Browsing by Author "Ardeshirrouhanifard, Shirin"

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    Associations of Nutritional, Environmental, and Metabolic Biomarkers with Diabetes-Related Mortality in U.S. Adults: The Third National Health and Nutrition Examination Surveys between 1988–1994 and 2016
    (MDPI, 2022-06-24) Zhang, Xi; Ardeshirrouhanifard, Shirin; Li, Jing; Li, Mingyue; Dai, Hongji; Song, Yiqing; Epidemiology, School of Public Health
    Background: Nutritional, environmental, and metabolic status may play a role in affecting the progression and prognosis of type 2 diabetes. However, results in identifying prognostic biomarkers among diabetic patients have been inconsistent and inconclusive. We aimed to evaluate the associations of nutritional, environmental, and metabolic status with disease progression and prognosis among diabetic patients. Methods: In a nationally representative sample in the NHANES III (The Third National Health and Nutrition Examination Survey, 1988−1994), we analyzed available data on 44 biomarkers among 2113 diabetic patients aged 20 to 90 years (mean age: 58.2 years) with mortality data followed up through 2016. A panel of 44 biomarkers from blood and urine specimens available from NHANES III were included in this study and the main outcomes as well as the measures are mortalities from all-causes. We performed weighted logistic regression analyses after controlling potential confounders. To assess incremental prognostic values of promising biomarkers beyond traditional risk factors, we compared c-statistics of the adjusted models with and without biomarkers, separately. Results: In total, 1387 (65.2%) deaths were documented between 1988 and 2016. We observed an increased risk of all-cause mortality associated with higher levels of serum C-reactive protein (p for trend = 0.0004), thyroid stimulating hormone (p for trend = 0.04), lactate dehydrogenase (p for trend = 0.02), gamma glutamyl transferase (p for trend = 0.02), and plasma fibrinogen (p for trend = 0.03), and urine albumin (p for trend < 0.0001). In contrast, higher levels of serum sodium (p for trend = 0.005), alpha carotene (p for trend = 0.006), and albumin (p for trend = 0.005) were associated with a decreased risk of all-cause mortality. In addition, these significant associations were not modified by age, sex, or race. Inclusion of thyroid stimulating hormone (p = 0.03), fibrinogen (p = 0.01), and urine albumin (p < 0.0001), separately, modestly improved the discriminatory ability for predicting all-cause mortality among diabetic patients. Conclusions: Our nationwide study findings provide strong evidence that some nutritional, environmental, and metabolic biomarkers were significant predictors of all-cause mortality among diabetic patients and may have potential clinical value for improving stratification of mortality risk.
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    Hearing Loss and Use of Medications for Anxiety and/or Depression in Testicular Cancer Survivors Treated with Cisplatin-Based Chemotherapy
    (2020-05) Ardeshirrouhanifard, Shirin; Song, Yiqing; Travis, Lois; Monahan, Patrick; Wessel, Jennifer
    Testicular cancer is the most common solid tumor among young men. Although testicular cancer survivors (TCS) are expected to live for over 40 years after cancer diagnosis, they are at risk for chemotherapy adverse effects such as hearing loss (HL), tinnitus, and psychosocial effects. The aim of this study was to investigate factors associated with discrepancies between subjective and objective HL, factors associated with HL, and factors associated with the use of medications for anxiety/depression. TCS were enrolled in the Platinum Study. Sociodemographic characteristics, health behaviors, morbidities, and prescription medications were assessed though self-reporting using validated questionnaires. Bilateral pure-tone air conduction thresholds were collected at frequencies 0.25-12 kHz. To assess HL severity, hearing thresholds were classified according to American Speech-Language-Hearing Association criteria. Multivariable multinomial, ordinal, and binomial logistic regressions were used to test factors for association with discrepancy between subjective and objective HL, cisplatin-induced HL, and use of medications for anxiety/depression, respectively. Patients with HL at only extended high frequencies (10-12 kHz) could perceive hearing deficits; thus, it would be preferable for these frequencies to be included in audiometric assessments of cisplatin-treated adult-onset cancer survivors. Age, no noise exposure, and mixed/conductive HL were significantly associated with more underestimation of HL severity. Hearing aid use and education were significantly associated with less underestimation of HL severity. Having tinnitus was associated with more overestimation of HL severity. Age, cumulative cisplatin dose, and hypertension showed significant association with greater HL severity, whereas post-graduate education was associated with less HL severity. Factors associated with more use of medications for anxiety/depression were tinnitus, and peripheral sensory neuropathy, while being employed and engaging in physical activity were significantly associated with less use of anxiety/depression medications. The sole use of patient-reported measures of HL might not be well-suited to evaluate HL in cancer survivors; thus, the use of audiometry may complement patient-reported HL. In terms of modifiable risk factors of cisplatin-induced HL, healthcare providers should monitor patients’ blood pressure and manage hypertension appropriately. In addition, healthcare providers need to effectively manage tinnitus and peripheral neuropathy to improve treatment outcomes of anxiety and depression.
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    Ototoxicity After Cisplatin-Based Chemotherapy: Factors Associated With Discrepancies Between Patient-Reported Outcomes and Audiometric Assessments
    (Wolters Kluwer, 2022) Ardeshirrouhanifard, Shirin; Fossa, Sophie D.; Huddart, Robert; Monahan, Patrick O.; Fung, Chunkit; Song, Yiqing; Dolan, M. Eileen; Feldman, Darren R.; Hamilton, Robert J.; Vaughn, David; Martin, Neil E.; Kollmannsberger, Christian; Dinh, Paul; Einhorn, Lawrence; Frisina, Robert D.; Travis, Lois B.; The Platinum Study Group; Biostatistics and Health Data Science, School of Medicine
    Objectives: To provide new information on factors associated with discrepancies between patient-reported and audiometrically defined hearing loss (HL) in adult-onset cancer survivors after cisplatin-based chemotherapy (CBCT) and to comprehensively investigate risk factors associated with audiometrically defined HL. Design: A total of 1410 testicular cancer survivors (TCS) ≥6 months post-CBCT underwent comprehensive audiometric assessments (0.25 to 12 kHz) and completed questionnaires. HL severity was defined using American Speech-Language-Hearing Association criteria. Multivariable multinomial regression identified factors associated with discrepancies between patient-reported and audiometrically defined HL and multivariable ordinal regression evaluated factors associated with the latter. Results: Overall, 34.8% of TCS self-reported HL. Among TCS without tinnitus, those with audiometrically defined HL at only extended high frequencies (EHFs) (10 to 12 kHz) (17.8%) or at both EHFs and standard frequencies (0.25 to 8 kHz) (23.4%) were significantly more likely to self-report HL than those with no audiometrically defined HL (8.1%) [odds ratio (OR) = 2.48; 95% confidence interval (CI), 1.31 to 4.68; and OR = 3.49; 95% CI, 1.89 to 6.44, respectively]. Older age (OR = 1.09; 95% CI, 1.07 to 1.11, p < 0.0001), absence of prior noise exposure (OR = 1.40; 95% CI, 1.06 to 1.84, p = 0.02), mixed/conductive HL (OR = 2.01; 95% CI, 1.34 to 3.02, p = 0.0007), no hearing aid use (OR = 5.64; 95% CI, 1.84 to 17.32, p = 0.003), and lower education (OR = 2.12; 95% CI, 1.23 to 3.67, p = 0.007 for high school or less education versus postgraduate education) were associated with greater underestimation of audiometrically defined HL severity, while tinnitus was associated with greater overestimation (OR = 4.65; 95% CI, 2.64 to 8.20 for a little tinnitus, OR = 5.87; 95% CI, 2.65 to 13.04 for quite a bit tinnitus, and OR = 10.57; 95% CI, 4.91 to 22.79 for very much tinnitus p < 0.0001). Older age (OR = 1.13; 95% CI, 1.12 to 1.15, p < 0.0001), cumulative cisplatin dose (>300 mg/m2, OR = 1.47; 95% CI, 1.21 to 1.80, p = 0.0001), and hypertension (OR = 1.80; 95% CI, 1.28 to 2.52, p = 0.0007) were associated with greater American Speech-Language-Hearing Association-defined HL severity, whereas postgraduate education (OR = 0.58; 95% CI, 0.40 to 0.85, p = 0.005) was associated with less severe HL. Conclusions: Discrepancies between patient-reported and audiometrically defined HL after CBCT are due to several factors. For survivors who self-report HL but have normal audiometric findings at standard frequencies, referral to an audiologist for additional testing and inclusion of EHFs in audiometric assessments should be considered.