Purpose: As the oncological results of prostate brachytherapy (BT) are excellent for low-risk (LR) or favorable intermediate-risk (FIR) prostate cancer (PCa), evaluating the side effects has become a major issue, especially for young men. The objective of the study was to compare the oncologic and functional results of BT using Quadrella index for patients aged 60 or less compared with older patients.Material and methods: From June, 2007 to June, 2017, 222 patients, including 70 ≤ 60 years old and 152 > 60 years old, underwent BT for LR-FIR PCa, with good erectile function at baseline according to International Index of Erectile Function-5 (IIEF-5) > 16. Quadrella index was achieved under the following circumstances: 1) Absence of biological recurrence (Phoenix criteria); 2) Absence of erectile dysfunction (ED) (IIEF-5 > 16); 3) No urinary toxicity (international prostate score symptom) IPSS < 15 or IPSS > 15, and ΔIPSS < 5; 4) No rectal toxicity (RT) (Radiation Therapy Oncology Group, RTOG = 0). Patients were treated on demand with phosphodiesterase inhibitors (PDE5i) post-operatively.Results: The Quadrella index was satisfied for about 40-80% of patients ≤ 60 years vs. 33-46% for older patients during 6-year follow-up (significant difference from the second year). At year 5, 100% of evaluable patients aged ≤ 60 and 91.8% > 60 (p = 0.29) reached Phoenix criteria. The criterion of ED (IIEF-5 < 16) largely explained the validity rate of Quadrella alone. There was no ED for 67.2-81.4% of patients ≤ 60 years compared with 40.0-56.1% for patients > 60 (significant difference since year 4 in favor of young men). After two years of follow-up, more than 90% of patients in both the groups showed neither urinary nor rectal toxicities.Conclusions: For young men displaying LR-FIR PCa, BT appears to be a first-class therapeutic option, as the oncological results were at least equivalent to those of older patients with good long-term tolerance.
Implementation Facilitators and Barriers to the Expansion of a Peer-led Overdose Prevention ProgramIn Canada, there has been a substantial increase of opioid overdoses in recent years.PROFAN, a peer-led overdose prevention initiative, was successfully implemented in Montreal, Quebec, for people who use drugs (PWUD), or those likely to witness overdoses. The worsening of the situation during the COVID-19 pandemic sparked the need to expand the program across the province. Individual interviews were conducted with 17 key informants from 12 health regions to identify implementation facilitators and barriers. A thematic analysis was conducted based on emerging themes. Four main facilitators were reported: 1) presence of an active peer network involved with harm reduction in the region, 2) collaboration among community and public health sectors, 3) stakeholders' awareness of opioid situation, and 4) perceived appropriateness of training.Six main barriers also emerged: 1) geographical isolation, 2) existing offer of similar services, 3) difficulty reaching isolated PWUD, 4) stigmatization of PWUD, 5) unwillingness of stakeholders to address situation, and 6) lack of funding stability. The expansion achieved by the PROFAN program highlights the ability of a peer-driven community organization to lead an overdose prevention program when provided with funding and support from government health agencies and partnerships with other organizations such as addiction worker associations.
La fin du XIXe siècle bolivien est marquée par une solidification de la structure de l’État. Ce raffermissement permet l’émergence d’un nationalisme structuré en un outil de légitimation de l’État. Dans ce contexte, l’institution judiciaire devient l’une des sphères où s’observe cette dynamique qui prend alors les traits d’une théâtralité politique. À travers l’exemple du procès Peñas, qui suit la Guerre fédérale, le présent article montre comment la Justice, partie constitutive et constituante de l’État, apparaît comme un lieu clé où les conditions d’appartenance et les limites de la communauté nationale se définissent, légitimant au passage l’État lui-même.
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