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We investigated whether prostate cancer patients treated with external beam radiation therapy (EBRT) have a higher cumulative incidence of secondary cancer compared with patients treated with radical prostatectomy (RP). We used state-wide linked data from South Australia to follow men with prostate cancer diagnosed from 2002 to 2019. The cumulative incidence of overall and site-specific secondary cancers between 5 and 15 years after treatment was estimated. Fine-Gray competing risk analyses were performed with additional sensitivity analyses to test different scenarios. A total of 7625 patients were included (54% underwent RP and 46% EBRT). Characteristics of the two groups differed significantly, with the EBRT group being older (71 vs. 64 years), having higher comorbidity burden and being more likely to die during follow-up than the RP group. Fifteen-year cumulative incidence for all secondary cancers was 27.4% and 22.3% in EBRT and RP groups, respectively. In the adjusted models, patients in the EBRT group had a significantly higher risk of genitourinary (adjusted subhazard ratio (aSHR), 2.29; 95%CI 1.16–4.51) and lung (aSHR, 1.93; 95%CI 1.05–3.56) cancers compared with patients in the RP group. However, there was no statistically significant difference between the two groups for risk of any secondary cancer, gastro-intestinal, skin or haematologic cancers. No statistically significant differences in overall risk of secondary cancer were observed in any of the sensitivity analyses and patterns for risk at specific cancer sites were relatively consistent across different age restriction and latency/time-lag scenarios. In conclusion, the increased risk of genitourinary and lung cancers among men undergoing EBRT may relate partly to treatment effects and partly to unmeasured residual confounding.

Background Although sexual dysfunction is a common treatment side-effect affecting men’s quality of life, many prostate cancer patients do not receive or seek out treatments for erectile dysfunction (ED). The aims of this study are to investigate the extent and patterns of use of ED treatments and their perceived impact at different times following prostate cancer treatment. Methods This retrospective cohort study included all men on the South Australian prostate cancer registry who completed one or more Patient Reported Outcome Measures (PROMs) survey from 2016 to 2023 ( n  = 5561). Outcomes included self-reported use of ED treatment (oral medications, intra-cavernosal injections (ICI) and vacuum pumps) and their impact men’s sex life at various time points after treatment. The type and timing of ED treatments used was analysed descriptively. Sociodemographic and clinical characteristics associated with utilisation and self-reported satisfaction were examined using multivariable mixed-effects binomial logistic regression. Results Post-treatment use of ED treatments did not exceed 43% at any timepoint, with utilisation rates decreasing over time. Oral medications were most frequently used, while vacuum pump and ICI use was limited. Oral medications were more likely to be used at three-months (odds ratio [OR] = 2.48; 95% confidence interval [95%CI] = 1.88–3.27) and six-months (OR = 2.10; 95%CI = 1.63–2.27) than at 12-months post-treatment, and among men from higher socioeconomic areas (OR = 2.41; 95%CI = 1.47–3.93, highest vs. lowest quintile), and following prostatectomy (OR = 4.37; 95%CI = 2.92–6.42), and less likely among older men (OR = 0.08; 95%CI = 0.05–0.13, < 60yrs vs. 70-79yrs). Men were more likely to report an improved sex life with oral medication use at two-years (OR = 3.79; 95%CI = 1.69–8.47) and five-years (OR = 3.07; 95%CI = 1.51–6.25) post-treatment compared with 12-months or if they were socioeconomically advantaged (OR = 3.22; 95%CI = 1.30–7.96, highest vs. lowest quintile). Conclusions A substantial proportion of Australian men do not access or continue to use ED treatments after prostate cancer treatment, with many users reporting only modest effects on their sex life. There is a need to improve access to and maintenance of ED treatments following prostate cancer treatment.

Some studies in developing countries have shown that infant mortality is highly associated with maternal education, implying that maternal education might play an important role in the reduction of infant mortality. However, other research has shown that lower levels of maternal education does not have any significant contribution to infant survival. In this systematic review, we focus on the effect of different levels of maternal education on infant mortality in Ethiopia. MEDLINE, EMBASE, CINAHL, Scopus, and Maternity and Infant Care databases were searched between November 15, 2017 and February 20, 2018. All articles published until February 20, 2018 were included in the study. The data extraction was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA 2009) guidelines. An I2 test was used to assess heterogeneity and a funnel plot was used to check publication bias. We retrieved 441 records after removing duplications. During screening, 31 articles were fully accessed for data extraction. Finally, five articles were included for analysis. The overall pooled estimate indicated that attending primary education was associated with a 28% reduction in the odds of infant mortality compared to those infants born to mothers who were illiterate, OR: 0.72 (95% CI = 0.66, 0.78). Another pooled estimate indicated that attending secondary education and above was associated with a 45% reduction in the odds of infant mortality compared to those infants born to mothers who were illiterate, OR: 0.55 (95% CI = 0.47, 0.64). From this study, understanding the long-term impact of maternal education may contribute to reduce infant mortality. Therefore, policy makers should give more attention in promoting the role of women through removing institutional and cultural barriers, which hinder women from access to education in order to reduce infant mortality in Ethiopia.

Intimate partner violence (IPV) continues to be a major public health problem globally. Although Ethiopia has a high prevalence of IPV, previous studies in this country have only investigated individual-level determinants of IPV within small geographic areas. The current study aimed to identify the individual-, relationship-, community-, and societal-level determinants of IPV directed against women in Ethiopia since women are predominantly affected. A retrospective analysis of nationally representative data from the 2016 Ethiopian Demographic and Health Survey (EDHS) was conducted. A sample of 3,897 married women of reproductive age (15-49 years) who participated in the domestic violence module of the survey were included in the analysis. Three-level mixed-effects multilevel logistic regression models were used to estimate the individual-, relationship-, community-, and societal-level determinants of IPV. Variability at the community- and societal-level were also assessed. About 1,328 (34.1%) of 3,897 participants reported experiencing IPV (a composite measure of physical, sexual and emotional abuse). In adjusted models, the odds of lifetime IPV experience were higher among women who were older, were married before the age of 18 years, witnessed inter-parental violence during their childhood, had a partner who drank alcohol, and lived in a community with high IPV accepting norms. Alternatively, the odds of IPV were lower among women who had decision-making autonomy in the household, had the same or lower educational attainment as their partner, and lived in a community with low proportions of educated women. These findings reveal that although individual-level factors were significant determinants of IPV, higher level factors, including female education and IPV acceptance in the community, were also important influences on this major public health issue in Ethiopia. These findings suggest combined interventions at different levels may reduce IPV in this country.

Background The aim of this study was to describe changes in patient-reported functional outcome measures (PROMs) comparing pre-treatment and 12 months after radical prostatectomy (RP), external beam radiation therapy (EBRT), brachytherapy and active surveillance (AS). Methods Men enrolled from 2010 to 2019 in the South Australian Prostate Cancer Clinical Outcomes Collaborative registry a prospective clinical registry were studied. Urinary, bowel, and sexual functions were measured using Expanded Prostate Cancer Index Composite (EPIC-26) at baseline and 12 months post-treatment. Higher scores on the EPIC-26 indicate better function. Multivariable regression models were applied to compare differences in function and extent of bother by treatment. Results Of the 4926 eligible men, 57.0% underwent RP, 20.5% EBRT, 7.0% brachytherapy and 15.5% AS. While baseline urinary and bowel function varied little across treatment groups, sexual function differed greatly (adjusted mean scores: RP = 56.3, EBRT = 45.8, brachytherapy = 61.4, AS = 52.8; p < 0.001). Post-treatment urinary continence and sexual function declined in all treatment groups, with the greatest decline for sexual function after RP (adjusted mean score change − 28.9). After adjustment for baseline differences, post-treatment sexual function scores after EBRT (6.4; 95%CI, 0.9–12.0) and brachytherapy (17.4; 95%CI, 9.4–25.5) were higher than after RP. Likewise, urinary continence after EBRT (13.6; 95%CI, 9.0-18.2), brachytherapy (10.6; 95%CI, 3.9–17.3) and AS (10.6; 95%CI, 5.9–15.3) were higher than after RP. Conversely, EBRT was associated with lower bowel function (− 7.9; 95%CI, − 12.4 to − 3.5) than RP. EBRT and AS were associated with lower odds of sexual bother (OR 0.51; 95%CI, 0.29–0.89 and OR 0.60; 95%CI, 0.38–0.96, respectively), and EBRT with higher odds of bowel bother (OR 2.01; 95%CI, 1.23–3.29) compared with RP. Conclusion The four common treatment approaches for prostate cancer were associated with different patterns of patient-reported functional outcomes, both pre- and 12 months post-treatment. However, after adjustment, RP was associated with a greater decline in urinary continence and sexual function than other treatments. This study underscores the importance of collecting baseline PROMs to interpret post-treatment functional outcomes.

Background and Purpose Evidence on how treatment outcomes vary by patient characteristics helps to inform clinical practice. In this study, we measured socioeconomic and geographic disparity in post‐radiotherapy procedures, as an indication of short‐term radiotherapy adverse effects, among men with prostate cancer. Materials and Methods We studied 8344 South Australian diagnosed men with prostate cancer (2002–2020) who received external beam radiotherapy. The outcomes were anorectal and urinary procedures, identified using hospital admission procedure codes and Medicare Benefits Schedule item codes. Crude rates per 1000 person‐time were estimated at two years post‐radiotherapy. Socioeconomic and geographic disparities were identified through multivariable adjusted zero‐inflated Poisson regression. Results Fifteen percent of men underwent at least one post‐radiotherapy procedure within two years. The rates of anorectal, urinary and overall (both anorectal and urinary) procedures were 18, 66 and 81 per 1000 person‐years, respectively. Men in the highest socioeconomic quintile had lower rates of overall (incidence rate ratio [IRR] 0.70, 95% CI: 0.61–0.81), anorectal (IRR 0.32, 95% CI: 0.20–0.52) and urinary (IRR 0.69, 95% CI: 0.56–0.86) procedures than men in the lowest socioeconomic quintile. Men from non‐metropolitan areas had higher rates of anorectal procedures (IRR 1.36, 95% CI: 1.05–1.77) than men from metropolitan areas, which was further compounded by low socioeconomic advantage. Receiving radiotherapy in more recent years was associated with lower rates of post‐radiotherapy procedures. Conclusion Anorectal and urinary procedures following radiotherapy significantly vary across different population subgroups. Observed differences in procedure rates may suggest socioeconomic and geographic disparities in radiotherapy adverse effects for prostate cancer. This underscores the importance of follow‐up care for at‐risk population subgroups.

Understanding the relative contribution of modifiable risk factors to cancer morbidity and mortality is crucial for designing effective cancer prevention and control strategies. Our study estimated cancer-related deaths and disability-adjusted life years (DALYs) lost attributable to potentially modifiable risk factors in Australia using data from the Global Burden of Diseases 2021 study. In 2021, an estimated 20,409 cancer deaths (37.5%) and 431,575 cancer DALYs lost (37.9%) in Australia were attributable to potentially modifiable risk factors. Males had higher modifiable risk attributed to cancer death and DALY rates than females. Behavioral risks accounted for 25.0% of cancer deaths and 26.5% of DALYs. Metabolic risks and environmental/occupational risks accounted for 9.4% and 9.3% of deaths, respectively. Smoking remained the leading attributable risk factor, accounting for 12.2% cancer deaths and 13.1% DALYs lost. Dietary risks accounted for 40.0% of colorectal cancer deaths and DALYs lost. Cervical, larynx, liver, lung, and colorectal cancers had a high proportion of deaths and DALYs lost attributed to modifiable risks. Liver and nasopharyngeal cancers had the highest burden attributed to alcohol use (39.1% and 39.0%, respectively), while 21.3% liver cancer deaths were attributed to drug use. Strengthening public health interventions, such as multi-disciplinary approaches to promote a healthy lifestyle, is required.

Background Women are often the primary caregivers of children, and as such, their empowerment could influence the nutritional status of their children. However, the role of maternal empowerment on the nutritional status of children in Ethiopia is largely unknown. Aim To determine the association of women’s empowerment with childhood stunting in rural northwest Ethiopia. Methods A community-based cross-sectional study was conducted among 582 mothers with children aged 6–59 months. A multistage sampling technique was used to select the study participants. Binomial logistic regression analyses were used to assess whether women’s empowerment (categorized as low, moderate and high) and its five dimensions (household decision-making, educational status, cash earnings, house/land ownership, and membership in community groups) were associated with stunting in children. Odds ratios with 95% CI were estimated, and statistical significance was declared at a p-value of < 0.05. Results A total of 114 (19.6%), 312 (53.6%), and 156 (26.8%) participants had low, moderate, and high empowerment levels, respectively. In addition, 255 (43.8%) mothers had children who were stunted (too short for their age). In the adjusted models, mothers with moderate empowerment (AOR 0.60, 95% CI: 0.35, 0.97) and high empowerment (AOR 0.56, 95% CI: 0.37, 0.86) had lower odds of having stunted children compared to mothers with low empowerment. Mothers who had a secondary education or higher (AOR 0.57, 95% CI: 0.35, 0.93), owned a house or land (AOR 0.64, 95% CI: 0.44, 0.94) and were members of community groups (AOR 0.54, 95% CI: 0.36, 0.80) were less likely to have stunted children. Conclusion High women empowerment was significantly associated with a lower likelihood of childhood stunting. The findings suggest a need to look beyond the direct causes of stunting and incorporate targeted strategies for empowering women into child nutrition programs.

Objectives To describe real‐world clinical and functional outcomes in an Australian cohort of men with localised prostate cancer according to treatment type and risk category. Subjects and methods Men diagnosed from 2008 to 2018 who were enrolled in South Australian Prostate Cancer Clinical Outcomes Collaborative registry—a multi‐institutional prospective clinical registry—were studied. The main outcome measures were overall survival, cancer‐specific survival, decline in functional outcomes, biochemical recurrence and transition to active treatment following active surveillance. Multivariable adjusted models were applied to estimate outcomes. Results Of the 8513 eligible men, majority of men (46%) underwent radical prostatectomy (RP) followed by external beam radiation therapy with or without androgen deprivation therapy (EBRT +/− ADT) in 22% of the cohort. Five‐year overall survival was above 91%, and 5‐year prostate cancer‐specific survival was above 97% in the low‐ and intermediate‐risk categories across all treatments. Five‐year prostate cancer‐specific survival in the active surveillance group was 100%. About 37% of men with high‐risk disease treated with RP and 17% of men treated with EBRT +/− ADT experienced biochemical recurrence within 5 years of treatment. Of men on active surveillance, 15% of those with low risk and 20% with intermediate risk converted to active treatment within 2 years. The decline in urinary continence and sexual function 12 months after treatment was greatest among men who underwent RP while the decline in bowel function was greatest for men who received EBRT +/− ADT. Conclusion This contemporary real‐world evidence on risk‐appropriate treatment outcomes helps inform treatment decision‐making for clinicians and patients.

Background Intimate partner violence (IPV) affects one in every three women globally. Previous studies have revealed that women’s experiences of different forms of IPV are significantly associated with a higher rate of unintended pregnancy, reduced uptake of contraception, and reduced ability to make decisions regarding their fertility. The aim of this study was to investigate whether previously observed relationships between IPV and unintended pregnancy in Ethiopia are mediated by contraceptive use and women’s autonomy. Methods This study was performed using nationally representative data from the 2016 Ethiopian Demographic and Health Survey (EDHS). A subsample of married women of reproductive age reporting a pregnancy within the 5 years preceding 2016 and who participated in the domestic violence sub-study of the survey were included in analyses. Logistic regression models, together with the product of coefficients method, were used to estimate direct and mediated effects. Results Twenty six percent of participants reported an unintended pregnancy in the 5 years preceding the survey. Sixty-four percent reported having ever experienced IPV (a composite measure of physical, sexual, emotional abuse, and partner controlling behaviour). After adjusting for potential confounding factors, unintended pregnancy was significantly positively associated with reporting sexual IPV, emotional IPV, IPV (a composite measure of physical, sexual, or emotional abuse), and multiple partner controlling behaviour. However, IPV (as a composite of all four forms), physical IPV, and partner control (single act) were not significantly associated with unintended pregnancy. Women’s autonomy, but not contraception use, had a significant partial mediation effect in the relationships between some forms of IPV and unintended pregnancy. Women’s autonomy mediated about 35, 35, and 43% of the total effect of emotional IPV, IPV (physical, sexual, and/or emotional), and multiple partner control on unintended pregnancy respectively. Conclusion Women’s autonomy appears to play a significant role in mediating the effect of IPV on unintended pregnancy in Ethiopia. Maternal health service interventions in Ethiopia could incorporate measures to improve women’s decision-making power to reduce the negative reproductive health effects of IPV.