Long-term anxiety and depression signatures of participants that received esophageal cancer screening: A multicenter population-based cohort study

BackgroundCurrent evidence on the psychological impact of screening and diagnosis of esophageal cancer (EC) is limited and unclear. MethodsThis multicenter, population-based, prospective study was conducted in five high-incidence regions in China from 2017 to 2020. The screened participants were diagnosed as healthy, esophagitis, low-grade intraepithelial neoplasia (LGIN), high-grade intraepithelial neoplasia (HGIN), or EC based on pathological biopsy. The psychological impact of the screening was assessed by comparing anxiety and depression symptoms at baseline and follow-up. ResultsA total of 1973 individuals were ultimately included, with an average follow-up of 22.2 months. The prevalence of anxiety and depression symptoms in screened population at baseline was 14.3% and 18.4%. The prevalence of anxiety and depression symptoms of screeners at follow-up declined (all p < 0.001). The anxiety (RR [95% CI]: 0.37 [0.30-0.46]) and depression (0.29 [0.24-0.36]) of screeners weakened over time, but the anxiety and depression symptoms was continuous for patients with HGIN and patients with EC. Compared with the participants classified as normal, the RRs(95% CI) of anxiety and depression symptoms were 2.20 (1.10-4.30) and 2.03 (1.07-3.86) for the patients with HGIN and 2.30 (0.82-6.20) and 3.79 (01.71-8.43) for the patients with EC. ConclusionThe anxiety and depression symptoms of screeners weakened over time, except in patients with HGIN and EC, for whom it remained lasting and high. Psychological assistance and interventions are urgently needed for individuals who are ready for screening and for those diagnosed as having HGIN or EC

Biological correlates before esophageal cancer screening and after diagnosis

Almost 50% of the world&#39;s esophageal cancer (EC) cases occur in China, and the impact of cancer screening has long been a controversial topic. The study was designed to evaluate the biological correlates of EC screening and subsequent diagnosis in China. Based on the national cohort of esophageal cancer program, a prospective multicenter study in high-risk regions was conducted from 2017 to 2019. 61 participants received twice esophageal endoscopy screening and pathological biopsy successively (with a mean follow-up of 14.03 months). Box-Cox-power transformation and two-way repeated measures ANOVA were used to evaluate hormone cortisol and immunoglobulin (IgA, IgG, IgM) levels in plasma, reflecting their stress, immune function, and biological correlates before screening and after knowing the diagnosis. The median of cortisol, IgA, IgG, and IgM in pre-screening was 15.46 ug/dL, 1.86 g/L, 12.14 g/L, and 0.91 g/L, corresponding value at post-diagnosis was 15.30 ug/dL, 2.00 g/L, 12.79 g/L, and 0.94 g/L, respectively. No significant differences in biological indicators were found between normal and esophagitis and low-grade intraepithelial neoplasia before screening and after diagnosis. After normality transformation, cortisol, IgA, IgG and IgM levels were (0.25 +/- 0.04) U/mL, (0.72 +/- 0.13) (g/L), (2.44 +/- 0.22) (g/L) and (0.98 +/- 0.25) (g/L) before screening, (0.25 +/- 0.05) U/mL, (0.70 +/- 0.13) (g/L), (2.48 +/- 0.21) (g/L) and (1.00 +/- 0.25) (g/L) after diagnosis, respectively. Repeated Measures ANOVA showed that the main effects were significant on IgA levels between pre-screening and post-diagnosis (P = 0.019). No interaction effects on biological levels between pre-post screening and esophageal pathology, anxiety states (all P &gt; 0.05). Little biological correlates were found both before screening and after diagnosis. Cortisol and IgA dropped less significantly, while IgM and IgA were increased slightly after diagnosis. Further multi-round longitudinal studies are needed to validate these results.</p

Long‐term anxiety and depression signatures of participants that received esophageal cancer screening: A multicenter population‐based cohort study

Abstract Background Current evidence on the psychological impact of screening and diagnosis of esophageal cancer (EC) is limited and unclear. Methods This multicenter, population‐based, prospective study was conducted in five high‐incidence regions in China from 2017 to 2020. The screened participants were diagnosed as healthy, esophagitis, low‐grade intraepithelial neoplasia (LGIN), high‐grade intraepithelial neoplasia (HGIN), or EC based on pathological biopsy. The psychological impact of the screening was assessed by comparing anxiety and depression symptoms at baseline and follow‐up. Results A total of 1973 individuals were ultimately included, with an average follow‐up of 22.2 months. The prevalence of anxiety and depression symptoms in screened population at baseline was 14.3% and 18.4%. The prevalence of anxiety and depression symptoms of screeners at follow‐up declined (all p < 0.001). The anxiety (RR [95% CI]: 0.37 [0.30–0.46]) and depression (0.29 [0.24–0.36]) of screeners weakened over time, but the anxiety and depression symptoms was continuous for patients with HGIN and patients with EC. Compared with the participants classified as normal, the RRs(95% CI) of anxiety and depression symptoms were 2.20 (1.10–4.30) and 2.03 (1.07–3.86) for the patients with HGIN and 2.30 (0.82–6.20) and 3.79 (01.71–8.43) for the patients with EC. Conclusion The anxiety and depression symptoms of screeners weakened over time, except in patients with HGIN and EC, for whom it remained lasting and high. Psychological assistance and interventions are urgently needed for individuals who are ready for screening and for those diagnosed as having HGIN or EC

The association between anxiety and esophageal cancer: A nationwide population-based study

Objective Research on generalized anxiety disorder (GAD) and its association with esophageal cancer (EC) is sparse. The study aimed to explore the association between GAD and EC. Methods A multicenter, population-based study in high-risk regions for EC (ECHRRs) was conducted from 2017 to 2019. All participants received free endoscopy screening. If the esophageal endoscopy results were suspicious, the pathological biopsy was performed to confirm normal, esophagitis, low-grade intraepithelial neoplasia (LGIN), high-grade intraepithelial neoplasia (HGIN), and EC. Information on participants&#39; exposure to risk factors was collected. GAD was assessed with Generalized Anxiety Disorder Scale-7. Results With esophageal endoscopy, 25,650 participants in ECHRRs were examined, 9586 of whom were suspicious and confirmed by esophageal pathology. The detection rate of EC and precancerous lesions was 6.83% (1751/25,650), with 1377 LGIN (5.37%), 272 HGIN (1.06%), and 102 EC (0.40%) cases. The overall mean GAD score (95% CI) and prevalence among 25,650 participants with endoscopy were 1.96 (1.93-1.99) and 16.90%, respectively. The mean GAD score and prevalence among 9586 participants with pathology were 1.96 (1.91-2.02) and 17.98%, respectively. The mean GAD scores of patients confirmed with normal, esophagitis, LGIN, HGIN, and EC were 1.73 (1.62-1.85), 1.91 (1.85-1.97), 1.94 (1.80-2.08), 3.98 (3.73-4.23). and 2.97 (2.49-3.45), respectively (p &lt; 0.001). The corresponding prevalence of GAD were 5.21%, 18.72%, 17.72%, 43.75%, and 36.27%, respectively (p &lt; 0.001). The age- and gender-adjusted odds ratios (ORs) between GAD and each esophageal lesion type were 1.02 (0.99-1.04), 1.01 (0.98-1.04), 1.27 (1.21-1.33), and 1.16 (1.08-1.24), respectively. The ORs (95% CIs) of the positive associations were 1.08 (1.05-1.12), 1.03 (0.99-1.07), 1.35 (1.29-1.42), and 1.19 (1.10-1.29) after further adjustment for potential confounders (all p &lt; 0.001). Sensitivity analysis showed that the positive association persisted. Conclusions GAD was significantly higher in patients with EC and precancerous lesions. Focusing on and alleviating anxiety in high-risk groups (including patients with HGIN and EC) may be an effective strategy for EC prevention and control. Further prospective studies are warranted to validate the results.</p

The association between depression and esophageal cancer in China: a multicentre population-based study

Background Esophageal cancer (EC) is one of the leading contributors to the global burden of cancer, and the underlying mechanism is still unknown. Recently, there has been a growing interest in understanding modifiable psychosocial risk factors, particularly depression, to prevent EC and reduce morbidity and mortality. However, related research is sparse and has been ignored. The study was designed to assess the association between depression and EC in China. Methods From 2017 to 2019, a population-based multicenter study was conducted in high-risk regions of EC. Participants underwent a free endoscopy screening. If the endoscopic results were suspicious, a pathological biopsy was applied to confirm. Depression was measured with Patient Health Questionnaire-9 (PHQ-9). In addition, information on demographic characteristics and risk factors was collected from participants by trained interviewers using uniform questionnaires. Results After Endoscopy and pathologic diagnosis, 15,936 participants in high-risk regions of EC (ECHRRs) were enrolled, 10,907 (68.44%) of which were diagnosed health, 4048 (25.40%) with esophagitis, 769 (4.83%) with low-grade intraepithelial neoplasia (LGIN), 157 (0.99%) with high-grade intraepithelial neoplasia (HGIN), and 55 (0.35%) with EC, respectively. The overall prevalence of depression symptoms of participants was 4.16% (health: 4.63%, esophagitis: 2.99%, LGIN: 2.99%, HGIN: 5.73%, and EC: 9.09%). Multiple logistic regression analyses revealed that the unadjusted OR (95% CI) between depression and each esophageal pathology grades were esophagitis 0.93 (0.92-0.95), LGIN 0.97 (0.94-0.99), HGIN 1.05 (1.00-1.10), and EC 1.04 (0.97-1.14), respectively. However, after adjustment for potential confounders (age, gender, region, alcohol consumption, BMI), no statistically significant associations between depression and EC (adjusted OR = 1.10, 0.99-1.21) and esophageal lesions (esophagitis: adjusted OR = 1.02, 0.99-1.04; LGIN: adjusted OR = 0.98, 0.95-1.01; HGIN: adjusted OR = 1.04, 0.98-1.11) were observed in this study. Conclusions No significant association was observed between depression and EC in the study. Future prospective cohort studies are needed to verify this preliminary finding

Is glucose pattern of OGTT associated with late-onset gestational diabetes and adverse pregnant outcomes?

AbstractBackground The heterogeneity of oral glucose tolerance test (OGTT) patterns during pregnancy remains unclear. This study aims to identify latent OGTT patterns in pregnant women and investigate the high-risk population for late-onset gestational diabetes mellitus (GDM).Methods This study including 17,723 participants was conducted from 2018 to 2021. Latent mixture modeling was used to identify subgroups. Modified Poisson regression was performed to explore the relationship between OGTT patterns and late-onset GDM or adverse perinatal outcomes.Results Three distinct glucose patterns, high, medium, and low glucose levels (HG, MG, and LG patterns) were identified. The HG pattern represented 28.5% of the participants and 5.5% of them developed late-onset GDM. A five-fold higher risk of late-onset GDM was found in HG pattern than in LG pattern (relative risk [RR]: 5.17, 95% confidence interval [CI]: 3.38-7.92) after adjustment. Participants in HG pattern were more likely to have macrosomia, large for gestational age, preterm birth, and cesarean deliveries, with RRs of 1.59 (1.31-1.93), 1.55 (1.33-1.82), 1.30 (1.02-1.64) and 1.15 (1.08-1.23), respectively.Conclusion Three distinct OGTT patterns presented different risks of late-onset GDM and adverse perinatal outcomes, indicating that timely monitoring of glucose levels after OGTT should be performed in pregnant women with HG pattern

Is the Tradeoff between Folic Acid or/and Multivitamin Supplementation against Birth Defects in Early Pregnancy Reconsidered? Evidence Based on a Chinese Birth Cohort Study

Background: Several studies have reported conflicting results on the association between maternal exposure to folic acid (FA) and/or multivitamin (MV) supplements and the risk of birth defects (BDs), especially for different subtypes of BDs. The present study aimed to identify the association between maternal exposure to FA or/and MV and BDs in offspring. Methods: In the Chinese Birth Cohort Study initiated from 20 November 2017, 120,652 pregnant women completed follow-up until 20 August 2021. The participants were classified into four groups: without exposure to FA and MV, exposure to only FA, exposure to only MV, and exposure to FA and MV. Birth defects were coded by the International Classification of Diseases (ICD)-10. In order to explore the structural relationship between maternal FA or MV supplements and BDs, directed acyclic graphs were drawn. Then, an inverse probability treatment weighting was utilized to reduce the systematic differences in the baseline characteristics among the different groups. Lastly, a two-level mixed-effect log binomial regression analysis was used to estimate the relative risk (RR) value of the different subtypes of BDs under different exposures to FA and/or MV. Results: Compared with the maternal group without exposure to FA and MV, the RR values of nervous system defects, face, ear, and neck defects, limb defects, and CHDs in the maternal group with only FA supplementation were less than 1.0, but they were not statistically significant. The RR values of genitourinary defects, abnormal chromosomes, and oral clefts were more than 1.0, and they were also not statistically significant. However, the risk of genitourinary defects (RR: 3.22, 95% CI: 1.42–7.29) and chromosomal abnormalities (RR: 2.57, 95% CI: 1.16–5.73) in the maternal group with only MV supplementation increased more than those in the maternal group without exposure to FA and MV. In addition, the RR values of all subtypes of BDs in the maternal group with exposure to FA and MV were closer to 1.0 than those in maternal group with exposure to only MV, but they were not statistically significant. Conclusions: It was indicated that the simultaneous supplementation of FA and MV in early pregnancy may have an interaction for the prevention of BDs and may have inconsistent effects for different subtypes of BDs. At the same time, excessive FA supplementation in pregnant women may increase the risk of BDs in their offspring. Although the mechanism is not clear, this evidence reminded us that more trade-offs are necessary for formulating strategies for the prevention of BDs with FA and/or MV supplementation in early pregnancy

Associations of residential greenness exposure during early pregnancy with the risk of spontaneous abortion: the China Birth Cohort Study

Abstract Background Living in higher greenness level community has many benefits for pregnancy outcomes, however, few research have explored the relationship between greenness and spontaneous abortion (SAB). We aimed to analyze relationships between SAB and community greenness in Chinese pregnant women, and further assessed the modifying effects from air pollutants. Methods We studied 90 890 pregnant women from the China Birth Cohort Study from February 2018 to December 2021. We diagnosed SAB by certified obstetricians and gynecologists. The level of exposure to greenness during the first trimester was measured using the normalized difference vegetation index (NDVI) and the enhanced vegetation index (EVI). Particulate matter ≤ 2.5 μm (PM2.5), nitrogen dioxide (NO2) and ozone (O3) were used as proxies of ambient air pollution. Time-dependent multivariable adjusted Cox proportional hazards models, with gestational weeks as the time scale, were used to analyze the association between SAB and greenness. We additionally performed subgroup analyses stratified by age, urbanicity, research location, season of birth, temperature, humidity and air pollution levels. Results Lower SAB prevalence was related to living in greener places. A 0.1 unit increase in NDVI500m and EVI500m was significantly associated with a 12.3% (95% CI 9.9%, 15.5%) and 16.2% (95% CI 11.4%, 20.6%) lower risks of SAB, respectively. In sensitivity analysis, these relationships remained consistent. The associations were stronger among older, participants lived in the north of China and lived in places with higher PM2.5 and lower NO2 levels. Conclusions Our findings indicate significantly inverse associations between community greenness and SAB in Chinese pregnant women, especially for older and participants who live in the north of China, the PM2.5 and NO2 may modify the effects of greenness on SAB