scholarly journals Mediating Effects of Frailty Indicators on the Risk of Sepsis After Cancer

2018 ◽  
Vol 35 (7) ◽  
pp. 708-719 ◽  
Author(s):  
Justin Xavier Moore ◽  
Tomi Akinyemiju ◽  
Alfred Bartolucci ◽  
Henry E. Wang ◽  
John Waterbor ◽  
...  
Keyword(s):  
Physical Activity ◽  
Cancer Survivors ◽  
Racial Differences ◽  
Cancer Survivorship ◽  
Cox Regression ◽  
Mediation Effect ◽  
Cancer History ◽  
Mediation Effects ◽  
Increased Risk ◽  
Using Data

Background: Cancer survivors are at increased risk of sepsis, possibly attributed to weakened physiologic conditions. The aims of this study were to examine the mediation effect of indicators of frailty on the association between cancer survivorship and sepsis incidence and whether these differences varied by race. Methods: We performed a prospective analysis using data from the REasons for Geographic and Racial Differences in Stroke cohort from years 2003 to 2012. We categorized frailty as the presence of ≥2 frailty components (weakness, exhaustion, and low physical activity). We categorized participants as “cancer survivors” or “no cancer history” derived from self-reported responses of being diagnosed with any cancer. We examined the mediation effect of frailty on the association between cancer survivorship and sepsis incidence using Cox regression. We repeated analysis stratified by race. Results: Among 28 062 eligible participants, 2773 (9.88%) were cancer survivors and 25 289 (90.03%) were no cancer history participants. Among a total 1315 sepsis cases, cancer survivors were more likely to develop sepsis (12.66% vs 3.81%, P < .01) when compared to participants with no cancer history (hazard ratios: 2.62, 95% confidence interval: 2.31-2.98, P < .01). The mediation effects of frailty on the log-hazard scale were very small: weakness (0.57%), exhaustion (0.31%), low physical activity (0.20%), frailty (0.75%), and total number of frailty indicators (0.69%). Similar results were observed when stratified by race. Conclusion: Cancer survivors had more than a 2-fold increased risk of sepsis, and indicators of frailty contributed to less than 1% of this disparity.

scholarly journals A Prospective Study of Community Mediators on the Risk of Sepsis After Cancer

2019 ◽  
Vol 35 (12) ◽  
pp. 1546-1555
Author(s):  
Justin Xavier Moore ◽  
Tomi Akinyemiju ◽  
Alfred Bartolucci ◽  
Henry E. Wang ◽  
John Waterbor ◽  
...  
Keyword(s):  
Cancer Survivors ◽  
Racial Differences ◽  
Cox Proportional Hazards ◽  
Mediation Effect ◽  
Community Characteristics ◽  
Cancer History ◽  
Mediation Effects ◽  
Community Factors ◽  
Increased Risk ◽  
After Cancer

Background: Few studies have examined whether community factors mediate the relationship between patients surviving cancer and future development of sepsis. We determined the influence of community characteristics upon risk of sepsis after cancer, and whether there are differences by race. Methods: We performed a prospective analysis using data from the REasons for Geographic and Racial Differences in Stroke cohort years 2003 to 2012 complemented with county-level community characteristics from the American Community Survey and County Health Rankings. We categorized those with a self-reported prior cancer diagnosis as “cancer survivors” and those without a history of cancer as “no cancer history.” We defined sepsis as hospitalization for a serious infection with ≥2 systemic inflammatory response syndrome criteria. We examined the mediation effect of community characteristics on the association between cancer survivorship and sepsis incidence using Cox proportional hazards models adjusted for age, sex, race, and total number of comorbidities. We repeated analysis stratified by race. Results: There were 28 840 eligible participants, of which 2860 (9.92%) were cancer survivors, and 25 289 (90.08%) were no cancer history participants. The only observed community-level mediation effects were from income (% mediated 0.07%; natural indirect effect [NIE] on hazard scale] = 1.001, 95% confidence interval [95% CI]: 1.000-1.005) and prevalence of adult smoking (% mediated = 0.21%; NIE = 1.002, 95% CI: 1.000-1.004). We observed similar effects when stratified by race. Conclusion: Cancer survivors are at increased risk of sepsis; however, this association is weakly mediated by community poverty and smoking prevalence.

Risk and Prognosis of Subsequent Primary Gastric Cancer

2022 ◽  
Author(s):  
Rongrong Wei ◽  
Xinyu Du ◽  
Jing Wang ◽  
Qi Wang ◽  
Xiaojie Zhu ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Cancer Survivors ◽  
Cox Regression ◽  
Prognostic Impact ◽  
Cancer Specific Survival ◽  
Cancer History ◽  
Primary Gastric Cancer ◽  
Actual Observation ◽  
Increased Risk

Introduction: The incidence and prognostic impact of subsequent primary gastric cancer (GC) in a population of other cancer survivors is unclear. We aimed to evaluate susceptibility to subsequent primary GC in cancer survivors and prognosis of GC with prior cancer history. Methods: 2,211 and 23,416 GC cases with and without prior cancer history were retrospectively selected from the Surveillance, Epidemiology and End Results (SEER) database. Potential risk of developing subsequent primary GC was assessed through standardized incidence ratios (SIRs). Cox regression were adopted to analyze the influence of prior cancer history and clinical characteristic factors on the prognosis of subsequent primary GC. A nomogram was established to predict overall survival (OS). Propensity score matching (PSM) was conducted to eliminate possible bias. Results: Compared with general population, cancer survivors had an increased risk of subsequent primary GC (SIR 1.17, 95% CI 1.15-1.20, P<0.05). Prior cancer history was related to poor OS of GC [adjusted hazard ratio (aHR) 1.12, 95% CI 1.06-1.19, P<0.001], but not cancer-specific survival (aHR 0.97, 95% CI 0.89-1.05, P=0.441). In addition, age, grade, stage, year of diagnosis, surgery, TNM stage and tumor size were independent prognostic factors for OS in GC cases with prior cancers. The concordance index of the nomogram was 0.72 (95% CI 0.71-0.74), and calibrate curves showed good agreement between prediction by the nomogram and actual observation. Conclusions: Cancer survivors with increased risk of developing subsequent primary GC should strengthen their monitoring and follow-up to prevent occurrence of subsequent primary gastric cancer.

Sibling Alcohol Use Disorder Is Associated With Increased Risk for Suicide Attempt

2021 ◽  
pp. 216770262110250
Author(s):  
Mallory E. Stephenson ◽  
Sara Larsson Lönn ◽  
Jessica E. Salvatore ◽  
Jan Sundquist ◽  
Kenneth S. Kendler ◽  
...  
Keyword(s):  
Alcohol Use ◽  
Suicide Attempt ◽  
Alcohol Use Disorder ◽  
Cox Regression ◽  
Population Based ◽  
Swedish Population ◽  
Sibling Pairs ◽  
Increased Risk ◽  
Using Data ◽  
Shared Genetic

The association between having a sibling diagnosed with alcohol use disorder (AUD) and risk for suicide attempt may be attributable to shared genetic liability between AUD and suicidal behavior, effects of environmental exposure to a sibling’s AUD, or both. To distinguish between these alternatives, we conducted a series of Cox regression models using data derived from Swedish population-based registers with national coverage. Among full sibling pairs (656,807 males and 607,096 females), we found that, even after we accounted for the proband’s AUD status, the proband’s risk for suicide attempt was significantly elevated when the proband’s sibling was affected by AUD. Furthermore, the proband’s risk for suicide attempt was consistently higher when the sibling’s AUD registration had occurred more recently. Our findings provide evidence for exposure to sibling AUD as an environmental risk factor for suicide attempt and suggest that clinical outreach may be warranted following a sibling’s diagnosis with AUD.

scholarly journals Causal mediation analysis with multiple causally non-ordered mediators

2015 ◽  
Vol 27 (1) ◽  
pp. 3-19 ◽  
Author(s):  
Masataka Taguri ◽  
John Featherstone ◽  
Jing Cheng
Keyword(s):  
Indirect Effect ◽  
Interactive Effect ◽  
Mediation Effect ◽  
Mediation Effects ◽  
Mediation Analyses ◽  
Intermediate Variable ◽  
Causal Mediation ◽  
Health Studies ◽  
Using Data ◽  
The Individual

In many health studies, researchers are interested in estimating the treatment effects on the outcome around and through an intermediate variable. Such causal mediation analyses aim to understand the mechanisms that explain the treatment effect. Although multiple mediators are often involved in real studies, most of the literature considered mediation analyses with one mediator at a time. In this article, we consider mediation analyses when there are causally non-ordered multiple mediators. Even if the mediators do not affect each other, the sum of two indirect effects through the two mediators considered separately may diverge from the joint natural indirect effect when there are additive interactions between the effects of the two mediators on the outcome. Therefore, we derive an equation for the joint natural indirect effect based on the individual mediation effects and their interactive effect, which helps us understand how the mediation effect works through the two mediators and relative contributions of the mediators and their interaction. We also discuss an extension for three mediators. The proposed method is illustrated using data from a randomized trial on the prevention of dental caries.

Abstract P150: Association of Cholesterol Measures With Coronary Heart Disease Risk in Blacks and Whites in the Reasons for Geographic and Racial Differences in Stroke Study (regards)

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Neil Zakai ◽  
Jessica Minnier ◽  
Monika M Safford ◽  
Lisandro Colantonio ◽  
Marguerite M Irvin ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Total Cholesterol ◽  
Racial Differences ◽  
Cox Regression ◽  
Disease Risk ◽  
Point Estimate ◽  
Chd Risk ◽  
Increased Risk ◽  
Blacks And Whites

Introduction: Abnormal plasma lipid levels associate with coronary heart disease (CHD) risk. Race interaction for these associations are not established. Hypothesis: We hypothesized that the association of HDL, LDL, and triglyceride with CHD is stronger in whites versus blacks. Methods: The REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort recruited 30,283 black and white individuals aged 45+ from the contiguous U.S. from 2003-7. Participants were followed until December 31, 2016 for CHD events (i.e., myocardial infarction or CHD death), participants with history of CHD at baseline were excluded. Cox regression models were used to assess the association between baseline lipids and incident CHD events adjusting for traditional cardiovascular risk factors. Results: With 23,894 participants (57.8% white and 58.4% female, mean age 64.11± 9.32), over a median 9.9 years of follow-up, 1,487 CHD events occurred (615 among blacks). Overall, higher total Cholesterol, LDL cholesterol, and triglycerides were associated with increased risk of CHD in both blacks and whites with no evidence of a race interaction (Table 1). For HDL, the point estimate was more protective in whites (HR 0.90) than in blacks (HR 0.98), but the interaction was non-significant (p=0.15). However, when HDL was stratified into clinical categories (<40, 40-59, and ≥60), the reduction in point estimates was maintained among whites (HR 1.00, 0.88, and 0.74) but not among blacks (HR 1.00, 1.31, and 1.19) for HDL <40, 40-59, and ≥60 respectively, p-interaction 0.01. Conclusion: Total cholesterol, LDL, and triglycerides predict CHD risk equally in blacks and whites in the REGARDS study, however there is heterogeneity in the protective effect by race, especially when traditional clinical categories are used. In whites, higher HDL is associated with reduced risk, whereas in blacks the association is not maintained. These findings suggest that HDL levels are a more viable metric for white than blacks to predict CHD risk.

scholarly journals Premature Atrial Contractions on the Screening Electrocardiogram and Risk of Ischemic Stroke: The Reasons for Geographic and Racial Differences in Stroke Study

2016 ◽  
Vol 47 (1) ◽  
pp. 53-58 ◽  
Author(s):  
Wesley T. O'Neal ◽  
Hooman Kamel ◽  
Dawn Kleindorfer ◽  
Suzanne E. Judd ◽  
George Howard ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Racial Differences ◽  
Stroke Risk ◽  
Cox Regression ◽  
Stroke Risk Factors ◽  
Stroke Study ◽  
Increased Risk ◽  
Study Participants ◽  
The Relationship

Background: It is currently unknown if premature atrial contractions (PACs) detected on the routine screening electrocardiogram are associated with an increased risk of ischemic stroke. Methods: We examined the association between PACs and ischemic stroke in 22,975 (mean age 64 ± 9.2; 56% women; 40% black) participants from the Reasons for Geographic and Racial Differences in Stroke study. Participants who were free of stroke at baseline were included. PACs were detected from centrally read electrocardiograms at baseline. Cox regression was used to examine the association between PACs and ischemic stroke events through March 31, 2014. Results: PACs were present in 1,687 (7.3%) participants at baseline. In a Cox regression model adjusted for stroke risk factors and potential confounders, PACs were associated with an increased risk of ischemic stroke (hazards ratio (HR) 1.34, 95% CI 1.04-1.74). The relationship was limited to non-lacunar infarcts (HR 1.42, 95% CI 1.08-1.87), and not lacunar strokes (HR 1.01, 95% CI 0.51-2.03). An interaction by sex was detected, with the association between PACs and ischemic stroke being stronger among women (HR 1.82, 95% CI 1.29-2.56) than men (HR 1.03, 95% CI 0.69-1.52; p-interaction = 0.0095). Conclusion: PACs detected on the routine electrocardiogram are associated with an increased risk for non-lacunar ischemic strokes, especially in women.

Population Estimates of Meeting Strength Training and Aerobic Guidelines, by Gender and Cancer Survivorship Status: Findings From the Health Information National Trends Survey (HINTS)

2015 ◽  
Vol 12 (5) ◽  
pp. 675-679 ◽  
Author(s):  
Allison Ottenbacher ◽  
Mandi Yu ◽  
Richard P. Moser ◽  
Siobhan M. Phillips ◽  
Catherine Alfano ◽  
...  
Keyword(s):  
Physical Activity ◽  
Cancer Survivors ◽  
Strength Training ◽  
Health Information ◽  
Population Estimates ◽  
Cancer History ◽  
Aerobic Activity ◽  
History Of ◽  
National Trends ◽  
History Of Cancer

Background:Evidence is building that strength training may reduce complications associated with cancer such as fatigue, muscle wasting, and lymphedema, particularly among breast and prostate cancer survivors. Population estimates are available for rates of aerobic physical activity; however, data on strength training in this population are limited. The objective of this study was to identify rates of meeting public health recommendations for strength training and aerobic activity among cancer survivors and individuals with no cancer history.Methods:Data from the Health Information National Trends Survey (HINTS), Iteration 4 Cycle 1 and Cycle 2 were combined to conduct the analyses. Missing data were imputed, and weighted statistical analyses were conducted in SAS.Results:The proportion of individuals meeting both strength training and aerobic guidelines were low for both cancer survivors and those without a history of cancer. The odds of meeting strength training guidelines were significantly lower for women with a history of any cancer except breast, compared with women with no history of cancer (OR: 0.70, 95% CI: 0.51−0.96).Conclusions:More work needs to be done to understand why women with cancers other than breast, may be less inclined to engage in aerobic physical activity and strength training.

scholarly journals Resiliency as a Mediator in the Relationship Between Aggressiveness and School Achievement – Differences Related to Gender and Levels of Physical Activity

2020 ◽  
Author(s):  
Magdalena Jochimek ◽  
Ariadna Łada-Maśko ◽  
Mariusz Lipowski
Keyword(s):  
Physical Activity ◽  
Physical Education ◽  
Protective Factor ◽  
School Achievement ◽  
Mediation Effect ◽  
School Grade ◽  
Mediation Effects ◽  
The Relationship ◽  
Average School ◽  
Athlete Group

Abstract BackgroundTaking part in physical activity has a major positive influence on the development of adolescents. Research shows that physical activity has an impact on cognitive and behavioral functioning. Aggressiveness is a factor negatively correlated with school achievement and resiliency is a protective factor for coping with stressful situations. The purpose of this study is to analyze the mediation effect of resiliency as a dispositional protective factor in the relationship between aggressiveness and school achievement in the context of gender and levels of physical activity. MethodsThe research was carried out on N = 787 adolescents (Mage = 15.95; SD = .29) from the Pomeranian region in Poland. The participants were divided into three subgroups: 1) a non-active group, n = 130 (90 girls); 2) a Physical Education (PE) group, n = 490 (303 girls); and 3) an athlete group, n = 130 (65 girls). The following research tools were used in the study: a socio-demographic survey; a questionnaire about average grades at the end of the school year; the Adolescent Aggressiveness Questionnaire – Emotional Reactivity; and the Resiliency Assessment Scale for Children and Adolescents to evaluate resiliency levels. ResultsAnalyzing the average school grades, resiliency, as well as levels of aggressiveness and its components revealed statistically significant differences in terms of gender and physical activity. Furthermore, the effects of general aggressiveness level and all its components on average school grade, mediated by resiliency, proved insignificant for boys in all three research groups and for girls in the athlete group. However, the analysis showed a mediation effect of resiliency in relation to emotional irritability and average school grade in the group of non-active girls. The mediation analysis revealed significant mediation effects for emotional irritability, opposition, and verbal aggression, as well as for general aggressiveness levels in the group of PE girls. ConclusionsResiliency is a protective factor in the relation between aggressiveness and school achievement, especially in the female PE group. The mechanisms governing boys’ functioning seem different and require further research. Compulsory physical education classes may help build resources that facilitate learning.

scholarly journals Increasing Physical Activity Amongst Overweight and Obese Cancer Survivors Using an Alexa-Based Intelligent Agent for Patient Coaching: Protocol for the Physical Activity by Technology Help (PATH) Trial (Preprint)

2017 ◽  
Author(s):  
Ahmed Hassoon ◽  
Jennifer Schrack ◽  
Daniel Naiman ◽  
Dina Lansey ◽  
Yasmin Baig ◽  
...  
Keyword(s):  
Physical Activity ◽  
Cancer Survivors ◽  
Text Message ◽  
Intelligent Agent ◽  
Data Driven ◽  
Artificial Intelligence Technology ◽  
Intelligent Technology ◽  
Using Data ◽  
Assist Intervention ◽  
Written Materials

BACKGROUND Physical activity has established health benefits, but motivation and adherence remain challenging. OBJECTIVE We designed and launched a three-arm randomized trial to test artificial intelligence technology solutions to increase daily physical activity in cancer survivors. METHODS A single-center, three-arm randomized clinical trial with an allocation ration of 1:1:1: (A) control, in which participants are provided written materials about the benefits of physical activity; (B) text intervention, where participants receive daily motivation from a fully automated, data-driven algorithmic text message via mobile phone (Coachtext); and (C) Voice Assist intervention, where participants are provided with an in-home on demand autonomous Intelligent Agent using data driven Interactive Digital Voice Assist on the Amazon Alexa/Echo (MyCoach). RESULTS The study runs for 5 weeks: a one-week run-in to establish baseline, followed by 4 weeks of intervention. Data for study outcomes is collected automatically through a wearable sensor, and data are transferred in real-time to the study server. The recruitment goal is 42 participants, 14 in each arm. Electronic health records are used to prescreen candidates, with 39 participants recruited to date. DISCUSSION This study aims to investigate the effects of different types of intelligent technology solutions on promoting physical activity in cancer survivors. This innovative approach can easily be expanded and customized to other interventions. Early lessons from our initial participants are helping us develop additional advanced solutions to improve health outcomes. CLINICALTRIAL Retrospectively registered on July 10, 2017 at ClinicalTrials.gov: NCT03212079; https://clinicaltrials.gov/ct2/show/NCT03212079 (Archived by WebCite at http://www.webcitation.org/6wgvqjTji)

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