Background: Care leavers transitioning into adulthood represent a highly vulnerable population, confronted with usual developmental tasks under difficult predisposing conditions. Early-risk and... Show moreBackground: Care leavers transitioning into adulthood represent a highly vulnerable population, confronted with usual developmental tasks under difficult predisposing conditions. Early-risk and persistent substance use may be an obstacle for care leavers transitioning from youth residential care settings into an independent adult life.Objectives: This study aims to address the following questions: (1) How stable is high-risk substance use from within care to after youth residential care? (2) Are there differences between longitudinal substance use risk pathways and sociodemographic characteristics, placement history, and adverse exposures? (3) Is the persistency of high-risk substance use associated with impaired young adult psychosocial functioning?Method: In a prospective longitudinal design, with a baseline in youth residential care (t1) and a follow-up ten years later (t2), we investigated the courses of substance use in 182 young adult care leavers in Switzerland (32.4 % women; Mean age = 26.7 years). Psychosocial functioning was assessed across health, legal, educational, and financial domains.Results: We found large prevalence rates of high-risk substance use in and after residential youth care (41.2 % in residential care; 46.2 % after leaving care). Of those care leavers who reported earlier high-risk substance use, 61.3 % persisted, while 38.7 % remitted. Four substance risk pathways were identified longitudinally: low (N = 69, 37.9 %), remitted (N = 29, 15.9 %), newly-developed (N = 38, 20.9 %), and persistent risk (N = 46, 25.3 %). Persistent high-risk substance use was associated with higher rates of adverse functional outcomes in young adulthood.Conclusions: Findings of this study shed light on the high prevalence of earlier and persistent high-risk substance use in youth residential care leavers. High-risk substance use appears to have the potential to coincide with impaired psychosocial functioning during and after the transition to young adulthood. Implications for educational and vocational paths as well as harm-reducing interventions are discussed. More research disentangling risk pathways and intervention research in at-risk populations is warranted. Show less
Tappero, S.; Dell'Oglio, P.; Longoni, M.; Buratto, C.; Palagonia, E.; Scilipoti, P.; ... ; Galfano, A. 2022
Objective: To evaluate the relationship between enlarged prostate, bulky median lobe (BML) or prior benign prostatic hyperplasia (BPH) surgery and perioperative functional, and oncological outcomes... Show moreObjective: To evaluate the relationship between enlarged prostate, bulky median lobe (BML) or prior benign prostatic hyperplasia (BPH) surgery and perioperative functional, and oncological outcomes in high-risk (HR) prostate cancer (PCa) patients treated with Retzius-sparing robot-assisted radical prostatectomy (RS-RARP). Methods: 320 HR-PCa patients treated with RS-RARP between 2011 and 2020 at a single high-volume center. The relationship between prostate volume, BML, prior BPH surgery and perioperative outcomes, Clavien-Dindo (CD) grade >= 2 90-day postoperative complications, positive surgical margins (PSMs), and urinary continence (UC) recovery was evaluated respectively in multivariable linear, logistic and Cox regression models. Complications were collected according to the standardized methodology proposed by EAU guidelines. UC recovery was defined as the use of zero or one safety pad.Results: Overall, 5.9% and 5.6% had respectively a BML or prior BPH surgery. Median PV was 45 g (range: 14-300). The rate of focal and non-focal PSMs was 8.4% and 17.8%. 53% and 10.9% patients had immediate UC recovery and CD >= 2. The 1- and 2-yr UC recovery was 84 and 85%. PV (p = 0.03) and prior BPH surgery (p = 0.02) was associated with longer operative time. BML was independent predictor of time to bladder catheter removal (p = 0.001). PV was independent predictor of PSMs (OR: 1.02; p = 0.009). Prior BPH surgery was associated with lower UC recovery (HR: 0.5; p = 0.03). Conclusion: HR-PCa patients with enlarged prostate have higher risk of PSMs, while patients with prior BPH surgery have suboptimal UC recovery. These findings should help physicians for accurate preoperative counseling and to improve surgical planning in case of HR-PCa patients with challenging features. Show less
Dell'Oglio, P.; Tappero, S.; Longoni, M.; Buratto, C.; Scilipoti, P.; Secco, S.; ... ; Galfano, A. 2022
Background: Retzius-sparing (RS) robot-assisted radical prostatectomy represents a valid surgical treatment option for prostate cancer (PCa) patients. However, the available evidence on the role of... Show moreBackground: Retzius-sparing (RS) robot-assisted radical prostatectomy represents a valid surgical treatment option for prostate cancer (PCa) patients. However, the available evidence on the role of RS in high-risk (HR) PCa setting is sparse.& nbsp;Objective: To describe our RS technique for HR-PCa patients and to evaluate intra-, peri-, and postoperative oncological and functional outcomes.& nbsp;Design, setting, and participants: A total of 340 D'Amico HR-PCa patients under -went RS at a single high-volume centre between 2011 and 2020. Surgical procedure:& nbsp;Surgical procedures were performed by five experienced robotic surgeons.& nbsp;Measurements: Complications were collected according to the standardised methodology proposed by the European Association of Urology guidelines. Postoperative outcomes were evaluated in patients with complete follow-up data (n = 320). Biochemical recurrence (BCR) was defined as two consecutive prostate-specific antigen values of >= 0.2 ng/ml. Urinary continence (UC) recovery was defined as the use of zero or one safety pad. Kaplan-Meier and multivariable logistic and Cox regression models were performed.& nbsp;Results and limitations: Fourteen patients (4%) experienced intraoperative complications and 52 90-d complications occurred in 44 patients (14%), of whom 24 had Clavien-Dindo 3a/b. Final pathology reported 49% International Society of Urological Pathology (ISUP) grade 4-5, 55% > pT3a, and 28.8% positive surgical mar-gins (PSMs; 9.4% focal and 19.4% extended PSMs). The median follow-up was 47 mo. Overall, 35.3% and 1.3% harboured BCR and died from PCa. At 4 yr of follow-up, BCR-free survival and additional treatment-free survival were 63.6% and 56.6%, respectively. ISUP 4-5 at biopsy (odds ratio [OR]: 2.6), prostate volume (OR: 1.03), partial or full nerve sparing (OR: 1.9), and full bladder neck preservation (OR: 2.2) were independent predictors of PSMs. Pathological ISUP 4-5 (hazard ratio [HR]: 1.5) and PSMs (HR: 2.3) were independent predictors of BCR. Pathological ISUP 4-5 (HR: 1.5), PSMs (HR: 2.4), pT >= 3b (HR: 1.8), and pN >= 1 (HR: 1.8) were independent predictors of additional treatment. Immediate UC recovery was recorded in 53% patients. The 1-and 2-yr UC recovery and erectile function recovery were, respectively, 84% and 85%, and 43% and 50%.& nbsp;Conclusions: RS in HR-PCa patients allows optimal intra-, peri-, and postoperative outcomes. The RS approach should be considered a valid surgical treatment option for HR-PCa patients in expert hands.& nbsp;Patient summary: Relying on the largest cohort of high-risk prostate cancer patients treated with Retzius sparing (RS), we observed that the RS approach is safe and allows optimal cancer control, without significantly compromising functional outcomes. (C)& nbsp;2022 The Author(s). Published by Elsevier B.V. on behalf of European Association of Urology.& nbsp; Show less
The scope of this thesis spanned several issues in the measurement and evaluation of OD. The screening, assessment, and treatment effect for OD have been covered,with a special emphasis on... Show moreThe scope of this thesis spanned several issues in the measurement and evaluation of OD. The screening, assessment, and treatment effect for OD have been covered,with a special emphasis on patient self-evaluation. Show less
