scholarly journals Epigenome-wide association studies of three social determinants of health and implications for lung functions among survivors of childhood cancer

2020 ◽  
Author(s):  
Nan Song ◽  
Jin-ah Sim ◽  
Qian Dong ◽  
Yinan Zheng ◽  
Lifang Hou ◽  
...  
Keyword(s):  
Educational Attainment ◽  
Childhood Cancer ◽  
Social Determinants Of Health ◽  
Median Time ◽  
Social Determinants ◽  
Association Studies ◽  
Personal Income ◽  
Mediation Effect ◽  
Survivors Of Childhood Cancer

AbstractBackgroundEmerging evidence suggests that social determinants of health (SDOH) may influence health and wellness through an epigenetic mechanism in the general population. However, the social epigenomic approach has not yet been applied to survivors of childhood cancer, a vulnerable population with elevated risk for chronic health conditions (CHCs).MethodsStudy participants were drawn from the St Jude Lifetime Cohort, a hospital-based retrospective cohort with prospective follow up. DNA methylation (DNAm) profiling was generated based on blood derived DNA collected during follow-up visit. SDOH included educational attainment, personal income, and area deprivation index (ADI) based on baseline or follow-up questionnaires and geocoding. CHCs were clinically assessed with severity grade.ResultsWe included 258 childhood cancer survivors of African ancestry (AA) (median time from diagnosis=25.2 years, interquartile range [IQR]=19.9-32.1 years) and 1,618 survivors of European ancestry (EA) (median time from diagnosis=27.3, IQR=21.1-33.7 years). Through epigenome-wide association studies, we identified 130 SDOH-CpG associations including educational attainment (N=88), personal income (N=23), and ADI (N=19) at epigenome-wide significance level (P<9×10−8). There were 13 CpGs, commonly associated with all three SDOH factors, with attenuated remaining effect sizes (36.8-48.3%) after additionally adjusting body mass index and smoking, mapped to smoking-related genes including GPR55, CLDND1, CPOX, GPR15, AHRR, PRRC2B, and ELMSAN1. Among 130 SDOH-related CpGs, three independent CpGs (cg04180924, cg1120500, and cg27470486) had a significant combined mediation effect for educational attainment (%mediation=48.9%), and a single mediator cg08064403 was found with significant mediation effect for personal income (25.9%) and ADI (24.1%) on pulmonary diffusion deficit, which showed higher incidence in AA than in EA survivors implying racial disparity which is possibly due to more disadvantageous SDOH factors in AA than in EA.ConclusionsWe demonstrated striking DNAm signatures associated with multiple SDOH factors (educational attainment, personal income, and ADI) and many epigenome-wide significant CpG sites resembling the effect of smoking exposure. We also identified an exemplified racial health disparity in pulmonary diffusion deficit between AA and EA survivors and illuminated DNAm as potential mechanistic mediators for SDOH factors using a social epigenomic approach.

Social determinants of health affecting treatment of pediatric brain tumors

2019 ◽  
Vol 24 (2) ◽  
pp. 159-165
Author(s):  
Jillian M. Berkman ◽  
Jonathan Dallas ◽  
Jaims Lim ◽  
Ritwik Bhatia ◽  
Amber Gaulden ◽  
...  
Keyword(s):  
African American ◽  
Health Disparities ◽  
Brain Tumors ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Determinants Of Health ◽  
Cns Tumor ◽  
Initial Symptoms ◽  
Caucasian Patients

OBJECTIVELittle is understood about the role that health disparities play in the treatment and management of brain tumors in children. The purpose of this study was to determine if health disparities impact the timing of initial and follow-up care of patients, as well as overall survival.METHODSThe authors conducted a retrospective study of pediatric patients (< 18 years of age) previously diagnosed with, and initially treated for, a primary CNS tumor between 2005 and 2012 at Monroe Carell Jr. Children’s Hospital at Vanderbilt. Primary outcomes included time from symptom presentation to initial neurosurgery consultation and percentage of missed follow-up visits for ancillary or core services (defined as no-show visits). Core services were defined as healthcare interactions directly involved with CNS tumor management, whereas ancillary services were appointments that might be related to overall care of the patient but not directly focused on treatment of the tumor. Statistical analysis included Pearson’s chi-square test, nonparametric univariable tests, and multivariable linear regression. Statistical significance was set a priori at p < 0.05.RESULTSThe analysis included 198 patients. The median time from symptom onset to initial presentation was 30.0 days. A mean of 7.45% of all core visits were missed. When comparing African American and Caucasian patients, there was no significant difference in age at diagnosis, timing of initial symptoms, or tumor grade. African American patients missed significantly more core visits than Caucasian patients (p = 0.007); this became even more significant when controlling for other factors in the multivariable analysis (p < 0.001). African American patients were more likely to have public insurance, while Caucasian patients were more likely to have private insurance (p = 0.025). When evaluating survival, no health disparities were identified.CONCLUSIONSNo significant health disparities were identified when evaluating the timing of presentation and survival. A racial disparity was noted when evaluating missed follow-up visits. Future work should focus on identifying reasons for differences and whether social determinants of health affect other aspects of treatment.

Echocardiography for the 10-year prediction of cardiomyopathy in long-term survivors of childhood cancer

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J.M Leerink ◽  
H.J.H Van Der Pal ◽  
E.A.M Feijen ◽  
P.G Meregalli ◽  
M.S Pourier ◽  
...  
Keyword(s):  
Childhood Cancer ◽  
Median Time ◽  
Cancer Diagnosis ◽  
Predictive Value ◽  
Validation Cohort ◽  
Funding Source ◽  
Derivation Cohort ◽  
After Cancer ◽  
Radiotherapy Dose

Abstract Background Childhood cancer survivors (CCS) treated with anthracyclines and/or chest-directed radiotherapy receive life-long echocardiographic surveillance to detect cardiomyopathy early. Current risk stratification and surveillance frequency recommendations are based on anthracycline- and chest-directed radiotherapy dose. We assessed the added prognostic value of an initial left ventricular ejection fraction (EF) measurement at &gt;5 years after cancer diagnosis. Patients and methods Echocardiographic follow-up was performed in asymptomatic CCS from the Emma Children's Hospital (derivation; n=299; median time after diagnosis, 16.7 years [inter quartile range (IQR) 11.8–23.15]) and from the Radboud University Medical Center (validation; n=218, median time after diagnosis, 17.0 years [IQR 13.0–21.7]) in the Netherlands. CCS with cardiomyopathy at baseline were excluded (n=16). The endpoint was cardiomyopathy, defined as a clinically significant decreased EF (EF&lt;40%). The predictive value of the initial EF at &gt;5 years after cancer diagnosis was analyzed with multivariable Cox regression models in the derivation cohort and the model was validated in the validation cohort. Results The median follow-up after the initial EF was 10.9 years and 8.9 years in the derivation and validation cohort, respectively, with cardiomyopathy developing in 11/299 (3.7%) and 7/218 (3.2%), respectively. Addition of the initial EF on top of anthracycline and chest radiotherapy dose increased the C-index from 0.75 to 0.85 in the derivation cohort and from 0.71 to 0.92 in the validation cohort (p&lt;0.01). The model was well calibrated at 10-year predicted probabilities up to 5%. An initial EF between 40–49% was associated with a hazard ratio of 6.8 (95% CI 1.8–25) for development of cardiomyopathy during follow-up. For those with a predicted 10-year cardiomyopathy probability &lt;3% (76.9% of the derivation cohort and 74.3% of validation cohort) the negative predictive value was &gt;99% in both cohorts. Conclusion The addition of the initial EF &gt;5 years after cancer diagnosis to anthracycline- and chest-directed radiotherapy dose improves the 10-year cardiomyopathy prediction in CCS. Our validated prediction model identifies low-risk survivors in whom the surveillance frequency may be reduced to every 10 years. Calibration in both cohorts Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Dutch Heart Foundation

scholarly journals The willingness of general practitioners to be involved in the follow-up of adult survivors of childhood cancer

2007 ◽  
Vol 1 (4) ◽  
pp. 292-297 ◽  
Author(s):  
Ria Blaauwbroek ◽  
Nynke Zwart ◽  
Martijn Bouma ◽  
Betty Meyboom-de Jong ◽  
Willem A. Kamps ◽  
...  
Keyword(s):  
Childhood Cancer ◽  
General Practitioners ◽  
Adult Survivors ◽  
Survivors Of Childhood Cancer

scholarly journals The personal and clinical impact of screen-detected maternal rheumatic heart disease in Uganda: a prospective follow up study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Sonia Voleti ◽  
Emmy Okello ◽  
Meghna Murali ◽  
Rachel Sarnacki ◽  
Albert Majwala ◽  
...  
Keyword(s):  
Heart Disease ◽  
Social Determinants Of Health ◽  
Rheumatic Heart Disease ◽  
Social Determinants ◽  
Determinants Of Health ◽  
World Health ◽  
Medical Decision ◽  
Rheumatic Heart

Abstract Background Pre-existing maternal cardiac disease is a significant contributor to adverse maternal, fetal, and neonatal outcomes. In 2015–2017, our team conducted the first community-based study of maternal rheumatic heart disease (RHD) in sub-Saharan Africa and identified RHD in 88% of those with pre-existing heart disease. Here we conducted a follow up investigation of women previously identified with RHD, describing clinical and echocardiographic outcomes, identifying barriers to medical adherence and evaluating the personal impact of RHD. Methods A 2 week prospective follow up was completed at sites in Central and Eastern Uganda. Participants underwent a three-step mixed methods study comprising of 1) direct structured interview targeting clinical history and medication adherence, 2) echocardiogram to evaluate left-sided heart valves, and 3) semi-structured guideline interview to elicit personal impacts of RHD. Results The team evaluated 40 (80%) of the original 51 mothers with RHD at a median post-partum time of 2.5 years after delivery (IQR 0.5). Echocardiographic data showed improvement in nine women with the remaining 31 women showing stable echocardiographic findings. Adherence to Benzathine penicillin G (BPG) prophylaxis was poor, with 70% of patients either poorly adherent or non-adherent. Three major themes emerged from interviews: 1) social determinants of health (World Health Organization, Social determinants of health, 2019) negatively affecting healthcare, 2) RHD diagnosis negatively affecting female societal wellbeing, 3) central role of spouse in medical decision making. Conclusions Screening echocardiography can identify women with pre-existing rheumatic heart disease during pregnancy, but long-term follow-up in Uganda reveals adherence to medical care following diagnosis, including BPG, is poor. Additionally, mothers diagnosed with RHD may experience unintended consequences such as social stigmatization. As identification of occult RHD is critical to prevent adverse pregnancy outcomes, further research is needed to determine how to best support women who face a new diagnosis of RHD, and to determine the role of screening echocardiography in high-risk settings.

scholarly journals Clinical Trial Enrollment is Associated With Improved Follow-up Rates Among Survivors of Childhood Cancer

2019 ◽  
Vol 41 (1) ◽  
pp. e18-e23
Author(s):  
Kelley K. Hutchins ◽  
Süreyya Savaşan ◽  
Ronald L. Thomas ◽  
Laura A. Strathdee ◽  
Zhihong J. Wang ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Childhood Cancer ◽  
Clinical Trial Enrollment ◽  
Survivors Of Childhood Cancer

scholarly journals Educational attainment among survivors of childhood cancer: a population-based cohort study in Denmark

2004 ◽  
Vol 91 (5) ◽  
pp. 923-928 ◽  
Author(s):  
S V Koch ◽  
A M T Kejs ◽  
G Engholm ◽  
C Johansen ◽  
K Schmiegelow
Keyword(s):  
Cohort Study ◽  
Educational Attainment ◽  
Childhood Cancer ◽  
Population Based ◽  
Survivors Of Childhood Cancer
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