Impact of Insurance Status on Diagnostic Stage in Hodgkin's Lymphoma in the United States: Implications for Detection and Outcomes.

Introduction and objective Hodgkin's lymphoma (HL) is a form of cancer originating from white blood cells that presents upon diagnosis with well-characterized symptoms (palpable lymph nodes, fever, night sweats, weight loss). HL is currently one of the most treatable cancers, with a successful treatment rate of 75% worldwide. The objective of this study is to evaluate the association between insurance status and the stage of diagnosis of HL in the United States from the years 2007 to 2016. Methods A cross-sectional study using secondary data from the Surveillance, Epidemiology, and End Results (SEER) program database was used. Insurance status of each patient was defined as uninsured (not insured or self-pay), any Medicaid (includes Indian/public health service), insured (private insurance, managed care, Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), or Medicare) and insured not specified. Staging was dictated via the SEER combined/American Joint Committee on Cancer (AJCC) cancer staging guidelines. We divided the stages into early-stage (localized) and late-stage (regional by direct extension, involving distant sites/nodes). We used univariate descriptive analysis to determine baseline characteristics, bivariate analysis to evaluate potential confounding, and binary logistic regression to compute unadjusted and adjusted odd ratios and corresponding 95% confidence intervals.  Results  Approximately 77% of insured individuals presented with a late-stage diagnosis, compared with 78.1% for insured not specified, 82% for any Medicaid, and 84.9% for uninsured. After adjusting for age, sex, race and marital status, insurance status had a significant impact on the stage of diagnosis of Hodgkin's lymphoma. The odds ratio (OR) for advanced stage diagnosis of HL in uninsured patients compared to insured patients was 1.72 (95% CI 1.03-2.86, p=0.037); for any Medicaid, the OR was 1.37 (95% CI 1.02-1.83, p=0.036), and for insured not specified, 1.09 (95% CI 0.83-1.44, p=0.522). Conclusions Uninsured patients are significantly more likely to have a later stage diagnosis of HL compared to those that are insured. The findings of this study coincide with the associations found in previous studies involving other cancers such as breast, cervical, prostate, colorectal, hepatocellular, bladder and kidney cancers outcomes and insurance status.

Improvements in cognition and associations with measures of aerobic fitness and muscular power following structured exercise.

OBJECTIVES: Cognition, along with aerobic and muscular fitness, declines with age. Although research has shown that resistance and aerobic exercise may improve cognition, no consensus exists supporting the use of one approach over the other. The purpose of this study was to compare the effects of steady-state, moderate-intensity treadmill training (TM) and high-velocity circuit resistance training (HVCRT) on cognition, and to examine its relationships to aerobic fitness and neuromuscular power. METHODS: Thirty older adults were randomly assigned to one of three groups: HVCRT, TM, or control. Exercise groups attended training 3 days/wk for 12 weeks, following a 2 week adaptation period. The NIH Cognitive Toolbox was used to assess specific components of cognition and provided an overall fluid composite score (FCS). The walking response and inhibition test (WRIT) was specifically used to assess executive function (EF) and provided an accuracy (ACC), reaction time (RT) and global score (GS). Aerobic power (AP) and maximal neuromuscular power (MP) were measured pre- and post-intervention. Relationships between variables using baseline and mean change scores were assessed. RESULTS: Significant increases were seen from baseline in ACC (MD = 14.0, SE = 4.3, p = .01, d = 1.49), GS (MD = 25.6, SE = 8.0, p = .01, d = 1.16), and AP (MD = 1.4, SE = 0.6, p = .046, d = 0.31) for HVCRT. RT showed a trend toward a significant decrease (MD = -0.03, SE = 0.016, p = .068, d = 0.32) for HVCRT. No significant within-group differences were detected for TM or CONT. Significant correlations were seen at baseline between AP and FCS, as well as other cognitive domains; but none were detected among change scores. Although no significant correlation was evident between MP and FCS or GS, there was a trend toward higher MP values being associated with higher FCS and GS scores. CONCLUSIONS: Our results support the use of HVCRT over TM for improving cognition in older persons, although the precise mechanisms that underlie this association remain unclear.

Effects of high-velocity circuit resistance and treadmill training on cardiometabolic risk, blood markers, and quality of life in older adults.

The presence of cardiometabolic syndrome (CMS) confers an increased risk for cardiovascular disease (CVD) and mortality and is associated with reduced health-related quality of life (HRQoL). Although the effects of exercise on biomarkers, HRQoL, and future risk have been studied, no study has measured the effects on all three components. The present study compared the effects of steady-state, moderate-intensity treadmill training (TM) and high-velocity circuit resistance training (HVCRT) on biological markers, HRQoL, and overall CVD risk in adults with CMS and CVD risk factors. Thirty participants (22 females, 8 males) were randomly assigned to 1 of 3 groups: HVCRT, TM, or control. Participants in the exercise groups attended training 3 days/week for a total of 12 weeks. Of the 30 participants who began the study, 24 (19 females, 5 males) were included in the final analysis. Primary outcome measures included CMS criteria, hemodynamic measures, Framingham Risk Score (FRS), and HRQoL. All variables were measured pre- and post-intervention. CMS z score significantly decreased for HVCRT (p = 0.03), while there were no significant changes for TM or control. FRS significantly decreased for HVCRT compared with TM (p = 0.03) and control (p = 0.03). Significant decreases in systolic (p < 0.01) and diastolic blood pressures (p < 0.01) for HVCRT accompanied significant increases from baseline in stroke volume (p = 0.03) and end-diastolic volume (p < 0.01). Systemic vascular resistance significantly decreased (p = 0.05) for HVCRT compared with control. Emotional well-being significantly improved following HVCRT and TM compared with control (p = 0.04; p = 0.03). HVCRT represents a novel training modality that improved factors in each of the 3 components assessed.

Loads and Movement Speeds Dictate Differences in Power Output During Circuit Training.

Power training has become a common exercise intervention for improving muscle strength, power, and physical function while reducing injury risk. Few studies, however, have evaluated acute load changes on power output during traditional resistance training protocols. Therefore, the aim of this study was to quantify the effects of different loading patterns on power output during a single session of circuit resistance training (CRT). Nine male (age = 19.4 ± 0.9 years) and 11 female participants (age = 20.6 ± 1.6 years) completed 3 CRT protocols during separate testing sessions using 7 pneumatic exercises. Protocols included heavy load explosive contraction (HLEC: 80% one repetition maximum [1RM], maximum speed concentric-2 seconds eccentric), heavy load controlled contraction (HLCC: 80% 1RM, 2 seconds concentric-2 seconds eccentric), and moderate load explosive contraction (MLEC: 50% 1RM, maximum speed concentric-2 seconds eccentric). Protocols were assigned randomly using a counterbalanced design. Power for each repetition and set were determined using computerized software interfaced with each machine. Blood lactate was measured at rest and immediately postexercise. For male and female participants, average power was significantly greater during all exercises for HLEC and MLEC than HLCC. Average power was greatest during the HLEC for leg press (LP), hip adduction (ADD), and hip abduction (ABD) (p ≤ 0.05), whereas male participants alone produced their greatest power during HLEC for leg curl (LC) (p < 0.001). For male and female participants, significantly greater power was detected by set for LP, lat pull-down (LAT), ADD, LC, and ABD for the MLEC protocol (p < 0.02) and for LP, LAT, CP, and LC for the HLEC protocol (p < 0.03). A condition × sex interaction was seen for blood lactate changes ((Equation is included in full-text article.)= 0.249; p = 0.024), with female participants producing a significantly greater change for MLEC than HLEC (Mdiff = 1.61 ± 0.35 mmol·L; p = 0.011), whereas male participants showed no significant differences among conditions. Performing a CRT protocol using explosive training patterns, especially at high loads for lower-body exercises and moderate loads for upper-body exercises, produces significantly higher power than controlled speed training in most exercises. These results provide exercisers, personal trainers, and strength coaches with information that can assist in the design of training protocols to maximize power output during CRT.