Hospitalization and Mortality Outcomes among Childhood Cancer Survivors by Race, Ethnicity, and Time since Diagnosis

Importance: Cancer outcomes are relatively poor in adults who belong to minoritized racial and ethnic groups. Survival and long-term outcomes by race and ethnicity in individuals with childhood cancers are less studied. Objective: To evaluate survival and hospitalization among American Indian and Alaska Native, Asian, Black, and Hispanic children compared with non-Hispanic White children with cancer. Design, Setting, and Participants: This cohort study evaluated all individuals born in Washington State who were younger than 20 years (hereafter referred to as children) and had been diagnosed with cancer during 1987 to 2012, with follow-up ranging from 1 to 27 years. The data subset was built in 2019, and statistical analyses were completed in January 2022. Exposures: Race and ethnicity. Main Outcomes and Measures: Mortality and hospitalization events for all other racial and ethnic groups relative to non-Hispanic White children estimated by Cox proportional hazards regressions for the first 5 years after diagnosis and among cancer survivors 5 or more years after diagnosis. Results: A total of 4222 children (mean [SD] age, 8.4 [6.4] years; 2199 [52.1%] male; 113 American Indian and Alaska Native [2.7%], 311 Asian [7.4%], 196 Black [4.6%], 387 Hispanic [9.2%], and 3215 non-Hispanic White [76.1%]) with cancer diagnosed at younger than 20 years during 1987 to 2012 were included. Mortality was similar across all groups. Compared with non-Hispanic White survivors at less than 5 years after diagnosis, there were no greatly increased hazard ratios (HRs) for hospitalization. Among survivors at 5 or more years after diagnosis, hospitalization HRs were 1.7 (95% CI, 1.0-3.0) for American Indian and Alaska Native survivors and 1.5 (95% CI, 0.9-2.4) for Black survivors. Significantly increased HRs among Hispanic children were observed for infection-related (HR, 1.4; 95% CI, 1.2-1.6), endocrine-related (HR, 1.3; 95% CI, 1.1-1.6), hematologic-related (HR, 1.3; 95% CI, 1.1-1.5), respiratory-related (HR, 1.3; 95% CI, 1.0-1.5), and digestive-related (HR, 1.2; 95% CI, 1.0-1.5) conditions. American Indian and Alaskan Native children had increased HRs for infection-related (HR, 2.3; 95% CI, 1.2-4.5), hematologic-related (HR, 3.0; 95% CI, 1.4-6.5), and digestive-related (HR, 2.6; 95% CI, 1.3-5.4) conditions. Both American Indian and Alaska Native (HR, 3.6; 95% CI, 1.4-9.0) and Black (HR, 2.5; 95% CI, 1.2-5.5) children had increased mental health-related hospitalizations and death. Conclusions and Relevance: In this cohort study, disproportionately increased long-term risks of hospitalization for physical and mental conditions may have contributed to worse outcomes by race. A key component to bridging the morbidity gap by race is improved understanding of reasons for greater cause-specific hospitalizations in some groups, with development of culturally appropriate intervention strategies.

Avaliação da qualidade de vida, da dor nas costas, da funcionalidade e de alterações da coluna vertebral de estudantes de fisioterapia

O objetivo deste estudo foi avaliar a qualidade de vida, dor nas costas, funcionalidade e as alterações da coluna vertebral de estudantes de fisioterapia. Participaram 42 universitários, sendo avaliada a coluna vertebral por meio do arcômetro, a dor nas costas por meio de um questionário multidimensional de dor, a qualidade de vida por meio do questionário SF-36 e funcionalidade a partir do Roland-Morris. Foi realizada estatística descritiva e teste qui-quadrado (α=0,05). Os resultados demonstraram: prevalência de alterações nas curvaturas da coluna vertebral de 38,1%; (n=16); alta prevalência de dor nas costas (69%; n=29); baixa prevalência de comprometimento da funcionalidade (3,4%; n=1); que não há associação entre as alterações nas curvaturas da coluna vertebral e funcionalidade e dor nas costas; e que os escores dos domínios do SF-36 foram maiores que 45, exceto o domínio "dor", cujo escore aproximado foi de 35. Conclui-se que quanto menor os níveis de intensidade da dor melhor o nível de qualidade de vida

Comprehensive analysis of epigenetic clocks reveals associations between disproportionate biological ageing and hippocampal volume

The concept of age acceleration, the difference between biological age and chronological age, is of growing interest, particularly with respect to age-related disorders, such as Alzheimer’s Disease (AD). Whilst studies have reported associations with AD risk and related phenotypes, there remains a lack of consensus on these associations. Here we aimed to comprehensively investigate the relationship between five recognised measures of age acceleration, based on DNA methylation patterns (DNAm age), and cross-sectional and longitudinal cognition and AD-related neuroimaging phenotypes (volumetric MRI and Amyloid-β PET) in the Australian Imaging, Biomarkers and Lifestyle (AIBL) and the Alzheimer’s Disease Neuroimaging Initiative (ADNI). Significant associations were observed between age acceleration using the Hannum epigenetic clock and cross-sectional hippocampal volume in AIBL and replicated in ADNI. In AIBL, several other findings were observed cross-sectionally, including a significant association between hippocampal volume and the Hannum and Phenoage epigenetic clocks. Further, significant associations were also observed between hippocampal volume and the Zhang and Phenoage epigenetic clocks within Amyloid-β positive individuals. However, these were not validated within the ADNI cohort. No associations between age acceleration and other Alzheimer’s disease-related phenotypes, including measures of cognition or brain Amyloid-β burden, were observed, and there was no association with longitudinal change in any phenotype. This study presents a link between age acceleration, as determined using DNA methylation, and hippocampal volume that was statistically significant across two highly characterised cohorts. The results presented in this study contribute to a growing literature that supports the role of epigenetic modifications in ageing and AD-related phenotypes

Uncovering the heterogeneity and temporal complexity of neurodegenerative diseases with Subtype and Stage Inference

The heterogeneity of neurodegenerative diseases is a key confound to disease understanding and treatment development, as study cohorts typically include multiple phenotypes on distinct disease trajectories. Here we introduce a machine-learning technique\u2014Subtype and Stage Inference (SuStaIn)\u2014able to uncover data-driven disease phenotypes with distinct temporal progression patterns, from widely available cross-sectional patient studies. Results from imaging studies in two neurodegenerative diseases reveal subgroups and their distinct trajectories of regional neurodegeneration. In genetic frontotemporal dementia, SuStaIn identifies genotypes from imaging alone, validating its ability to identify subtypes; further the technique reveals within-genotype heterogeneity. In Alzheimer\u2019s disease, SuStaIn uncovers three subtypes, uniquely characterising their temporal complexity. SuStaIn provides fine-grained patient stratification, which substantially enhances the ability to predict conversion between diagnostic categories over standard models that ignore subtype (p = 7.18 7 10 124 ) or temporal stage (p = 3.96 7 10 125 ). SuStaIn offers new promise for enabling disease subtype discovery and precision medicine

Alien flora across European coastal dunes

Questions: The spread of alien plant species is one of the main threats to the biodiversity of different natural habitats, and coastal dune habitats are among the most affected. There is a considerable local and regional variation in the level of alien plant invasion on coastal dunes. We asked what are the patterns of invasion across European coastal dunes and how they depend on habitat types and coastal regions. Location: Atlantic, Baltic, Black Sea and Mediterranean coasts of Europe. Methods: We used vegetation-plot records from shifting dunes and stable dune grasslands extracted from the European Vegetation Archive (EVA). We quantified richness, frequency and distribution of alien plant (neophyte) species across dune habitats and coastal regions. We also explored the donor habitats and invasion trajectories of these species. Results: In the flora of European coastal dunes, 7% of species were neophytes, for two-thirds originating from outside of Europe and mostly naturalised and ruderal. Shifting and stable dunes were similar in neophyte species composition, but there were more individual occurrences of neophytes in shifting dunes. The neophyte flora composition differed considerably between the Atlantic, Baltic, Black Sea and Mediterranean regions. The highest number of neophyte species was observed on the Atlantic dunes, while the highest number of neophyte occurrences was on the Black Sea dunes. Most of the neophytes originated from North America and the Mediterranean-Turanian region. Erigeron canadensis, Xanthium orientale, Oenothera biennis and Oenothera oakesiana were the most common neophytes. Conclusions: We provided a comprehensive assessment of alien plant invasions in the coastal dunes across Europe and highlighted that coastal dunes should be in the focus of European invasion management strategies.</p