Journal: BMC Medical Ethics Authors: Judy M. Luu, Anand K. Sergeant, Sonia S. Anand, Dipika Desai, Karleen Schulze, Bartha M. Knoppers, Ma’n H. Zawati, Eric E. Smith, Alan R. Moody, Sandra E. Black, Eric Larose, Francois Marcotte, Erika Kleiderman, Jean-Claude Tardif, Douglas S. Lee, Matthias G. Friedrich on behalf of the CAHHM Study Investigators Abstract Background In the Canadian Alliance for Healthy Hearts and Minds (CAHHM) cohort, participants underwent magnetic resonance imaging (MRI) of the brain, heart, and abdomen, that generated incidental findings (IFs). The approach to managing these unexpected results remain a complex issue. Our objectives were to describe the CAHHM policy for the management of IFs, to understand the impact of disclosing IFs to healthy research participants, and to reflect on the ethical obligations of researchers in future MRI studies. Methods Between 2013 and 2019, 8252 participants (mean age 58 ± 9 years, 54% women) were recruited with a follow-up questionnaire administered to 909 participants (40% response rate) at 1-year. The CAHHM policy followed a restricted approach, whereby routine feedback on IFs was not provided. Only IFs of severe structural abnormalities were reported. Results Severe structural abnormalities occurred in 8.3% (95% confidence interval 7.7–8.9%) of participants, with the highest proportions found in the brain (4.2%) and abdomen (3.1%). The majority of participants (97%) informed of an IF reported no change in quality of life, with 3% of participants reporting that the knowledge of an IF negatively impacted their quality of life. Furthermore, 50% reported increased stress in learning about an IF, and in 95%, the discovery of an IF did not adversely impact his/her life insurance policy. Most participants (90%) would enrol in the study again and perceived the MRI scan to be beneficial, regardless of whether they were informed of IFs. While the implications of a restricted approach to IF management was perceived to be mostly positive, a degree of diagnostic misconception was present amongst participants, indicating the importance of a more thorough consent process to support participant autonomy. Conclusion The management of IFs from research MRI scans remain a challenging issue, as participants may experience stress and a reduced quality of life when IFs are disclosed. The restricted approach to IF management in CAHHM demonstrated a fair fulfillment of the overarching ethical principles of respect for autonomy, concern for wellbeing, and justice. The approach outlined in the CAHHM policy may serve as a framework for future research studies.   Link: https://bmcmedethics.biomedcentral.com/articles/10.1186/s12910-021-00706-3#group-1

Journal: Brain and Behavior Authors: Lonneke A. van Tuijl, Adri C. Voogd, Alexander de Graeff, Adriaan W. Hoogendoorn, Adelita V. Ranchor, Kuan-Yu Pan, Maartje Basten, Femke Lamers, Mirjam I. Geerlings, Jessica G. Abell, Philip Awadalla, Marije F. Bakker, Aartjan T.F. Beekman, Ottar Bjerkeset, Andy Boyd, Yunsong Cui, Henrike Galenkamp, Bert Garssen, Sean Hellingman, Martijn Huisman, Anke Huss, Melanie R. Keats, Almar A. L. Kok, Annemarie I. Luik, Nolwenn Noisel, N. Charlotte Onland-Moret, Yves Payette, Brenda W. J. H. Penninx, Lützen Portengen, Ina Rissanen, Annelieke M. Roest, Judith G. M. Rosmalen, Rikje Ruiter, Robert A. Schoevers, David M. Soave, Mandy Spaan, Andrew Steptoe, Karien Stronks, Erik R. Sund, Ellen Sweeney, Alison Teyhan, Ilonca Vaartjes, Kimberly D. van der Willik, Flora E. van Leeuwen, Rutger van Petersen, W.M.Monique Verschuren, Frank Visseren, Roel Vermeulen, Joost Dekker. (2021). “Psychosocial factors and cancer incidence (PSY-CA): protocol for individual participant data meta-analyses.” Brain and Behavior. Abstract Objectives: Psychosocial factors have been hypothesized to increase the risk of cancer. This study aims (1) to test whether psychosocial factors (depression, anxiety, recent loss events, subjective social support, relationship status, general distress, and neuroticism) are associated with the incidence of any cancer (any, breast, lung, prostate, colorectal, smoking-related, and alcohol-related); (2) to test the interaction between psychosocial factors and factors related to cancer risk (smoking, alcohol use, weight, physical activity, sedentary behavior, sleep, age, sex, education, hormone replacement therapy, and menopausal status) with regard to the incidence of cancer; and (3) to test the mediating role of health behaviors (smoking, alcohol use, weight, physical activity, sedentary behavior, and sleep) in the relationship between psychosocial factors and the incidence of cancer. Methods: The psychosocial factors and cancer incidence (PSY-CA) consortium was established involving experts in the field of (psycho-)oncology, methodology, and epidemiology. Using data collected in 18 cohorts (N = 617,355), a preplanned two-stage individual participant data (IPD) meta-analysis is proposed. Standardized analyses will be conducted on harmonized datasets for each cohort (stage 1), and meta-analyses will be performed on the risk estimates (stage 2). Conclusion: PSY-CA aims to elucidate the relationship between psychosocial factors and cancer risk by addressing several shortcomings of prior meta-analyses. https://doi.org/10.1002/brb3.2340

Title: Post-Treatment Adverse Health Correlates among Prostate Cancer Survivors in a Sample of Men Residing in Atlantic Canada Journal: Current Oncology Authors: Gabriela Ilie, Rob Rutledge and Ellen Sweeney Abstract: Background: Recent large population-based studies have shed light on an association between prostate cancer (PCa) survivorship and mental health, which emerged when the comparison group was either men without a history of cancer or those with any other type of cancer except prostate. Here we examine the role of surgery alone, compared to other types of treatment modalities in this association in a population-based sample of men with prostate or other types of cancer. Methods: A cross-sectional analysis was conducted on a subsample of 632 male participants aged 36–69 from the 2009–2015 survey cycle of the Atlantic PATH cohort study. The primary outcomes were the presence of mild, moderate or severe depression or anxiety indicators and were assessed using the seven-item generalized anxiety disorder (GAD-7) scale and the nine-item Patient Health Questionnaire (PHQ-9), respectively. The presence of a lifetime history of PCa or other form of cancer (except PCa) was the main predictor variable and was assessed in cancer treatment modality (surgery or other types of treatment modalities) stratified analyses. Covariates included age, marital status, household income, comorbidity, and survivorship time. Results: The presence of depression in this sample was prevalent among 17.7% of men, and of anxiety among 9.3% of men. Survivors who were treated with surgery for their PCa diagnosis had 7.55 statistically significantly higher odds of screening positive for current depression symptoms compared with those of other forms of cancer in controlled analyses. These differences were not observed for anxiety. Conclusions: These findings emphasize the need for multidisciplinary survivorship care plans among PCa patients, especially those who undergo surgery. Targeted programming aimed at prioritizing and delivering comprehensive mental health support to PCa survivors early in the survivorship journey is justified. https://doi.org/10.3390/curroncol28040246

Journal: Journal of Cardiopulmonary Rehabilitation and Prevention Authors: Daniel Stevens, Pantelis Andreou, Daniel Rainham Abstract : Purpose: Physical activity (PA) predicts important health outcomes in chronic obstructive pulmonary disease (COPD). In the general population, environmental factors have the potential to influence PA; however, data are limited in this clinical population. Therefore, we sought to investigate associations between the environment and PA, sedentary behavior, and self-rated health in COPD. Methods: Sociodemographic, PA, sedentary behavior, and self-rated health data were collected from a prospective cohort of 418 individuals with COPD (65% female; 58 ± 8 yr), while environmental data were drawn from a national environmental data repository and individually matched to participant postal code. Environmental variables included social and material deprivation, urban form index, surrounding greenness, and air quality (concentrations of air pollution for fine particles, nitrogen dioxide, ozone, and sulphur dioxide). Logistic and multivariate linear regression models were used to investigate the strongest environmental predictors. Results: The models showed a statistically significant negative correlation between PA level and ozone pollution (P = .023; adjusted OR = 0.85: 95% CI, 0.74-0.98). Urban form index was also significantly associated with sedentary behavior (β = 0.113; t value = 1.71; P = .011). Self-rated health was significantly positively correlated with PA level (P = .006; adjusted OR = 2.22: 95% CI, 1.25-3.94), and significantly inversely correlated with sedentary behavior (β = −0.159; t value =−2.42; P = .016). Conclusion: These new data may identify barriers to PA and assist clinicians in the prescription of exercise for individuals living with COPD. doi: 10.1097/HCR.0000000000000628

Title: Age and Sex-Specific Associations in Health Risk Factors for Chronic Disease: Evidence from the Atlantic Partnership for Tomorrow’s Health (PATH) Cohort Journal: Canadian Journal on Aging Authors: Vanessa DeClercq and Ellen Sweeney Abstract: The objective of this study was to discern health risk factors for chronic disease by age and sex in a Canadian cohort. Participants of the Atlantic Partnership for Tomorrow’s Health (PATH) cohort with health risk factor data (physical activity, smoking, alcohol consumption, diet, body mass index [BMI]) were included (n = 16,165). Multivariable logistic regression models were used to evaluate the relationship among health risk factors, age, and sex. Regression analysis revealed that the odds of engaging in high levels of physical activity and having a BMI ≥ 25 was lower for females than males across all age groups, whereas the odds of abdominal obesity was substantially higher for females of all ages than for males. The odds of habitually consuming alcohol was lower for females of all ages than for males, and the odds of being a former/current smoker was lower for older (57–74 years of age) females than for males. The odds of consuming five or more servings of fruit and vegetables per day was higher for females of all ages than for males. There are evident differences in health risk factors for males and for females, as well as across age groups, and public health efforts need to account for the role played by sex and age in addressing chronic disease burden in Canadian adults.