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Simão D, Barata PC, Alves M, Papoila AL, Oliveira S, Lawlor P. Symptom Clusters in Patients With Advanced Cancer: A Prospective Longitudinal Cohort Study to Examine Their Stability and Prognostic Significance. Oncologist 2024; 29:e152-e163. [PMID: 37536276 PMCID: PMC10769798 DOI: 10.1093/oncolo/oyad211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 06/23/2023] [Indexed: 08/05/2023] Open
Abstract
This study's purpose was to assess symptom cluster (SC) stability during disease progression and determine their strength of association with survival in patients with advanced cancer . Consecutively eligible patients with advanced cancer not receiving cancer-specific treatment and referred to a Tertiary Palliative Care Clinic were enrolled in a prospective cohort study. At first consultation (D0) and in subsequent consultations at day 15 (D15) and day 30 (D30), patients rated 9 symptoms through the Edmonton Symptom Assessment System scale (0-10) and 10 others using a Likert scale (1-5). Principal components factor analysis with varimax rotation was used to determine SCs at each consultation. Of 318 patients with advanced cancer, 301 met eligibility criteria with a median age of 69 years (range 37-94). Three SCs were identified: neuro-psycho-metabolic (NPM), gastrointestinal, and sleep impairment, with some variations in their constitution over time. Exploratory factor analysis accounted for 40% of variance of observed variables in all SCs. Shorter median survival was observed continuously for NPM cluster (D0 23 vs. 58 days, P < .001; D15 41 vs. 104 days, P=.004; D30 46 vs. 114 days, P = .002), although the presence of 2 or more SCs on D0 and D15 also had prognostic significance (D0: 21 vs. 45 days, P = .005; D30: 50 vs. 96 days, P = .040). In a multivariable model, NPM cluster (D0 hazard ratio estimate: HR 1.64; 95%CI, 1.17-2.31; P = .005; D15 HR: 2.51; 95%CI, 1.25-5.05; P = .009; D30 HR: 3.9; 95%CI, 1.54-9.86; P = .004) and hospitalization (D0 HR: 2.27; 95%CI, 1.47-3.51; P < .001; D15 HR: 2.43; 95%CI, 1.18-5.01; P = .016; D30 HR: 3.41; 95%CI, 1.35-8.62; P = .009) were independently and significantly associated with worse survival. Three clinically relevant SCs were identified, and their constitution had small variations, maintaining a stable set of nuclear symptoms through disease progression. Presence of the NPM cluster and hospitalization maintained their prognostic value over time.
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Affiliation(s)
- Diana Simão
- Medical Oncology, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Pedro C Barata
- Medical Oncology, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
- Division of Solid Tumor Oncology, University Hospitals Seidman Cancer Center, Cleveland, OH, USA
| | - Marta Alves
- Epidemiology and Statistics Unit, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Ana L Papoila
- Epidemiology and Statistics Unit, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Sónia Oliveira
- Medical Oncology, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Peter Lawlor
- Bruyere Continuing Care, Division of Palliative Care, Department of Medicine, Bruyere and Ottawa Hospital Research Institutes, University of Ottawa, Ottawa, Canada
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Zhu K, Hunter M, Hui J, Murray K, James A, Lim EM, Cooke BR, Walsh JP. Longitudinal Stability of Vitamin D Status and Its Association With Bone Mineral Density in Middle-aged Australians. J Endocr Soc 2022; 7:bvac187. [PMID: 36578880 PMCID: PMC9780649 DOI: 10.1210/jendso/bvac187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Indexed: 12/12/2022] Open
Abstract
Context The skeletal effects of vitamin D remain controversial and it is uncertain whether variation in serum 25-hydroxyvitamin D (25OHD) levels over time influences bone mineral density (BMD). Objective We evaluated longitudinal stability of serum 25OHD and associations with changes in BMD in participants aged 46-70 years at baseline. Methods We studied 3698 Busselton Healthy Ageing Study participants (2040 female) with serum 25OHD and dual-energy x-ray absorptiometry (DXA) BMD assessments at baseline and at ∼6 years follow-up. Restricted cubic splines were used to evaluate associations between changes in 25OHD and BMD. Results Mean season-corrected serum 25OHD was 81.3 ± 22.7 and 78.8 ± 23.1 nmol/L at baseline and 6 years, respectively, and showed moderate correlation (intraclass correlation coefficient: 0.724). Significant predictors of change in 25OHD concentration (Δ25OHD) included baseline 25OHD, change in body mass index and vitamin D supplementation at follow-up. Greater decline in serum 25OHD over time was associated with significantly greater reduction in BMD at total hip and femoral neck, but the magnitude of the differences was small (estimated differences 0.004 g/cm2 and 0.005-0.007 g/cm2, respectively, for lowest quartile of Δ25OHD compared with higher quartiles, adjusted for sex, baseline BMD, 25OHD, and demographics). No significant associations between Δ25OHD and lumbar spine BMD were observed. Increase in 25OHD levels was not associated with change in BMD. Conclusions In this predominantly vitamin D-replete middle-aged cohort, serum 25OHD showed moderate longitudinal stability. Declining serum 25OHD over time was associated with greater reduction in BMD at the total hip and femoral neck.
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Affiliation(s)
- Kun Zhu
- Correspondence: Kun Zhu, PhD, Department of Endocrinology and Diabetes, Sir Charles Gardiner Hospital, Hospital Ave, Nedlands, WA 6009, Australia.
| | - Michael Hunter
- School of Population and Global Health, University of Western Australia, Crawley, WA 6009, Australia,Busselton Population Medical Research Institute, Busselton, WA 6280, Australia
| | - Jennie Hui
- School of Population and Global Health, University of Western Australia, Crawley, WA 6009, Australia,Busselton Population Medical Research Institute, Busselton, WA 6280, Australia,Department of Clinical Biochemistry, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Nedlands, WA 6009, Australia
| | - Kevin Murray
- School of Population and Global Health, University of Western Australia, Crawley, WA 6009, Australia
| | - Alan James
- Medical School, University of Western Australia, Crawley, WA 6009, Australia,Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia
| | - Ee Mun Lim
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia,Department of Clinical Biochemistry, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Nedlands, WA 6009, Australia
| | - Brian R Cooke
- Department of Clinical Biochemistry, PathWest Laboratory Medicine, Fiona Stanley Hospital, Murdoch, WA 6150, Australia
| | - John P Walsh
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia,Medical School, University of Western Australia, Crawley, WA 6009, Australia
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Radhoe TA, Agelink van Rentergem JA, Kok AAL, Huisman M, Geurts HM. Subgroups in Late Adulthood Are Associated With Cognition and Wellbeing Later in Life. Front Psychol 2021; 12:780575. [PMID: 34925184 PMCID: PMC8671814 DOI: 10.3389/fpsyg.2021.780575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/08/2021] [Indexed: 12/05/2022] Open
Abstract
Objectives: In this study, we aim to discover whether there are valid subgroups in aging that are defined by modifiable factors and are determinant of clinically relevant outcomes regarding healthy aging. Method: Data from interviews were collected in the Longitudinal Aging Study Amsterdam at two measurement occasions with a 3-year interval. Input for the analyses were seven well-known vulnerability and protective factors of healthy aging. By means of community detection, we tested whether we could distinguish subgroups in a sample of 1478 participants (T1-sample, aged 61–101 years). We tested both the external validity (T1) and predictive validity (T2) for wellbeing and subjective cognitive decline. Moreover, replicability and long-term stability were determined in 1186 participants (T2-sample, aged 61–101 years). Results: Three similar subgroups were identified at T1 and T2. Subgroup A was characterized by high levels of education with personal vulnerabilities, subgroup B by being physically active with low support and low levels of education, and subgroup C by high levels of support with low levels of education. Subgroup C showed the lowest wellbeing and memory profile, both at T1 and T2. On most measures of wellbeing and memory, subgroups A and B did not differ from each other. At T2, the same number of subgroups was identified and subgroup profiles at T1 and T2 were practically identical. Per T1 subgroup 47–62% retained their membership at T2. Discussion: We identified valid subgroups that replicate over time and differ on external variables at current and later measurement occasions. Individual change in subgroup membership over time shows that transitions to subgroups with better outcomes are possible.
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Affiliation(s)
- Tulsi A Radhoe
- Dutch Autism and ADHD Research Center (d'Arc), Department of Psychology, Brain and Cognition, University of Amsterdam, Amsterdam, Netherlands
| | - Joost A Agelink van Rentergem
- Dutch Autism and ADHD Research Center (d'Arc), Department of Psychology, Brain and Cognition, University of Amsterdam, Amsterdam, Netherlands
| | - Almar A L Kok
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC - Location VU University Medical Center, Amsterdam, Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Public Health, Amsterdam, Netherlands
| | - Martijn Huisman
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC - Location VU University Medical Center, Amsterdam, Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Sociology, Amsterdam Public Health, Amsterdam, Netherlands
| | - Hilde M Geurts
- Dutch Autism and ADHD Research Center (d'Arc), Department of Psychology, Brain and Cognition, University of Amsterdam, Amsterdam, Netherlands.,Leo Kannerhuis (Youz/Parnassia Groep), Amsterdam, Netherlands
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Vincent KM, Xie W, Nelson CA. Using different methods for calculating frontal alpha asymmetry to study its development from infancy to 3 years of age in a large longitudinal sample. Dev Psychobiol 2021; 63:e22163. [PMID: 34292586 DOI: 10.1002/dev.22163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 06/06/2021] [Accepted: 06/25/2021] [Indexed: 12/28/2022]
Abstract
Frontal electroencephalography (EEG) alpha asymmetry (FAA), defined as the difference in frontal alpha power observed over the right and left frontal scalp regions, has been widely used in developmental research as a measure of multiple aspects of child behavior, such as temperament. Studies have used different equations to calculate FAA, which renders comparison of results across studies challenging. Furthermore, few studies have examined FAA's longitudinal stability across infancy and early childhood, which is a desirable feature of a temperament measure. We investigated the cross-sectional and the longitudinal correlations of FAA values from four different equations to calculate FAA used in the literature. We used baseline EEG data from a longitudinal sample of 321 infants and 168 3-year-old children (149 of whom had data at both timepoints). Consistent with previous work, FAA values calculated using two commonly used equations were highly correlated with each other cross-sectionally but not with values from a different equation that used log-transformed relative power. The log-transformed relative power FAA values were the only values that showed significant longitudinal stability. These findings suggest that researchers interested in FAA as a trait-like measure in children should consider using the relative power equation that renders stability across ages.
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Affiliation(s)
- Katherine M Vincent
- Laboratories of Cognitive Neuroscience, Division of Developmental Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Center for Cognitive and Brain Health, Department of Psychology, Northeastern University, Boston, Massachusetts, USA
| | - Wanze Xie
- Laboratories of Cognitive Neuroscience, Division of Developmental Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,School of Psychological and Cognitive Sciences, Peking University, China; and PKU-IDG/McGovern Institute for Brain Research, Peking University, China.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Charles A Nelson
- Laboratories of Cognitive Neuroscience, Division of Developmental Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.,Graduate School of Education, Harvard University, Cambridge, Massachusetts, USA
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Brandenburg J, Hartmann D, Visser L, Schwenck C, Hasselhorn M. [Differential Stability and Interrater-Dependencies in the Assessment of Psychopathological Symptoms: Longitudinal Analyses Based on the SDQ in Children with and without Specific Learning Disabilities]. Prax Kinderpsychol Kinderpsychiatr 2021; 70:282-97. [PMID: 33977880 DOI: 10.13109/prkk.2021.70.4.282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Differential Stability and Interrater-Dependencies in the Assessment of Psychopathological Symptoms: Longitudinal Analyses Based on the SDQ in Children with and without Specific Learning Disabilities A widely used open access instrument for screening of internalising and externalising problem behaviour is the Strengths and Difficulties Questionnaire (SDQ). For the use of the SDQ in clinical practice, information about its differential validity and applicability for follow-up assessments is relevant. Therefore, the aim was to study the SDQ regarding differential stability in the repeatedly collected child, parent and teacher reports. As the social context influences the perception of symptoms, we additionally explored the extent to which the child, parent and teacher reports influenced each other. Also, we studied differences in problem behaviour between children with and without specific learning disabilities and between girls and boys. To this end, 60 children from 5th and 6th grade with and without specific learning disabilities and their parents and teachers filled in the SDQ at three time points during secondary school. The results of the cross-lagged-panel-analyses showed substantial stability for almost all subscales. This shows that in their SDQ-reports, parents, children and teachers can separate the stable parts of problem behaviour from situational variations therein. Inter-rater dependencies between the different reports in the form of cross-delayed effects could be identified mainly from the adult to the child reports and clarify the caregiver's influence on the children's symptom perception. With respect to specific learning disabilities, the results showed differences only for the subscale related to hyperactivity: children with specific learning disabilities had more parent-reported, but less self-reported hyperactive symptoms than children without. Girls reported more emotional problems and boys more conduct problems and less prosocial behavior. Teacher and parents reported almost no differences between boys and girls. The results support the usefulness of the SDQ for repeated assessments in clinical practice.
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Rescorla LA, Ghassabian A, Ivanova MY, Jaddoe VW, Verhulst FC, Tiemeier H. Structure, longitudinal invariance, and stability of the Child Behavior Checklist 1½-5's Diagnostic and Statistical Manual of Mental Disorders-Autism Spectrum Disorder scale: Findings from Generation R (Rotterdam). Autism 2017; 23:223-235. [PMID: 29143542 DOI: 10.1177/1362361317736201] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Although the Child Behavior Checklist 1½-5's 12-item Diagnostic and Statistical Manual of Mental Disorders-Autism Spectrum Problems Scale (formerly called Pervasive Developmental Problems scale) has been used in several studies as an autism spectrum disorder screener, the base rate and stability of its items and its measurement model have not been previously studied. We therefore examined the structure, longitudinal invariance, and stability of the Child Behavior Checklist 1½-5's Diagnostic and Statistical Manual of Mental Disorders-Autism Spectrum Problems Scale in the diverse Generation R (Rotterdam) sample based on mothers' ratings at 18 months (n = 4695), 3 years (n = 4571), and 5 years (n = 5752). Five items that seemed especially characteristic of autism spectrum disorder had low base rates at all three ages. The rank order of base rates for the 12 items was highly correlated over time (Qs ⩾ 0.86), but the longitudinal stability of individual items was modest (phi coefficients = 0.15-0.34). Confirmatory factor analyses indicated that the autism spectrum disorder scale model manifested configural, metric, and scalar longitudinal invariance over the time period from 18 months to 5 years, with large factor loadings. Correlations over time for observed autism spectrum disorder scale scores (0.25-0.50) were generally lower than the correlations across time of the latent factors (0.45-0.68). Results indicated significant associations of the autism spectrum disorder scale with later autism spectrum disorder diagnoses.
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Mackin RS, Insel P, Aisen PS, Geda YE, Weiner MW. Longitudinal stability of subsyndromal symptoms of depression in individuals with mild cognitive impairment: relationship to conversion to dementia after 3 years. Int J Geriatr Psychiatry 2012; 27:355-63. [PMID: 21744390 PMCID: PMC3685477 DOI: 10.1002/gps.2713] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Accepted: 02/14/2011] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To evaluate the degree to which longitudinal stability of subsyndromal symptoms of depression (SSD) is associated with conversion to dementia in patients with mild cognitive impairment (MCI). METHODS Data from 405 MCI participants from the Alzheimer's Disease Neuroimaging Initiative (ADNI) study were analyzed. Participants were evaluated at baseline and 12-month intervals over 3 years. Participants were designated as MCI converters if dementia was diagnosed within 3 years or as cognitively stable MCI if dementia was not diagnosed during this interval. SSD were evaluated utilizing the 15-item Geriatric Depression Scale (GDS). Endorsement of specific SSD at baseline and the stability of SSD over 36 months were compared between the two MCI groups. RESULTS Baseline symptom endorsement and stability of total GDS scores did not differentiate MCI groups. Worsening of four individual items from the GDS over time (memory problems, feelings of helplessness, loss of interest, and preference for staying at home) differentiated MCI converters from cognitively stable MCI (p < 0.05 for all). However, only increased endorsement of memory symptoms over time was associated with progression to dementia after controlling for other clinical variables (p = 0.05). CONCLUSIONS SSD in MCI participants largely consist of cognitive symptoms and activity limitations, and the stability of SSD over time differentiated the MCI groups better than baseline endorsement of symptoms. However, the only significant predictor of conversion to dementia was increased endorsement of memory problems, which likely represents insight into cognitive problems more than depressive symptomatology in MCI individuals.
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Affiliation(s)
- R. Scott Mackin
- Center for Imaging of Neurodegenerative Diseases, Veterans Administration Medical Center, San Francisco, CA, USA,Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Philip Insel
- Center for Imaging of Neurodegenerative Diseases, Veterans Administration Medical Center, San Francisco, CA, USA
| | - Paul S. Aisen
- Department of Neurosciences, University of California, San Diego, CA USA
| | - Yonas E. Geda
- Departments of Psychiatry & Psychology, Neurology and Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Michael W. Weiner
- Center for Imaging of Neurodegenerative Diseases, Veterans Administration Medical Center, San Francisco, CA, USA,Department of Psychiatry, University of California, San Francisco, CA, USA,Department of Radiology, University of California, San Francisco, CA, USA,Department of Medicine, University of California, San Francisco, CA, USA
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