| 1. |
- Bill-Axelson, Anna, et al.
(author)
-
Radical Prostatectomy or Watchful Waiting in Early Prostate Cancer
- 2014
-
In: New England Journal of Medicine. - Waltham : Massachusetts Medical Society. - 0028-4793 .- 1533-4406. ; 370:10, s. 932-942
-
Journal article (peer-reviewed)abstract
- BackgroundRadical prostatectomy reduces mortality among men with localized prostate cancer; however, important questions regarding long-term benefit remain. MethodsBetween 1989 and 1999, we randomly assigned 695 men with early prostate cancer to watchful waiting or radical prostatectomy and followed them through the end of 2012. The primary end points in the Scandinavian Prostate Cancer Group Study Number 4 (SPCG-4) were death from any cause, death from prostate cancer, and the risk of metastases. Secondary end points included the initiation of androgen-deprivation therapy. ResultsDuring 23.2 years of follow-up, 200 of 347 men in the surgery group and 247 of the 348 men in the watchful-waiting group died. Of the deaths, 63 in the surgery group and 99 in the watchful-waiting group were due to prostate cancer; the relative risk was 0.56 (95% confidence interval [CI], 0.41 to 0.77; P=0.001), and the absolute difference was 11.0 percentage points (95% CI, 4.5 to 17.5). The number needed to treat to prevent one death was 8. One man died after surgery in the radical-prostatectomy group. Androgen-deprivation therapy was used in fewer patients who underwent prostatectomy (a difference of 25.0 percentage points; 95% CI, 17.7 to 32.3). The benefit of surgery with respect to death from prostate cancer was largest in men younger than 65 years of age (relative risk, 0.45) and in those with intermediate-risk prostate cancer (relative risk, 0.38). However, radical prostatectomy was associated with a reduced risk of metastases among older men (relative risk, 0.68; P=0.04). ConclusionsExtended follow-up confirmed a substantial reduction in mortality after radical prostatectomy; the number needed to treat to prevent one death continued to decrease when the treatment was modified according to age at diagnosis and tumor risk. A large proportion of long-term survivors in the watchful-waiting group have not required any palliative treatment. (Funded by the Swedish Cancer Society and others.) The randomized Swedish trial of prostatectomy versus watchful waiting in disease detected mainly clinically (not by PSA screening) continues to show a benefit for early prostatectomy. The number of men younger than 65 needed to treat to prevent one death is now four. The Scandinavian Prostate Cancer Group Study Number 4 (SPCG-4), a randomized trial of radical prostatectomy versus watchful waiting in men with localized prostate cancer diagnosed before the era of prostate-specific antigen (PSA) testing, showed a survival benefit of radical prostatectomy as compared with observation at 15 years of follow-up.(1) By contrast, the Prostate Cancer Intervention versus Observation Trial (PIVOT), initiated in the early era of PSA testing, showed that radical prostatectomy did not significantly reduce prostate cancer-specific or overall mortality after 12 years.(2) PSA screening profoundly changes the clinical domain of study. Among other considerations, the substantial additional lead time ...
|
|
| 2. |
- Bill-Axelson, Anna, et al.
(author)
-
Radical prostatectomy versus watchful waiting in early prostate cancer.
- 2011
-
In: The New England journal of medicine. - : Massachussetts Medical Society. - 1533-4406 .- 0028-4793. ; 364:18, s. 1708-17
-
Research review (peer-reviewed)abstract
- In 2008, we reported that radical prostatectomy, as compared with watchful waiting, reduces the rate of death from prostate cancer. After an additional 3 years of follow-up, we now report estimated 15-year results.
|
|
| 3. |
- Nordling, Monica, et al.
(author)
-
Glöm inte munhälsan – den kan vara livsviktig för sjukvården
- 2011
-
In: Dagens Medicin. ; 17:11, s. 1-2
-
Journal article (other academic/artistic)abstract
- Det nuvarande tandvårdsstödet för uppsökande och nödvändig tandvård till äldre och funktionshindrade har snabbt blivit otillräckligt. Nya data för hemmaboende äldre visar att munhälsan redan hos dem med måttligt omvårdnadsbehov är avsevärt sämre än hos friska äldre. Uppsökande tandvård är konkurrensutsatt. Liknelsen med gamla tiders fattigvård och utförsäljning till lägstbjudande är slående. Sveriges Kommuner och Landsting, SKL, redovisar för 2009 lägre kostnader för uppsökande tandvård men kraftigt ökande för nödvändig tandvård, det vill säga den tandvård som ges enligt hälso- och sjukvårdstaxa och där vårdgivaren ersätts från landstinget. Ständigt nya vårdgivare förhindrar också att goda samarbetsrutiner upparbetas och bibehålls. Vi föreslår ett omvårdnadsbidrag för munvård där tandvårdspersonal knyts till hemtjänst och äldre boenden samt en obligatorisk utbildning till den personal som svarar för den dagliga vården. En samordningsansvarig tandhygienist kan med tandläkare och omvårdnadspersonal utgöra det system som fångar upp och tillgodoser munvårdsbehoven i tid.
|
|
| 4. |
- Rehfisch, Pia, et al.
(author)
-
Lung Function and Respiratory Symptoms in Hard Metal Workers Exposed to Cobalt
- 2012
-
In: Journal of Occupational and Environmental Medicine. - Philadelphia, USA : Lippincott Williams & Wilkins. - 1076-2752 .- 1536-5948. ; 54:4, s. 409-413
-
Journal article (peer-reviewed)abstract
- Objective: To follow-up lung function and airway symptoms in workers exposed to cobalt dust at a hard metal plant. Methods: A total of 582 employees underwent spirometry and completed a questionnaire. A historical exposure matrix was created, assigning figures for historical and recent work-related exposure. Results: At the time of employment, 5% reported symptoms from respiratory tract. At follow-up, 5% suffered from persistent coughing and 7% reported asthma; 20% were daily smokers. Among nonsmokers without asthma, an evident, statistically nonsignificant, dose-response effect was seen between increasing cobalt exposure and decline in FEV1 (forced expiratory volume in the first second). In all exposure categories, the FEV1 in smokers declined 10 mL more per year than for nonsmokers. Conclusions: Even low levels of cobalt exposure seem to hamper lung function both in smokers and nonsmokers. This impact is considered low in relation to the effect of aging.
|
|
