Quality of life compared during pharmacological treatments and clinical monitoring for non-localized prostate cancer: a randomized controlled trial

To investigate the effects of different management strategies for non-localized prostate cancer on men's quality of life and cognitive functioning. Men with prostate cancer were randomly assigned to one of four treatment arms: leuprorelin, goserelin, cyproterone acetate (CPA), or close clinical monitoring. In a repeated-measures design, men were assessed before treatment (baseline) and after 6 and 12 months of treatment. A community comparison group of men of the same age with no prostate cancer participated for the same length of time. The men were recruited from public and private urology departments from university teaching hospitals. All those with prostate cancer who were eligible for hormonal therapy had no symptoms requiring immediate therapy. In all, 82 patients were randomized and 62 completed the 1-year study, and of the 20 community participants, 15 completed the study. The main outcome measures were obtained from questionnaires on emotional distress, existential satisfaction, physical function and symptoms, social and role function, subjective cognitive function, and sexual function, combined with standard neuropsychological tests of memory, attention, and executive functions. Sexual dysfunction increased for patients on androgen-suppressing therapies, and emotional distress increased in those assigned to CPA or close clinical monitoring. Compared with before treatment there was evidence of an adverse effect of leuprorelin, goserelin, and CPA on cognitive function. In deciding the timing of androgen suppression therapy for prostate cancer, consideration should be given to potential adverse effects on quality of life and cognitive function.

Attitude-behaviour consistency: the role of group norms, attitude accessibility, and mode of behavioural decision-making

The interplay between two perspectives that have recently been applied in the attitude area-the social identity approach to attitude-behaviour relations (Terry & Hogg, 1996) and the MODE model (Fazio, 1990a)-was examined in the present research. Two experimental studies were conducted to examine the role of group norms, group identification, attitude accessibility, and mode of behavioural decision-making in the attitude-behaviour relationship. In Study I (N = 211), the effects of norms and identification on attitude-behaviour consistency as a function of attitude accessibility and mood were investigated. Study 2 (N = 354) replicated and extended the first experiment by using time pressure to manipulate mode of behavioural decision-making. As expected, the effects of norm congruency varied as a function of identification and mode of behavioural decision-making. Under conditions assumed to promote deliberative processing (neutral mood/low time pressure), high identifiers behaved in a manner consistent with the norm. No effects emerged under positive mood and high time pressure conditions. In Study 2, there was evidence that exposure to an attitude-incongruent norm resulted in attitude change only under low accessibility conditions. The results of these studies highlight the powerful role of group norms in directing individual behaviour and suggest limited support for the MODE model in this context. Copyright (C) 2003 John Wiley Sons, Ltd.

Punctuated equilibrium and linear progression: Toward a new understanding of group development

This study proposes gaining a new understanding of group development by considering the integrative and the punctuated equilibrium models of group development as complementary rather than competing. We hypothesized that we would observe both punctuated equilibrium and linear progression in content-analyzed data from 25 simulated project teams, albeit on different dimensions. We predicted changes in time awareness and in task and pacing activity in line with the punctuated equilibrium model and changes in structure and process on task and socioemotional dimensions in line with the integrative model. Results partially supported predictions for both models.

Dragging down and dragging up: How relative group status affects responses to common fate

The authors examined whether status differences moderate the effects of common fate on subgroup relations. University students (N = 103) were led to believe that their subgroup was performing well (high status) or poorly (low status) relative to another subgroup. They were then told that the combined performances of the subgroups would have shared implications for their subgroup's welfare. (common fate) or that there would be a direct link between their subgroup's performance and its welfare (no common fate). High-status (but not low-status) group members responded to the common fate situation by (a) decategorizing and (b) showing benevolence to the out-group. Results are discussed with respect to their implications for managing subgroup relations.

Not being what you claim to be: impostors as sources of group threat

We examine the notion of impostors within groups, defined in this paper as people who make public claims to an identity while disguising their failure to fulfil key criteria for group membership. In Experiment 1, vegetarians showed heightened levels of negative affect toward vegetarians who ate meat occasionally compared to an authentic vegetarian. In contrast, non-vegetarians saw the impostor to be marginally more likeable than the authentic vegetarian. In Experiments 2 and 3, participants evaluated only a vegetarian who ate meat. Evaluations of the target were influenced by group attachment, such that participants who identified strongly as vegetarians downgraded the target more strongly and experienced more negative affect than did moderate identifiers and non-vegetarians. Participants were also sensitive to the size of the gulf between the target's claims for identity and their behaviour. Thus, targets who made public claims to being a vegetarian but ate meat were evaluated more negatively than were people who kept their claims for identity private (Experiment 2). Similarly, targets who tried to keep their deviant behaviour secret were evaluated more negatively than were people who openly admitted their deviant behaviour (Experiment 3). The reasons why impostors might threaten the integrity of group identities are discussed. Copyright (C) 2003 John Wiley Sons, Ltd.

On being loud and proud: Non-conformity and counter-conformity to group norms

Most experiments on conformity have been conducted in relation to judgments of physical reality; surprisingly few papers have experimentally examined the influence of group norms on social issues with a moral component. In response to this, participants were told that they were either in a minority or in a majority relative to their university group in terms of their attitudes toward recognition of gay couples in law (Expt 1: N = 205) and a government apology to Aborigines (Expt 2: N = 110). In both experiments, it was found that participants who had a weak moral basis for their attitude conformed to the group norm on private behaviours. In contrast, those who had a strong moral basis for their attitude showed non-conformity on private behaviours and counter-conformity on public behaviours. Incidences of nonconformity and counter-conformity are discussed with reference to theory and research on normative influence.

Kinetic and phylogenetic characterization of an anaerobic dechlorinating microbial community

The reductive dechlorination (RD) of tetrachloroethene (PCE) to vinyl chloride (VC) and, to a lesser extent, to ethene (ETH) by an anaerobic microbial community has been investigated by studying the processes and kinetics of the main physiological components of the consortium. Molecular hydrogen, produced by methanol-utilizing acetogens, was the electron donor for the PCE RD to VC and ETH without forming any appreciable amount of other chlorinated intermediates and in the near absence of methanogenic activity. The microbial community structure of the consortium was investigated by preparing a 1 6S rDNA clone library and by fluorescence in situ hybridization (FISH). The PCR primers used in the clone library allowed the harvest of 16SrDNA from both bacterial and archaeal members in the community. A total of 616 clones were screened by RFLP analysis of the clone inserts followed by the sequencing of RFLP group representatives and phylogenetic analysis. The clone library contained sequences mostly from hitherto undescribed bacteria. No sequences similar to those of the known RD bacteria like 'Dehalococcoides ethenogenes' or Dehalobacter restrictus were found in the clone library, and none of these bacteria was present in the RD consortium according to FISH. Almost all clones fell into six previously described phyla of the bacterial domain, with the majority (56(.)6%) being deep-branching members of the Spirochaetes phylum. Other clones were in the Firmicutes phylum (18(.)5%), the Chloroflexi phylum (16(.)4%), the Bacteroidetes phylum (6(.)3%), the Synergistes genus (11(.)1%) and a lineage that could not be affiliated with existing phyla (11(.)1%). No archaeal clones were found in the clone library. Owing to the phylogenetic novelty of the microbial community with regard to previously cultured microorganisms, no specific microbial component(s) could be hypothetically affiliated with the RD phenotype. The predominance of Spirochaetes in the microbial consortium, the main group revealed by clone library analysis, was confirmed by FISH using a purposely developed probe.

Leaders and their treatment of subgroups: implications for evaluations of the leader and the superordinate group

This experiment examined members' evaluations of a group leader and the group in contexts where a superordinate group comprised two subgroups and the group leader was aligned with one or other subgroup. The design varied group leader (ingroup, outgroup) and leader behavior (ingroup favoring, outgroup favoring) as well as the broader comparative context (intragroup, intergroup). Across a number of measures, results indicated a consistent Group Leader x Leader Behavior interaction that was independent of comparative context. Although group members were most satisfied with an ingroup leader who favored the ingroup, ingroup leaders were perceived positively irrespective of their behavior Outgroup leaders who unexpectedly favored the other subgroup were also perceived positively. However, outgroup leaders who favored their own subgroup were perceived as less fair and as more biased than other leaders. They also engendered less identification with the superordinate group and a less unified perception of the group. Results demonstrate the importance of social identity concerns to leadership in nested group contexts and emphasize the fact that perceptions of leader fairness and concern for the common group mediate responses to the superordinate category. Copyright (C) 2003 John Wiley Sons, Ltd.

Secondary prevention of renal and cardiovascular disease: Results of a renal and cardiovascular treatment program in an Australian aboriginal community

Australian Aborigines are experiencing an epidemic of renal and cardiovascular disease. In late 1995 we introduced a treatment program into the Tiwi community, which has a three- to fivefold increase in death rates and a recent annual incidence of treated ESRD of 2760 per million. Eligible for treatment were people with hypertension, diabetics with micro or overt albuminuria, and all people with overt albuminuria. Treatment centered around use of perindopril (Coversyl, Servier), with other agents added to reach BP goals; attempts to control glucose and lipid levels; and health education. Thirty percent of the adult population, or 267 people, were enrolled, with a mean follow up of 3.39 yr. Clinical parameters were followed every 6 mo, and rates of terminal endpoints were compared with those of 327 historical controls matched for baseline disease severity, followed in the pretreatment program era. There was a dramatic reduction in BP in the treatment group, which was sustained through 3 yr of treatment. Albuminuria and GFR stabilized or improved. Rates of natural deaths were reduced by an estimated 50% (P = 0.012); renal deaths were reduced by 57% (P = 0.038); and nonrenal deaths by 46% (P = 0.085). Survival benefit was suggested at all levels of overt albuminuria, and regardless of diabetes status, baseline BP, or prior administration of angiotensin converting enzyme inhibitors (ACEI). No significant benefit was apparent among people without overt albuminuria, nor among those with GFR less than 60 ml/min. An estimated 13 renal deaths and 10 nonrenal deaths were prevented, with the number-needed-to-treat to avoid one terminal event of only 11.6. Falling deaths and renal failure in the whole community support these estimates. The program was extremely cost-effective. Programs like this should be introduced to all high-risk communities as a matter of urgency.

Renal function and cardiovascular risk markers in a remote Australian Aboriginal community

Background. Australian Aborigines living in remote areas have exceedingly high rates of renal failure together with increased cardiovascular morbidity and mortality. To examine the basis of this association, we studied markers of renal function and cardiovascular (CV) risk in a coastal Aboriginal community in a remote area of the Northern Territory of Australia. End-stage renal disease (ESRD) incidence rates in that community are 15 times the national non-Aboriginal rate and CV mortality rates in the region are increased 5-fold. Methods. A cross-sectional community survey was conducted. Markers of early renal disease examined included urine albumin/creatinine ratio (ACR), serum creatinine concentration and calculated glomerular filtration rate (GFR). CV risk markers included blood pressure as well as measures of glycaemia, diabetes and serum lipids. Results. The study group included 237 people, 58% of the adult population of the community. The crude prevalence of microalbuminuria (urine ACR: 3.4-33.9 g/mol, 30-299 mg/g) was 31% and of overt albuminuria (urine ACR: greater than or equal to34 g/mol, greater than or equal to300 mg/g), 13%. The prevalence of overt albuminuria increased with age, but the prevalence of microalbuminuria was greatest in the 45-54 year age group. Microalbuminuria was associated with increasing body mass index, whereas overt albuminuria was associated with increasing glycated haemoglobin (HbA1c) and systolic blood pressure and a history of diabetes. The prevalence of elevated serum creatinine concentration (greater than or equal to120 mumol/l) was 10%. GFR (calculated using the MDRD equation) was <60 ml/min/1.73m(2) in 12% and 60-79 ml/min/1.73 m(2) in a further 36% of the study population. Although many people with albuminuria had well preserved GFRs, mean GFR was lower in people with higher levels of albuminuria. Conclusions. The high prevalence of markers of renal disease in this community was consistent with their high rates of ESRD. The distribution of microalbuminuria suggested a 'cohort effect', representing a group who will progress to overt albuminuria. The powerful association of renal disease markers with CV risk factors confirms a strong link between renal and CV disease in the early, asymptomatic stages of each. Thus, pathologic albuminuria, in part, might be a manifestation of the metabolic/haemodynamic syndrome and both conditions might arise out of a common menu of risk factors. Hence, a single agenda of primary and secondary intervention may benefit both.