This cohort study examines whether racial disparities exist in treatment received and in survival among patients undergoing surgical intervention with curative intent for gastrointestinal tract cancer.

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Depression and insulin resistance are becoming increasingly prevalent in younger populations. The origin and consequence of insulin resistance in depressed youth may, in part, be rooted in exposure to environmental stressors, such as early life abuse, that may lead to aberrant brain motivational networks mediating maladaptive food-seeking behaviors and insipient insulin resistance. In this paper, we aimed to investigate the impact of early life abuse on the development of insulin resistance in depressed and overweight youth aged 9 to 17 years. We hypothesized that youth with the greatest burden of early life abuse would have the highest levels of insulin resistance and corresponding aberrant reward network connectivities. To test this hypothesis, we evaluated sixty-nine depressed and overweight youth aged 9 to 17, using multimodal assessments of early life abuse, food-seeking behavior, and insulin resistance. Based on results of the Childhood Trauma Questionnaire (CTQ), we separated our study participants into two groups: 35 youth who reported high levels of the sum of emotional, physical, or sexual abuse and 34 youth who reported insignificant or no levels of any abuse. Results of an oral glucose tolerance test (OGTT) and resting state functional connectivity (RSFC), using the amygdala, insula, and nucleus accumbens (NAcc) as seed-based reward network regions of interest, were analyzed for group differences between high abuse and low abuse groups. High abuse youth exhibited differences from low abuse youth in amygdala-precuneus, NAcc-paracingulate gyrus, and NAcc-prefrontal cortex connectivities, that correlated with levels of abuse experienced. The more different their connectivity from of that of low abuse youth, the higher were their fasting glucose and glucose at OGTT endpoint. Importantly, level of abuse moderated the relation between reward network connectivity and OGTT glucose response. In contrast, low abuse youth showed hyperinsulinemia and more insulin resistance than high abuse youth, and their higher OGTT insulin areas under the curve correlated with more negative insula-precuneus connectivity. Our findings suggest distinct neural and endocrine profiles of youth with depression and obesity based on their histories of early life abuse.

Context: Sexual dysfunction is an under-recognized complication of diabetes and rarely addressed.Objective: To identify attitudes toward sex and to define the prevalence of sexual dysfunction and assess associated factors among middle-aged and older individuals with diabetes.Dataset/Population Studied: Using data from the National Social Life, Health, and Aging Project, we identified individuals who self-reported diabetes and assessed their survey responses related to attitudes toward sex (mailed surveys) and sexual dysfunction (based on face-to-face interviews). Participants were survivors from an earlier round of the study (57-85yo in 2005-2006) and individuals recruited in 2015-2016 (50-67yo in 2015). We excluded individuals who did not answer a single question about sexual dysfunction.Study Design and Analysis: We conducted a cross-sectional analysis and applied weights to account for complex survey design. We examined the prevalence of importance of sex and sexual dysfunction and used multivariate logistic regression to assess factors (age, sex, race/ethnicity, education, marital status, and self-reported health) associated with sexual dysfunction. A 2-sided p-value <0.05 was considered statistically significant.Results: Overall survey response rate was 69%. Of the 4439 participants, 746 (17%) reported diabetes and 29 (4%) of them were excluded due to missing answers. Among the 717 included, 54% reported sex was somewhat to extremely important (45% among women, 62% men; 59% in 50-59yo, 50% in 60-69yo, 57% in 70-79yo, and 35% among 80+yo). Prevalence of any sexual dysfunction was 69% (73% among women, 65% men; 65% in 50-59yo, 71% in 60-69yo, 74% in 70-79yo, and 53% among 80+yo); 48% reported lack of interest, 25% inability to climax, 18% anxiety with ability to perform, 10% lacked pleasure in sex, 7% experienced painful sex. Among women, 27% reported issues with lubrication; among men, 44% reported erectile dysfunction. In a multivariate regression model, individuals were more likely to report sexual dysfunction if they were women vs men ).Conclusions: Two-thirds of middle aged/older individuals with diabetes reported sexual dysfunction and more than half reported sex was an important part of their lives. Our findings suggest dysfunction is a common and important problem among patients with diabetes.

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