Variation in treatment strategies of Swiss general practitioners for subclinical hypothyroidism in older adults.

QUESTIONS UNDER STUDY As the best management of subclinical hypothyroidism is controversial, we aimed to assess variations in treatment strategies depending on different Swiss regions, physician and patient characteristics. METHODS We performed a case-based survey among general practitioners (GPs) in different Swiss regions, which consisted of eight hypothetical cases presenting a female patient with subclinical hypothyroidism and nonspecific complaints differing by age, vitality status and thyroid-stimulating hormone (TSH) concentration. RESULTS A total of 262 GPs participated in the survey. There was considerable variation in the levothyroxine starting dose chosen by GPs, ranging from 25 µg to 100 µg. Across the Swiss regions, GPs in the Bern region were significantly more inclined to treat, with a higher probability of initiating treatment (60%, p = 0.01) and higher mean starting doses (45 µg, p <0.01) compared with the French-speaking region (44%, 36 µg); the Zurich region had intermediate values (52%, 39 µg). We found no association between treatment rate and other physician characteristics. GPs were more reluctant to initiate treatment in 85-year-old than in 70-year-old women (odds ratio [OR] 0.77, 95% confidence interval [CI] 0.63-0.94), and more likely to treat women with a TSH of 15 mU/l than those with a TSH of 6mU/l (OR 8.71, 95% CI 6.21-12.20). CONCLUSIONS There are strong variations in treatment strategies for elderly patients with subclinical hypothyroidism across different Swiss regions, including use of higher starting doses than the recommended 25 µg in the Swiss guidelines, which recommend a starting dose of 25 µg. These variations likely reflect the current uncertainty about the benefits of treatment, which arise from the current lack of evidence from adequately powered clinical trials.

Chlorine isotope composition in chlorofluorocarbons CFC-11, CFC-12 and CFC-113 in firn, stratospheric and tropospheric air

The stratospheric degradation of chlorofluorocarbons (CFCs) releases chlorine, which is a major contributor to the destruction of stratospheric ozone (O3). A recent study reported strong chlorine isotope fractionation during the breakdown of the most abundant CFC (CFC-12, CCl2F2, Laube et al., 2010a), similar to effects seen in nitrous oxide (N2O). Using air archives to obtain a long-term record of chlorine isotope ratios in CFCs could help to identify and quantify their sources and sinks. We analyse the three most abundant CFCs and show that CFC-11 (CCl3F) and CFC-113 (CClF2CCl2F) exhibit significant stratospheric chlorine isotope fractionation, in common with CFC-12. The apparent isotope fractionation (ϵapp) for mid- and high-latitude stratospheric samples are respectively −2.4 (0.5) and −2.3 (0.4) ‰ for CFC-11, −12.2 (1.6) and −6.8 (0.8) ‰ for CFC-12 and −3.5 (1.5) and −3.3 (1.2) ‰ for CFC-113, where the number in parentheses is the numerical value of the standard uncertainty expressed in per mil. Assuming a constant isotope composition of emissions, we calculate the expected trends in the tropospheric isotope signature of these gases based on their stratospheric 37Cl enrichment and stratosphere–troposphere exchange. We compare these projections to the long-term δ (37Cl) trends of all three CFCs, measured on background tropospheric samples from the Cape Grim air archive (Tasmania, 1978–2010) and tropospheric firn air samples from Greenland (North Greenland Eemian Ice Drilling (NEEM) site) and Antarctica (Fletcher Promontory site). From 1970 to the present day, projected trends agree with tropospheric measurements, suggesting that within analytical uncertainties, a constant average emission isotope delta (δ) is a compatible scenario. The measurement uncertainty is too high to determine whether the average emission isotope δ has been affected by changes in CFC manufacturing processes or not. Our study increases the suite of trace gases amenable to direct isotope ratio measurements in small air volumes (approximately 200 mL), using a single-detector gas chromatography–mass spectrometry (GC–MS) system.

Very long-term survival patterns of young patients treated with radical prostatectomy for high-risk prostate cancer

OBJECTIVE In patients with a long life expectancy with high-risk (HR) prostate cancer (PCa), the chance to die from PCa is not negligible and may change significantly according to the time elapsed from surgery. The aim of this study was to evaluate long-term survival patterns in young patients treated with radical prostatectomy (RP) for HRPCa. MATERIALS AND METHODS Within a multiinstitutional cohort, 600 young patients (≤59 years) treated with RP between 1987 and 2012 for HRPCa (defined as at least one of the following adverse characteristics: prostate specific antigen>20, cT3 or higher, biopsy Gleason sum 8-10) were identified. Smoothed cumulative incidence plot was performed to assess cancer-specific mortality (CSM) and other cause mortality (OCM) rates at 10, 15, and 20 years after RP. The same analyses were performed to assess the 5-year probability of CSM and OCM in patients who survived 5, 10, and 15 years after RP. A multivariable competing risk regression model was fitted to identify predictors of CSM and OCM. RESULTS The 10-, 15- and 20-year CSM and OCM rates were 11.6% and 5.5% vs. 15.5% and 13.5% vs. 18.4% and 19.3%, respectively. The 5-year probability of CSM and OCM rates among patients who survived at 5, 10, and 15 years after RP, were 6.4% and 2.7% vs. 4.6% and 9.6% vs. 4.2% and 8.2%, respectively. Year of surgery, pathological stage and Gleason score, surgical margin status and lymph node invasion were the major determinants of CSM (all P≤0.03). Conversely, none of the covariates was significantly associated with OCM (all P≥ 0.09). CONCLUSIONS Very long-term cancer control in young high-risk patients after RP is highly satisfactory. The probability of dying from PCa in young patients is the leading cause of death during the first 10 years of survivorship after RP. Thereafter, mortality not related to PCa became the main cause of death. Consequently, surgery should be consider among young patients with high-risk disease and strict PCa follow-up should enforce during the first 10 years of survivorship after RP.

Zur Bedeutung sportbezogener Verhaltensmuster in der Familie für die Sportpartizipation Jugendlicher

Einleitung: In der Sportpartizipation Jugendlicher und junger Erwachsener bestehen trotz vielfältiger Bemühungen der Sport- und Bewegungsförderung nach wie vor soziale Ungleichheiten und die Ausstiegsraten sind darüber hinaus relativ hoch (Nagel, 2003). Ein möglicher Erklärungsansatz für diese sozialen Ungleichheiten dürften aus einer sozialisationstheoretischen Perspektive die transgenerationale Vermittlung von sportbezogenen Wertvorstellungen und Verhaltensmuster in der Familie sein (Baur, 1989; Burrmann, 2005). Im Familienalltag wird den Aspekten Bewegung und Sport eine unterschiedliche Bedeutung zugesprochen, weshalb der Frage nachgegangen wird, inwiefern das Sportverhalten von Jugendlichen über sportbezogene Wertvorstellungen und Verhaltensmuster in der Familie beeinflusst wird. Methode: Mittels eines Online-Fragebogens wurden insgesamt 1909 Heranwachsende im Alter von 15 bis 20 Jahren (n = 1909; M = 17.3, SD = 1.7) zu ihrem aktuellen Sportverhalten sowie zu den sportbezogenen Verhaltensmustern in ihrer Familie befragt. Nebst dieser quantitativen Untersuchung wurden teilstrukturierte Interviews mit 13 Jugendlichen und jungen Erwachsenen im Alter zwischen 15 und 25 Jahren mit denselben Themenschwerpunkten geführt. Resultate: Die Ergebnisse der multiplen linearen Regression zeigen, dass wichtige Prädiktoren der Sportpartizipation von Jugendlichen die Kommunikation über Sport (β = .19, p < .001), die gegenseitige Unterstützung (β = .16, p < .001), die regelmässige Sportaktivität (β = .11, p < .01) sowie der Stellenwert des Sports in der Familie (β = .09, p < .05) darstellen. Die gemeinsame Sportaktivität in der Familie sowie das sportbezogene Gesundheitsbewusstsein im Familienalltag sind für die Sportbeteiligung Jugendlicher nicht relevant. Die signifikanten familiären Sportverhaltensmuster klären 16.8% der Varianz auf. Mithilfe der strukturierenden qualitativen Inhaltsanalyse nach Mayring (2002) lassen sich aus den Interviews vertiefende Aussagen zu den einzelnen Prädiktoren machen. Diskussion: Die quantitativen sowie qualitativen Ergebnisse zeigen die Relevanz des Stellenwerts des Sports sowie gewisser habitueller Sportverhaltensmuster in der Familie für die Sportbeteiligung der Jugendlichen auf. Die Sportförderung der jüngeren Generation über das familiäre Sportverhalten und deren sportbezogenen Wertvorstellungen scheint eine fruchtbare Strategie zu sein, um beim Nachwuchs aktive Sportverhaltensmuster zu entwickeln und dadurch die Sportpartizipation bis hin zum Jugend- und Erwachsenenalter aufrecht zu erhalten. Um zielgerichtet auf Familien zugeschnittene Sportförderprogramme schaffen zu können, sind jedoch weitere Untersuchungen zur transgenerationalen Vermittlung von sportbezogenen Wertvorstellungen und Verhaltensmuster in Familien notwendig. Literatur: Baur, J. (1989). Körper- und Bewegungskarrieren. Schorndorf: Hofmann. Burrmann, U. (2005). Zur Vermittlung und intergenerationalen "Vererbung" von Sport(vereins)engagements in der Herkunftsfamilie. Sport und Gesellschaft, 2, 125-154. Mayring, P. (2002). Einführung in die qualitative Sozialforschung: Eine Anleitung zu qualitativem Denken. Weinheim: Beltz. Nagel, M. (2003). Soziale Ungleichheiten im Sport. Aachen: Meyer & Meyer. 31