient-centred recommendations for improving follow-up care. Methods Qualitative analysis of 29 in-depth interviews conducted with Australian patients undergoing long-term follow-up after surgical treatment of stage I/II melanoma. Results Patient-perceived benefits of follow-up included reassurance, early detection of new melanomas and non-melanoma skin cancers, education about skin self-examination, the opportunity to ask questions, and reinforcement of ‘sunsafe’ behaviours. Downsides included anxiety leading up to and during follow-up visits; inconvenience of travel to attend visits; and lost work time. Patients varied in their engagement with skin self-examination, and their views on multiple skin excisions, but highly valued access to specialists for unscheduled visits. Most patients felt their follow-up intervals could be extended to 12 months if recommended by their clinician. Conclusion The benefits and potential downsides of follow-up should be discussed with patients when deciding on a melanoma follow-up plan to achieve a balance between inducing additional patient anxiety and providing reassurance. Follow-up intervals of 12 months appear to be acceptable to patients

When to remeasure cardiovascular risk in untreated people at low and intermediate risk: Observational study

Objective: To estimate the probability of becoming high risk for cardiovascular disease among people at low and intermediate risk and not being treated for high blood pressure or lipid levels. Design: Observational study. Setting: General communities in Japan and the United States. Participants: 13 757 participants of the Tokyo health check-up study and 3855 of the Framingham studies aged 30-74 years with complete data on risk equation covariates, not receiving blood pressure or cholesterol lowering treatment, and with an estimated risk of cardiovascular disease 20% using the Framingham equation. Results: At baseline most participants had 10% probability of crossing the treatment threshold at one year for the 15-<20% baseline risk group. Conclusions: Decisions on the frequency of remeasuring for cardiovascular risk should be made on the basis of baseline risk. Repeat risk estimation before 8-10 years is not warranted for most people initially not requiring treatment. However, remeasurement within a year seems warranted in those with an initial 15-<20% risk