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167 Research products, page 1 of 17

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  • Publication . Other literature type . Article . 2019
    Restricted English
    Authors: 
    Jessica Chan; Jeppe Friborg; Mikhail Chernov; Mikhail Cherkashin; Cai Grau; Michael Brundage; Ben J. Slotman;
    Country: Netherlands

    Summary Cancer is a substantial health burden for Inuit populations, an Indigenous peoples who primarily inhabit the circumpolar regions of Alaska, Canada, Greenland, and Russia. Access to radiotherapy is lacking or absent in many of these regions, despite it being an essential component of cancer treatment. This Review presents an overview of factors influencing radiotherapy delivery in each of the four circumpolar Inuit regions, which include population and geography, health-systems infrastructure, and cancer epidemiology. This Review also provides insight into the complex patient pathways needed to access radiotherapy, and on radiotherapy use. The unique challenges in delivering radiotherapy to circumpolar Inuit populations are discussed, which, notably, include geographical and cultural barriers. Recommendations include models of care that have successfully addressed these barriers, and highlight the need for increased collaboration between circumpolar referral centres in Alaska, Canada, Greenland, and Russia to ultimately allow for better delivery of cancer treatment.

  • Publication . Part of book or chapter of book . Other literature type . 2019
    Restricted
    Authors: 
    Johnston, Bradley C.; Patrick, Donald L.; Devji, Tahira; Maxwell, Lara J.; Bingham, Clifton O.; Beaton, Dorcas E.; Boers, Maarten; Briel, Matthias; Busse, Jason W.; Carrasco-Labra, Alonso; +19 more
    Publisher: Wiley
    Country: Netherlands

    Authors of systematic reviews that include patient-reported outcomes (PROs) should have a good understanding of how patient-reported outcome measures (PROMs) are developed, including the constructs they are intended to measure, their reliability, validity and responsiveness. This chapter describes the category of outcomes known as PROs and their importance for healthcare decision making, and illustrates the key issues related to reliability, validity and responsiveness that systematic review authors should consider when including PROs. It also addresses the structure and content of PROs and provides guidance for combining information from different PROs. The chapter outlines a step-by-step approach to addressing each of these elements in the systematic review process. The focus is on the use of PROs in randomized trials, and what is crucial in this context when selecting PROs to include in a meta-analysis. The chapter describes PROMs in more detail and discusses some issues to consider when deciding which PROMs to address in a review.

  • Restricted English
    Authors: 
    Drew Moghanaki; Berend J. Slotman; Anand Swaminath; Benjamin E. Nelms; Brian Wang;
    Country: Netherlands

    Abstract Purpose The quality of stereotactic body radiation therapy (SBRT) treatment plans for early stage lung cancer are unknown outside of peer-reviewed publications. Thus, a study was conducted to crowdsource and analyze a variety of lung SBRT treatment plans from around the world. Methods and Materials This study had 2 parts, planning and contouring, and each was facilitated by a web-based technology platform. For planning, lung SBRT planners were invited to design, score, and submit their treatment plans (prescription of 11 Gy × 5) for a centralized stage I lung cancer case using standardized images and predefined contours. Each plan was scored with 20 weighted metrics adapted from currently recruiting phase 3 lung SBRT trials. For contouring, a separate image set was used to evaluate organ-at-risk contour accuracy using Dice coefficients and a StructSure score. Results For planning 227 plans were submitted in total with 7 different treatment planning systems and 7 different delivery methods represented. Variability was primarily user driven and not associated with the treatment planning system, delivery modality, total monitor units, or estimated beam-on time. Many of the highest-quality plans required the shortest amount of time to deliver, independent of the delivery technique. For contouring, organ-at-risk contours were frequently over- or undercontoured and often included only the luminal air of the trachea, proximal bronchial tree, and esophagus, even when the mucosal linings were within a few centimeters of the target tumor. Conclusions These findings demonstrate the importance of quality assurance to help improve planning and contouring and the value of peer review and comparison. More readily accessible quality evaluation software solutions, such as the one used herein, may help meet this growing need.

  • Restricted English
    Authors: 
    Ivana Logar; Roy Brouwer; Danny Campbell;
    Countries: Croatia, Netherlands

    Abstract The existing empirical evidence shows that both contingent valuation and discrete choice experiment (DCE) methods are susceptible to various ordering effects. However, very few studies have analysed attribute-ordering effects in DCEs, and no study has investigated their potential influence on information-processing strategies, such as attribute non-attendance (ANA). This paper tests for attribute-ordering effects and examines whether the order of attributes describing the alternatives affects respondents’ propensity to attend to or ignore an attribute. A split-sample approach is used, where one sample received a DCE version in which the positions of the first and last non-monetary attributes are switched across the sequence of choice tasks compared with the other sample. The results show that attribute order does not affect welfare estimates in a significant way under the standard assumption of full attribute attendance, thus rejecting the notion of procedural bias. However, the welfare estimates for the attributes whose order was reversed and the share of respondents who ignored them differ significantly between the two attribute-ordering treatments once ANA behaviour is accounted for in the estimated choice models. These results highlight the important role of information-processing strategies in the design and evaluation of DCEs.

  • Restricted English
    Authors: 
    Caroline F. Finch; Roald Bahr; Jonathan A. Drezner; Jiri Dvorak; Lars Engebretsen; Timothy E. Hewett; Astrid Junge; Karim M. Khan; Domhnall MacAuley; Gordon O. Matheson; +2 more
    Country: Netherlands

    A decade ago, Blair1 pondered the future of physical activity research, much of which has since come to pass. More recently, a BJSM Blog2 invited readers to consider how their future research would look. Given the increased international focus on reducing injury/illness in athletes, it is timely to consider what research needs to be undertaken and acted on to achieve feasible reductions over the next 10 years. ‘Future Studies’3 or ‘Thought Leadership’ happens when a defined group of experts calls attention to what they think will be important for their field in the future. This is common in social science disciplines (eg, finance) and in scientific areas with major implications for policy development (eg, in climate control/environmental science). It has been less commonly applied in medicine, though it has underpinned discussion in areas like cancer research4 and academic medicine.5 Thought leadership involves big picture thinking and can lead to new ideas for major developments over time. There is evidence that such exercises can significantly shape research agenda and priority setting. This novel approach was applied to Sports and Exercise Medicine through asking a select group of international experts to contribute their priority research directions for the next 10 years. This is intended as a starting point only, to stimulate discussion with, and elicit responses from, the broader community interested in the prevention of injury and illness in athletes. International experts were invited to participate if they had delivered ≥1 keynote addresses at the International Olympic Committee (IOC) World Conferences of Prevention of Injury and Illness in Sport in 2011, 2014 or their precursor conferences organised by the Oslo Sports Trauma Research Centre in 2005 and 2008. Of 21 keynote speakers, 12 contributed their views to this paper. The experts covered a range of disciplines, including clinical sports …

  • Restricted English
    Authors: 
    Zehua Pan; Roy Brouwer;
    Country: Netherlands

    Green infrastructure for source water protection in the form of forest protection and afforestation is gaining interest worldwide. It is considered more sustainable in the long-term than traditional engineering-based approaches. This paper presents a theoretical model to support investment decisions in green and grey infrastructure to deliver safe drinking water. We first develop a static optimal control model accounting for the uncertainties surrounding green infrastructure. This model is then extended to factor in key characteristics surrounding investment decisions aimed at optimizing the stock of green and grey infrastructure. We first include dynamic forest growth, followed by the risk of wildfires and finally the potential offsetting effect of carbon sequestration on long-term climate change and the reduced risk of wildfires. We provide a numerical example to analyze the performance of the different model specifications, interpret their outcomes and draw conclusions to guide future investment decisions in green and grey infrastructure.

  • Restricted
    Authors: 
    Zia Mehrabi; Verena Seufert; Navin Ramankutty;
    Publisher: Elsevier BV
    Country: Netherlands

    Garibaldi et al. [1] provide a much-needed discussion on the state of our knowledge on the socioecological impacts of different farming choices. They highlight a lack of data on comparisons of different farming choices, and recommend a research program for comparing alternative versus conventional systems as a way to solve this problem. We discuss here some of the ongoing challenges the scientific community faces in making conventional and alternative system comparisons. Although we see value in categorizing farming systems, we contend that our classifications are never black and white in their outcomes – there can be environmentally sound and socially just conventional systems, and alternative systems that are environmentally and socially detrimental.

  • Restricted English
    Authors: 
    Vincent Gouttebarge; Imtiaz Ahmad; Margo Mountjoy; Simon M Rice; Gino M. M. J. Kerkhoffs;
    Country: Netherlands

    Objective: The primary objective of our study was to establish the prevalence of anxiety and depressive symptoms among professional football (ie, soccer; hereinafter “football”) players during the COVID-19 emergency period, drawing comparisons with players assessed before exposure to the COVID-19 emergency period. Design: Observational comparative cross-sectional study by means of electronic questionnaire. Setting: Professional football. Participants: A total of 468 female (mean age: 22.8 years) and 1134 male (mean age: 26.0 years) players participated. The non-COVID-19 comparison group consisted of 132 female (mean age: 23.1 years) and 175 male (mean age: 24.8 years) professional footballers. Intervention: N/A. Main Outcome Measures: Anxiety symptoms were measured with the validated Generalized Anxiety Disorder 7 and depressive symptoms with the validated Patient Health Questionnaire 9. Both instruments have been widely used in both clinical and research settings among different populations, showing excellent psychometric properties. Results: During the COVID-19 emergency period, the 2-week prevalence of symptoms consistent with a diagnosis of generalized anxiety disorder and depression was 18.2% and 21.6%, respectively, among female professional footballers and 15.5% and 12.9%, respectively, among male players. The 2-week prevalence of anxiety and depressive symptoms among professional footballers was significantly higher during the COVID-19 emergency period than before the global pandemic (P< 0.01). Differences were most pronounced for those worried about the playing future. Conclusions: The COVID-19 emergency period is associated with increased symptoms of anxiety and depression in professional footballers, especially among those worried about their future as players.

  • Restricted English
    Authors: 
    Elisabeth E. Fransen van de Putte; Judith Bosschieter; Theo H. van der Kwast; Simone Bertz; Stefan Denzinger; Quentin Manach; Eva Comperat; Joost L. Boormans; Michael A.S. Jewett; Robert Stoehr; +9 more
    Country: Netherlands

    Objectives: To compare the prognostic value of the World Health Organization (WHO) 1973 and 2004 classification systems for grade in T1 bladder cancer (T1-BC), as both are currently recommended in international guidelines. Patients and Methods: Three uro-pathologists re-revised slides of 601 primary (first diagnosis) T1-BCs, initially managed conservatively (bacille Calmette–Guérin) in four hospitals. Grade was defined according to WHO1973 (Grade 1–3) and WHO2004 (low-grade [LG] and high-grade [HG]). This resulted in a lack of Grade 1 tumours, 188 (31%) Grade 2, and 413 (69%) Grade 3 tumours. There were 47 LG (8%) vs 554 (92%) HG tumours. We determined the prognostic value for progression-free survival (PFS) and cancer-specific survival (CSS) in Cox-regression models and corrected for age, sex, multiplicity, size and concomitant carcinoma in situ. Results: At a median follow-up of 5.9 years, 148 patients showed progression and 94 died from BC. The WHO1973 Grade 3 was negatively associated with PFS (hazard ratio [HR] 2.1) and CSS (HR 3.4), whilst WHO2004 grade was not prognostic. On multivariable analysis, WHO1973 grade was the only prognostic factor for progression (HR 2.0). Grade 3 tumours (HR 3.0), older age (HR 1.03) and tumour size >3 cm (HR 1.8) were all independently associated with worse CSS. Conclusion: The WHO1973 classification system for grade has strong prognostic value in T1-BC, compared to the WHO2004 system. Our present results suggest that WHO1973 grade cannot be replaced by the WHO2004 classification in non-muscle-invasive BC guidelines.

  • Restricted English
    Authors: 
    Danielle S. Cha; Nicole E. Carmona; Mehala Subramaniapillai; Rodrigo B. Mansur; Yena Lee; Jae Hon Lee; Jung Goo Lee; Joshua D. Rosenblat; Margarita Shekotikhina; Caroline Park; +6 more
    Country: Netherlands

    Background Psychosocial impairment represents an important treatment target in major depressive disorder (MDD). The majority of patients with MDD do not regain premorbid levels of psychosocial functioning despite the resolution of core depressive symptoms. This study aimed to investigate the respective effects of cognitive function and depression severity on impaired psychosocial function in MDD. Methods Adults aged 18–65 with moderate-to-severe MDD (n = 100) and age-, sex-, and education-matched healthy controls participated in a cross-sectional study validating the THINC-integrated tool (THINC-it), a cognitive screening tool comprised of objective and subjective measures of cognitive function. Depression severity was assessed using the Montgomery-Åsberg Depression Rating Scale and psychosocial function was assessed using the Sheehan Disability Scale (SDS). Results Subjects with MDD reported greater impairment in psychosocial function than healthy controls, with significant differences in SDS total and domain scores (ps <.01) after controlling for age, sex, and education. Generalized linear models indicated that subjective cognitive function was most strongly associated with SDS total score (RR =.14, p =.01) and SDS domains of work/school (RR =.15, p =.03), family and home responsibilities (RR =.15, p =.02), and economic days lost (RR =.18, p =.03). Depression severity was most strongly associated with SDS social life (RR =.08, p <.01) and economic days underproductive (RR =.07, p <.01). Objective cognitive function was not significantly associated with any SDS outcomes. Limitations The cross-sectional, observational study design limits temporal inferences. The self-report nature of measures included may have influenced associations observed. Potential medication effects are not noted. Conclusions Cognitive deficits, as measured by the THINC-it, are associated with significant psychosocial impairment in MDD. These results provide empirical support for the assessment of both subjective and objective measures of cognition, as they are not associated with each other and have differential effects on functional trajectory.

search
Include:
The following results are related to Canada. Are you interested to view more results? Visit OpenAIRE - Explore.
167 Research products, page 1 of 17
  • Publication . Other literature type . Article . 2019
    Restricted English
    Authors: 
    Jessica Chan; Jeppe Friborg; Mikhail Chernov; Mikhail Cherkashin; Cai Grau; Michael Brundage; Ben J. Slotman;
    Country: Netherlands

    Summary Cancer is a substantial health burden for Inuit populations, an Indigenous peoples who primarily inhabit the circumpolar regions of Alaska, Canada, Greenland, and Russia. Access to radiotherapy is lacking or absent in many of these regions, despite it being an essential component of cancer treatment. This Review presents an overview of factors influencing radiotherapy delivery in each of the four circumpolar Inuit regions, which include population and geography, health-systems infrastructure, and cancer epidemiology. This Review also provides insight into the complex patient pathways needed to access radiotherapy, and on radiotherapy use. The unique challenges in delivering radiotherapy to circumpolar Inuit populations are discussed, which, notably, include geographical and cultural barriers. Recommendations include models of care that have successfully addressed these barriers, and highlight the need for increased collaboration between circumpolar referral centres in Alaska, Canada, Greenland, and Russia to ultimately allow for better delivery of cancer treatment.

  • Publication . Part of book or chapter of book . Other literature type . 2019
    Restricted
    Authors: 
    Johnston, Bradley C.; Patrick, Donald L.; Devji, Tahira; Maxwell, Lara J.; Bingham, Clifton O.; Beaton, Dorcas E.; Boers, Maarten; Briel, Matthias; Busse, Jason W.; Carrasco-Labra, Alonso; +19 more
    Publisher: Wiley
    Country: Netherlands

    Authors of systematic reviews that include patient-reported outcomes (PROs) should have a good understanding of how patient-reported outcome measures (PROMs) are developed, including the constructs they are intended to measure, their reliability, validity and responsiveness. This chapter describes the category of outcomes known as PROs and their importance for healthcare decision making, and illustrates the key issues related to reliability, validity and responsiveness that systematic review authors should consider when including PROs. It also addresses the structure and content of PROs and provides guidance for combining information from different PROs. The chapter outlines a step-by-step approach to addressing each of these elements in the systematic review process. The focus is on the use of PROs in randomized trials, and what is crucial in this context when selecting PROs to include in a meta-analysis. The chapter describes PROMs in more detail and discusses some issues to consider when deciding which PROMs to address in a review.

  • Restricted English
    Authors: 
    Drew Moghanaki; Berend J. Slotman; Anand Swaminath; Benjamin E. Nelms; Brian Wang;
    Country: Netherlands

    Abstract Purpose The quality of stereotactic body radiation therapy (SBRT) treatment plans for early stage lung cancer are unknown outside of peer-reviewed publications. Thus, a study was conducted to crowdsource and analyze a variety of lung SBRT treatment plans from around the world. Methods and Materials This study had 2 parts, planning and contouring, and each was facilitated by a web-based technology platform. For planning, lung SBRT planners were invited to design, score, and submit their treatment plans (prescription of 11 Gy × 5) for a centralized stage I lung cancer case using standardized images and predefined contours. Each plan was scored with 20 weighted metrics adapted from currently recruiting phase 3 lung SBRT trials. For contouring, a separate image set was used to evaluate organ-at-risk contour accuracy using Dice coefficients and a StructSure score. Results For planning 227 plans were submitted in total with 7 different treatment planning systems and 7 different delivery methods represented. Variability was primarily user driven and not associated with the treatment planning system, delivery modality, total monitor units, or estimated beam-on time. Many of the highest-quality plans required the shortest amount of time to deliver, independent of the delivery technique. For contouring, organ-at-risk contours were frequently over- or undercontoured and often included only the luminal air of the trachea, proximal bronchial tree, and esophagus, even when the mucosal linings were within a few centimeters of the target tumor. Conclusions These findings demonstrate the importance of quality assurance to help improve planning and contouring and the value of peer review and comparison. More readily accessible quality evaluation software solutions, such as the one used herein, may help meet this growing need.

  • Restricted English
    Authors: 
    Ivana Logar; Roy Brouwer; Danny Campbell;
    Countries: Croatia, Netherlands

    Abstract The existing empirical evidence shows that both contingent valuation and discrete choice experiment (DCE) methods are susceptible to various ordering effects. However, very few studies have analysed attribute-ordering effects in DCEs, and no study has investigated their potential influence on information-processing strategies, such as attribute non-attendance (ANA). This paper tests for attribute-ordering effects and examines whether the order of attributes describing the alternatives affects respondents’ propensity to attend to or ignore an attribute. A split-sample approach is used, where one sample received a DCE version in which the positions of the first and last non-monetary attributes are switched across the sequence of choice tasks compared with the other sample. The results show that attribute order does not affect welfare estimates in a significant way under the standard assumption of full attribute attendance, thus rejecting the notion of procedural bias. However, the welfare estimates for the attributes whose order was reversed and the share of respondents who ignored them differ significantly between the two attribute-ordering treatments once ANA behaviour is accounted for in the estimated choice models. These results highlight the important role of information-processing strategies in the design and evaluation of DCEs.

  • Restricted English
    Authors: 
    Caroline F. Finch; Roald Bahr; Jonathan A. Drezner; Jiri Dvorak; Lars Engebretsen; Timothy E. Hewett; Astrid Junge; Karim M. Khan; Domhnall MacAuley; Gordon O. Matheson; +2 more
    Country: Netherlands

    A decade ago, Blair1 pondered the future of physical activity research, much of which has since come to pass. More recently, a BJSM Blog2 invited readers to consider how their future research would look. Given the increased international focus on reducing injury/illness in athletes, it is timely to consider what research needs to be undertaken and acted on to achieve feasible reductions over the next 10 years. ‘Future Studies’3 or ‘Thought Leadership’ happens when a defined group of experts calls attention to what they think will be important for their field in the future. This is common in social science disciplines (eg, finance) and in scientific areas with major implications for policy development (eg, in climate control/environmental science). It has been less commonly applied in medicine, though it has underpinned discussion in areas like cancer research4 and academic medicine.5 Thought leadership involves big picture thinking and can lead to new ideas for major developments over time. There is evidence that such exercises can significantly shape research agenda and priority setting. This novel approach was applied to Sports and Exercise Medicine through asking a select group of international experts to contribute their priority research directions for the next 10 years. This is intended as a starting point only, to stimulate discussion with, and elicit responses from, the broader community interested in the prevention of injury and illness in athletes. International experts were invited to participate if they had delivered ≥1 keynote addresses at the International Olympic Committee (IOC) World Conferences of Prevention of Injury and Illness in Sport in 2011, 2014 or their precursor conferences organised by the Oslo Sports Trauma Research Centre in 2005 and 2008. Of 21 keynote speakers, 12 contributed their views to this paper. The experts covered a range of disciplines, including clinical sports …

  • Restricted English
    Authors: 
    Zehua Pan; Roy Brouwer;
    Country: Netherlands

    Green infrastructure for source water protection in the form of forest protection and afforestation is gaining interest worldwide. It is considered more sustainable in the long-term than traditional engineering-based approaches. This paper presents a theoretical model to support investment decisions in green and grey infrastructure to deliver safe drinking water. We first develop a static optimal control model accounting for the uncertainties surrounding green infrastructure. This model is then extended to factor in key characteristics surrounding investment decisions aimed at optimizing the stock of green and grey infrastructure. We first include dynamic forest growth, followed by the risk of wildfires and finally the potential offsetting effect of carbon sequestration on long-term climate change and the reduced risk of wildfires. We provide a numerical example to analyze the performance of the different model specifications, interpret their outcomes and draw conclusions to guide future investment decisions in green and grey infrastructure.

  • Restricted
    Authors: 
    Zia Mehrabi; Verena Seufert; Navin Ramankutty;
    Publisher: Elsevier BV
    Country: Netherlands

    Garibaldi et al. [1] provide a much-needed discussion on the state of our knowledge on the socioecological impacts of different farming choices. They highlight a lack of data on comparisons of different farming choices, and recommend a research program for comparing alternative versus conventional systems as a way to solve this problem. We discuss here some of the ongoing challenges the scientific community faces in making conventional and alternative system comparisons. Although we see value in categorizing farming systems, we contend that our classifications are never black and white in their outcomes – there can be environmentally sound and socially just conventional systems, and alternative systems that are environmentally and socially detrimental.

  • Restricted English
    Authors: 
    Vincent Gouttebarge; Imtiaz Ahmad; Margo Mountjoy; Simon M Rice; Gino M. M. J. Kerkhoffs;
    Country: Netherlands

    Objective: The primary objective of our study was to establish the prevalence of anxiety and depressive symptoms among professional football (ie, soccer; hereinafter “football”) players during the COVID-19 emergency period, drawing comparisons with players assessed before exposure to the COVID-19 emergency period. Design: Observational comparative cross-sectional study by means of electronic questionnaire. Setting: Professional football. Participants: A total of 468 female (mean age: 22.8 years) and 1134 male (mean age: 26.0 years) players participated. The non-COVID-19 comparison group consisted of 132 female (mean age: 23.1 years) and 175 male (mean age: 24.8 years) professional footballers. Intervention: N/A. Main Outcome Measures: Anxiety symptoms were measured with the validated Generalized Anxiety Disorder 7 and depressive symptoms with the validated Patient Health Questionnaire 9. Both instruments have been widely used in both clinical and research settings among different populations, showing excellent psychometric properties. Results: During the COVID-19 emergency period, the 2-week prevalence of symptoms consistent with a diagnosis of generalized anxiety disorder and depression was 18.2% and 21.6%, respectively, among female professional footballers and 15.5% and 12.9%, respectively, among male players. The 2-week prevalence of anxiety and depressive symptoms among professional footballers was significantly higher during the COVID-19 emergency period than before the global pandemic (P< 0.01). Differences were most pronounced for those worried about the playing future. Conclusions: The COVID-19 emergency period is associated with increased symptoms of anxiety and depression in professional footballers, especially among those worried about their future as players.

  • Restricted English
    Authors: 
    Elisabeth E. Fransen van de Putte; Judith Bosschieter; Theo H. van der Kwast; Simone Bertz; Stefan Denzinger; Quentin Manach; Eva Comperat; Joost L. Boormans; Michael A.S. Jewett; Robert Stoehr; +9 more
    Country: Netherlands

    Objectives: To compare the prognostic value of the World Health Organization (WHO) 1973 and 2004 classification systems for grade in T1 bladder cancer (T1-BC), as both are currently recommended in international guidelines. Patients and Methods: Three uro-pathologists re-revised slides of 601 primary (first diagnosis) T1-BCs, initially managed conservatively (bacille Calmette–Guérin) in four hospitals. Grade was defined according to WHO1973 (Grade 1–3) and WHO2004 (low-grade [LG] and high-grade [HG]). This resulted in a lack of Grade 1 tumours, 188 (31%) Grade 2, and 413 (69%) Grade 3 tumours. There were 47 LG (8%) vs 554 (92%) HG tumours. We determined the prognostic value for progression-free survival (PFS) and cancer-specific survival (CSS) in Cox-regression models and corrected for age, sex, multiplicity, size and concomitant carcinoma in situ. Results: At a median follow-up of 5.9 years, 148 patients showed progression and 94 died from BC. The WHO1973 Grade 3 was negatively associated with PFS (hazard ratio [HR] 2.1) and CSS (HR 3.4), whilst WHO2004 grade was not prognostic. On multivariable analysis, WHO1973 grade was the only prognostic factor for progression (HR 2.0). Grade 3 tumours (HR 3.0), older age (HR 1.03) and tumour size >3 cm (HR 1.8) were all independently associated with worse CSS. Conclusion: The WHO1973 classification system for grade has strong prognostic value in T1-BC, compared to the WHO2004 system. Our present results suggest that WHO1973 grade cannot be replaced by the WHO2004 classification in non-muscle-invasive BC guidelines.

  • Restricted English
    Authors: 
    Danielle S. Cha; Nicole E. Carmona; Mehala Subramaniapillai; Rodrigo B. Mansur; Yena Lee; Jae Hon Lee; Jung Goo Lee; Joshua D. Rosenblat; Margarita Shekotikhina; Caroline Park; +6 more
    Country: Netherlands

    Background Psychosocial impairment represents an important treatment target in major depressive disorder (MDD). The majority of patients with MDD do not regain premorbid levels of psychosocial functioning despite the resolution of core depressive symptoms. This study aimed to investigate the respective effects of cognitive function and depression severity on impaired psychosocial function in MDD. Methods Adults aged 18–65 with moderate-to-severe MDD (n = 100) and age-, sex-, and education-matched healthy controls participated in a cross-sectional study validating the THINC-integrated tool (THINC-it), a cognitive screening tool comprised of objective and subjective measures of cognitive function. Depression severity was assessed using the Montgomery-Åsberg Depression Rating Scale and psychosocial function was assessed using the Sheehan Disability Scale (SDS). Results Subjects with MDD reported greater impairment in psychosocial function than healthy controls, with significant differences in SDS total and domain scores (ps <.01) after controlling for age, sex, and education. Generalized linear models indicated that subjective cognitive function was most strongly associated with SDS total score (RR =.14, p =.01) and SDS domains of work/school (RR =.15, p =.03), family and home responsibilities (RR =.15, p =.02), and economic days lost (RR =.18, p =.03). Depression severity was most strongly associated with SDS social life (RR =.08, p <.01) and economic days underproductive (RR =.07, p <.01). Objective cognitive function was not significantly associated with any SDS outcomes. Limitations The cross-sectional, observational study design limits temporal inferences. The self-report nature of measures included may have influenced associations observed. Potential medication effects are not noted. Conclusions Cognitive deficits, as measured by the THINC-it, are associated with significant psychosocial impairment in MDD. These results provide empirical support for the assessment of both subjective and objective measures of cognition, as they are not associated with each other and have differential effects on functional trajectory.