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Sawadogo W, Adera T, Burch JB, Alattar M, Perera R, Howard VJ. Sleep duration and all-cause mortality among stroke survivors. J Stroke Cerebrovasc Dis 2024; 33:107615. [PMID: 38307468 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107615] [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: 10/16/2023] [Revised: 01/25/2024] [Accepted: 01/30/2024] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Post stroke sleep duration could increase the risk of death. This study tested the hypothesis that inadequate sleep duration is associated with increased mortality among stroke survivors. METHODS The REasons for Geographic And Racial Differences in Stroke (REGARDS), a national population-based longitudinal study, was the data source. Sleep duration was ascertained between 2013 and 2016 among stroke survivors who were subsequently followed up until death or censored on December 31, 2022. Sleep duration was estimated as the difference between wake-up time and bedtime to which was subtracted the time spent in bed without sleep. Cox proportional hazards regression models were employed to investigate the association between sleep duration and all-cause mortality adjusting for demographic factors, socioeconomic factors, behavioral factors, and co-morbidities. RESULTS A total of 468 non-Hispanic Black and White stroke survivors were included in this analysis. The mean age was 76.3 years, 52.6% were females and 56.0% were non-Hispanic White individuals. The distribution of short (≤6 h), adequate (7.0-8.9 h), and long sleep (≥9 h) was 30.3%, 44.7%, and 25%, respectively. Over a mean follow-up of 5.0 years, 190 (40.6%) deaths occurred. Compared to stroke survivors with adequate sleep (7.0-8.9 h), stroke survivors with long sleep (≥9 h) were at increased risk of all-cause mortality (HR=1.46, 95% CI=1.01, 2.12). However, short sleep (≤6 h) was not significantly associated with an increased risk of all-cause mortality (HR=1.31, 95% CI=0.90, 1.91). Subgroup analyses indicated higher risk in the age <75 years, females, non-Hispanic Black individuals, and those living in the Stroke Belt region, but those differences were not statistically significant. CONCLUSION In this study of stroke survivors, 9 hours or more of sleep per day was associated with an increased risk of all-cause mortality. This finding suggests that excessive sleep duration may be a warning sign of poor life expectancy in stroke survivors.
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Affiliation(s)
- Wendemi Sawadogo
- Department of Public Health, College of Human and Health Services, Southern Connecticut State University, New Haven, CT, United States; Department of Epidemiology, School of Population Health, Virginia Commonwealth University, Richmond, VA, United States.
| | - Tilahun Adera
- Department of Epidemiology, School of Population Health, Virginia Commonwealth University, Richmond, VA, United States
| | - James B Burch
- Department of Epidemiology, School of Population Health, Virginia Commonwealth University, Richmond, VA, United States
| | - Maha Alattar
- Division of Adult Neurology, Sleep Medicine, Vascular Neurology, Department of Neurology, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Robert Perera
- Department of Biostatistics, School of Population Health, Virginia Commonwealth University, Richmond, VA, United States
| | - Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
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Burch JB, Delage AF, Zhang H, McLain AC, Ray MA, Miller A, Adams SA, Hébert JR. Sleep disorders and cancer incidence: examining duration and severity of diagnosis among veterans. Front Oncol 2024; 14:1336487. [PMID: 38469244 PMCID: PMC10927008 DOI: 10.3389/fonc.2024.1336487] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/29/2024] [Indexed: 03/13/2024] Open
Abstract
Introduction Sleep disruption affects biological processes that facilitate carcinogenesis. This retrospective cohort study used de-identified data from the Veterans Administration (VA) electronic medical record system to test the hypothesis that patients with diagnosed sleep disorders had an increased risk of prostate, breast, colorectal, or other cancers (1999-2010, N=663,869). This study builds upon existing evidence by examining whether patients with more severe or longer-duration diagnoses were at a greater risk of these cancers relative to those with a less severe or shorter duration sleep disorder. Methods Incident cancer cases were identified in the VA Tumor Registry and sleep disorders were defined by International Classification of Sleep Disorder codes. Analyses were performed using extended Cox regression with sleep disorder diagnosis as a time-varying covariate. Results Sleep disorders were present among 56,055 eligible patients (8% of the study population); sleep apnea (46%) and insomnia (40%) were the most common diagnoses. There were 18,181 cancer diagnoses (41% prostate, 12% colorectal, 1% female breast, 46% other). The hazard ratio (HR) for a cancer diagnosis was 1.45 (95% confidence interval [CI]: 1.37, 1.54) among those with any sleep disorder, after adjustment for age, sex, state of residence, and marital status. Risks increased with increasing sleep disorder duration (short [<1-2 years] HR: 1.04 [CI: 1.03-1.06], medium [>2-5 years] 1.23 [1.16-1.32]; long [>5-12 years] 1.52 [1.34-1.73]). Risks also increased with increasing sleep disorder severity using cumulative sleep disorder treatments as a surrogate exposure; African Americans with more severe disorders had greater risks relative to those with fewer treatments and other race groups. Results among patients with only sleep apnea, insomnia, or another sleep disorder were similar to those for all sleep disorders combined. Discussion The findings are consistent with other studies indicating that sleep disruption is a cancer risk factor. Optimal sleep and appropriate sleep disorder management are modifiable risk factors that may facilitate cancer prevention.
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Affiliation(s)
- James B. Burch
- Department of Epidemiology, School of Population Health, Virginia Commonwealth University, Richmond, VA, United States
| | - Alexandria F. Delage
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- Palmetto GBA, Columbia, SC, United States
| | - Hongmei Zhang
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, United States
| | - Alexander C. McLain
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Meredith A. Ray
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, United States
| | - Austin Miller
- Alabama College of Osteopathic Medicine, Dothan, AL, United States
| | - Swann A. Adams
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- Department of Biobehavioral Health and Nursing Science, College of Nursing, University of South Carolina, Columbia, SC, United States
| | - James R. Hébert
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- South Carolina Statewide Cancer Prevention & Control Program, University of South Carolina, Columbia, SC, United States
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Sawadogo W, Adera T, Alattar M, Perera R, Burch JB. Association Between Insomnia Symptoms and Trajectory With the Risk of Stroke in the Health and Retirement Study. Neurology 2023; 101:e475-e488. [PMID: 37286360 PMCID: PMC10401688 DOI: 10.1212/wnl.0000000000207449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 04/10/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Insomnia is a common condition affecting more than a third of the US population. However, the link between insomnia symptoms and stroke is understudied and the underlying mechanism remains unclear. This study aimed to investigate the relationship between insomnia symptoms and the incidence of stroke. METHODS The Health and Retirement Study, a survey of Americans older than 50 years and their spouses, from 2002 to 2020 was used as the data source. Only those who were stroke-free at baseline were included in this study. The exposure variable was insomnia symptoms and was derived from self-reported sleep-related factors including difficulty initiating sleep, difficulty maintaining sleep, waking up too early, and nonrestorative sleep. Repeated-measures latent class analysis was used to identify insomnia trajectories over time. To investigate the relationship between insomnia symptoms and stroke events reported during the follow-up period, Cox proportional hazards regression models were used. Mediation analyses of comorbidities were performed using causal mediation within a counterfactual framework. RESULTS A total of 31,126 participants were included with a mean follow-up of 9 years. The mean age was 61 years (SD = 11.1) and 57% were females. Insomnia symptom trajectories remained constant over time. Compared with those with no insomnia symptoms, an increased risk of stroke was observed for those with insomnia symptom scores ranging from 1 to 4 and 5 to 8 (hazard ratio (HR) = 1.16, 95% confidence interval (CI) 1.02-1.33) and (HR = 1.51, 95% CI 1.29-1.77), respectively, indicating a dose-response relationship. The association was stronger in participants younger than 50 years (HR = 3.84, 95% CI 1.50-9.85) than in those aged 50 years and older (HR = 1.38, 95% CI 1.18-1.62), comparing those with insomnia symptoms ranging from 5 to 8 with those with no insomnia symptoms. This association was mediated by diabetes, hypertension, heart disease, and depression. DISCUSSION Insomnia symptoms were associated with an increased risk of stroke, especially in adults younger than 50 years, and the risk was mediated by certain comorbidities. Increased awareness and management of insomnia symptoms may contribute to the prevention of stroke occurrence.
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Affiliation(s)
- Wendemi Sawadogo
- From the Division of Epidemiology (W.S., T.A., J.B.B.), Department of Family Medicine and Population Health, and Division of Adult Neurology (M.A.), Sleep Medicine, Vascular Neurology, Department of Neurology; and Department of Biostatistics (R.P.), Virginia Commonwealth University, School of Medicine, Richmond.
| | - Tilahun Adera
- From the Division of Epidemiology (W.S., T.A., J.B.B.), Department of Family Medicine and Population Health, and Division of Adult Neurology (M.A.), Sleep Medicine, Vascular Neurology, Department of Neurology; and Department of Biostatistics (R.P.), Virginia Commonwealth University, School of Medicine, Richmond
| | - Maha Alattar
- From the Division of Epidemiology (W.S., T.A., J.B.B.), Department of Family Medicine and Population Health, and Division of Adult Neurology (M.A.), Sleep Medicine, Vascular Neurology, Department of Neurology; and Department of Biostatistics (R.P.), Virginia Commonwealth University, School of Medicine, Richmond
| | - Robert Perera
- From the Division of Epidemiology (W.S., T.A., J.B.B.), Department of Family Medicine and Population Health, and Division of Adult Neurology (M.A.), Sleep Medicine, Vascular Neurology, Department of Neurology; and Department of Biostatistics (R.P.), Virginia Commonwealth University, School of Medicine, Richmond
| | - James B Burch
- From the Division of Epidemiology (W.S., T.A., J.B.B.), Department of Family Medicine and Population Health, and Division of Adult Neurology (M.A.), Sleep Medicine, Vascular Neurology, Department of Neurology; and Department of Biostatistics (R.P.), Virginia Commonwealth University, School of Medicine, Richmond
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Nevels TL, Wirth MD, Ginsberg JP, McLain AC, Burch JB. The role of sleep and heart rate variability in metabolic syndrome: evidence from the Midlife in the United States study. Sleep 2023; 46:zsad013. [PMID: 36727300 PMCID: PMC10171632 DOI: 10.1093/sleep/zsad013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 12/11/2022] [Indexed: 02/03/2023] Open
Abstract
STUDY OBJECTIVES Poor sleep and autonomic dysregulation can both disrupt metabolic processes. This study examined the individual and combined effects of poor sleep and reduced heart rate variability (HRV) on metabolic syndrome among 966 participants in the Midlife in the United States II (MIDUS II) study. METHODS Self-reported sleep was assessed using the Pittsburgh Sleep Quality Index (PSQI). HRV was acquired from 11-minute resting heart rate recordings. Spearman correlations, general linear regression, and logistic regression models were used to examine the study hypotheses. RESULTS Poor sleep quality was associated with metabolic syndrome when global PSQI scores were evaluated as a continuous (odds ratio [OR]: 1.07, 95% confidence interval [CI]: 1.03 to 1.11) or categorical measure (cutoff > 5, OR: 1.58, 95% CI: 1.19 to 2.10), after adjustment for confounding. There also was an association between reduced HRV and metabolic syndrome (ln [HF-HRV] OR: 0.89, 95% CI: 0.80 to 0.99; ln [LF-HRV] OR: 0.82, 95% CI: 0.72 to 0.92; ln [SDRR] OR: 0.59, 95% CI: 0.43 to 0.79; ln [RMSSD] OR: 0.75, 95% CI: 0.60 to 0.94). When the combined effects of poor sleep and low HRV were examined, the association with metabolic syndrome was further strengthened relative to those with normal sleep and HRV. CONCLUSIONS To the best of the author's knowledge, this is the first study to suggest a combined effect of poor sleep and low HRV on the odds of metabolic syndrome.
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Affiliation(s)
- Torrance L Nevels
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Columbia Veterans Affairs Health Care System, Columbia, SC, USA
- U.S. Military Interservice Physician Assistant Program, MEDCoE, Joint Base San Antonio-Fort Sam Houston, TX, USA
| | - Michael D Wirth
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- College of Nursing, University of South Carolina, Columbia, SC, USA
| | - J P Ginsberg
- Department of Pathology, Microbiology, and Immunology, Saybrook University, Pasadena, CA, USA
| | - Alexander C McLain
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - James B Burch
- Department of Family Medicine and Population Health, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
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Wirth MD, Fekedulegn D, Andrew ME, McLain AC, Burch JB, Davis JE, Hébert JR, Violanti JM. Longitudinal and cross-sectional associations between the dietary inflammatory index and objectively and subjectively measured sleep among police officers. J Sleep Res 2021; 31:e13543. [PMID: 34967055 PMCID: PMC9240102 DOI: 10.1111/jsr.13543] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/01/2021] [Accepted: 12/18/2021] [Indexed: 11/30/2022]
Abstract
Police officers experience exposures associated with increased inflammation, such as the stress associated with shiftwork and poor-quality diet, both of which have been shown to affect sleep duration and quality. This study examined the longitudinal and cross-sectional effects of the Energy-density Dietary Inflammatory Index (E-DII™) on objectively and subjectively measured sleep among police officers. Data were derived from the Buffalo Cardio-Metabolic Occupational Police Stress Cohort (n = 464 at baseline), with longitudinal data collected from 2004 to 2019. A food frequency questionnaire obtained estimated dietary intake from which E-DII scores were calculated. Dependent variables were objectively (Micro Motion Logger Sleep Watch™) and subjectively (Pittsburgh Sleep Quality Index) measured sleep quality and quantity. The analyses included a series of linear mixed-effects models used to examine cross-sectional and longitudinal associations between the E-DII and sleep quantity and quality. Cross-sectionally, more pro-inflammatory diets were associated with higher wake-after-sleep-onset but improved subjective sleep quality. In models accounting for both longitudinal and cross-sectional effects, for every 1-unit increase in the E-DII scores over time (representing a pro-inflammatory change), wake-after-sleep-onset increased by nearly 1.4 min (p = 0.07). This result was driven by officers who primarily worked day shifts (β = 3.33, p = 0.01). Conversely, for every 1-unit increase in E-DII score, the Pittsburgh Sleep Quality Index global score improved. More pro-inflammatory diets were associated with increased wake-after-sleep-onset, an objective measure of sleep quality. Intervention studies to reduce dietary inflammatory potential may provide greater magnitude of effect for changes in sleep quality.
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Affiliation(s)
- Michael D Wirth
- College of Nursing, University of South Carolina, Columbia, South Carolina, USA.,Department of Epidemiology and Biostatistics and Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.,Department of Nutrition, Connecting Health Innovations, LLC, Columbia, South Carolina, USA
| | - Desta Fekedulegn
- Bioanalytics Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia, USA
| | - Michael E Andrew
- Bioanalytics Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia, USA
| | - Alexander C McLain
- Department of Epidemiology and Biostatistics and Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - James B Burch
- Department of Epidemiology and Biostatistics and Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.,WJB Dorn VA Medical Center, Columbia, South Carolina, USA.,Department of Family Medicine and Population Health, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jean E Davis
- College of Nursing, University of South Carolina, Columbia, South Carolina, USA
| | - James R Hébert
- Department of Epidemiology and Biostatistics and Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.,Department of Nutrition, Connecting Health Innovations, LLC, Columbia, South Carolina, USA
| | - John M Violanti
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, New York, USA
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Burch JB, Ginsberg JP, McLain AC, Franco R, Stokes S, Susko K, Hendry W, Crowley E, Christ A, Hanna J, Anderson A, Hébert JR, O'Rourke MA. Symptom Management Among Cancer Survivors: Randomized Pilot Intervention Trial of Heart Rate Variability Biofeedback. Appl Psychophysiol Biofeedback 2021; 45:99-108. [PMID: 32358782 DOI: 10.1007/s10484-020-09462-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Chronic cancer-related symptoms (stress, fatigue, pain, depression, insomnia) may be linked with sympathetic nervous system over-activation and autonomic imbalance. Decreased heart rate variability (HRV) is an indicator of autonomic dysregulation that is commonly observed among cancer survivors. HRV biofeedback (HRVB) training induces HRV coherence, which maximizes HRV and facilitates autonomic and cardiorespiratory homeostasis. This randomized, wait-list-controlled, pilot intervention trial tested the hypothesis that HRVB can improve HRV coherence and alleviate cancer-related symptoms. The intervention group (n = 17) received 4-6 weekly HRVB training sessions until participants demonstrated skill acquisition. Controls (n = 17) received usual care. Outcomes assessed at baseline and follow-up included 15-min HRV recordings (HRV Coherence Ratio), and symptoms of: stress, distress, post-traumatic stress disorder (PTSD), pain, depression, fatigue, and sleep disturbance. Linear mixed models for repeated measures were used to assess Group-by-Time interactions, pre- versus post-treatment differences in mean symptom scores, and group differences at follow-up. Mean HRV Coherence Ratios (± standard error) improved in the HRVB group at follow-up (baseline: 0.37 ± 0.05, post-intervention: 0.84 ± 0.18, p = 0.01), indicating intervention validity. Statistically significant Group-by-Time interactions indicated treatment-related improvements in HRV Coherence Ratios (p = 0.03, Pre-vs. post-treatment effect size [Cohen's d]: 0.98), sleep symptoms (p = 0.001, d = 1.19), and sleep-related daytime impairment (p = 0.005, d = 0.86). Relative to controls, the intervention group experienced trends toward improvements in stress, distress, fatigue, PTSD, and depression, although no other statistically significant Group-by-Time interactions were observed. This pilot intervention found that HRVB training reduced symptoms of sleep disturbance among cancer survivors. Larger-scale interventions are warranted to further evaluate the role of HRVB for managing symptoms in this population. Registration: NCT03692624 www.clinicaltrials.gov.
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Affiliation(s)
- James B Burch
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA. .,South Carolina Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, USA. .,WJB Dorn Department of Veterans Affairs Medical Center, Columbia, SC, USA. .,Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Room 226, Columbia, SC, 29208, USA.
| | - J P Ginsberg
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Alexander C McLain
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA
| | - Regina Franco
- Integrative Oncology, PRISMA Health Upstate Cancer Institute, Greenville, SC, USA
| | | | - Kerri Susko
- Integrative Oncology, PRISMA Health Upstate Cancer Institute, Greenville, SC, USA
| | - William Hendry
- Integrative Oncology, PRISMA Health Upstate Cancer Institute, Greenville, SC, USA
| | - Elizabeth Crowley
- Integrative Oncology, PRISMA Health Upstate Cancer Institute, Greenville, SC, USA
| | - Alex Christ
- Integrative Oncology, PRISMA Health Upstate Cancer Institute, Greenville, SC, USA
| | - John Hanna
- Integrative Oncology, PRISMA Health Upstate Cancer Institute, Greenville, SC, USA
| | - Annie Anderson
- Integrative Oncology, PRISMA Health Upstate Cancer Institute, Greenville, SC, USA
| | - James R Hébert
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA.,South Carolina Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, USA
| | - Mark A O'Rourke
- Integrative Oncology, PRISMA Health Upstate Cancer Institute, Greenville, SC, USA
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Nevels TL, Burch JB, Wirth MD, Ginsberg JP, McLain AC, Andrew ME, Allison P, Fekedulegn D, Violanti JM. Shift Work Adaptation Among Police Officers: The BCOPS Study. Chronobiol Int 2021; 38:907-923. [PMID: 33781135 PMCID: PMC8262273 DOI: 10.1080/07420528.2021.1895824] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 02/13/2021] [Accepted: 02/22/2021] [Indexed: 01/02/2023]
Abstract
Few studies have examined shiftwork adaptation among police officers or potential differences in disease biomarkers among adapted and maladapted shiftworkers. This study characterized shiftwork adaptation among 430 police officers from the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) study. Police officers working fixed night shifts with symptoms characteristic of adaptation and maladaptation were identified using latent class analysis (n = 242). Two approaches were applied, one with police-specific symptoms and another using more general symptoms as shiftwork adaptation indicators. Biomarkers of inflammation, heart rate variability, and cardiometabolic risk were then compared between shiftwork adaptation groups, and with officers working day shifts, after adjusting for confounding. When analyses included police-specific symptoms, maladapted shiftworkers (n = 73) had more self-reported stress, sleep disturbances, fatigue, and less social support than adapted shiftworkers (n = 169). Using more general symptoms, maladapted officers (n = 56) reported more stress and depression, and less social support than adapted officers (n = 186). In police-specific models, adjusted (least-squares) means (± standard error) of circulating interleukin-6 (IL-6) concentrations in maladapted officers (0.8 ± 0.1 ln[pg/ml]) were modestly elevated relative to adapted shiftworkers (0.7 ± 0.1 ln[pg/ml], p = .09) and relative to permanent day workers (0.5 ± 0.1 ln[pg/ml], p ≤ 0.01), and leptin levels in maladapted officers (9.6 ± 0.1 ln[pg/ml]) exceeded those in the adapted (9.4 ± 0.1 ln[pg/ml], p ≤ 0.01) and day shift groups (9.4 ± 0.1 ln[pg/ml], p = .03). In the general model, adjusted mean tumor necrosis factor-alpha (TNF-α) concentrations among maladapted officers (5.6 ± 0.23 pg/ml) exceeded the adapted (4.8 ± 0.2 pg/ml, p ≤ 0.01) and day workers (5.0 ± 0.2 pg/ml, p = .04), and insulin among maladapted officers was higher (2.4 ± 0.1 ln[uu/ml]) than the adapted group (1.8 ± 0.1 ln[uu/ml], p = .03). No differences were observed for the other biomarkers. The results suggest that maladaptation among police officers working fixed night shifts may lead to increases in leptin, insulin, IL-6, and TNF-α; however, the cross-sectional design and possible residual confounding preclude interpretation of cause and effect. Prospective studies are planned to further characterize the relationship between shiftwork maladaptation and biomarkers of chronic disease risk in this police officer cohort.
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Affiliation(s)
- Torrance L. Nevels
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- Dorn Research Institute, WJB Dorn Department of Veterans Affairs Medical Center, Columbia, South Carolina, USA
- Interservice-Physician Assistant Program, MEDCoE, Joint Base San Antonio-Fort Sam Houston,, Texas, USA
| | - James B. Burch
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- Dorn Research Institute, WJB Dorn Department of Veterans Affairs Medical Center, Columbia, South Carolina, USA
| | - Michael D. Wirth
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - JP Ginsberg
- Dorn Research Institute, WJB Dorn Department of Veterans Affairs Medical Center, Columbia, South Carolina, USA
- Department of Pharmacology, Physiology and Neuroscience, School of Medicine, University of South Carolina, Columbia, South Carolina, USA
| | - Alexander C. McLain
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Michael E. Andrew
- Bioanalytics Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia, USA
| | - Penelope Allison
- Bioanalytics Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia, USA
| | - Desta Fekedulegn
- Bioanalytics Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia, USA
| | - John M. Violanti
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, the State University of New York, Buffalo, New York, USA
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8
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Holst MM, Wirth MD, Allison P, Burch JB, Andrew ME, Fekedulegn D, Hussey J, Charles LE, Violanti JM. An analysis of shiftwork and self-reported depressive symptoms in a police cohort from Buffalo, New York. Chronobiol Int 2021; 38:830-838. [PMID: 33706643 DOI: 10.1080/07420528.2021.1895197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/21/2022]
Abstract
Shiftwork has been associated with elevated depressive symptoms; police officers frequently work shifts and may experience depressive symptoms. This study assessed the association between depressive symptoms and shiftwork in a police cohort from Buffalo, New York, USA using a repeated cross-sectional design with data collected in 2004-2009 (n = 428) and 2010-2014 (n = 261). Electronic payroll records were used to quantitatively classify officers on the day, evening, or night shift based on the shift they spent most of their working hours. Two self-reported depressive symptomology measures were used as outcomes - the Center for Epidemiological Studies - Depression (CES-D) scale and the Beck Depression Inventory (BDI). Repeated measures linear and logistic regression analyses were used to estimate least squares means or odds, respectively, of depressive symptom questionnaire scores by shiftwork category. Those working the evening/night shift had higher odds for depressive symptoms according to the BDI (based on a cut-point score of 14) than those working the day shift (OR = 4.60, 95% CI = 1.15-18.39). Similar results were observed for the evening shift group. No differences in mean CES-D or BDI scores were observed between groups for short-term shiftwork, long-term shiftwork, or shift changes. After stratifying by stress, as measured by the Perceived Stress Scale (PSS), total Impact of Events (IES), and the Spielberger Police Stress Survey (SPSS), mean values for depressive symptoms were higher in the high-stress categories regardless of shiftwork status. Further research should include biomarkers for depression, a longitudinal study design with a larger cohort, and joint effects of shiftwork and stress on depressive symptoms.
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Affiliation(s)
- Meghan M Holst
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Michael D Wirth
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.,Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, USA.,College of Nursing, University of South Carolina, Columbia, SC, USA
| | - Penelope Allison
- Bioanalytics Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - James B Burch
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.,Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, USA.,WJB Dorn VA Medical Center, Columbia, SC, USA
| | - Michael E Andrew
- Bioanalytics Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Desta Fekedulegn
- Bioanalytics Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - James Hussey
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Luenda E Charles
- Bioanalytics Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - John M Violanti
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University of Buffalo, the State University of New York, Buffalo, NY, USA
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9
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Youngstedt SD, Kline CE, Reynolds AM, Crowley SK, Burch JB, Khan N, Han S. Bright Light Treatment of Combat-related PTSD: A Randomized Controlled Trial. Mil Med 2021; 187:e435-e444. [PMID: 33511988 DOI: 10.1093/milmed/usab014] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/28/2020] [Accepted: 01/11/2021] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Post-traumatic stress disorder (PTSD) is a prevalent consequence of combat with significant associated morbidity. Available treatments for PTSD have had limitations, suggesting a need to explore alternative or adjuvant treatments. Numerous rationales for bright light treatment of PTSD include its benefits for common PTSD comorbidities of depression, anxiety, and circadian misalignment and its relative ease of use with few side effects. The primary aims of this research were to examine the effects of bright light treatment for combat-related PTSD and associated morbidity. MATERIALS AND METHODS A randomized controlled trial was performed in N = 69 veterans with PTSD attributable to combat in Afghanistan and/or Iraq. Following a 1-week baseline, participants were randomized to 4 weeks of daily morning bright light treatment (10,000 lux for 30 min/day) or a control treatment (inactivated negative ion generator). At baseline and at the end of treatment, participants were rated blindly on the Clinician Assessed PTSD Scale (CAPS), the Clinical Global Impressions Scale (CGI), and the Hamilton Depression Scale and rated themselves on the PTSD Checklist-Military (PCL-M). Following baseline and each treatment week, participants completed self-reported scales of state anxiety, depression, and sleep, and sleep and the circadian rhythm of wrist activity were also assessed with wrist actigraphy. RESULTS Compared with the control treatment, bright light elicited significantly greater improvements in the CAPS and CGI-Improvement. The bright light also elicited a significantly greater rate of treatment response (reduction ≥33%) for the CAPS (44.1% vs. 8.6%) and PCL-M (33% vs. 6%), but no participant had remission from PTSD. Changes in depression, anxiety, and sleep did not differ between treatments. Improvement in CAPS was significantly correlated with a phase advance of the circadian rhythm of wrist activity. CONCLUSIONS The most comprehensive study on the topic to date indicated significant short-term efficacy of bright light treatment on the primary variables (CAPS and CGI) with clinical relevance (i.e., treatment response) in veterans with chronic PTSD who did not report extremely high habitual light exposure. No significant effects were found for anxiety, depression, or sleep disturbance. Further research is warranted, particularly exploration of circadian phase-shifting mechanisms of bright light for PTSD.
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Affiliation(s)
- Shawn D Youngstedt
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ 85004, USA.,Phoenix VA Health Care System, Phoenix, AZ 85012, USA
| | - Christopher E Kline
- Department of Health and Human Development, Research Service, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Alexandria M Reynolds
- Department of Psychology, University of Virginia's College at Wise, Wise, VA 24293, USA
| | - Shannon K Crowley
- Department of Exercise Science, Department of Health Promotion, North Carolina Wesleyan College, Rocky Mount, NC 27804, USA
| | - James B Burch
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC 29208, USA
| | - Nidha Khan
- Department of Environmental Health Sciences, University of South Carolina, Columbia, SC 29208, USA
| | - SeungYong Han
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ 85004, USA
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10
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Holst MM, Wirth MD, Mnatsakanova A, Burch JB, Charles LE, Tinney-Zara C, Fekedulegn D, Andrew ME, Hartley TA, Violanti JM. Shiftwork and Biomarkers of Subclinical Cardiovascular Disease: The BCOPS Study. J Occup Environ Med 2019; 61:391-396. [PMID: 30649009 PMCID: PMC6610651 DOI: 10.1097/jom.0000000000001541] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the association of shiftwork with biomarkers of subclinical cardiovascular disease and examine the moderating role of body mass index (BMI) in a police cohort. METHODS A cross-sectional analysis was conducted among officers who were categorized as working the day, evening, or night shift. Comparisons with inflammatory biomarkers were performed among shifts using analysis of variance/covariance and further stratified by BMI to assess potential effect modification. RESULTS Associations were observed between day and night shiftworkers for leukocytes, tumor necrosis factor alpha, and homocysteine. After BMI stratification, higher c-reactive protein (CRP) levels were observed among evening shiftworkers with a BMI more than or equal to 30 kg/m versus the day shift. CONCLUSIONS Future studies examining prospective changes in these markers will allow for more comprehensive evaluation of their association with shiftwork.
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Affiliation(s)
- Meghan M. Holst
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Michael D. Wirth
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Cancer Prevention and Control Program, University of South Carolina, Columbia, SC USA
- College of Nursing, University of South Carolina, Columbia, SC, USA
| | - Anna Mnatsakanova
- Biostatistics and Epidemiology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - James B. Burch
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Cancer Prevention and Control Program, University of South Carolina, Columbia, SC USA
- WJB Dorn VA Medical Center, Columbia, SC, USA
| | - Luenda E. Charles
- Biostatistics and Epidemiology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Cathy Tinney-Zara
- Biostatistics and Epidemiology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Desta Fekedulegn
- Biostatistics and Epidemiology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Michael E. Andrew
- Biostatistics and Epidemiology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Tara A. Hartley
- Biostatistics and Epidemiology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - John M. Violanti
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University of Buffalo, The State University of New York, Buffalo, NY, USA
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11
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Burch JB, Alexander M, Balte P, Sofge J, Winstead J, Kothandaraman V, Ginsberg JP. Shift Work and Heart Rate Variability Coherence: Pilot Study Among Nurses. Appl Psychophysiol Biofeedback 2019; 44:21-30. [PMID: 30232570 PMCID: PMC6373270 DOI: 10.1007/s10484-018-9419-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This study used ambient heart rate monitoring among health care workers to determine whether a novel measure of heart rate variability (HRV), as well as sleep disturbances, fatigue, or cognitive performance differed among non-rotating night shift nurses relative to those working permanent day shifts. Continuous ambulatory HRV monitoring was performed among night nurses (n = 11), and a comparison group of permanent day nurses (n = 7), over a 36-h period coinciding with the last two 12-h shifts of each participant's work week. Symptoms and psychomotor vigilance were assessed at the end of the ambient HRV monitoring period, and no differences between shifts were observed. Day nurses exhibited an increase in hourly mean HRV coherence ratios during their sleep period, suggesting a circadian pattern of cardiorespiratory phase coupling, whereas night nurses had no increase in HRV coherence ratios during their sleep period. The HRV coherence patterns were similar to high frequency HRV power among nurses on the same shift. To the authors knowledge, this study was the first to quantify patterns of the HRV coherence ratio among shiftworkers in a non-experimental (work/home) setting. The results suggest a pattern of autonomic dysregulation among night workers during their sleep period relative to those working day shifts. The HRV coherence ratio may serve as a novel indicator of HRV dysregulation among shift workers.
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Affiliation(s)
- James B Burch
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
- WJB Dorn Department of Veterans Affairs Medical Center, Columbia, SC, USA.
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Room 226, Columbia, SC, 29208, USA.
| | - Melannie Alexander
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- WJB Dorn Department of Veterans Affairs Medical Center, Columbia, SC, USA
| | - Pallavi Balte
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- WJB Dorn Department of Veterans Affairs Medical Center, Columbia, SC, USA
- Columbia University, New York, NY, USA
| | - Jameson Sofge
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- WJB Dorn Department of Veterans Affairs Medical Center, Columbia, SC, USA
| | - James Winstead
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- WJB Dorn Department of Veterans Affairs Medical Center, Columbia, SC, USA
| | - Venkat Kothandaraman
- WJB Dorn Department of Veterans Affairs Medical Center, Columbia, SC, USA
- Department of Biological Sciences, University of South Carolina, Columbia, SC, USA
| | - J P Ginsberg
- WJB Dorn Department of Veterans Affairs Medical Center, Columbia, SC, USA
- Department of Pharmacology, Physiology and Neuroscience, School of Medicine, University of South Carolina, Columbia, SC, USA
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12
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McMahon DM, Burch JB, Youngstedt SD, Wirth MD, Hardin JW, Hurley TG, Blair SN, Hand GA, Shook RP, Drenowatz C, Burgess S, Hebert JR. Relationships between chronotype, social jetlag, sleep, obesity and blood pressure in healthy young adults. Chronobiol Int 2019; 36:493-509. [PMID: 30663440 DOI: 10.1080/07420528.2018.1563094] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Daria M. McMahon
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina, USA
| | - James B. Burch
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina, USA
- Cancer Prevention and Control Program, University of South Carolina, Columbia, South Carolina, USA
- WJB Dorn Department of Veterans Affairs Medical Center Research Department, Columbia, South Carolina, USA
| | - Shawn D. Youngstedt
- College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
- Department of Veterans Affairs, Phoenix Health Care System Research Department, Phoenix, Arizona, USA
| | - Michael D. Wirth
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina, USA
- Cancer Prevention and Control Program, University of South Carolina, Columbia, South Carolina, USA
- College of Nursing, University of South Carolina, Columbia, South Carolina, USA
| | - James W. Hardin
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina, USA
| | - Thomas G. Hurley
- Cancer Prevention and Control Program, University of South Carolina, Columbia, South Carolina, USA
| | - Steven N. Blair
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina, USA
- Department of Exercise Science, University of South Carolina, Columbia, South Carolina, USA
| | - Gregory A. Hand
- School of Public Health, West Virginia University, Morgantown, West Virginia, USA
| | - Robin P. Shook
- Department of Pediatrics, Center for Healthy Lifestyles and Nutrition, Children’s Mercy Hospital, Kansas City, Missouri, USA
| | - Clemens Drenowatz
- Department of Exercise Science, University of South Carolina, Columbia, South Carolina, USA
- Division of Physical Education, University of Education Upper Austria, Linz, Austria
| | - Stephanie Burgess
- College of Nursing, University of South Carolina, Columbia, South Carolina, USA
| | - James R. Hebert
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina, USA
- Cancer Prevention and Control Program, University of South Carolina, Columbia, South Carolina, USA
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13
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McMahon DM, Burch JB, Hébert JR, Hardin JW, Zhang J, Wirth MD, Youngstedt SD, Shivappa N, Jacobsen SJ, Caan B, Van Den Eeden SK. Diet-related inflammation and risk of prostate cancer in the California Men's Health Study. Ann Epidemiol 2018; 29:30-38. [PMID: 30503073 DOI: 10.1016/j.annepidem.2018.10.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 06/08/2018] [Revised: 10/22/2018] [Accepted: 10/26/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE The purpose of the study was to examine the relationship between proinflammatory diet and prostate cancer risk. METHODS Energy-adjusted Dietary Inflammatory Index (E-DII) scores were computed among 40,161 participants in the California Men's Health Study. Over 9.7 ± 3.8 years of follow-up, 2707 incident prostate cancer cases were diagnosed and categorized as low-, intermediate-, or high-risk, based on disease grade and stage. Accelerated failure-time models assessed time to diagnosis of prostate cancer. Cox proportional hazard models estimated hazard ratios (HR) and 95% confidence intervals (95% CI). Nonlinear effects of E-DII were modeled as third-order polynomials. RESULTS Time to prostate cancer diagnosis did not differ by E-DII quartile. The HR for high-risk prostate cancer increased in the third E-DII quartile (HRQ3 vs. Q1 = 1.36; 95% CI: 1.04-1.76), but not in the fourth (HRQ4 vs. Q1 = 0.99; 95% CI: 0.74-1.32, Ptrend = .74), suggesting a nonlinear dose-response. HR curves for prostate cancer increased exponentially above an E-DII threshold of ≈+3.0. HR curves for high-risk prostate cancer had a much steeper incline above an E-DII threshold of ≈+2.5. Curves were higher among Blacks and Whites relative to other races and among overweight or obese men. No relationship was observed between E-DII scores and intermediate- or low-risk disease. CONCLUSIONS Relationships between proinflammatory diet and prostate cancer risk may be nonlinear, with an increased risk above an E-DII threshold of ≈+2.5.
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Affiliation(s)
- Daria M McMahon
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia
| | - James B Burch
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia; Cancer Prevention and Control Program, University of South Carolina, Columbia; WJB Dorn Department of Veterans Affairs Medical Center, Columbia, SC
| | - James R Hébert
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia; Cancer Prevention and Control Program, University of South Carolina, Columbia; Connecting Health Innovations, LLC, Columbia, SC.
| | - James W Hardin
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia
| | - Michael D Wirth
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia; Cancer Prevention and Control Program, University of South Carolina, Columbia; Connecting Health Innovations, LLC, Columbia, SC
| | - Shawn D Youngstedt
- College of Nursing and Health Innovation, Arizona State University, Phoenix; Phoenix VA Health Care System, Phoenix, AZ
| | - Nitin Shivappa
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia; Cancer Prevention and Control Program, University of South Carolina, Columbia; Connecting Health Innovations, LLC, Columbia, SC
| | - Steven J Jacobsen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Bette Caan
- Division of Research, Kaiser Permanente Northern California, Oakland
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14
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Donohue A, Wagner CL, Burch JB, Rothenberg SE. Blood total mercury and methylmercury among pregnant mothers in Charleston, South Carolina, USA. J Expo Sci Environ Epidemiol 2018; 28:494-504. [PMID: 29670220 PMCID: PMC7425126 DOI: 10.1038/s41370-018-0033-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 02/06/2018] [Accepted: 02/23/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Maternal blood total mercury (THg) is a biomarker for prenatal methylmercury (MeHg) exposure. Few studies have quantified both blood THg and MeHg during pregnancy, and few studies have reported longitudinal trends. OBJECTIVES We analyzed blood THg and MeHg in a cohort of pregnant mothers in Charleston, South Carolina (n = 83), and investigated whether blood THg or MeHg changed between early and late gestation. METHODS THg and MeHg were analyzed in blood samples from early (12 ± 1.7 weeks) and late (35 ± 2.2 weeks) gestation. RESULTS Blood %MeHg (of THg) averaged 63% (range: 10-114%) and 61% (range: 12-117%) during early and late gestation, respectively. In unadjusted analyses, blood MeHg decreased from early to late pregnancy (paired t-test, p = 0.04), while THg did not change (paired t-test, p = 0.34). When blood MeHg was normalized by the hematocrit, this decrease was no longer statistically significant (paired t-test, p = 0.09). CONCLUSIONS In unadjusted analyses, blood MeHg, but not THg, decreased significantly between early and late gestation; this decrease was due in part to hemodilution. Percent MeHg (of THg) varied by up to one order of magnitude. Results highlight the importance of Hg speciation in maternal blood samples to assess prenatal MeHg exposure.
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Affiliation(s)
- Alexis Donohue
- Department of Environmental Health Sciences, University of South Carolina, Columbia, SC, USA
| | - Carol L Wagner
- Department of Pediatrics, Division of Neonatology, Medical University of South Carolina, Charleston, SC, USA
| | - James B Burch
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA
- WJB Dorn, Department of Veterans Affairs Medical Center, Columbia, SC, USA
| | - Sarah E Rothenberg
- Department of Environmental Health Sciences, University of South Carolina, Columbia, SC, USA.
- School of Biological and Population Health Sciences, Oregon State University, Corvallis, OR, USA.
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15
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McMahon DM, Burch JB, Wirth MD, Youngstedt SD, Hardin JW, Hurley TG, Blair SN, Hand GA, Shook RP, Drenowatz C, Burgess S, Hebert JR. Persistence of social jetlag and sleep disruption in healthy young adults. Chronobiol Int 2017; 35:312-328. [PMID: 29231745 DOI: 10.1080/07420528.2017.1405014] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [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: 12/14/2022]
Abstract
Sleep disruption has been associated with increased risks for several major chronic diseases that develop over decades. Differences in sleep/wake timing between work and free days can result in the development of social jetlag (SJL), a chronic misalignment between a person's preferred sleep/wake schedule and sleep/wake timing imposed by his/her work schedule. Only a few studies have examined the persistence of SJL or sleep disruption over time. This prospective investigation examined SJL and sleep characteristics over a 2-year period to evaluate whether SJL or poor sleep were chronic conditions during the study period. SJL and sleep measures (total sleep time [TST], sleep onset latency [SOL], wake after sleep onset [WASO]), and sleep efficiency [SE]), were derived from armband monitoring among 390 healthy men and women 21-35 years old. Participants wore the armband for periods of 4-10 days at 6-month intervals during the follow-up period (N = 1431 repeated observations). The consistency of SJL or sleep disruption over time was analyzed using generalized linear mixed models (GLMMs) for repeated measures. Repeated measures latent class analysis (RMLCA) was then used to identify subgroups among the study participants with different sleep trajectories over time. Individuals in each latent group were compared using GLMMs to identify personal characteristics that differed among the latent groups. Minor changes in mean SJL, chronotype, or TST were observed over time, whereas no statistically significant changes in SOL, WASO, or SE were observed during the study period. The RMLCA identified two groups of SJL that remained consistent throughout the study (low SJL, mean ± SE: 0.4 ± 0.04 h, 42% of the study population; and high SJL, 1.4 ± 0.03 h, 58%). Those in the SJL group with higher values tended to be employed and have an evening chronotype. Similarly, two distinct subgroups were observed for SOL, WASO, and SE; one group with a pattern suggesting disrupted sleep over time, and another with a consistently normal sleep pattern. Analyses of TST identified three latent groups with relatively short (5.6 ± 1.0 h, 21%), intermediate (6.5 ± 1.0 h, 44%), and long (7.3 ± 1.0 h, 36%) sleep durations, all with temporally stable, linear trajectories. The results from this study suggest that sleep disturbances among young adults can persist over a 2 year period. Latent groups with poor sleep tended to be male, African American, lower income, and have an evening chronotype relative to those with more normal sleep characteristics. Characterizing the persistence of sleep disruption over time and its contributing factors could be important for understanding the role of poor sleep as a chronic disease risk factor.
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Affiliation(s)
- Daria M McMahon
- a Department of Epidemiology and Biostatistics , University of South Carolina , Columbia , SC , USA
| | - James B Burch
- a Department of Epidemiology and Biostatistics , University of South Carolina , Columbia , SC , USA.,b Cancer Prevention and Control Program , University of South Carolina , Columbia , SC , USA.,c WJB Dorn Department of Veterans Affairs Medical Center , Columbia , SC , USA
| | - Michael D Wirth
- a Department of Epidemiology and Biostatistics , University of South Carolina , Columbia , SC , USA.,b Cancer Prevention and Control Program , University of South Carolina , Columbia , SC , USA.,d College of Nursing , University of South Carolina , Columbia , SC , USA
| | - Shawn D Youngstedt
- e College of Nursing and Health Innovation , Arizona State University , Phoenix , AZ , USA.,f Phoenix VA Health Care System , Phoenix , AZ , USA
| | - James W Hardin
- a Department of Epidemiology and Biostatistics , University of South Carolina , Columbia , SC , USA
| | - Thomas G Hurley
- b Cancer Prevention and Control Program , University of South Carolina , Columbia , SC , USA
| | - Steven N Blair
- a Department of Epidemiology and Biostatistics , University of South Carolina , Columbia , SC , USA.,g Department of Exercise Science , University of South Carolina , Columbia , SC , USA
| | - Gregory A Hand
- h School of Public Health , West Virginia University , Morgantown, WV , USA
| | - Robin P Shook
- i Department of Pediatrics , Center for Healthy Lifestyles and Nutrition, Children's Mercy Hospital , Kansas City, MO , USA
| | - Clemens Drenowatz
- g Department of Exercise Science , University of South Carolina , Columbia , SC , USA.,j University of Education Upper Austria , Division of Physical Education , Linz , Austria
| | - Stephanie Burgess
- d College of Nursing , University of South Carolina , Columbia , SC , USA
| | - James R Hebert
- a Department of Epidemiology and Biostatistics , University of South Carolina , Columbia , SC , USA.,b Cancer Prevention and Control Program , University of South Carolina , Columbia , SC , USA
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16
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Abstract
Shift workers may experience disrupted sleep-wake or circadian cycles which, in turn, may lead to major health problems such as hypertension, obesity, and diabetes. Research indicates that shift workers have increased levels of leukocytes. Data from the National Health and Nutrition Examination Survey (2005-2010) examined the relationship between self-reported current shiftwork and leukocytes with adjustment for important confounders. Using linear regression, we found no association between shiftwork and leukocyte counts. Those not working had elevated levels compared to day workers but values in both groups were still within normal ranges. Additional research is needed to fully understand how shiftwork influences changes in leukocyte counts.
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Affiliation(s)
- Megan R Buss
- a Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC
| | - Michael D Wirth
- a Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC.,b Cancer Prevention and Control Program, University of South Carolina, Columbia, SC.,c College of Nursing, University of South Carolina , Columbia , SC.,d Connecting Healthy Innovations , Columbia , SC
| | - James B Burch
- a Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC.,b Cancer Prevention and Control Program, University of South Carolina, Columbia, SC.,e WJB Dorn VA Medical Center , Columbia , SC
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17
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Wirth MD, Shivappa N, Burch JB, Hurley TG, Hébert JR. The Dietary Inflammatory Index, shift work, and depression: Results from NHANES. Health Psychol 2017; 36:760-769. [PMID: 28557499 DOI: 10.1037/hea0000514] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Abnormal physiology (e.g., inflammation), brought on by environmental exposures (e.g., diet or shift work [SW]), can affect numerous bodily systems, including the brain, and may be associated with depressive symptomatology. The study examined the associations between SW and depressive symptoms and diet-related inflammation (estimated by the Dietary Inflammatory Index [DII]) and depressive symptoms. Additionally, diet was examined as a mediator between SW and depressive symptoms. METHOD Data were obtained from the U.S. National Health and Nutrition Examination Survey (Centers for Disease Control and Prevention, 2013). SW data were based on self-report. Dietary data were collected using 24-hr dietary recalls for DII calculation. Depressive symptoms were defined using a cut-point of 10 (moderate) on the Patient Health Questionnaire-9 (PHQ-9). Logistic regression was used to estimate odds ratios and 95% confidence intervals (95% CI) for depressive symptoms by SW and DII quartiles. RESULTS DII scores were associated with depressive symptoms among women. Women in DII quartile 4 were 30% more likely to report depressive symptoms than women in quartile 1 (95% CI [1.00-1.68]). There was no association between symptoms and SW when using a PHQ-9 cut-point of 10. When using a cut-point of 5 (mild depressive symptoms), those working any form of SW were more likely to suffer from mild symptoms than day workers (odds ratio = 1.22; 95% CI [1.04-1.43]). There was some evidence for mediation by the DII between SW and depressive symptoms. CONCLUSIONS Future longitudinal studies should examine effects of reductions in inflammation through diet on depressive symptoms, especially among shift workers, to elucidate the role of diet on depression among these groups. (PsycINFO Database Record
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Affiliation(s)
- Michael D Wirth
- Cancer Prevention and Control Program, Department of Epidemiology and Biostatistics, University of South Carolina
| | - Nitin Shivappa
- Cancer Prevention and Control Program, Department of Epidemiology and Biostatistics, University of South Carolina
| | - James B Burch
- Cancer Prevention and Control Program, Department of Epidemiology and Biostatistics, University of South Carolina
| | - Thomas G Hurley
- Cancer Prevention and Control Program, University of South Carolina
| | - James R Hébert
- Cancer Prevention and Control Program, Department of Epidemiology and Biostatistics, University of South Carolina
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18
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Wirth MD, Andrew ME, Burchfiel CM, Burch JB, Fekedulegn D, Hartley TA, Charles LE, Violanti JM. Association of shiftwork and immune cells among police officers from the Buffalo Cardio-Metabolic Occupational Police Stress study. Chronobiol Int 2017; 34:721-731. [PMID: 28488901 DOI: 10.1080/07420528.2017.1316732] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [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: 01/03/2023]
Abstract
Shift workers suffer from a constellation of symptoms associated with disruption of circadian rhythms including sleep abnormalities, and abnormal hormone secretion (e.g. melatonin, cortisol). Recent, but limited, evidence suggests that shift workers have elevated levels of circulating white blood cells (WBCs) compared to their day working counterparts. Interestingly, recent reviews highlight the strong linkage between the immune system and circadian rhythms which includes, but is not limited to, circulating cell populations and functions. The elevated levels of these WBCs may be associated with the increased chronic disease risk observed among this group. The purpose of this analysis was to examine the cross-sectional association between long- and short-term (3, 5, 7, and 14 days) shiftwork (SW) and counts of WBCs among officers in the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) cohort. Data collection for this analysis took place among 464 police officers working in Buffalo, New York, USA between 2004 and 2009. Precise SW histories were obtained using electronic payroll records. Officers were assigned a shift type based on the shift (i.e. day, evening, night) that they spent a majority (i.e. ≥50%) of their time from 1994 to the data collection date for long-term SW. The same process was applied to SW over 3, 5, 7, and 14 days prior to data collection. A fasted blood sample collected in the morning of a non-work day was used for characterization of WBCs (total), neutrophils, monocytes, lymphocytes, eosinophils, and basophils. Potential confounding factors included demographic characteristics (e.g. age, sex, race), occupational characteristics (e.g. rank), health behaviors (e.g. smoking, alcohol consumption, diet), anthropometrics, and other biomarkers (e.g. lipids, hemoglobin A1C, leptin). Generalized linear models were used to estimate least square means of the immune cells according to SW categorization for long- and short-term SW histories. Compared to the day shift group, those working long-term night shifts had greater absolute numbers of total WBCs, neutrophils, lymphocytes, and monocytes (all p < 0.05). Those working mainly on the night shift over 7-days had elevated counts of WBCs, lymphocytes, and monocytes (p < 0.05) compared to those mainly working day shifts. Results based on 3-, 5-, and 14-day SW were similar to the 7-day results. This study corroborates other studies with similar findings. However, this analysis provided insights into the effect of both long- and short-term SW on the number of circulating WBCs. SW may lead to disruption of circadian-influenced components of the immune system, which in term, may result in various chronic diseases. These findings, plus previous findings, may provide evidence that SW may lead to immune system dysregulation. Future research is needed to understand whether increases in immune cells among shift workers may be associated with the increased disease risk among this group.
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Affiliation(s)
- Michael D Wirth
- a Cancer Prevention and Control Program , University of South Carolina , Columbia , SC , USA.,b Department of Epidemiology and Biostatistics , University of South Carolina , Columbia , SC , USA.,c Connecting Health Innovations , Columbia , SC , USA
| | - Michael E Andrew
- d Biostatistics and Epidemiology Branch, Health Effects Laboratory Division , National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention , Morgantown , WV , USA
| | - Cecil M Burchfiel
- d Biostatistics and Epidemiology Branch, Health Effects Laboratory Division , National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention , Morgantown , WV , USA
| | - James B Burch
- a Cancer Prevention and Control Program , University of South Carolina , Columbia , SC , USA.,b Department of Epidemiology and Biostatistics , University of South Carolina , Columbia , SC , USA.,e WJB Dorn VA Medical Center , Columbia , SC , USA
| | - Desta Fekedulegn
- d Biostatistics and Epidemiology Branch, Health Effects Laboratory Division , National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention , Morgantown , WV , USA
| | - Tara A Hartley
- d Biostatistics and Epidemiology Branch, Health Effects Laboratory Division , National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention , Morgantown , WV , USA
| | - Luenda E Charles
- d Biostatistics and Epidemiology Branch, Health Effects Laboratory Division , National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention , Morgantown , WV , USA
| | - John M Violanti
- f Department of Epidemiology and Environmental Health, School of Public Health and Health Professions , University of Buffalo, The State University of New York , Buffalo , New York , USA
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Alexander M, Burch JB, Steck SE, Chen CF, Hurley TG, Cavicchia P, Shivappa N, Guess J, Zhang H, Youngstedt SD, Creek KE, Lloyd S, Jones K, Hébert JR. Case-control study of candidate gene methylation and adenomatous polyp formation. Int J Colorectal Dis 2017; 32:183-192. [PMID: 27771773 PMCID: PMC5288296 DOI: 10.1007/s00384-016-2688-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2016] [Indexed: 02/04/2023]
Abstract
PURPOSE Colorectal cancer (CRC) is one of the most common and preventable forms of cancer but remains the second leading cause of cancer-related death. Colorectal adenomas are precursor lesions that develop in 70-90 % of CRC cases. Identification of peripheral biomarkers for adenomas would help to enhance screening efforts. This exploratory study examined the methylation status of 20 candidate markers in peripheral blood leukocytes and their association with adenoma formation. METHODS Patients recruited from a local endoscopy clinic provided informed consent and completed an interview to ascertain demographic, lifestyle, and adenoma risk factors. Cases were individuals with a histopathologically confirmed adenoma, and controls included patients with a normal colonoscopy or those with histopathological findings not requiring heightened surveillance (normal biopsy, hyperplastic polyp). Methylation-specific polymerase chain reaction was used to characterize candidate gene promoter methylation. Odds ratios (ORs) and 95 % confidence intervals (95% CIs) were calculated using unconditional multivariable logistic regression to test the hypothesis that candidate gene methylation differed between cases and controls, after adjustment for confounders. RESULTS Complete data were available for 107 participants; 36 % had adenomas (men 40 %, women 31 %). Hypomethylation of the MINT1 locus (OR 5.3, 95% CI 1.0-28.2) and the PER1 (OR 2.9, 95% CI 1.1-7.7) and PER3 (OR 11.6, 95% CI 1.6-78.5) clock gene promoters was more common among adenoma cases. While specificity was moderate to high for the three markers (71-97 %), sensitivity was relatively low (18-45 %). CONCLUSION Follow-up of these epigenetic markers is suggested to further evaluate their utility for adenoma screening or surveillance.
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Affiliation(s)
- M Alexander
- South Carolina Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, USA
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene St, Room 228, Columbia, SC, 29209, USA
| | - J B Burch
- South Carolina Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, USA.
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene St, Room 228, Columbia, SC, 29209, USA.
- William Jennings Bryant Dorn Department of Veterans Affairs Medical Center, Columbia, SC, USA.
| | - S E Steck
- South Carolina Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, USA
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene St, Room 228, Columbia, SC, 29209, USA
| | - C-F Chen
- Center for Molecular Studies, Greenwood Genetic Center, Greenwood, SC, USA
| | - T G Hurley
- South Carolina Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, USA
| | - P Cavicchia
- South Carolina Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, USA
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene St, Room 228, Columbia, SC, 29209, USA
- Division of Community Health Promotion, Florida Department of Health, Tallahassee, FL, USA
| | - N Shivappa
- South Carolina Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, USA
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene St, Room 228, Columbia, SC, 29209, USA
| | - J Guess
- South Carolina Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, USA
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene St, Room 228, Columbia, SC, 29209, USA
| | - H Zhang
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, USA
| | - S D Youngstedt
- College of Nursing and Health Innovation, College of Health Solutions, Arizona State University and Phoenix VA Health Care System, Phoenix, AZ, USA
| | - K E Creek
- Department of Drug Discovery and Biomedical Sciences, South Carolina College of Pharmacy, University of South Carolina, Columbia, SC, USA
| | - S Lloyd
- South Carolina Medical Endoscopy Center, and Department of Family Medicine, University of South Carolina School of Medicine, Columbia, SC, USA
| | - K Jones
- Center for Molecular Studies, Greenwood Genetic Center, Greenwood, SC, USA
| | - J R Hébert
- South Carolina Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, USA
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene St, Room 228, Columbia, SC, 29209, USA
- Department of Family and Preventive Medicine, School of Medicine, University of South Carolin, Columbia, SC, USA
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Molzof HE, Wirth MD, Burch JB, Shivappa N, Hebert JR, Johnson RL, Gamble KL. The impact of meal timing on cardiometabolic syndrome indicators in shift workers. Chronobiol Int 2017; 34:337-348. [PMID: 28107043 DOI: 10.1080/07420528.2016.1259242] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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: 01/12/2023]
Abstract
The aims of this study were to 1) compare the inflammatory potential of night- and day-shift nurses' diets with regard to time of day and work status and 2) explore how the timing of food intake during work and off-work is associated with cardiometabolic syndrome (CMS) risk factors between these two groups. Female nurses (N = 17; 8 day-shift and 9 night-shift) reported food intake over 9 days. On a middle day off of work, metabolic parameters were measured after an overnight fast. Energy/macronutrient intake and inflammatory potential of dietary intake (as assessed via the Dietary Inflammatory IndexTM) were calculated for nurses' workdays, work nights, off-work days, and off-work nights. Work-night total food intake (grams) accounted for a significant amount of variance in CMS risk factors for night-shift nurses only. Increased total gram consumption during night-shift nurses' work nights was associated with increased lipid levels - independent of the macronutrient composition of the food consumed. Alternatively, for night-shift nurses, work-day intake of several food parameters accounted for a significant proportion of variance in HDL cholesterol levels, with higher intake associated with higher HDL levels. For both day- and night-shift nurses, food intake during the day was more pro-inflammatory regardless of shift type or work status. Our novel approach of combining time-of-day-specific and work-day-specific analyses of dietary inflammatory factors and macronutrient composition with measurement of CMS risk factors suggests a link between meal timing and cardiometabolic health for shift-working nurses.
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Affiliation(s)
- Hylton E Molzof
- a Department of Psychology , University of Alabama , Tuscaloosa , AL , USA
| | - Michael D Wirth
- b Cancer Prevention and Control Program, and Department of Epidemiology and Biostatistics , University of South Carolina , Columbia , SC , USA.,c Connecting Health Innovations , LLC , Columbia , SC , USA
| | - James B Burch
- b Cancer Prevention and Control Program, and Department of Epidemiology and Biostatistics , University of South Carolina , Columbia , SC , USA.,d WJB Dorn Department of Veterans Affairs Medical Center , Columbia , SC , USA
| | - Nitin Shivappa
- b Cancer Prevention and Control Program, and Department of Epidemiology and Biostatistics , University of South Carolina , Columbia , SC , USA.,c Connecting Health Innovations , LLC , Columbia , SC , USA
| | - James R Hebert
- b Cancer Prevention and Control Program, and Department of Epidemiology and Biostatistics , University of South Carolina , Columbia , SC , USA.,c Connecting Health Innovations , LLC , Columbia , SC , USA
| | - Russell L Johnson
- e Department of Psychiatry and Behavioral Neurobiology , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Karen L Gamble
- e Department of Psychiatry and Behavioral Neurobiology , University of Alabama at Birmingham , Birmingham , AL , USA
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Alexander M, Ray MA, Hébert JR, Youngstedt SD, Zhang H, Steck SE, Bogan RK, Burch JB. The National Veteran Sleep Disorder Study: Descriptive Epidemiology and Secular Trends, 2000-2010. Sleep 2016; 39:1399-410. [PMID: 27091538 DOI: 10.5665/sleep.5972] [Citation(s) in RCA: 121] [Impact Index Per Article: 15.1] [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: 12/18/2015] [Accepted: 03/16/2016] [Indexed: 12/31/2022] Open
Abstract
STUDY OBJECTIVES A large proportion of individuals affected by sleep disorders are untreated and susceptible to accidents, injuries, long-term sequelae (e.g., risk of cardiovascular disease, cancer, psychiatric disorders), and increased mortality risk. Few studies have examined the scope and magnitude of sleep disorder diagnoses in the United States (US) or factors influencing them. Veterans are particularly vulnerable to factors that elicit or exacerbate sleep disorders. METHODS This serial cross-sectional study characterized secular trends in diagnosed sleep disorders among veterans seeking care in US Veterans Health Administration facilities over an eleven-year span (FY2000-2010, n = 9,786,778). Electronic medical records from the national Veterans Administration Informatics and Computing Infrastructure database were accessed. Cases were defined using diagnostic codes specified by the American Academy of Sleep Medicine. Age-adjusted annual prevalence was summarized by sex, race, combat exposure, body mass index, and comorbid diagnoses (cardiovascular disease, cancer, mental disorders). RESULTS Sleep apnea (47%) and insomnia (26%) were the most common diagnoses among patients with any sleep disorder. There was a six-fold relative increase in total sleep disorder prevalence over the study period. Posttraumatic stress disorder, which tripled over the same time period, was associated with the highest prevalence of sleep disorders (16%) among the comorbid conditions evaluated. CONCLUSIONS The results indicate a growing need for integration of sleep disorder management with patient care and health care planning among US veterans. COMMENTARY A commentary on this article appears in this issue on page 1331.
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Affiliation(s)
- Melannie Alexander
- South Carolina Statewide Cancer Prevention & Control Program, University of South Carolina, Columbia, SC.,Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Meredith A Ray
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN
| | - James R Hébert
- South Carolina Statewide Cancer Prevention & Control Program, University of South Carolina, Columbia, SC.,Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC.,Department of Family and Preventive Medicine, School of Medicine, University of South Carolina, Columbia, SC
| | - Shawn D Youngstedt
- College of Nursing and Health Innovation, College of Health Solutions, Arizona State University, Phoenix VA Health Care System, Phoenix, AZ
| | - Hongmei Zhang
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN
| | - Susan E Steck
- South Carolina Statewide Cancer Prevention & Control Program, University of South Carolina, Columbia, SC.,Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | | | - James B Burch
- South Carolina Statewide Cancer Prevention & Control Program, University of South Carolina, Columbia, SC.,Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC.,WJB Dorn Department of Veterans Affairs Medical Center, Columbia, SC
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Makris KC, Andrianou XD, Charisiadis P, Burch JB, Seth RK, Ioannou A, Picolos M, Christophi CA, Chatterjee S. Association between exposures to brominated trihalomethanes, hepatic injury and type II diabetes mellitus. Environ Int 2016; 92-93:486-493. [PMID: 27173514 DOI: 10.1016/j.envint.2016.04.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 04/07/2016] [Accepted: 04/08/2016] [Indexed: 06/05/2023]
Abstract
Non-alcoholic fatty liver disease (NAFLD) is considered the most common liver disorder in the Western world, commonly diagnosed in the majority of obese patients with type 2 diabetes mellitus (T2DM). Metabolic disrupting chemicals with short half-lives, such as those of halogenated structure (trihalomethanes, THM) have been linked with hepatic insulin resistance phenomena in animal studies. However, human studies evaluating the role of THM exposure on liver pathogenesis and T2DM disease process are scarce. The objectives of this study were to: i) determine the association of urinary brominated THM (BrTHM) levels and T2DM disease status, and ii) investigate the association between urinary BrTHM levels and serum alanine aminotransferase (ALT) concentrations, often used as surrogate markers of NAFLD. A pilot case-control study was conducted in Nicosia, Cyprus (n=95). Cases were physician-diagnosed T2DM patients and controls were healthy individuals. Liver enzymes, leptin and TNF-α were measured in sera, while urinary THM levels were measured using tandem mass spectrometry. Diabetics had higher levels of serum leptin, body mass index and ALT than the controls. Among all study participants those with serum ALT levels above the median (17IU/L) had higher mean tribromomethane (TBM) concentrations compared to those with serum ALT below 17IU/L. A significant increase in the odds of having above the median serum ALT levels [OR 6.38, 95% CI: 1.11, 42.84 (p=0.044)] was observed for each unit increase in creatinine-unadjusted urinary TBM levels, along with BMI and past smoking, after adjusting for possible confounders, such as urinary creatinine, age, sex, and leptin; no other THM compound showed a significant association with serum ALT. Logistic regression models for T2DM using the urinary BrTHM as exposure variables did not reach the predetermined level of significance. The interplay between exposures to BrTHM and the initiation of key pathophysiological events relating to hepatic injury (ALT) and inflammation (leptin) was recognized via the use of selected biomarkers of effect. Our evidence that THM could act as hepatic toxins with a further initiation of diabetogenic effects call for additional studies to help us better understand the disease process of the two co-morbidities (NAFLD and T2DM).
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Affiliation(s)
- Konstantinos C Makris
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus.
| | - Xanthi D Andrianou
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - Pantelis Charisiadis
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - James B Burch
- South Carolina Statewide Cancer Prevention & Control Program, University of South Carolina, Columbia, SC, USA; Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA; Dorn Department of Veterans Affairs Medical Center, Columbia, SC, USA
| | - Ratanesh K Seth
- Environmental Health & Disease Laboratory, Department of Environmental Health Sciences, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Androniki Ioannou
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus
| | | | - Costas A Christophi
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - Saurabh Chatterjee
- Environmental Health & Disease Laboratory, Department of Environmental Health Sciences, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
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Davis HT, Aelion CM, Liu J, Burch JB, Cai B, Lawson AB, McDermott S. Potential sources and racial disparities in the residential distribution of soil arsenic and lead among pregnant women. Sci Total Environ 2016; 551-552:622-30. [PMID: 26897405 PMCID: PMC4808624 DOI: 10.1016/j.scitotenv.2016.02.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Revised: 02/02/2016] [Accepted: 02/02/2016] [Indexed: 05/20/2023]
Abstract
Exposure to arsenic (As) or lead (Pb) has been associated with adverse health outcomes, and high-risk populations can be disproportionately exposed to these metals in soils. The objectives of this study were: to examine if predicted soil As and Pb concentrations at maternal residences of South Carolina (SC) low-income mothers differed based on maternal race (non-Hispanic black versus white), to examine whether differences in predicted residential soil As and Pb concentrations among black and white mothers differed by socioeconomic status (SES), and to examine whether such disparities persisted after controlling for anthropogenic sources of these metals, including direction from, and distance to industrial facilities. Kriged soil As and Pb concentrations were estimated at maternal residences in 11 locations in SC, and models with maternal race and individual and US Census block group level SES measures were examined. US Environmental Protection Agency Toxics Release Inventory (TRI) facility As and Pb releases categorized by distance and direction to block groups in which mothers resided were also identified, as were proxy measures for historic use of leaded gasoline (road density) and Pb-based paint (categories of median year home built by US Census block group). Consistent racial disparities were observed for predicted residential soil As and Pb concentrations, and the disparity was stronger for Pb than As (betas from adjusted models for black mothers were 0.12 and 2.2 for As and Pb, respectively, all p<0.006). Higher road density and older homes in block groups were more closely associated with higher predicted soil As and Pb concentrations than on-site releases of As and Pb categorized by facility location. These findings suggest that non-Hispanic black mothers in this study population had elevated residential As and Pb soil concentrations, after adjusting for SES, and that soil As and Pb concentrations were not associated with recent industrial releases.
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Affiliation(s)
- Harley T Davis
- Department of Epidemiology and Biostatistics, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
| | - C Marjorie Aelion
- School of Public Health and Health Sciences, University of Massachusetts Amherst, 715 No. Pleasant Street, Amherst, MA 01003, USA.
| | - Jihong Liu
- Department of Epidemiology and Biostatistics, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
| | - James B Burch
- Department of Epidemiology and Biostatistics, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
| | - Bo Cai
- Department of Epidemiology and Biostatistics, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
| | - Andrew B Lawson
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street Suite 303, Charleston, SC 29401, USA
| | - Suzanne McDermott
- Department of Epidemiology and Biostatistics, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
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Hébert JR, Braun KL, Kaholokula JK, Armstead CA, Burch JB, Thompson B. Considering the Role of Stress in Populations of High-Risk, Underserved Community Networks Program Centers. Prog Community Health Partnersh 2015. [PMID: 26213406 DOI: 10.1353/cpr.2015.0028] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cancer disparities are associated with a broad range of sociocultural determinants of health that operate in community contexts. High-risk populations may be more vulnerable to social and environmental factors that lead to chronic stress. Theoretical and empirical research indicates that exposure to contextual and sociocultural stress alters biological systems, thereby influencing cancer risk, progression, and, ultimately, mortality. OBJECTIVE We sought to describe contextual pathways through which stress likely increases cancer risk in high-risk, underserved populations. METHODS This review presents a description of the link between contextual stressors and disease risk disparities within underserved communities, with a focus on 1) stress as a proximal link between biological processes, such as cytokine responses, inflammation, and cancer and 2) stress as a distal link to cancer through biobehavioral risk factors such as poor diet, physical inactivity, circadian rhythm or sleep disruption, and substance abuse. These concepts are illustrated through application to populations served by three National Cancer Institute-funded Community Networks Program Centers (CNPCs): African Americans in the Deep South (the South Carolina Cancer Disparities Community Network [SCCDCN]), Native Hawaiians ('Imi Hale-Native Hawaiian Cancer Network), and Latinos in the Lower Yakima Valley of Washington State (The Center for Hispanic Health Promotion: Reducing Cancer Disparities). CONCLUSIONS Stress experienced by the underserved communities represented in the CNPCs is marked by social, biological, and behavioral pathways that increase cancer risk. A case is presented to increase research on sociocultural determinants of health, stress, and cancer risk among racial/ethnic minorities in underserved communities.
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Tabung FK, Steck SE, Burch JB, Chen CF, Zhang H, Hurley TG, Cavicchia P, Alexander M, Shivappa N, Creek KE, Lloyd SC, Hebert JR. A healthy lifestyle index is associated with reduced risk of colorectal adenomatous polyps among non-users of non-steroidal anti-inflammatory drugs. J Prim Prev 2015; 36:21-31. [PMID: 25331980 DOI: 10.1007/s10935-014-0372-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
In a Columbia, South Carolina-based case-control study, we developed a healthy lifestyle index from five modifiable lifestyle factors (smoking, alcohol intake, physical activity, diet, and body mass index), and examined the association between this lifestyle index and the risk of colorectal adenomatous polyps (adenoma). Participants were recruited from a local endoscopy center and completed questionnaires related to lifestyle behaviors prior to colonoscopy. We scored responses on each of five lifestyle factors as unhealthy (0 point) or healthy (1 point) based on current evidence and recommendations. We added the five scores to produce a combined lifestyle index for each participant ranging from 0 (least healthy) to 5 (healthiest), which was dichotomized into unhealthy (0-2) and healthy (3-5) lifestyle scores. We used logistic regression to calculate odds ratios (OR) and 95% confidence intervals (CI) for adenoma with adjustment for multiple covariates. We identified 47 adenoma cases and 91 controls. In the main analyses, there was a statistically nonsignificant inverse association between the dichotomous (OR 0.54; 95% CI 0.22, 1.29) and continuous (OR 0.75; 95% CI 0.51, 1.10) lifestyle index and adenoma. Odds of adenoma were significantly modified by the use of non-steroidal anti-inflammatory drugs (NSAIDs) (p(interaction) = 0.04). For participants who reported no use of NSAIDs, those in the healthy lifestyle category had a 72% lower odds of adenoma as compared to those in the unhealthy category (OR 0.28; 95% CI 0.08, 0.98), whereas a one-unit increase in the index significantly reduced odds of adenoma by 53% (OR 0.47; 95% CI 0.26, 0.88). Although these findings should be interpreted cautiously given our small sample size, our results suggest that higher scores from this index are associated with reduced odds of adenomas, especially in non-users of NSAIDs. Lifestyle interventions are required to test this approach as a strategy to prevent colorectal adenomatous polyps.
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Affiliation(s)
- Fred K Tabung
- Department of Epidemiology and Biostatistics, University of South Carolina, 915 Greene Street, 4th Floor, Columbia, SC, 29208, USA,
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Burch JB, Everson TM, Seth RK, Wirth MD, Chatterjee S. Trihalomethane exposure and biomonitoring for the liver injury indicator, alanine aminotransferase, in the United States population (NHANES 1999-2006). Sci Total Environ 2015; 521-522:226-34. [PMID: 25847167 PMCID: PMC4462191 DOI: 10.1016/j.scitotenv.2015.03.050] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 03/12/2015] [Accepted: 03/13/2015] [Indexed: 05/08/2023]
Abstract
Exposure to trihalomethanes (or THMs: chloroform, bromoform, bromodichloromethane, and dibromochloromethane [DBCM]) formed via drinking water disinfection has been associated with adverse reproductive outcomes and cancers of the digestive or genitourinary organs. However, few studies have examined potential associations between THMs and liver injury in humans, even though experimental studies suggest that these agents exert hepatotoxic effects, particularly among obese individuals. This study examined participants in the National Health and Nutrition Examination Survey (1999-2006, N=2781) to test the hypothesis that THMs are associated with liver injury as assessed by alanine aminotransferase (ALT) activity in circulation. Effect modification by body mass index (BMI) or alcohol consumption also was examined. Associations between blood THM concentrations and ALT activity were assessed using unconditional multiple logistic regression to calculate prevalence odds ratios (ORs) with 95% confidence intervals (CIs) for exposure among cases with elevated ALT activity (men: >40IU/L, women: >30IU/L) relative to those with normal ALT, after adjustment for variables that may confound the relationship between ALT and THMs. Compared to controls, cases were 1.35 times more likely (95% CI: 1.02, 1.79) to have circulating DBCM concentrations exceeding median values in the study population. There was little evidence for effect modification by BMI, although the association varied by alcohol consumption. Among non-drinkers, cases were more likely than controls to be exposed to DBCM (OR: 3.30, 95% CI: 1.37, 7.90), bromoform (OR: 2.88, 95% CI: 1.21, 6.81), or brominated THMs (OR: 4.00, 95% CI: 1.31, 12.1), but no association was observed among participants with low, or moderate to heavy alcohol consumption. Total THM levels exceeding benchmark exposure limits continue to be reported both in the United States and globally. Results from this study suggest a need for further characterization of ALT activity and possibly other hepatic or metabolic diseases in populations with elevated drinking water THM concentrations.
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Affiliation(s)
- James B Burch
- South Carolina Statewide Cancer Prevention & Control Program, University of South Carolina, Columbia, SC, United States; Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States; Dorn Department of Veterans Affairs Medical Center, Columbia, SC, United States.
| | - Todd M Everson
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Ratanesh K Seth
- Environmental Health & Disease Laboratory, Department of Environmental Health Sciences, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Michael D Wirth
- South Carolina Statewide Cancer Prevention & Control Program, University of South Carolina, Columbia, SC, United States; Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Saurabh Chatterjee
- Environmental Health & Disease Laboratory, Department of Environmental Health Sciences, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.
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Xirasagar S, Li YJ, Burch JB, Daguisé VG, Hurley TG, Hébert JR. Reducing Colorectal Cancer Incidence and Disparities: Performance and Outcomes of a Screening Colonoscopy Program in South Carolina. Adv Public Health 2015; 2014:787282. [PMID: 25705719 PMCID: PMC4332847 DOI: 10.1155/2014/787282] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
This study evaluated the efficiency, effectiveness, and racial disparities reduction potential of Screening Colonoscopies for People Everywhere in South Carolina (SCOPE SC), a state-funded program for indigent persons aged 50-64 years (45-64 years for African American (AA)) with a medical home in community health centers. Patients were referred to existing referral network providers, and the centers were compensated for patient navigation. Data on procedures and patient demographics were analyzed. Of 782 individuals recruited (71.2% AA), 85% (665) completed the procedure (71.1% AA). The adenoma detection rate was 27.8% (males 34.6% and females 25.1%), advanced neoplasm rate 7.7% (including 3 cancers), cecum intubation rate 98.9%, inadequate bowel preparation rate 7.9%, and adverse event rate 0.9%. All indicators met the national quality benchmarks. The adenoma rate of 26.0% among AAs aged 45-49 years was similar to that of older Whites and AAs. We found that patient navigation and a medical home setting resulted in a successful and high-quality screening program. The observed high adenoma rate among younger AAs calls for more research with larger cohorts to evaluate the appropriateness of the current screening guidelines for AAs, given that they suffer 47% higher colorectal cancer mortality than Whites.
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Affiliation(s)
- Sudha Xirasagar
- Department of Health Services Policy and Management, University of South Carolina, Arnold School of Public Health, 915 Greene Street, Columbia, SC 29208, USA
| | - Yi-Jhen Li
- Department of Health Services Policy and Management, University of South Carolina, Arnold School of Public Health, 915 Greene Street, Columbia, SC 29208, USA
| | - James B. Burch
- South Carolina Statewide Cancer Prevention & Control Program, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
- Department of Epidemiology and Biostatistics, University of South Carolina, Arnold School of Public Health, 915 Greene Street, Columbia, SC 29208, USA
- WJB Dorn Department of Veterans Affairs Medical Center, 6439 Garners Ferry Road, Columbia, SC 29209-1639, USA
| | - Virginie G. Daguisé
- Division of Cancer Prevention and Control, South Carolina Department of Health and Environmental Control, 2100 Bull Street, Columbia, SC 29201, USA
| | - Thomas G. Hurley
- South Carolina Statewide Cancer Prevention & Control Program, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
| | - James R. Hébert
- South Carolina Statewide Cancer Prevention & Control Program, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
- Department of Epidemiology and Biostatistics, University of South Carolina, Arnold School of Public Health, 915 Greene Street, Columbia, SC 29208, USA
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Burch JB, Wagner Robb S, Puett R, Cai B, Wilkerson R, Karmaus W, Vena J, Svendsen E. Mercury in fish and adverse reproductive outcomes: results from South Carolina. Int J Health Geogr 2014; 13:30. [PMID: 25127892 PMCID: PMC4154616 DOI: 10.1186/1476-072x-13-30] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 07/21/2014] [Indexed: 11/18/2022] Open
Abstract
Background Mercury is a metal with widespread distribution in aquatic ecosystems and significant neurodevelopmental toxicity in humans. Fish biomonitoring for total mercury has been conducted in South Carolina (SC) since 1976, and consumption advisories have been posted for many SC waterways. However, there is limited information on the potential reproductive impacts of mercury due to recreational or subsistence fish consumption. Methods To address this issue, geocoded residential locations for live births from the Vital Statistics Registry (1995–2005, N = 362,625) were linked with spatially interpolated total mercury concentrations in fish to estimate potential mercury exposure from consumption of locally caught fish. Generalized estimating equations were used to test the hypothesis that risk of low birth weight (LBW, <2,500 grams) or preterm birth (PTB, <37 weeks clinical gestation) was greater among women living in areas with elevated total mercury in fish, after adjustment for confounding. Separate analyses estimated term LBW and PTB risks using residential proximity to rivers with fish consumption advisories to characterize exposure. Results Term LBW was more likely among women residing in areas in the upper quartile of predicted total mercury in fish (odds ratio [OR] = 1.04; 95% confidence interval [CI]: 1.00-1.09) or within 8 kilometers of a river with a ‘do not eat’ fish advisory (1.05; 1.00-1.11) compared to the lowest quartile, or rivers without fish consumption restrictions, respectively. When stratified by race, risks for term LBW or PTB were 10-18% more likely among African-American (AA) mothers living in areas with the highest total fish mercury concentrations. Conclusions To our knowledge, this is the first study to examine the relationship between fish total mercury concentrations and adverse reproductive outcomes in a large population-based sample that included AA women. The ecologic nature of exposure assessment in this study precludes causal inference. However, the results suggest a need for more detailed investigations to characterize patterns of local fish consumption and potential dose–response relationships between mercury exposure and adverse reproductive outcomes, particularly among AA mothers.
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Affiliation(s)
- James B Burch
- Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
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Wirth MD, Burch JB, Hébert JR, Kowtal P, Kapoor A, Steck SE, Hurley TG, Gupta PC, Pednekar MS, Youngstedt SD, Zhang H, Sarin R. Case-control study of breast cancer in India: Role of PERIOD3 clock gene length polymorphism and chronotype. Cancer Invest 2014; 32:321-9. [PMID: 24903750 PMCID: PMC4100474 DOI: 10.3109/07357907.2014.919305] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND This study examined a PERIOD3 (PER3) gene variable number tandem repeat polymorphism and chronotype as potential BrCA risk factors among Indian women. METHODS This case-control study included sporadic, histologically confirmed BrCA cases (n = 255) and controls (n = 249) from India with data collection from 2010-2012. RESULTS Women with the 4/5 or 5/5 PER3 genotype had a nonstatistically significant 33% increased odds of BrCA. Cases were more likely to have a morning (OR = 2.43, 95% CI = 1.23-4.81) or evening (OR = 2.55, 95% CI = 1.19-5.47) chronotype. CONCLUSIONS Findings are consistent with the possibility that extremes in chronotype may elicit circadian desynchronization, resulting in increased BrCA susceptibility.
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Affiliation(s)
- Michael D. Wirth
- South Carolina Statewide Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - James B. Burch
- South Carolina Statewide Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- WJB Dorn VA Medical Center, Columbia, SC, USA
| | - James R. Hébert
- South Carolina Statewide Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Pradnya Kowtal
- Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Navi Mumbai, India
| | - Aparna Kapoor
- Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Navi Mumbai, India
| | - Susan E. Steck
- South Carolina Statewide Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Thomas G. Hurley
- South Carolina Statewide Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Prakash C. Gupta
- Healis - Sekhsaria Institute for Public Health, Navi Mumbai, India
| | | | - Shawn D. Youngstedt
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- WJB Dorn VA Medical Center, Columbia, SC, USA
| | - Hongmei Zhang
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis
| | - Rajiv Sarin
- Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Navi Mumbai, India
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Ray MA, Youngstedt SD, Zhang H, Robb SW, Harmon BE, Jean-Louis G, Cai B, Hurley TG, Hébert JR, Bogan RK, Burch JB. Examination of wrist and hip actigraphy using a novel sleep estimation procedure ☆. ACTA ACUST UNITED AC 2014; 7:74-81. [PMID: 25580202 PMCID: PMC4286157 DOI: 10.1016/j.slsci.2014.09.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [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] [Indexed: 11/27/2022]
Abstract
Objective Improving and validating sleep scoring algorithms for actigraphs enhances their usefulness in clinical and research applications. The MTI® device (ActiGraph, Pensacola, FL) had not been previously validated for sleep. The aims were to (1) compare the accuracy of sleep metrics obtained via wrist- and hip-mounted MTI® actigraphs with polysomnographic (PSG) recordings in a sample that included both normal sleepers and individuals with presumed sleep disorders; and (2) develop a novel sleep scoring algorithm using spline regression to improve the correspondence between the actigraphs and PSG. Methods Original actigraphy data were amplified and their pattern was estimated using a penalized spline. The magnitude of amplification and the spline were estimated by minimizing the difference in sleep efficiency between wrist- (hip-) actigraphs and PSG recordings. Sleep measures using both the original and spline-modified actigraphy data were compared to PSG using the following: mean sleep summary measures; Spearman rank-order correlations of summary measures; percent of minute-by-minute agreement; sensitivity and specificity; and Bland–Altman plots. Results The original wrist actigraphy data showed modest correspondence with PSG, and much less correspondence was found between hip actigraphy and PSG. The spline-modified wrist actigraphy produced better approximations of interclass correlations, sensitivity, and mean sleep summary measures relative to PSG than the original wrist actigraphy data. The spline-modified hip actigraphy provided improved correspondence, but sleep measures were still not representative of PSG. Discussion The results indicate that with some refinement, the spline regression method has the potential to improve sleep estimates obtained using wrist actigraphy.
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Affiliation(s)
- Meredith A Ray
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Shawn D Youngstedt
- College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA ; Phoenix VA Health Care System, Phoenix, AZ, USA ; School of Nutrition and Health Promotion, Arizona State University, Phoenix, AZ, USA
| | - Hongmei Zhang
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, USA
| | - Sara Wagner Robb
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA
| | - Brook E Harmon
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN, USA ; South Carolina Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, USA
| | - Girardin Jean-Louis
- Departments of Population Health and Psychiatry, New York University School of Medicine, New York, NY, USA
| | - Bo Cai
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Thomas G Hurley
- South Carolina Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, USA
| | - James R Hébert
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA ; South Carolina Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, USA
| | | | - James B Burch
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA ; South Carolina Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, USA ; WJB Dorn VA Medical Center, Columbia, SC, USA
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Rao GA, Mann JR, Bottai M, Uemura H, Burch JB, Bennett CL, Haddock KS, Hébert JR. Angiotensin receptor blockers and risk of prostate cancer among United States veterans. J Clin Pharmacol 2013; 53:773-8. [PMID: 23686462 DOI: 10.1002/jcph.98] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 04/12/2013] [Indexed: 12/18/2022]
Abstract
To address concerns regarding increased risk of prostate cancer (PrCA) among angiotensin receptor blocker (ARB) users, we used national retrospective data from the Department of Veterans Affairs (VA) through the Veterans Affairs Informatics and Computing Infrastructure. We identified a total of 543,824 unique Veterans who were classified into either ARB treated or not-treated in 1:15 ratio. The two groups were balanced using inverse probability of treatment weights. A double-robust cox-proportional hazards model was used to estimate the hazard ratio for PrCA incidence. To evaluate for a potential Gleason score stage migration, we conducted weighted Cochrane-Armitage test. Post weighting, the rates of PrCA in treated and not-treated groups were 506 (1.5%) and 8,269 (1.6%), respectively; representing a hazard ratio of (0.91, p-value .049). There was no significant difference in Gleason scores between the two groups. We found a small, but statistically significant, reduction in the incidence of clinically detected PrCA among patients assigned to receive ARB with no countervailing effect on degree of differentiation (as indicated by Gleason score). Findings from this study support Food and Drug Administration's recent conclusion that ARB use does not increase risk of incident PrCA.
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Affiliation(s)
- Gowtham A Rao
- University of South Carolina, Columbia, South Carolina, USA; William J.B. Dorn Veterans Affairs Medical Center, Columbia, SC 29203, USA.
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Kline CE, Ewing GB, Burch JB, Blair SN, Durstine JL, Davis JM, Youngstedt SD. Exercise training improves selected aspects of daytime functioning in adults with obstructive sleep apnea. J Clin Sleep Med 2012; 8:357-65. [PMID: 22893765 DOI: 10.5664/jcsm.2022] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [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: 01/08/2023]
Abstract
STUDY OBJECTIVES To explore the utility of exercise training for improving daytime functioning in adults with obstructive sleep apnea (OSA). METHODS Forty-three sedentary and overweight/obese adults aged 18-55 years with at least moderate-severity untreated OSA (apnea-hypopnea index ≥ 15) were randomized to 12 weeks of moderate-intensity aerobic and resistance exercise training (n = 27) or low-intensity stretching control treatment (n = 16). As part of a trial investigating the efficacy of exercise training on OSA severity, daytime functioning was assessed before and following the intervention. Sleepiness, functional impairment due to sleepiness, depressive symptoms, mood, and quality of life (QOL) were evaluated with validated questionnaires, and cognitive function was assessed with a neurobehavioral performance battery. OSA severity was measured with one night of laboratory polysomnography before and following the intervention. RESULTS Compared with stretching control, exercise training resulted in significant improvements in depressive symptoms, fatigue and vigor, and aspects of QOL (p < 0.05). Sleepiness and functional impairment due to sleepiness also were improved following exercise versus control to a similar degree in terms of effect sizes (d > 0.5), though these changes were not statistically significant. No neurobehavioral performance improvements were found. Reduced fatigue following exercise training was mediated by a reduction in OSA severity, but changes in OSA severity did not significantly mediate improvement in any other measure of daytime functioning. CONCLUSIONS These data provide preliminary evidence that exercise training may be helpful for improving aspects of daytime functioning of adults with OSA. Larger trials are needed to further verify the observed improvements.
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Affiliation(s)
- Christopher E Kline
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O’Hara Street, Pittsburgh, PA 15213, United States.
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Kline CE, Crowley EP, Ewing GB, Burch JB, Blair SN, Durstine JL, Davis JM, Youngstedt SD. The effect of exercise training on obstructive sleep apnea and sleep quality: a randomized controlled trial. Sleep 2011; 34:1631-40. [PMID: 22131599 PMCID: PMC3208839 DOI: 10.5665/sleep.1422] [Citation(s) in RCA: 209] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
STUDY OBJECTIVES To evaluate the efficacy of a 12-week exercise training program for reducing obstructive sleep apnea (OSA) severity and improving sleep quality, and to explore possible mechanisms by which exercise may reduce OSA severity. DESIGN Randomized controlled trial. SETTING Clinical exercise physiology center, sleep laboratory. PARTICIPANTS Forty-three sedentary and overweight/obese adults aged 18-55 years with at least moderate-severity untreated OSA (screening apnea-hypopnea index [AHI] ≥ 15). INTERVENTIONS Participants randomized to exercise training (n = 27) met 4 times/week for 12 weeks and performed 150 min/week of moderate-intensity aerobic activity, followed by resistance training twice/week. Participants randomized to a stretching control (n = 16) met twice weekly for 12 weeks to perform low-intensity exercises designed to increase whole-body flexibility. MEASUREMENTS AND RESULTS OSA severity was assessed with one night of laboratory polysomnography (PSG) before and following the 12-week intervention. Measures of sleep quality included PSG, actigraphy (7-10 days), and the Pittsburgh Sleep Quality Index. Compared with stretching, exercise resulted in a significant AHI reduction (exercise: 32.2 ± 5.6 to 24.6 ± 4.4, stretching: 24.4 ± 5.6 to 28.9 ± 6.4; P < 0.01) as well as significant changes in oxygen desaturation index (ODI; P = 0.03) and stage N3 sleep (P = 0.03). Reductions in AHI and ODI were achieved without a significant decrease in body weight. Improvements in actigraphic sleep and subjective sleep quality were also noted following exercise compared with stretching. CONCLUSIONS Exercise training had moderate treatment efficacy for the reduction of AHI in sedentary overweight/obese adults, which suggests that exercise may be beneficial for the management of OSA beyond simply facilitating weight loss. TRIAL REGISTRATION Clinicaltrials.gov identification number NCT00956423.
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Affiliation(s)
- Christopher E Kline
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
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Kline CE, Crowley EP, Ewing GB, Rowell EA, Giles KL, Blair SN, Durstine JL, Davis JM, Burch JB, Youngstedt SD. Exercise Training Improves Heart Rate Recovery In Adults With Obstructive Sleep Apnea. Med Sci Sports Exerc 2011. [DOI: 10.1249/01.mss.0000400768.59989.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Xirasagar S, Hurley TG, Burch JB, Mansaray A, Hébert JR. Colonoscopy screening rates among patients of colonoscopy-trained African American primary care physicians. Cancer 2011; 117:5151-60. [PMID: 21523762 DOI: 10.1002/cncr.26142] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Revised: 12/03/2010] [Accepted: 02/25/2011] [Indexed: 01/22/2023]
Abstract
BACKGROUND When performed competently, colonoscopy screening can reduce colorectal cancer rates, especially in high-risk groups such as African Americans. Training primary care physicians (PCPs) to perform colonoscopy may improve screening rates among underserved high-risk populations. METHODS The authors compared colonoscopy screening rates and computed adjusted odds ratios for colonoscopy-eligible patients of trained African American PCPs (study group) versus untrained PCPs (comparison group), before and after initiating colonoscopy training. All colonoscopies were performed at a licensed ambulatory surgery center with specialist standby support. Retrospective chart review was conducted on 200 consecutive, established outpatients aged ≥50 years at each of 12 PCP offices (7 trained African American PCPs and 5 untrained PCPs, practicing in the same geographic region). There were a total of 1244 study group and 923 comparison group patients. RESULTS Post-training colonoscopy rates in both groups were higher than pretraining rates: 48.3% versus 9.3% in the study group, 29.6% versus 9.8% in the comparison group (both P < .001). African American patients in the study group showed a >5-fold increase (8.9% pretraining vs 52.8% post-training), with no change among whites (18.2% vs 25.0%). Corresponding pretraining and post-training rates among comparison patients were 10.4%% and 38.7%, respectively, among African Americans (P < .001), and 13.3% versus 13.2%, respectively, among whites. After adjusting for demographics, duration since becoming the PCP's patient, and health insurance, the study group had a 66% higher likelihood of colonoscopy in the post-training period (odds ratio, 1.66; 95% confidence interval, 1.30-2.13), and African Americans had a 5-fold increased likelihood of colonoscopy relative to whites. CONCLUSIONS Colonoscopy-trained PCPs may help reduce colorectal cancer disparities.
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Affiliation(s)
- Sudha Xirasagar
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.
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Steck SE, Burch JB, Hurley T, Cavicchia P, Alexander M, Shivappa N, Hebert JR. A pilot study of diet and colorectal polyps by race. FASEB J 2011. [DOI: 10.1096/fasebj.25.1_supplement.978.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Susan E. Steck
- Epidemiology & Biostatistics
- Cancer Prevention and Control ProgramUniversity of South CarolinaColumbiaSC
| | - James B. Burch
- Epidemiology & Biostatistics
- Cancer Prevention and Control ProgramUniversity of South CarolinaColumbiaSC
| | - Tom Hurley
- Cancer Prevention and Control ProgramUniversity of South CarolinaColumbiaSC
| | - Philip Cavicchia
- Epidemiology & Biostatistics
- Cancer Prevention and Control ProgramUniversity of South CarolinaColumbiaSC
| | | | - Nitin Shivappa
- Epidemiology & Biostatistics
- Cancer Prevention and Control ProgramUniversity of South CarolinaColumbiaSC
| | - James R. Hebert
- Epidemiology & Biostatistics
- Cancer Prevention and Control ProgramUniversity of South CarolinaColumbiaSC
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Wagner SE, Burch JB, Bottai M, Puett R, Porter D, Bolick-Aldrich S, Temples T, Wilkerson RC, Vena JE, Hébert JR. Groundwater uranium and cancer incidence in South Carolina. Cancer Causes Control 2010; 22:41-50. [PMID: 21080052 DOI: 10.1007/s10552-010-9669-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Accepted: 10/09/2010] [Indexed: 12/29/2022]
Abstract
OBJECTIVE This ecologic study tested the hypothesis that census tracts with elevated groundwater uranium and more frequent groundwater use have increased cancer incidence. METHODS Data sources included: incident total, leukemia, prostate, breast, colorectal, lung, kidney, and bladder cancers (1996-2005, SC Central Cancer Registry); demographic and groundwater use (1990 US Census); and groundwater uranium concentrations (n = 4,600, from existing federal and state databases). Kriging was used to predict average uranium concentrations within tracts. The relationship between uranium and standardized cancer incidence ratios was modeled among tracts with substantial groundwater use via linear or semiparametric regression, with and without stratification by the proportion of African Americans in each area. RESULTS A total of 134,685 cancer cases were evaluated. Tracts with ≥50% groundwater use and uranium concentrations in the upper quartile had increased risks for colorectal, breast, kidney, prostate, and total cancer compared to referent tracts. Some of these relationships were more likely to be observed among tracts populated primarily by African Americans. CONCLUSION SC regions with elevated groundwater uranium and more groundwater use may have an increased incidence of certain cancers, although additional research is needed since the design precluded adjustment for race or other predictive factors at the individual level.
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Affiliation(s)
- Sara E Wagner
- College of Public Health, Department of Epidemiology and Biostatistics, Paul D. Coverdell Center for Biomedical and Health Sciences, University of Georgia, 500 D.W. Brooks Drive, Athens, GA 30602-7396, USA.
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Wagner SE, Burch JB, Bottai M, Pinney SM, Puett R, Porter D, Vena JE, Hébert JR. Hypertension and hematologic parameters in a community near a uranium processing facility. Environ Res 2010; 110:786-97. [PMID: 20889151 PMCID: PMC2978648 DOI: 10.1016/j.envres.2010.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Revised: 08/16/2010] [Accepted: 09/10/2010] [Indexed: 05/03/2023]
Abstract
BACKGROUND Environmental uranium exposure originating as a byproduct of uranium processing can impact human health. The Fernald Feed Materials Production Center functioned as a uranium processing facility from 1951 to 1989, and potential health effects among residents living near this plant were investigated via the Fernald Medical Monitoring Program (FMMP). METHODS Data from 8216 adult FMMP participants were used to test the hypothesis that elevated uranium exposure was associated with indicators of hypertension or changes in hematologic parameters at entry into the program. A cumulative uranium exposure estimate, developed by FMMP investigators, was used to classify exposure. Systolic and diastolic blood pressure and physician diagnoses were used to assess hypertension; and red blood cells, platelets, and white blood cell differential counts were used to characterize hematology. The relationship between uranium exposure and hypertension or hematologic parameters was evaluated using generalized linear models and quantile regression for continuous outcomes, and logistic regression or ordinal logistic regression for categorical outcomes, after adjustment for potential confounding factors. RESULTS Of 8216 adult FMMP participants 4187 (51%) had low cumulative uranium exposure, 1273 (15%) had moderate exposure, and 2756 (34%) were in the high (>0.50 Sievert) cumulative lifetime uranium exposure category. Participants with elevated uranium exposure had decreased white blood cell and lymphocyte counts and increased eosinophil counts. Female participants with higher uranium exposures had elevated systolic blood pressure compared to women with lower exposures. However, no exposure-related changes were observed in diastolic blood pressure or hypertension diagnoses among female or male participants. CONCLUSIONS Results from this investigation suggest that residents in the vicinity of the Fernald plant with elevated exposure to uranium primarily via inhalation exhibited decreases in white blood cell counts, and small, though statistically significant, gender-specific alterations in systolic blood pressure at entry into the FMMP.
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Affiliation(s)
- Sara E Wagner
- College of Public Health, Department of Epidemiology and Biostatistics, Paul D. Coverdell Center for Biomedical and Health Sciences, University of Georgia, 500 D.W. Brooks Drive, Athens, GA 30602-7396, USA.
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Du-Quiton J, Wood PA, Burch JB, Grutsch JF, Gupta D, Tyer K, Lis CG, Levin RD, Quiton DFT, Reynolds JL, Hrushesky WJM. Actigraphic assessment of daily sleep-activity pattern abnormalities reflects self-assessed depression and anxiety in outpatients with advanced non-small cell lung cancer. Psychooncology 2010; 19:180-9. [PMID: 19199317 DOI: 10.1002/pon.1539] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES We measured subjectively evaluated depression and anxiety, and objectively measured daily sleep-activity patterns in inpatients and outpatients with advanced non-small cell lung cancer (NSCLC) and determined whether cancer-associated depression and anxiety are accompanied by characteristic circadian rhythm abnormalities. METHODS Equal numbers of inpatients (n=42) and outpatients (n=42) with advanced NSCLC were studied. Baseline depression and anxiety, assessed by the Hospital Anxiety and Depression Scale (HADS), and actigraphy were recorded before chemotherapy initiation. The effects of the presence and severity of chronic obstructive pulmonary disease (COPD) on depression, anxiety, and actigraphy were assessed only among the 42 outpatients. RESULTS Anxiety occurred in 40% and depression in 25% of these lung cancer patients, equally among inpatients and outpatients. All patients suffer extremely disturbed daily sleep-activity cycles but each patient also maintains some degree of circadian organization. Outpatients maintain more robust daily activity patterns and longer, more consolidated nighttime sleep compared with inpatients. The more disrupted the daily sleep-activity rhythm, the worse the depression and/or anxiety scores for outpatients. These relationships are obscured among inpatients. COPD has no independent measurable effects on the daily organization of sleep-activity, depression, or anxiety. CONCLUSIONS Lung cancer patients whose diurnal activity is disturbed by prolonged and frequent sedentary episodes and whose sleep is disturbed by frequent and prolonged waking are most anxious and depressed. These findings and relationships are masked by hospitalization. Since diurnal exercise improves both sleep and mood, it is reasonable to test whether enhancing daytime activity and nighttime sleep can diminish cancer-associated depression.
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Affiliation(s)
- Jovelyn Du-Quiton
- Medical Chronobiological Laboratory, WJB Dorn Veterans Affairs Medical Center, Columbia, SC 29209, USA
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40
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Burch JB, Svendsen E, Siegel PD, Wagner SE, von Essen S, Keefe T, Mehaffy J, Martinez AS, Bradford M, Baker L, Cranmer B, Saito R, Tessari J, Linda P, Andersen C, Christensen O, Koehncke N, Reynolds SJ. Endotoxin exposure and inflammation markers among agricultural workers in Colorado and Nebraska. J Toxicol Environ Health A 2010; 73:5-22. [PMID: 19953416 DOI: 10.1080/15287390903248604] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The adverse respiratory effects of agricultural dust inhalation are mediated in part by endotoxin, a constituent of gram-negative bacterial cell walls. This study quantified personal work-shift exposures to inhalable dust, endotoxin, and its reactive 3-hydroxy fatty acid (3-OHFA) constituents among workers in grain elevators, cattle feedlots, dairies, and on corn farms. Exposures were compared with post-work-shift nasal lavage fluid inflammation markers and respiratory symptoms. Breathing-zone personal air monitoring was performed over one work shift to quantify inhalable dust (Institute of Medicine samplers), endotoxin (recombinant factor C [rFC] assay), and 3-OHFA (gas chromatography/mass spectrometry). Post-shift nasal lavage fluids were assayed for polymorphonuclear neutrophils (PMN), myeloperoxidase (MPO), interleukin 8 (IL-8), albumin, and eosinophilic cation protein (ECP) concentrations. The geometric mean (GSD) of endotoxin exposure (rFC assay) among the 125 male participants was 888 +/- (6.5) EU/m(3), and 93% exceeded the proposed exposure limit (50 EU/m(3)). Mean PMN, MPO, albumin, and ECP levels were two- to threefold higher among workers in the upper quartile of 3-OHFA exposure compared to the lowest exposure quartile. Even numbered 3-OHFA were most strongly associated with nasal inflammation. Symptom prevalence was not elevated among exposed workers, possibly due to endotoxin tolerance or a healthy worker effect in this population. This is the first study to evaluate the relationship between endotoxin's 3-OHFA constituents in agricultural dust and nasal airway inflammation. More research is needed to characterize the extent to which these agents contribute to respiratory disease among agricultural workers.
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Affiliation(s)
- James B Burch
- Department of Epidemiology and Biostatistics, Cancer Prevention and Control Program, and Center for Colon Cancer Research, University of South Carolina, Columbia, SC 29208, USA.
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Clark ML, Reynolds SJ, Burch JB, Conway S, Bachand AM, Peel JL. Indoor air pollution, cookstove quality, and housing characteristics in two Honduran communities. Environ Res 2010; 110:12-18. [PMID: 19922911 DOI: 10.1016/j.envres.2009.10.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2009] [Revised: 09/05/2009] [Accepted: 10/20/2009] [Indexed: 05/26/2023]
Abstract
Elevated indoor air pollution exposures associated with the burning of biomass fuels in developing countries are well established. Improved cookstoves have the potential to substantially reduce these exposures. However, few studies have quantitatively evaluated exposure reductions associated with the introduction of improved stoves, likely due to the cost and time-intensive nature of such evaluations. Several studies have demonstrated the value of estimating indoor air pollution exposures by evaluating personal cooking practices and household parameters in addition to stove type. We assessed carbon monoxide (n=54) and fine particulate matter (PM(2.5)) (n=58) levels among non-smoking Honduran women cooking with traditional or improved wood-burning cookstoves in two communities, one semi-urban and one rural. Exposure concentrations were assessed via 8-h indoor monitoring, as well as 8-h personal PM(2.5) monitoring. Housing characteristics were determined to indicate ventilation that may affect carbon monoxide and PM(2.5). Stove quality was assessed using a four-level subjective scale representing the potential for indoor emissions, ranging from poorly functioning traditional stoves to well-functioning improved stoves. Univariately, the stove scale as compared to stove type (traditional versus improved) accounted for a higher percent of the variation in pollutant concentrations; for example, the stove scale predicted 79% of the variation and the stove type predicted 54% of the variation in indoor carbon monoxide concentrations. In multivariable models, the stove scale, age of the stove, and ventilation factors predicted more than 50% of the variation in personal and indoor PM(2.5) and 85% of the variation in indoor carbon monoxide. Results indicate that using type of stove alone as a proxy for exposure may lead to exposure misclassification and potentially biased exposure and health effects relationships. Utilizing stove quality and housing characteristics that influence ventilation may provide a viable alternative to the more time- and cost-intensive pollutant assessments for larger-scale studies. Designing kitchens with proper ventilation structures could lead to improved indoor environments, especially important in areas where biomass will continue to be the preferred and necessary cooking fuel for some time.
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Affiliation(s)
- Maggie L Clark
- Department of Environmental and Radiological Health Sciences, Colorado State University, Campus Delivery 1681, Fort Collins, CO 80523-1681, USA.
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Guess J, Burch JB, Ogoussan K, Armstead CA, Zhang H, Wagner S, Hebert JR, Wood P, Youngstedt SD, Hofseth LJ, Singh UP, Xie D, Hrushesky WJM. Circadian disruption, Per3, and human cytokine secretion. Integr Cancer Ther 2009; 8:329-36. [PMID: 19926609 DOI: 10.1177/1534735409352029] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Circadian disruption has been linked with inflammation, an established cancer risk factor. Per3 clock gene polymorphisms have also been associated with circadian disruption and with increased cancer risk. Patients completed a questionnaire and provided a blood sample prior to undergoing a colonoscopy (n = 70). Adjusted mean serum cytokine concentrations (IL-6, TNF-alpha, gamma-INF, IL-1ra, IL-1-beta, VEGF) were compared among patients with high and low scores for fatigue (Multidimensional Fatigue Inventory), depressive symptoms (Beck Depression Inventory II), or sleep disruption (Pittsburgh Sleep Quality Index), or among patients with different Per3 clock gene variants. Poor sleep was associated with elevated VEGF, and fatigue-related reduced activity was associated with elevated TNF-alpha concentrations. Participants with the 4/5 or 5/5 Per3 variable tandem repeat sequence had elevated IL-6 concentrations compared to those with the 4/4 genotype. Biological processes linking circadian disruption with cancer remain to be elucidated. Increased inflammatory cytokine secretion may play a role.
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Affiliation(s)
- Jaclyn Guess
- Department of Epidemiology and Biostatistics, Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
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Clark ML, Peel JL, Burch JB, Nelson TL, Robinson MM, Conway S, Bachand AM, Reynolds SJ. Impact of improved cookstoves on indoor air pollution and adverse health effects among Honduran women. Int J Environ Health Res 2009; 19:357-68. [PMID: 19626518 DOI: 10.1080/09603120902842705] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Elevated indoor air pollution levels due to the burning of biomass in developing countries are well established. Few studies have quantitatively assessed air pollution levels of improved cookstoves and examined these measures in relation to health effects. We conducted a cross-sectional survey among 79 Honduran women cooking with traditional or improved cookstoves. Carbon monoxide and fine particulate matter (PM(2.5)) levels were assessed via indoor and personal monitoring. Pulmonary function and respiratory symptoms were ascertained. Finger-stick blood spot samples were collected to measure C-reactive protein (CRP) concentrations. The use of improved stoves was associated with 63% lower levels of personal PM(2.5), 73% lower levels of indoor PM(2.5), and 87% lower levels of indoor carbon monoxide as compared to traditional stoves. Women using traditional stoves reported symptoms more frequently than those using improved stoves. There was no evidence of associations between cookstove type or air quality measures with lung function or CRP.
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Affiliation(s)
- Maggie L Clark
- Environmental & Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA.
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Hébert JR, Daguise VG, Hurley DM, Wilkerson RC, Mosley CM, Adams SA, Puett R, Burch JB, Steck SE, Bolick-Aldrich SW. Mapping cancer mortality-to-incidence ratios to illustrate racial and sex disparities in a high-risk population. Cancer 2009; 115:2539-52. [PMID: 19296515 DOI: 10.1002/cncr.24270] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Comparisons of incidence and mortality rates are the metrics used most commonly to define cancer-related racial disparities. In the US, and particularly in South Carolina, these largely disfavor African Americans (AAs). Computed from readily available data sources, the mortality-to-incidence rate ratio (MIR) provides a population-based indicator of survival. METHODS South Carolina Central Cancer Registry incidence data and Vital Registry death data were used to construct MIRs. ArcGIS 9.2 mapping software was used to map cancer MIRs by sex and race for 8 Health Regions within South Carolina for all cancers combined and for breast, cervical, colorectal, lung, oral, and prostate cancers. RESULTS Racial differences in cancer MIRs were observed for both sexes for all cancers combined and for most individual sites. The largest racial differences were observed for female breast, prostate, and oral cancers, and AAs had MIRs nearly twice those of European Americans (EAs). CONCLUSIONS Comparing and mapping race- and sex-specific cancer MIRs provides a powerful way to observe the scope of the cancer problem. By using these methods, in the current study, AAs had much higher cancer MIRs compared with EAs for most cancer sites in nearly all regions of South Carolina. Future work must be directed at explaining and addressing the underlying differences in cancer outcomes by region and race. MIR mapping allows for pinpointing areas where future research has the greatest likelihood of identifying the causes of large, persistent, cancer-related disparities. Other regions with access to high-quality data may find it useful to compare MIRs and conduct MIR mapping.
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Affiliation(s)
- James R Hébert
- South Carolina Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia, South Carolina 29208, USA.
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Wagner SE, Burch JB, Hussey J, Temples T, Bolick-Aldrich S, Mosley-Broughton C, Liu Y, Hebert JR. Soil zinc content, groundwater usage, and prostate cancer incidence in South Carolina. Cancer Causes Control 2008; 20:345-53. [PMID: 18949566 DOI: 10.1007/s10552-008-9248-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2008] [Accepted: 10/04/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Prostate cancer (PrCA) incidence in South Carolina (SC) exceeds the national average, particularly among African Americans (AAs). Though data are limited, low environmental zinc exposures and down-regulation of prostatic zinc transporter proteins among AAs may explain, in part, the racial PrCA disparity. METHODS Age-adjusted PrCA rates were calculated by census tract. Demographic data were obtained from the 1990 census. Hazardous waste site locations and soil zinc concentrations were obtained from existing federal and state databases. A geographic information system and Poisson regression were used to test the hypothesis that census tracts with reduced soil zinc concentrations, elevated groundwater use, or more agricultural or hazardous waste sites had elevated PrCA risks. RESULTS Census tracts with high groundwater use and low zinc concentrations had higher PrCA rate ratios (RR: 1.270; 95% confidence interval: 1.079, 1.505). This effect was not more apparent in areas populated primarily by AAs. CONCLUSION Increased PrCA rates were associated with reduced soil zinc concentrations and elevated groundwater use, although this observation is not likely to contribute to SC's racial PrCA disparity. Statewide mapping and statistical modeling of relationships between environmental factors, demographics, and cancer incidence can be used to screen hypotheses focusing on novel PrCA risk factors.
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Affiliation(s)
- Sara E Wagner
- Cancer Prevention and Control Program, University of South Carolina, 2221 Devine Street, Columbia, SC 29208, USA.
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Burch JB, Reif JS, Yost MG. Geomagnetic activity and human melatonin metabolite excretion. Neurosci Lett 2008; 438:76-9. [PMID: 18472329 DOI: 10.1016/j.neulet.2008.04.031] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2007] [Revised: 04/09/2008] [Accepted: 04/11/2008] [Indexed: 10/22/2022]
Abstract
Elevated geomagnetic activity has been linked with human psychological, neurological and cardiovascular outcomes, and altered melatonin production has been implicated as an underlying mechanism to explain these effects. The relationship between geomagnetic activity and overnight excretion of the melatonin metabolite, 6-hydroxymelatonin sulfate (6-OHMS), was evaluated in a population of 153 male electric utility workers. The effect of geomagnetic activity combined with either 60Hz magnetic field or ambient light exposures was also evaluated. Elevated equivalent amplitudes (USGS, Boulder, CO) were associated with lower adjusted mean nocturnal 6-OHMS/cr concentrations and reduced total overnight 6-OHMS excretion, consistent with a previous study. Time intervals in which geomagnetic activity predicted the largest differences in mean 6-OHMS excretion generally occurred between 15- and 33-h prior to urine sample collection. These times coincide with key periods of melatonin regulation and production, respectively, suggesting that geomagnetic activity may play a role in the entrainment of human melatonin rhythms.
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Affiliation(s)
- James B Burch
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC 29208, USA.
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Clark ML, Burch JB, Yost MG, Cragin LA, Fitzpatrick CTE, Bachand AM, Ramaprasad J, Reif JS. Residential Radiofrequency Exposure and Estrogen Production Among Pre- And Postmenopausal Women. Epidemiology 2006. [DOI: 10.1097/00001648-200611001-01168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Burch JB, Walling M, Rush A, Hennesey M, Craven W, Finlayson C, Anderson BO, Cosma G, Wells RL. Melatonin and estrogen in breast cyst fluids. Breast Cancer Res Treat 2006; 103:331-41. [PMID: 17061046 DOI: 10.1007/s10549-006-9372-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2006] [Accepted: 08/10/2006] [Indexed: 12/21/2022]
Abstract
Increased breast cancer risks have been reported among women with gross cystic breast disease (GCBD), although the mechanism for this increase remains unexplained. Relationships between GCBD characteristics, breast cancer risk factors, and the biochemical composition and growth properties of 142 breast cyst fluid (BCF) samples were studied among 93 women with GCBD. Concentrations of melatonin, estrogen (17-beta-estradiol), dehydroepiandrosterone-sulfate (DHEA-S), epidermal growth factor (EGF), transforming growth factor beta (TGF-B1 and TGF-B2), sodium (Na), and potassium (K) were quantified in BCF samples, and human breast cancer cells (MCF-7) were treated with BCF in vitro. Patients were grouped according to BCF Na:K ratios previously linked with increased breast cancer risks (Na:K </= 3, Type 1), and mean concentrations of BCF constituents were compared with low risk (Na:K > 3, Type 2) and mixed cyst groups. Women with larger and more frequently occurring cysts had higher BCF estrogen and DHEA-S, and lower TGF-B1 levels. Women with Type 1 cysts had elevated BCF melatonin, estrogen, DHEA-S, and EGF, and lower concentrations of TGF-B2 compared to women with Type 2 cysts. BCF generally inhibited cell growth relative to serum-treated controls, consistent with previous studies. Melatonin and estrogen in BCF independently predicted growth inhibition and stimulation, respectively. Biological monitoring of BCF may help identify women with GCBD at greatest risk for breast cancer development.
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Affiliation(s)
- James B Burch
- Cancer Prevention and Control Program, Center for Colon Cancer Research, WJB Dorn Veterans Affairs Medical Center, Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC 29208, USA.
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Daguise VG, Burch JB, Horner MJ, Mosley C, Hofseth LJ, Wargovich MJ, Lloyd SC, Hebert JR. Colorectal cancer disparities in South Carolina: descriptive epidemiology, screening, special programs, and future direction. J S C Med Assoc 2006; 102:212-20. [PMID: 17319233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
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50
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Clark ML, Burch JB, Yost MG, Cragin LA, Fitzpatrick CTE, Bachand AM, Ramaprasad J, Reif JS. Residential Radiofrequency Exposure and Estrogen Production among Pre- and Postmenopausal Women. Am J Epidemiol 2006. [DOI: 10.1093/aje/163.suppl_11.s119-d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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