Health Risk Profiles Research Articles

Risk assessment of using off-label morphine sulfate in a population-based retrospective cohort of opioid-dependent patients.

Several addictovigilance studies have described the off-label use of morphine sulfate (MS) for nonchronic pain in opioid use disorder (OUD) patients as an alternative to conventional opioid substitution treatments (OSTs). This study primarily sought to compare the incidence of unintentional opioid-related overdose in the year following the prescription initiation in off-label MS users, compared to OST-maintained patients. Sequential cohorts of OUD patients who were regularly dispensed MS, buprenorphine, or methadone, between 1 April 2012 and 31 December 2014, were retrospectively identified using the French nationwide healthcare data system. The incidence of overdoses, deaths, doctor shopping, and complications of a viral, bacterial or thrombotic nature, was compared using the Cox regression method. Overall, 1075, 20834 and 9778 OUD patients without chronic-pain were included in the MS, buprenorphine, and methadone cohorts, respectively. Overdose incidence was 3.8 (P<.01 [95% confidence interval (CI): 2.1-6.8]) and 2.0 (P=.02 [95%CI: 1.1-3.6]) higher in the MS cohort vs buprenorphine and methadone, respectively. Death incidence was 9.1 (P < .01 [95%CI: 3.2-25.9]) and 3.9 (P < .01 [95%CI: 1.4-10.7]) higher in the MS cohort vs buprenorphine and methadone, respectively. The incidences of other associated risks were significantly higher in the MS group vs OSTs, except for hepatitis C viral infection and thrombotic complications. This first French comprehensive nationwide study reveals increasing overdose, death, bacterial infection, abuse and diversion risks when off-label MS is initiated as alternative to OST. These results question the relevance of prescribing MS as a safe opioid maintenance treatment, considering its health risk profile.

Aging and the Hidden Costs of Going Home to Mexico.

Data from the Mexican Census reveal that between 2005 and 2015, nearly two million migrants returned voluntarily to Mexico from the United States. Currently, high rates of voluntary-return migration to Mexico continue at the same time that migration flows to the U.S. steadily decline. This return migration trend presents serious challenges for Mexico, a country that has long struggled to satisfy the health care demands of its population. However, little is known about return migrants' health care needs. In this study, we examine the health risk profiles and healthcare utilization for Mexican return migrants and the non-migrant population. We examine how these outcomes are affected by both the migration and return migration experience of the returnee population, while paying close attention to age-group differences. We employ inverse probability weighting regression adjustment (IPWRA) and logistic regression analysis of a sample of 348,450 respondents from the 2014 National Survey of Demographic Dynamics (ENADID) to test for differences in health conditions between those Mexican return migrants and non-migrants. We then turn to the Survey of Migration at Mexico's Northern Border (EMIF Norte, for its Spanish acronym) for the 2014-2017 period to further assess whether certain characteristics linked to aging and the migration experience influence the prevalence of chronic health conditions, and health insurance coverage among 17,258 returned migrants. Findings reveal that compared to non-migrants, returnees are more likely to be physically impaired. These poor health outcomes are influenced by the migration and return migration experience and vary by age group and duration of residence, the time that has elapsed since returning to Mexico. We do not find an association between return migration and mental or emotional distress. Policy implications are discussed in light of immigration reform and restrictions on eligibility for health insurance coverage for older adults in Mexico.

Interactions between familial risk profiles and preschoolers' emotionality in predicting executive function

We identified familial risk profiles and examined interactions between these profiles and child emotionality in predicting child executive function (EF). Among 126 mother-child dyads (child mean age = 3.23 years), four profiles were found based on maternal education, family income-to-needs ratio, and maternal depressive symptoms, anxiety, and parenting stress: Higher SES-Lower Mental Health Risk, Lower SES-Lower Mental Health Risk, Lower SES-Average Mental Health Risk, and Lower SES-Higher Mental Health Risk profiles. We found that high child positive emotionality at age 3 predicted high inhibitory control and low attention flexibility a year later exclusively in the Lower SES-Higher Mental Health Risk profile. Overall, children in the Higher SES-Lower Mental Health Risk profile showed better inhibitory control and attention flexibility than those in the Lower SES-Higher Mental Health Risk. This study extends our understanding of how different constellations of familial risks interact with child emotionality to contribute to child EF development.

Advancing perspectives on health literacy in childhood and youth.

Children and young people's importance as core target population for health literacy has been highlighted throughout the literature due to the relevance of the early life phases for maintaining, restoring and promoting health during the life course. Transferring health literacy concepts to the target population, however, requires proper testing of their applicability and their fit to the developmental phases as well as the target populations' realities and needs. This article aims to discuss children's and young people's health literacy by elaborating and exploring childhood and youth as life phases with unique characteristics from multidisciplinary perspectives. Drawing on theories and findings from developmental studies, sociology and socialization research, health literacy in childhood and youth is discussed along five 'D' dimensions: (i) disease patterns and health perspectives, (ii) demographic patterns, (iii) developmental change, (iv) dependency and (v) democracy. The unique particularities of children and young people relevant for health literacy include their disease and health-risk profiles, their vulnerability to demographic factors, their social role and status, and their right to participation. Inter- and intra-generational relationships and an unequal distribution of power can either promote or hinder children and young people's health literacy development and their opportunities for participating in health-related decision making. Specifying what is called the 'contextual' and 'relational' dimension of health literacy for the target group requires considering their personal attributes and agency as contextually embedded and interrelated. Taking these considerations into account can help to move towards a more tailored and holistic approach to health literacy of children and young people.

Voluntary pooling of genetic risk: A health insurance experiment

Abstract Scientific and technological advances increasingly allow for better tailoring of health insurance plans to individual health risk profiles. This development questions the sustainability of health plans that feature strong cross-subsidization across different health risk types and health behaviors. An important observation is that the willingness to cross-subsidize risks in health plans might depend on whether the risk is uncontrollable by individuals, such as genetic risk, or modifiable via health behaviors. This paper provides the results of an experiment on the willingness to pool genetic risk in health insurance. Subjects’ overall health risk has an assigned, uncontrollable genetic risk part that differs across individuals as well as a behavioral risk part, which can be reduced by costly effort. Participants can decide between a pooling, community-rated group insurance scheme and an insurance with a fully individually risk-adjusted premium. In the experimental variation, the group insurance scheme either includes behavioral risk or separates it out via individual premium discounts. Although we observe social preferences for pooling, only a low level of actual genetic risk pooling emerges across the experimental conditions. This is due to both large heterogeneity in social preferences across subjects, and the dynamics of the willingness to pay for group insurance in the different experimental markets.

Abstract P125: Cardiovascular Health Improves in High Transportation Vulnerable Girls With Decreased Exposures to Residential Segregation

Introduction: Transportation equity ensures that all citizens benefit from a clean, fair, safe and healthy environment. Residential segregation also impacts health, and transportation disadvantage is particularly high in areas with high segregation, where residents typically lack proximity to quality education, jobs, healthy food, safe playgrounds, and medical care. Recent research demonstrates improvements in cardiovascular risk profiles among minority girls after reduced exposure to segregation. There is a need to examine differences in the segregation-youth cardiovascular health association across transportation vulnerability and gender to inform health equity interventions. Hypothesis: It was hypothesized that girls with reduced segregation exposure and low transportation vulnerability would have the most improved cardiovascular health. Methods: Data for these analyses were drawn from the Fit2Play dataset (2010-2018; N=2742). Youth were followed over 4 consecutive years of participation in a year-long afterschool physical activity program. Change in segregation exposure was based on concentration of minorities living in block groups from the participant’s home to program areas using the 2010 Census. Transportation vulnerability was based on percent of households in the participant’s home zip code with vehicle access (0, 1, 2, or ≥3 vehicles) drawn from the American Community Survey (2012-16). Longitudinal mixed models were used to compare the association between change in residential segregation and five cardiovascular health risk measures (body mass index, systolic and diastolic blood pressure, skinfold thickness and 400 meter run tests) stratified by transportation vulnerability and gender. Results: Participants were 54% male, 51% Hispanic, 49% non-Hispanic black, and 52% high poverty (mean age 9.5 years). After accounting for child age, race/ethnicity, poverty, and year, girls with high transportation vulnerability and reduced segregation exposure showed the most reduced cardiovascular health risk profiles, including improvements in body mass index (26%, 95% CI: 23.84, 28.30), skinfold thicknesses (18%, 95% CI: 14.90, 20.46), run time (17%, 95% CI: 14.88, 18.64), systolic blood pressure (15%, 95% CI: 11.96, 17.08), and diastolic blood pressure (12%, 95% CI: 9.09, 14.61). In contrast, no clear patterns emerged for low transportation vulnerable girls, and high or low transportation vulnerable boys. Conclusions: In conclusion, high transportation vulnerable girls exposed to reduced segregation had greater improvements in all cardiovascular health risk outcomes compared with low transportation vulnerable girls, and both high and low transportation vulnerable boys. Transportation equity interventions may provide a means to reduce youth cardiovascular health disparities, particularly for girls living highly segregated areas.

Improvements in an Organization's Culture of Health Reduces Workers' Health Risk Profile and Health Care Utilization.

To examine changes in internal and external cultures of health scores and relate those changes to employees' health risks, health care utilization, and costs for 21 large employers (N = 641,901). We measured the relationship between changes in internal and external culture of health scores and changes in employee health risks, health care utilization, and costs. Improvements in a company's internal culture of health predicted lower levels of obesity, poor diet, and tobacco use but higher stress for employees reporting high baseline risk. For those not at high baseline risk, health improved for depression, alcohol consumption, and diet. Improvements in internal culture of health also led to lower prescription drug utilization. Investments in internal culture of health predict improvements in some employee health risks and health care utilization.

Behavioral health risk profiles of physical education undergraduates

Abstract Aims: To analyze the prevalence of risky behaviors among physical education undergraduates; to determine prevalence of risk factors for non-communicable chronic diseases (NCCD) among university, and; to determine the association between healthy life habits and physical activity. Method: A cross-sectional study with 903 undergraduate Physical Education students. The study used a self-administered questionnaire on health-related life habits. All questions were obtained from the Surveillance of Risk and Protection Factors for Chronic Diseases through Telephone Interviews. Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (95% CI). Results: Of the 903 students, 57.4% were women, 67.6% were between 20-29 years of age, 68.7% consumed alcohol, 28.5% did not do physical activity, and 33.2% were overweight. Regarding the eating habits considered a risk for NCCD, women exhibited more risk factors than men, whereas 41.1% drank more full-fat milk (p = 0.01) and 31.8% ate more fatty meats, while men drank more soda (p < 0.01). Physically active students consumed more fruits (p < 0.01) and salads (p = 0.01) and drank less soda (p < 0.01). The physically inactive students had a high prevalence of getting diabetes (p < 0.01) and of suffering from hypertension (p = 0.01) and high cholesterol (p < 0.01). Conclusions: University students in our study had unhealthy lifestyles. There is an urgent need for both a formulation and implementation of public health policies to promote health and decrease risk factors for NCCD.

Cardiovascular and Metabolic Risk in Women in the First Year Postpartum: Allostatic Load as a Function of Race, Ethnicity, and Poverty Status.

Allostatic load (AL) represents multisystem physiological "wear-and-tear" reflecting emerging chronic disease risk. We assessed AL during the first year postpartum in a diverse community sample with known health disparities. The Eunice Kennedy Shriver National Institute for Child Health and Human Development Community Child Health Network enrolled 2,448 predominantly low-income African-American, Latina, and White women immediately after delivery of liveborn infants at ≥20 weeks' gestation, following them over time with interviews, clinical measures, and biomarkers. AL at 6 and 12 months postpartum was measured by body mass index, waist:hip ratio, blood pressure, pulse, hemoglobin A1c, high-sensitive C-reactive protein, total cholesterol and high-density lipoprotein, and diurnal cortisol slope. Adverse AL health-risk profiles were significantly more prevalent among African-American women compared with non-Hispanic Whites, with Latinas intermediate. Breastfeeding was protective, particularly for White women. Complications of pregnancy were associated with higher AL, and disparities persisted or worsened through the first year postpartum. Adverse AL profiles occurred in a substantial proportion of postpartum women, and disparities did not improve from birth to 1 year. Breastfeeding was protective for the mother.

Mental health in older men in Chile: a reality to be prioritizedSaúde mental de homens idosos no Chile: uma realidade a ser priorizada

RESUMENLos problemas de salud mental constituyen un conjunto de condiciones de alto impacto. Las personas de 60 y más años presentan vulnerabilidades particulares que aumentan el riesgo de experimentar problemas de salud mental y consecuencias terminales como el suicidio. En este grupo etario, los hombres constituyen un subgrupo poco considerado como destinatarios particulares de acciones en salud. En el caso de Chile, este artículo busca caracterizar la realidad de la salud mental de los hombres adultos mayores mediante cifras provenientes de encuestas poblacionales realizadas en el país (Encuesta Nacional de Salud [ENS] 2003-2009, Estudio Nacional de Dependencia en las Personas Mayores [ENADEAM] 2009, Encuesta de Caracterización Socioeconómica Nacional [CASEN] 2015). El artículo aborda indicadores relativos a depresión y síntomas depresivos, suicidio e ideación suicida, y consultas de salud mental. Las cifras reportadas en las encuestas seleccionadas informan que, en Chile, los hombres adultos mayores son el grupo que presenta la mayor tasa de suicidio, el menor número de ideación e intento suicida, y la menor frecuencia reportada de consultas de salud mental. De igual modo, presentan menor reporte de depresión en comparación con mujeres. Estas cifras permiten aproximar a un perfil de salud mental en hombres mayores en Chile y cuestionar la pertinencia de los actuales modelos epidemiológicos para la identificación de perfiles de riesgo de salud mental en este grupo. Asimismo, emerge la urgente necesidad de diseñar programas de salud que incorporen dicha consideración de género, para lograr una adecuada pesquisa y aceptabilidad de las potenciales intervenciones dirigidas a promover la salud mental y reducir riesgos en hombres adultos mayores.

Health risk profile for terrestrial radionuclides in soil around artisanal gold mining area at Alsopag, Sudan

This study shows the assessment of radiation hazard parameters due to terrestrial radionuclides in the soil around artisanal gold mining for addressing the issue of natural radioactivity in mining areas. Hence, the levels 238U, 232Th, 40K and 226Ra in soil (using gamma spectrometry), 222Rn in soil and 222Rn in air were determined. Radiation hazard parameters were then computed. These include absorbed dose D, annual effective dose E, radium equivalent activity Raeq, external hazard Hex, annual gonadal dose equivalent hazard index AGDE and excess lifetime cancer risk ELCR due to the inhalation of radon (222Rn) and consumption of radium (226Ra) in vegetation. Uranium (238U), thorium (232Th) and potassium (40K) averages were, respectively, 26, 36 and 685 Becquerel per kilogram (Bq kg−1). Soil radon (4671 Bq m−3) and radon in air (14.77 Bq m−3) were found to be less than worldwide data. Nevertheless, the average 40K concentration was 685 Bq kg−1. This is slightly higher than the United Nations Scientific Committee on the Effects of Atomic Radiation average value of 412 Bq kg−1. The obtained result indicates that some of the radiation hazard parameters seem unsavory. The mean value of absorbed dose rate (62.49 nGy h−1) was slightly higher than average value of 57 nGy h−1 (~ 45% from 40K), and that of AGDE (444 μSv year−1) was higher than worldwide average reported value (300 μSv year−1). This study highlights the necessity to launch extensive nationwide radiation protection program in the mining areas for regulatory control.

Which Compounds Contribute Most to Elevated Soil Pollution and the Corresponding Health Risks in Floodplains in the Headwater Areas of the Central European Watershed?

The main topic of this study is a human health risk assessment of a defined exposure scenario in the floodplain soils of the headwater areas of the central European watershed, with the aim of exploring both multivariate and regional data structures. Flood-prone areas are recognized worldwide to be susceptible to contamination and its redistribution. Contributions of various classes of toxic compounds (organochlorine pesticides (OCPs), polycyclic aromatic hydrocarbons (PAHs), polychlorinated biphenyls (PCBs)) to human health risks were assessed in a screening risk assessment. However, due to the relative nature of our data and a high PAH dominancy over the data ensemble, reliance solely on the standard statistical processing of raw data might lead to incomplete insight into the structure of the multivariate data. Explanatory analysis of the data structure using the compositional approach was found to be beneficial to elucidating human health risk profiles and provided robust evidence that a contrast between agricultural and airborne industrial pollution controlled the whole human toxicological variation of persistent organic pollutants (POPs) in floodplain soils. These results were effectively quantified with the subcomposition of benzo(a)pyrene, DDT, and alpha-hexachlorocyclohexane (aHCH), allowing for an interpretation of structural differences in regional pollution patterns, which conferred different extents and compositions of human health risks in floodplain soils.

Behavioral Health Risk Profiles of Undergraduate University Students in England, Wales, and Northern Ireland: A Cluster Analysis.

Limited research has explored clustering of lifestyle behavioral risk factors (BRFs) among university students. This study aimed to explore clustering of BRFs, composition of clusters, and the association of the clusters with self-rated health and perceived academic performance. We assessed (BRFs), namely tobacco smoking, physical inactivity, alcohol consumption, illicit drug use, unhealthy nutrition, and inadequate sleep, using a self-administered general Student Health Survey among 3,706 undergraduates at seven UK universities. A two-step cluster analysis generated: Cluster 1 (the high physically active and health conscious) with very high health awareness/consciousness, good nutrition, and physical activity (PA), and relatively low alcohol, tobacco, and other drug (ATOD) use. Cluster 2 (the abstinent) had very low ATOD use, high health awareness, good nutrition, and medium high PA. Cluster 3 (the moderately health conscious) included the highest regard for healthy eating, second highest fruit/vegetable consumption, and moderately high ATOD use. Cluster 4 (the risk taking) showed the highest ATOD use, were the least health conscious, least fruit consuming, and attached the least importance on eating healthy. Compared to the healthy cluster (Cluster 1), students in other clusters had lower self-rated health, and particularly, students in the risk taking cluster (Cluster 4) reported lower academic performance. These associations were stronger for men than for women. Of the four clusters, Cluster 4 had the youngest students. Our results suggested that prevention among university students should address multiple BRFs simultaneously, with particular focus on the younger students.

Effect of participation in a park-based afterschool program on cardiovascular disease risk among severely obese youth

ObjectivesThe prevalence of severe obesity in youth is rising, despite reports of obesity rates stabilizing overall. While reports on treatment outcomes for youth with severe obesity (bariatric surgery, behavioral and pharmacological treatments) exist, very few community-based programs have reported changes in health outcomes in this population. We assessed changes in cardiovascular health risk profiles among racial/ethnic minority youth with severe obesity who participated in Fit2Play™, a park-based afterschool health promotion program. Study designA longitudinal cohort study. MethodsChildren aged 6–14 years (N = 1546, 51% Hispanic, 44% non-Hispanic black) who participated in the Fit2Play™ in one of 34 urban park sites for one school year over five separate school years (2010–2015) had height, weight, four-site skinfold thicknesses, systolic blood pressure (SBP)/diastolic blood pressure (DBP), fitness tests, and a health/wellness knowledge test collected at the beginning and end of the school year. Two-level repeated measures mixed models examined changes in cardiovascular health outcomes (body mass index [BMI], skinfold thickness, systolic/diastolic blood pressure percentile [SBPP/DBPP], cardiorespiratory fitness [PACER]) in youth with severe obesity over 1- and 2-year follow-up. ResultsCompared with baseline, BMI decreased 13% (incidence rate ratio [IRR] 95% confidence interval [CI]: 0.83–0.90), sumof skinfold thicknesses decreased 5% (IRR 95% CI: 0.91–0.99), SBPP decreased 5% (IRR 95% CI: 0.90–0.99), DBPP decreased 19% (IRR 95% CI: 0.77–0.86), and PACER scores increased 12% (IRR 95% CI: 1.0–1.27) after two years of participation in the Fit2Play™ program. ConclusionsFindings here support community/park-based youth programs as effective and accessible treatment options for reducing cardiovascular disease risk among youth with severe obesity.

Sex Differences in Perceived Health and Cardiovascular Risk Profiles in Patients Enrolled in Cardiac Rehabilitation

Sex Differences in Perceived Health and Cardiovascular Risk Profiles in Patients Enrolled in Cardiac Rehabilitation

Health-Risk Behavior Profiles and Reciprocal Relations With Depressive Symptoms From Adolescence to Young Adulthood

PurposeWe examined co-occurrences of multiple health-risk behaviors among adolescents in a 5-year longitudinal design as well as their associations with mental health outcomes. MethodsLatent transition analyses explored subgroups of adolescents (N = 229; 51% males) who engaged in distinct patterns of health-risk behaviors and transitions over time. Moreover, longitudinal relations between risk behavior profiles and depressive symptoms were also explored. ResultsWe identified four latent profiles based on risk levels of safety and violence, sexual behavior, alcohol use, and marijuana and other drug use at both 18 years and 23 years: low risk, modest risk, medium risk, and high risk. Some adolescents maintained their latent profile membership over time, but more transitioned between risk profiles. Adolescents with more depressive symptoms had a higher probability of developing into the high-risk versus low-risk and modest risk profiles at 23 years. Adolescents in the high-risk, low-risk, and modest risk profiles at 18 years developed more depressive symptoms in young adulthood compared with medium risk adolescents. ConclusionsThis study provides a better understanding of the prevalence, distribution, and change patterns of health-risk profiles across adolescence and young adulthood in a European American sample. Reciprocal relations between high-risk profiles and depressive symptoms suggest the need for integrated but tailored prevention and intervention programs.

Intranasal heroin use – an emerging trend in Lebanon: A single institution study presenting sociodemographic profiles of intranasal versus intravenous users

ABSTRACTBackground: High production levels and availability of heroin in Middle East and North African (MENA) countries have been leading to the continuous rise in injecting drug use. On the contrary, in most Western countries, the proportion of heroin injectors may be falling. Interestingly, in Lebanon heroin sniffing has been gaining popularity. We therefore aimed at exploring the characteristics of intranasal heroin use compared to intravenous heroin use in patients admitted to treatment at Skoun, Lebanese Addiction Center. Methods: Between January and September 2013, 186 heroin-dependent users participated in this study: 92 were heroin sniffers and 94 injectors. Data collection was carried out using structured questionnaires on different sociodemographic characteristics and psychological and social functioning. Results: Injectors were significantly younger and had lower levels of employment compared to heroin sniffers. Analysis of health-risk profiles revealed that although injectors were significantly at higher risk of overdose, Hepatitis C infection, and anxiety, sniffers were not risk-free. Other sociodemographic and health-risk profiles did not materialize between the two study groups. Conclusion: The study provides evidence that heroin sniffers share many common characteristics with heroin injectors and therefore do not represent a protected group of heroin users.

Weight status, fatness and body image perception of North African immigrant women in Italy.

To investigate the nutritional status of North African (NA) immigrant women in Italy, analysing their body size, adiposity and body image perception in comparison to Italian natives and NA residents. The study utilized a cross-sectional design. Anthropometric traits were directly measured and a few indices were computed as proxy measures of nutritional status and adiposity. Body image perception was assessed using silhouette drawings. ANCOVA, adjusted for age, was used to compare anthropometric traits among different groups of women and the χ 2 test to analyse differences in the prevalence of nutritional status. Italy and North Africa (Tunisia, Morocco). A sample of 433 women aged 18-60 years old: NA immigrants (n 105); Italians (n 100); Tunisians (n 104); Moroccans (n 124). Overweight/obesity prevalence was very high in immigrants (79·8 %). Immigrants had the highest BMI value, the greatest hip circumference and mid upper-arm circumference. Their triceps skinfold thickness was significantly higher than that of Italians, but lower than that of NA residents. NA immigrant women in Italy showed a higher incidence of overweight compared with Italians and NA residents. All groups showed a preference for a thinner body in comparison to their actual bodies and the immigrants are the most dissatisfied. Immigrants remain a high-risk group for obesity. Assessment of their body composition and health risk profile should be improved by using specific anthropometric measures that are easy to collect even in the case of large migration flows.

Pilot Enhancement of the Arthritis Foundation Exercise Program with a Healthy Aging Program.

Older adults with arthritis or joint pain were targeted for a pilot program enhancing the Arthritis Foundation Exercise Program with the 10 Keys™ to Healthy Aging Program. Using a one-group, pre-post design, feasibility was examined and improvements in preventive behaviors, arthritis outcomes, and cardiometabolic outcomes were explored. A 10-week program was developed, instructors were recruited and trained, and four sites and 51 participants were recruited. Measures included attendance, adherence, satisfaction, preventive behaviors, Western Ontario and McMaster Universities Osteoarthritis Index (pain and stiffness), glucose, and cholesterol. Three fourths of participants attended >50% of the sessions. At 6 and 12 months, more than one half performed the exercises 1 to 2 days per week, whereas 28% and 14% exercised 3 to 7 days per week, respectively. Participants (92%) rated the program as excellent/very good. Nonsignificant changes were observed in expected directions. Effect sizes were small for arthritis and cardiometabolic outcomes. This program engaged community partners, demonstrated feasibility, and showed improvements in some preventive behaviors and health risk profiles. [Res Gerontol Nurs. 2016; 9(3):123-132.].

More Older Adults Needed in Cancer Trials

Cancer research must include more older adult participants because the evidence base for treating this patient population is too sparse, according to an American Society of Clinical Oncology position statement published online in the Journal of Clinical Oncology. Key evidence is lacking because older adults are usually excluded from clinical trials, even though most cancer patients are 65 and older. Both patients and their clinicians are forced to base treatment plans on data from younger, healthier patients, from studies that often don't even consider endpoints that matter most to them: not just survival rates but quality of life measures and rates of functional independence. ‘We need to see clinical trials that mirror the age distribution and health risk profile of patients with cancer.’ Moreover, older adults respond differently than younger adults to cancer treatments because age-associated physiologic changes, higher incidence of comorbidities, and greater use of medications may interact with cancer therapies. “We need to see clinical trials that mirror the age distribution and health risk profile of patients with cancer,” said Arti Hurria, MD, coauthor of the statement and director of the cancer and aging research program at City of Hope, Duarte, CA, and her associates. The position statement includes five recommendations and 16 specific action items to achieve this goal. First, the cancer research community — regulatory agencies, study funders, and researchers — must expand eligibility criteria so that more older adults can participate in studies. A rationale must be provided for all restrictions based on age, performance status, or comorbidities. And funders such as the National Cancer Institute and the National Institute on Aging should incentivize research that includes older adults. Second, research design and infrastructure must be used to incentivize the inclusion of older adults. For example, Medicare could cover the off-label use of cancer therapies in older patients in selected trials, and research databases could be encouraged to collect information pertaining to older patients. Third, the Food and Drug Administration should be given authority to both incentivize and require studies to include older adults. For example, the agency could reward drug manufacturers for including older patients in trials of new cancer therapies by granting them 6-month patent extensions, or it could encourage the development of new agents by expediting their review. Alternatively, the FDA could limit the compensation available to manufacturers that don't include older study subjects. And the FDA should include geriatrics experts on its advisory boards, such as the Oncology Drug Advisory Committee. Fourth, clinicians should encourage the recruitment of their older patients into clinical trials. The single most important predictor of whether or not a cancer patient enrolls in a study is that his or her clinician has recommended it. And one way to increase such recommendations is to increase reimbursement for the time and effort it takes clinicians to find and explain relevant studies to patients. Finally, professional journals should incentivize researchers to report on the substantial data they already collect about older study subjects, but do not analyze or report on. And professional journals should include geriatric oncology experts on their editorial boards and as peer reviewers, to ensure that cancer research results are applicable to the majority of people who have cancer, according to the position statement (J Clin Oncol 2015 July 20 [doi:10.1200/JCO.2015.63.0319]). This position statement was supported by a subcommittee of the American Society of Clinical Oncology's cancer research committee. Mary Ann Moon is a Frontline Medical News freelance writer based in Clarksburg, MD.