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Frontiers in Endocrinology 2023Pancreatic signet ring cell carcinoma (PSRCC) is a rare and aggressive cancer that has been reported primarily as case reports. Due to limited large-scale... (Observational Study)
Observational Study
BACKGROUND
Pancreatic signet ring cell carcinoma (PSRCC) is a rare and aggressive cancer that has been reported primarily as case reports. Due to limited large-scale epidemiological and prognostic analyses, the outcomes of PSRCC patients varies greatly in the absence of recognized first-line treatment strategies. This study aimed to compare the clinical features, treatment, and prognosis of PSRCC and pancreatic ductal cell carcinoma (PDAC), the most common subtype of pancreatic cancer, and to establish predictive models for these subtypes.
METHODS
The data on PSRCC and PDAC patients from 1998 to 2018 was obtained from the Surveillance, Epidemiology, and End Results (SEER) database. Thereafter, the clinical, demographic, and treatment characteristics of the two groups and the differences and influencing factors of the two groups were evaluated by propensity score matching (PSM), Kaplan-Meier survival curves, Cox risk regression analyses, and least absolute shrinkage and selection operator (LASSO) analysis. Next, prognosis models were constructed and validated by KM and ROC analysis. Finally, a nomogram was constructed, based on the results of these analyses, to predict survival outcomes of PSRCC and PDAC patients.
RESULTS
A total of 84,789 patients (432 PSRCC and 84357 PDAC patients) were included in this study. The results of the study revealed that, compared to the PDAC patients, PSRCC patients were more likely to be male, aged between 58-72 years, have larger tumor masses, and less likely to undergo chemotherapy. Before PSM, the overall survival and cancer-specific survival of the PSRCC group were significantly lower than those PDAC group, but there was no difference in the prognosis of the two groups after PSM. Additionally, lymph node ratio (LNR), log odds of positive lymph node (LODDS), tumor size, age, T-stage, marital status, and summary stage were found to be independent prognostic factors for PSRCC. Lastly, the prediction model and nomogram based on these prognostic factors could accurately predict the survival rate of the patients in SEER datasets and external validation datasets.
CONCLUSION
The prognosis of PSRCC and PDAC patients is similar under the same conditions; however, PSRCC patients may have more difficulty in receiving better treatment, thus resulting in their poor prognosis.
Topics: Humans; Male; Middle Aged; Aged; Female; Prognosis; Pancreatic Neoplasms; Carcinoma, Pancreatic Ductal; Carcinoma, Signet Ring Cell
PubMed: 37534212
DOI: 10.3389/fendo.2023.1205594 -
Journal of Marital and Family Therapy Oct 2023
Topics: Humans; Marital Therapy; Family Therapy
PubMed: 37873556
DOI: 10.1111/jmft.12675 -
Journal of Marital and Family Therapy Apr 2024The connection between adverse childhood experiences (ACEs) and anxiety disorders is well-documented. Additionally, therapy has been shown to be effective at reducing...
The connection between adverse childhood experiences (ACEs) and anxiety disorders is well-documented. Additionally, therapy has been shown to be effective at reducing anxiety symptoms. Yet more needs to be known about how ACEs may shape the process of therapy and the trajectory of anxiety symptoms. This study was designed to compare the trajectory of improvement in anxiety symptoms over the course of 12 sessions of therapy in adults (N = 472), who reported more (greater than four) and fewer (fewer than four) ACEs using a multigroup latent growth curve analysis. Data were drawn from the Marriage and Family Therapy Practice Research Network database. Results suggested that the rate of improvement in those with more and fewer ACEs was not significantly different; however, those with more ACEs had a significantly higher average starting point of anxiety symptoms.
PubMed: 38602712
DOI: 10.1111/jmft.12703 -
Circulation Jul 2023Low socioeconomic status is associated with worse secondary prevention use and prognosis after myocardial infarction (MI). Actions for health equity improvements warrant...
BACKGROUND
Low socioeconomic status is associated with worse secondary prevention use and prognosis after myocardial infarction (MI). Actions for health equity improvements warrant identification of risk mediators. Therefore, we assessed mediators of the association between socioeconomic status and first recurrent atherosclerotic cardiovascular disease event (rASCVD) after MI.
METHODS
In this cohort study on 1-year survivors of first-ever MI with Swedish universal health coverage ages 18 to 76 years, individual-level data from SWEDEHEART (Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) and linked national registries was collected from 2006 through 2020. Exposure was socioeconomic status by disposable income quintile (principal proxy), educational level, and marital status. The primary outcome was rASCVD and secondary outcomes were cardiovascular and all-cause mortality. We initially assessed the incremental attenuation of hazard ratios with 95% CIs in sequential multivariable models adding groups of potential mediators (ie, previous risk factors, acute presentation and infarct severity, initial therapies, and secondary prevention). Thereafter, the proportion of excess rASCVD associated with a low income mediated through nonparticipation in cardiac rehabilitation, suboptimal statin management, a cardiometabolic risk profile, persistent smoking, and blood pressure above target after MI were calculated using causal mediation analysis.
RESULTS
Among 68 775 participants (73.8% men), 7064 rASCVD occurred during a mean 5.7-year follow-up. Income, adjusted for age, sex, and calendar year, was associated with rASCVD (hazard ratio, 1.63 [95% CI, 1.51-1.76] in the lowest versus highest income quintile). Risk attenuated most by adjustment for previous risk factors and by adding secondary prevention variables for a final model (hazard ratio, 1.38 [95% CI, 1.26-1.51]) in the lowest versus highest income quintile. The proportions of the excess 15-year rASCVD risk in the lowest income quintile mediated through nonparticipation in cardiac rehabilitation, cardiometabolic risk profile, persistent smoking, and poor blood pressure control were 3.3% (95% CI 2.1-4.8), 3.9% (95% CI, 2.9-5.5), 15.2% (95% 9.1-25.7), and 1.0% (95% CI 0.6-1.5), respectively. Risk mediation through optimal statin management was negligible.
CONCLUSIONS
Nonparticipation in cardiac rehabilitation, a cardiometabolic risk profile, and persistent smoking mediate income-dependent prognosis after MI. In the absence of randomized trials, this causal inference approach may guide decisions to improve health equity.
Topics: Male; Humans; Female; Cardiovascular Diseases; Cohort Studies; Socioeconomic Disparities in Health; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Myocardial Infarction; Atherosclerosis; Risk Factors
PubMed: 37459408
DOI: 10.1161/CIRCULATIONAHA.123.064440 -
Journal of Marital and Family Therapy Oct 2023Relationship standards are beliefs about what is important in high-quality couple relationships. Clarifying standards cross-culturally informs theory about relationship...
Relationship standards are beliefs about what is important in high-quality couple relationships. Clarifying standards cross-culturally informs theory about relationship quality and goals for culturally appropriate couple therapy. The current study assessed four standards (Couple Bond, Family Responsibility, Relationship Effort, and Religion) in n = 113 Malay Muslim couples, and the association of those standards with marital satisfaction. All four standards were strongly endorsed, Religion was the most strongly endorsed, and there were minimal sex differences. Separate actor-partner interdependence models showed actor effects of all four standards on own satisfaction for husbands and wives, partner effects of three of the four husbands' standards (not Relationship Effort) on wives' satisfaction, but no partner effects of female standards on male satisfaction. The findings underscore the importance of all four standards in Malay Muslim marriages and that attention to all these standards might need to be part of couple therapy with Malay couples.
PubMed: 37545186
DOI: 10.1111/jmft.12659 -
Annals of the American Thoracic Society Dec 2023Pulmonary arterial hypertension (PAH) is a heterogeneous disease within a complex diagnostic and treatment environment. Other complex heart and lung diseases have...
Pulmonary arterial hypertension (PAH) is a heterogeneous disease within a complex diagnostic and treatment environment. Other complex heart and lung diseases have substantial regional variation in characteristics and outcomes; however, this has not been previously described in PAH. To identify baseline differences between U.S. census regions in the characteristics and outcomes for participants in the Pulmonary Hypertension Association Registry (PHAR). Adults with PAH were divided into regional groups (Northeast, South, Midwest, and West), and baseline differences between census regions were presented. Kaplan-Meier survival analyses and Cox proportional hazards were used to estimate the association between region and mortality in unadjusted and adjusted models. Substantial differences by census regions were seen in age, race, ethnicity, marital status, employment, insurance payor breakdown, active smoking, and current alcohol use. Differences were also seen in PAH etiology and baseline 6-minute walk distance test results. Treatment characteristics varied by census region, and mortality appeared to be lower in PHAR participants in the West (hazard ratio, 0.60; 95% confidence interval, 0.43-0.83, = 0.005). This difference was not readily explained by differences in demographic characteristics, PAH etiology, baseline severity, baseline medication regimen, or disease prevalence. The present study suggests significant regional variation among participants at accredited pulmonary vascular disease centers in multiple baseline characteristics and mortality. This variation may have implications for clinical research planning and represent an important focus for further study to better understand whether there are remediable care aspects that can be addressed in the pursuit of providing equitable care in the United States.
Topics: Adult; Humans; United States; Hypertension, Pulmonary; Pulmonary Arterial Hypertension; Familial Primary Pulmonary Hypertension; Proportional Hazards Models; Registries
PubMed: 37683277
DOI: 10.1513/AnnalsATS.202305-424OC -
Journal of Hand Surgery Global Online Sep 2023With trapeziometacarpal osteoarthritis (TMC OA), the relationship between disease severity and pretreatment dysfunction, patient expectations, and preferred patient...
PURPOSE
With trapeziometacarpal osteoarthritis (TMC OA), the relationship between disease severity and pretreatment dysfunction, patient expectations, and preferred patient treatment and management remains unclear. This study aimed to assess the association between functional status, pretreatment expectations, and demographic and clinical characteristics of TMC OA patients who decide to undergo operative management.
METHODS
Patients diagnosed with TMC OA (n = 96) were administered the Thumb Arthritis Expectations Survey and the Brief Michigan Hand Questionnaire (bMHQ) during their initial office visit. Demographic data (sex, age, race, education level, marital status, comorbidities, and hand dominance) and clinical characteristics (prior injury, and therapeutic interventions including splinting, steroid injections, therapy, and anti-inflammatory medication) were collected. Multiple logistic regression was used to assess the association between surgical treatment and expectation scores.
RESULTS
Our logistic regression model found that lower bMHQ scores, high thumb arthritis expectation survey scores, and prior treatments for TMC OA were associated significantly with the surgical treatment of TMC OA. After controlling for all possible covariates, the odds of having surgery was 3.9 times higher among patients with high expectations (above median) compared to patients with low expectations (adjusted odds ratio [AOR], 3.9; 95% confidence interval [CI], 1.3-11.2). Patients with average function, as measured by bMHQ scores, were 74.5% less likely to elect for surgery than those with the lowest bMHQ (AOR, 0.3; 95% CI, 0.1-0.9). Patients treated previously with steroids were 13 times more likely to elect for surgery than those who were never treated for TMC arthritis (AOR,13.1; 95% CI, 2.2-77.0).
CONCLUSIONS
Patients with TMC OA who elect to proceed with surgical management have lower bMHQ (greater perceived dysfunction) and higher expectations, and have had prior treatment. Age was not a significant predictor of surgical management of TMC OA.
TYPE OF STUDY/LEVEL OF EVIDENCE
Prognostic IV.
PubMed: 37790830
DOI: 10.1016/j.jhsg.2023.05.001 -
Heliyon Jan 2024Marital infidelity is a highly distressing experience for those involved. Understanding the psychological factors related to infidelity can help develop targeted...
OBJECTIVES
Marital infidelity is a highly distressing experience for those involved. Understanding the psychological factors related to infidelity can help develop targeted interventions. The primary aim of this study was to assess the association between attachment styles and marital infidelity.
METHODS
Seventeen studies were included, sourced from electronic databases including PubMed, Scopus, Web of Science, and PsycInfo, with no time limitations, up to April 2023. The search employed terms like "attachment AND marital infidelity." Study quality was evaluated using the Risk of Bias Assessment Tool from RevMan version 5.3.
RESULTS
The meta-analysis involved a total of 13,666 participants, ranging from 208 to 4047 individuals. Findings showed that higher levels of anxiety and avoidance in attachment were significantly associated with increased marital infidelity ( = 0.18, 95 % CI = 0.14-0.22, p < 0.0001). Conversely, weaker attachment insecurity was linked to reduced rates of marital infidelity. Additionally, both dismissive and fearful attachment styles correlated with marital infidelity, with respective weighted effect sizes of = 0.07, p < 0.001 (95 % CI = 0.04-0.10) and = 0.19, p < 0.001 (95 % CI = 0.10-0.29). No association was found between preoccupied attachment and infidelity.
CONCLUSION
Individuals with insecure attachment styles, specifically those with high levels of anxiety or avoidance, are more likely to engage in marital infidelity. Attachment styles should be a focus in couples therapy, especially for treatment related to infidelity. Assessing and addressing these underlying attachment issues can better guide therapists in their work with couples facing infidelity.
PubMed: 38163207
DOI: 10.1016/j.heliyon.2023.e23261 -
JMIR Research Protocols Apr 2024Patients with gastric cancer experience different degrees of fear of cancer recurrence. The fear of cancer recurrence can cause and worsen many physical and...
BACKGROUND
Patients with gastric cancer experience different degrees of fear of cancer recurrence. The fear of cancer recurrence can cause and worsen many physical and psychological problems. We considered the "intimacy and relationship processes in couples' psychosocial adaptation" model.
OBJECTIVE
The study aims to examine the effectiveness of a marital self-disclosure intervention for improving the level of fear of cancer recurrence and the dyadic coping ability among gastric cancer survivors and their spouses.
METHODS
This is a quasiexperimental study with a nonequivalent (pretest-posttest) control group design. The study will be conducted at 2 tertiary hospitals in Taizhou City, Jiangsu Province, China. A total of 42 patients with gastric cancer undergoing chemotherapy and their spouses will be recruited from each hospital. Participants from Jingjiang People's Hospital will be assigned to an experimental group, while participants from Taizhou People's Hospital will be assigned to a control group. The participants in the experimental group will be involved in 4 phases of the marital self-disclosure (different topics, face-to-face) intervention. Patients will be evaluated at baseline after a diagnosis of gastric cancer and reassessed 2 to 4 months after baseline. The primary outcome is the score of the Fear of Progression Questionnaire-Short Form (FoP-Q-SF) for patients. The secondary outcomes are the scores of the FoP-Q-SF for partners and the Dyadic Coping Inventory.
RESULTS
Research activities began in October 2022. Participant enrollment and data collection began in February 2023 and are expected to be completed in 12 months. The primary results of this study are anticipated to be announced in June 2024.
CONCLUSIONS
This study aims to assess a marital self-disclosure intervention for improving the fear of cancer recurrence in Chinese patients with gastric cancer and their spouses. The study is likely to yield desirable positive outcomes as marital self-disclosure is formulated based on evidence and inputs obtained through stakeholder interviews and expert consultation. The study process will be carried out by nurses who have received psychological training, and the quality of the intervention will be strictly controlled.
TRIAL REGISTRATION
ClinicalTrials.gov NCT05606549; https://clinicaltrials.gov/study/NCT05606549.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)
DERR1-10.2196/55102.
Topics: Adult; Female; Humans; Male; Middle Aged; Adaptation, Psychological; China; East Asian People; Fear; Marriage; Neoplasm Recurrence, Local; Self Disclosure; Spouses; Stomach Neoplasms; Surveys and Questionnaires
PubMed: 38684089
DOI: 10.2196/55102 -
Journal of Pain and Symptom Management Aug 2023Evidence-based interventions addressing the needs of couples co-parenting young children while facing an advanced cancer diagnosis are lacking. Thus, this study seeks to...
BACKGROUND
Evidence-based interventions addressing the needs of couples co-parenting young children while facing an advanced cancer diagnosis are lacking. Thus, this study seeks to identify parenting-related intervention needs and delivery preferences of advanced cancer patients and their spouses/co-parents.
METHODS
Twenty-one couples completed quantitative measures of cancer-related parenting concerns, relationship and family functioning, and service needs along with individual semi-structured interviews.
RESULTS
Patients (mean age=44 years, 48% female, 91% White) and spouses (mean age=45 years, 52% female, 91% White) reported family distress (62% of couples) and marital distress (29% of couples). Parenting concerns were generally high with patients revealing concerns particularly regarding the practical impact of the cancer on the child(ren). Spouses rated concerns about the co-parent significantly higher (P<.001) than patients. Parenting concerns were inversely associated with relationship (P<.001 for patients; P=.03 for spouses) and family functioning (P<.001 for patients). Themes identified through qualitative interviews include needs related to maintenance of family routines and traditions, childcare, transportation, meals, home maintenance, and finances. Couples who endorsed marital distress also indicated a need for conflict resolution skills. All patients and 89% of spouses would like to receive parenting-related education/services; up to 50% of couples preferred targeted, self-led readings without therapist support; and up to 50% desired counseling sessions indicating a preference towards dyadic and video conferenced intervention delivery.
CONCLUSIONS
The delivery of optimal supportive care involves a family-focused perspective such as screening for parenting status and referrals to social work services to address the need of tangible resources and manage parenting-related distress.
Topics: Child; Humans; Female; Child, Preschool; Adult; Middle Aged; Male; Parenting; Needs Assessment; Parents; Neoplasms; Spouses
PubMed: 37148983
DOI: 10.1016/j.jpainsymman.2023.04.027