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Kuypers AM, Vliet KEV, MacDonald A, Ahring K, Abeln D, Ford S, Hildebrandt-Karlsen S, van Spronsen FJ, Heiner-Fokkema MR. Satisfaction with home blood sampling methods and expectations for future point-of-care testing in phenylketonuria: Perspectives from patients and professionals. Mol Genet Metab 2024; 142:108361. [PMID: 38442492 DOI: 10.1016/j.ymgme.2024.108361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 03/07/2024]
Abstract
INTRODUCTION Phenylketonuria (PKU) requires regular phenylalanine monitoring to ensure optimal outcome. However, home sampling methods used for monitoring suffer high pre-analytical variability, inter-laboratory variability and turn-around-times, highlighting the need for alternative methods of home sampling or monitoring. METHODS A survey was distributed through email and social media to (parents of) PKU patients and professionals working in inherited metabolic diseases in Denmark, The Netherlands, and United Kingdom regarding satisfaction with current home sampling methods and expectations for future point-of-care testing (POCT). RESULTS 210 parents, 156 patients and 95 professionals completed the survey. Countries, and parents and patients were analysed together, in absence of significant group differences for most questions. Important results are: 1) Many patients take less home samples than advised. 2) The majority of (parents of) PKU patients are (somewhat) dissatisfied with their home sampling method, especially with turn-around-times (3-5 days). 3) 37% of professionals are dissatisfied with their home sampling method and 45% with the turn-around-times. 4) All responders are positive towards developments for POCT: 97% (n = 332) of (parents of) patients is willing to use a POC-device and 76% (n = 61) of professionals would recommend their patients to use a POC-device. 5) Concerns from all participants for future POC-devices are costs/reimbursements and accuracy, and to professionals specifically, accessibility to results, over-testing, patient anxiety, and patients adjusting their diet without consultation. CONCLUSION The PKU community is (somewhat) dissatisfied with current home sampling methods, highlighting the need for alternatives of Phe monitoring. POCT might be such an alternative and the community is eager for its arrival.
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Affiliation(s)
- Allysa M Kuypers
- Section of Metabolic Diseases, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Kimber Evers-van Vliet
- Section of Metabolic Diseases, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Anita MacDonald
- Birmingham Women's and Children's Hospital NHS Foundation Trust, Steelhouse Lane, Birmingham B4 6NH, UK
| | | | | | - Suzanne Ford
- The National Society for Phenylketonuria (NSPKU), Richard House, Lancashire, UK
| | | | - Francjan J van Spronsen
- Section of Metabolic Diseases, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - M Rebecca Heiner-Fokkema
- Laboratory of Metabolic Diseases, Department of Laboratory Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
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Hu P, Crimmins EM, Kim JK, Potter A, Cofferen J, Merkin S, McCreath H, Seeman T. Harmonization of four biomarkers across nine nationally representative studies of older persons. Am J Hum Biol 2024; 36:e24030. [PMID: 38069621 PMCID: PMC11062831 DOI: 10.1002/ajhb.24030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/26/2023] [Accepted: 11/26/2023] [Indexed: 01/07/2024] Open
Abstract
INTRODUCTION A growing number of international population surveys have included measurement of biomarkers, but differ in the type of specimens collected, sample processing procedures, shipment protocols, and laboratory assay platforms. The purpose of this study is to harmonize biomarker data from nine nationally representative studies of people 50 years of age and over by adjusting for assay platforms and type of specimens for total cholesterol (total-C), high-density lipoprotein cholesterol (HDL-C), glycosylated hemoglobin (HbA1c), and C-reactive protein (CRP). METHODS Sets of 24 identical serum, plasma, whole blood, and dried blood spot harmonization samples with known analyte levels were generated at a reference laboratory, shipped at -80°C to the respective study laboratories, and subsequently assayed following the study laboratory's protocol. Both original and harmonized study data were used to calculate mean values and at-risk prevalence. RESULTS The correlation coefficients between the biomarker values of the harmonization samples obtained by the study laboratories and the reference laboratory were 0.99 or above for all analytes and laboratories, indicating the high quality of assays at all laboratories. However, using the harmonized data from each study, there were significant differences in the mean values and country ranking of the prevalence of at-risk levels of these four biomarkers. CONCLUSIONS While the biomarker data from the different study laboratories were highly correlated, indicating very high correlation of rank order of specimens, absolute values did vary significantly. This can have a major impact on assessment of international differences in estimates of risks for chronic morbidity and mortality.
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Affiliation(s)
- Peifeng Hu
- Division of Geriatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Eileen M Crimmins
- Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Jung Ki Kim
- Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Alan Potter
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA, USA
| | - Jake Cofferen
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA, USA
| | - Sharon Merkin
- Division of Geriatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Heather McCreath
- Division of Geriatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Teresa Seeman
- Division of Geriatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
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Kim JK, Faul J, Weir DR, Crimmins EM. Dried blood spot based biomarkers in the Health and Retirement Study: 2006 to 2016. Am J Hum Biol 2024; 36:e23997. [PMID: 37803815 PMCID: PMC10873048 DOI: 10.1002/ajhb.23997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/22/2023] [Accepted: 09/22/2023] [Indexed: 10/08/2023] Open
Abstract
INTRODUCTION The Health and Retirement Study (HRS) has collected biomarker data over multiple waves. Such data can help improve our understanding of health changes in individuals and the causal pathways related to health. There are, however, technical challenges to using the HRS dried blood spots (DBS) biomarker data due to changes over time in assay protocols, platforms, and laboratories. We provide technical and summary information on biological indicators collected as part of the HRS from 2006 to 2016 that should be helpful to users of the data. METHODS We describe the opportunities and challenges provided by the HRS DBS data as well as insights provided by the data. The HRS collected DBS from its nationally representative sample of respondents 51 years of age or older from 2006 to 2016. DBS-based biomarkers were collected from half the sample in 2006, 2010, and 2014, and from the other half of the sample in 2008, 2012, and 2016. These DBS specimens were used to assay total and HDL cholesterol, glycosylated hemoglobin, C-reactive protein, and cystatin C from 2006 to 2016, and Interleukin 6 was added in 2014/2016. Samples included approximately 6000 individuals at each wave, and completion rates ranged from 81% to 90%. HRS transformed DBS values into venous blood equivalents to make them more comparable to those of the whole blood-based assays collected in most other studies and to facilitate longitudinal analysis. RESULTS Distribution of changes over time by age shows that total cholesterol levels decreased for each age, while HbA1c levels increased. Cystatin C shows a clear age gradient, but a number of other markers do not. Non-Hispanic Black persons and Hispanic respondents have a higher incidence of risk levels of each biomarker except for CRP among non-Hispanic Black older persons. CONCLUSION These public-use DBS data provide analysis opportunities that can be used to improve our understanding of health change with age in both populations and among individuals.
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Affiliation(s)
- Jung Ki Kim
- Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Jessica Faul
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - David R. Weir
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Eileen M. Crimmins
- Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
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Borbye-Lorenzen N, Deza-Lougovski YI, Holmgaard S, Weiss LM, Bækvad-Hansen M, Skogstrand K, Rieckmann A, Börsch-Supan A, Börsch-Supan M. Assessment of circulating apoE4 levels from dried blood spot samples in a large survey setting. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2024; 16:e12555. [PMID: 38390562 PMCID: PMC10883237 DOI: 10.1002/dad2.12555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 12/11/2023] [Accepted: 01/16/2024] [Indexed: 02/24/2024]
Abstract
INTRODUCTION The apolipoprotein E (APOE) ε4 allele is associated with high risk for Alzheimer's disease. It is unclear whether individual levels of the circulating apoE4 protein in ε4 carriers confer additional risk. Measuring apoE4 protein levels from dried blood spots (DBS) has the potential to provide information on genetic status as well as circulating levels and to include these measures in large survey settings. METHODS We developed a multiplex immunoassay to detect apoE4 protein levels in DBS from 15,974 participants, aged 50+ from Wave 6 of the Survey of Health, Ageing and Retirement in Europe (SHARE). RESULTS The apoE4 protein signal was presented in two separable distributions. One distribution corresponded to carriers of at least one copy of the ε4 allele. Fieldwork cofounders affected protein levels but did not explain individual differences. DISCUSSION Future research should investigate how genotype and apoE4 level interact with lifestyle and other variables to impact cognitive aging.
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Affiliation(s)
- Nis Borbye-Lorenzen
- Department of Congenital Disorders Center for Neonatal Screening, Statens Serum Institut Copenhagen Denmark
| | - Yacila I Deza-Lougovski
- Institute of Psychology University of the Bundeswehr München Neubiberg Germany
- Max Planck Institute for Social Law and Social Policy Munich Germany
| | - Solveig Holmgaard
- Department of Congenital Disorders Center for Neonatal Screening, Statens Serum Institut Copenhagen Denmark
| | - Luzia M Weiss
- Max Planck Institute for Social Law and Social Policy Munich Germany
| | - Marie Bækvad-Hansen
- Department of Congenital Disorders Center for Neonatal Screening, Statens Serum Institut Copenhagen Denmark
| | - Kristin Skogstrand
- Department of Congenital Disorders Center for Neonatal Screening, Statens Serum Institut Copenhagen Denmark
| | - Anna Rieckmann
- Institute of Psychology University of the Bundeswehr München Neubiberg Germany
- Max Planck Institute for Social Law and Social Policy Munich Germany
| | - Axel Börsch-Supan
- Max Planck Institute for Social Law and Social Policy Munich Germany
- The Munich Research Institute for the Economics of Aging and SHARE Analyses (MEA) Munich Germany
- National Bureau of Economic Research Cambridge Massachusetts USA
| | - Martina Börsch-Supan
- The Munich Research Institute for the Economics of Aging and SHARE Analyses (MEA) Munich Germany
- Survey of Health, Ageing and Retirement in Europe (SHARE Biomarker Project) Munich Germany
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Horton HM. The Long Arm of childhood hypothesis and systematic low-grade inflammation: Evidence from parental education of older European adults. SSM Popul Health 2023; 21:101334. [PMID: 36712147 PMCID: PMC9873659 DOI: 10.1016/j.ssmph.2022.101334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/09/2022] [Accepted: 12/28/2022] [Indexed: 01/01/2023] Open
Abstract
Childhood SES has been extensively studied as a predictor for health outcomes in adulthood, though the direct mechanisms remain unclear. The Long Arm of Childhood Model hypothesizes that this process is a chain of events, moderated by numerous factors such as family economic status and environment, health behaviors, as well as biological processes. We expand on this model with objective measures of health in older age, namely C-reactive protein (CRP), as chronic low grade inflammation, which has been found to be connected to both childhood SES as well as a number of cardiovascular diseases in adulthood. Using life history data from SHARE, as well as a novel dried blood spot dataset, we explore the protective role of parent education on the blood level of C-reactive protein in adulthood. Estimating a stepwise linear regression model, we find evidence that years of parental education are negatively associated with CRP in adulthood, with a one-year increase in mother's (father's) years of education decreasing adult CRP by 1.8% (1.1%). Using a modified Sobel test, we measure both the direct and indirect effects, estimating the extent in which later-life mediators significantly alter the relationship between parental education and CRP. While father's education is completely mediated by individual factors such as respondent's education, employment, and health behavior - we observe a lasting association from mother's education, suggesting a direct link between mother's education and CRP in adulthood.
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Affiliation(s)
- Hannah Marie Horton
- Max Planck Institute for Social Law and Social Policy, Munich Center for the Economics of Aging (MEA) and Survey of Health, Ageing and Retirement in Europe (SHARE), Amalienstrasse 33, 80799, Munich, Germany
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6
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Groh R, Weiss LM, Börsch-Supan M, Börsch-Supan A. Effects of spot size on biomarker levels of field-collected dried blood spots: A new algorithm for exact dried blood spot size measurement. Am J Hum Biol 2022; 34:e23777. [PMID: 36001479 PMCID: PMC9606603 DOI: 10.1002/ajhb.23777] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 05/24/2022] [Accepted: 06/03/2022] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES The quality of blood values analyzed from survey-collected dried blood spot (DBS) samples is affected by fieldwork conditions, particularly spot size. We offer an image-based algorithm that accurately measures the area of field-collected DBS and we investigate the impact of spot size on the analyzed blood marker values. METHODS SHARE, a pan-European study, collected 24 000 DBS samples in 12 countries in its sixth wave. Our new algorithm uses photographs of the DBS samples to calculate the number of pixels of the blood-covered area to measure the spot sizes accurately. We ran regression models to examine the association of spot size and seven DBS analytes. We then compared the application of our new spot-size measures to common spot-size estimation. RESULTS Using automated spot-size measurement, we found that spot size has a significant effect on all markers. Smaller spots are associated with lower measured levels, except for HbA1c, for which we observe a negative effect. Our precisely measured spot sizes explain substantially more variance of DBS analytes compared to commonly used spot-size estimation. CONCLUSION The new algorithm accurately measures the size of field-collected DBS in an automated way. This methodology can be applied to surveys even with very large numbers of observations. The measured spot sizes improve the accuracy of conversion formulae that translate blood marker values derived from DBS into venous blood values. The significance of the spot-size effects on biomarkers in DBS should also incentivize the improvement of fieldwork training and monitoring.
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Affiliation(s)
- Rebecca Groh
- Technical University of Munich, Munich, Germany
- Munich Center for the Economics of Aging at the Max Planck Institute for Social Law and Social Policy, Munich, Germany
| | - Luzia M. Weiss
- Munich Center for the Economics of Aging at the Max Planck Institute for Social Law and Social Policy, Munich, Germany
| | | | - Axel Börsch-Supan
- Technical University of Munich, Munich, Germany
- Munich Center for the Economics of Aging at the Max Planck Institute for Social Law and Social Policy, Munich, Germany
- Survey of Health, Ageing and Retirement in Europe, Munich, Germany
- National Bureau of Economic Research, Cambridge, Massachusetts
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Advanced Microsamples: Current Applications and Considerations for Mass Spectrometry-Based Metabolic Phenotyping Pipelines. SEPARATIONS 2022. [DOI: 10.3390/separations9070175] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Microsamples are collections usually less than 50 µL, although all devices that we have captured as part of this review do not fit within this definition (as some can perform collections of up to 600 µL); however, they are considered microsamples that can be self-administered. These microsamples have been introduced in pre-clinical, clinical, and research settings to overcome obstacles in sampling via traditional venepuncture. However, venepuncture remains the sampling gold standard for the metabolic phenotyping of blood. This presents several challenges in metabolic phenotyping workflows: accessibility for individuals in rural and remote areas (due to the need for trained personnel), the unamenable nature to frequent sampling protocols in longitudinal research (for its invasive nature), and sample collection difficulty in the young and elderly. Furthermore, venous sample stability may be compromised when the temperate conditions necessary for cold-chain transport are beyond control. Alternatively, research utilising microsamples extends phenotyping possibilities to inborn errors of metabolism, therapeutic drug monitoring, nutrition, as well as sport and anti-doping. Although the application of microsamples in metabolic phenotyping exists, it is still in its infancy, with whole blood being overwhelmingly the primary biofluid collected through the collection method of dried blood spots. Research into the metabolic phenotyping of microsamples is limited; however, with advances in commercially available microsampling devices, common barriers such as volumetric inaccuracies and the ‘haematocrit effect’ in dried blood spot microsampling can be overcome. In this review, we provide an overview of the common uses and workflows for microsampling in metabolic phenotyping research. We discuss the advancements in technologies, highlighting key considerations and remaining knowledge gaps for the employment of microsamples in metabolic phenotyping research. This review supports the translation of research from the ‘bench to the community’.
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Pekmezi D, Fontaine K, Rogers LQ, Pisu M, Martin MY, Schoenberger-Godwin YM, Oster RA, Kenzik K, Ivankova NV, Demark-Wahnefried W. Adapting MultiPLe behavior Interventions that eFfectively Improve (AMPLIFI) cancer survivor health: program project protocols for remote lifestyle intervention and assessment in 3 inter-related randomized controlled trials among survivors of obesity-related cancers. BMC Cancer 2022; 22:471. [PMID: 35488238 PMCID: PMC9051494 DOI: 10.1186/s12885-022-09519-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/10/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Scalable, multiple behavior change interventions are needed to address poor diet, inactivity, and excess adiposity among the rising number of cancer survivors. Efficacy-tested diet (RENEW) and exercise (BEAT Cancer) programs were adapted for web delivery among middle-aged and older cancer survivors for the AMPLIFI study, a National Cancer Institute-funded, multi-site, program project. METHODS Throughout the continental U.S., survivors of several obesity-related cancers are being recruited for three interconnected randomized controlled trials (RCTs). Projects 1 and 2 test 6-month diet or exercise interventions versus a wait-list control condition. Upon completion of the 6-month study period, the intervention participants receive the next behavior change sequence (i.e., diet receives exercise, exercise receives diet) and the wait-list control arm initiates a 12-month combined diet and exercise intervention. Project 3 tests the efficacy of the sequential versus simultaneous interventions. Assessments occur at baseline and semi-annually for up to 2-years and include: body mass index, health behaviors (diet quality, accelerometry-assessed physical activity/sleep), waist circumference, D3 creatine-assessed muscle mass, physical performance, potential mediators/moderators of treatment efficacy, biomarkers of inflammation and metabolic regulation, health care utilization, cost, and overall health. Four shared resources support AMPLIFI RCTs: 1) Administrative; 2) Adaptation, Dissemination and Implementation; 3) Recruitment and Retention; and 4) Assessment and Analysis. DISCUSSION Representing a new generation of RCTs, AMPLIFI will exclusively use remote technologies to recruit, intervene and assess the efficacy of the newly-adapted, web-based diet and exercise interventions and determine whether sequential or combined delivery works best for at-risk (older, rural, racial minority) cancer survivors. TRIAL REGISTRATION ClinicalTrials.gov , NCT04000880 . Registered 27 June 2019.
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Affiliation(s)
- Dori Pekmezi
- Department of Health Behavior, University of Alabama at Birmingham (UAB), Birmingham, AL, USA.
- O'Neal Comprehensive Cancer Center, UAB, Birmingham, AL, USA.
| | - Kevin Fontaine
- Department of Health Behavior, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
- O'Neal Comprehensive Cancer Center, UAB, Birmingham, AL, USA
| | - Laura Q Rogers
- O'Neal Comprehensive Cancer Center, UAB, Birmingham, AL, USA
- Department of Medicine, UAB, Birmingham, AL, USA
| | - Maria Pisu
- O'Neal Comprehensive Cancer Center, UAB, Birmingham, AL, USA
- Department of Medicine, UAB, Birmingham, AL, USA
| | - Michelle Y Martin
- Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Yu-Mei Schoenberger-Godwin
- O'Neal Comprehensive Cancer Center, UAB, Birmingham, AL, USA
- Department of Medicine, UAB, Birmingham, AL, USA
| | - Robert A Oster
- O'Neal Comprehensive Cancer Center, UAB, Birmingham, AL, USA
- Department of Medicine, UAB, Birmingham, AL, USA
| | - Kelly Kenzik
- O'Neal Comprehensive Cancer Center, UAB, Birmingham, AL, USA
- Department of Medicine, UAB, Birmingham, AL, USA
| | | | - Wendy Demark-Wahnefried
- O'Neal Comprehensive Cancer Center, UAB, Birmingham, AL, USA
- Department of Nutrition Sciences, UAB, Birmingham, AL, USA
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Duminy L, Sivapragasam NR, Matchar DB, Visaria A, Ansah JP, Blankart CR, Schoenenberger L. Validation and application of a needs-based segmentation tool for cross-country comparisons. Health Serv Res 2021; 56 Suppl 3:1394-1404. [PMID: 34755337 PMCID: PMC8579203 DOI: 10.1111/1475-6773.13873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 07/28/2021] [Accepted: 08/09/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To compare countries' health care needs by segmenting populations into a set of needs-based health states. DATA SOURCES We used seven waves of the Survey of Health, Aging and Retirement in Europe (SHARE) panel survey data. STUDY DESIGN We developed the Cross-Country Simple Segmentation Tool (CCSST), a validated clinician-administered instrument for categorizing older individuals by distinct, homogeneous health and related social service needs. Using clinical indicators, self-reported physician diagnosis of chronic disease, and performance-based tests conducted during the survey interview, individuals were assigned to 1-5 global impressions (GI) segments and assessed for having any of the four identifiable complicating factors (CFs). We used Cox proportional hazard models to estimate the risk of mortality by segment. First, we show the segmentation cross-sectionally to assess cross-country differences in the fraction of individuals with different levels of medical needs. Second, we compare the differences in the rate at which individuals transition between those levels and death. DATA COLLECTION/EXTRACTION METHODS We segmented 270,208 observations (from Austria, Belgium, Czech Republic, Denmark, France, Germany, Greece, Israel, Italy, the Netherlands, Poland, Spain, Sweden, and Switzerland) from 96,396 individuals into GI and CF categories. PRINCIPAL FINDINGS The CCSST is a valid tool for segmenting populations into needs-based states, showing Switzerland with the lowest fraction of individuals in high medical needs segments, followed by Denmark and Sweden, and Poland with the highest fraction, followed by Italy and Israel. Comparing hazard ratios of transitioning between health states may help identify country-specific areas for analysis of ecological and cultural risk factors. CONCLUSIONS The CCSST is an innovative tool for aggregate cross-country comparisons of both health needs and transitions between them. A cross-country comparison gives policy makers an effective means of comparing national health system performance and provides targeted guidance on how to identify strategies for curbing the rise of high-need, high-cost patients.
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Affiliation(s)
- Lize Duminy
- Institute for Health Policy and Health EconomicsBern University of Applied SciencesBernSwitzerland
- Swiss Institute of Translational and Entrepreneurial MedicineBernSwitzerland
| | - Nirmali Ruth Sivapragasam
- Program in Health Services and Systems Research ServiceDuke‐NUS Medical School SingaporeSingaporeSingapore
| | - David Bruce Matchar
- Program in Health Services and Systems Research ServiceDuke‐NUS Medical School SingaporeSingaporeSingapore
- Duke University Medical CenterDuke UniversityDurhamNorth CarolinaUSA
| | - Abhijit Visaria
- Centre for Ageing Research and EducationDuke‐NUS Medical School SingaporeSingaporeSingapore
| | - John Pastor Ansah
- Program in Health Services and Systems Research ServiceDuke‐NUS Medical School SingaporeSingaporeSingapore
| | - Carl Rudolf Blankart
- Swiss Institute of Translational and Entrepreneurial MedicineBernSwitzerland
- KPM Center for Public ManagementUniversity of BernBernSwitzerland
| | - Lukas Schoenenberger
- Institute for Health Policy and Health EconomicsBern University of Applied SciencesBernSwitzerland
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Pekmezi DW, Crane TE, Oster RA, Rogers LQ, Hoenemeyer T, Farrell D, Cole WW, Wolin K, Badr H, Demark-Wahnefried W. Rationale and Methods for a Randomized Controlled Trial of a Dyadic, Web-Based, Weight Loss Intervention among Cancer Survivors and Partners: The DUET Study. Nutrients 2021; 13:nu13103472. [PMID: 34684474 PMCID: PMC8539255 DOI: 10.3390/nu13103472] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 02/01/2023] Open
Abstract
Scalable, effective interventions are needed to address poor diet, insufficient physical activity, and obesity amongst rising numbers of cancer survivors. Interventions targeting survivors and their friends and family may promote both tertiary and primary prevention. The design, rationale, and enrollment of an ongoing randomized controlled trial (RCT) (NCT04132219) to test a web-based lifestyle intervention for cancer survivors and their supportive partners are described, along with the characteristics of the sample recruited. This two-arm, single-blinded RCT randomly assigns 56 dyads (cancer survivor and partner, both with obesity, poor diets, and physical inactivity) to the six-month DUET intervention vs. wait-list control. Intervention delivery and assessment are remotely performed with 0-6 month, between-arm tests comparing body weight status (primary outcome), and secondary outcomes (waist circumference, health indices, and biomarkers of glucose homeostasis, lipid regulation and inflammation). Despite COVID-19, targeted accrual was achieved within 9 months. Not having Internet access was a rare exclusion (<2%). Inability to identify a support partner precluded enrollment of 42% of interested/eligible survivors. The enrolled sample is diverse: ages 23-81 and 38% racial/ethnic minorities. Results support the accessibility and appeal of web-based lifestyle interventions for cancer survivors, though some cancer survivors struggled to enlist support partners and may require alternative strategies.
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Affiliation(s)
- Dorothy W. Pekmezi
- Department of Health Behavior, University of Alabama at Birmingham (UAB), Birmingham, AL 35294, USA
- O’Neal Comprehensive Cancer Center at University of Alabama at Birmingham (UAB), Birmingham, AL 35294, USA; (R.A.O.); (L.Q.R.); (W.D.-W.)
- Correspondence: ; Tel.: +1-205-975-8061
| | - Tracy E. Crane
- Sylvester Comprehensive Cancer Center, Miami, FL 33136, USA;
| | - Robert A. Oster
- O’Neal Comprehensive Cancer Center at University of Alabama at Birmingham (UAB), Birmingham, AL 35294, USA; (R.A.O.); (L.Q.R.); (W.D.-W.)
- Division of Preventive Medicine, Department of Medicine, Birmingham, AL 35294, USA
| | - Laura Q. Rogers
- O’Neal Comprehensive Cancer Center at University of Alabama at Birmingham (UAB), Birmingham, AL 35294, USA; (R.A.O.); (L.Q.R.); (W.D.-W.)
- Division of Preventive Medicine, Department of Medicine, Birmingham, AL 35294, USA
| | - Teri Hoenemeyer
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), Birmingham, AL 35294, USA; (T.H.); (W.W.C.)
| | | | - William W. Cole
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), Birmingham, AL 35294, USA; (T.H.); (W.W.C.)
| | | | - Hoda Badr
- Department of Medicine, Epidemiology and Population Sciences, Baylor College of Medicine, Houston, TX 77030, USA;
| | - Wendy Demark-Wahnefried
- O’Neal Comprehensive Cancer Center at University of Alabama at Birmingham (UAB), Birmingham, AL 35294, USA; (R.A.O.); (L.Q.R.); (W.D.-W.)
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), Birmingham, AL 35294, USA; (T.H.); (W.W.C.)
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