Purpose-Multivariate prognostic instruments aim to predict risk of recurrence among patients with localized prostate cancer. We sought to devise a novel risk assessment tool which would be a strong predictor of outcome across various levels of risk, and which could be easily applied and intuitively understood.Materials and Methods-We studied 1,439 men who had undergone radical prostatectomy and were followed in the CaPSURE database (a longitudinal, community-based disease registry of prostate cancer patients) diagnosed between 1992 and 2001 were included. Disease recurrence was defined as prostate specific antigen (PSA) ≥0.2 ng/ml on 2 consecutive occasions following prostatectomy, or a second cancer treatment more than six months after surgery. The UCSF-CAPRA score was developed using pre-operative PSA, Gleason score, clinical T-stage, biopsy results, and age. The index was developed and validated using Cox proportional hazards and life table analyses.Results-210 patients (15%) recurred, 145 by PSA criteria and 65 by second treatment. Based on the results of the Cox analysis, points were assigned based on PSA (0-4 points), Gleason score (0-3), T stage (0-1), age (0-1), and biopsy data (0-1). The CAPRA score range is 0 to 10, with roughly double the risk of recurrence for each 2-point increase in score. Recurrence-free survival at 5 years ranged from 85% for a CAPRA score of 0-1 (95% CI 73-92%) to 8% for a score of 7-10 (95% CI 0-28%). The concordance index for the CAPRA score was 0.66. Conclusions-The UCSF-CAPRA score is a straightforward yet powerful preoperative risk assessment tool. It must be externally validated in future studies.

Packy & Marlon, an interactive video game designed to improve self-care among children and adolescents with diabetes, was evaluated in a six-month randomized controlled trial. In the game, players take the role of animated characters who manage their diabetes by monitoring blood glucose, taking insulin injections, and choosing foods, while setting out to save a diabetes summer camp from marauding rats and mice who have stolen the diabetes supplies. Study participants were patients aged 8 to 16 from two separate diabetes clinics. Each participant received a Super Nintendo video game system at an initial clinic visit and was randomly assigned to receive either Packy & Marlon (treatment group, N = 31) or an entertainment video game containing no diabetes-related content (control group, N = 28). Participants were interviewed and a parent filled out a questionnaire at baseline, three months, and six months. The findings in this study indicate that well-designed, educational video games can be effective interventions. There was improvement in the treatment group relative to the control group in terms of diabetes-related self-efficacy (p = 0.07), communication with parents about diabetes (p = 0.025), and self-care behaviours (p = 0.003), and a decrease in unscheduled urgent doctor visits (p = 0.08). There were no significant differences between the groups in knowledge about diabetes or in glycated haemoglobin (HbA1c) levels. Since participants in the study were in general well-controlled patients who were receiving excellent medical care, future research is contemplated involving youngsters who are not under good glycaemic control.

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The use of PCI for patients with cardiogenic shock was associated with improved survival in a large group of hospitals with revascularization capability. The American College of Cardiology and American Heart Association guidelines had no detectable temporal impact on revascularization rates. These findings support the need for increased adherence to these guidelines.

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We present a theoretical framework that organizes individual-level fertility motivations into a couple-level model. One feature of this framework is the Traits-Desires-Intentions-Behaviour (TDIB) sequence through which the fertility motivations of individuals produce instrumental behaviours that are designed to promote or prevent childbearing. A second feature of this framework is the cognitive capacity of individuals to perceive a partner's motivational structure. We combine these two features into a dyad-level model that addresses interactions between partners at each step of the motivational sequence. We elaborate this model first with respect to the perception of partner's motivational structure and second with respect to the combination of partner's and own motivational structure. In the process we consider how couple-level processes of communication, influence, and disagreement can be measured and studied through these interactions. We conclude with a summary discussion of the framework and a consideration of the implications it has for a theory of reproductive psychology, population surveys, and family planning services.

Objective. To obtain estimates of medical care expenditures and earnings losses associated with arthritis and other rheumatic conditions and the increment in such costs attributable to arthritis and other rheumatic conditions in the US in 2003, and to compare these estimates with those from 1997.Methods. Estimates for 2003 were derived from the Medical Expenditures Panel Survey (MEPS), a national probability sample of households. We tabulated medical care expenditures of adult MEPS respondents, stratified by arthritis and comorbidity status, and used regression techniques to estimate the increment of medical care expenditures attributable to arthritis and other rheumatic conditions. We also estimated the earnings losses sustained by working-age adults with arthritis and other rheumatic conditions. Concern about the individual and population economic burden of arthritis and other rheumatic conditions is growing in developed and developing countries alike, crystallized by the activities of the Bone and Joint Decade (1-4). In developed countries, this burden is in part the result of the aging of the population (4) and of the increased medical care costs associated with the expansion of joint replacement surgery, the rise (and then fall) of the coxibs, and, for inflammatory conditions, the development and increasing use of biologic agents (5). This concern is reflected in systematic reviews of evidence on the economic impact of select rheumatic conditions (summarizing studies on clinical samples) (6-13) and in a series of studies on the total economic burden associated with arthritis, many using the arthritis and other rheumatic conditions rubric and/or population-based data (14-24).