Low-dose-rate brachytherapy as a primary treatment for localised and locally advanced prostate cancer: a systematic review of economic evaluations.

BACKGROUND: This study supports a value-based approach to prostate cancer (PCa) treatment by systematically reviewing economic evaluations that compare the cost and cost-effectiveness of low-dose-rate brachytherapy (LDR-BT) with that of other treatment options for localised and locally advanced PCa. METHODS: Studies published between 2008 and 2023 were searched for in MEDLINE, EMBASE and Tufts Medical Center's Cost-Effectiveness Analysis (CEA) Registry (Prospero protocol CRD42023-442027). Two reviewers independently screened the title and abstracts based on agreed inclusion and exclusion criteria, followed by full-text screening. The Drummond checklist was used to critically appraise the quality of the included studies. RESULTS: After screening 453 records, 36 were sought for retrieval and 14 eligible studies included. Of them, 11 compared treatments for low- and/or favourable intermediate-risk PCa, 2 compared options for unfavourable intermediate- and/or high-risk disease and 1 analysed treatments for both risk groups. Considerable heterogeneity was seen in the populations, perspectives, time horizons, costs and outcomes data used. If the oncological outcomes of standard treatment approaches are considered equivalent, LDR-BT was the most cost-effective type of radiation therapy (RT) in 9 (75%) of 12 studies, was more cost-effective than radical prostatectomy (RP) in 6 (67%) of 9 studies and, depending on the time horizon, was more cost-effective than active surveillance (AS) in 3 (60%) of 5 studies. LDR-BT was more cost-effective than high-dose-rate brachytherapy (HDR-BT) in all 4 (100%) of the studies that made this comparison and, overall, LDR-BT was the least costly of all active treatment options in 7 (50%) of the 14 studies. CONCLUSION: The available health economic evidence suggests that LDR-BT has significant cost advantages and an important role to play in the delivery of value-based PCa care. In the future these advantages could be challenged if radiotherapy favours ultrahypofractionated strategies such as stereotactic body radiation therapy (SBRT) and reduced fractionation in HDR-BT.

Twenty-Five Years of Research and Advocacy on Violence Against Women: What Have We Accomplished, and Where Do We Go From Here? A Conversation.

This article is a conversation between two academic experts, Callie Rennison and Nikki Jones, who endeavor to sum up what has been accomplished in eliminating violence against women in the United States during the 25 years of the journal's existence. Domestic violence, rape, and sexual harassment are discussed. Although prevalence rates are down in domestic violence, rape and sexual harassment remain persistent problems. Looking at violence against women from an analysis of President Trump voters in the 2016 U.S. presidential election, Rennison and Jones observe the extent to which the current ideas and attitudes of women-both young and old-will need to change before violence can be eliminated. Rather than viewing events in the United States as totally negative, they see them as presenting new opportunities for greater understanding of violence against women and for new methods of prevention and perpetrator accountability.

Social and health outcomes following upgrades to a national housing standard: a multilevel analysis of a five-wave repeated cross-sectional survey.

BACKGROUND: While existing research indicates that housing improvements are associated with health improvements, less is known about the wider social and health benefits of meeting national housing standards, as well as those of their specific constituent measures. This study evaluates the impacts of a managed housing upgrade programme through a repeated cross-sectional survey design. METHODS: A five-wave repeated cross-sectional survey was conducted over a seven-year period from 2009 to 2016 (n = 2075; n = 2219; n = 2015; n = 1991; and n = 1709, respectively). The study followed a managed upgrade programme designed to meet a national social housing standard over an extended period. The data were analysed from a multilevel perspective to take account of the time-dependent nature of the observations and differences in socio-demographic composition. RESULTS: The installation of the majority of individual housing measures (new windows and doors; boilers; kitchens; bathrooms; electrics; loft insulation; and cavity/external wall insulation) were associated with improvements in several social (housing suitability, satisfaction, and quality; thermal comfort and household finances) and health (mental, respiratory and general health) outcomes; and analyses showed relationships between the number of measures installed and the total amount invested on the one hand and the social and health outcomes on the other. There were however a few exceptions. Most notably, the installation of cavity wall insulation was associated with poorer health outcomes, and did not lead to better social outcomes. Also, no association was found between the number of measures installed and respiratory health. CONCLUSIONS: The study suggests that substantial housing investments through a managed upgrade programme may result in better social and health outcomes, and that the size of the improvements are proportionate to the number of measures installed and amount invested. However, there may be risks associated with specific measures; and more attention is needed for mechanical ventilation when upgrading energy efficiency of houses through fabric work. In addition to providing new evidence regarding the wider social and health outcomes, the study provides an analytical approach to evaluate upgrade programmes that are delivered over multiple years.

Neighborhood Quality and Attachment: Validation of the Revised Residential Environment Assessment Tool.

Various studies have shown that neighborhood quality is linked to neighborhood attachment and satisfaction. However, most have relied upon residents' own perceptions rather than independent observations of the neighborhood environment. This study examines the reliability and validity of the revised Residential Environment Assessment Tool (REAT 2.0), an audit instrument covering both public and private spaces of the neighborhood environment. The research shows that REAT 2.0 is a reliable, easy-to-use instrument and that most underlying constructs can be validated against residents' own neighborhood perceptions. The convergent validity of the instrument, which was tested against digital map data, can be improved for a number of miscellaneous urban form items. The research further found that neighborhood attachment was significantly associated with the overall REAT 2.0 score. This association can mainly be attributed to the property-level neighborhood quality and natural elements components. The research demonstrates the importance of private spaces in the outlook of the neighborhood environment.

Theorizing alternative pathways through adulthood: unequal social arrangements in the lives of young disadvantaged men.

This chapter introduces the innovative field-based studies on disadvantaged men that are featured in this volume. Together, these studies of disadvantaged men from diverse racial and ethnic backgrounds and both urban and nonurban settings complement and extend recent discussions of emerging adulthood, which typically conceptualizes the transition to adulthood as a normative and linear process. The authors offer that the research presented here provides a more accurate rendering of the transition to adulthood for young disadvantaged men. For disadvantaged young men, the transition to adulthood is often complex and nonlinear, and features a diversity of pathways that are often overlooked in contemporary research on transitions to adulthood. The chapter ends with a call for research and theory that better reflects the precarious nature of pathways to adulthood for disadvantaged men in urban and nonurban settings. Researchers are encouraged to draw on findings from field-based studies to inform policies and practices directed at minimizing the marginalization of disadvantaged men from mainstream society.