Hasil untuk "Men"

C. Kuehner

C. Pritchard, J. Mateo, M. Walsh et al.

S. Dutta, P. Sengupta

M. Hussain, K. Fizazi, F. Saad et al.

BACKGROUND Men with nonmetastatic, castration‐resistant prostate cancer and a rapidly rising prostate‐specific antigen (PSA) level are at high risk for metastasis. We hypothesized that enzalutamide, which prolongs overall survival among patients with metastatic, castration‐resistant prostate cancer, would delay metastasis in men with nonmetastatic, castration‐resistant prostate cancer and a rapidly rising PSA level. METHODS In this double‐blind, phase 3 trial, we randomly assigned, in a 2:1 ratio, men with nonmetastatic, castration‐resistant prostate cancer and a PSA doubling time of 10 months or less who were continuing androgen‐deprivation therapy to receive enzalutamide (at a dose of 160 mg) or placebo once daily. The primary end point was metastasis‐free survival (defined as the time from randomization to radiographic progression or as the time to death without radiographic progression). RESULTS A total of 1401 patients (median PSA doubling time, 3.7 months) underwent randomization. As of June 28, 2017, a total of 219 of 933 patients (23%) in the enzalutamide group had metastasis or had died, as compared with 228 of 468 (49%) in the placebo group. The median metastasis‐free survival was 36.6 months in the enzalutamide group versus 14.7 months in the placebo group (hazard ratio for metastasis or death, 0.29; 95% confidence interval, 0.24 to 0.35; P<0.001). The time to the first use of a subsequent antineoplastic therapy was longer with enzalutamide treatment than with placebo (in 142 vs. 226 patients; hazard ratio, 0.21; P<0.001) as was the time to PSA progression (in 208 vs. 324 patients; hazard ratio, 0.07; P<0.001). At the first interim analysis of overall survival, 103 patients (11%) receiving enzalutamide and 62 (13%) receiving placebo had died. Adverse events of grade 3 or higher occurred in 31% of the patients receiving enzalutamide, as compared with 23% of those receiving placebo. CONCLUSIONS Among men with nonmetastatic, castration‐resistant prostate cancer with a rapidly rising PSA level, enzalutamide treatment led to a clinically meaningful and significant 71% lower risk of metastasis or death than placebo. Adverse events were consistent with the established safety profile of enzalutamide. (Funded by Pfizer and Astellas Pharma; PROSPER ClinicalTrials.gov number, NCT02003924.)

A. Steptoe, A. Shankar, P. Demakakos et al.

J. Baeten, D. Donnell, P. Ndase et al.

F. Bonnet

S. Yang, K. Dou, Wen Song

R. Landovitz, D. Donnell, M. Clement et al.

BACKGROUND Safe and effective long-acting injectable agents for preexposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) infection are needed to increase the options for preventing HIV infection. METHODS We conducted a randomized, double-blind, double-dummy, noninferiority trial to compare long-acting injectable cabotegravir (CAB-LA, an integrase strand-transfer inhibitor [INSTI]) at a dose of 600 mg, given intramuscularly every 8 weeks, with daily oral tenofovir disoproxil fumarate-emtricitabine (TDF-FTC) for the prevention of HIV infection in at-risk cisgender men who have sex with men (MSM) and in at-risk transgender women who have sex with men. Participants were randomly assigned (1:1) to receive one of the two regimens and were followed for 153 weeks. HIV testing and safety evaluations were performed. The primary end point was incident HIV infection. RESULTS The intention-to-treat population included 4566 participants who underwent randomization; 570 (12.5%) identified as transgender women, and the median age was 26 years (interquartile range, 22 to 32). The trial was stopped early for efficacy on review of the results of the first preplanned interim end-point analysis. Among 1698 participants from the United States, 845 (49.8%) identified as Black. Incident HIV infection occurred in 52 participants: 13 in the cabotegravir group (incidence, 0.41 per 100 person-years) and 39 in the TDF-FTC group (incidence, 1.22 per 100 person-years) (hazard ratio, 0.34; 95% confidence interval, 0.18 to 0.62). The effect was consistent across prespecified subgroups. Injection-site reactions were reported in 81.4% of the participants in the cabotegravir group and in 31.3% of those in the TDF-FTC group. In the participants in whom HIV infection was diagnosed after exposure to CAB-LA, INSTI resistance and delays in the detection of HIV infection were noted. No safety concerns were identified. CONCLUSIONS CAB-LA was superior to daily oral TDF-FTC in preventing HIV infection among MSM and transgender women. Strategies are needed to prevent INSTI resistance in cases of CAB-LA PrEP failure. (Funded by the National Institute of Allergy and Infectious Diseases and others; HPTN 083 ClinicalTrials.gov number, NCT02720094.).

J. Kanis, O. Johnell, A. Odén et al.

SummaryA fracture risk assessment tool (FRAX™) is developed based on the use of clinical risk factors with or without bone mineral density tests applied to the UK.IntroductionThe aim of this study was to apply an assessment tool for the prediction of fracture in men and women with the use of clinical risk factors (CRFs) for fracture with and without the use of femoral neck bone mineral density (BMD). The clinical risk factors, identified from previous meta-analyses, comprised body mass index (BMI, as a continuous variable), a prior history of fracture, a parental history of hip fracture, use of oral glucocorticoids, rheumatoid arthritis and other secondary causes of osteoporosis, current smoking, and alcohol intake 3 or more units daily.MethodsFour models were constructed to compute fracture probabilities based on the epidemiology of fracture in the UK. The models comprised the ten-year probability of hip fracture, with and without femoral neck BMD, and the ten-year probability of a major osteoporotic fracture, with and without BMD. For each model fracture and death hazards were computed as continuous functions.ResultsEach clinical risk factor contributed to fracture probability. In the absence of BMD, hip fracture probability in women with a fixed BMI (25 kg/m2) ranged from 0.2% at the age of 50 years for women without CRF’s to 22% at the age of 80 years with a parental history of hip fracture (approximately 100-fold range). In men, the probabilities were lower, as was the range (0.1 to 11% in the examples above). For a major osteoporotic fracture the probabilities ranged from 3.5% to 31% in women, and from 2.8% to 15% in men in the example above. The presence of one or more risk factors increased probabilities in an incremental manner. The differences in probabilities between men and women were comparable at any given T-score and age, except in the elderly where probabilities were higher in women than in men due to the higher mortality of the latter.ConclusionThe models provide a framework which enhances the assessment of fracture risk in both men and women by the integration of clinical risk factors alone and/or in combination with BMD.

M. Addis, J. R. Mahalik

J. Mestas, C. Hughes

W. Craig

A. Coker, K. Davis, I. Arias et al.

A. Eagly, Mary C. Johannesen-Schmidt, M. V. van Engen

I. Janssen, S. Heymsfield, Zimian Wang et al.

I. Thompson, D. Pauler, P. Goodman et al.

S. Cerri, Liudmila Mus, F. Blandini

Increasing evidence points to biological sex as an important factor in the development and phenotypical expression of Parkinson’s disease (PD). Risk of developing PD is twice as high in men than women, but women have a higher mortality rate and faster progression of the disease. Moreover, motor and nonmotor symptoms, response to treatments and disease risk factors differ between women and men. Altogether, sex-related differences in PD support the idea that disease development might involve distinct pathogenic mechanisms (or the same mechanism but in a different way) in male and female patients. This review summarizes the most recent knowledge concerning differences between women and men in PD clinical features, risk factors, response to treatments and mechanisms underlying the disease pathophysiology. Unraveling how the pathology differently affect the two sexes might allow the development of tailored interventions and the design of innovative programs that meet the distinct needs of men and women, improving patient care.

Tanja Hentschel, M. Heilman, C. Peus

We used a multi-dimensional framework to assess current stereotypes of men and women. Specifically, we sought to determine (1) how men and women are characterized by male and female raters, (2) how men and women characterize themselves, and (3) the degree of convergence between self-characterizations and charcterizations of one’s gender group. In an experimental study, 628 U.S. male and female raters described men, women, or themselves on scales representing multiple dimensions of the two defining features of gender stereotypes, agency and communality: assertiveness, independence, instrumental competence, leadership competence (agency dimensions), and concern for others, sociability and emotional sensitivity (communality dimensions). Results indicated that stereotypes about communality persist and were equally prevalent for male and female raters, but agency characterizations were more complex. Male raters generally descibed women as being less agentic than men and as less agentic than female raters described them. However, female raters differentiated among agency dimensions and described women as less assertive than men but as equally independent and leadership competent. Both male and female raters rated men and women equally high on instrumental competence. Gender stereotypes were also evident in self-characterizations, with female raters rating themselves as less agentic than male raters and male raters rating themselves as less communal than female raters, although there were exceptions (no differences in instrumental competence, independence, and sociability self-ratings for men and women). Comparisons of self-ratings and ratings of men and women in general indicated that women tended to characterize themselves in more stereotypic terms – as less assertive and less competent in leadership – than they characterized others in their gender group. Men, in contrast, characterized themselves in less stereotypic terms – as more communal. Overall, our results show that a focus on facets of agency and communality can provide deeper insights about stereotype content than a focus on overall agency and communality.

Steven Maxwell, M. Shahmanesh, M. Gafos

BACKGROUND 'Chemsex' is the use of drugs before or during planned sexual events to facilitate, enhance, prolong and sustain the experience. Drugs associated with chemsex are methamphetamine, GHB/GBL, mephedrone, cocaine and ketamine. This review syntheses published research on the antecedents, behaviours and consequences associated with chemsex behaviours among men who have sex with men (MSM). METHODS Papers from high income countries which were published between January 2000 and September 2018 reporting the use of chemsex drugs before or during sex were identified through Medline, Web of Science, CINAHL and Central. Results were synthesised using a narrative approach and conceptualised using a behavioural analysis framework. RESULTS The search identified 2492 publications, of which 38 were included in the final synthesis. There were wide variations in chemsex prevalence estimates due to the heterogeneous sampling in the studies. Chemsex participants have expectations that the drugs will positively affect their sexual encounters and HIV positive MSM are more likely to engage in the behaviour than HIV negative MSM. There were wide ranging prevalence estimates on injecting drugs for sexual purposes and the sharing of injecting equipment with some evidence of unsafe injecting practices. Participants were more likely to engage in condomless anal intercourse than men who do not engage in chemsex. This may increase the risk of transmission for HIV and other sexually transmitted infections. CONCLUSION A minority of MSM appear to engage in chemsex behaviours but they are at risk of this negatively impacting on their health and well-being. Further research is required to examine high risk chemsex behaviours, impact of chemsex on psycho-social well-being and if chemsex influences uptake of PrEP, PEP and sexual health screening.