Widespread prostate-specific antigen (PSA) screening detects many cancers that would have otherwise gone undiagnosed. To estimate the prevalence of unsuspected prostate cancer, we reviewed 19 studies of prostate cancer discovered at autopsy among 6,024 men. Among men aged 70-79, tumor was found in 36% of Caucasians and 51% of African-Americans. This enormous prevalence, coupled with the high sensitivity of PSA screening, has led to the marked increase in the apparent incidence of prostate cancer. The impact of PSA screening on clinical practice is well-recognized, but its effect on epidemiologic research is less appreciated. Before screening, a larger proportion of incident prostate cancers had lethal potential and were diagnosed at advanced stage. However, in the PSA era, overall incident prostate cancer mainly is indolent disease, and often reflects the propensity to be screened and biopsied. Studies must therefore focus on cancers with lethal potential, and include long follow-up to accommodate the lead time induced by screening. Moreover, risk factor patterns differ markedly for potentially lethal and indolent disease, suggesting separate etiologies and distinct disease entities. Studies of total incident or indolent prostate cancer are of limited clinical utility, and the main focus of research should be on prostate cancers of lethal potential.

/pdf/the-high-prevalence-of-undiagnosed-prostate-cancer-at-4n6rnevbdw.pdf

The High Prevalence of Undiagnosed Prostate Cancer at Autopsy: Implications for Epidemiology and Treatment of Prostate Cancer in the Prostate-Specific Antigen-Era

This article draws on the articulation of a value for reflexivity that has accumulated within qualitative methods debates in the past decade. It demonstrates how reflexivity is interwoven with the concept of ethical mindfulness. The argument has developed from a consideration of the ethical dilemmas that were a salient aspect of an ongoing research relationship with children and young people during an unusually long longitudinal study, undertaken from the time the 10 participants were aged three to seventeen. The study explores the ongoing creation of a personal self during this time and draws on a range of ethnographic methods. The author focuses on two aspects of the “ethics in practice” that imbued her research relationships: the gaining and maintaining of consent, and the matching of methods to children’s interests. The author makes a series of recommendations about how to do reflexivity, incorporating a set of guidelines for informed consent with children. The author concludes that reflexivity and ethical mindfulness are interdependent concepts, an understanding that is particularly valuable for child-focused researchers.

Ethical Mindfulness and Reflexivity Managing a Research Relationship With Children and Young People in a 14-Year Qualitative Longitudinal Research (QLR) Study

People with anorexia often feel ambivalent about whether they wish to maintain it or recover from it. One place where individuals can communicate their experiences of wanting to maintain their anorexia is through pro-anorexia websites. This study investigated the experiences and understandings of those who wish to maintain their anorexia and looked at how these understandings may affect their treatment experiences. Data were collected online and analysed using interpretative phenomenological analysis (IPA). Anorexia denoted meanings of a 'tool', an 'entity' and a 'disease'. Participants felt ambivalent about whether their anorexia gave them control or controlled them, whether it played a positive or negative role and whether they wished to maintain their behaviours or recover. Participants also discussed barriers to recovery. Theoretical and treatment implications are discussed.

Understanding the experience of ambivalence in anorexia nervosa: the maintainer's perspective

The United Kingdom (UK) Focal Point on Drugs is based at the Department of Health and the North West Public Health Observatory at the Centre for Public Health, Liverpool John Moores University. It is the national partner of the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) and provides comprehensive information to the Centre on the drug situation in England, Northern Ireland, Scotland and Wales.

United Kingdom drug situation: annual report to the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) 2012.

This publication looks at the co-occurrence of drug use problems and mental health disorders, taking in the theoretical background of psychiatric comorbidity, the tools for clinical diagnosis and the prevalence and clinical relevance of the problem in Europe.

Comorbidity of substance use and mental disorders in Europe.

Enhancing Motivation to Change

Fundamentals of Treatment

Working with Emotions

Are hazardous drinkers more impulsive than light drinkers? A comprehensive assessment in young adults.

Cocaine use disorder (CUD) is a debilitating psychopathology, with no recommended medication therapy or specific psychological intervention. Memory-focused cognitive therapy (MFCT) is a novel psych...

https://journals.sagepub.com/doi/pdf/10.1177/2043808719860714

Does craving for cocaine mediate cocaine use? Analysis of a randomized controlled pilot trial of memory-focused cognitive therapy

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