Demographics, Medical Comorbidities, and Functional Factors Associated with Radiation Therapy Regimen Length in Older Patients

PURPOSE/OBJECTIVE(S)

To determine demographic, comorbidity, and functional factors associated with radiation therapy (RT) regimen length in older patients.

MATERIALS/METHODS

Using data from the Medicare Current Beneficiary Survey (MCBS), we identified patients who were diagnosed with cancer from 2002-2019 and received RT. The MCBS dataset is comprised of linked patient survey and Medicare claims data. Days of RT were used as a proxy for fractions of RT each patient received. We used treatment guidelines to identify a minimum treatment threshold for each cancer type to differentiate patients with low RT utilization from normal or supra-palliative RT utilization. Statistical analyses of patient demographics, comorbidities, and activities of daily living (ADL) were performed using chi-square and t-tests.

RESULTS

A total of 880 patients were included in this analysis, of whom 669 had high RT utilization. Of the demographic factors considered, age 85+ was associated with longer RT regimen length (p = 0.045), as was being "other" or multi-race, community, or facility treatment setting, and residing in the south (p = 0.013, 0.006, 0.003, 0.038, respectively). Of medical comorbidities, only lung disease was associated with longer RT regime (p = 0.020). Longer RT regimen length was significantly associated with requiring assistance with any ADLs (bathing, dressing, eating, chair, walking, toileting, all with p <0.001).

CONCLUSION

This abstract identifies specific patient demographics, medical comorbidities, and ADL limitations which may be associated with RT regimen length in older patients. Future work should focus on optimizing patients and delivery systems for RT and the relationship between pre- and post-treatment ADLs.

OP0007-HPR AN EPIDEMIOLOGICAL STUDY OF FOOT AND ANKLE PAIN AND HEALTH-RELATED JOB LOSS IN ADULTS OVER 50: CROSS-SECTIONAL FINDINGS FROM THE HEAF COHORT

Background

Foot and ankle pain (FAP), particularly that of musculoskeletal origin, is increasingly prevalent in our aging populations1. Moreover, governments need people to work to older ages to reduce the costs of pensions and welfare benefits. It is not currently known however whether people with FAP are able to keep working or to what extent it pushes people out of work. We investigated this question in older working adults.

Objectives

To determine whether FAP is associated with HRJL amongst older working adults.

Methods

Health And Employment After Fifty2 is a longitudinal population-based cohort incepted 2013 to investigate health and retirement. At follow-up two years later, people were asked to complete a full-body mannequin which included the ankles/feet. Mannequins were coded: foot/ankle pain (FAP) with pain at other sites; pain elsewhere but not FAP; and no pain. Two years later, participants were asked whether they had left paid work entirely or partly because of health (Health-related job loss (HRJL). A Cox proportional hazards model was used to explore associations between health-related job loss, FAP, and other potential risk factors (such as age, mental health, BMI, and finances). A sensitivity analysis was carried out to determine which occupational activities were significantly associated with health-related job loss due to FAP.

Results

At 2 years, 4050 participants completed a pain mannequin, amongst whom 3762 were in paid work. Over 2 further years of follow-up, there were 235 incident HRJLs. Amongst those with HRJL, 73 had no pain, 54 had pain involving FAP, 108 had pain not involving FAP. After adjusting for age and sex, people with FAP had 83% increased risk of HRJL compared to people with no pain (HR=1.83, 95% CI 1.29-2.61), whilst those with pain NOT involving FAP had 34% increased risk (HR1.34, 95% CI 1.00 – 1.80). FAP remained a significant predictor of HRJL within a fully adjusted model (HR=1.65, 95% CI 1.15-2.36). Sensitivity analyses confirmed that doing jobs which involved climbing more than 30 flights of stairs was associated with increased risk of HRJL amongst people with FAP (HR=1.96, 95% CI 1.00-3.80).

Conclusion

FAP is a risk factor for HRJL amongst older working adults, particularly if their job involves stair climbing. Potentially, modification of duties to reduce stair climbing could mitigate job loss amongst people with FAP.

References

[1]Executive HaS. Work-related ill health and occupational disease. https://www.hse.gov.uk/statistics/causdis/; 2020.

[2]Keith T. Palmer KW-B, E. Clare Harris, Cathy Linaker, Stefania D’ANgelo, Avan Aihi Sayer, Catharine R. Gale, Maria Evandrou, Tjeerd van Staa, Cyrus Cooper, David Coggon. Health and Employment after Fifty (HEAF): a new prospective cohort study. BMC Public Health 2015.

Disclosure of Interests

None declared.

Lifetime occupation is not associated with radiographic osteoarthritis of the first metatarsophalangeal joint in a cohort study of UK women

OBJECTIVE

The study aim was to determine whether lifetime occupation was associated with the presence of radiographic osteoarthritis (ROA) of the first metatarsophalangeal joint (MTPJ) in women.

METHOD

Data were collected from the prospective, population-based Chingford 1000 Women study. This cohort of women, aged 45-64 years at inception, was established in 1989 from a single general practice in Chingford, UK. Data has subsequently been collected repeatedly. Data from baseline, year six and year ten was used for the purposes of this cross-sectional study. The primary outcome was the presence of dorsal view ROA of the first MTPJ. The main exposure was lifetime occupation, categorised according to levels of occupation previously defined via international consensus: 1. Sedentary, 2. Light, 3. Light manual, 4. Heavy manual. Logistic regression analyses were conducted to quantify the relationship between lifetime occupation type and the presence of ROA of the first MTPJ, adjusting for age, body mass index and lifetime high-heeled footwear use as potential interactive variables for each decade.

RESULTS

Data for 209 women were included within this study. The mean (SD) age was 57 (±5.2) years. Predominant lifetime occupation was reported as sedentary by 51.7%, as light by 0%, as light manual by 33.5% and as heavy manual by 14.8% of participants. There were no statistical associations between lifetime occupation type and the presence of ROA of the first MTPJ in either the unadjusted (OR = 0.99, CI = 0.78-1.26,P = 0.96) partially adjusted (for age and BMI; OR = 1.00, CI = 0.78-1.29, P = 0.99) or fully adjusted models (for age, BMI and lifetime high heel footwear use for each decade of working life (OR = 1.02, CI = 0.79-1.31, P = 0.91); high-heel footwear use up to 20s (OR = 0.83, CI = 0.71-1.31, P = 0.83); high-heel footwear use in 20-30s (OR = 1.00, CI = 0.75-1.3, P = 0.98); high-heel footwear use in 30-40s (OR = 1.00, CI = 0.70-1.42, P = 0.99); high-heel footwear use in 40-50s (OR = 0.90, CI = 0.58-1.40, P = 0.65); high-heel footwear use in 50s (OR = 0.63,CI = 0.36-1.09, P = 0.10).

CONCLUSIONS

The findings suggest that lifetime occupation is not associated with the presence of ROA of the fist metatarsophalangeal joint. There does not appear to be any interactive effect between lifetime occupation, lifetime high-heel footwear use, age or BMI and ROA of the first MTPJ. In later life a positive trend towards increased ROA in those who reported lifetime high-heel footwear use was noted and this may be worthy of further research.

Work participation, mobility and foot symptoms in people with systemic lupus erythematosus: findings of a UK national survey

Objective

The aim of this study was to investigate whether foot and lower limb related symptoms were associated with work participation and poor mobility in people with Systemic Lupus Erythematosus (SLE).

Method

A quantitative, cross-sectional, self-reported survey design was utilised. People with SLE from six United Kingdom (UK) treatment centres and a national register were invited to complete a survey about lower limb and foot health, work participation and mobility. Data collected included work status and the prevalence of foot symptoms. The focus of the analyses was to explore potential associations between poor foot health work non-participation.

Results

In total, 182 useable surveys were returned. Seventy-nine respondents reported themselves as employed and 32 reported work non-participation. The remaining were retired due to age or reported work non-participation for other reasons. Work non-participation due to foot symptoms was significantly associated with difficulty walking (p = 0.024), past episodes of foot swelling (p = 0.041), and past episodes of foot ulceration (p = 0.018). There was a significant increase in foot disability scores amongst those not working (mean 18.13, 95% CI: 14.85–21.41) compared to those employed (mean 10.16, 95% CI: 8.11–12.21).

Conclusions

Twenty-nine% of people with SLE reported work non-participation because of lower limb or foot problems. Our results suggest that foot health and mobility may be important contributors to a persons’ ability to remain in work and should be considered as part of a clinical assessment.

Patients’ experiences of lupus-related foot problems: a qualitative investigation

Background

Systemic lupus erythematosus (SLE) can present with a variety of symptoms. Previous research has shown there is a high prevalence of lower limb and foot problems in patients with SLE associated with the musculoskeletal, vascular and neurological changes. Furthermore, there is a high prevalence of infections affecting the feet and a range of common skin and nail problems. However, it is not known how these foot problems impact upon people’s lives. Therefore, we aimed to explore this using a qualitative approach.

Method

Following ethical approval, 12 participants were recruited who had a diagnosis of SLE, current and/or past experience of foot problems and were over 18 years in age. Following consent, interviews were carried out with an interpretivist phenomenological approach to both data collection and analysis.

Results

Seven themes provide insight into: foot problems and symptoms; the impact of these foot problems and symptoms on activities; disclosure and diagnosis of foot problems; treatment of foot problems and symptoms; perceived barriers to professional footcare; unanswered questions about feet and footcare; and identification of the need for professional footcare and footcare advice.

Conclusion

These participants tend to “self-treat” rather than disclose that they may need professional footcare. A lack of focus upon foot health within a medical consultation is attributed to the participant’s belief that it is not within the doctor’s role, even though it is noted to contribute to reduced daily activity. There is a need for feet to be included as a part of patient monitoring and for foot health management to be made accessible for people with SLE.

The prevalence of self-reported lower limb and foot health problems experienced by participants with systemic lupus erythematosus: Results of a UK national survey

Objective The main aim of this survey was to determine the frequency of self-reported lower limb or foot and ankle complications experienced by participants with systemic lupus erythematosus (SLE). A secondary aim was to determine the frequency of treatments that have been received or that participants with SLE may like to receive if offered. Method A quantitative, cross-sectional, self-reported survey design was utilized. The developed survey was checked for face and content validity prior to patient partner cognitive debriefing in order to ensure usability, understanding of the process of completion and of the questions posed. The full protocol for survey development has been published previously. Results This is the first comprehensive national UK survey of lower limb and foot health problems reported by participants with SLE. A high prevalence of vascular, dermatological and musculoskeletal complications was reported by survey respondents. Additionally, whilst the relative prevalence of sensory loss was low, a quarter of people reported having had a fall related to changes in foot sensation demonstrating a previously unknown rate and cause of falls. Conclusion Complications related to vascular, dermatological and musculoskeletal health are identified as particularly prevalent in participants with SLE. Further, there is a suggestion that the provision of interventions to maintain lower limb health is highly varied and lacks national standardization, despite there being a strong indication of participant reported need. The findings of this work can be used to inform care guideline development in addition to identifying areas for future research.

Prenatal molecular diagnosis of beta-thalassemia: report on the first two cases in Romania

Thalassaemia major is a classical example of a disease that can be prevented by prenatal diagnosis. In Romania there are currently 300 patients with thalassaemia major under the management of specialized institutions. Prenatal diagnoses of thalassemia have offered a new dimension to the prevention of this disease, but in order to implement prenatal diagnosis, knowledge of mutations and of their incidence is essential. Molecular testing using Denaturing Gradient Gel Electrophoresis (DGGE) scanning and direct mutation detection with Amplificaton Refractory Mutation System-PCR (ARMS-PCR) and Restriction endonuclease Analysis of PCR fragments (PCR-RFLP) was performed by using amplified DNA from amniotic cells samples, while mutations in the parents were determined in advance. Using our experience in molecular diagnosis, we were able to perform the first prenatal diagnosis for two young couples at risk for thalassaemia major. Foetal samplings were collected by amniocentesis and chorionic villus sampling in the second trimester of the pregnancies. Maternal contamination of the foetal DNA was ruled out by STR genotyping. The prenatal diagnosis revealed affected foetuses with homozygous status of beta-thalassemia major. The IVSI-110 (G-A)/IVS II-745 (C-G) genotype in the first case foetus and ed 8 (-AA)/cd 8 (-AA) in the second case foetus were reported. The results of this study point to a successful future prenatal diagnosis of beta-thalassnemia in Romania, using a rapid and accurate molecular method. Together with the implementation of proper preventive health measures and the education of parents regarding their carrier status, we are hoping that this method will be used as the common application approach to decrease the incidence of thalassacmia major.

Associations of adiponectin with metabolic and vascular risk parameters in the British Regional Heart Study reveal stronger links to insulin resistance-related than to coronory heart disease risk-related parameters

BACKGROUND AND AIM

Adiponectin is considered by many to be part of the 'common soil' linking type 2 diabetes and coronary heart disease (CHD). We examined the relationship between adiponectin and insulin resistance, metabolic, inflammatory and haemostatic risk factors and hepatic function.

METHODS AND RESULTS

The study was carried out in 3640 non-diabetic men aged 60-79 years drawn from general practices in 24 British towns and who were not on warfarin. Adiponectin was associated with waist circumference (inversely), alcohol intake (positively) and physical activity (nonlinearly); no association was seen with cigarette smoking, prevalent CHD or stroke. After adjustment for these factors, adiponectin was significantly inversely associated with insulin resistance, triglyceride, C-reactive protein (but not interleukin 6), tissue plasminogen activator and alanine aminotransferase and positively associated with high-density lipoprotein cholesterol (HDL-cholesterol) and Factor VIII, factors associated with diabetes. No association was seen with cholesterol, smoking, systolic blood pressure or coagulation factors. Risk of the metabolic syndrome decreased significantly with increasing adiponectin.

CONCLUSION

Adiponectin is inversely associated with factors strongly associated with the development of diabetes. Limited associations with the established major risk factors for CHD suggest adiponectin may be a stronger marker of risk for diabetes than for CHD.

Flexibility of the alpha-spectrin N-terminus by EPR and fluorescence polarization

The structure and flexibility of the biologically important alpha-spectrin amino terminal region was examined by the use of fluorescence and EPR spectroscopy. The region studied has been previously demonstrated to be essential for the alpha-spectrin:beta-spectrin association of the tetramerization site. Appropriate spectroscopic probe moieties were coupled to this region in a recombinant fragment of human erythroid alpha-spectrin. There was good agreement between the EPR and fluorescence techniques in most of this region. Mobility determinations indicated that a portion of the region was relatively immobilized. This is significant, since although predictive methods have indicated that this region should be alpha-helical, previous experimental evidence obtained on smaller synthetic peptides had indicated that this region was disordered. Observed rigidity appears to be incompatible with such a disordered state, and has important ramifications for the flexibility of this molecule that is so integral to its role in stabilizing erythrocyte membranes.

Spin label EPR structural studies of the N-terminus of alpha-spectrin

Spectrin, a vital component in human erythrocyte, is composed of alpha- and beta-subunits, which associate to form (alphabeta)2 tetramers. The tetramerization site is believed to involve the alpha-spectrin N-terminus and the beta-spectrin C-terminus. Abnormal interactions in this region may lead to blood disorders. It has been proposed that both termini consist of partial structural domains and that tetramerization involves the association of these partial domains. We have studied the N-terminal region of a model peptide for alpha-spectrin by making a series of double spin-labeled peptides and studying their dipolar interaction by electron paramagnetic resonance methods. Our results indicate that residues 21-42 of the N-terminus region exhibit an alpha-helical conformation, even in the absence of B-spectrin.

Interactions of the alpha-spectrin N-terminal region with beta-spectrin. Implications for the spectrin tetramerization reaction

Spectrin of the erythrocyte membrane skeleton is composed of alpha- and beta-spectrin, which associate to form heterodimers and tetramers. It has been suggested that a fractional domain (helix C) in the amino-terminal region of alpha-spectrin (Nalpha region) bundles with another fractional domain in the carboxyl-terminal region of beta-spectrin (Cbeta region) to yield a triple alpha-helical bundle and that this helical bundling is largely responsible for tetramer formation. However, there are certain objections to assigning a preeminent role to this helical bundling in the tetramerization reactions. We prepared several recombinant peptides of alpha-spectrin fragments spanning only the Nalpha region (lacking the dimer nucleation site) and quantitatively studied their interaction with beta-spectrin. We found that a majority of the interactions were localized, as expected, in the Nalpha-helix C region but that there was also some contribution from the nonhomologous region. More importantly, the temperature and ionic strength dependence of this interaction in our model peptides was different from that in intact spectrin. We suggest that, although the regions involving the putative helical bundling in alpha- and beta-spectrin undoubtedly play a significant role in tetramerization, regions distal to the Nalpha-helix C region in spectrin are also involved in tetramer formation. Structural flexibility and lateral interactions may play a role in spectrin tetramerization.

Aging in adults with Down syndrome: report from a longitudinal study

Changes in functioning related to aging were examined in 34 adults (14 females, 20 males) with Down syndrome who were 22 to 56 years of age. Changes in functioning over 3 to 4 years were examined, with age, IQ at entry into the study, and gender considered. Neither effects of age at entry nor change over time were significant, suggesting that changes related to aging in adults with Down syndrome were minimal. In contrast, IQ at entry had a significant effect on all performances, suggesting that any examination of aging must consider intellectual level. Results do not support the idea that adults with Down syndrome show rapid age-related declines in functioning apart from the occurrence of a progressive dementia such as Alzheimer's disease.

Cation transport mediated by Na+,K(+)-adenosine triphosphatase in lymphoblastoma cells from patients with bipolar I disorder, their relatives, and unrelated control subjects

In an investigation of cation transport in bipolar affective disorder, we have measured parameters related to Na+,K(+)-adenosine triphosphatase, the enzyme that carries out active transport of sodium and potassium, in lymphoblastoid cells cultured from patients with bipolar affective disorder, age-matched nonaffected family relatives, and unrelated control subjects. Patients had lower ion transport per cell and per transport enzyme site than did related or unrelated control subjects. The rate of transport per cell appeared higher in nonaffected relatives of patients than in unrelated control subjects, though this difference did not reach significance. These data suggest that abnormally regulated ion transport may be associated with bipolar affective disorder independently of clinical state.

A social marketing approach to involving Afghans in community-level alcohol problem prevention

A program for preventing alcohol-related problems at the community level using environmentally-focused, public health approaches sought to involve a new segment of the community. That segment consisted of recently-immigrated Afghans from a traditionally abstinent culture. Social marketing research was employed to elicit value-based benefits to be used in promoting the product (involvement with environmental change efforts) to the target audience. While the channels of distribution for promotional messages were easily identified, special attention was required relative to effective spokespersons. Much was also learned about the immigration experience of Afghans in a San Francisco Bay Area community that has significance for other fields.