Complementary and Alternative Medicine Use at a Comprehensive Cancer Center

Background. Complementary and alternative medicine (CAM) use is common among cancer patients, but the majority of CAM studies do not specify the time periods in relation to cancer diagnoses. We sought to define CAM use by cancer patients and investigate factors that might influence changes in CAM use in relation to cancer diagnoses. Methods. We conducted a cross-sectional survey of adults diagnosed with breast, prostate, lung, or colorectal cancer between 2010 and 2012 at the Lineberger Comprehensive Cancer Center. Questionnaires were sent to 1794 patients. Phone calls were made to nonrespondents. Log binomial/Poisson regressions were used to investigate the association between cancer-related changes in CAM use and conversations about CAM use with oncology providers. Results. We received 603 (33.6 %) completed questionnaires. The mean age (SD) was 64 (11) years; 62% were female; 79% were white; and 98% were non-Hispanic. Respondents reported the following cancer types: breast (47%), prostate (27%), colorectal (14%), lung (11%). Eighty-nine percent reported lifetime CAM use. Eighty-five percent reported CAM use during or after initial cancer treatment, with category-specific use as follows: mind-body medicine 39%, dietary supplements 73%, body-based therapies 30%, and energy medicine 49%. During treatment CAM use decreased for all categories except energy medicine. After treatment CAM use returned to pretreatment levels for most CAMs except chiropractic. Initiation of CAM use after cancer diagnosis was positively associated with a patient having a conversation about CAM use with their oncology provider, mainly driven by patient-initiated conversations. Conclusions. Consistent with previous studies, CAM use was common among our study population. Conversations about CAM use with oncology providers appeared to influence cessation of mind-body medicine use after cancer diagnosis

SEXUAL ATTRACTIVENESS, SEXUAL SATISFACTION AND PSYCHOLOGICAL DISTRESS IN LIUZHOU, CHINA

We hypothesized that sexual satisfaction and psychological distress are both related to self-rated sexual attractiveness, but in different ways: on the one hand, greater sexual satisfaction is associated with greater sexual attractiveness; on the other hand, higher psychological distress is associated with basing one's sexual attractiveness primarily on body image-oriented features ("face" and "body type"). We analyzed cross-sectional household survey data from Liuzhou city in southern China with a series of regression analyses. We found: 1. Self-rated sexual attractiveness was associated more strongly with women's emotional sexual satisfaction (ESS) (prevalence ratio [PR] 1.34, 95% confidence interval [CI]: 0.93-1.93) and especially physical sexual satisfaction (PSS) (PR 1.81, 95% CI: 1.11-2.94) than with men's ESS (PR 0.93 95% CI: 0.64-1.35) and PSS (PR 1.21, 95% CI: 0.86-1.70). For men, the associations of partner's attractiveness with ESS (PR 2.22, 95% CI: 1.85-2.67) and with PSS (PR 2.30, 95% CI: 1.70-3.09) were both stronger than the corresponding associations for women (PR 0.96, 95% CI: 0.57-1.61 for ESS and 1.33, 95% CI: 0.67-2.63 for PSS). Similarly, the associations of the feeling that one's partner takes enough care of one with ESS (PR 3.69, 95% CI: 1.77-7.70) and with PSS (PR 2.37, 95% CI: 1.13-4.95) were stronger for men than the corresponding associations for women (PR 1.59, 95% CI: 0.79-3.20 for ESS, and PR 1.44, 95% CI: 0.74-2.80 for PSS). 2.Compared to women who rated themselves as sexually attractive with their most attractive aspect a non-body- image oriented feature: (1) women who self-rated attractive but ranked "face" or "body type" as their most attractive feature had a 0.91(95% CI: 0.00-1.82) point higher psychological distress score (PDS); (2) women who self-rated unattractive but ranked a body-image aspect as their most attractive feature had a 0.79 (95% CI: 0.21-1.37) point higher PDS; and (3) women who considered themselves "not attractive in any aspect" had a 0.88 (95% CI: 0.10-1.66) point higher PDS. Our study results highlighted the health impact of self-rated sexual attractiveness. Awareness of how perceptions of one's sexual attractiveness relate to sexual wellbeing and psychological health will present additional opportunities for improving quality of life in China.Doctor of Philosoph

An in silico framework for integrating epidemiologic and genetic evidence with health care applications: ventilation-related pneumothorax as a case illustration

OBJECTIVE: To illustrate an in silico integration of epidemiologic and genetic evidence that is being developed at the Center for Devices and Radiological Health/US Food and Drug Administration as part of regulatory research on postmarket device performance. In addition to using conventional epidemiologic evidence from registries, this innovative approach explores the vast potential of open-access omics databases for identifying genetic evidence pertaining to devices. MATERIAL AND METHODS: A retrospective analysis of Agency for Healthcare Research and Quality (AHRQ)/Healthcare Cost and Utilization Project (HCUPNet) data (2002-2011) was focused on the ventilation-related iatrogenic pneumothorax (Vent-IP) outcome in discharges with mechanical ventilation (MV) and continuous positive airway pressure (CPAP). The derived epidemiologic evidence was analyzed in conjunction with pre-existing genomic data from Gene Expression Omnibus/National Center for Biotechnology Information and other databases. RESULTS: AHRQ/HCUPNet epidemiologic evidence showed that annual occurrence of Vent-IP did not decrease over a decade. While the Vent-IP risk associated with noninvasive CPAP comprised about 0.5%, the Vent-IP risk due to longer-term MV reached 2%. Along with MV posing an independent risk for Vent-IP, female sex and white race were found to be effect modifiers, resulting in the highest Vent-IP risk among mechanically ventilated white females. The Vent-IP risk was also potentiated by comorbidities associated with spontaneous pneumothorax (SP) and fibrosis. Consistent with the epidemiologic evidence, expression profiling in a number of animal models showed that the expression of several collagens and other SP/fibrosis-related genes was modified by ventilation settings. CONCLUSION: Integration of complementary genetic evidence into epidemiologic analysis can lead to a cost- and time-efficient discovery of the risk predictors and markers and thus can facilitate more efficient marker-based evaluation of medical product performance

Carbon dynamics of terrestrial ecosystems on the Tibetan Plateau during the 20th century: An analysis with a process-based biogeochemical model

Aim:  The Tibetan Plateau accounts for about a quarter of the total land area of China and has a variety of ecosystems ranging from alpine tundra to evergreen tropics. Its soils are dominated by permafrost and are rich in organic carbon. Its climate is unique due to the influence of the Asian monsoon and its complex topography. To date, the carbon dynamics of the Tibetan Plateau have not been well quantified under changes of climate and permafrost conditions. Here we use a process-based biogeochemistry model, the Terrestrial Ecosystem Model (TEM), which was incorporated with a soil thermal model, to examine the permafrost dynamics and their effects on carbon dynamics on the plateau during the past century. Location: The Tibetan Plateau. Methods: We parameterize and verify the TEM using the existing data for soil temperature, permafrost distribution and carbon and nitrogen from the region. We then extrapolate the model and parameters to the whole plateau. Results:  During the 20th century, the Tibetan Plateau changed from a small carbon source or neutral in the early part of the century to a sink later, with a large inter-annual and spatial variability due to changes of climate and permafrost conditions. Net primary production and soil respiration increased by 0.52 and 0.22 Tg C year−1, respectively, resulting in a regional carbon sink increase of 0.3 Tg C year−1. By the end of the century, the regional carbon sink reached 36 Tg C year−1 and carbon storage in vegetation and soils is 32 and 16 Pg C, respectively. On the plateau, from west to east, the net primary production, soil respiration and net ecosystem production increased, due primarily to the increase of air temperature and precipitation and lowering elevation. In contrast, the decrease of carbon fluxes from south to north was primarily controlled by precipitation gradient. Dynamics of air temperature and associated soil temperature and active layer depth resulted in a higher plant carbon uptake than soil carbon release, strengthening the regional carbon sink during the century. Main conclusions:  We found that increasing soil temperature and deepening active layer depth enhanced soil respiration, increasing the net nitrogen mineralization rate. Together with the effects of warming air temperature and rising CO2 concentrations on photosynthesis, the stronger plant nitrogen uptake due to the enhanced available nitrogen stimulates plant carbon uptake, thereby strengthening the regional carbon sink as the rate of increase net primary production was faster than that of soil respiration. Further, the warming and associated soil thermal dynamics shifted the regional carbon sink from the middle of July in the early 20th century to early July by the end of the century. Our study suggests that soil thermal dynamics should be considered for future quantification of carbon dynamics in this climate-sensitive region

A systematic review and meta-analysis of the association between daily mean temperature and mortality in China

Abstract Purpose: We summarized the evidence on the effects of heat and cold exposures on mortality in China. We included studies published on this topic in both Chinese and English, thereby filling a gap in knowledge using data from a country that consists of one-fifth of the world’s population. Methods: We conducted a systematic search of peer-reviewed studies on the association between daily mean temperature and mortality published from 2001 up to July 2018. We searched one Chinese database (China National Knowledge infrastructure, http://www.cnki.net) and three English databases (PubMed, Scopus, Web of Science). We converted the effect estimates of heat/cold to rate ratios (RRs) associated with 1° increase/decrease beyond the heat/cold reference temperatures. For studies that provided lag-specific estimates, we used both the maximum and minimum of RR estimates. We calculated summary effect estimates for all-cause and cause-specific mortalities, as well as RRs stratified by sex, age, and socioeconomic status. We also investigated patterns of heat and cold adaptation at different latitudes, and at different reference temperatures. Results: In total, 45 articles were included in this systematic review. For every 1° temperature increase/decrease beyond reference points, the rate of non-accidental mortality increased by 2% (RR, 1.02; 95% confidence interval (95% CI [1.01–1.02]) for heat and 4% (RR, 1.04; 95% CI [1.03–1.04]) for cold, respectively; the rate of cardiovascular mortality increased 3% (RR, 1.03; 95% CI [1.03–1.04]) for heat and 6% (RR, 1.06; 95% CI [1.04–1.07]) for cold; the rate of respiratory mortality increased 2% (RR, 1.02; 95% CI [1.01–1.03]) for heat and 2% (RR, 1.02; 95% CI [1.00–1.04]) for cold; the rate of cerebrovascular mortality increased 2% (RR, 1.02; 95% CI [1.02–1.03]) for heat and 3% (RR, 1.03; 95% CI [1.02–1.04]) for cold. We identified a variation in optimal temperature range related to latitude of the residential area, and differences in people’s capability to adapt to heat versus cold. Conclusion: We found consistent evidence of the association between temperature and mortality, as well as evidence of patterns in human adaptation, and we discussed the implications of our findings

Cumulative incidence of anal cancer since HIV or AIDS diagnosis in the United States.

Treatment of screen-detected anal high-grade squamous intraepithelial lesions has been shown to effectively reduce the incidence of invasive anal cancer in people with HIV. We provide population-based estimates of cumulative incidence of anal cancer by risk group and age at HIV or AIDS diagnosis. The 0- to 10-year cumulative incidence of anal cancer for men who have sex with men and are younger than 30 years of age at HIV diagnosis was 0.17% (95% confidence interval [CI] = 0.13% to 0.20%) compared with 0.04% (95% CI = 0.02% to 0.06%) in other men and 0.03% (95% CI = 0.01% to 0.04%) in women. For men who have sex with men and have a diagnosis of AIDS and are younger than 30 years of age, the 0- to 10-year cumulative incidence was 0.35% (95% CI = 0.28% to 0.41%). Among people with HIV, men who have sex with men are at the greatest risk of anal cancer, and those with a diagnosis of AIDS had higher risk than those without AIDS. These estimates may inform recommendations for priority populations that could benefit most from anal cancer screening and treatment

Severe anal intraepithelial neoplasia trends and subsequent invasive anal cancer in the United States.

BACKGROUND: Anal intraepithelial neoplasia grade III is a precursor to squamous cell carcinoma of the anus for which rates are nearly 20-fold higher in people with HIV than in the general population in the United States. We describe trends in anal intraepithelial neoplasia grade III diagnosis and risk of squamous cell carcinoma of the anus following anal intraepithelial neoplasia grade III by HIV status and sex. METHODS: We used data from a population-based linkage between cancer and HIV registries in 11 US states; Puerto Rico; and Washington, DC, during 1996-2019. We identified all individuals with a diagnosis of anal intraepithelial neoplasia grade III and determined their HIV status. We estimated the average annual percentage change of anal intraepithelial neoplasia grade III using Poisson regression stratified by HIV status and sex. We estimated the 5-year cumulative incidence of squamous cell carcinoma of the anus following an anal intraepithelial neoplasia grade III diagnosis stratified by sex, HIV status, and prior AIDS diagnosis. RESULTS: Among people with HIV, average annual percentage changes for anal intraepithelial neoplasia grade III were 15% (95% confidence interval [CI] = 12% to 17%) per year among females and 12% (95% CI = 11% to 14%) among males. Average annual percentage changes for those without HIV were 8% (95% CI = 7% to 8%) for females and 8% (95% CI = 6% to 9%) for males. Among people with HIV, a prior AIDS diagnosis was associated with a 2.7-fold (95% CI = 2.23 to 3.40) and 1.9-fold (95% CI = 1.72 to 2.02) increased risk of anal intraepithelial neoplasia grade III diagnosis for females and males, respectively. Five-year cumulative incidence of squamous cell carcinoma of the anus following anal intraepithelial neoplasia grade III for people with HIV with a prior AIDS diagnosis were 3.4% and 3.7% for females and males, respectively. CONCLUSIONS: Rates of anal intraepithelial neoplasia grade III diagnoses have increased since 1996, particularly for people with HIV, likely influenced by increased screening. A prior AIDS diagnosis was strongly associated with risk of anal intraepithelial neoplasia grade III diagnosis

Analysis of Factors Influencing the Clinical Severity of Omicron and Delta Variants

The Omicron variant is the dominant strain circulating globally, and studies have shown that Omicron cases have milder symptoms than Delta cases. This study aimed to analyze the factors that affect the clinical severity of Omicron and Delta variants, evaluate and compare the effectiveness of COVID-19 vaccines with different technological platforms, and assess the vaccine effectiveness against different variants. We retrospectively collected the basic information of all local COVID-19 cases reported by Hunan Province to the National Notifiable Infectious Disease Reporting System from January 2021 to February 2023, including gender, age, clinical severity, and COVID-19 vaccination history. From 1 January 2021 to 28 February 2023, Hunan Province reported a total of 60,668 local COVID-19 cases, of which, 134 were infected with the Delta variant and 60,534 were infected with the Omicron variant. The results showed that infection with the Omicron variant (adjusted OR (aOR): 0.21, 95% CI: 0.14–0.31), getting vaccinated (booster immunization vs. unvaccinated aOR: 0.30, 95% CI: 0.23–0.39) and being female (aOR: 0.82, 95% CI: 0.79–0.85) were protective factors for pneumonia, while old age (≥60 years vs. <3 years aOR: 4.58, 95% CI: 3.36–6.22) was a risk factor for pneumonia. Being vaccinated (booster immunization vs. unvaccinated aOR: 0.11, 95% CI: 0.09–0.15) and female (aOR: 0.54, 95% CI: 0.50–0.59) were protective factors for severe cases, while older age (≥60 years vs. < 3 years aOR: 4.95, 95% CI: 1.83–13.39) was a risk factor for severe cases. The three types of vaccines had protective effects on both pneumonia and severe cases, and the protective effect on severe cases was better than that on pneumonia. The recombinant subunit vaccine booster immunization had the best protective effect on pneumonia and severe cases, with ORs of 0.29 (95% CI: 0.2–0.44) and 0.06 (95% CI: 0.02–0.17), respectively. The risk of pneumonia from Omicron variant infection was lower than that from Delta. Chinese-produced vaccines had protective effects on both pneumonia and severe cases, with recombinant subunit vaccines having the best protective effect on pneumonia and severe pneumonia cases. Booster immunization should be advocated in COVID-19 pandemic-related control and prevention policies, especially for the elderly, and booster immunization should be accelerated

A follow up study of cycle threshold values of SARS-CoV-2 in Hunan Province, China

Since the epidemic of the severe acute respiratory syndrome coronavirus 2 (SARS-COV-2), many governments have used reverse transcription polymerase chain reaction (RT-PCR) to detect the virus. However, there are fewer measures of CT values information based on RT-PCR results, and the relationship between CT values and factors from consecutive tests is not clear enough. So in this study, we analyzed the connection between CT values and the factors based on cohort data from Delta variant of SARS-CoV-2 in Hunan Province. Previous studies have showed that the mean age of the cases was 33.34 years (±18.72 years), with a female predominance (55.03%, n = 71), and the greatest proportion of clinical symptoms were of the common type (60.47%, n = 78). There were statistical differences between the N and ORF1ab genes in the CT values for the cases. Based on the analysis of the association between CT values and the factors, the lowest CT values were obtained for the unvaccinated, older and clinically symptomatic group at 3–10 days, the maximum peak of viral load occurred. Therefore, it is recommended to use patient information to focus on older, clinically symptomatic, unvaccinated patients and to intervene promptly upon admission