Maximum smoothed likelihood estimation and smoothed maximum likelihood estimation in the current status model

We consider the problem of estimating the distribution function, the density and the hazard rate of the (unobservable) event time in the current status model. A well studied and natural nonparametric estimator for the distribution function in this model is the nonparametric maximum likelihood estimator (MLE). We study two alternative methods for the estimation of the distribution function, assuming some smoothness of the event time distribution. The first estimator is based on a maximum smoothed likelihood approach. The second method is based on smoothing the (discrete) MLE of the distribution function. These estimators can be used to estimate the density and hazard rate of the event time distribution based on the plug-in principle.Comment: Published in at http://dx.doi.org/10.1214/09-AOS721 the Annals of Statistics (http://www.imstat.org/aos/) by the Institute of Mathematical Statistics (http://www.imstat.org

Religious revelation, secrecy and the limits of visual representation

This article seeks to contribute to a more adequate understanding of the adoption of modern audiovisual mass media by contemporary religious groups. It does so by examining Pentecostal-charismatic churches as well as the Christian mass culture instigated by its popularity, and so-called traditional religion in Ghana, which develop markedly different attitudes towards audiovisual mass media and assume different positions in the public sphere. Taking into account the complicated entanglement of traditional religion and Pentecostalism, approaching both religions from a perspective of mediation which regards media as intrinsic to religion, and seeking to avoid the pitfall of overestimating the power of modern mass media to determine the world, this article seeks to move beyond an unproductive recurrence to oppositions such as tradition and modernity, or religion and technology. It is argued that instead of taking as a point of departure more or less set ideas about the nexus of vision and modernity, the adoption of new mass media by religious groups needs to be analyzed by a detailed ethnographic investigation of how these new media transform existing practices of religious mediation. Special emphasis is placed on the tension between the possibilities of gaining public presence through new media, and the difficulty in authorizing these media, and the experiences they induce, as authentic. Copyright © 2006 SAGE Publications

Predicting long-term sickness absence among retail workers after four days of sick-listing

Objective This study tested and validated an existing tool for its ability to predict the risk of long-term (ie, ≥6 weeks) sickness absence (LTSA) after four days of sick-listing. Methods A 9-item tool is completed online on the fourth day of sick-listing. The tool was tested in a sample (N=13 597) of food retail workers who reported sick between March and May 2017. It was validated in a new sample (N=104 698) of workers (83% retail) who reported sick between January 2020 and April 2021. LTSA risk predictions were calibrated with the Hosmer-Lemeshow (H-L) test; non-significant H-L P-values indicated adequate calibration. Discrimination between workers with and without LTSA was investigated with the area (AUC) under the receiver operating characteristic (ROC) curve. Results The data of 2203 (16%) workers in the test sample and 14 226 (13%) workers in the validation sample was available for analysis. In the test sample, the tool together with age and sex predicted LTSA (H-L test P=0.59) and discriminated between workers with and without LTSA [AUC 0.85, 95% confidence interval (CI) 0.83–0.87]. In the validation sample, LTSA risk predictions were adequate (H-L test P=0.13) and discrimination was excellent (AUC 0.91, 95% CI 0.90–0.92). The ROC curve had an optimal cut-off at a predicted 36% LTSA risk, with sensitivity 0.85 and specificity 0.83. Conclusion The existing 9-item tool can be used to invite sick-listed retail workers with a ≥36% LTSA risk for expedited consultations. Further studies are needed to determine LTSA cut-off risks for other economic sectors

Changes in supportive care needs over time from diagnosis up to two years after treatment in head and neck cancer patients:A prospective cohort study

Objectives: To investigate changes in supportive care needs (SCNs) over time from diagnosis up to 2 years after treatment among head and neck cancer (HNC) patients, in relation to demographic, personal, clinical, psychological, physical, social, lifestyle, and cancer-related quality of life factors.Materials and methods: Data of the longitudinal NETherlands QUality of Life and Biomedical Cohort study (NET-QUBIC) was used. SCNs were measured using the Supportive Care Needs Survey (SCNS-SF34) and HNC-specific module (SCNS–HNC) before treatment, three, six, 12 and 24 months after treatment. Linear mixed model analyses were used to study SCNs on the physical &amp; daily living (PDL), psychological (PSY), sexuality (SEX), health system, information and patient support (HSIPS), HNC-functioning (HNC-Function), and lifestyle (HNC-Lifestyle) domain, in relation to demographic, personal, clinical, psychological, physical, social, lifestyle, and cancer-related symptoms as measured at baseline.Results: In total, 563 patients were included. SCNs changed significantly over time. At baseline, 65% had ≥1 moderate/high SCN, versus 42.8% at 24 months. Changes in PDL needs were associated with gender, tumor location, smoking, fear of cancer recurrence, oral pain, and appetite loss, changes in PSY with tumor location, fear of recurrence, social support, emotional functioning, physical functioning, coughing, and use of painkillers, changes in SEX with treatment, changes in HSIPS with muscle strength, changes in HNC-Function with tumor stage, location, social support, physical functioning, fatigue, nausea and vomiting, and speech problems, and changes in HNC-Lifestyle with smoking and alcohol use.Conclusion: SCNs diminish over time, but remain prevalent in HNC patients.</p

Risk factors for advanced colorectal neoplasia and colorectal cancer detected at surveillance:a nationwide study in the modern era

Aim: Recommendations for surveillance after colonoscopy are based on risk factors for metachronous advanced colorectal neoplasia (AN) and colorectal cancer (CRC). The value of these risk factors remains unclear in populations enriched by individuals with a positive faecal immunochemical test and were investigated in a modern setting. Methods and Results: This population-based cohort study included all individuals in the Netherlands of ≥55 years old with a first adenoma diagnosis in 2015. A total of 22,471 patients were included. Data were retrieved from the Dutch Nationwide Pathology Databank (Palga). Primary outcomes were metachronous AN and CRC. Patient and polyp characteristics were evaluated by multivariable Cox regression analyses. During follow-up, 2416 (10.8%) patients were diagnosed with AN, of which 557 (2.5% from the total population) were CRC. Adenomas with high-grade dysplasia (hazard ratio [HR] 1.60, 95% confidence interval [CI] 1.40–1.83), villous histology (HR 1.91, 95% CI 1.59–2.28), size ≥10 mm (HR 1.12, 95% CI 1.02–1.23), proximal location (HR 1.12, 95% CI 1.02–1.23), two or more adenomas (HR 1.28, 95% CI 1.16–1.41), and serrated polyps ≥10 mm (HR 1.67, 95% CI 1.42–1.97) were independent risk factors for metachronous AN. In contrast, only adenomas with high-grade dysplasia (HR 2.49, 95% CI 1.92–3.24) were an independent risk factor for metachronous CRC. Conclusions: Risk factors for metachronous AN and CRC were identified for populations with access to a faecal immunochemical test (FIT)-based screening programme. If only risk factors for metachronous CRC are considered, a reduction in criteria for surveillance seems reasonable.</p

Mental healthcare utilization among head and neck cancer patients:A longitudinal cohort study

Objective: To investigate utilization of mental healthcare among head and neck cancer (HNC) patients from diagnosis to 2 years after treatment, in relation to psychological symptoms, mental disorders, need for mental healthcare, and sociodemographic, clinical and personal factors. Methods: Netherlands Quality of life and Biomedical Cohort study data as measured before treatment, at 3 and 6 months, and at 1 and 2 years after treatment was used (n = 610). Data on mental healthcare utilization (iMCQ), psychological symptoms (Hospital Anxiety and Depression Scale, Cancer Worry Scale), mental disorders (CIDI interview), need for mental healthcare (Supportive Care Needs Survey Short-Form 34, either as continuous outcome indicating the level of need or dichotomized into unmet need (yes/no)) and several sociodemographic, clinical and personal factors were collected. Factors associated with mental healthcare utilization were investigated using generalized estimating equations (p &lt; 0.05). Results: Of all HNC patients, 5%–9% used mental healthcare per timepoint. This was 4%–14% in patients with mild-severe psychological symptoms, 4%–17% in patients with severe psychological symptoms, 15%–35% in patients with a mental disorder and 5%–16% in patients with an unmet need for mental healthcare. Among all patients, higher symptoms of anxiety, a higher need for mental healthcare, lower age, higher disease stage, lower self-efficacy and higher social support seeking were significantly associated with mental healthcare utilization. Conclusion: Mental health care utilization among HNC patients is limited, and is related to psychological symptoms, need for mental healthcare, and sociodemographic, clinical and personal factors.</p

The association between health-related quality of life and five-year overall survival among head and neck cancer patients:A prospective cohort study

Objective: To estimate associations between health-related quality of life (HRQOL) at baseline (T0), six months after treatment (M6), and change in HRQOL (T0-M6) and five-year overall survival (OS) among head and neck cancer (HNC) patients, after adjusting for potential confounders. Furthermore, we explored whether personal, clinical, physical, psychological, social, lifestyle, HNC-related and biological factors moderate the association. Methods: Data of a prospective multi-center cohort study (NET-QUBIC) was used. In this specific study, patients with HRQOL data at T0 (n = 596), M6 (n = 489), and T0 and M6 (n = 463) were included. HRQOL was operationalized by the EORTC QLQ-C30 global quality of life subscale (QL) and summary score (SumSc). Cox regression analyses investigated associations between HRQOL and OS, adjusted for confounders, and explored which variables moderate the association. Results: Adjusted models showed that higher baseline QL (HR: 0.85 (95% CI: 0.76–0.96)) and SumSc (HR: 0.90 (95% CI: 0.81–0.99)) were associated with longer OS. Adjusted M6 models and adjusted T0-M6 models found no such association. The association between QL and OS was moderated by sex (significant among males) and mean arterial blood pressure (BP) (significant for patients with high BP). The association between SumSc and OS was moderated by coping (significant for patients with no avoidant coping style) and systemic BP (significant for patients with normal BP). Conclusion: Higher HRQOL at baseline (how patients enter the cancer trajectory) was associated with longer OS, but (change in) HRQOL at 6 months (how they overcome cancer treatment) was not. This knowledge is important to personalize treatment plans.</p

Changes in Sexuality and Sexual Dysfunction over Time in the First Two Years after Treatment of Head and Neck Cancer

The aim of this study was to investigate changes in sexuality and sexual dysfunction in head and neck cancer (HNC) patients in the first two years after treatment, in relation to the type of treatment. Data were used of 588 HNC patients participating in the prospective NETherlands Quality of life and Biomedical Cohort Study (NET-QUBIC) from diagnosis to 3, 6, 12 and 24 months after treatment. Primary outcome measures were the International Index of Erectile Function (IIEF) and the Female Sexual Function Index (FSFI). The total scores of the IIEF and FSFI were dichotomized into sexual (dys)function. In men, type of treatment was significantly associated with change in erectile function, orgasm, satisfaction with intercourse, and overall satisfaction. In women, type of treatment was significantly associated with change in desire, arousal, and orgasm. There were significant differences between treatment groups in change in dysfunctional sexuality. A deterioration in sexuality and sexual dysfunction from baseline to 3 months after treatment was observed especially in patients treated with chemoradiation. Changes in sexuality and sexual dysfunction in HNC patients were related to treatment, with an acute negative effect of chemoradiation. This effect on the various domains of sexuality seems to differ between men and women.</p

Supportive Care Needs From Mid-to Long-Term Follow-Up Among Head and Neck Cancer Survivors:A Longitudinal Cohort Study

Background: There is limited knowledge on the supportive care needs (SCNs) of head and neck cancer (HNC) survivors during long-term survivorship. Aims: To investigate SCNs from 2 to 5 years after treatment among HNC survivors, and its association with demographic, personal, clinical, physical, psychological, social and lifestyle, and cancer-related quality of life factors. Methods: SCNs were measured at 2, 3, 4 and 5 years using the supportive care needs survey (SCNS-SF34 and SCNS-HNC) in 403 HNC survivors. Linear mixed model analyses were performed to investigate changes in SCNs (continuous outcome) over time and factors associated with SCNs (continuous). Also, the proportion of unmet moderate-high SCNs (dichotomous) was calculated. Results: SCNs on the health system, information and patient support and lifestyle domain decreased from 2 to 5 years, whereas physical and daily living, psychological, sexuality and HNC-function needs were stable. At 5 years, 33% of HNC survivors had unmet SCNs, in particular lack of energy/tiredness (9.2%) and dry mouth/sticky mucus (8.1%). Demographic (male, higher education), personal (personality, coping, self-efficacy), clinical (advanced tumor stage, tumor recurrence), physical (low handgrip strength), psychological (anxiety, depression, fear of cancer recurrence (FCR)), lifestyle (smoking, drinking, being underweight) and cancer-related factors (lower levels of functioning, lower levels of nausea and vomiting, higher levels of fatigue, constipation, financial, speech, social eating, dry mouth and sexuality problems, and painkiller usage) were associated with SCNs. Specifically FCR and painkillers usage were very consistently associated with higher SCNs. Conclusions: SCNs of HNC survivors decrease over time. A third experiences SCNs at long-term follow-up.</p

Profiling of psychoneurological symptoms in newly diagnosed head and neck cancer patients

Purpose: He ad and neck cancer (HNC) can trigger a significant mental health burden, including psychoneurological symptoms (PNS). Better insight into the profiling of PNS is important for advancing personalized mental health screening and management. Methods: Data from 538 newly diagnosed adult HNC patients participating in a prospective multicenter cohort study (NET-QUBIC) were used. Questionnaires were used to assess PNS. Sociodemographic, clinical, lifestyle, and biological variables were collected. Latent class analysis was performed to identify differential classes of PNS. Between-class comparisons and multivariable logistic regression analyses were conducted to characterize each profile in relation to sociodemographic, clinical, lifestyle, and biological variables.Results: Fit indexes supported a three-class solution, with patients distributed in mild (60%), moderate (26%), and severe (14%) PNS classes. Pain and sleep problems were featured in all classes, anxiety and depression in the moderate and severe classes, and fatigue only in the severe class. Patients in the moderate and severe classes were more often women, had oral cavity cancer, showed impaired performance, had a history of anxiety and depression disorders, were daily smokers, had higher CRP, and had a flatter cortisol slope compared to the mild class. Conclusion: Newly diagnosed HNC patients can be classified according to the severity of PNS. Several sociodemographic, clinical, lifestyle, and biological variables are proposed as drivers for early detection and treatment of mental health burden.</p