Trajectories of depressive and anxiety symptoms and associated risk factors during the COVID-19 pandemic in Germany: A longitudinal cohort study

BACKGROUND

Most COVID-19-related mental health research focused on average levels of mental health parameters in the general population. However, considering heterogeneous groups and their long-term responses could deepen our understanding of mental health during community crises. This four-wave study aimed to (1) identify subgroups with different trajectories of depressive and anxiety symptoms in the German general population, and (2) investigate associated risk factors.

METHODS

We analyzed self-report data from N = 1257 German adults participating in a European cohort study, assessed in summer 2020 (T1), and at 6 (T2), 12 (T3), and 30 months (T4). Depressive and anxiety symptoms were measured using the PHQ-4. Sociodemographic, health-related, and pandemic-related variables were assessed at baseline. We applied growth mixture modeling to identify subgroups of symptom trajectories and conducted multinomial logistic regression to examine factors associated with class membership.

RESULTS

We identified six symptom trajectories: Low-stable (n = 971, 77.2 %), Continuous deterioration (n = 30, 2.4 %), Transient deterioration (n = 75, 6.0 %), Continuous improvement (n = 97, 7.7 %), Transient improvement (n = 38, 3.0 %) and Chronicity (n = 46, 3.7 %). Age, education, work status, mental health diagnoses, self-reported health, and pandemic-related news consumption were significantly associated with subgroup membership.

LIMITATIONS

The generalizability of the study is constrained by an unrepresentative sampling method, a notable dropout rate, and limited consideration of risk factors.

CONCLUSION

Most people experienced low symptoms or improvement during the pandemic, while others experienced chronic or transient symptoms. Specific risk factors were associated with these trajectories, revealing nuanced mental health dynamics.

Abstract P1-07-28: Retrospective analysis of clinicopathologic features predictive of oncotype DX discordance in estrogen receptor positive, node negative breast cancer patients

BACKGROUND: Oncotype DX (ODX) is a validated recurrence score (RS) used to predict the risk of recurrence and benefit of chemotherapy in ER positive, node negative breast cancer patients. Prior to ODX, treatment recommendations regarding adjuvant chemotherapy and mortality approximation have taken into account clinical and pathologic risk factors. A discordance rate of 7-19% between risk allocating pathologic factors and ODX RS has been previously reported with progesterone receptor (PR) negativity noted as a defining clinical feature in numerous cases. The association between other clinicopathologic features and discordance is less certain.

METHODS: ODX data and clinicopathologic features were retrospectively reviewed for 724 breast cancer tumors belonging to 704 patients between 2006 and 2016. ODX discordance was defined as either 1-step discordance or 2-step discordance between ODX risk group (low, intermediate, high) and tumor grade (TG) (well differentiated, moderately differentiated, poorly differentiated). Tumors with 1-step discordance received a discordance score (DS) of 1 while those with 2-step discordance received a DS of 2. The database was subsequently analyzed using Paik's RS cutoffs as well as those outlined in the TAILORx trial. An odds ratio (OR) of >1 was consistent with discordance.

RESULTS: Among 724 tumor samples, ODX ER score (p=0.000), ODX PR score (p=0.000), ODX HER2 score (p=0.000), TG (p=0.000), mitotic count (MC) (p=0.0012), DCIS grade (p=0.0046), DCIS type (comedo necrosis vs. non-comedo necrosis) (p=0.0335) and micropapillary features (p=0.0044) were significantly associated with RS. Median age of cohort was 59 years and median tumor size was 1.2 cm.

Of 724 tumors, 619 from 604 subjects were eligible for assessment of discordance. Median RS was 16. Using Paik's RS cutoffs, 64.3% discordance was observed: 52.5% 1-step discordance (DS 1) and 11.8% 2-step discordance (DS 2). The TAILORx categorization yielded a discordance rate of 44.3%: 40.1% 1-step discordance and 4.2% 2-step discordance.

On univariate analysis and using Paik's RS cutoffs, young age (p= 0.0240), high MC (p=0.0006), large tumor size (>20 mm) (p=0.0209), the presence of DCIS (p=0.0480), high DCIS grade (p= 0.0033), and high ODX PR and ER scores (p= 0.0000) were significant clinicopathologic features predictive of discordance. On multivariate analysis, high MC (p= 0.0000), high ODX PR and ER scores (p=0.0000) remained significant as well as premenopausal status (p=0.026).

Per TAILORx cutoffs, univariate analysis revealed younger age (p= 0.0060), high MC (p= 0.0270), premenopausal status (p= 0.0124), and high ODX PR and ER scores (p= 0.0000) as significant for discordance. On multivariate analysis, high ODX PR and ER scores (p= 0.0000) remained significant.

CONCLUSION: In this retrospective ODX database, premenopausal status, high MC, high ODX PR and ER scores as per Paik's RS cutoffs were significant predictors for ODX discordance while high ODX PR and ER scores were significant predictors per the RS's outlined in the TAILORx trial. RS cutoffs per the TAILORX trial appear to create less discordance between RS and TG than the original cutoffs outlined by Paik and colleagues.

Citation Format: Cascetta KP, Zimmerman BS, Eggert L, Molot MC, Ru M, Nayak A, Bleiweiss I, Tiersten A. Retrospective analysis of clinicopathologic features predictive of oncotype DX discordance in estrogen receptor positive, node negative breast cancer patients [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-07-28.

Abstract P1-07-16: Retrospective analysis of oncotype DX recurrence score (RS) and discordance in patients with node-negative, ER+ breast cancer with recurrence

BACKGROUND: Oncotype RS is a 21-gene assay used to predict the likelihood of distant recurrence and benefit of chemotherapy in patients with node-negative, tamoxifen treated breast cancer. We developed a database to determine tumor recurrence rates and identify cases of discordance between Oncotype RS and tumor grade (TG). Our goal was to recognize patients with discordant tumors who had breast cancer recurrence and to understand the implications for patient management.

METHODS/RESULTS: We analyzed patient and tumor characteristics from 704 breast cancer patients between 2006-2016. Of these patients, there were thirteen recurrences (n=13), or 1.9% recurrence rate at a median follow-up of 4.2 years. When stratified by RS, recurrence rates were 1%, 2.4% and 4.3% in low, intermediate and high-risk groups respectively. Of the 13 patients who recurred, 31% had a low RS (<18), 54% had an intermediate RS (18-30) and 15% had a high RS (>31). The median RS was 23 and median age at time of recurrence was 55 years (62% postmenopausal). Tumor characteristics at time of recurrence were notable for: 77% metastatic, 23% locally recurrent, 85% PR positive, 69% moderately-differentiated (MD) and 31% poorly-differentiated (PD). No well-differentiated (WD) tumors recurred.

We defined Oncotype discordance as either 1-step or 2-step difference between Oncotype risk group (low, intermediate, high) and tumor grade (WD, MD, PD). Prior studies have demonstrated 7-19% “2-step discordance” between TG and RS (i.e. PD tumors with low-risk RS or WD tumors with high-risk RS). Of the 13 recurrences in our database, 46% were at least 1-step discordant, compared with 64.3% in our overall database. Among these recurrences, we compared discordant versus concordant tumors using two-sided T-tests. We found that fewer patients were treated with systemic chemotherapy in the discordant group (p=0.045), which was statistically significant. Among discordant patients, only one received chemotherapy, though all displayed MD or PD tumor grade. Discordant tumors tended to have lower RS (mean 17 vs. 27, p=0.34) and tended to be larger (mean 1.88cm vs. 1.33cm), however this was not statistically significant (p=0.84). Notably, the two largest tumors were both discordant. There were no significant differences in terms of age, Oncotype ER/PR score or mitotic count.

CONCLUSION: Although the sample size of recurrent patients is small, our data may suggest that patients with discordant tumors of low-risk Oncotype RS but higher TG may be receiving inadequate treatment (i.e. no chemotherapy). In addition to RS, other factors such as discordance, TG and tumor size should perhaps be considered when determining treatment plans.

Characteristics of Breast Cancer Recurrences in Oncotype DX DatabaseSubject #Age (years)Oncotype RSTumor GradeDiscordancePath PR%Tumor Size (cm)Chemotherapy14111MDY600.9N25811MDY1001.7N35713MDY301.0N45515MDY902.7N56122MDN301.5Y64522MDN901.8Y75323MDN00.9N83324MDN951.4Y96324PDY802.9U104129MDN801.1Y116530PDY102.1Y124933PDN01.6Y136135PDN51.0YMD=moderately-differentiated, PD=poorly-differentiated, Y=Yes, N=No, U=Unknown

Citation Format: Zimmerman BS, Cascetta KP, Ru M, Eggert L, Molot MC, Nayak A, Bleiweiss I, Tiersten A. Retrospective analysis of oncotype DX recurrence score (RS) and discordance in patients with node-negative, ER+ breast cancer with recurrence [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-07-16.

Is HIV infection a cofactor for cervical squamous cell neoplasia?

The objective of this study was to test the hypothesis that HIV interacts with human papilloma virus (HPV) to increase the odds of cervical neoplasia. The study design was a meta-analysis using data pooled from published sources. Studies published between January 1986 and March 1998 were eligible for inclusion if they included data on neoplasia (cytology-based), HIV (defined by laboratory and/or standard clinical criteria), and HPV (assessed by PCR, Southern blot, dot-blot hybridization, or cytology of an otherwise well designed study) among nonpregnant women. Blinded data abstraction was performed independently by the investigators. There were 15 studies that were eligible and presented data in a format that could be abstracted for analysis. Data were pooled using a Mantel-Haenszel summary odds ratio (OR); generalized estimation regression equations were used to examine independent effects of HIV and HPV. Overall, based on the Mantel-Haenszel ORs, there was a strong overall association between HPV and neoplasia [OR, 8.1; 95% confidence interval (CI), 6.5-10.1]. Stratifying by HIV status, HIV-positive women had higher odds of disease (OR, 8.8; 95% CI, 6.3-12.5) than HIV-negative women (OR, 5.0; 95% CI, 3.7-6.8). In the regression model, there was an interaction between HPV and HIV (P = 0.01); immunosuppression also tended to predict neoplasia (P = 0.058). HIV seems to be a cofactor in the association between HPV and cervical neoplasia; this effect may vary by level of immune function. These speculations are biologically plausible. Additional data from large, well designed studies are needed to confirm these hypotheses.

Use of polymorphic short and clustered coding-region microsatellites to distinguish strains of Candida albicans

We describe the identification of polymorphic microsatellite loci in the pathogenic yeast, Candida albicans. A search for all coding-region microsatellites with more than four repeats that can be found in Candida sequences in GenBank was conducted. Nine such microsatellite sequences consisting of trinucleotide motifs were found. Three of these were perfect microsatellites while the remaining six sequences were found in one imperfect microsatellite and two compound microsatellites. Because of the close proximity of some of these repeats, all could be assayed with six PCR primer pairs. All of these microsatellite sequences were found in five nuclear genes, ZNF1, CCN1, CPH1, EFG1, and MNT2. Except for a single (CTT)5 serine tract, all coded for polyglutamine tracts. Another locus with seven alleles, a region of the ERK1 protein kinase gene, was also examined, and may be a representative of a new class of highly polymorphic "clustered' microsatellites. Such loci, in which several non-contiguous but closely linked microsatellites are clustered together, may be a useful source of DNA polymorphisms in microorganisms in which long microsatellite sequences are unavailable. All seven regions amplified were polymorphic, having between two and seven variable length alleles in the 11 strains of Candida albicans examined. The results of this and similar searches will facilitate epidemiological and evolutionary studies of Candida and other microorganisms.

Keto fatty acids not containing doubly allylic methylenes are lipoxygenase substrates

The soybean lipoxygenase I oxygenates the unusual substrate 12-keto-(9Z)-octadecenoic acid methyl ester as indicated by oxygen uptake and spectral changes of the incubation mixture. The main oxygenation products have been isolated by HPLC and identified as 9,12-diketo-(10E)-octadecenoic acid methyl ester and 12-keto-(10E)-dodecenoic acid methyl ester by UV and IR spectroscopy, cochromatography with an authentic standard, gas chromatography/mass spectroscopy, and 1H NMR. In the formation of both compounds the oxygenase and hydroperoxidase activities of the enzyme appear to be involved. These data and the earlier results on the oxygenation of furanoic fatty acids (Boyer et al., 1979) indicate that the lipoxygenase reaction is not restricted to substrates containing a 1,4-pentadiene structure.

Birth weights in term infants. A 50-year perspective

An improvement in prenatal care over several generations could enhance the birth weights of term infants. We reviewed data on live-born, singleton infants born at our university medical center between 1935 and 1985. Our review of 42,185 such pregnancies revealed that the mean birth weight (3,279 g) of a term infant has not changed significantly during the past 50 years. The frequency of term infants' weighing less than 2,500 g has not changed, but there has been a significant increase in the percentage of macrosomic infants (greater than 4,000 g), from 3 to 14, in the last 15 years. White infants have been consistently heavier than black infants, by an average of 179 g (6.3 oz). Differences in mean birth weights have been consistently greater for male than female infants (123 g, 4.6 oz) and for multiparous than primiparous deliveries (79 g, 2.8 oz), regardless of race. Impressions from these data, spanning three generations, should be helpful for prenatal counseling.