Prostate cancer treatment and the relationship of androgen deprivation therapy to cognitive function.

Prostate cancer is the second most common form of cancer in men. For advanced, high risk prostate cancer, androgen deprivation therapy (ADT) is the preferred treatment and can induce remission, but resistance to ADT brings biochemical recurrence and progression of cancer. ADT brings adverse effects such as erectile dysfunction, decreased libido, and diminished physical strength. It is estimated that between 25 and 50% of men on ADT manifest some form of cognitive dysfunction that may be self-reported or reported by a family member. There is concern that impaired cognitive function with ADT is due to loss of testosterone support. Testosterone and its metabolites are known to possess neuroprotective properties. While a direct causal relationship between ADT and cognitive decline in prostate cancer patients has not been established, this review describes the controversy surrounding the possible connection between ADT and neurocognitive deterioration. The cellular and molecular mechanisms believed to underlie the protection of neuronal integrity by androgens are discussed. Results from animal models and human clinical studies are presented. Finally, we call attention to lifestyle modifications that may minimize cognitive issues in prostate cancer patients.

[Epidemiologic profile of induced abortion]. / Pérfil sociodemográfico del aborto inducido.

OBJECTIVE: To identify sociodemographic characteristics associated with induced abortion of the first pregnancy and quantify the strength of association between them. MATERIAL AND METHODS: Data were gathered from a survey conducted in the district of Diez de Octubre, Havana, Cuba throughout 1991 and the beginning of 1992. The study population was divided into two comparable groups: one group of women whose first pregnancy terminated in induced abortion and a second group of women whose pregnancy terminated in childbirth. For the variables with statistically significant differences, both the crude and adjusted odds ratio were obtained for the one potentially confounding factor:age. Multivariate logistic regression analysis was employed in the final stage. RESULTS: The sociodemographic characteristic identified as risk factor for induced abortion during the first pregnancy is being younger than 24 years of age, a risk which increased with women who were less than 20 years old, whether single or in union. CONCLUSIONS: Recurrence risk of induced abortion during the first pregnancy is higher in younger women who have not achieved their professional, working or marrying expectations. This situation seem to be incompatible with maternity in the studied group.

Traditional birth attendants in Mexico: advantages and inadequacies of care for normal deliveries.

In Mexico, traditional birth attendants (TBAs) are an essential resource for health care, especially in small rural communities where they attend approximately 45% of all deliveries. Both rural and urban women seek care with the TBAs because, amongst other things, they share the same cultural codes. In this study, qualitative and quantitative methods were used to analyze the concepts, resources and process of care during birth in rural areas of the state of Morelos. Results show that the socio-economic characteristics of the TBAs are similar to those of the patients, that they share the same precarious living conditions, and the resources to which they have access for providing care during births. When choosing a TBA as a health care provider, both the economic aspect and the importance of a shared symbolism come into play. We observed advantages in some of the traditional practices which should be incorporated into the medical system, for example protection through the massage of the perineum at the moment of expulsion. Nevertheless, there are inadequacies for which the implementation of training programs is fundamental, before articulate primary care programs using the TBAs can be promoted.

Postoperative adjuvant chemotherapy or BCG for colon cancer: results from NSABP protocol C-01.

Data are presented from 1,166 patients with Dukes B and C carcinoma of the colon who were entered into the National Surgical Adjuvant Breast and Bowel Project (NSABP) Protocol C-01 between November 1977 and February 1983. Patients were randomized to one of three therapeutic categories: 1) no further treatment following curative resection (394 patients); 2) postoperative chemotherapy consisting of 5-fluorouracil, semustine, and vincristine (379 patients); or 3) postoperative BCG (393 patients). The average time on study was 77.3 months. A comparison between patients receiving postoperative adjuvant chemotherapy and those treated with surgery alone indicated that there was an overall improvement in disease-free survival (P = .02) and survival (P = .05) in favor of the chemotherapy-treated group. At 5 years of follow-up, patients treated with surgery alone were at 1.29 times the risk of developing a treatment failure and at 1.31 times the likelihood of dying as were similar patients treated with combination adjuvant chemotherapy. Comparison of the BCG-treated group with the group treated with surgery alone indicated that there was no statistically significant difference in disease-free survival (P = .09). There was, however, a survival advantage in favor of the BCG-treated group (P = .03). At 5 years of follow-up, patients randomized to the surgery-alone arm were at 1.28 times the risk of dying as were similar patients treated with BCG. Further investigation disclosed that this survival advantage in favor of BCG was a result of a diminution in deaths that were non-cancer related. When analyses were conducted on which events not related to cancer recurrence were eliminated, the survival difference between the BCG and control groups became nonsignificant (P = .40); the cumulative odds at 5 years decreased from 1.28 to 1.10. The findings from this study are the first from a randomized prospective clinical trial to demonstrate that a significant disease-free survival and survival benefit can be achieved with postoperative adjuvant chemotherapy in patients with Dukes B and C carcinoma of the colon who have undergone curative resection.