Virus genomes reveal factors that spread and sustained the Ebola epidemic.

The 2013-2016 West African epidemic caused by the Ebola virus was of unprecedented magnitude, duration and impact. Here we reconstruct the dispersal, proliferation and decline of Ebola virus throughout the region by analysing 1,610 Ebola virus genomes, which represent over 5% of the known cases. We test the association of geography, climate and demography with viral movement among administrative regions, inferring a classic 'gravity' model, with intense dispersal between larger and closer populations. Despite attenuation of international dispersal after border closures, cross-border transmission had already sown the seeds for an international epidemic, rendering these measures ineffective at curbing the epidemic. We address why the epidemic did not spread into neighbouring countries, showing that these countries were susceptible to substantial outbreaks but at lower risk of introductions. Finally, we reveal that this large epidemic was a heterogeneous and spatially dissociated collection of transmission clusters of varying size, duration and connectivity. These insights will help to inform interventions in future epidemics

Prostate cancer and QOL: impact of treatment, disease burden and psychosocial interventions

Prostate cancer is highly prevalent and the second leading cause of cancer-related deaths in American men. Treatment of localized prostate cancer is highly effective but can result in urinary, bowel and sexual dysfunction, undermining quality of life. Within 5 years of treatment, approximately a third of men will have a rising prostate-specific antigen level necessitating hormonal therapy which has a broad range of detrimental side effects. Moreover, the impact of hormonal therapy may overlay existing issues (e.g., comorbid illness) common to older men. Men with advanced disease experience significant disease- (e.g., metastasis) and treatment-related impairments, which may further compromise quality of life. A substantial amount of literature indicates that cancer patients benefit significantly from psychosocial interventions, and psychosocial factors may serve to buffer prostate cancer patients from some disease- and treatment-related decrements in quality of life. While very few randomized clinical trials have been conducted with prostate cancer patients, recent results suggest that such interventions improve coping skills, increase prostate cancer knowledge, reduce treatment-related disruption of daily activities, diminish bother associated with sexual problems and enhance global quality of life. In order to better understand who benefits most from psychosocial interventions, additional studies are needed to more fully assess the potential mediators and moderators of these intervention findings

Exercise and well-being: a review of mental and physical health benefits associated with physical activity

This review highlights recent work evaluating the relationship between exercise, physical activity and physical and mental health. Both cross-sectional and longitudinal studies, as well as randomized clinical trials, are included. Special attention is given to physical conditions, including obesity, cancer, cardiovascular disease and sexual dysfunction. Furthermore, studies relating physical activity to depression and other mood states are reviewed. The studies include diverse ethnic populations, including men and women, as well as several age groups (e.g. adolescents, middle-aged and older adults). Results of the studies continue to support a growing literature suggesting that exercise, physical activity and physical-activity interventions have beneficial effects across several physical and mental-health outcomes. Generally, participants engaging in regular physical activity display more desirable health outcomes across a variety of physical conditions. Similarly, participants in randomized clinical trials of physical-activity interventions show better health outcomes, including better general and health-related quality of life, better functional capacity and better mood states. The studies have several implications for clinical practice and research. Most work suggests that exercise and physical activity are associated with better quality of life and health outcomes. Therefore, assessment and promotion of exercise and physical activity may be beneficial in achieving desired benefits across several populations. Several limitations were noted, particularly in research involving randomized clinical trials. These trials tend to involve limited sample sizes with short follow-up periods, thus limiting the clinical implications of the benefits associated with physical activity

Physical activity interventions in the elderly: cancer and comorbidity

The relationship among age, comorbidity, and physical activity have been relatively understudied among breast, colorectal, and prostate cancer populations despite their known impact on morbidity and mortality. In this article, we review evidence supporting the efficacy of physical activity interventions in improving cardiovascular risk groups, the elderly and cancer patients. Preliminary studies conducted with older patients suggest that physical activity interventions can reduce fatigue, elevate mood, improve physical functioning, reduce physical, role limitations, decrease falls, attenuate losses in bone density, promote weight loss, and modify CHD risk factors. Although relatively few randomized clinical trials have assessed the efficacy of physical activity interventions in cancer patients, the research suggests that these interventions can have both physical and mental health benefits. The implications and limitations of these findings are discussed. Further studies that use larger sample sizes and examine possible moderating variables, such as age, on the efficacy of such interventions are needed

Ethnicity and determinants of quality of life after prostate cancer treatment

To examine the quality of life (QOL) in a sample of men recently treated for localized prostate cancer to determine whether minority men are at greater risk of decrements in QOL and to identify factors that might explain disparities in QOL outcomes. The relationship between ethnicity and QOL was evaluated in a diverse sample of 204 men (85 non-Hispanic white, 37 African-American, and 82 Hispanic men). We also assessed associations with other factors known to be related to QOL (ie, sociodemographic, medical, and health behavior factors). Hierarchical regression analysis was used to assess the relationship between ethnicity and QOL. Factors that were anticipated to explain the ethnic differences in QOL were then added in stepwise analyses. Ethnic group membership was related to QOL such that minority men had lower QOL than non-Hispanic white men. In subsequent steps, the association between ethnic group membership and QOL was partially mediated by sociodemographic, medical, and health behavior factors, with each factor adding significant incremental variance (5%, 5%, and 17%, respectively). Three variables remained significant in the final model, which explained 37% of the variance in QOL scores: medical comorbidity, physical activity, and sleep functioning. Health behaviors appear to be strongly related to men’s QOL after prostate cancer treatment. Intervention studies aimed at improving QOL should include a brief assessment of health behaviors and may want to incorporate intervention components designed to address physical activity and sleep functioning

Physical activity and sexual functioning after radiotherapy for prostate cancer: Beneficial effects for patients undergoing external beam radiotherapy

To evaluate, in a cross-sectional study, the relationships among physical activity, sexual functioning, and treatment type for 111 men who had undergone radiotherapy for localized prostate cancer within the past 18 months. Physical activity preserves the sexual functioning capacity of older men. However, little information exists regarding the association of physical activity with sexual functioning after treatment for localized prostate cancer. We tested the main effects of physical activity and treatment procedure, as well as their interaction, using hierarchical regression analysis. We hypothesized that greater physical activity would relate to better reported sexual functioning and that this relationship would be moderated by the type of medical treatment. After controlling for age, medical comorbidity, fatigue, and urinary and bowel functioning, more physical activity was significantly associated with better sexual functioning, and the interaction of physical activity and treatment procedure added a significant amount of explained variance. Overall, 35% of the variance in sexual functioning was accounted for by the model. Post hoc tests of moderation revealed that men who underwent external beam radiotherapy had significantly greater sexual functioning scores as physical activity increased but the effect of physical activity on sexual function after brachytherapy and combination therapy was nonsignificant. Physical activity was positively correlated with sexual functioning for those who underwent external beam radiotherapy. These relationships should be replicated and explored in a larger, longitudinal sample to ascertain whether the effects of physical activity in this at-risk population extend over time and protect men from treatment-related decrements in sexual functioning

Psychosocial and sociodemographic correlates of benefit-finding in men treated for localized prostate cancer

Prostate cancer (PCa) treatment involves decrements in quality of life such as decreased sexual functioning and urinary/bowel incontinence. Prior work in other cancers has identified positive consequences (e.g. personal growth) following diagnosis and treatment, a phenomenon that has been referred to as benefit-finding (BF) and positively related to quality of life. The present study evaluated demographic and psychosocial correlates of BF in men treated for localized PCa. Participants were 250 men who were 6-18 months post treatment, who completed measures of coping strategies, perceived social support, and BF. In regression models both coping and social support were positively related to BF scores, even after controlling for income, education and ethnic identification. Active coping strategies and greater perceived social support are important correlates of greater BF following localized PCa treatment

Sexual Bother in Men with Advanced Prostate Cancer Undergoing Androgen Deprivation Therapy

Men with advanced prostate cancer (APC) undergoing androgen deprivation therapy (ADT) often experience distressing sexual side effects. Sexual bother is an important component of adjustment. Factors associated with increased bother are not well understood. This study sought to describe sexual dysfunction and bother in APC patients undergoing ADT, identify socio‐demographic and health/disease‐related characteristics related to sexual bother, and evaluate associations between sexual bother and psychosocial well‐being and quality of life (QOL). Baseline data of a larger psychosocial intervention study was used. Pearson's correlation and independent samples t‐test tested bivariate relations. Multivariate regression analysis evaluated relations between sexual bother and psychosocial and QOL outcomes. The Expanded Prostate Cancer Index Composite sexual function and bother subscales, Center for Epidemiologic Studies Depression Scale, Functional Assessment of Cancer Therapy—General, and Dyadic Adjustment Scale were the main outcome measures. Participants (N = 80) were 70 years old (standard deviation [SD] = 9.6) and reported 18.7 months (SD = 17.3) of ADT. Sexual dysfunction (mean = 10.1; SD = 18.0) was highly prevalent. Greater sexual bother (lower scores) was related to younger age (β = 0.25, P = 0.03) and fewer months of ADT (β = 0.22, P = 0.05). Controlling for age, months of ADT, current and precancer sexual function, sexual bother correlated with more depressive symptoms (β = −0.24, P  = 0.06) and lower QOL (β = 0.25, P = 0.05). Contrary to hypotheses, greater sexual bother was related to greater dyadic satisfaction (β = −0.35, P = 0.03) and cohesion (β = −0.42, P = 0.01). The majority of APC patients undergoing ADT will experience sexual dysfunction, but there is variability in their degree of sexual bother. Psychosocial aspects of sexual functioning should be considered when evaluating men's adjustment to ADT effects. Assessment of sexual bother may help identify men at risk for more general distress and lowered QOL. Psychosocial interventions targeting sexual bother may complement medical treatments for sexual dysfunction and be clinically relevant, particularly for younger men and those first starting ADT. Benedict C, Traeger L, Dahn JR, Antoni M, Zhou ES, Bustillo N, and Penedo FJ. Sexual bother in men with advanced prostate cancer undergoing androgen deprivation therapy. J Sex Med 2014;11:2571–2580

Fatalism, medical mistrust, and pretreatment health-related quality of life in ethnically diverse prostate cancer patients

Few studies have examined the impact of cultural processes prevalent in minority ethnic groups such as cancer fatalism and medical mistrust on health-related quality of life (HRQoL) following a cancer diagnosis. The present study examined relationships among ethnicity, HRQoL, and two possible cultural vulnerability factors-fatalistic attitudes and medical mistrust-among an ethnically diverse sample of men with prostate cancer (PC) prior to undergoing active treatment. A total of 268 men with localized PC (30% African American, 29% Hispanic, and 41% non-Hispanic White) were assessed cross-sectionally prior to active treatment. Path analyses examined relationships among ethnicity, vulnerability factors, and HRQoL. Ethnicity was not related to HRQoL after controlling for relevant covariates. Hispanic men reported greater cancer fatalism compared with non-Hispanic White men (β = 0.15, p = 0.03), and both Hispanics (β = 0.19, p < 0.01) and African Americans (β = 0.20, p < 0.01) reported greater medical mistrust than non-Hispanic Whites. Fatalism demonstrated a trend toward negatively impacting physical well-being (β = -0.12, p = 0.06), but was not significantly related to emotional well-being (β = -0.10, p = 0.11). Greater medical mistrust was associated with poorer physical (β = -0.14, p = 0.03) and emotional well-being (β = -0.13, p = 0.04). Results indicate that fatalistic attitudes and medical system mistrust were more prevalent among minority men. Less trust in the medical system was associated with poorer physical and emotional well-being. Attention to perceptions of the healthcare system and its relation to HRQoL may have implications for targeting culturally driven attitudes that may compromise adjustment to a PC diagnosis.Copyright © 2015 John Wiley & Sons, Ltd

Perceived social support as a predictor of disease-specific quality of life in head-and-neck cancer patients

Treatment for head-and-neck cancer (HNC) can lead to severe decrements in disease-specific quality of life (DSQOL) due to disfigurement and disability in speech, eating, and/or breathing. Psychosocial factors such as social support may explain individual variance in DSQOL outcomes. The researchers sought to evaluate changes in perceived availability of social support from pretreatment to posttreatment and to determine whether decreases in perceived social support predicted poorer posttreatment DSQOL among HNC patients, controlling for disease- and treatment-related factors. Participants (n = 32) were newly diagnosed with HNC and were awaiting surgery and/or radiation treatment. Measures included the ENRICHD Social Support instrument (ESSI) to assess perceived social support and the Functional Assessment of Cancer Therapy-Head & Neck (FACT-H&N) to assess DSQOL. Paired-samples t-tests and hierarchical regression analyses were conducted to determine relationships between pretreatment and posttreatment perceived social support and DSQOL. Perceived social support decreased significantly from pre- to posttreatment (F[31] = -2.71, P < .01). After adjusting for relevant covariates and pretreatment DSQOL, change in perceived social support remained a significant predictor of posttreatment DSQOL (β = .47, P < .01). This study included a relatively small sample of HNC patients, which limited power to evaluate mechanisms of observed relationships. Increased social isolation may be a risk factor for poorer physical recovery from, or adjustment to, treatment-related side effects. Social support may be an important target for psychosocial interventions for patients who face challenging treatment side effects