A Qualitative Study Into the Relative Stigmatization of Mental Illness by Mental Health Professionals.

Mental health professionals stigmatize mental illness, which has significant ramifications for public health and policy. Within this domain, there is a lack of comprehensive research on relative stigma, emotions, and behaviors and an absence of literature that can guide research on these topics. The current study sought to address these limitations. Unstructured interviews were conducted with 22 mental health professionals, and data were analyzed using a grounded theory approach. The current study identified a collection of mental disorders (e.g., borderline personality disorder), stereotypes (e.g., dangerousness), emotion-related responses (e.g., fear), and behaviors (e.g., helping) as being key to the relative stigmatization of mental illness by mental health professionals. The results also suggested that professional context and familiarity with mental illness decrease the stigmatization of mental illness by mental health professionals. These variables and constructs were combined to form a grounded theory of mental health professionals stigmatizing mental illness. The current study has implications for the direction of future research on the stigmatization of mental illness by mental health professionals and interventions that strive to mitigate this type of stigmatization.

eHealth literacy in prostate cancer: A systematic review.

OBJECTIVE: This systematic review (PROSPERO ID: CRD42022226375) aimed to identify the eHealth literacy of men with prostate cancer, and their caregivers. METHODS: 8 databases (MEDLINE, SCOPUS, EMBASE, Web Of Science, PsycINFO, ERIC, CINAHL, Cochrane CENTRAL) and grey literature sources (e.g. Google Scholar) were searched from inception to December 2023. Articles were included if assessing eHealth/digital literacy of men with prostate cancer, or their carers', and health outcome associations. Formats such as case reports, and review papers were excluded. Records and full texts underwent independent screening and data extraction. Author disagreements were resolved by discussion. The Mixed Methods Appraisal Tool (MMAT) was used to appraise included literature, with narrative synthesis of results. RESULTS: 21,581 records were retrieved, with 7 articles satisfying inclusion criteria. A heterogenous field was characterised with lack of modern eHealth literacy measurement tools identified. Results suggest novice eHealth literacy using web 1.0 technologies. Non-validated measures of literacy demonstrate mixed results, while health outcome effects limited in scope and reliability. CONCLUSION: Prostate cancer survivors' eHealth literacy levels is likely novice, and requires further investigation. PRACTICE IMPLICATIONS: Digital technologies/resources implemented as part of patient communication practices should be vetted for quality, and tailored to patients' eHealth literacy abilities and/or needs.

Age-related disgust responses to signs of disease.

Previous studies found similarities in adults' disgust responses to benign (e.g. obesity) and actual disease signs (e.g. influenza). However, limited research has compared visual (i.e. benign and actual) to cognitive (i.e. disease label) disease cues in different age groups. The current study investigated disgust responses across middle childhood (7-9 years), late childhood (10-12 years), adolescence (13-17 years), and adulthood (18+ years). Participants viewed individuals representing a benign visual disease (obese), sick-looking (staphylococcus), sick-label (cold/flu), and healthy condition. Disgust-related outcomes were: (1) avoidance, or contact level with apparel the individual was said to have worn, (2) disgust facial reactions, and (3) a combination of (1) and (2). Avoidance was greater for the sick-looking and sick-label than the healthy and obese conditions. For facial reaction and combination outcomes, middle childhood participants responded with greater disgust to the sick-looking than the healthy condition, while late childhood participants expressed stronger disgust towards the sick-looking and obese conditions than the healthy condition. Adolescents and adults exhibited stronger disgust towards sick-label and sick-looking than obese and healthy conditions. Results suggest visual cues are central to children's disgust responses whereas adolescents and adult responses considered cognitive cues.

Factors associated with cessation of smoking in health professionals: a scoping review.

BACKGROUND: Offering cessation support to health professionals who smoke to ensure optimal implementation of cessation support for patients is a key recommendation of the WHO Framework Convention on Tobacco Control Article 14 guidelines. However, direct efforts to support this population to quit are limited. Although numerous articles on the topic of tobacco use among health professionals have been published, the factors associated with their own cessation have not been systematically synthesised. OBJECTIVE: We sought to synthesise existing literature on the predictors and processes informing attitudes and beliefs of smoking health professionals' own cessation. METHODS: A five-step methodological framework for scoping reviews was followed. We conducted a systematic search of EMBASE, PubMed, Web of Science, and PsycINFO databases, as well as Google Scholar for relevant articles. Titles, abstracts, and full texts were screened against predefined criteria: research published between 1990 and 2021, in English-language peer-reviewed journals; participants included doctors, nurses, medical, and student nurses who smoke. RESULTS: The initial search yielded 120, 883 articles, with 27 selected for synthesis. Prevalence estimates and predictors of smoking behaviour have remained the primary focus of smoking health professional research. Few studies explicitly examined the relevant predictors of quit attempts and quit attempt success. There is evidence that age and work environment factors predict quit attempt success in some health professional groups. There is also some evidence of tobacco smoking stigma experiences among nurses and nursing students who smoke. CONCLUSION: Although cessation support is desperately needed for health professionals who smoke, the evidence for factors predicting quit success remains limited. To better guide future research, first, more theoretical work is required to identify the relevant predictors. Second, these should be tested using prospective research designs that take a multi-focal perspective to clarify the targets for change.

The stigmatization of mental illness by mental health professionals: Scoping review and bibliometric analysis.

Although research suggests that mental health professionals stigmatize mental illness, studies on this topic are relativity new. Little is known about the state of this research and existing literature reviews exhibit multiple limitations. Accordingly, a scoping review was performed on the endorsed stigmatization of mental illness by mental health professionals, with the aim of exploring how research is conducted and whether there are gaps in the literature. Studies were included from any time period if they supplied findings on the endorsed stigmatization of mental illness by mental health professionals. Research was identified through electronic databases (i.e., PsycINFO, Embase, Medline, Scopus) and other sources (i.e., the Griffith University library, Google Scholar, literature reviews). It was found that the research is characterized by a number of limitations, and little progress has been made in this important domain. Among other limitations, there was a lack of comprehensive studies on the relative stigma of mental illness and how the components of stigmatization relate to each other. A bibliometric analysis also found that a large proportion of the research is not connected by references. Recommendations were made with respect to future research in this area.

Development and psychometric evaluation of the Aversion to Bowel Cancer Screening Scale.

OBJECTIVE: Avoidance of colorectal cancer (CRC) screening is well documented with emotional barriers deterring screening intention and uptake. However, the assessment of such aversion is limited by the available instruments focusing on siloed emotions or screening procedures, limiting relevance to the complete process of decision-making in the CRC context. METHODS: To address this gap, psychometric properties of the newly developed Aversion to Bowel Cancer Screening Scale (ABCSS) were assessed using data from 640 CRC screening eligible asymptomatic community members. Item review and piloting reduced 179 items to the initial 29-item scale. Using a holdout sample technique, exploratory and confirmatory factor analysis, reliability and validity checks were conducted. RESULTS: A three-factor model (Fecal Occult Blood Test [FOBT] Aversion, Colonoscopy Aversion and Health Conscientiousness) with 21 items was identified. Analyses of the 21-item ABCSS indicated excellent reliabilities for the scale and subscales (α = .91 to .95). Correlations with relevant existing measures, intention and behaviour indicated good construct validity. CONCLUSION: The ABCSS is a valid measure of aversion to CRC screening for asymptomatic community members facing the decision to undertake CRC screening. This instrument may provide a more comprehensive understanding of the decision-making process for CRC screening.

An investigation of the link between prenatal alcohol exposure and sleep problems across childhood.

OBJECTIVE: To investigate the association between dose and frequency of prenatal alcohol exposure (PAE) and sleep problems in children, after controlling for established risk factors for sleep problems. METHODS: Data from the birth cohort of the Longitudinal Study of Australian Children (LSAC) was used. Mothers of 3447 children provided information on alcohol consumption during pregnancy, children's sleep problems from 2- to 9-years, and potential confounders associated with sleep problems. Children were classified into PAE groups based on distinct patterns of maternal drinking during pregnancy: abstinent, occasional, low, moderate, and heavy. The effect of PAE on the number and persistence of sleep problems across childhood (2-9 years) was examined. RESULTS: After controlling for multiple covariates that impact sleep, children with heavy PAE had 1.13 more sleep problems across childhood (2-9 years) relative to children whose mothers were abstainers, in particular 0.37 more at 2- to 3-years (0.504, 95 % CI 0.053, 0.956), and 0.34 more at 6- to 7-years (0.847, 95 % CI 0.299, 1.396). Compared to children of abstainers, heavy PAE increases the probability of having persistent sleep problems from 2- to 9-years by 22.57 %. No negative associations between moderate or low PAE and sleep were observed. Parenting, family, economic, and child health factors also significantly affected child sleep. CONCLUSION: Heavy PAE was associated with significantly more sleep problems across childhood and a higher probability of reporting persistent sleep problems, relative to children with no PAE. Implications for the understanding and management of sleep in young children with PAE and FASD are discussed.

A prospective study of psychological distress after prostate cancer surgery.

BACKGROUND: Men treated for prostate cancer experience heightened psychological distress and have an increased risk of suicide. Management of this distress and risk is crucial for quality urological care. OBJECTIVE: To identify risk indicators for poorer trajectories of psychological adjustment and health-related quality of life (QoL) after surgery for localised prostate cancer. DESIGN, SETTING, AND PARTICIPANTS: Patients were newly diagnosed with localised prostate cancer scheduled for surgical treatment. Patients were assessed at baseline (pre-surgery) and 6 weeks, 3 months, 6 months, 12 months, and 24 months post-surgery. MEASUREMENTS: Assessment measures included sociodemographics, domain-specific and health-related QoL, and psychological distress. Mixed effects regression models were used to analyse the data. RESULTS AND LIMITATIONS: A total of 233 patients provided data for this analysis (Mage = 60 years, standard deviation [SD] = 4.02; MPSA = 7.37 ng/mL). At baseline, the prevalence of high psychological distress was 28% reducing to 21% at 24 months. Before treatment, younger age, more comorbidities, and worse bowel function were related to greater psychological distress; and younger age and better urinary, sexual, and bowel function were related to better health-related QoL. By contrast, for changes over time, only bowel function was important with better bowel function predicting decreasing psychological distress for men. CONCLUSIONS: Regular distress screening is indicated over the 24 months after surgery for localised prostate cancer. Care pathways for men with prostate cancer need also to respond to age-specific concerns and health problems associated with comorbidities in aging men. Focussed symptom control for bowel bother should be a priority.

Measuring Masculinity in Men With Chronic Disease.

The Masculinity in Chronic Disease Inventory (MCD-I) is a new measure of internalized masculine beliefs previously validated in the context of prostate cancer. The present study assessed the validity of the MCD-I in men with other chronic diseases to explore its potential for wider application. A cross-sectional survey of 633 men aged 47-93 years old (M = 68 years), of whom 68% reported ≥2 chronic conditions, was conducted. Measures included the MCD-I and Erectile Function. Exploratory and confirmatory factor analyses were performed followed by tests for discriminant validity. A five-factor structure was confirmed that explained 60% of the variance, with good to excellent reliabilities (α = 0.68-0.93) for the domains of Optimistic Action, Sexual Importance/Priority, Family Responsibilities, Emotional Self-Reliance, and Strength/Fitness. The MCD-I is a valid measure of internalized masculine beliefs for men with chronic disease that appears sensitive to age and to sexual health. The tailoring of health services for men can be guided by MCD-I outcomes to ensure gender-sensitized men's health interventions.

Five-year outcomes from a randomised controlled trial of a couples-based intervention for men with localised prostate cancer.

OBJECTIVE: Psychosexual morbidity is common after prostate cancer treatment, however, long-term prospective research is limited. We report 5-year outcomes from a couples-based intervention in dyads with men treated for localised prostate cancer with surgery. METHODS: A randomised controlled trial was conducted involving 189 heterosexual couples, where the man received a radical prostatectomy for prostate cancer. The trial groups were peer support vs. nurse counselling versus usual care. Primary outcomes were sexual adjustment, unmet sexual supportive care needs, masculine self-esteem, marital satisfaction, and utilisation of erectile aids at 2-, 3-, 4- and 5-year follow-up. RESULTS: The effects of the interventions varied across the primary outcomes. Partners in the peer group had higher sexual adjustment than those in the usual care and nurses group at 2 and 3 years (P = 0.002-0.035). Men in usual care had lower unmet sexual supportive care needs than men in the peer and nurse groups (P = 0.001; P = 0.01) at 3 years. Women in usual care had lower sexual supportive care needs than women in the peer group at 2 and 3 years (P = 0.038; P = 0.001). Men in the peer and nurse group utilised sexual aids more than men in usual care; at 5 years 54% of usual care men versus 87% of men in peer support and 80% of men in the nurse group. CONCLUSION: Peer and nurse-administered psychosexual interventions have potential for increasing men's adherence to treatments for erectile dysfunction. Optimal effects may be achieved through an integrated approach applying these modes of support.

A prospective and population-based inquiry on the use and acceptability of peer support for women newly diagnosed with breast cancer.

The degree to which peer support is used and accepted as a supportive care approach by women with breast cancer is unclear. We examine peer support use across three major modalities (i.e. support groups, online platforms, one-on-one) and identify enablers and barriers to peer support using the beliefs framework of the theory of planned behaviour. A population-based sample of women newly diagnosed with breast cancer (n = 3105) who were on average 54.08 weeks since diagnosis completed mailed surveys at baseline measuring beliefs about peer support and intention. Peer support use was measured via telephone interview at baseline and prospectively at 12-month follow-up (n = 2780). In all, 37% of women had used at least one peer support service since diagnosis (support group = 20%, online = 18%, one-on-one = 10%). A path analysis examined what beliefs enabled or acted as barriers to peer support use at follow-up adjusting for past behaviour (i.e. baseline use), sociodemographic characteristics, and treatment. In order of relative strength, enablers included beliefs that peer support is an outlet for honest expression of feelings (ß = .35), a source of empathy (ß = .30), approved by doctors (ß = .07), and approved by family/partner (ß = .04). Barriers were beliefs that it encourages dwelling about breast cancer (ß = - .06) and involves exposure to negative stories about this disease (ß = - .04). Strategies which communicate the potential emotional support benefits of a shared illness experience and social approval by others, particularly the medical profession, may help to promote acceptance of peer support and encourage service uptake in breast cancer.

Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: 24-month outcomes from a randomised controlled study.

BACKGROUND: Previous trials have found similar early outcomes after robot-assisted laparoscopic prostatectomy and open radical retropubic prostatectomy. We report functional and oncological postoperative outcomes up to 24 months after surgery for these two surgical techniques. METHODS: In this randomised controlled phase 3 study, men who had newly diagnosed clinically localised prostate cancer and who had chosen surgery as their treatment approach, and were aged between 35 years and 70 years were eligible and recruited from the Royal Brisbane and Women's Hospital (Brisbane, QLD, Australia). Participants were randomly assigned (1:1) to have either robot-assisted laparoscopic prostatectomy or open radical retropubic prostatectomy. Randomisation was computer generated and occurred in blocks of ten. This was an open trial; however, study investigators involved in data analysis were masked to each patient's surgical treatment. Primary outcomes were urinary function (urinary domain of Expanded Prostate Cancer Index Composite [EPIC]) and sexual function (sexual domain of EPIC and International Index of Erectile Function Questionnaire [IIEF]) at 6 months, 12 months, and 24 months and oncological outcome (biochemical recurrence and imaging evidence of progression). The trial was powered to assess health-related and domain-specific quality-of-life outcomes over 24 months. All analyses were done on a per-protocol basis. The trial was registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12611000661976. FINDINGS: Between Aug 23, 2010, and Nov 25, 2014, 326 men were enrolled, of whom 163 were randomly assigned to robot-assisted laparoscopic prostatectomy and 163 to open radical retropubic prostatectomy. 18 withdrew (12 assigned to radical retropubic prostatectomy and six assigned to robot-assisted laparoscopic prostatectomy); thus, 151 in the radical retropubic prostatectomy group and 157 in the robot-assisted laparoscopic prostatectomy group proceeded to surgery. At the 24-month follow-up time point, 150 men remained in the robot-assisted laparoscopic prostatectomy group and 146 remained in the open radical retropubic prostatectomy group. Urinary function scores did not differ significantly between robot-assisted laparoscopic prostatectomy and open radical retropubic prostatectomy at 6 months post-surgery (88·68 [95% CI 86·79-90·58] vs 88·45 [86·54-90·36]; p1<0·0001, p2<0·0001), 12 months post-surgery (90·76 [88·89-92·62] vs 91·53 [90·07-92·98]; p1<0·0001, p2<0·0001), or 24 months post-surgery (91·33 [89·64-93·03] vs 90·86 [89·01-92·70]; p1<0·0001, p2<0·0001). Sexual function scores were not significantly different between robot-assisted laparoscopic prostatectomy and open radical retropubic prostatectomy at 6 months post-surgery (EPIC: 37·40 [33·60-41·19] vs 38·63 [34·76-42·49], p1=0·0001, p2<0·0001; IIEF: 29·75 [26·66-32·84] vs 29·78 [26·41-33·16], p1<0·0001, p2<0·0001), 12 months post-surgery (EPIC: 42·28 [38·05-46·51] vs 42·51 [38·29-46·72], p1<0·0001, p2<0·0001; IIEF: 33·10 [29·59-36·61] vs 33·50 [29·87-37·13], p1=0·0002, p2<0·0001), or 24 months post-surgery (EPIC: 45·70 [41·17-50·23] vs 46·90 [42·20-51·60], p1=0·0003, p2<0·0001; IIEF: 33·95 [30·11-37·78] vs 33·89 [29·82-37·96], p1=0·0003, p2=0·0004). Equivalence testing on the difference between the proportion of biochemical recurrences between the two groups (13 [9%] in the open radical retropubic prostatectomy group vs four [3%] in the robot-assisted laparoscopic prostatectomy group) showed that equality between the two techniques could not be established based on a 90% CI with a prespecified margin of 10%. However, a superiority test showed that the two proportions were significantly different (p=0·0199). Equivalence testing on the proportion of patients who had imaging evidence of progression revealed that the two groups were not significantly different (p=0·2956). INTERPRETATION: Robot-assisted laparoscopic prostatectomy and open radical retropubic prostatectomy yielded similar functional outcomes at 24 months. We advise caution in interpreting the oncological outcomes of our study because of the absence of standardisation in postoperative management between the two trial groups and the use of additional cancer treatments. Clinicians and patients should view the benefits of a robotic approach as being largely related to its minimally invasive nature. FUNDING: Cancer Council Queensland.

Lung Cancer Stigma across the Social Network: Patient and Caregiver Perspectives.

OBJECTIVE: To examine the personal experiences of people with lung cancer and their caregivers and how stigma is manifested throughout a patient's social network. METHODS: A qualitative thematic analysis of interviews with 28 patients with lung cancer and their caregivers was conducted. Telephone interviews were conducted and transcribed verbatim. Data analysis was guided by contemporary stigma theory. RESULTS: Patients and caregivers reported feeling high levels of felt stigma and concomitant psychological distress in response to the diagnosis of lung cancer. Three overarching themes emerged: the nexus of lung cancer and smoking, moralization, and attacking the link between lung cancer and smoking. Stigma was inevitably linked to smoking, and this formed the hub around which the other themes were organized. Caregivers reported feeling invisible and noted a lack of support systems for families and caregivers. In addition, there was evidence that caregivers experienced stigma by association as members of the patients' close networks. Both groups responded ambivalently to stigmatizing antismoking advertisements. CONCLUSIONS: The qualitative analysis demonstrated the complex interplay of the social and personal domains in the experience and outcomes of stigma in lung cancer. There is a significant potential for caregivers of patients with lung cancer to experience exacerbations of psychosocial distress as a consequence of widely shared negative views about lung cancer and its prognosis. It remains for researchers and practitioners to incorporate such complexity in addressing stigma and psychosocial distress in both patients and caregivers.

Randomized controlled trial of a peer led multimodal intervention for men with prostate cancer to increase exercise participation.

OBJECTIVE: Exercise may reduce morbidity, increase survival, and improve quality of life (QoL) in prostate cancer patients. However, effective ways to encourage exercise outside carefully controlled clinical trials remain uncertain. We evaluated the effectiveness of peer-led self-management for increasing exercise participation in men with localized prostate cancer. METHODS: Four hundred and sixty-three prostate cancer patients from Queensland, Australia were randomized to a monthly telephone-based group peer support for 6 months supported by self-management materials and exercise equipment (INT, n = 232) or usual care (UC, n = 231). Participants were assessed at baseline, 3, 6, and 12 months. Primary outcomes were compliance with exercise guidelines; secondary outcomes were psychological distress and QoL. RESULTS: Patients in INT engaged in more resistance exercise than UC at 3 months (19.4 [95% CI 6.52 to 32.28] min/wk, P = .003) and 6 months (14.6 [95% CI 1.69 to 27.58] min/wk, P = .027); more men achieved sufficient physical activity levels at 3 months (χ2  = 8.89, P = 0.003). There was no difference between groups for aerobic-based activity at any time point nor for resistance exercise time at 12-month follow-up. INT had higher QoL Relationships scores at 3 months (.03 [95% CI .00 to .06], P = .038) compared with UC. Limitation included self-reported assessment of exercise. CONCLUSIONS: Peer-led intervention was effective in increasing patients' resistance exercise participation in the short-to-medium term and in the number of men achieving sufficient activity levels in the short-term; however, this was not accompanied by overall improvements in QoL or psychological distress. Methods to increase effectiveness and maintain long-term adherence require further investigation.

Predictors of long-term distress in female partners of men diagnosed with prostate cancer.

OBJECTIVE: Female partners of men with prostate cancer (PCa) experience heightened psychological distress; however, long-term distress for this group is not well described. We examined partner's psychological and cancer-specific distress over 2 years and predictors of change. METHODS: A cohort of 427 female partners (63% response; mean age 62.6 y) of PCa survivors completed baseline (2-4 y post-PCa treatment) assessments of anxiety, depression, and cancer-specific distress and were followed up at 6, 12, 18, and 24 months. Caregiver burden, threat and challenge appraisal, self-efficacy, and dyadic adjustment were assessed as potential predictors of distress. RESULTS: Over time, 23% to 25% of women reported anxiety; 8% to 11% depression; 5% to 6% high cancer-specific distress. Higher caregiver burden and more threat appraisals were associated with increased distress, anxiety, depression, and cancer-specific distress over time. Higher dyadic adjustment over time and more challenge appraisals at 24 months were associated with less distress, anxiety, and depression. Increased partner self-efficacy was associated with lower distress and depression at baseline. CONCLUSIONS: A substantial subgroup of partners experience ongoing anxiety, with depression less prevalent but also persistent. Caregiver burden, partner self-efficacy, threat, and challenge appraisals present as potential supportive care targets.

Four year effects of couple relationship education on low and high satisfaction couples: A randomized clinical trial.

OBJECTIVE: Relationship education (RE) usually is conceived of as relationship enhancement for currently satisfied couples, with a goal of helping couples sustain satisfaction. However, RE also might be useful as a brief, indicated intervention for couples with low satisfaction. The current study evaluated the effect of RE on couples with low and high relationship satisfaction. METHOD: The study was a randomized controlled trial in which 182 couples were randomly assigned to: a book reading control condition (control); RELATE online assessment with feedback and relationship goal setting (RELATE); or RELATE with CoupleCARE (RCC), a flexible delivery skill-based education program. Couples were assessed on relationship satisfaction and individual mental health before and after RE, and through to 4-year follow-up. RESULTS: Couples with high initial satisfaction showed no effects of RE on satisfaction. RCC but not RELATE increased satisfaction in couples with low initial satisfaction, but effects dissipated between 6 and 12 months after RE. There were no effects of RE on mental health. CONCLUSION: Flexible delivery RE produces immediate effects as an indicated early intervention for couples with low relationship satisfaction, but the effects attenuate. Future research needs to seek methods to produce better maintained effects. (PsycINFO Database Record

Mindfulness-Based Cognitive Therapy in Advanced Prostate Cancer: A Randomized Controlled Trial.

Purpose Advanced prostate cancer (PC) is associated with substantial psychosocial morbidity. We sought to determine whether mindfulness-based cognitive therapy (MBCT) reduces distress in men with advanced PC. Methods Men with advanced PC (proven metastatic and/or castration-resistant biochemical progression) were randomly assigned to an 8-week, group-based MBCT intervention delivered by telephone (n = 94) or to minimally enhanced usual care (n = 95). Primary intervention outcomes were psychological distress, cancer-specific distress, and prostate-specific antigen anxiety. Mindfulness skills were assessed as potential mediators of effect. Participants were assessed at baseline and were followed up at 3, 6, and 9 months. Main statistical analyses were conducted on the basis of intention to treat. Results Fourteen MBCT groups were conducted in the intervention arm. Facilitator adherence ratings were high (> 93%). Using random-effects mixed-regression models, intention-to-treat analyses indicated no significant changes in intervention outcomes or in engagement with mindfulness for men in MBCT compared with those receiving minimally enhanced usual care. Per-protocol analyses also found no differences between arms in outcomes or engagement, with the exception of the mindfulness skill of observing, which increased over time for men in MBCT compared with usual care ( P = .032). Conclusion MBCT in this format was not more effective than minimally enhanced usual care in reducing distress in men with advanced PC. Future intervention research for these men should consider approaches that map more closely to masculinity.

The essence of crime: Contagious transmission from those who have committed moral transgressions.

Across four studies, we investigated the relationship between moral contagion and disgust. Study 1 established that the contamination effect is unique to transgressions that fall within the moral domain. Study 2 replicated this effect and further showed that the underlying mechanism is intimately related to disgust, as disgust was found to uniquely mediate the relationship between moral transgressions and contamination responses. In Study 3, disgust was again found to mediate this relationship. In addition, the results of Study 3 show that the moral contagion effect was not dependent upon the presence of a core disgust cue within the transgression. In Study 4, we investigated whether or not moral contagion leads to behavioural avoidance. Results show that behavioural avoidance only occurred when the moral transgression contained a core disgust cue. Taken together, the results of our studies show that disgust plays a key role in moral contagion processes. However, the difference in findings between the thought experiments (Studies 1-3) and the behavioural experiment (Study 4) identifies a need for further research to examine the conditions under which moral contagion leads to behavioural avoidance.

Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: early outcomes from a randomised controlled phase 3 study.

BACKGROUND: The absence of trial data comparing robot-assisted laparoscopic prostatectomy and open radical retropubic prostatectomy is a crucial knowledge gap in uro-oncology. We aimed to compare these two approaches in terms of functional and oncological outcomes and report the early postoperative outcomes at 12 weeks. METHOD: In this randomised controlled phase 3 study, men who had newly diagnosed clinically localised prostate cancer and who had chosen surgery as their treatment approach, were able to read and speak English, had no previous history of head injury, dementia, or psychiatric illness or no other concurrent cancer, had an estimated life expectancy of 10 years or more, and were aged between 35 years and 70 years were eligible and recruited from the Royal Brisbane and Women's Hospital (Brisbane, QLD). Participants were randomly assigned (1:1) to receive either robot-assisted laparoscopic prostatectomy or radical retropubic prostatectomy. Randomisation was computer generated and occurred in blocks of ten. This was an open trial; however, study investigators involved in data analysis were masked to each patient's condition. Further, a masked central pathologist reviewed the biopsy and radical prostatectomy specimens. Primary outcomes were urinary function (urinary domain of EPIC) and sexual function (sexual domain of EPIC and IIEF) at 6 weeks, 12 weeks, and 24 months and oncological outcome (positive surgical margin status and biochemical and imaging evidence of progression at 24 months). The trial was powered to assess health-related and domain-specific quality of life outcomes over 24 months. We report here the early outcomes at 6 weeks and 12 weeks. The per-protocol populations were included in the primary and safety analyses. This trial was registered with the Australian New Zealand Clinical Trials Registry (ANZCTR), number ACTRN12611000661976. FINDINGS: Between Aug 23, 2010, and Nov 25, 2014, 326 men were enrolled, of whom 163 were randomly assigned to radical retropubic prostatectomy and 163 to robot-assisted laparoscopic prostatectomy. 18 withdrew (12 assigned to radical retropubic prostatectomy and six assigned to robot-assisted laparoscopic prostatectomy); thus, 151 in the radical retropubic prostatectomy group proceeded to surgery and 157 in the robot-assisted laparoscopic prostatectomy group. 121 assigned to radical retropubic prostatectomy completed the 12 week questionnaire versus 131 assigned to robot-assisted laparoscopic prostatectomy. Urinary function scores did not differ significantly between the radical retropubic prostatectomy group and robot-assisted laparoscopic prostatectomy group at 6 weeks post-surgery (74·50 vs 71·10; p=0·09) or 12 weeks post-surgery (83·80 vs 82·50; p=0·48). Sexual function scores did not differ significantly between the radical retropubic prostatectomy group and robot-assisted laparoscopic prostatectomy group at 6 weeks post-surgery (30·70 vs 32·70; p=0·45) or 12 weeks post-surgery (35·00 vs 38·90; p=0·18). Equivalence testing on the difference between the proportion of positive surgical margins between the two groups (15 [10%] in the radical retropubic prostatectomy group vs 23 [15%] in the robot-assisted laparoscopic prostatectomy group) showed that equality between the two techniques could not be established based on a 90% CI with a Δ of 10%. However, a superiority test showed that the two proportions were not significantly different (p=0·21). 14 patients (9%) in the radical retropubic prostatectomy group versus six (4%) in the robot-assisted laparoscopic prostatectomy group had postoperative complications (p=0·052). 12 (8%) men receiving radical retropubic prostatectomy and three (2%) men receiving robot-assisted laparoscopic prostatectomy experienced intraoperative adverse events. INTERPRETATION: These two techniques yield similar functional outcomes at 12 weeks. Longer term follow-up is needed. In the interim, we encourage patients to choose an experienced surgeon they trust and with whom they have rapport, rather than a specific surgical approach. FUNDING: Cancer Council Queensland.