Time spent sitting is distinctly different from accumulating too little physical activity and may have independent deleterious effects. Few studies have examined the association between sitting time ...and site-specific cancer incidence.
Among 69,260 men and 77,462 women who were cancer-free and enrolled in the American Cancer Society Cancer Prevention Study II Nutrition Cohort, 18,555 men and 12,236 women were diagnosed with cancer between 1992 and 2009. Extended Cox proportional hazards regression was used to estimate multivariable-adjusted relative risks (RR) and 95% confidence intervals (CI) of leisure-time spent sitting with total and site-specific cancer incidence.
Longer leisure-time spent sitting, after adjustment for physical activity, BMI, and other factors, was associated with risk of total cancer in women (RR = 1.10; 95% CI, 1.04-1.17 for ≥6 hours vs. <3 hours per day), but not men (RR = 1.00; 95% CI, 0.96-1.05). In women, sitting time was associated with risk of multiple myeloma (RR = 1.65; 95% CI, 1.07-2.54), invasive breast cancer (RR = 1.10; 95% CI, 1.00-1.21), and ovarian cancer (RR = 1.43; 95% CI, 1.10-1.87). There were no associations between sitting time and site-specific cancers in men.
Longer leisure-time spent sitting was associated with a higher risk of total cancer risk in women, and specifically with multiple myeloma, breast, and ovarian cancers, but sitting time was not associated with cancer risk in men. Further research is warranted to better understand the differences in associations between men and women.
For women, these findings support American Cancer Society guidelines for cancer prevention to reduce sitting time when possible.
Background & Aims Type 2 diabetes mellitus (DM) is associated with an increased risk of colorectal cancer (CRC); it is not clear if this association varies by sex or other factors. Insulin use might ...also be associated with CRC risk. We investigated associations of type 2 DM and insulin use with CRC risk. Methods The Cancer Prevention Study II Nutrition Cohort is a prospective study of cancer incidence. In 1992 or 1993, adult participants (n = 184,194) completed a detailed, self-administered questionnaire. Follow-up questionnaires were sent in 1997 and every 2 years thereafter. Cox proportional hazards regression analysis was used to calculate relative risks (RR) and 95% confidence intervals (CI), adjusting for covariates. Results After exclusions, 73,312 men and 81,663 women remained in the final analytic cohort; 1567 men (227 with type 2 DM) and 1242 women (108 with type 2 DM) were diagnosed with colon or rectal cancer by 2007. Among men, type 2 DM was associated with increased risk of incident CRC compared to not having type 2 DM (RR: 1.24; 95% CI: 1.08−1.44); risk was higher for participants with type 2 DM using insulin (RR: 1.36; 95% CI: 1.05−1.78), and participants with type 2 DM not using insulin (RR: 1.22, 95% CI: 1.04−1.45). Among women, type 2 DM and insulin use were not associated with risk of incident CRC (RR: 1.01; 95% CI: 0.82−1.23 and RR: 0.95; 95% CI: 0.64−1.41, respectively). Conclusions There is a modest association between type 2 DM and CRC among men, but not women. Insulin use is not associated with a substantially increased risk of CRC.
This review aimed to synthesize knowledge about multi-criteria decision analysis methods for supporting rehabilitation service design and delivery decisions, including: (1) describing the use of ...these methods within rehabilitation, (2) identifying decision types that can be supported by these methods, (3) describing client and family involvement, and (4) identifying implementation considerations.
We conducted a rapid review in collaboration with a knowledge partner, searching four databases for peer-reviewed articles reporting primary research. We extracted relevant data from included studies and synthesized it descriptively and with conventional content analysis.
We identified 717 records, of which 54 met inclusion criteria. Multi-criteria decision analysis methods were primarily used to understand the strength of clients' and clinicians' preferences (n = 44), and five focused on supporting decision making. Shared decision making with stakeholders was evident in only two studies. Clients and families were mostly engaged in data collection and sometimes in selecting the relevant criteria. Good practices for supporting external validity were inconsistently reported. Implementation considerations included managing cognitive complexity and offering authentic choices.
Multi-criteria decision analysis methods are promising for better understanding client and family preferences and priorities across rehabilitation professions, contexts, and caseloads. Further work is required to use these methods in shared decision making, for which increased use of qualitative methods and stakeholder engagement is recommended.
IMPLICATIONS FOR REHABILITATION
Multi-criteria decision analysis methods are promising for evidence-based, shared decision making for rehabilitation.
However, most studies to date have focused on estimating stakeholder preferences, not supporting shared decision making.
Cognitive complexity and modelling authentic and realistic decision choices are major barriers to implementation.
Stakeholder-engagement and qualitative methods are recommended to address these barriers.
While tobacco and alcohol are established risk factors for hepatocellular carcinoma (HCC), the most common type of primary liver cancer, it is unknown whether they also increase the risk of ...intrahepatic cholangiocarcinoma (ICC). Thus, we examined the association between tobacco and alcohol use by primary liver cancer type.
The Liver Cancer Pooling Project is a consortium of 14 US-based prospective cohort studies that includes data from 1,518,741 individuals (HCC n = 1423, ICC n = 410). Multivariable-adjusted hazards ratios (HRs) and 95% confidence intervals (CI) were estimated using proportional hazards regression.
Current smokers at baseline had an increased risk of HCC (hazard ratio (HR) = 1.86, 95% confidence interval (CI): 1.57-2.20) and ICC (HR = 1.47, 95% CI: 1.07-2.02). Among individuals who quit smoking >30 years ago, HCC risk was almost equivalent to never smokers (HR = 1.09, 95% CI: 0.74-1.61). Compared to non-drinkers, heavy alcohol consumption was associated with an 87% increased HCC risk (HR
= 1.87, 95% CI: 1.41-2.47) and a 68% increased ICC risk (HR
= 1.68, 95% CI: 0.99-2.86). However, light-to-moderate alcohol consumption of <3 drinks/day appeared to be inversely associated with HCC risk (HR
= 0.77, 95% CI: 0.67-0.89; HR
= 0.57, 95% CI: 0.44-0.73; HR
= 0.71, 95% CI: 0.58-0.87), but not ICC.
These findings suggest that, in this relatively healthy population, smoking cessation and light-to-moderate drinking may reduce the risk of HCC.
Diaphragmatic reconstruction is a vital, but challenging component of hiatal hernia and antireflux surgery. Results are optimized by minimizing axial tension along the esophagus, assessed with ...intra-abdominal length, and radial tension across the hiatus, which has not been standardized. We categorized hiatal openings into 4 shapes, as a surrogate for radial tension, to correlate their association with operative interventions and recurrence.
We retrospectively reviewed all primary hiatal hernias (≥3 cm) repaired at a single center between 2010 and 2020. Patients with intraoperative hiatal photos with at least 1 year of follow-up were included. The hiatal openings were classified into 4 shapes: slit, inverted teardrop, “D,” and oval, and ordered in this manner of hypothesized increased complexity and tension.
A total of 239 patients were studied, with 113 (47%) having a recurrence. Age (P < .001), proportion of paraesophageal hernias (P < .001), hernia axial length (P < .001), and hiatal width (P < .001) all increased as shape progressed from slit to inverted teardrop to “D” to oval. Mesh (P = .003) and relaxing incisions (P < .001) were more commonly employed in more advanced shapes, “D” and ovals. However, recurrence (P = .88) did not correlate with hiatal shape.
Four different hiatal shapes are commonly seen during hernia repair. These shapes represent a spectrum of hernia chronicity and complexity necessitating increased use of operative measures but not correlating with recurrence. Despite failing to be a direct marker for recurrence risk, hiatal shape may serve as an intraoperative tool to inform surgeons of the potential need for additional hiatal interventions.
Physical activity is known to provide important health benefits in school-age youth. However, until recently, few studies have examined associations between physical activity and health in young ...children. The purpose of this study was to conduct a systematic review of the relationship between physical activity and selected health outcomes in children younger than 6 yr.
A systematic search identified randomized controlled trials and prospective cohort studies examining the associations between physical activity and adiposity/weight status, bone health, cardiometabolic health, and cognition in children younger than 6 yr.
Twenty-seven studies met inclusion criteria and served as the basis for this systematic review. For weight status/adiposity, 12 of 15 studies found negative associations between physical activity and one or more measures of the outcome. For bone health, 10 articles based on four studies were identified, and nine studies showed stronger bone in more active children. For cardiometabolic health, three studies were identified and findings were limited and inconsistent. For cognition, two systematic reviews were identified and findings were limited. For all four health outcomes, evidence of dose-response relationships and effect modification by demographic factors was very limited.
There is strong evidence indicating that higher amounts of physical activity are associated with better indicators of bone health and with reduced risk for excessive increases in weight and adiposity in children 3 to 6 yr. Evidence was too limited to support conclusions regarding the effects of physical activity on cardiometabolic health and cognition.
Objective
This study was undertaken to identify metabolites associated with BMI and waist circumference (WC) in women and to determine whether these metabolites are associated with biomarkers of ...metabolic health.
Methods
Untargeted metabolomic analysis was done on serum from 1,534 women. Metabolites associated with BMI and WC were identified using linear regression with a Bonferroni‐corrected P value. Clustered blocks of these metabolites were then defined whose association with the anthropometric measures could be represented by a single metabolite. The association of these representative metabolites with biomarkers for diabetes and inflammation was then determined.
Results
About one‐third of 781 metabolites included in the analyses were associated with BMI and/or WC. Associations were found for some novel metabolites, including several sphingolipids, nucleotides, and modified fatty acids. Among metabolites most strongly inversely associated with BMI, the choline‐containing plasmalogen (O‐16:0/18:1) (β = −0.30, P = 6.62 × 10−32) was also inversely associated with c‐peptide and positively associated with adiponectin. Adjustment for BMI attenuated the metabolite‐biomarker associations more for hemoglobin A1c (> 100%) and c‐peptide (58.8% to > 100%) than for C‐reactive protein (10.5%‐40.0%) and adiponectin (7.0%‐30.4%).
Conclusions
These results add to the list of metabolites associated with adiposity and indicate that some may influence processes that contribute to the development of obesity‐related diseases.
Summary
Objective
To evaluate the extent to which self‐esteem mediates the impacts of epilepsy‐specific and environmental factors on mental health outcomes in young people with epilepsy.
Methods
A ...prospective cohort of 480 young people with epilepsy and their families participated in five visits over 28 months. We collected data on clinical seizure burden, cognitive comorbidity, peer and parental support, self‐esteem, and self‐reported mental health symptoms. We used structural equation modeling to specify and test relationships among these constructs simultaneously. Direct, indirect, and total effects were estimated with confidence intervals constructed through bias‐corrected bootstrapping.
Results
Self‐esteem mediated the effects of clinical seizure burden (β = 0.23, 95% confidence interval 0.05, 0.42) and peer support (β = −0.15, 95% CI −0.28, −0.03) on mental health. There were no mediating effects of parental support (β = −0.07, 95% CI −0.14, 0.00) or cognitive comorbidity (β = −0.01, 95% CI −0.02, 0.01) on mental health.
Significance
We found evidence that self‐esteem mediates the impact that both clinical seizure burden and peer support have on mental health outcomes, indicating that assessment of and interventions targeting self‐esteem may be appropriate for young people with epilepsy. Supporting self‐esteem could mitigate negative influences on mental health, whether from resistant epilepsy or low peer support.
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