Anxiety and dysthymia: local prevalence estimates based on drug prescriptions by general practitioners in Turin (Italy).

BACKGROUND: The aim of the study was to obtain local estimates of the prevalence of anxiety and dysthymic disorders among attendees of primary care at local level, useful to pursue a better management of the health care services. METHODS: The study was conducted in the Health District no. 2 of Turin (industrial town in northwest Italy). The criteria for identification of cases were based on the drugs prescriptions made by general practitioners (GPs), selected in order to assure high specificity. The study involved 86 physicians (with 87,885 attendees). RESULTS: As expected, the crude and standardized prevalences were higher in women (anxiety: 2.9% vs 1.3% in men; dysthymia: 3.8% vs 1.7% in men), with a peak in women aged over 75 yrs (anxiety: 4.8%; dysthymia: 6.2%). In comparison to male GPs, female GPs had an higher prevalence of patients with anxious disorders, whereas the prevalences of dysthymia were similar. CONCLUSIONS: Despite the discussed limitations, the used methodology allows to obtain sufficiently reliable estimates of prevalence of common mental disorders at local level, providing informations useful for organizing the primary care in the Health district.

[Inequalities in protection and promotion of workers' health]. / Le disuguaglianze nella protezione e promozione della salute di chi lavora.

BACKGROUND: Occupational risks contribute to health inequalities, combined with psychosocial, behavioural, and environmental risk factors. Job Strain is a well-known risk factor for cardio-vascular and psychiatric diseases. Furthermore, stressful conditions at work promote unhealthy life styles. Among workers, sex (female), young age and migration are all causes of health inequalities. CONCLUSIONS: Although evidence on the effectiveness of workplace interventions for addressing inequalities is limited, equity audits to support decisions need to be implemented in conjunction with workability and health promotion programmes, and simultaneously with measures of an environmental and social nature.

[Working conditions and health problems among call-centre operators: a study on self-reported data in the Piedmont Region (Italy)]. / Condizioni lavorative e problemi di salute negli operatori dei call center: uno studio su dati autoriferiti nella regione Piemonte.

BACKGROUND: Currently, about 250,000 workers are employed in the call-centre sector in Italy. The nature and the organization of the work exposes workers to a variety of psychosocial and ergonomic hazards, with a potential impact on physical and psychological health. OBJECTIVE: The aim of the study was to investigate working conditions and health status among call-centre operators, in order to estimate the prevalence of exposure to psychosocial and ergonomic risk factors, and of potentially work-related health problems. METHODS: Workers from seven call-centres operating in the Torino area were invited to participate in the survey. During the period 2005-2006, 775 subjects working in telecommunications (70%), telemarketing (14%) and finance (16%) completed a standardized questionnaire on socio-demographics and lifestyle, working conditions, symptoms and diseases. RESULTS: Poor microclimatic conditions, elevated noise, high levels of exposure to psychosocial factors and a high prevalence of unfavourable ergonomic working conditions were observed With regard to health conditions, the mental health index was lower than that expected for the Italian population. Overall, 60%, of the subjects reported headache, 57% musculoskeletal symptoms and 46% voice disorders, for which they consulted a physician and/or took medication. CONCLUSION: A high proportion of call-centre operators were exposed to organizational and psychosocial risk factors, while the self-reported prevalence of potentially work-related health conditions was also high, as has been reported by other authors. Although further epidemiological studies are needed to meaningfully evaluate these associations, it also appears necessary to implement interventions on the most frequently encountered hazards in this sector.

[Carpal tunnel syndrome (CTS) in the Piedmont Region: regional incidence and prevalence of CTS based on hospital records of patients who underwent surgery]. / La sindrome del tunnel carpale in Piemonte: un esempio regionale di stima di incidenza e prevalenza di casi trattati chirurgicamente.

BACKGROUND: Carpal tunnel syndrome (CTS) is the most frequent entrapment neuropathy of the upper extremities. Despite CTS being a priority for public health, only a few studies have investigated the prevalence and incidence in the general population. In Italy, administrative data are available only for CTS cases which were judged work-related by the Workers Compensation Board. These data indicate a steady increase in CTS over the last decade. Hospital admission archives (SDO) also contain information on CTS patients who underwent surgery. OBJECTIVES: To determine: 1) the incidence and prevalence of first CTS, based on hospital records of patients who underwent surgery in the Piedmont Region; 2) to describe the geographical and temporal variation. METHODS: Crude and standardized incidence rates of CTS were computed for the period 2002-2003; geographical variation was assessed using bayesan estimators to detect spatial clusters. Crude and standardized prevalence rates of first hospitalization were calculated for every two-year period between 1996 and 2003. RESULTS AND CONCLUSIONS: The crude incidence rate was 227.2 (C.I.95% 221.9-232.7) per 100,000 women and 54.4 (C.I. 95% 51.9-57.1) per 100,000 men. The prevalence of first hospitalization was very high and varied widely by geographic area. Two possible explanations for such wide variation between areas include differences in exposure to risk factors for CTS and in the diagnostic criteria used. The increasing prevalence over time was only partly explained by an increase in work-related cases. The development of standardized diagnostic criteria would improve understanding of the effect of workplace exposures on CTS. The number of new cases per year in Piedmont was estimated at 1,500, much higher than the compensation claims related to CTS. Health education campaigns addressed to general practitioners on compensation law could improve reporting to the workers' compensation board.

[Carpal tunnel syndrome: example of assessment of the role of occupational exposure based on self-reported data]. / Sindrome del tunnel carpale: un esempio di valutazione del ruolo delle esposizioni lavorative basata su dati auto- riferiti.

BACKGROUND: The prevalence of surgical cases of carpal tunnel syndrome (CTS) tends to increase in the general population in Italy. Nevertheless, it is still unclear what percentage of CTS is attributable to occupational exposure, to ergonomic or psychosocial factors. Moreover, the problem of obtaining a reliable definition of occupational exposure in the absence of direct observation and measurement in the workplace remains unsolved. Piedmont (north-western Italy) is one of the Italian regions with the highest number of musculoskeletal disorders recognized and compensated as work-related. The aim of this study was to estimate the proportion of work-related CTS surgical cases, based on self-reported exposure data. METHODS: An interview-based questionnaire included items on medical history, workplace exposures and non-occupational risk factors for CTS. The study was carried out between June 2003 and November 2004. A total of 260 adult patients (aged 18-65 years) were interviewed. An evaluation of the questionnaires was made by 3 occupational physicians, assigning every patient a probability score of occupational aetiology. Seventy-four per cent of the sample were female; the mean age was 48.4 years. RESULTS: Seventy-one percent of the patients reported bilateral CTS. Occupational exposure preceded the onset of CTS symptoms for 184 patients. The probability that CTS was work-related was estimated as high for 66 patients (26% of the sample). Agreement among examiners, evaluated using the kappa statistic, was good. CONCLUSIONS: Despite the limitations of the study, the number of cases attributable to occupation was much higher than the number of diseases reported to INAIL (National Institute for the Insurance of Industrial Accidents), which suggests that there is substantial under-notification in Italy.

[Regional surveillance of occupational percutaneous and mucocutaneous exposure to blood-borne pathogens in health care workers: strategies for prevention]. / Sorveglianza regionale delle esposizioni professionali percutanee o mucocutanee a patogeni a trasmissione ematica negli operatori sanitari: aree di intervento preventivo.

BACKGROUND: Several studies have investigated both the frequency and modality of occurrence of occupational exposure of health-care workers to blood-borne pathogens. At the moment no complete epidemiological data are available covering the hospitals of an entire Region. OBJECTIVES AND METHODS: To describe the characteristics of mucocutaneous and percutaneous exposure to body fluids of the healthcare workers in 47 out of the 56 public hospitals (90% of a total 15,000 beds, 28,000 health-care workers full time equivalent) in Piedmont, Northern Italy (4.5 million inhabitants) over a three-year period (1999-2002), using SIROH (Studio Italiano Rischio Occupazionale da HIV) model to collect the data. RESULTS AND CONCLUSIONS: 5174 percutaneous injuries (12.7/100 beds) and 1724 mucocutaneous exposure (4.1/100 beds) were recorded. Surveillance data were similar to those collected in other multi-hospital studies. The variability of rates between hospitals was high, most likely due to the amount of underreporting. The categories most at risk of percutaneous and mucocutaneous exposure were, respectively, surgeons (9.3/100 surgeons) and midwives (2.9/100 midwives). Needles (syringe, winged steel, suture) were the medical devices most frequently involved in percutaneous injuries, 60% of which occurred after the use of such devices. Eighty-three per cent of healthcare workers had been HBV-vaccinated versus only 45% of cleaning staff. After percutaneous injuries with exposure to an HIV positive source only 40% of those exposed received post-exposure prophylaxis; in the case of mucocutaneous exposure the rate was 11%. We recorded 2 seroconversions following occupational exposure to an HCV positive source (risk of seroconversion: 0,2%). In order to implement preventive programmes the use of safety devices, an increase in the number of HBV-vaccinated contract workers, the use of chemoprophylaxis for HIV exposure, and the use of protective equipment are deemed necessary.

[Occupational mortality in the population employed at 1991 Census]. / La mortalità per professioni nella popolazione occupata al Censimento 1991.

BACKGROUND: Despite limitations and problems connected to occupational surveillance systems based on mortality data, mortality from specific causes continues to be a crucial indicator for evaluating the differences in health among various occupations. OBJECTIVES: To evaluate the potential of a surveillance system of occupational mortality based on census and mortality data obtained from ISTAT (Italian Central Statistics Institute). METHODS: By means of record-linkage between Census data and death records from ISTAT, occupational mortality was assessed during the twelve month period following the 1991 census, limited to subjects aged 18-64 years for whom occupational information was available. The study population consisted of deceased subjects, 19,527 of whom were men and 3,547 were women. A cross-sectional model was used to evaluate odds ratios for cause-specific mortality. The risk estimates were then compared to the results obtained in a previous analysis on Census data gathered in the 1981 census. RESULTS: Among the significantly increased risks observed both in 1981 and 1991, of particular interest are the excesses of mortality from liver cirrhosis in caretakers, janitors, and cleaning staff; and the excess of breast cancer in teachers. Mortality from cirrhosis in masons, porters, and waiters, and from violent causes in transport workers and bar and restaurant workers, was instead significantly in excess only in 1991. CONCLUSIONS: The data on mortality by occupation does not permit inferences about occupational risks, though they can be useful to highlight socio-economic differences in premature death in the employed segment of the population and to draw attention to possible trends over time.

[Workplace injuries and professional mobility correlated with health problems. The potential and limitations of the ISTAT Labour Force survey--July 1999]. / Infortuni e mobilità lavorativa correlata a problemi di salute. Potenzialità e limiti della Rilevazione Trimestrale sulle Forze di Lavoro--luglio 1999 dell'ISTAT.

BACKGROUND: Knowledge on the occupational and social factors that influence the relationship between illness, absence from work and occupational mobility is at present insufficient. OBJECTIVES: To map out, by social class and occupational group, the impact of health problems on work and the distribution of accidents and morbidity associated with occupation. METHODS: Using data from the National Survey of the Italian Labour Force (ISTAT, 1999), covering a sample of 200,384 subjects, prevalence odds ratios of morbidity, work injuries and change of occupation due to health problems were calculated by social class and occupation, adjusting for age and residence. RESULTS: The working class showed a higher risk, due to health problems, of a reduction in time worked (OR = 3.70 in men and OR = 4.10 in women), of choosing to work part-time (OR = 2.04 in men and OR = 2.27 in women), or of withdrawing from the workforce (for artisans, skilled manual workers, farmers and agricultural labourers OR = 1.63 in men and OR = 1.47 in women). This class was also at a greater disadvantage not only with respect to accident rates (OR = 1.85 in men and OR = 1.88 in women), but also with respect to the time needed for post-trauma rehabilitation and return to work (for absences of one week to one month: OR = 1.67 and 1.83 for men and women, respectively; for absences of more than one month: OR = 1.29 and OR = 1.69). Moreover, the working class, when compared to other social classes, had a higher rate of suffering from illness, physical impairment or other physical and psychological problems caused or aggravated by working activity (25% in men and 32% in women). CONCLUSIONS: The ISTAT National Survey provides an estimate of minor accidents with prognoses of less than three days, including those not reported to the National Institute for Insurance against Occupational Accidents and Diseases (INAIL). This allows a preliminary exploration of the relationship between health problems and occupational mobility; however, it seems necessary to collect more detailed information in order to more exhaustively explore the mechanisms which generate the inequalities observed.

[Risk of workplace injuries by occupation in Italy in the 1990's]. / Rischio di infortuni per professione in Italia negli anni novanta.

BACKGROUND: In Italy it is not possible to assess the incidence of workplace injuries by occupation due to the absence of denominator data. OBJECTIVES: To evaluate severe workplace injuries by occupation, age and gender, via discussion of the validity of the available methods and informative systems. METHODS: The database included injuries in the industrial and artisan sectors in Italy during the period 1995-1999, as classified by INAIL (National Institute for the Insurance against Occupational Accidents and Diseases). A proportional case-control study was used. Three types of severe injuries were analyzed: fatal (3,685), permanently disabling (88,254) and injuries resulting in temporary disability for more than 40 days (238,609). Controls were represented by minor injuries with temporary disability lasting between 8 and 13 days (512,643). The relative risks were calculated by occupation and stratified by age and sex. The control group was chosen in order to minimize distortions and represented a balance between empirical criteria based on the experience of safety technicians and the quality and limits of INAIL archives. RESULTS: Among men in some construction occupations (operators of construction equipment, crane operators and masons), and in truck drivers, farm workers, messengers, and miners there were elevated risks in all age groups and for all levels of injuries severity. The model was more problematic to apply to women because the control group was less representative of the work population at risk. CONCLUSIONS: The case-control study model produced results consistent with those in the international literature, even if the use of minor injuries as the control group gives partly distorted risk estimates. The results supply information for decision making and for allocating resources for prevention and safety.

[Severity of workplace injuries by occupation in Italy in the 1990's]. / Gravità degli infortuni in Italia negli anni novanta: indici per professione.

BACKGROUND: The indicators of severity commonly used for studying workplace injuries are somewhat limited. It is possible to use RIDIT Analysis (Relative to an Identified Distribution) as an alternative method OBJECTIVES: To order occupations in Italy by severity of workplace injuries and discuss the methodological problems and the outcomes from available administrative data. METHODS: The database included injuries defined by INAIL (National Institute for Insurance against Occupational Accidents and Diseases) in Italy in the period 1995-99 in the industrial and artisan sectors (1,647,220 events). RIDIT Analysis was applied using Bross analysis of ordinal data. A distribution of injuries in Italy for the same period on a six-level scale of severity was used as a reference. The RIDIT value for each occupation was calculated and stratified by age, sex, and occupational sector. RESULTS: Among men, the occupations in which injuries were more severe than the average in Italy were construction, transport, woodworking, and mining. Above-average injury severity among women was found in transport drivers, postwomen, messengers, and workers in performing arts, the food industry, and tourism. A positive relationship between age and severity of injury was observed in all occupations in both sexes. Average severity was higher among artisans. CONCLUSIONS: The method used allows ranking of occupations according to injury severity and should be systematically introduced into existing systems of surveillance so that data can be used to foster prevention and workplace safety.

[Risk of repeated injuries by economic activity in Italy in the 1990's]. / Infortuni ripetuti, rischio per professioni in Italia negli anni novanta.

BACKGROUND: Repetitive work injuries are a phenomenon that has not been sufficiently studied. Using data gathered by INAIL (National Institute for Insurance against Occupational Accidents and Diseases), it is possible to study the propensity of having a further injuries at the workplace after the first one. OBJECTIVES: To identify the risk of experiencing multiple injuries according to occupation, with discussion of how useful the available information systems are. METHODS: The data base includes workplace injuries, as classified by INAIL in Italy between 1994 and 2000 in the industrial and artisan sectors (2,162,702 subjects, ages 25-55). Selecting data on accidents occurring among 107,082 subjects who had experienced the first accident in 1996-99, in this cohort we assessed the occurrence of further accidents within two years in the same occupation, taking into account job mobility and factors eventually influencing underreporting (geographic area, age, severity of first accident and size of the enterprise). The risk for each occupation was computed stratifying by gender. RESULTS: There were significant differences between the first and successive accidents when examined by type, age group, severity of physical consequences and company size. Among men, the occupations showing higher risk were those already known to be at high risk for accidents: cleaning staff and refuse workers, foundry workers, masons, pilots, woodworkers, carpenters, transport workers, sailors, farmers, and miners. Among women the occupations most at risk were postwomen and messengers, cleaning staff and refuse workers, waitresses, cooks, bartenders, machine tool operators, woodworkers, and weavers in the textile industry. CONCLUSIONS: Among men, the risk of recurrent workplace accidents by occupation tends to reflect the frequency of the total accidents in each occupation. The results indicate that the study model employed is efficient and useful in providing risk profiles which allow identification of where to direct future studies, investigations, and preventive measures for each sex.

[Study of the relationship among work and demographic characteristics, sickness absence and occupational mobility]. / Le indennità di malattia per valutare la relazione fra fattori occupazionali, assenze dal lavoro e mobilità lavorativa.

BACKGROUND: The problem of sick absences from work is correlated to a series of organizational, social and psychological factors which interact with risk factors typical of the work performed, and thus determine how frequently absences occur. The correlation between morbidity and work is of interest in itself for studying the processes of occupational mobility. OBJECTIVES: To examine, using data from administrative sources, the association of sick absence with individual and workplace factors, as well as the relationship between illness and career mobility. METHODS: Employee sick absence data registered at INPS (National Institute of Social Insurance) in the period 1992-95 were studied using a sample of 124,686 subjects. RESULTS: The probability of being absent from work due to illness did not appear to be affected by sex or age. The sectors more at risk for sick absences were the service sector, business and commerce. Inequalities were noted in illness rates to the disadvantage of those who had received redundancy payments in the previous years. New hirings and upward mobility were associated with a lower occurrence of illness. A higher probability of illness was observed in those who had lost their jobs and in those who had changed from full-time to part-time work. CONCLUSIONS: It is likely that formal regulations and practices in use within INPS vary according to the different economic activities. Therefore this source allows investigation of illness only in activities with homogeneous regulatory aspects. The results confirm a link between unstable work situations and illness and between illness and career advancement.

[Use of pension records for occupational health surveillance: example of record-linkage with hospital discharge records to study the association between work and the incidence of leukaemias, lung and bladder cancer, and miscarriage]. / Il linkage tra le storie professionali di fonte INPS e i dati dei ricoveri ospedalieri per lo studio delle cause lavorative di alcuni tumori e degli aborti spontanei.

BACKGROUND: Epidemiologic surveillance of occupational health based on routinely collected data allows groups of workers to be studied, whose type of work (e.g. small enterprises, self-employed workers, artisans) makes it difficult to use a traditional cohort study design. OBJECTIVE: To evaluate the validity of a study design based on the record-linkage between hospital discharge records and INPS social security records (National Institute for Social Security), in order to investigate the association between past employment in an economic sector and occurrence of diseases with a low fraction attributable to occupation and a high frequency in the population, where it is too costly to perform retrospective interviews to gather data from each recruited subject. METHODS: A case-control study design was used in which hospital discharge records from 1995 in the Piedmont Region represented the source of subjects enrolled. Four series of cases were identified: males aged 40-75 years, with first hospital admission for leukaemia, lung or bladder cancer; and women aged 18-39 years, admitted for miscarriage. The controls were a random sample of patients admitted in the same year and matched by sex and age. The exposure variable was the prevalent economic sector in the occupational history of the subjects enrolled, as inferred from INPS social security records. RESULTS: No economic sector examined showed a significant excess of incidence of bladder cancer or leukaemia. There was a significant excess of lung cancer in subjects with longest employment in the building industry, in metal working, and in the "foundries, heat pressing, forging, and rolling mills" sector. A significant excess of miscarriages was present only in women working in commerce. DISCUSSION: The results demonstrated overall a low consistency compared with those obtained via other surveillance systems of occupational morbidity and mortality, as well as by means of analytical studies. The results appear more plausible for the sectors characterized by a low number of job tasks, or by a more homogenous exposure to risk factors among workers in different jobs. Among the limitations of this study the lack of a complete occupational history, the absence of information on potential confounders like smoking and alcohol consumption, and the probable non-differential misclassification of the longest held job need to be stressed

Mortality of a cohort of road construction and maintenance workers with work disability compensation.

BACKGROUND: Surveillance systems of occupational mortality are useful tools to identify cases of diseases suspected as occupational and to monitor their occurrence over time, in space and in population subgroups. Many surveillance systems make use of administrative data in which information about occupations and/or economic sectors of the subjects enrolled is reported, such as death certificates, hospital discharge data, census data, tax and pension records, and workers' compensation archives. OBJECTIVES: In the present study we analyzed the mortality of a cohort of road construction and maintenance workers enrolled through the Italian national archive of work disability compensations, also in order to evaluate the possible use of this administrative source to monitor occupational mortality. METHODS: 8,000 subjects (7,879 males) receiving a disability compensation while working in the "road construction and maintenance" sector were identified from INAIL (National Institute for Insurance of Accidents at Work) archives. Vital status of these subjects was ascertained using the information available in INAIL archives and in the national tax register. For those found to be deceased from INAIL or tax archives, or without any information on vital status, a mail follow-up was started. We considered as observation period the years from 1980 to 1993. A record linkage with the ISTAT (Italian Institute of Statistics) national mortality registry was performed and the cause of death was retrieved for 964 out of 1,259 subjects. The analysis was restricted to males, leaving altogether 863 observed deaths with ascertained cause (84.7% of 1,019 total male deaths). SMR for overall mortality and PMR for specific cause mortality were computed, using the general Italian male population as reference. RESULTS: Overall mortality was significantly reduced (SMR = 79.0; 95% CI = 74.2-84.0). Proportional mortality analysis revealed significant excess risks for all malignant tumours (332 deaths, PMR = 1.08) and for digestive diseases (87 deaths, PMR = 1.34), while mortality for cardiovascular diseases was significantly decreased (288 deaths, PMR = 0.90). Among specific causes of death, significant excess mortality was found for cancer of testicles (2 deaths, PMR = 5.98), liver and biliary ducts (32 deaths, PMR = 1.40), and for silicosis (10 deaths, PMR = 3.07) and cirrhosis (64 deaths, PMR = 1.40). CONCLUSIONS: The excess mortality observed for all cancers, digestive diseases and silicosis, and the decreased risk for cardiovascular diseases are in agreement with the results of other studies conducted on workers in road construction and maintenance. As expected, the low overall mortality and the reduced risk from cardiovascular diseases indicate that these workers present a strong "healthy worker effect".

Evolution of toxicity after conformal radiotherapy for prostate cancer.

The limiting factor for radiation (RT) dose-escalation is normal tissue toxicity. In dose-escalation studies, it is important to determine the factors associated with toxicity and the length of follow-up period after which a particular RT dose is considered safe. We analyzed 449 prostate cancer patients treated with RT at our institution and followed for a median of 27 months. Genitourinary (GU) and gastrointerological (GI) complications were graded and analyzed using three different statistical models. Univariate and multivariate analyses were conducted for factors associated with toxicity. There was no RTOG grade 4 or 5 toxicity. Only 23 patients (5%) experienced grade 3 toxicity. After treatment, there was an initial rapid decline in the risk of toxicity following treatment, followed by an increase or stabilization of the toxicity with time of follow-up. The breakpoints between the two periods were 2 y (any toxicity) and 1 y (high toxicity) for GU and 9 months (any toxicity, high toxicity) for GI. Age, dose, fraction size, duration of treatment and hospital of treatment emerge as important factors in the probability of developing toxicity. Our study shows that delivering conventional doses using conformal techniques is associated with minimal high-grade toxicity. However, even within a narrow dose range and fraction size used, differences do emerge which should lead one to be cautious in extending the results of dose escalation study to the community practice without a sufficient follow-up.

Self-assessed health-related quality of life in men being treated for prostate cancer with radiotherapy: instrument validation and its relation to patient-assessed bother of symptoms.

OBJECTIVES: To develop a psychometrically valid and clinically useful questionnaire to assess health-related quality of life (HRQOL) in patients with prostate cancer (PCa) undergoing external beam radiotherapy. The most important factors in three dimensions (bowel function [BF], urinary function [UF], and sexual function [SF]) were identified by patient survey. METHODS: Three HRQOL dimensions were assessed using Likert-type questions. Responses were analyzed by factor analysis to create HRQOL scales. Reliability and validity of the scales were assessed. Because patients can suffer symptoms yet not report their lives to be affected, the scales were compared with patient-reported bother. RESULTS: Two scales were identified within each dimension: BF, urgency and daily living; UF, urgency and weakness of stream; and SF, interest/satisfaction and impotence. Cronbach's alpha for the scales ranged from 0.63 to 0.94, and item-scale correlations and item-scale divergence correlations supported scale validity. Rising median scores correlated with rising levels of perceived bother. CONCLUSIONS: The questionnaire is a suitable tool for assessing HRQOL in three distinct dimensions for patients undergoing radiotherapy for PCa. Six dimensions of HRQOL were found to be related to bother, suggesting important relationships to be monitored for patients. Urgency of bowel movements, urgency of urination, and level of interest/satisfaction in sex correlated most strongly with bother.

Dietary oxysterols are incorporated in plasma triglyceride-rich lipoproteins, increase their susceptibility to oxidation and increase aortic cholesterol concentration of rabbits.

Early fatty streaks and advanced lesions are characterized by the deposition of cholesterol and cholesterol oxidation products (oxysterols). Oxysterols have been shown to be cytotoxic and pro-atherogenic compared to cholesterol and are found in cholesterol-rich processed foods. The consumption of dietary oxysterols may be significant in the onset and development of vascular disease. In order to study the short term effects of low levels of ingested dietary oxysterols on lipoprotein and aortic cholesterol and oxysterol levels, rabbits were fed either standard chow, chow supplemented with 1.0% oxidized cholesterol (containing 6% oxysterols), or 1.0% purified cholesterol (control). To determine the distribution and uptake of oxysterols after a 2-week dietary period, triglyceride-rich plasma lipoproteins, low density lipoproteins and aorta were analyzed by GC-MS. The concentration of 7beta-hydroxycholesterol was similar in all groups but the oxidized cholesterol-fed animals showed five times the concentration of 5alpha,6alpha-epoxycholesterol and double the level of 7-ketocholesterol in triglyceride-rich lipoproteins compared to the purified cholesterol-fed animals. The presence of 7-ketocholesterol in LDL was exclusive to animals fed the oxidized cholesterol diet. In addition, oxidation of triglyceride-rich lipoproteins was significantly greater in rabbits fed oxidized cholesterol compared to the pure cholesterol-fed animals. The oxidized cholesterol-fed animals also had a 64% increase in total aortic cholesterol, despite lower plasma cholesterol levels compared to the pure cholesterol control animals. Taken together these results suggest that dietary oxysterols may substantially increase the atherogenicity of lipoproteins.