Higher Proportion Of Men Research Articles

Quantifying severe urinary complications after radical prostatectomy: the development and validation of a surgical performance indicator using hospital administrative data.

To develop and validate a surgical performance indicator based on severe urinary complications that require an intervention within 2 years of radical prostatectomy (RP), identified in hospital administrative data. Men who underwent RP between 2008 and 2012 in England were identified using hospital administrative data. A transparent coding framework based on procedure codes was developed to identify severe urinary complications which were grouped into 'stricture', 'incontinence' and 'other'. Their validity as a performance indicator was assessed by evaluating the consistency with diagnosis codes and association with patient and surgical characteristics. Kaplan-Meier methods were used to assess time to first occurrence and multivariable logistic regression was used to estimate adjusted odds ratios (ORs) for patient and surgical characteristics. A total of 17 299 men were included, of whom 2695 (15.6%) experienced at least one severe urinary complication within 2 years. High proportions of men with a complication had relevant diagnosis codes: 86% for strictures and 93% for incontinence. Urinary complications were more common in men from poorer socio-economic backgrounds (OR comparing lowest with highest quintile: 1.45; 95% confidence interval [CI] 1.26-1.67) and in those with prolonged length of hospital stay (OR 1.54, 95% CI 1.40-1.69), and were less common in men who underwent robot-assisted surgery (OR 0.65, 95% CI 0.58-0.74). These results show that severe urinary complications identified in administrative data provide a medium-term performance indicator after RP. They can be used for research assessing outcomes of treatment methods and for service evaluation comparing performance of prostate cancer surgery providers.

Feasibility of Using HIV Care-Continuum Outcomes to Identify Geographic Areas for Targeted HIV Testing.

Improved detection and linkage to care of previously undiagnosed HIV infections require innovative approaches to testing. We sought to determine the feasibility of targeted HIV testing in geographic areas, defined by continuum of care parameters, to identify HIV-infected persons needing linkage or engagement in care. Using HIV surveillance data from Washington, DC, we identified census tracts that had an HIV prevalence >1% and were either above (higher risk areas-HRAs) or below (lower risk areas-LRAs) the median for 3 indicators: monitored viral load, proportion of persons out of care (OOC), and never in care. Community-based HIV rapid testing and participant surveys were conducted in the 20 census tracts meeting the criteria. Areas were mapped using ArcGIS, and descriptive and univariate analyses were conducted comparing the areas and participants. Among 1471 persons tested, 28 (1.9%) tested HIV positive; 2.1% in HRAs vs. 1.7% in LRAs (P = 0.57). Higher proportions of men (63.7% vs. 56.7%, P = 0.007) and fewer blacks (91.0% vs. 94.6%, P = 0.008) were tested in LRAs vs. HRAs; no differences were observed in risk behaviors between the areas. Among HIV-positive participants, 54% were new diagnoses (n = 9) or OOC (n = 6), all were Black, 64% were men with a median age of 51 years. Although significant differences in HIV seropositivity were not observed between testing areas, our approach proved feasible and enabled identification of new diagnoses and OOC HIV-infected persons. This testing paradigm could be adapted in other locales to identify areas for targeted HIV testing and other reengagement efforts.

Prevalence of and Factors Associated with Sarcopenia in Korean Cancer Survivors: Based on Data Obtained by the Korea National Health and Nutrition Examination Survey (KNHANES) 2008–2011

ABSTRACTUsing a representative dataset from the Korea National Health and Nutrition Examination Survey (KNHANES) from 2008 to 2011, we analyzed anthropometric and dual-energy X-ray absorptiometry (DXA)-determined body composition findings for 493 cancer survivors (mean age a61.1 ± 12.6 years; 35.7% male). A much higher proportion of men (30.1%) than women (0.6%) met the criteria of sarcopenia. Subjects with a history of lung cancer, genitourinary cancer, or gastric cancer were prone to develop sarcopenia (31.6%, 26.3%, and 21.4%, respectively). Furthermore, sarcopenia was more prevalent among elderly (≥65 years; P < 0.001), those with a lower BMI level (<23 kg/m2; P < 0.001), heavy drinker (P = 0.012), or smoker (P < 0.001), and those with inadequate intakes of protein (P = 0.017) and vitamin A (P = 0.024). Multivariable logistic analyses revealed sarcopenia was significantly associated with male gender (odds ratio [OR], 68.14; 95% CI, 15.52–299.13), a BMI of <23 kg/m2 (OR 35.93, 95% CI, 8.24–156.67), and inadequate protein intake (OR 3.07, 95% CI, 1.30–7.22); these factors are significant predictors of sarcopenia in Korean cancer survivors.

Multiple factor analysis of symptomatic intracranial arterial stenosis

Objective To discuss the correlation among intracranial arterial stenosis and its risk factors. Methods A total of 486 patients with transient ischemic attack (TIA) or ischemic cerebral infarction were examined using color doppler flow imaging (CDFI) and transcranial doppler ultrosonography (TCD).According to the degrees of extracranial arterial stenosis, patients with mild-to-moderate extracranial stenosis were classified into group A (435 cases) while those with constant severe stenosis or occlusion were classified into group B (51 cases).The differences between the two groups of risk factors were compared, and the multi-factor logistic regression analysis of risk factors associated with moderately severe intracranial arterial stenosis was performed. Results ① The risk factors that were significantly associated with intracranial arterial stenosis included age ( P =0.034) and gender ( P =0.044).② Intracranial artery stenosis was observed in both anterior and posterior cerebral arteries in patients with hypertension, diabetes, and coronary heart disease respectively ( P P =0.000), with a higher proportion of men ( P =0.037), and the intracranial arterial stenosis degrees were significantly higher ( P =0.013).â'£ Multi-factor logistic regression analysis showed that diabetes is a risk factor for moderately severe intracranial arterial stenosis ( P P =0.012). Conclusions Age, gender, hypertension, diabetes, coronary heart disease, and smoking are risk factors for the distribution of intracranial arterial stenosis.The degrees of intracranial arterial stenosis are related with extracranial arterial stenosis.Diabetes is a risk factor for moderately severe intracranial arterial stenosis while hyperlipidemia is a protective factor.

Is rule of halves still an occurrence in South India: Findings from community-based survey in a selected urban area of Puducherry.

Background:The objective of the present study was to assess the applicability of the rule of halves in an urban population of Puducherry, South India. We also aimed to find the correlates associated with undiagnosed hypertension to facilitate targeted screening.Methodology:We derive our observation from a community-based cross-sectional study conducted using the World Health Organization STEPwise approach to surveillance in urban slum of Puducherry during 2014–15. Blood pressure (BP) was measured for all the study subjects (n = 2399), and the subjects were classified as hypertensive using Joint National Committee 8 criteria, systolic BP (SBP) ≥140 mm Hg and/or diastolic BP (DBP) ≥90 mmHg and/or known hypertensives and/or treatment with antihypertensive drugs. Controlled hypertension was defined as SBP <140 mmHg and DBP <90 mmHg.Results:Of 2399, 799 (33.3%; 95% confidence interval [CI]: 31.4%–35.2%) adults were found to have raised BP by any means (known and unknown hypertensives). Of the 799, 367 (15.3%; 95%CI: 13.9%–16.8%) of study participants were known hypertensives. Of the known hypertensives, 74.7% (274/367) were put on treatment (drugs and or lifestyle modification), and 80% (218/274) were on regular treatment. Higher proportions of men were found to have undiagnosed hypertension compared to women (26.1 vs. 19.8%, P < 0.001). Similarly, adult from below poverty line (23.8 vs. 20%, P < 0.001), unskilled laborer (26.6 vs. 20%, P < 0.001), and literacy less than middle school (12.3 vs. 23%, P < 0.001) had more undiagnosed hypertension.Conclusion:In the selected urban area of Puducherry around one-third of the adult populations are having hypertension, including the 54% of undiagnosed hypertension. Adults from the vulnerable subgroups such as lower level of literacy, below poverty line, and unskilled work are found to have higher proportions of undiagnosed hypertension.

Will magnetic resonance imaging-guided biopsy replace systematic biopsy?

The main disadvantages of the current diagnostic pathway in men with an elevated risk of prostate cancer (PCa) are that: (1) systematic transrectal ultrasound (TRUS) biopsy misses a substantial proportion (20%) of significant PCa because of inherent systematic sampling errors, especially in the anterior gland [1,2]; (2) misclassifies pathologic status including Gleason score (Gl) and tumour stage [3]; and (3) detects a high proportion of men with disease that is unlikely to be harmful (clinically insignificant), with subsequently overtreatments resulting in unintended harm [4]. The latter was the main reason for the U.S. Preventive Services Task Force recommendation against prostate-specific antigenbased screening for prostate cancer in 2012 [5].

Use of complementary and alternative medicine in patients with health complaints attributed to former dental amalgam fillings

The dental filling material amalgam is generally well tolerated. However, a small proportion of dental patients experience health complaints which they attribute to amalgam. The symptom pattern is often similar to patients with medically unexplained physical symptoms (MUPS) and the health complaints may persist after amalgam removal. Among patients with MUPS, the use of complementary and alternative medicine (CAM) seems to be high. The aim of this survey was to describe the prevalence and range of CAM use among people with health complaints attributed to dental amalgam fillings in which the health problems persist after the removal of all amalgam fillings. Specific attention was paid to (1) self-reported effects of CAM, (2) differences in CAM use dependent on self-reported health, and (3) gender differences in self-reported CAM use. A survey was distributed to all members of The Norwegian dental patient association (NDPA) (n = 999), the response rate was 36.4 %. The anonymous questionnaire asked for socio-demographic data, health complaints related to former amalgam fillings, subjectively perceived health status, symptoms, and experience with therapeutic interventions, mostly from the spectrum of CAM. Only participants who had all their fillings removed, which was the vast majority, were analysed. A total of 88.9 % of included respondents had used at least one CAM modality, with a higher proportion of men (95.7 %) compared to women (86.2 %, p = 0.015). The most frequently used therapies were dietary supplements, vitamins and minerals recommended by a therapist (used by 66.7 %) followed by self-prescribed dietary supplements, vitamins and minerals (59.0 %), homeopathy (54.0 %), acupuncture (48.8 %) and special diets (47.5 %). Use of CAM was similar for participants reporting normal to good health compared to participants reporting poor health. For all but two CAM modalities, the self-reported treatment effect was better in the group reporting normal to good health compared to the group reporting poor health. CAM was widely used by participants in our study, a finding similar to findings from studies of MUPS patients. To date, health problems associated with the use of dental amalgam is not an accepted diagnosis in the healthcare system. Consequently, people suffering from such complaints experience a lack of adequate treatment and support within conventional health care, which might have contributed to the high number of CAM users in this study.

Opium addiction as an independent risk factor for coronary microvascular dysfunction: A case–control study of 250 consecutive patients with slow–flow angina

BackgroundApproximately 20% to 30% of patients who undergo coronary angiography for assessment of typical cardiac chest pain display microvascular coronary dysfunction (MCD). This study aimed to determine potential relationships between baseline clinical characteristics and likelihood of MCD diagnosis in a large group of patients with stable angina symptoms, positive exercise test and angiographic ally normal epicardial coronary arteries. Material and methodsThis cross-sectional study included 250 Iranian with documented evidence of cardiac ischemia on exercise testing, class I or II indication for coronary angiography, and either: (1) angiographically normal coronary arteries and diagnosis of MCD with slow-flow phenomenon, or (2) normal angiogram and no evidence of MCD. All patients completed a questionnaire designed to capture key data including clinical demographics, past medical history, and social factors. Data was evaluated using single and multivariable logistic regression models to identify potential individual patient factors that might help to predict a diagnosis of MCD. Results125 (11.2% of total) patients were subsequently diagnosed with MCD. 125 consecutive control subjects were selected for comparison. The mean age was similar among the two groups (52.38 vs. 53.26%, p=ns), but there was a higher proportion of men in the study group compared to control (42.4 vs. 27.2%, p=0.012). No significant relationships were observed between traditional cardiovascular risk factors (diabetes, hypertension, and dyslipidemia) or body mass index (BMI), and likelihood of MCD diagnosis. However, opium addiction was found to be an independent predictor of MCD on single and multivariable logistic regression model (OR=3.575, 95%CI: 1.418–9.016; p=0.0069). ConclusionsWe observed a significant relationship between opium addiction and microvascular angina. This novel finding provides a potential mechanistic insight into the pathogenesis of MCD with slow-flow phenomenon.

The COBATEST network: a platform to perform monitoring and evaluation of HIV community-based testing practices in Europe and conduct operational research

ABSTRACTThe European project “HIV community-based testing practices in Europe” (HIV-COBATEST) has contributed to the establishment of a network of community-based voluntary counselling and testing services (CBVCTs) that monitors and evaluates HIV testing activity in the communities. The objective of this paper is to describe the data that have been collected during 2014 by the COBATEST network in order to provide an insight into testing activity of CBVCTs in Europe. Members of the CBVCT network share common instruments for data collection and data entry. The network has a common database that allows global data analysis and comparison between different centres. In 2014, 40 CBVCTs of 18 European countries were participating in the network, and, from those, 20 CBVCTs were using the common COBATEST data collection tools. In these 20 CBVCTs, a total of 9266 HIV screening tests were performed on 8554 people, of which 1.58% (135/8554) were reactive and 51.1% (69/135) confirmed positive. Five cases were false positives, and 84.1% (58/69) of the confirmed positive cases were linked to care. Most of the tested individuals were men (70.8%), between 21 and 35 years of age (57.6%) and natives (67.1%). A higher proportion of men who had sex with men (MSM) (38.8%; 3267/8554) were tested compared to heterosexual men (27.7%) and women (23.5%). Rapid blood test was used in 78.5% of the cases and mostly performed in CBVCT offices (88.3%). Among sex workers (SWs), the percentage of reactive screening tests was particularly high (4.0%), especially among male SWs (7.7%) as compared to other risk groups, such as MSM (3.1%). The COBATEST network contributes to the availability of standardized information about the activity and impact of CBVCT centres in Europe. This information and standardized tools can help improve these services and inform decision-makers to better contextualize these interventions within their national HIV-prevention programmes.

Women on the Move: Reinterpreting Haitian Migration to Cuba through an Analysis of the Bahamas

Of the many legacies of the first US occupation of Haiti, migration has been paramount in shaping economic development and cultural transformation. In giving rise to mass migration among the peasantry, the US occupation instituted migration as a livelihood option for Haitians. The large majority of Haitian migrants went to Cuba. Since Haitian men traditionally harvested sugar and, accordingly, were recruited to work on Cuban sugar plantations owned by US companies, the composition of the migration was primarily male. Given the high proportion of men, Haitian migration to Cuba during the occupation has largely been interpreted through a male perspective. Studies have generally focused on the conditions of laborers, presented as exclusively male, on sugar estates. The attention given to male labor migrants has framed the study of the movement of Haitian women to Cuba. When Haitian women have been considered, their mobility has been defined in relation to Haitian men, stripping Haitian women of their agency. In this paper, I argue for a reinterpretation of Haitian migration to Cuba that considers the mobility of Haitian women independently of Haitian men, based on the descriptions of two Haitian women who migrated unaccompanied to the Bahamas. In presenting their stories, I draw on observations gained from ethnographic fieldwork among Haitian migrants in the Bahamas during the late 1990s to call into question the historical depiction of Haitian women in Cuba. I discuss the hardships unaccompanied Haitian women faced in the Bahamas and propose that these difficulties would have been similar for Haitian women who migrated independently to Cuba. Given the scale of the migration and the role of foreign interests and investments in its direction, the migration of Haitian peasants to Cuba during the US occupation of Haiti established precedents that were repeated in later movements across the Caribbean, including the Bahamas. Understanding the conditions under which Haitian women migrated to Cuba, therefore, is critical for interpreting subsequent migrations of Haitian women in the region.

Cancer Incidence in Heart Transplant Recipients With Previous Neoplasia History.

Neoplasm history increases morbidity and mortality after solid organ transplantation and has disqualified patients from transplantation. Studies are needed to identify factors to be considered when deciding on the suitability of a patient with previous tumor for heart transplantation. A retrospective epidemiological study was conducted in heart transplant (HT) recipients (Spanish Post-Heart Transplant Tumor Registry) comparing the epidemiological data, immu-nosuppressive treatments and incidence of post-HT tumors between patients with previous malignant noncardiac tumor and with no previous tumor (NPT). The impact of previous tumor (PT) on overall survival (OS) was also assessed. A total of 4561 patients, 77 PT and 4484 NPT, were evaluated. The NPT group had a higher proportion of men than the PT group (p < 0.001). The incidence of post-HT tumors was 1.8 times greater in the PT group (95% confidence interval [CI] 1.2-2.6; p < 0.001), mainly due to the increased risk in patients with a previous hematologic tumor (rate ratio 2.3, 95% CI 1.3-4.0, p < 0.004). OS during the 10-year posttransplant period was significantly lower in the PT than the NPT group (p = 0.048) but similar when the analysis was conducted after a first post-HT tumor was diagnosed. In conclusion, a history of PT increases the incidence of post-HT tumors and should be taken into account when considering a patient for HT.

Clinicopathological Characteristics of RET Rearranged Lung Cancer in European Patients

IntroductionRearrangements of RET are rare oncogenic events in patients with non–small cell lung cancer (NSCLC). While the characterization of Asian patients suggests a predominance of nonsmokers of young age in this genetically defined lung cancer subgroup, little is known about the characteristics of non-Asian patients. We present the results of an analysis of a European cohort of patients with RET rearranged NSCLC. MethodsNine hundred ninety-seven patients with KRAS/EGFR/ALK wildtype lung adenocarcinomas were analyzed using fluorescence in situ hybridization for RET fusions. Tumor specimens were molecularly profiled and clinicopathological characteristics of the patients were collected. ResultsRearrangements of RET were identified in 22 patients, with a prevalence of 2.2% in the KRAS/EGFR/ALK wildtype subgroup. Co-occurring genetic aberrations were detected in 10 patients, and the majority had mutations in TP53. The median age at diagnosis was 62 years (range, 39–80 years; mean ± SD, 61 ± 11.7 years) with a higher proportion of men (59% versus 41%). There was only a slight predominance of nonsmokers (54.5%) compared to current or former smokers (45.5%). ConclusionsPatients with RET rearranged adenocarcinomas represent a rare and heterogeneous NSCLC subgroup. In some contrast to published data, we see a high prevalence of current and former smokers in our white RET cohort. The significance of co-occurring aberrations, so far, is unclear.

Use of complementary and alternative medicine in patients with health complaints attributed to former dental amalgam fillings.

BackgroundThe dental filling material amalgam is generally well tolerated. However, a small proportion of dental patients experience health complaints which they attribute to amalgam. The symptom pattern is often similar to patients with medically unexplained physical symptoms (MUPS) and the health complaints may persist after amalgam removal. Among patients with MUPS, the use of complementary and alternative medicine (CAM) seems to be high. The aim of this survey was to describe the prevalence and range of CAM use among people with health complaints attributed to dental amalgam fillings in which the health problems persist after the removal of all amalgam fillings. Specific attention was paid to (1) self-reported effects of CAM, (2) differences in CAM use dependent on self-reported health, and (3) gender differences in self-reported CAM use.MethodsA survey was distributed to all members of The Norwegian dental patient association (NDPA) (n = 999), the response rate was 36.4 %. The anonymous questionnaire asked for socio-demographic data, health complaints related to former amalgam fillings, subjectively perceived health status, symptoms, and experience with therapeutic interventions, mostly from the spectrum of CAM. Only participants who had all their fillings removed, which was the vast majority, were analysed.ResultsA total of 88.9 % of included respondents had used at least one CAM modality, with a higher proportion of men (95.7 %) compared to women (86.2 %, p = 0.015). The most frequently used therapies were dietary supplements, vitamins and minerals recommended by a therapist (used by 66.7 %) followed by self-prescribed dietary supplements, vitamins and minerals (59.0 %), homeopathy (54.0 %), acupuncture (48.8 %) and special diets (47.5 %). Use of CAM was similar for participants reporting normal to good health compared to participants reporting poor health. For all but two CAM modalities, the self-reported treatment effect was better in the group reporting normal to good health compared to the group reporting poor health.ConclusionsCAM was widely used by participants in our study, a finding similar to findings from studies of MUPS patients. To date, health problems associated with the use of dental amalgam is not an accepted diagnosis in the healthcare system. Consequently, people suffering from such complaints experience a lack of adequate treatment and support within conventional health care, which might have contributed to the high number of CAM users in this study.

Abstract 12260: Sex Differences in Cardiac Troponin I and the Risk of Death or Major Cardiovascular Events in Primary Prevention

Introduction: Circulating cardiac troponin I concentrations are higher in men than in women, but the biological causes and clinical implications of this observation are poorly understood. Methods and Results: We measured cardiac troponin I with a novel high-sensitivity assay (hsTnI) in 4696 women and 8260 men enrolled in the JUPITER trial who had LDL-C &lt; 130 mg/dL and hsCRP ≥ 2.0 mg/L and no diabetes or clinical evidence of vascular disease. Median (IQR) hsTnI was higher in men [3.6 ng/L (2.7-5.3)] than in women [3.1 ng/L (2.3-4.5); P&lt;0.0001]. A higher proportion of men (3.7%) than women (2.9%) were above the proposed upper reference limit of 24 ng/L (P=0.008). In linear regression models, sex remained a significant predictor of natural log normalized hsTnI after adjusting for a wide array of confounders, including age, race, height, weight, lipids, fasting glucose, blood pressure, and renal function. Across quintiles of hsTnI measured at baseline, the unadjusted incidence rate of the composite outcome of myocardial infarction, stroke, hospitalization for unstable angina, revascularization, or death increased across hsTnI categories but appeared similar in women and men (Figure 1). In adjusted Cox models stratified by sex, the increase in the relative risk of the composite endpoint across quintiles of hsTnT appeared similar in men and women (Figure 2; P-interaction=0.45). Conclusions: In a contemporary primary prevention population, women have lower baseline cardiac troponin I concentrations but similar increases in the rates of vascular events and death across troponin I categories.

Abstract 15581: Nocturnal Blood Pressure is Associated With Localized Retinal Nerve Fiber Layer Defects on Optical Coherence Tomography

Introduction: Retinal damages have been suggested a surrogate marker of end-organ damage and prognostic marker in hypertensive patients. Recent study reported that localized retinal nerve fiber layer defects (RNFLDs) assessed by noninvasive optical coherence tomography (OCT) was related to the degree of hypertension severity and cerebrovascular disease. Purpose: We hypothesize that RNFLDs are related to the parameters of 24 hour ambulatory blood pressure monitoring (ABPM). Methods: RNFLDs were assessed by retinal OCT in 562 consecutive subjects enrolled in Cardiovascular and Metabolic Disease Etiology Research Center - HIgh Risk Cohort (CMERC-HI, NCT02003781). We excluded the patients with glaucoma, which known to be related to RNFLD independently of cardiovascular risk factors. Results: RNFLD was found in 129 (23.0%) patients. In patients with RNFLD, there were higher proportion of men, higher prevalence of hypertension, higher glucose levels and lower HDL-cholesterol levels. The RNFLD patients had higher 24 hour mean systolic and diastolic blood pressure (SBP/DBP, 133±16/80±9 vs. 129±13/78±8, p=0.022/p=0.015, respectively) and nocturnal mean SBP/DBP (124±19/74±9 vs. 120±15/72±9, p=0.013/p=0.010, respectively) compared to those without RNFLD. Multivariate stepwise linear regression analysis revealed that RNFLD was independently associated with nocturnal mean SBP after controlling for age, gender, diabetes mellitus, smoking, body mass index, brachial systolic blood pressure, heart rate, estimated glomerular filtration rate, heart to femoral pulse wave velocity (β=0.093, p=0.036, R2=0.263). Conclusion: We reported that RNFLD on OCT was related to nocturnal blood pressure in 24 hour ABPM for the first time. Further studies which validate RNFLD as a cardiovascular surrogate and risk marker should be warranted.

Abstract 11930: Sex Differences in Cardiac Troponin and the Risk of Death or Major Cardiovascular events in Men and Women With Diabetes and Coronary Artery Disease

Background: Circulating cardiac troponin T concentrations are higher in men than in women, but the biological causes and clinical implications of this observation are poorly understood. Methods and Results: We measured cardiac troponin T with a high-sensitivity assay (hsTnT) in 684 women and 1601 men with type 2 diabetes (T2D) and stable ischemic heart disease (SIHD) who were enrolled in the BARI 2D trial. Median (IQR) hsTnT was higher in men [12.4 ng/L (8.7-20.8)] than in women [9.1 ng/L (6.4-15.6); P&lt;0.0001] and a higher proportion of men (43.6%) than women (29.1%) were above the current established upper reference limit of 14 ng/L (P&lt;0.0001). Sex remained a significant predictor of natural log normalized hsTnT after adjusting for a wide array of covariables, including age, race, insulin use, renal function, ejection fraction, and HbA1c. Within quintiles of hsTnT measured at baseline, the 5-year incidence of the composite cardiovascular outcome of myocardial infarction, stroke, heart failure, or death was consistently higher in women than in men (Figure 1). In sex-stratified Cox models adjusting for possible confounders, the increase in the relative risk of the composite endpoint across quintiles of hsTnT appeared similar in men and women (Figure 2). Conclusions: In the BARI 2D trial, women have lower baseline hsTnT concentrations, but higher absolute risk of myocardial infarction, stroke, heart failure, or death for a given concentration of hsTnT. These data raise the question of whether sex-specific cutoffs for cardiac troponin T should be considered.

An international comparison of patients undergoing percutaneous coronary intervention: A collaborative study of the National Cardiovascular Data Registry (NCDR) and Japan Cardiovascular Database–Keio interhospital Cardiovascular Studies (JCD-KiCS)

Details on Japanese patients undergoing percutaneous coronary intervention (PCI) and how they compare to US patients remain unclear. Furthermore, the application of US risk models has not been evaluated internationally. The JCD-KiCS, a multicenter registry of consecutive PCI patients, was launched in 2008, with variables defined in accordance with the US NCDR. Patient and procedural characteristics from patients enrolled from 2008 to 2010 in the JCD-KiCS database (n = 9,941) and those in the NCDR (n = 732,345) were compared. The primary outcomes of this analysis were the hospital-level all-cause mortality and bleeding complications. The NCDR risk models for these 2 outcomes were evaluated in the Japanese data set; from the expected mortality and bleeding rates, the observed/expected ratios were calculated. The Japanese patients were older, with a higher proportion of men, diabetes, and smoking than the US patients. The Japanese patients also had a higher rate of complex lesions (26.1 vs 12.7% for bifurcation and 6.2% vs 3.2% for chronic total occlusions, all P < .001), longer procedure time (29.7 ± 21.5 vs 14.4 ± 11.5 minutes, P < .001), and higher mortality (1.6% vs 0.9%, P < .001) and bleeding rates (2.9% vs 1.8%, P < .001) compared with US patients. The observed/expected ratios for mortality and bleeding were 0.921 and 0.467, respectively, in Japanese patients, and 1.002 and 0.981, respectively, for US patients. The characteristics of patients undergoing PCI in clinical practice in Japan and the US differ substantially. The NCDR risk models applied well in Japanese patients for prediction of mortality, but not for bleeding, which tended to underestimate the risk.

Lesiones por accidente de tráfico: aproximación desde el conjunto mínimo básico de datos de urgencias y hospitalización de agudos de Cataluña

ObjectiveTo verify the usefulness of the minimum data set (MDS) for acute-care hospitals and emergency resources for the study of road traffic injuries and to describe the use of health resources in Catalonia (Spain). MethodsThe study population consisted of patients treated in any kind of emergency service and patients admitted for acute hospitalization in Catalonia in 2013. A descriptive analysis was performed by age, gender, time and clinical variables. ResultsA total of 48,150 patients were treated in hospital emergency departments, 6,210 were attended in primary care, and 4,912 were admitted to hospital. There was a higher proportion of men (56.2%), mainly aged between 20 and 40 years. Men accounted for 54.9% of patients with minor injuries and 75.1% of those with severe injuries. Contusions are the most common injury (30.2%), followed by sprains (28.7%). Fractures mostly affected persons older than 64 years, internal injuries particularly affected men older than 64 years, and wounds mainly affected persons younger than 18 years and older than 64 years. In the adult population, the severity of the injuries increased with age, leading to longer length of stay and greater complexity. Hospital mortality was 0.2%. Fractures, internal injuries and wounds were more frequent in the group of very serious injuries, and sprains and contusions in the group of minor injuries. ConclusionsMDS records (acute hospitals and emergency resources) provide information that is complementary to other sources of information on traffic accidents, increasing the completeness of the data.

Will Magnetic Resonance Imaging-guided Biopsy Replace Systematic Biopsy?

The main disadvantages of the current diagnostic pathway in men with an elevated risk of prostate cancer (PCa) are that: (1) systematic transrectal ultrasound (TRUS) biopsy misses a substantial proportion (20%) of significant PCa because of inherent systematic sampling errors, especially in the anterior gland [1,2]; (2) misclassifies pathologic status including Gleason score (Gl) and tumour stage [3]; and (3) detects a high proportion of men with disease that is unlikely to be harmful (clinically insignificant), with subsequently overtreatments resulting in unintended harm [4]. The latter was the main reason for the U.S. Preventive Services Task Force recommendation against prostate-specific antigenbased screening for prostate cancer in 2012 [5].

Occupational gender segregation in an equilibrium search model

Abstract This paper develops an equilibrium search model to explain gender asymmetry in occupational distribution. Workers’ utility depends on salary and working hours, and women have a greater aversion to longer working hours than men. Simulations indicate that women crowd into shorter-hour, lower-paying jobs than men. If employers discriminate against women, offers are tailored more toward the working-hour preferences of men by requiring longer working hours. Similarly, if women have a disutility factor in their utility toward positions with a higher proportion of men, fewer women work at these jobs. In both cases, gender segregation is reinforced. JEL classification: E24, J16, J64, J71