Cohort Of Health Professionals Research Articles

Drinking pattern and time lag of alcohol consumption with colorectal cancer risk in US men and women.

Association between light to moderate alcohol consumption and colorectal cancer (CRC) incidence remains understudied, especially regarding drinking pattern, beverage type and temporal aspects. Hazard ratios (HRs) and 95% confidence intervals (CIs) for time to CRC diagnosis were estimated among 137,710 participants. Estimates based on remote (eg, >10 years before follow-up) and recent (eg, the preceding 10 years before follow-up) alcohol intake, using different cutoffs (eg, 8, 10, 12 years, etc) and mutual adjustment, enabled separating independent effects and investigating time lag of alcohol-CRC association. 3,599 CRC cases were documented over three decades. Light to moderate drinking was associated with an increased CRC risk only in men: HR (95% CI) for 5-14.9 and 15-29.9 vs 0 g/day of alcohol intake was 1.19 (1.01, 1.41) and 1.38 (1.13, 1.67). In women, that for 0.1-4.9 and 5-14.9 vs 0 g/day of alcohol was 1.07 (0.96, 1.20) and 1.05 (0.91, 1.20). Drinkers with both high drinking frequency and daily intake had the highest CRC risk, suggesting total alcohol intake was the critical factor. We estimated the time lag between alcohol consumption and CRC occurrence to be 8 to 12 years. Former drinkers did not experience a significant reduction in CRC risk even after 10 years of quitting or reducing consumption. Based on two cohorts of health professionals, our findings suggest that the increased risk of CRC associated with alcohol intake is mainly driven by total quantity and remote intake. Former drinkers did not experience an immediate reduction in CRC risk after quitting or reducing consumption.

Smoking Behaviour Changes After Diagnosis of Inflammatory Bowel Disease and Risk of All-cause Mortality.

We examined smoking behaviour changes after diagnoses of Crohn's disease [CD] and ulcerative colitis [UC] and evaluated their impact on mortality. Study population included incident CD or UC cases from three cohorts of the Nurses' Health Study [NHS], NHSII, and Health Professionals Follow-up Study. Smoking and other risk factors were prospectively assessed. Smoking behaviour changes were categorised as never, former [i.e., quit smoking before diagnosis], quitters [i.e., quit smoking after diagnosis], and current [i.e., continue smoking after diagnosis]. Follow-up for date and cause of death was completed through linkage to the National Death Index. Cox proportional hazard regression was used to estimate hazard ratios [HRs] and 95% confidence intervals [CIs]. Among 909 eligible CD and UC cases, 45% were never smokers, 38% were past smokers, and 16% were active smokers at the time of diagnosis. Among active smokers, 70% of patients with CD and 44% of patients with UC continued to smoke after diagnosis. In patients with CD, compared with current smokers, the multivariable-adjusted HRs [95% CI] of death were 0.19 [0.10 to 0.38] for never smokers, 0.31 [0.16 to 0.57] for former smokers, and 0.41 [0.18 to 0.93] for quitters. Similarly for UC, compared with current smokers, we observed a reduced risk of mortality for never smokers [HR = 0.23, 95% CI 0.10 to 0.51], former smokers [HR = 0.23, 95% CI 0.11 to 0.48], and quitters [HR = 0.28, 95% CI 0.11 to 0.72]. In three cohorts of health professionals, a substantial proportion of patients with new diagnosis of CD and UC and history of smoking continued to smoke after diagnosis. Smoking cessation around the time of diagnosis was associated with a significant reduction in mortality.

FaceBit

The COVID-19 pandemic has dramatically increased the use of face masks across the world. Aside from physical distancing, they are among the most effective protection for healthcare workers and the general population. Face masks are passive devices, however, and cannot alert the user in case of improper fit or mask degradation. Additionally, face masks are optimally positioned to give unique insight into some personal health metrics. Recognizing this limitation and opportunity, we present FaceBit: an open-source research platform for smart face mask applications. FaceBit's design was informed by needfinding studies with a cohort of health professionals. Small and easily secured into any face mask, FaceBit is accompanied by a mobile application that provides a user interface and facilitates research. It monitors heart rate without skin contact via ballistocardiography, respiration rate via temperature changes, and mask-fit and wear time from pressure signals, all on-device with an energy-efficient runtime system. FaceBit can harvest energy from breathing, motion, or sunlight to supplement its tiny primary cell battery that alone delivers a battery lifetime of 11 days or more. FaceBit empowers the mobile computing community to jumpstart research in smart face mask sensing and inference, and provides a sustainable, convenient form factor for health management, applicable to COVID-19 frontline workers and beyond.

What Are the Real-World Podcast-Listening Habits of Medical Professionals?

IntroductionEducational podcasts are increasingly being utilized by health professionals for continuing education, but how they are being used remains poorly understood. Given their extensive reach, they represent a phenomenal opportunity for researchers to engage in knowledge translation of their scholarly works. The design, study, and effectiveness of these resources should be informed by a deeper understanding of their pragmatic usage. We aimed to prospectively determine the pragmatic, real-world listening habits of health professionals.MethodsWe performed a prospective observational study of a broad, interprofessional sample of participants (medical students, residents, physicians, nurses, physician assistants, and paramedics) recruited through a multimodal social media (Twitter and Facebook) campaign. Recruitment materials included an infographic and study website. Participants listened to eight podcasts and described their use of each in subsequent questionnaires.ResultsA total of 393 participants enrolled in the study, and 241 completed the survey for all eight podcasts. Listening behaviors were consistent across the podcasts with the majority selecting a normal speed of playback and engaging in concomitant activities such as driving. One-third of participants paused the podcasts due to interruption.ConclusionWe describe the prospective use of medical podcasts by a cohort of health professionals. This work should inform the role of podcasts in the communication of medical research.

Abstract 845: Association of nut consumption with risk of total and specific cancers: Evidence from three large prospective cohort studies

Abstract Background The associations between nut consumption, especially specific types of nuts, and cancer risk have not been extensively investigated. Methods Nut consumption and other risk factors were assessed at baseline and updated every 2 to 4 years in the Nurses' Health Study (1980 to 2014), the Nurses' Health Study II (1991 to 2015), and the Health Professionals Follow-up Study (1986 to 2018). We examined the associations between the intake of total and specific types of nuts and the risk of total cancer, as well as common cancers with a high incidence including cancers of lung, colorectum, breast, bladder, and aggressive prostate cancer among participants who were free of cancer, heart disease, and stroke at baseline. Cox proportional hazards models were used to obtain the hazard ratios (HRs) and 95% confidence intervals (95% CIs) in each cohort separately as well as pooled. To check the robustness of simply pooled HRs, we pooled the HRs in each cohort with meta-analysis using both random-effect model and fixed-effect model. We also added a 12-year lag period between nut-intake assessment and each follow-up period. Results During a median of 26.8 years of follow-up (1,015,834 person-years) in HPFS, 35.4 years (2,575,205 person-years) in NHS, 26.0 years (2,282,632 person-years) in NHSII, we documented 44,561 incidence cancer cases, including 3,972 lung cancer, 4,184 colorectal cancer, 1,588 bladder cancer, 10,936 breast cancer, and 1,171 aggressive prostate cancer cases. As compared to non-consumers, the pooled multivariable HRs of total nut consumption for five or more servings/week were 0.99 (95% CI: 0.94 to 1.04, P trend = 0.52) for total cancer, 0.88 (95% CI: 0.74 to 1.03, P trend = 0.16) for lung cancer, 1.08 (95% CI: 0.92 to 1.26, P trend = 0.87) for colorectal cancer, 0.90 (95% CI: 0.71 to 1.14, P trend = 0.64) for bladder cancer, 0.96 (95% CI: 0.85 to 1.08, P trend = 0.34) for breast cancer and 1.18 (95% CI: 0.92 to 1.51, P trend = 0.52) for aggressive prostate cancer. The associations between specific types of nuts and risk of total and specific cancers were also null. In the latency analysis, we did not observe any significant associations between nut consumption and 12-year latent risk of cancer in the pooled data. Conclusions In three large prospective cohorts of health professionals, frequent nut consumption was not associated with risk of total cancer and major individual cancers after adjustment for known or suspected risk factors. Citation Format: Zhe Fang, You Wu, Yanping Li, Xuehong Zhang, Walter Willett, A. Heather Eliassen, Bernard Rosner, Mingyang Song, Lorelei Mucci, Edward Giovannucci. Association of nut consumption with risk of total and specific cancers: Evidence from three large prospective cohort studies [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 845.

Associations of Weight Gain From Early to Middle Adulthood With Major Health Outcomes Later in Life

Data describing the effects of weight gain across adulthood on overall health are important for weight control. To examine the association of weight gain from early to middle adulthood with health outcomes later in life. Cohort analysis of US women from the Nurses' Health Study (1976-June 30, 2012) and US men from the Health Professionals Follow-Up Study (1986-January 31, 2012) who recalled weight during early adulthood (at age of 18 years in women; 21 years in men), and reported current weight during middle adulthood (at age of 55 years). Weight change from early to middle adulthood (age of 18 or 21 years to age of 55 years). Beginning at the age of 55 years, participants were followed up to the incident disease outcomes. Cardiovascular disease, cancer, and death were confirmed by medical records or the National Death Index. A composite healthy aging outcome was defined as being free of 11 chronic diseases and major cognitive or physical impairment. A total of 92 837 women (97% white; mean [SD] weight gain: 12.6 kg [12.3 kg] over 37 years) and 25 303 men (97% white; mean [SD] weight gain: 9.7 kg [9.7 kg] over 34 years) were included in the analysis. For type 2 diabetes, the adjusted incidence per 100 000 person-years was 207 among women who gained a moderate amount of weight (≥2.5 kg to <10 kg) vs 110 among women who maintained a stable weight (weight loss ≤2.5 kg or gain <2.5 kg) (absolute rate difference [ARD] per 100 000 person-years, 98; 95% CI, 72 to 127) and 258 vs 147, respectively, among men (ARD, 111; 95% CI, 58 to 179); hypertension: 3415 vs 2754 among women (ARD, 662; 95% CI, 545 to 782) and 2861 vs 2366 among men (ARD, 495; 95% CI, 281 to 726); cardiovascular disease: 309 vs 248 among women (ARD, 61; 95% CI, 38 to 87) and 383 vs 340 among men (ARD, 43; 95% CI, -14 to 109); obesity-related cancer: 452 vs 415 among women (ARD, 37; 95% CI, 4 to 73) and 208 vs 165 among men (ARD, 42; 95% CI, 0.5 to 94). Among those who gained a moderate amount of weight, 3651 women (24%) and 2405 men (37%) achieved the composite healthy aging outcome. Among those who maintained a stable weight, 1528 women (27%) and 989 men (39%) achieved the composite healthy aging outcome. The multivariable-adjusted odds ratio for the composite healthy aging outcome associated with moderate weight gain was 0.78 (95% CI, 0.72 to 0.84) in women and 0.88 (95% CI, 0.79 to 0.97) in men. Higher amounts of weight gain were associated with greater risks of major chronic diseases and lower likelihood of healthy aging. In these cohorts of health professionals, weight gain during adulthood was associated with significantly increased risk of major chronic diseases and decreased odds of healthy aging. These findings may help counsel patients regarding the risks of weight gain.

Pharmacist-industry relationships.

The purpose of this study was to document, in their own words, beliefs and attitudes that American pharmacists have towards the pharmaceutical industry and pharmacists' interactions with industry. An ethnographic-style qualitative study was conducted utilizing open-ended interviews with four hospital pharmacists, two independent pharmacists, two retail pharmacists and one administrative pharmacist in the Washington, DC, metropolitan area to elicit descriptions of and attitudes towards pharmacists' relationships with industry. Analysis of the qualitative material followed established ethnographic conventions of narrative thematic analysis. All pharmacists reported interactions with pharmaceutical company representatives. Most had received free resources or services from industry, including educational courses. Respondents uniformly believed that industry promotional efforts are primarily directed towards physicians. Although respondents felt strongly that drug prices were excessive and that 'me-too' drugs were of limited use, they generally had a neutral-to-positive view of industry-funded adherence/compliance programmes, coupons, vouchers, and copay payment programmes. Interviewees viewed direct-to-consumer advertising negatively, but had a generally positive view of industry-funded drug information. Pharmacists may represent a hitherto under-identified cohort of health professionals who are targeted for industry influence; expanding roles for pharmacists may make them even more attractive targets for future industry attention. Pharmacy schools should ensure that students learn to rely on unbiased information sources and should teach students about conflicts of interest and the risks of interacting with industry. Further research should be conducted on the extent to which pharmacists' attitudes towards their duties and towards drug assessment and recommendation are influenced by the pharmaceutical industry.

A Prospective Analysis of Meat Mutagens and Colorectal Cancer in the Nurses' Health Study and Health Professionals Follow-up Study.

Background:Heterocyclic amines (HCAs) in cooked meats may play a role in colorectal cancer (CRC) development.Objectives:We aimed to prospectively examine the association between estimated intakes of HCAs and meat-derived mutagenicity (MDM) in two cohorts of health professionals, the Health Professionals Follow-up Study (HPFS) and the Nurses’ Health Study (NHS).Methods:In 29,615 men and 65,875 women, intake of the HCAs 2-amino-3,8-dimethylimidazo(4,5-j)quinoxaline (MeIQx), 2-amino-1-methyl-6-phenylimidazo(4,5-b)pyridine (PhIP), 2-amino-3,4,8-trimethylimidazo(4,5-f)quinoxaline (DiMeIQx), and MDM was estimated using a 1996 cooking questionnaire, the 1994 food frequency questionnaire, and an online database. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) and to adjust for potential confounders. Estimates for both cohorts were pooled using random-effects meta-analysis.Results:Between 1996 and 2010, 418 male and 790 female CRC cases were identified. Meat mutagen intake was not statistically significantly associated with risk of CRC [highest vs. lowest quintile, pooled HR (95% CI) for MeIQx: 1.12 (0.93, 1.34), p for trend 0.23; PhIP: 1.10 (0.90, 1.33), p for trend 0.35; MDM: 1.03 (0.86, 1.24), p for trend 0.75] or subtypes of CRC defined by tumor location (proximal or distal colon, or rectum). When analyzed by source of meat, PhIP from red but not from white meat was nonsignificantly positively associated with CRC and significantly positively associated with proximal cancers [HR (95% CI) per standard deviation increase of log-transformed intake: PhIP red meat: CRC: 1.06 (0.99, 1.12), proximal: 1.11 (1.02, 1.21); PhIP white meat: CRC: 0.99 (0.94, 1.04), proximal: 1.00 (0.93, 1.09)].Conclusions:Estimated intakes of meat mutagens were not significantly associated with CRC risk over 14 years of follow-up in the NHS and HPFS cohorts. Results for PhIP from red but not from white meat warrant further investigation.Citation:Le NT, Michels FA, Song M, Zhang X, Bernstein AM, Giovannucci EL, Fuchs CS, Ogino S, Chan AT, Sinha R, Willett WC, Wu K. 2016. A prospective analysis of meat mutagens and colorectal cancer in the Nurses’ Health Study and Health Professionals Follow-up Study. Environ Health Perspect 124:1529–1536; http://dx.doi.org/10.1289/EHP238

Students' Beliefs about Willingness to Access Complementary and Alternative Therapies (CAT) Training for Future Integration into Psychology Practice

It is suggested that all psychologists gain basic training in the types of complementary and alternative therapies (CAT) their clients may be using. As psychology students are the next cohort of health professionals who will inform future initiatives in the field, it is important to understand the factors which influence their decisions about CAT integration. Drawing on the theory of planned behavior, we investigated the beliefs that differentiate between psychology students who are high or low on willingness to access training in CAT for future practice use. Undergraduate psychology students () completed a questionnaire assessing the likelihood of positive and negative consequences of accessing training and utilizing CAT within a psychological practice, important others’ approval, and barriers preventing them from this integration behavior. Those students higher on willingness were more likely to endorse positive outcomes (e.g., offering a more holistic approach to therapy) of accessing CAT training for future practice use and to believe that important others (e.g., clients) would support this behavior. A regression analysis examining the relative importance of these belief sets broadly supported the belief-based analyses. These beliefs of student psychologists can inform educators and policy makers about CAT training and integration in psychology practice.

Smoking and prostate cancer survival and recurrence

Smoking and prostate cancer survival and recurrence

Abstract B91: Long-term aspirin use and the risk of total, fatal and aggressive prostate cancer in a prospective cohort of health professionals, 1988-2004.

Abstract B91 Background Experimental studies support aspirin in the chemoprevention of prostate cancer and an increasing body of epidemiological evidence supports a modest inverse association between regular aspirin use and prostate cancer risk, with stronger and more consistent associations for advanced disease. Methods In a prospective cohort study of 48,834 health professionals aged 40-75 years at baseline, we evaluated long-term aspirin use and the incidence of total, fatal and aggressive (Gleason 8-10 or T3b-T4 or N1 or M1) prostate cancer from 1988-2004. We used Cox proportional hazards regression to evaluate the risk of prostate cancer associated with cumulative averages of aspirin frequency (days/week), quantity (adult-strength tablets/week), and total duration (years) after multivariable adjustment for age, race, family history and other predictors of prostate cancer risk and mortality in the Health Professionals Follow-up Study cohort. Combined aspirin patterns were evaluated through the number of aspirin tablet-years, a measure of adult-strength tablets/day multiplied by number of years in frequent users (&amp;gt; 6 days/week). Results A total of 4,437 men were diagnosed with prostate cancer over 697,669 person-years of follow-up during the 16-year study period. Aspirin use was not associated with total prostate cancer risk, although non-significant inverse associations were observed for longer durations (&amp;gt; 5 years, HR: 0.90, 95% CI: 0.80, 1.02) after excluding PSA-detected disease (T1c). For fatal disease (n=347), mixed patterns emerged but there were no significant associations with aspirin frequency, quantity or duration. For aggressive prostate cancer (n=619), when compared to non-users, men who took aspirin &amp;gt; 4 days/week experienced a non-significant 20% reduction in risk (95% CI: 0.49, 1.32), while those taking &amp;gt; 4 adult-strength tablets had a non-significant 19% lower risk (95% CI: 0.57, 1.15) and men with a duration of &amp;gt; 5 had a non-significant 17% reduction (95% CI: 0.65, 1.05). A lower number of days/week, tablets/week and shorter durations yielded estimates that were similar in magnitude and statistically significant (p&amp;lt;0.05) but there was no evidence of a dose-response effect. Single and combined parameters (aspirin tablet-years) both suggest a threshold, rather than dose-response effect of aspirin on aggressive prostate cancer risk. Analytical approaches to address a potential bias from higher PSA screening among aspirin users, including stratification, adjustment for screening, and exclusion of screen-detected disease, did not change the overall conclusions. Conclusions We observed a suggestive reduced risk of aggressive prostate cancer associated with measurements of aspirin use in a large, prospective cohort of health professionals. Our data support earlier observations of modest inverse associations with advanced prostate cancer. Citation Information: Cancer Prev Res 2008;1(7 Suppl):B91.

Factors Motivating the Acceptance of New Information and Communication Technologies in UK Healthcare

This paper discusses the use of three published models, the Technology acceptance model (TAM), Rogers diffusion of Innovation theory (IDT), and the Triandis theory of interpersonal behaviour (TIB), and attempts to bring them together in an integrated model to better predict the adoption of new information and communication technologies by a cohort of health professionals within UK primary care in an attempt to aid implementers in bringing technology in at an organizational level.

Transformative Professional Development: Outcomes of the Inner Life Renewal Program

Health professionals have jobs that are inherently stressful and most have had little opportunity or encouragement to focus on self-care. Over the past 10 years, professional development programs such as the “Courage to Teach” have been developed for teachers in primary and secondary schools. Reported outcomes include personal and professional growth, increased satisfaction and well-being, and renewed passion and commitment for teaching. Based on this model of transformational professional development, a program was developed for health professionals, the Inner Life Renewal Program. Four cohorts of health professionals have completed the program. This brief report provides descriptive information regarding the structure, format, and process of the program and evaluative data based on program evaluations and participant interviews. Outcomes reported by participants include an increase in self-awareness, improved listening skills and relationships with colleagues, and an increased ability to manage or cope with stress.

Alcohol for the Prevention of Type 2 Diabetes Mellitus?

While diabetes mellitus is recognized clinically as a complication of alcohol dependence, in the last 15 years several large prospective studies have demonstrated a significant reduction in risk of incident type 2 diabetes in moderate drinkers. In this article, we review prospective studies on the association between alcohol consumption and incidence of diabetes. Few prospective studies have demonstrated an unequivocal positive association between alcohol use and incidence of diabetes. A number of large prospective studies have now demonstrated an inverse association: typically a 40% risk reduction after controlling for other major risk factors. Studies based on cohorts of health professionals have not demonstrated an increased risk of diabetes with heavier consumption, but these cohorts contain few heavy drinkers. Some cohorts drawn from the general population have shown a J- or U-shaped association between level of alcohol consumption and incidence of diabetes. Frequent moderate drinking has been reported to be associated with lower risk than infrequent drinking. There have been contradictory reports on the importance of the type of alcoholic beverage and whether the effect of alcohol differs according to the bodyweight of the drinker. We conclude that like many other chronic diseases, there is a delicate balance between the harmful and beneficial effects of alcohol on the incidence of diabetes. In moderate amounts, drinking is associated with a reduced risk of diabetes, whereas in higher amounts with an increased risk.