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Background Adult survivors of childhood cancer are at increased risk of cardiac late effects. Methods Using whole-genome sequencing data from 1870 survivors of European ancestry in the St. Jude Lifetime Cohort (SJLIFE) study, genetic... more
Background Adult survivors of childhood cancer are at increased risk of cardiac late effects. Methods Using whole-genome sequencing data from 1870 survivors of European ancestry in the St. Jude Lifetime Cohort (SJLIFE) study, genetic variants were examined for association with ejection fraction (EF) and clinically assessed cancer therapy–induced cardiac dysfunction (CCD). Statistically significant findings were validated in 301 SJLIFE survivors of African ancestry and 4020 survivors of European ancestry from the Childhood Cancer Survivor Study. All statistical tests were 2-sided. Results A variant near KCNK17 showed genome-wide significant association with EF (rs2815063-A: EF reduction = 1.6%; P = 2.1 × 10-8) in SJLIFE survivors of European ancestry, which replicated in SJLIFE survivors of African ancestry (EF reduction = 1.5%; P = .004). The rs2815063-A also showed a 1.80-fold (P = .008) risk of severe or disabling or life-threatening CCD and replicated in 4020 Childhood Cancer Sur...
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Background: Arthritis is highly prevalent among older adults with type 2 diabetes mellitus (T2DM) and presents a barrier to participating in regular land-based physical activity. Aim: To examine the effects of a 12-week community-based... more
Background: Arthritis is highly prevalent among older adults with type 2 diabetes mellitus (T2DM) and presents a barrier to participating in regular land-based physical activity. Aim: To examine the effects of a 12-week community-based aquatic exercise program for overweight older adults (≥55 years of age) with T2DM and lower body arthritis. Methods: For this quasi-experimental study, participants completed an exercise specialist-led program consisting of 60-min, twice/week, of aquatic activities at intensities that increased at 4-week increments from 40% to 65% of heart rate reserve for a total of 12 weeks. Clinical and functional measures were completed at baseline and after 12 weeks. Results: Thirty participants completed baseline measures. Overall, half were female, mean (standard deviation = SD) age 67.7 (7.0) years, A1c = 6.7 (1.3)%, BMI = 35.9 (8.6) kg/m2, average daily steps = 4207 (5504). Actual mean heart rate responses during aquatic exercise sessions were at 85%, 90%, an...
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ABSTRACTWith mounting interest in translating GWAS hits from large meta-analyses (meta-GWAS) in diverse clinical settings, evaluating their generalizability in target populations is crucial. Here we consider long-term survivors of... more
ABSTRACTWith mounting interest in translating GWAS hits from large meta-analyses (meta-GWAS) in diverse clinical settings, evaluating their generalizability in target populations is crucial. Here we consider long-term survivors of childhood cancers from the St. Jude Lifetime Cohort Study and show the limited generalizability of 1,376 robust SNP associations reported in the general population across 12 complex anthropometric and cardiometabolic phenotypes (N=2,231; observed-to-expected replication ratio=0.68, P=2.4×10−9). An examination of five comparable phenotypes in a second independent cohort of survivors from the Childhood Cancer Survivor Study corroborated the overall limited generalizability of meta-GWAS hits to survivors (N=4,212, observed-to-expected replication ratio=0.53, P=1.1×10−16). Meta-GWAS hits were less likely to be replicated in survivors exposed to cancer therapies associated with phenotype risk. Examination of complementary DNA methylation data in a subset of sur...
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10056 Background: Chronic health conditions are frequent among childhood cancer survivors and lead to increased health care resource utilization. We compared rates of ED visits and hospitalizations between survivors and siblings. Methods:... more
10056 Background: Chronic health conditions are frequent among childhood cancer survivors and lead to increased health care resource utilization. We compared rates of ED visits and hospitalizations between survivors and siblings. Methods: Analyses included 10,762 ≥5-year survivors and 2,069 siblings who completed a questionnaire from 2014-2016. We calculated ED visits and non-obstetric hospitalizations in the last 12 months per 1,000 person-years (PY) and evaluated cause-specific hospitalization rates using ICD-10 categories. Multivariable Poisson regression models evaluated predictors of survivor visits. Results: Median age in survivors and siblings was 35.3 years (interquartile range [IQR] 29.0-43.1) and 42.9 years (IQR 35.6-50.2), respectively; time from cancer diagnosis was 27.8 years (IQR 21.7-34.1). 24.2% of survivors and 16.2% of siblings had ≥1 ED visit (p < 0.001); rates were 521/1,000 PY for survivors and 246/1,000 PY for siblings (age/sex-adjusted relative rate [RR] 2....
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Gestational diabetes mellitus (GDM) is a common complication in pregnancy and a significant risk factor for type 2 diabetes (T2D). Most women who have had GDM are not engaging in health behaviours known to reduce their risk for developing... more
Gestational diabetes mellitus (GDM) is a common complication in pregnancy and a significant risk factor for type 2 diabetes (T2D). Most women who have had GDM are not engaging in health behaviours known to reduce their risk for developing future T2D. The objective of this study is to evaluate the effectiveness of a lifestyle modification program targeting healthy eating and active living behaviours after a GDM pregnancy. This trial will randomize 100 women to either a lifestyle modification program or a control condition. Those allocated to the Healthy Eating and Active Living for Diabetes and Gestational Diabetes Mellitus (HEALD-GDM), program will receive a previously developed and tested 24-week program led by an Exercise Specialist at a local recreational facility. The original HEALD program will be tailored for women with GDM through the provision of complementary childcare at HEALD-GDM sessions and theory-guided peer-led telephone support. Our primary outcome is the 6-month cha...
Research Interests: Research Design, Adolescent, Medicine, Lipids, Gestational diabetes, and 14 morePregnancy, Humans, Blood Pressure, Female, Young Adult, Exercise, Middle Aged, Adult, Randomized Controlled Trial, Healthy Diet, Type 2 Diabetes Mellitus, Healthy Lifestyle, Glycated hemoglobin A, and Medical and Health Sciences
The association between obesity and mortality risks following coronary revascularization is not clear. We examined the associations of BMI (kg/m(2)) with short-, intermediate-, and long-term mortality following coronary artery bypass... more
The association between obesity and mortality risks following coronary revascularization is not clear. We examined the associations of BMI (kg/m(2)) with short-, intermediate-, and long-term mortality following coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI) in patients with different coronary anatomy risks and diabetes mellitus status. Data from the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) registry were analyzed. Using normal BMI (18.5-24.9) as a reference, multivariable-adjusted hazard ratios for all-cause mortality within 6 months, 1 year, 5 years, and 10 years were individually calculated for CABG and PCI with 4 prespecified BMI categories: overweight (25.0-29.9), obese class I (30.0-34.9), obese class II (35.0-39.9), and obese class III (≥40.0). The analyses were repeated after stratifying for coronary risks and diabetes mellitus status. The cohorts included 7560 and 30 258 patients for CABG...
Research Interests: Cardiology, Obesity, Medicine, Multivariate Analysis, Humans, and 15 moreInternal Medicine, Diabetes mellitus, Female, Male, Body Mass Index, Registries, Aged, Middle Aged, Percutaneous Coronary Intervention, Alberta, Protective factors, Chi Square Distribution, Coronary Artery Disease, Proportional Hazards Models, and Coronary Artery Bypass
Sleep is an important behavior for metabolic control and mental health in type 2 diabetes. The aim was to examine the relationship of objective estimates of sleep quantity and quality with health-related quality of life (HRQL) in adults... more
Sleep is an important behavior for metabolic control and mental health in type 2 diabetes. The aim was to examine the relationship of objective estimates of sleep quantity and quality with health-related quality of life (HRQL) in adults with type 2 diabetes. Participants completed a survey where HRQL was measured using the EQ-5D-5 L index score, and the SF-12 v2, which provides physical and mental composite summary (PCS and MCS) scores. Participants also wore wrist actigraphy (Actigraph GT3X+) during sleep to derive estimates of total sleep time (TST), sleep latency (SLAT), and sleep efficiency (SEFF) and wake after sleep onset (WASO). Adjusted multivariable linear regression models were used to examine the associations among actigraphy-derived sleep parameters with PCS, MCS, and EQ-5D-5 L index scores. On average, participants (N=168) were 65 years old (standard deviation [SD] 10), 46% were female, with a diabetes duration of 13 years (SD 9) and body mass index of 31 kg/m(2) (SD 6....
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To explore the comparative performance including discriminative and longitudinal validity of EQ-5D-5L and SF-6D index scores in adults with type 2 diabetes. Data from an on-going cohort study of adults with type 2 diabetes in Alberta,... more
To explore the comparative performance including discriminative and longitudinal validity of EQ-5D-5L and SF-6D index scores in adults with type 2 diabetes. Data from an on-going cohort study of adults with type 2 diabetes in Alberta, Canada, were used. Known-groups approach was used to examine discriminative validity. Correlation and agreement indices and scatter and Bland-Altman plots were used to examine the relationship between the two measures. Longitudinal validity was explored using Wilcoxon signed-rank test, effect size, and standardized response mean. In 1832 participants at baseline (age 64.3, standard deviation 10.6 years; 45% female), median EQ-5D-5L score was 0.85 [interquartile range (IQR) 0.17], and floor and ceiling effects of 0.1 and 16.1%, respectively; median SF-6D score was 0.72 (IQR 0.24), and floor and ceiling effects of 0.1 and 3.2%, respectively. EQ-5D-5L and SF-6D index scores were significantly correlated with an overall Spearman correlation coefficient of ...
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The association of obesity with coronary revascularization procedures is not clear. We examined rates of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) associated with obesity while accounting for the... more
The association of obesity with coronary revascularization procedures is not clear. We examined rates of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) associated with obesity while accounting for the severity of coronary disease and diabetes status. Patients who underwent cardiac catheterization were stratified according to coronary anatomy risks and diabetes status. Within each stratum, using normal body mass index (BMI) (18.5-24.9 kg/m(2)) as a reference, the associations of overweight (25.0-29.9 kg/m(2)), obese class I (30.0-34.9 kg/m(2)), obese class II (35.0-39.9 kg/m(2)), and obese class III (≥ 40.0 kg/m(2)) with the likelihood of receiving CABG and PCI were assessed while adjusting for clinical covariates. Of 56,722 patients analyzed, overall use of revascularization was higher in the overweight, obese class I, and obese class II groups (overweight: adjusted hazard ratio [aHR], 1.10; 95% confidence interval [CI], 1.06-1.13; obese class I:...
Research Interests: Cardiology, Obesity, Risk assessment, Medicine, Prospective studies, and 15 moreHumans, Internal Medicine, Female, Male, Myocardial Revascularization, Incidence, Body Mass Index, Risk factors, Cardiac Catheterization, Middle Aged, Alberta, Risk Factors, Risk Assessment, Coronary Artery Disease, and Cardiovascular medicine and haematology
Information is limited on the cost effectiveness of strategies to improve depressive symptoms in patients with Type 2 diabetes in primary care outside of the U.S. Using patient data from a 12-month controlled implementation trial,... more
Information is limited on the cost effectiveness of strategies to improve depressive symptoms in patients with Type 2 diabetes in primary care outside of the U.S. Using patient data from a 12-month controlled implementation trial, outcomes and healthcare costs determined through administrative database linkages were compared for a strategy of family physician notification and follow-up ("enhanced care") versus collaborative care. Two measures of effectiveness were used: depression-free days (DFDs) based on Patient Health Questionnaire, and quality-adjusted life years (QALYs) based on EQ-5D. Data were collected November 2010 to January 2013 with analyses completed in May 2015. Incremental cost-effectiveness ratios were also compared against true usual care patients. Among 227 patients, mean age was 58 years, 55% were female, and mean diabetes duration was 12 years. Compared with total 12-month cost per usual care patient (C$5,889), the incremental cost was C$450 for patient...
Research Interests: Primary Care, Education, Primary Health Care, Treatment Outcome, Medicine, and 13 moreHumans, Female, Male, Depressive Disorder, Cost effectiveness, Middle Aged, Quality adjusted life years, Cost Benefit Analysis, Health Care Costs, Type 2 Diabetes Mellitus, Cooperative Behavior, Collaborative Care, and Medical and Health Sciences
Depressive symptoms are common and, when coexisting with diabetes, worsen outcomes and increase health care costs. We evaluated a nurse case-manager-based collaborative primary care team model to improve depressive symptoms in diabetic... more
Depressive symptoms are common and, when coexisting with diabetes, worsen outcomes and increase health care costs. We evaluated a nurse case-manager-based collaborative primary care team model to improve depressive symptoms in diabetic patients. We conducted a controlled implementation trial in four nonmetropolitan primary care networks. Eligible patients had type 2 diabetes and screened positive for depressive symptoms, based on a Patient Health Questionnaire (PHQ) score of ≥10. Patients were allocated using an "on-off" monthly time series. Intervention consisted of case-managers working 1:1 with patients to deliver individualized care. The main outcome was improvement in PHQ scores at 12 months. A concurrent cohort of 71 comparable patients was used as nonscreened usual care control subjects. Of 1,924 patients screened, 476 (25%) had a PHQ score >10. Of these, 95 were allocated to intervention and 62 to active control. There were no baseline differences between groups...
Research Interests: Primary Health Care, Depression, Medicine, Humans, Diabetes mellitus, and 15 moreFemale, Male, Follow-up studies, Aged, Middle Aged, Adult, Community Networks, Comparative Effectiveness Research, Individualized Medicine, Type 2 Diabetes Mellitus, Continuity of Patient Care, Cooperative Behavior, Diabetes Care, mass Screening, and Medical and Health Sciences
Better understanding of the relationship between obesity and postsurgical adverse outcomes is needed to provide quality and efficient care. We examined the relationship of obesity with the incidence of early adverse outcomes and... more
Better understanding of the relationship between obesity and postsurgical adverse outcomes is needed to provide quality and efficient care. We examined the relationship of obesity with the incidence of early adverse outcomes and in-hospital length of stay following coronary artery bypass grafting surgery. We analyzed data from 7560 patients who underwent coronary artery bypass grafting. Using body mass index (BMI; in kg/m(2)) of 18.5 to 24.9 as a reference, the associations of 4 BMI categories (25.0-29.9, 30.0-34.9, 35.0-39.9, and ≥40.0) with rates of operative mortality, overall early complications, subgroups of early complications (ie, infection, renal and pulmonary complications), and length of stay were assessed while adjusting for clinical covariates. There was no difference in operative mortality; however, higher risks of overall complications were observed for patients with BMI 35.0 to 39.9 (adjusted odds ratio 1.35, 95% CI 1.11-1.63) and ≥40.0 (adjusted odds ratio 1.56, 95% ...
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Background The purpose was to examine associations between treatment and chronic health conditions with neurocognitive impairment survivors of acute lymphoblastic leukemia (ALL) treated with chemotherapy only. Methods This cross-sectional... more
Background The purpose was to examine associations between treatment and chronic health conditions with neurocognitive impairment survivors of acute lymphoblastic leukemia (ALL) treated with chemotherapy only. Methods This cross-sectional study included 1207 ALL survivors (54.0% female; mean age 30.6 years) and 2273 siblings (56.9% female; mean age 47.6 years), who completed the Childhood Cancer Survivor Study Neurocognitive Questionnaire. Multivariable logistic regression compared prevalence of neurocognitive impairment between survivors and siblings by sex. Associations between neurocognitive impairment with treatment exposures and chronic conditions (graded according to Common Terminology Criteria for Adverse Events) were also examined. Statistical tests were 2-sided. Results Relative to same-sex siblings, male and female ALL survivors reported increased prevalence of impaired task efficiency (males: 11.7% vs 16.9%; adjusted odds ratio [OR] = 1.89, 95% confidence interval [CI] = ...
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Stroke in children occurs across different phases of brain development. Age at onset may affect outcome and health-related quality of life (HRQL). We evaluated the influence of age at stroke onset on the long-term neurological outcomes... more
Stroke in children occurs across different phases of brain development. Age at onset may affect outcome and health-related quality of life (HRQL). We evaluated the influence of age at stroke onset on the long-term neurological outcomes and HRQL of pediatric stroke survivors. Children with ischemic stroke were recruited into three groups according to their age at onset of stroke (presumed perinatal, neonatal, and childhood). Neurological outcomes were assessed using the Pediatric Stroke Recovery and Recurrence Questionnaire. HRQL was evaluated using proxy report versions (2-18y) of the Pediatric Quality of Life Inventory (PedsQL 4.0). A χ(2) /Fisher's exact test and multivariable logistic regression analysis was performed for the neurological outcomes. HRQL scores from the different age groups were compared using linear regression. Ninety participants (presumed perinatal stroke, n=31; neonatal stroke, n=36; childhood stroke, n=23) were enrolled. Median age at the onset of stroke ...
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To better understand the factors that affect care and outcomes in patients with type 2 diabetes, we developed the prospective Alberta's Caring for Diabetes (ABCD) cohort to collect, monitor and analyze data concerning several... more
To better understand the factors that affect care and outcomes in patients with type 2 diabetes, we developed the prospective Alberta's Caring for Diabetes (ABCD) cohort to collect, monitor and analyze data concerning several sociodemographic, behavioural, psychosocial, clinical and physiological factors that might influence diabetes care and outcomes. We recruited 2040 individuals with type 2 diabetes through primary care networks, diabetes clinics and public advertisements. Data are being collected through self-administered surveys, including standardized measures of health status and self-care behaviours, and will eventually be linked to laboratory and administrative healthcare data and other novel databases. The average age of respondents was 64.4 years (SD=10.7); 45% were female, and 91% were white, with average duration of diabetes of 12 years (SD=10.0). The majority (76%) were physically inactive, and 10% were smokers. Most (88%) reported 2 or more chronic conditions in a...
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To examine the prevalence and predictors of foot disease, self-care and clinical monitoring in adults with type 2 diabetes in Alberta, Canada. Baseline data from a prospective cohort of adults with type 2 diabetes were used. Assessment of... more
To examine the prevalence and predictors of foot disease, self-care and clinical monitoring in adults with type 2 diabetes in Alberta, Canada. Baseline data from a prospective cohort of adults with type 2 diabetes were used. Assessment of foot disease included self-reported peripheral neuropathy, peripheral vasculopathy, foot or leg ulcer/infection or gangrene/amputation. Foot self-care was assessed using the Summary of Diabetes Self-Care Activities, and clinical monitoring using patients' reports of having feet checked for lesions or sensory loss. The mean age of respondents (N=2040) was 64 (SD 10.7) years; 45% were female, and 91% were Caucasian. Peripheral neuropathy was reported by 18% of the respondents, peripheral vasculopathy by 28%, ulcer/infection by 6% and gangrene/amputation by 1.4%. Only 14% of respondents performed foot self-care behaviours ≥6 days per week, and only 41% and 34% had their feet clinically checked for lesions or sensory loss, respectively. Predictors ...
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To evaluate the association between insulin secretagogues and adverse cardiovascular sequelae in type 2 diabetes patients hospitalized for ischemic heart disease (IHD). Administrative health records from Alberta, Canada between 1998 and... more
To evaluate the association between insulin secretagogues and adverse cardiovascular sequelae in type 2 diabetes patients hospitalized for ischemic heart disease (IHD). Administrative health records from Alberta, Canada between 1998 and 2010 were used to identify 2,254 gliclazide, 3,289 glyburide and 740 repaglinide users prior to an IHD-related hospitalization. Multivariable Cox regression models were used to compare the 30-day risk of a composite outcome of all-cause mortality or new onset of atrial fibrillation, stroke, heart failure or myocardial infarction according to insulin secretagogue use. Mean (SD) age was 76.1 (6.9) years, and 60.7% were men. The composite outcome occurred in 322 (30.2%) gliclazide users, 455 (28.1%) glyburide users and 81 (23.4%) repaglinide users within 30 days of IHD hospitalization. There were no differences in risk for glyburide use (adjusted hazard ratio [aHR] 0.91; 95% confidence interval [CI] 0.78-1.05) or repaglinide use (aHR 0.80; 95% CI 0.63-1...
Research Interests: Risk, Diabetes Mellitus and Its Complications, Humans, Hospitalization, Female, and 14 moreMale, Universal Coverage, Clinical Sciences, Aged, Alberta, Oral Hypoglycemic Agents, Retrospective Studies, Cardiovascular Diseases, Gliclazide, Type 2 Diabetes Mellitus, Carbamates, Proportional Hazards Models, Cohort Studies, and Piperidines
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To determine the effectiveness of an exercise specialist led lifestyle program for adults with type 2 diabetes in primary care. Eligible participants from four primary care networks in Alberta, Canada were assigned to either a lifestyle... more
To determine the effectiveness of an exercise specialist led lifestyle program for adults with type 2 diabetes in primary care. Eligible participants from four primary care networks in Alberta, Canada were assigned to either a lifestyle program or a control group. The program targeted increased daily walking through individualized daily pedometer step goals for the first 3 months and brisk walking speed, along with substitution of low-relative to high-glycemic index foods over the next 3 months. The outcomes were daily steps, diet, and clinical markers, and were compared using random effects models. 198 participants were enrolled (102 - intervention and 96 - control). For all participants, (51% were women), mean age 59.5 (SD 8.3) years, A1c 6.8% (SD 1.1), BMI 33.6 kg/m2 (SD 6.5), systolic BP 125.6 mmHg (SD 16.2), glycemic index 51.7 (4.6), daily steps 5879 (SD 3130). Daily steps increased for the intervention compared to the control at 3-months (1292 [SD 2698] vs. 418 [SD 2458] and 6-months (1481 [SD 2631] vs. 336 [SD 2712]; adjusted p=0.002). No significant differences were observed for diet or clinical outcomes. A 6-month lifestyle program delivered in primary care by an exercise specialist can be effective for increasing daily walking among adults with recently diagnosed type 2 diabetes. This short-term increase in daily steps requires longer follow-up to estimate the potential impact on health outcomes.
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Research Interests: Treatment Outcome, Risk assessment, Humans, Female, Male, and 14 moreFollow-up studies, Risk factors, Clinical Sciences, Aged, Acute Coronary Syndrome, Alberta, Odds ratio, Oral Hypoglycemic Agents, Risk Factors, Risk Assessment, Gliclazide, Type 2 Diabetes Mellitus, Case Control Studies, and Cohort Studies
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Depressive symptoms are common and, when coexisting with diabetes, worsen outcomes and increase health care costs. We evaluated a nurse case-manager-based collaborative primary care team model to improve depressive symptoms in diabetic... more
Depressive symptoms are common and, when coexisting with diabetes, worsen outcomes and increase health care costs. We evaluated a nurse case-manager-based collaborative primary care team model to improve depressive symptoms in diabetic patients. We conducted a controlled implementation trial in four nonmetropolitan primary care networks. Eligible patients had type 2 diabetes and screened positive for depressive symptoms, based on a Patient Health Questionnaire (PHQ) score of ≥10. Patients were allocated using an "on-off" monthly time series. Intervention consisted of case-managers working 1:1 with patients to deliver individualized care. The main outcome was improvement in PHQ scores at 12 months. A concurrent cohort of 71 comparable patients was used as nonscreened usual care control subjects. Of 1,924 patients screened, 476 (25%) had a PHQ score >10. Of these, 95 were allocated to intervention and 62 to active control. There were no baseline differences between groups...