Prevalence of the HOXB13 G84E germline mutation in British men and correlation with prostate cancer risk, tumour characteristics and clinical outcomes.

BACKGROUND: A rare recurrent missense variant in HOXB13 (rs138213197/G84E) was recently reported to be associated with hereditary prostate cancer. Population-based studies have established that, since the frequency of this single-nucleotide polymorphism (SNP) varies between geographic regions, the associated proportion of prostate cancer (PrCa) risk contribution is also highly variable by country. PATIENTS AND METHODS: This is the largest comprehensive case-control study assessing the prevalence of the HOXB13 G84E variant to date and is the first in the UK population. We genotyped 8652 men diagnosed with PrCa within the UK Genetic Prostate Cancer Study (UKGPCS) and 5252 healthy men from the UK ProtecT study. RESULTS: HOXB13 G84E was identified in 0.5% of the healthy controls and 1.5% of the PrCa cases, and it was associated with a 2.93-fold increased risk of PrCa [95% confidence interval (CI) 1.94-4.59; P = 6.27 × 10(-8)]. The risk was even higher among men with family history of PrCa [odds ratio (OR) = 4.53, 95% CI 2.86-7.34; P = 3.1 × 10(-8)] and in young-onset PrCa (diagnosed up to the age of 55 years; OR = 3.11, 95% CI 1.98-5.00; P = 6.1 × 10(-7)). There was no significant association between Gleason Score, presenting prostate specific antigen, tumour-node-metastasis (TNM) stage or NCCN risk group and carrier status. HOXB13 G84E was not associated with overall or cancer-specific survival. We found that the polygenic PrCa risk score (PR score), calculated using the 71 known single-nucleotide polymorphisms (SNPs) associated with PrCa and the HOXB13 G84E variant act multiplicatively on PrCa risk. Based on the estimated prevalence and risk, this rare variant explains ∼1% of the familial risk of PrCa in the UK population. CONCLUSIONS: The clinical importance of HOXB13 G84E in PrCa management has not been established. This variant was found to have no effect on prognostic implications but could be used for stratifying screening, by identifying men at high risk. CLINICAL TRIALS NUMBERS: Prostate Testing for Cancer and Treatment (ProtecT): NCT02044172. UK GENETIC PROSTATE CANCER STUDY: Epidemiology and Molecular Genetics Studies (UKGPCS): NCT01737242.

Services for infants and toddlers with disabilities: IDEA, Part H.

In October 1986 P.L. 99-457, the Education of the Handicapped Act Amendments of 1986, was enacted. Part H of this legislation obligates participating states to provide early intervention services to children with developmental disabilities from birth up to their third birthday. This act has since been renamed the Individuals with Disabilities Education Act. All states are now planning to implement this act through the development of multidisciplinary, comprehensive service delivery systems, and social workers in health care settings will play a critical role in the identification, referral, and case management of services for the affected population. This article describes the mandates of this legislation and defines the social worker's role.

Chronic child neglect in perspective.

Although the concept of chronic neglect is used in child welfare practice, studies have not differentiated chronic cases of neglect from those of more recent onset. In this study three groups of families referred to a large metropolitan county child welfare agency for child neglect are considered: those known to the agency for three years or more (chronic group), those more recently referred and substantiated (newly neglecting group), and those in which neglect was not substantiated (unconfirmed group). Significant differences among the three study groups included family size and composition, numbers and kinds of problems, neighborhood characteristics, family relationships, parenting knowledge and expectations, and mental health. Findings demonstrate the need for changes in social policy and social services delivery systems to supplement intervention with individual families.

Racial inequality and child neglect: findings in a metropolitan area.

Despite contradictory evidence, child neglect is often believed to occur more frequently in the African American than in the Caucasian population. This article reports findings on the racial differences among 182 families referred for neglect in a large metropolitan area. Although almost all of the families were poor, African American families in the neglect sample suffered even more from economic inequality than those in the general population. Implications of the findings for social welfare policy and child welfare practice are discussed.

Drug therapy in pregnancy: the lessons of diethylstilbestrol, thalidomide, and bendectin.

A pregnant woman and the fetus she carries face health risks from many sources. One risk that requires ongoing vigilance is the use of prescription drugs during pregnancy. The international health care community has been sensitized to the risks of drug use during pregnancy because of three pharmaceuticals that have caused widespread crises for mothers and their offspring. The crises that diethylstilbestrol, thalidomide, and, to a lesser extent, Bendectin have created in the past four decades are reviewed in this article. The lessons these drug crises can teach us are articulated in the belief that similar crises may be averted in the future.

Physical and psychological problems associated with exposure to diethylstilbestrol (DES).

The synthetic hormone diethylstilbestrol (DES) was widely prescribed between 1943 and 1971 to minimize pregnancy complications. It has caused serious physical and psychological damage to the women who took it and to their offspring. DES-exposed mothers may suffer a higher incidence of breast cancer, their exposed daughters are at risk for reproductive tract cancers and infertility, and their exposed sons are more likely to have genital abnormalities and reproductive dysfunction. Psychiatric disorders among DES-exposed persons are reportedly twice as common as for nonexposed persons, with anger, anxiety, low self-worth, identity confusion, and guilt the most frequent symptoms. The author describes therapeutic interventions designed to alleviate these problems.

A comparative study of attitudes toward child sexual abuse among social work and judicial system professionals.

To meet the needs of mutual clients, perpetrators and victims, social service and judicial system professionals share an obligation to collaborate in cases of child sexual abuse. Unknown is the extent to which individuals in counter professions share common beliefs about perpetrators and victims of child sexual abuse. This paper reports an inquiry into the attitudes of five professional groups within an urban criminal justice system specific to victim credibility, victim culpability, offender culpability, and the crime and punishment of child sexual abuse. As predicted, statistically significant differences in attitudes were found among child welfare social workers, police officers, district attorneys, public defenders, and judges. In particular, groups differed in their beliefs about victim credibility and punishment of offenders, suggesting conflict in addressing two fundamental questions in these cases: (1) Can a child be believed when he or she reports sexual abuse? and (2) How should the system deal with offenders? Both questions beg the continuing attention of all professionals invested in these cases, ultimately benefiting victims and offenders. Both quantitative and qualitative findings are provided in this report.

A social services-public health partnership in child protection: a rural model.

It is widely recognized that the amelioration of individual and family problems which contribute to child abuse and neglect requires a multidisciplinary effort. Unfortunately, however, these efforts are often sporadic or disjointed. This article is a description of a county social service-public health partnership in rural Minnesota which can serve as a model for other agencies interested in developing more interactive relationships with one another to the benefit of dysfunctional families and vulnerable children. A respect for one another's professional knowledge base and skills, a shared philosophy of intervention, and supportive agency administrators are the key components that make this model successful. Social workers and public health nurses working together--and in cooperation with still other professionals in the community--can identify and help to resolve those unmet social, psychological, and health needs which often are found in dysfunctional families. Public health nurses have many talents and a very diverse knowledge base that can be tapped by legally designated social workers who are charged by State statutes with intervening in cases involving physical or sexual abuse or neglect of children. The Brown County, MN, model is an example of a collaborative strategy that can be replicated nationwide.

The mental health professional, the mentally retarded, and sex.

Because of the departure of the mentally retarded from cloistered institutions and their placement in community living arrangements, community mental health professionals are being called on more than ever to help the retarded and their parents deal responsibly with issues of sexuality. The mental health professional who would counsel the retarded must first develop and appreciation of the unique medical and social issues that can affect the sexual expression of the retarded. These issues include sexual maturation, reproductive ability, contraception, sterilization, abortion, and sex education. The author, through a review of the literature, discuss these issues and offers guidance to counselors struggling with the difficult decisions concerning sexual expression among the mentally retarded.

Staff members' attitudes toward the sexual behavior of mentally retarded residents.

Seventy-five staff members from four private residential facilities for mentally retarded adults were surveyed to elicit their attitudes toward the sexual behavior and sexual knowledge of residents in their care. Facility policies and programs applicable to residents' sexuality were also the subject of inquiry. Comparable attitudinal surveys and studies dealing with the sexuality of mentally retarded persons were reviewed in the context of the present findings.