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Boverhoff D, Kool J, Pijnacker R, Ducarmon QR, Zeller G, Shetty S, Sie S, Mulder AC, van der Klis F, Franz E, Mughini-Gras L, van Baarle D, Fuentes S. Profiling the fecal microbiome and its modulators across the lifespan in the Netherlands. Cell Rep 2024; 43:114729. [PMID: 39264809 DOI: 10.1016/j.celrep.2024.114729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 05/23/2024] [Accepted: 08/22/2024] [Indexed: 09/14/2024] Open
Abstract
Defining what constitutes a healthy microbiome throughout our lives remains an ongoing challenge. Understanding to what extent host and environmental factors can influence it has been the primary motivation for large population studies worldwide. Here, we describe the fecal microbiome of 3,746 individuals (0-87 years of age) in a nationwide study in the Netherlands, in association with extensive questionnaires. We validate previous findings, such as infant-adult trajectories, and explore the collective impact of our variables, which explain over 40% of the variation in microbiome composition. We identify associations with less explored factors, particularly those ethnic related, which show the largest impact on the adult microbiome composition, diversity, metabolic profiles, and CAZy (carbohydrate-active enzyme) repertoires. Understanding the sources of microbiome variability is crucial, given its potential as a modifiable target with therapeutic possibilities. With this work, we aim to serve as a foundational element for the design of health interventions and fundamental research.
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Affiliation(s)
- David Boverhoff
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; Virology & Immunology Research, Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, Groningen, the Netherlands
| | - Jolanda Kool
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Roan Pijnacker
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Quinten R Ducarmon
- Structural and Computational Biology Unit, European Molecular Biology Laboratory, Heidelberg, Germany
| | - Georg Zeller
- Structural and Computational Biology Unit, European Molecular Biology Laboratory, Heidelberg, Germany
| | - Sudarshan Shetty
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; Virology & Immunology Research, Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, Groningen, the Netherlands
| | - Stephan Sie
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Annemieke Christine Mulder
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Fiona van der Klis
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Eelco Franz
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Lapo Mughini-Gras
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Debbie van Baarle
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; Virology & Immunology Research, Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, Groningen, the Netherlands
| | - Susana Fuentes
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
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Belsti Y, Mousa A, Jackson H, Moran LJ, Palmer KR, Dhungana RR, Callander E, Rolnik DL, Teede H, Enticott J. The Use of Multiple Medications During Pregnancy Among an Ethnically Diverse Population in South-Eastern Melbourne: A Retrospective Analysis to Explore Potential Risks and Complications. Drug Saf 2024:10.1007/s40264-024-01482-w. [PMID: 39302513 DOI: 10.1007/s40264-024-01482-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2024] [Indexed: 09/22/2024]
Abstract
BACKGROUND AND OBJECTIVE Medication use is increasing to treat both pre-existing and pregnancy-related medical conditions or complications. This study aims to investigate factors associated with multiple medication use during pregnancy, as well as any increased risk of pregnancy complications for women taking multiple medications. METHODS A retrospective analysis of routinely collected medical records of singleton pregnant women was conducted in Southeast Melbourne, Australia, between 2016 and 2021. Self-reported medication use was recorded as part of routine medical care, starting from the first antenatal booking appointment and continuing for every subsequent antenatal appointment until birth. Multimorbidity was defined as having two or more medical conditions. Logistic regression was used to assess factors influencing multiple medication use (defined as taking two or more non-supplemental medications at any stage of pregnancy) and associations with pregnancy complications. RESULTS Of 48,502 participants, 34.9% used one medication, while 11.7% used multiple medications. Women of older age (30-34, 35-39, and ≥ 40 years), higher body mass index (25.0-29.9 kg/m2 and ≥ 30 kg/m2), born in Australasia and Oceania, higher socioeconomic status, and multimorbidity were more likely to use multiple medications during pregnancy. Women taking multiple medications had a higher risk of preterm and caesarean deliveries, fetal death, and neonatal admissions to intensive care. Sensitivity analyses exploring different morbidity categories produced no changes to findings. CONCLUSIONS Medication use during pregnancy is prevalent, with many pregnant mothers taking multiple medications. Given the rising maternal age, body mass index, and morbidities in pregnancy, the use of medications during pregnancy is increasing. Such use correlates with an increased chance of adverse pregnancy outcomes. In the context of limited trials on the safety and efficacy of medications in pregnancy, timely harnessing of the information available within routine medical records for post-marketing surveillance is important.
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Affiliation(s)
- Yitayeh Belsti
- Monash Centre for Health Research and Implementation (MCHRI), Faculty of Medicine, Nursing and Health Sciences, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, Melbourne, VIC, 3168, Australia
| | - Aya Mousa
- Monash Centre for Health Research and Implementation (MCHRI), Faculty of Medicine, Nursing and Health Sciences, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, Melbourne, VIC, 3168, Australia
| | - Hannah Jackson
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Lisa J Moran
- Monash Centre for Health Research and Implementation (MCHRI), Faculty of Medicine, Nursing and Health Sciences, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, Melbourne, VIC, 3168, Australia
| | - Kirsten R Palmer
- Monash Health, Melbourne, VIC, Australia
- Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia
| | - Raja Ram Dhungana
- Monash Centre for Health Research and Implementation (MCHRI), Faculty of Medicine, Nursing and Health Sciences, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, Melbourne, VIC, 3168, Australia
| | - Emily Callander
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Daniel Lorber Rolnik
- Monash Health, Melbourne, VIC, Australia
- Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation (MCHRI), Faculty of Medicine, Nursing and Health Sciences, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, Melbourne, VIC, 3168, Australia
- Monash Health, Melbourne, VIC, Australia
| | - Joanne Enticott
- Monash Centre for Health Research and Implementation (MCHRI), Faculty of Medicine, Nursing and Health Sciences, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, Melbourne, VIC, 3168, Australia.
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3
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Carvajal DN, Anaya YB, McLean I, Aragón M, Figueroa E, Plasencia G, Martinez-Bianchi V, Rodríguez JE. We Are Not All the Same: Implications of Heterogeneity Among Latiné/e/x/o/a, Hispanic, and Spanish Origin People. Ann Fam Med 2024; 22:254-258. [PMID: 38806262 PMCID: PMC11237225 DOI: 10.1370/afm.3103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 01/29/2024] [Accepted: 02/02/2024] [Indexed: 05/30/2024] Open
Abstract
There is great variation in the experiences of Latiné/e/x/o/a, Hispanic, and/or Spanish origin (LHS) individuals in the United States, including differences in race, ancestry, colonization histories, and immigration experiences. This essay calls readers to consider the implications of the heterogeneity of lived experiences among LHS populations, including variations in country of origin, immigration histories, time in the United States, languages spoken, and colonization histories on patient care and academia. There is power in unity when advocating for community, social, and political change, especially as it pertains to equity, diversity, and inclusion (EDI; sometimes referred to as DEI) efforts in academic institutions. Yet, there is also a critical need to disaggregate the LHS diaspora and its conceptualization based on differing experiences so that we may improve our understanding of the sociopolitical attributes that impact health. We propose strategies to improve recognition of these differences and their potential health outcomes toward a goal of health equity.
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Affiliation(s)
- Diana N Carvajal
- Department of Family & Community Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Yohualli B Anaya
- Department of Family of Medicine and Community Health, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Ivonne McLean
- Department of Family Medicine and Community Health, The Institute for Family Health, Mount Sinai Hospital, New York, New York
| | - Miranda Aragón
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico
| | | | - Gabriela Plasencia
- Department of Family Medicine and Community Health, Duke University, Durham, North Carolina
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Adesanya EI, Henderson A, Hayes JF, Lewin A, Mathur R, Mulick A, Morton C, Smith C, Langan SM, Mansfield KE. Ethnic differences in depression and anxiety among adults with atopic eczema: Population-based matched cohort studies within UK primary care. Clin Transl Allergy 2024; 14:e12348. [PMID: 38526449 PMCID: PMC10962487 DOI: 10.1002/clt2.12348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 02/26/2024] [Accepted: 03/06/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Evidence demonstrates that individuals with atopic eczema (eczema) have increased depression and anxiety; however, the role of ethnicity in these associations is poorly understood. We aimed to investigate whether associations between eczema and depression or anxiety differed between adults from white and minority ethnic groups in the UK. METHODS We used UK Clinical Practice Research Datalink GOLD to conduct matched cohort studies of adults (≥18 years) with ethnicity recorded in primary care electronic health records (April 2006-January 2020). We matched (age, sex, practice) adults with eczema to up to five adults without. We used stratified Cox regression with an interaction between eczema and ethnicity, to estimate hazard ratios (HRs) for associations between eczema and incident depression and anxiety in individuals from white ethnic groups and a pooled minority ethnic group (adults from Black, South Asian, Mixed and Other groups). RESULTS We identified separate cohorts for depression (215,073 with eczema matched to 646,539 without) and anxiety (242,598 with eczema matched to 774,113 without). After adjusting for matching variables and potential confounders (age, sex, practice, deprivation, calendar period), we found strong evidence (p < 0.01) of ethnic differences in associations between eczema and depression (minority ethnic groups: HR = 1.33, 95% CI = 1.22,1.45; white ethnic groups: HR = 1.15, 95% CI = 1.12,1.17) and anxiety (minority ethnic groups: HR = 1.41, 95% CI = 1.28,1.55; white ethnic groups: HR = 1.17, 95% CI = 1.14,1.19). CONCLUSIONS Adults with eczema from minority ethnic groups appear to be at increased depression and anxiety risk compared with their white counterparts. Culturally adapted mental health promotion and prevention strategies should be considered in individuals with eczema from minority ethnic groups.
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Affiliation(s)
- Elizabeth I. Adesanya
- Department of Non‐Communicable Disease EpidemiologyLondon School of Hygiene & Tropical MedicineLondonUK
| | - Alasdair Henderson
- Department of Non‐Communicable Disease EpidemiologyLondon School of Hygiene & Tropical MedicineLondonUK
| | | | - Alexandra Lewin
- Department of Medical StatisticsLondon School of Hygiene & Tropical MedicineLondonUK
| | - Rohini Mathur
- Centre for Primary CareWolfson Institute of Population HealthQueen Mary University of LondonLondonUK
| | - Amy Mulick
- Department of Non‐Communicable Disease EpidemiologyLondon School of Hygiene & Tropical MedicineLondonUK
| | - Caroline Morton
- Centre for Primary CareWolfson Institute of Population HealthQueen Mary University of LondonLondonUK
| | - Catherine Smith
- St John's Institute of DermatologyGuys and St Thomas' Foundation Trust and King's College LondonLondonUK
| | - Sinéad M. Langan
- Department of Non‐Communicable Disease EpidemiologyLondon School of Hygiene & Tropical MedicineLondonUK
| | - Kathryn E. Mansfield
- Department of Non‐Communicable Disease EpidemiologyLondon School of Hygiene & Tropical MedicineLondonUK
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Mukhtyar CB, Beadsmoore C, Coath FL, Ducker G, Fordham S, Sisson K, Yong CY, Watts RA. Incidence of primary large vessel vasculitis in Norfolk, UK from 2011 to 2020. Ann Rheum Dis 2023; 82:1341-1347. [PMID: 37399329 DOI: 10.1136/ard-2023-224191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/20/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVES To report the annual incidence of primary large vessel vasculitis (LVV) in the adult population of Norfolk County, UK, including giant cell arteritis (GCA) (in those ≥50 years) and Takayasu arteritis (TAK). METHODS Individuals diagnosed by histology or imaging who lived in NR1-NR30 postcode districts were included. Validated criteria from 1990 and 2022 were applied for final classification. Population data were available from the Office of National Statistics, UK. RESULTS 270 individuals were diagnosed with primary LVV over 4.7 million person-years. The annual incidence (95% CI) of primary LVV was 57.5 (50.8, 64.7)/million person-years in the adult population. 227 and 244 individuals were diagnosed with GCA over ~2.5 million person-years using 1990 and 2022 criteria, respectively. The annual incidence (95% CI) of GCA was 91.6 (80.0, 104.3)/million person-years aged ≥50 years using 1990 criteria and 98.4 (86.4, 111.6)/million person-years aged ≥50 years using 2022 criteria. 13 and 2 individuals were diagnosed with TAK over 4.7 million person-years. The annual incidence (95% CI) of TAK was 2.8 (1.5, 4.7)/million person-years using 1990 criteria and 0.4 (0.0, 1.4)/million person-years using 2022 criteria, in the adult population. The incidence of GCA rose sharply in 2017 coincident with the introduction of a fast-track pathway and fell during the pandemic when the pathway was disrupted. CONCLUSIONS This is the first study that reports the incidence of objectively verified primary LVV in the adult population. The incidence of GCA may be affected by the availability of diagnostic pathways. The use of the 2022 classification criteria results in a rise in the classification of GCA and fall in that of TAK.
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Affiliation(s)
- Chetan B Mukhtyar
- Vasculitis Service, Rheumatology Department, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Clare Beadsmoore
- Radiology Department, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Fiona L Coath
- Vasculitis Service, Rheumatology Department, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Georgina Ducker
- Vasculitis Service, Rheumatology Department, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Sarah Fordham
- Vasculitis Service, Rheumatology Department, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Katherine Sisson
- Radiology Department, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Cee Y Yong
- Rheumatology Department, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Richard A Watts
- Norwich Medical School, University of East Anglia, Norwich, UK
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Petermann-Rocha F, Deo S, Celis-Morales C, Ho FK, Bahuguna P, McAllister D, Sattar N, Pell JP. An Opportunity for Prevention: Associations Between the Life's Essential 8 Score and Cardiovascular Incidence Using Prospective Data from UK Biobank. Curr Probl Cardiol 2023; 48:101540. [PMID: 36528209 DOI: 10.1016/j.cpcardiol.2022.101540] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
To investigate the association between the Life's Essential 8 (LE8) score and the incidence of four cardiovascular outcomes (ischemic heart disease, myocardial infarction, stroke, and heart failure [HF]) - separately and as a composite outcome of major adverse cardiovascular events (MACE) - in UK Biobank. 250,825 participants were included in this prospective study. Smoking, non-HDL cholesterol, blood pressure, body mass index, HbA1c, physical activity, diet, and sleep were used to create a modified version of the LE8 score. Associations between the score (both as a continuous score and as quartiles) and outcomes were investigated using adjusted Cox proportional hazard models. The potential impact fractions of two scenarios were also calculated. Over a median follow-up of 10.4 years, there were 25,068 MACE. Compared to individuals in the highest quartile of the score (healthiest), those in the lowest quartile (least healthy) had 2.07 (95% CI: 1.99; 2.16) higher risk for MACE. The highest relative risk gradient of the individual outcomes was observed for HF (HRlowest quartile: 2.67 [95% CI: 2.42; 2.94]). The magnitude of association was stronger in participants below 50 years, women, and ethnic minorities. A targeted intervention that increased, by 10-points, the score among individuals in the lowest quartile could have prevented 9.2% of MACE. Individuals with a lower LE8 score experienced more MACE, driven especially by incident HF. Our scenarios suggested that relevant interventions targeted towards those in the lowest quartile may have a greater impact than interventions producing small equal changes across all quartiles.
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Affiliation(s)
- Fanny Petermann-Rocha
- BHF Cardiovascular Research Centre. School of Cardiovascular and Metabolic Health, University of Glasgow. Glasgow, UK; Centro de Investigación Biomédica, Facultad de Medicina, Universidad Diego Portales, Santiago, Chile
| | - Salil Deo
- School of Health and Wellbeing, University of Glasgow. Glasgow, UK; Louis Stokes Cleveland VA Medical Center, Cleveland USA; Department of Surgery, Case School of Medicine, Case Western Reserve University, Cleveland USA
| | - Carlos Celis-Morales
- BHF Cardiovascular Research Centre. School of Cardiovascular and Metabolic Health, University of Glasgow. Glasgow, UK; Human Performance Laboratory, Education, Physical Activity and Health Research Unit, Universidad Católica del Maule, Talca, Chile
| | - Frederick K Ho
- School of Health and Wellbeing, University of Glasgow. Glasgow, UK
| | - Pankaj Bahuguna
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow Glasgow, UK
| | - David McAllister
- School of Health and Wellbeing, University of Glasgow. Glasgow, UK
| | - Naveed Sattar
- BHF Cardiovascular Research Centre. School of Cardiovascular and Metabolic Health, University of Glasgow. Glasgow, UK
| | - Jill P Pell
- School of Health and Wellbeing, University of Glasgow. Glasgow, UK.
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7
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Pearce N, Rhodes S, Stocking K, Pembrey L, van Veldhoven K, Brickley EB, Robertson S, Davoren D, Nafilyan V, Windsor-Shellard B, Fletcher T, van Tongeren M. Occupational differences in COVID-19 incidence, severity, and mortality in the United Kingdom: Available data and framework for analyses. Wellcome Open Res 2023; 6:102. [PMID: 34141900 PMCID: PMC8188261 DOI: 10.12688/wellcomeopenres.16729.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2023] [Indexed: 01/15/2023] Open
Abstract
There are important differences in the risk of SARS-CoV-2 infection and death depending on occupation. Infections in healthcare workers have received the most attention, and there are clearly increased risks for intensive care unit workers who are caring for COVID-19 patients. However, a number of other occupations may also be at an increased risk, particularly those which involve social care or contact with the public. A large number of data sets are available with the potential to assess occupational risks of COVID-19 incidence, severity, or mortality. We are reviewing these data sets as part of the Partnership for Research in Occupational, Transport, Environmental COVID Transmission (PROTECT) initiative, which is part of the National COVID-19 Core Studies. In this report, we review the data sets available (including the key variables on occupation and potential confounders) for examining occupational differences in SARS-CoV-2 infection and COVID-19 incidence, severity and mortality. We also discuss the possible types of analyses of these data sets and the definitions of (occupational) exposure and outcomes. We conclude that none of these data sets are ideal, and all have various strengths and weaknesses. For example, mortality data suffer from problems of coding of COVID-19 deaths, and the deaths (in England and Wales) that have been referred to the coroner are unavailable. On the other hand, testing data is heavily biased in some periods (particularly the first wave) because some occupations (e.g. healthcare workers) were tested more often than the general population. Random population surveys are, in principle, ideal for estimating population prevalence and incidence, but are also affected by non-response. Thus, any analysis of the risks in a particular occupation or sector (e.g. transport), will require a careful analysis and triangulation of findings across the various available data sets.
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Affiliation(s)
- Neil Pearce
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Sarah Rhodes
- University of Manchester, Manchester, M13 9PL, UK
| | | | - Lucy Pembrey
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Karin van Veldhoven
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Elizabeth B. Brickley
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Steve Robertson
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Donna Davoren
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Vahe Nafilyan
- Faculty of Public Health Policy, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
- Office of National Statistics (ONS), London, SWIV 2QQ, UK
| | | | - Tony Fletcher
- Faculty of Public Health Policy, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
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8
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Boychuk NA, Mulrooney NS, Kelly NR, Goldenberg AJ, Silver EJ, Wasserstein MP. Parental Depression and Anxiety Associated with Newborn Bloodspot Screening for Rare and Variable-Onset Disorders. Int J Neonatal Screen 2022; 8:ijns8040059. [PMID: 36412585 PMCID: PMC9680490 DOI: 10.3390/ijns8040059] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/20/2022] [Accepted: 10/31/2022] [Indexed: 11/11/2022] Open
Abstract
The ability to screen newborns for a larger number of disorders, including many with variable phenotypes, is prompting debate regarding the psychosocial impact of expanded newborn bloodspot screening (NBS) on parents. This study compares psychological outcomes of parents of children with a range of NBS/diagnostic experiences, with a particular focus on lysosomal storage disorders (LSDs) and X-linked adrenoleukodystrophy (X-ALD) as representative disorders with complex presentations. An online cross-sectional survey with six domains was completed in 2019 by a volunteer sample of parents with at least one child born between 2013 and 2018. Parents were classified in the analysis stage into four groups based on their child's rare disorder and means of diagnosis. Stress and depression were estimated using dichotomous measures of the depression subscale of the Hospital Anxiety and Depression Scale and the Parental Stress Scale. Logistic regression models were estimated for the relationship between the parent group and stress/depression, controlling for demographic variables (region of the US, income, education, major life events, relationship to the child, number of children, parent age, and race/ethnicity). One hundred seventy-four parents were included in this analysis. Parents of children with an LSD or X-ALD diagnosis clinically may have higher odds of depression (OR: 6.06, 95% CI: 1.64-24.96) compared to parents of children with the same disorders identified through NBS, controlling for covariates. Although a similar pattern was observed for parental stress (OR: 2.85, 95% CI: 0.82-10.37), this did not reach statistical significance. Ethically expanding NBS and genome sequencing require an understanding of the impacts of early detection for complex disorders on families. These initial findings are reassuring, and may have implications as NBS expands. Given our small sample size, it is difficult to generalize these findings to all families. These preliminary trends warrant further investigation in larger and more diverse populations.
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Affiliation(s)
- Natalie A. Boychuk
- Department of Pediatrics, Albert Einstein College of Medicine and Children’s Hospital at Montefiore, Bronx, NY 10467, USA
| | - Niamh S. Mulrooney
- Department of Pediatrics, Albert Einstein College of Medicine and Children’s Hospital at Montefiore, Bronx, NY 10467, USA
| | - Nicole R. Kelly
- Department of Pediatrics, Albert Einstein College of Medicine and Children’s Hospital at Montefiore, Bronx, NY 10467, USA
| | - Aaron J. Goldenberg
- Department of Bioethics, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Ellen J. Silver
- Department of Pediatrics, Albert Einstein College of Medicine and Children’s Hospital at Montefiore, Bronx, NY 10467, USA
| | - Melissa P. Wasserstein
- Department of Pediatrics, Albert Einstein College of Medicine and Children’s Hospital at Montefiore, Bronx, NY 10467, USA
- Correspondence:
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9
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Fyfe C, Barnard LT, Douwes J, Howden-Chapman P, Crane J. Retrofitting home insulation reduces incidence and severity of chronic respiratory disease. INDOOR AIR 2022; 32:e13101. [PMID: 36040274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/31/2022] [Accepted: 08/05/2022] [Indexed: 06/15/2023]
Abstract
To assess whether retrofitting home insulation can reduce the risk of respiratory disease incidence and exacerbation, a retrospective cohort study was undertaken using linked data from a national intervention program. The study population was made up of 1 004 795 residents from 205 001 New Zealand houses that received an insulation subsidy though a national Energy Efficiency and Conservation Authority program. A difference-in-difference model compared changes in the number of prescriptions dispensed for respiratory illness post- insulation to a control population over the same timeframe. New prescribing of chronic respiratory disease medication at follow-up was used to compare incidence risk ratios between intervention and control groups. Chronic respiratory disease incidence was significantly lower in the intervention group at follow-up: odds ratio 0.90 (95% CI: 0.86-0.94). There was also a 4% reduction in medication dispensed for treating exacerbations of chronic respiratory disease symptoms in the intervention group compared with the control group: relative rate ratio (RRR) 0.96 (95% CI: 0.96-0.97). There was no change in medication dispensed to prevent symptoms of chronic respiratory disease RRR: 1,00 (95% CI: 0.99-1.00). These findings support home insulation interventions as a means of improving respiratory health outcomes.
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Affiliation(s)
- Caroline Fyfe
- He Kāinga Oranga, Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Lucy Telfar Barnard
- He Kāinga Oranga, Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Jeroen Douwes
- Research Centre for Hauora and Health, Massey University Wellington, Wellington, New Zealand
| | - Philippa Howden-Chapman
- He Kāinga Oranga, Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Julian Crane
- Wellington Asthma Research Group, Department of Medicine, University of Otago Wellington, Wellington, New Zealand
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10
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Fyfe C, Barnard LT, Douwes J, Howden‐Chapman P, Crane J. Retrofitting home insulation reduces incidence and severity of chronic respiratory disease. INDOOR AIR 2022; 32:e13101. [PMID: 36040274 PMCID: PMC9545372 DOI: 10.1111/ina.13101] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/31/2022] [Accepted: 08/05/2022] [Indexed: 09/13/2023]
Abstract
To assess whether retrofitting home insulation can reduce the risk of respiratory disease incidence and exacerbation, a retrospective cohort study was undertaken using linked data from a national intervention program. The study population was made up of 1 004 795 residents from 205 001 New Zealand houses that received an insulation subsidy though a national Energy Efficiency and Conservation Authority program. A difference-in-difference model compared changes in the number of prescriptions dispensed for respiratory illness post- insulation to a control population over the same timeframe. New prescribing of chronic respiratory disease medication at follow-up was used to compare incidence risk ratios between intervention and control groups. Chronic respiratory disease incidence was significantly lower in the intervention group at follow-up: odds ratio 0.90 (95% CI: 0.86-0.94). There was also a 4% reduction in medication dispensed for treating exacerbations of chronic respiratory disease symptoms in the intervention group compared with the control group: relative rate ratio (RRR) 0.96 (95% CI: 0.96-0.97). There was no change in medication dispensed to prevent symptoms of chronic respiratory disease RRR: 1,00 (95% CI: 0.99-1.00). These findings support home insulation interventions as a means of improving respiratory health outcomes.
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Affiliation(s)
- Caroline Fyfe
- He Kāinga Oranga, Department of Public HealthUniversity of Otago WellingtonWellingtonNew Zealand
| | - Lucy Telfar Barnard
- He Kāinga Oranga, Department of Public HealthUniversity of Otago WellingtonWellingtonNew Zealand
| | - Jeroen Douwes
- Research Centre for Hauora and HealthMassey University WellingtonWellingtonNew Zealand
| | - Philippa Howden‐Chapman
- He Kāinga Oranga, Department of Public HealthUniversity of Otago WellingtonWellingtonNew Zealand
| | - Julian Crane
- Wellington Asthma Research Group, Department of MedicineUniversity of Otago WellingtonWellingtonNew Zealand
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Ethnic differences in cardiovascular risk: examining differential exposure and susceptibility to risk factors. BMC Med 2022; 20:149. [PMID: 35473626 PMCID: PMC9042646 DOI: 10.1186/s12916-022-02337-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 03/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ethnic differences in cardiovascular disease (CVD) risk have been known for decades, but a systematic exploration of how exposure and susceptibility to risk factors may contribute is lacking. This study aimed to investigate the potential impact of differential exposure and susceptibility between South Asian, Black, and White individuals. METHODS This is a population-based prospective cohort study of UK Biobank participants with a median follow-up of 11.3 years. The association between ethnic group and CVD risk was studied. Additional risk factors were then adjusted to examine mediations. Moderation analysis was conducted to identify whether risk factors had a stronger association in the ethnic minority groups. Population attributable fractions were also calculated to quantify the relative contributions of risk factors for each ethnic group. RESULTS When adjusted for only age and sex, there was a higher risk of CVD among South Asian (n=8815; HR [95% CI] 1.69 [1.59-1.79]) and Black (n=7526; HR [95% CI] 1.12 [1.03-1.22]) compared with White participants (n=434,809). The excess risk of Black participants was completely attenuated following adjustment for deprivation. Compared with White participants, the associations of BMI, triglycerides, and HbA1c with CVD were stronger in South Asians. Adiposity was attributable to the highest proportion of CVD regardless of ethnicity. Smoking had the second largest contribution to CVD among White and Black participants, and HbA1c among South Asian participants. CONCLUSIONS Adiposity is an important risk factor for CVD regardless of ethnicity. Ethnic inequalities in CVD incidence may be best tackled by targeting interventions according to ethnic differences in risk profiles.
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12
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Words matter. Pediatr Res 2022; 92:1223-1224. [PMID: 35854093 PMCID: PMC9700512 DOI: 10.1038/s41390-022-02198-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 06/28/2022] [Indexed: 11/08/2022]
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13
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Nsugbe E. A cybernetic framework for predicting preterm and enhancing care strategies: A review. BIOMEDICAL ENGINEERING ADVANCES 2021. [DOI: 10.1016/j.bea.2021.100024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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14
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Pearce N, Rhodes S, Stocking K, Pembrey L, van Veldhoven K, Brickley EB, Robertson S, Davoren D, Nafilyan V, Windsor-Shellard B, Fletcher T, van Tongeren M. Occupational differences in COVID-19 incidence, severity, and mortality in the United Kingdom: Available data and framework for analyses. Wellcome Open Res 2021; 6:102. [PMID: 34141900 PMCID: PMC8188261 DOI: 10.12688/wellcomeopenres.16729.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 01/22/2023] Open
Abstract
There are important differences in the risk of SARS-CoV-2 infection and death depending on occupation. Infections in healthcare workers have received the most attention, and there are clearly increased risks for intensive care unit workers who are caring for COVID-19 patients. However, a number of other occupations may also be at an increased risk, particularly those which involve social care or contact with the public. A large number of data sets are available with the potential to assess occupational risks of COVID-19 incidence, severity, or mortality. We are reviewing these data sets as part of the Partnership for Research in Occupational, Transport, Environmental COVID Transmission (PROTECT) initiative, which is part of the National COVID-19 Core Studies. In this report, we review the data sets available (including the key variables on occupation and potential confounders) for examining occupational differences in SARS-CoV-2 infection and COVID-19 incidence, severity and mortality. We also discuss the possible types of analyses of these data sets and the definitions of (occupational) exposure and outcomes. We conclude that none of these data sets are ideal, and all have various strengths and weaknesses. For example, mortality data suffer from problems of coding of COVID-19 deaths, and the deaths (in England and Wales) that have been referred to the coroner are unavailable. On the other hand, testing data is heavily biased in some periods (particularly the first wave) because some occupations (e.g. healthcare workers) were tested more often than the general population. Random population surveys are, in principle, ideal for estimating population prevalence and incidence, but are also affected by non-response. Thus, any analysis of the risks in a particular occupation or sector (e.g. transport), will require a careful analysis and triangulation of findings across the various available data sets.
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Affiliation(s)
- Neil Pearce
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Sarah Rhodes
- University of Manchester, Manchester, M13 9PL, UK
| | | | - Lucy Pembrey
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Karin van Veldhoven
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Elizabeth B. Brickley
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Steve Robertson
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Donna Davoren
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Vahe Nafilyan
- Faculty of Public Health Policy, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
- Office of National Statistics (ONS), London, SWIV 2QQ, UK
| | | | - Tony Fletcher
- Faculty of Public Health Policy, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
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15
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Abstract
We explore the different types of causes that are commonly investigated by epidemiologists. We first distinguish between causes which are events (including actions) and causes which are states. Second, we distinguish between modifiable and non-modifiable states. This yields three types of causes: fixed states (non-modifiable), dynamic states (modifiable) and events (including actions). Different causes may have different characteristics: the methods available to study them, the types of possible biases, and therefore the types of evidence needed to infer causality, may differ according to the specific cause-effect relationship under study. Nevertheless, there are also substantial commonalities. This paper is intended to improve understanding of the different types of causes, and the different types of causality, that underpin epidemiological practice.
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Affiliation(s)
- Neil Pearce
- London School of Hygiene and Tropical Medicine, London, UK
| | - Jan P Vandenbroucke
- London School of Hygiene and Tropical Medicine, London, UK
- Leiden University Medical Center, Leiden, The Netherlands
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
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16
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Premji S. Discourse on culture in research on immigrant and migrant workers' health. Am J Ind Med 2019; 62:460-470. [PMID: 31111524 DOI: 10.1002/ajim.22987] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/23/2019] [Accepted: 04/24/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND Health and safety researchers and practitioners have proposed that cultural differences help explain inequalities between foreign and native-born workers. While cultural explanations for inequalities have long been debated in other fields, there exists little critique of cultural discourses in occupational health. METHODS This article examines and discusses the discourse on culture in 107 articles on immigrant or migrant workers' health published between 2011 and 2015. For each article, passages on culture were identified and analysed for both the context and the manner in which culture was discussed. RESULTS The discourse on culture was found to be generally simplistic, individualistic, and uncritical, intentionally or unintentionally supporting the worldview that workers' "otherness" is both cause of inequalities and target for interventions. CONCLUSION The article argues that empirical, theoretical and interdisciplinary work is needed to document the mechanisms and pathways that underlie health and safety inequalities by foreign-born status.
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Affiliation(s)
- Stephanie Premji
- School of Labour Studies, Department of Health, Aging and SocietyMcMaster UniversityHamilton Ontario Canada
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17
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Chattopadhyay K, Akagwire U, Biswas M, Moore R, Rajania G, Lewis S. Role of lifestyle behaviours in the ethnic pattern of poor health outcomes in Leicester, England: analysis of a survey data set. Public Health 2019; 170:122-128. [PMID: 31029834 DOI: 10.1016/j.puhe.2019.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 02/10/2019] [Accepted: 03/11/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Mediation analyses were conducted to explore the contribution of lifestyle behaviours in the ethnic pattern of poor health outcomes in Leicester, England. STUDY DESIGN Cross-sectional study. METHODS The study used data on 1959 participants from the Leicester Health and Well-being Survey (2015). Lifestyle behaviours were physical activity, diet, smoking and alcohol drinking. Poor health outcomes were the presence of long-term illness and poor self-reported health. RESULTS Poor health outcomes were less common in Black and Minority Ethnic groups (BMEs) than Whites. Smoking was less common in BMEs than Whites. Poor health outcomes were more common in ex-smokers and current smokers than never smokers. Health outcomes were associated with smoking even after adjusting for ethnicity. The association of ethnicity and health outcomes reduced after adjusting for smoking, suggesting that the effect was mediated by smoking. CONCLUSIONS In Leicester, Whites had poorer health outcomes than BMEs, which were not mediated by physical activity, diet and alcohol drinking but were mediated by smoking.
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Affiliation(s)
- Kaushik Chattopadhyay
- Division of Epidemiology and Public Health, The University of Nottingham, Nottingham, UK.
| | - U Akagwire
- Division of Epidemiology and Public Health, The University of Nottingham, Nottingham, UK
| | - M Biswas
- Centre for Reviews and Dissemination, University of York, York, UK
| | - R Moore
- Leicester City Council, Leicester, UK; Health Sciences, University of Leicester, Leicester, UK
| | - G Rajania
- Leicester City Council, Leicester, UK
| | - S Lewis
- Division of Epidemiology and Public Health, The University of Nottingham, Nottingham, UK
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Romero DE, Maia L, Muzy J. Tendência e desigualdade na completude da informação sobre raça/cor dos óbitos de idosos no Sistema de Informações sobre Mortalidade no Brasil, entre 2000 e 2015. CAD SAUDE PUBLICA 2019; 35:e00223218. [DOI: 10.1590/0102-311x00223218] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 06/17/2019] [Indexed: 11/22/2022] Open
Abstract
A qualidade da informação sobre raça/cor é condição necessária para conhecer o impacto da desigualdade na mortalidade. O objetivo deste trabalho é analisar a tendência e a desigualdade na completude da raça/cor dos óbitos de idosos no Sistema de Informações sobre Mortalidade (SIM) entre 2000 e 2015 no Brasil. Analisa-se a completude dessa variável por diferentes abrangências geográficas, a raça/cor mais afetada pela má completude e a associação entre a excelência do preenchimento da raça/cor com a territorialidade e a condição socioeconômica dos municípios. Os dados dos óbitos de idosos provêm do SIM, e as informações de população, dos Censos e estimativas do Ministério da Saúde. Estima-se a variação percentual da proporção da incompletude. A variação percentual de pretos/pardos foi estimada entre 2000 e 2010 para o SIM e Censos. Estima-se regressão logística simples e ajustada (IC95%), tendo, como desfecho excelente, completude da raça/cor e, como resposta, variáveis territoriais e socioeconômicas. Encontrou-se acentuada melhora da qualidade do preenchimento no período, especialmente até 2006, sendo excelente a média nacional desde 2007. Nota-se desigualdade territorial em nível municipal. Municípios de IDH baixo/médio, com alta proporção de pobreza e desigualdade tiveram menor chance de ter excelente completude. O modelo ajustado mostra que a região e o tamanho do município são as características que explicam a excelente qualidade da variável raça/cor. Municípios do Nordeste e de pequeno porte têm menos chance de excelente completude. Conclui-se que raça/cor no SIM tem qualidade para ser utilizada nos estudos de desigualdade da mortalidade dos idosos, salvo exceções em nível municipal.
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How differing methods of ascribing ethnicity and socio-economic status affect risk estimates for hospitalisation with infectious disease. Epidemiol Infect 2018; 147:e40. [PMID: 30421688 PMCID: PMC6518588 DOI: 10.1017/s0950268818002935] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Significant ethnic and socio-economic disparities exist in infectious diseases (IDs) rates in New Zealand, so accurate measures of these characteristics are required. This study compared methods of ascribing ethnicity and socio-economic status. Children in the Growing Up in New Zealand longitudinal cohort were ascribed to self-prioritised, total response and single-combined ethnic groups. Socio-economic status was measured using household income, and both census-derived and survey-derived deprivation indices. Rates of ID hospitalisation were compared using linked administrative data. Self-prioritised ethnicity was simplest to use. Total response accounted for mixed ethnicity and allowed overlap between groups. Single-combined ethnicity required aggregation of small groups to maintain power but offered greater detail. Regardless of the method used, Māori and Pacific children, and children in the most socio-economically deprived households had a greater risk of ID hospitalisation. Risk differences between self-prioritised and total response methods were not significant for Māori and Pacific children but single-combined ethnicity revealed a diversity of risk within these groups. Household income was affected by non-random missing data. The census-derived deprivation index offered a high level of completeness with some risk of multicollinearity and concerns regarding the ecological fallacy. The survey-derived index required extra questions but was acceptable to participants and provided individualised data. Based on these results, the use of single-combined ethnicity and an individualised survey-derived index of deprivation are recommended where sample size and data structure allow it.
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20
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Huang H, Long W, Zhao W, Zou L, Song Y, Zuo J, Yang Z. Polymorphism of R353Q (rs6046) in factor VII and the risk of myocardial infarction: A systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e12566. [PMID: 30278561 PMCID: PMC6181591 DOI: 10.1097/md.0000000000012566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE Genetic components substantially contribute to the development of myocardial infarction (MI), and R353Q polymorphism (rs6046) in FVII gene has been suspected to be associated with the risk of MI. METHODS A meta-analysis was conducted on the links between R353Q polymorphism and the susceptibility of MI. A comprehensive literature search was performed on 8 electronic databases. The main effects of the genotypes were estimated using a logistic regression approach. The odds ratios with 95% confidence intervals were calculated using the conventional summary method meta-analysis. The possible sources of heterogeneity among the included studies were explored using meta-regression analysis and subgroup analysis. RESULTS A total of 18 eligible case-control studies, comprising of 4701 cases and 5329 controls, were included. No overall statistical relationship was identified between R353Q and MI by any of the genetic models. The meta-regression demonstrated that the Asian population, body mass index (BMI) category, and diabetes affected the heterogeneity. In addition, subgroup analyses showed that heterogeneities were identified in Asian population and BMI category, which highly agree with the results of meta-regression. CONCLUSIONS The current meta-analysis suggested that R353Q polymorphism was not associated with the MI risk. Asian population, BMI category, and diabetes might be related to the incidence of MI. However, large-scale, case-control studies with rigorous designs are essential to provide accurate evidence.
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Affiliation(s)
- Haoming Huang
- The First Clinical Medical College, Guangzhou University of Chinese Medicine
| | - Wenjie Long
- The First Clinical Medical College, Guangzhou University of Chinese Medicine
| | - Weixuan Zhao
- The First Clinical Medical College, Guangzhou University of Chinese Medicine
| | - Ling Zou
- The First Clinical Medical College, Guangzhou University of Chinese Medicine
| | - Yudi Song
- The First Clinical Medical College, Guangzhou University of Chinese Medicine
| | | | - Zhongqi Yang
- Department of Geriatrics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, P.R. China
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Malta DC, Stopa SR, Santos MAS, Andrade SSCDA, Oliveira MMD, Prado RRD, Silva MMAD. Risk and protective factors for noncommunicable chronic diseases in adolescents by race/skin color: National Adolescent School-Based Health Survey. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2018; 20:247-259. [PMID: 28832848 DOI: 10.1590/1980-5497201700020006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 06/16/2016] [Indexed: 11/21/2022] Open
Abstract
Introduction: The race/skin color is an important predictor of health status of the population, as well as a marker of social inequalities. Objective: The aim of this paper was to describe the prevalence of the main risks and the protective factors for chronic diseases in schoolchildren, according to race/skin color differences. Methods: Data from the National Adolescent School-Based Health Survey (2012) were used. This is a cross-sectional study carried out in public and private schools. Prevalences were calculated according to the distribution by race/skin color. Prevalence ratios adjusted for age and maternal schooling were analyzed. Results: White adolescents were younger, studied more frequently in private schools and had mothers with higher levels of education in comparison to the other students. Consumption of beans and fruits was higher among black, brown, and indigenous participants. Physical activity was more frequent among indigenous people. Experimentation with alcohol was higher among white adolescents. Indigenous students reported greater physical violence. Asian and black adolescents reported experiencing greater bullying. Conclusion: Minimizing racial and ethnic disparities in health is necessary to disease prevention and health promotion among adolescents.
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Affiliation(s)
- Deborah Carvalho Malta
- Escola de Enfermagem. Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brasil
| | | | - Maria Aline Siqueira Santos
- Departamento de Vigilância de Doenças e Agravos Não Transmissíveis e Promoção da Saúde, Secretaria de Vigilância em Saúde, Ministério da Saúde - Brasília (DF), Brasil
| | - Silvânia Suely Caribé de Araújo Andrade
- Departamento de Vigilância de Doenças e Agravos Não Transmissíveis e Promoção da Saúde, Secretaria de Vigilância em Saúde, Ministério da Saúde - Brasília (DF), Brasil
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Oliveira KAD, Araújo EMD, Oliveira KAD, Casotti CA, Silva CALD, Santos DBD. Association between race/skin color and premature birth: a systematic review with meta-analysis. Rev Saude Publica 2018; 52:26. [PMID: 29641651 PMCID: PMC5893270 DOI: 10.11606/s1518-8787.2018052000406] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 04/10/2017] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To analyze the association between race/skin color and the occurrence of prematurity. METHODS Meta-analysis with observational studies, selected by a systematic review in the bibliographic databases Medline and Biblioteca Virtual da Saúde with the descriptors: “Race or ethnic group” and “ethnicity and health” associated with the words “infant premature” and “obstetric labor premature”. Articles published in the period from 2010 to 2014, of the observational epidemiological type, in Portuguese, English and Spanish, were included. Articles that did not have abstracts or that were review articles, theses, dissertations, and editorials were excluded. We adopted the relative risk and their respective confidence intervals (95%CI) as measures of effect, obtained through the random effect model and represented by the forest plot type graph. The Egger test and the Newcastle-Ottawa scale, respectively, were used to analyze possible publication biases and the quality of the studies. RESULTS Of the 926 articles identified, 17 were eligible for the study. Of the 17 full texts published, seven were retrospective cohort studies, nine were cross-sectional studies, and one was a case-control study. Except for one study, the others reported a positive association between race/color of skin and prematurity. Compared with full-term newborns, the relative risk of the combined effect in those born preterm was 1.51 (95%CI 1.39-1.69). The funnel chart suggested publication bias. CONCLUSIONS The present meta-analysis indicated a positive association for the risk of prematurity according to race/skin color.
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Affiliation(s)
- Kelly Albuquerque de Oliveira
- Universidade Estadual de Feira de Santana. Programa de Pós-Graduação em Saúde Coletiva. Feira de Santana, BA, Brasil
| | - Edna Maria de Araújo
- Universidade Estadual de Feira de Santana. Departamento de Saúde. Feira de Santana, BA, Brasil
| | | | - Cesar Augusto Casotti
- Universidade Estadual do Sudoeste da Bahia. Departamento de Saúde. Jequié, BA, Brasil
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Zervou M, Dorschner J, Ghodke-Puranik Y, Boumpas D, Niewold T, Goulielmos G. Association of IRF5 polymorphisms with increased risk for systemic lupus erythematosus in population of Crete, a southern-eastern European Greek island. Gene 2017; 610:9-14. [DOI: 10.1016/j.gene.2017.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 01/30/2017] [Accepted: 02/05/2017] [Indexed: 11/28/2022]
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Malta DC, de Moura L, Bernal RTI. Differentials in risk factors for chronic non-communicable diseases from the race/color standpoint. CIENCIA & SAUDE COLETIVA 2017; 20:713-25. [PMID: 25760112 DOI: 10.1590/1413-81232015203.16182014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 11/11/2014] [Indexed: 01/22/2023] Open
Abstract
This article aims to analyze the differences between the prevalence of risk factors of non-communicable chronic disease by race/color. It is a cross-sectional study using data from a telephone survey of 45,448 adults. Prevalence ratios for chronic disease risk factors by race/color were calculated. After adjustments were made for education and income, race/color differences persisted. Among afro-descendant and mulatto women and mulatto men a higher prevalence ratio was identified of physical activity at work and physical activity at home. Afro-descendant women and mulatto men indulged in less physical inactivity. Mulatto men and women showed a lower prevalence of smoking and consumption of 20 cigarettes daily and lower consumption of fruit and vegetables. A higher consumption of full-fat milk with and beans was observed among afro-descendant and mulatto men. Afro-descendant women had a lower prevalence of drinking and driving. Afro-descendant women and men ate more meat with fat and afro-descendant men suffered more from hypertension. Differences in risk factors by race/color can be explained by cultural aspects, by not fully adjustable socioeconomic differences that determine less access to goods and less opportunities for the afro-descendant population.
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Affiliation(s)
- Deborah Carvalho Malta
- Departamento de Vigilância de Doenças e Agravos Não Transmissíveis e Promoção da Saúde, Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília, DF, Brasil,
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Auger M, Howell T, Gomes T. Moving toward holistic wellness, empowerment and self-determination for Indigenous peoples in Canada: Can traditional Indigenous health care practices increase ownership over health and health care decisions? CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2016; 107:e393-e398. [PMID: 28026704 PMCID: PMC6972123 DOI: 10.17269/cjph.107.5366] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 10/25/2016] [Accepted: 08/31/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This study aimed to understand the role that traditional Indigenous health care practices can play in increasing individual-level self-determination over health care and improving health outcomes for urban Indigenous peoples in Canada. METHODS This project took place in Vancouver, British Columbia and included the creation and delivery of holistic workshops to engage community members (n = 35) in learning about aspects of traditional health care practices. Short-term and intermediate outcomes were discussed through two gatherings involving focus groups and surveys. Data were transcribed, reviewed, thematically analyzed, and presented to the working group for validation. RESULTS When participants compared their experiences with traditional health care to western health care, they described barriers to care that they had experienced in accessing medical doctors (e.g., racism, mistrust), as well as the benefits of traditional healing (e.g., based on relationships, holistic approach). All participants also noted that they had increased ownership over their choices around, and access to, health care, inclusive of both western and traditional options. They stressed that increased access to traditional health care is crucial within urban settings. CONCLUSIONS Self-determination within Indigenous urban communities, and on a smaller scale, ownership for individuals, is a key determinant of health for Indigenous individuals and communities; this was made clear through the analysis of the research findings and is also supported within the literature. This research also demonstrates that access to traditional healing can enhance ownership for community members. These findings emphasize that there is a continued and growing need for support to aid urban Indigenous peoples in accessing traditional health care supports.
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Affiliation(s)
- Monique Auger
- Indigenous Research Partnerships, University of British Columbia (UBC), Vancouver, BC.
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Broadbent A, Vandenbroucke J, Pearce N. Authors' Reply to: VanderWeele et al., Chiolero, and Schooling et al. Int J Epidemiol 2016; 45:2203-2205. [PMID: 27524813 PMCID: PMC5841835 DOI: 10.1093/ije/dyw163] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Jan Vandenbroucke
- Leiden University Medical Centre, Department of Clinical Epidemiology, AND Department of Clinical Epidemiology, Aarhus University Hospital
| | - Neil Pearce
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine
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Aspinall PJ. The operationalization of race and ethnicity concepts in medical classification systems: issues of validity and utility. Health Informatics J 2016. [DOI: 10.1177/1460458205055688] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article looks at the operationalization of race and ethnicity concepts in medical classification systems, notably the main bibliographical databases of MEDLINE and EMBASE. In particular, an attempt is made to assess recent changes, including the impact of the 2004 major changes to the MeSH headings for race and ethnic groups, and the introduction of 'Continental Population Groups'. The underlying conceptual basis of the typologies, their relevance for capturing specific population groups, and their overall usefulness in appraising the literature on ethnic/racial disparities in health are examined. The bibliographical database thesauri reveal the pervasiveness of the notion of the biological basis of health differences by race/ethnicity as well as continuing use of antiquated racial terminology. Their system-oriented terminology is likely to limit the effectiveness of retrieval by users who may lack knowledge of their hierarchical structures.
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Affiliation(s)
- Peter J. Aspinall
- Centre for Health Services Studies, George Allen Wing, University of
Kent, Canterbury, Kent CT2 7NF, UK,
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Brewer KM, Andrews W(J. Foundations of equitable speech-language therapy for all: The Treaty of Waitangi and Māori health. SPEECH LANGUAGE AND HEARING 2016. [DOI: 10.1080/2050571x.2015.1122876] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Buu MC, Sanders LM, Mayo JA, Milla CE, Wise PH. Assessing Differences in Mortality Rates and Risk Factors Between Hispanic and Non-Hispanic Patients With Cystic Fibrosis in California. Chest 2016; 149:380-389. [PMID: 26086984 DOI: 10.1378/chest.14-2189] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Over the past 30 years, therapeutic advances have extended the median lifespan of patients with cystic fibrosis (CF). Hispanic patients are a vulnerable subpopulation with a high prevalence of risk factors for worse health outcomes. The consequences of these differences on health outcomes have not been well described. The objective of this study was to characterize the difference in health outcomes, including mortality rate, between Hispanic and non-Hispanic patients with CF. METHODS This study is a retrospective analysis of CF Foundation Patient Registry data of California residents with CF, diagnosed during or after 1991, from 1991 to 2010. Ethnicity was self-reported. The primary outcome was mortality. Hazard ratios were estimated from a Cox regression model, stratified by sex, and adjusted for socioeconomic status, clinical risk factors, and year of diagnosis. RESULTS Of 1,719 patients, 485 (28.2%) self-identified as Hispanic. Eighty-five deaths occurred, with an overall mortality rate of 4.9%. The unadjusted mortality rate was higher among Hispanic patients than among non-Hispanic patients (9.1% vs 3.3%, P < .0001). Compared with non-Hispanic patients, Hispanic patients had a lower survival rate 18 years after diagnosis (75.9% vs 91.5%, P < .0001). Adjusted for socioeconomic status and clinical risk factors, Hispanic patients had an increased rate of death compared with non-Hispanic patients (hazard ratio, 2.81; 95% CI, 1.70-4.63). CONCLUSIONS Hispanic patients with CF have a higher mortality rate than do non-Hispanic patients, even after adjusting for socioeconomic status and clinical severity. Further investigation into the mechanism for the measured difference in lung function will help inform interventions and improve the health of all patients with CF.
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Affiliation(s)
- MyMy C Buu
- Department of Pediatrics, Division of Pediatric Pulmonary Medicine, Center for Excellence in Pulmonary Biology, Stanford University School of Medicine, Stanford, CA.
| | - Lee M Sanders
- Department of Pediatrics, Division of General Pediatrics, Center for Policy, Outcomes and Prevention, Stanford University School of Medicine, Stanford, CA
| | - Jonathan A Mayo
- Department of Pediatrics, Division of General Pediatrics, Center for Policy, Outcomes and Prevention, Stanford University School of Medicine, Stanford, CA
| | - Carlos E Milla
- Department of Pediatrics, Division of Pediatric Pulmonary Medicine, Center for Excellence in Pulmonary Biology, Stanford University School of Medicine, Stanford, CA
| | - Paul H Wise
- Department of Pediatrics, Division of General Pediatrics, Center for Policy, Outcomes and Prevention, Stanford University School of Medicine, Stanford, CA
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Bernardes CM, Valery PC, Garvey G. Exploring the cancer risk perception and interest in genetic services among Indigenous people in Queensland, Australia. Aust N Z J Public Health 2015; 38:344-8. [PMID: 25091074 DOI: 10.1111/1753-6405.12256] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 01/01/2014] [Accepted: 04/01/2014] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE The purpose of this study is to explore the levels of interest among Indigenous people with cancer in identifying cancer risk in their family and seeking genetic counselling/testing. DESIGN AND SETTING A cross-sectional survey of Indigenous cancer patients recruited from four major treating hospitals in Queensland. Participants' family history of cancer and interest in genetic counselling/testing was sought using a structured questionnaire. RESULTS Overall, 73.0% of 252 participants reported having a family history of cancer; of those, 52.8% had at least one first-degree relative with cancer. A total of 68.3% of participants indicated concern about relatives being affected by cancer and 54.4% of participants indicated they would like to assess the cancer risk in their family with a specialist. Concern was associated with willingness to discuss the risk of cancer with a specialist (p<0.001). CONCLUSIONS Indigenous cancer patients do have a family history of cancer and appear willing to undergo genetic counselling/investigation. It is of great concern that this population could miss the benefits of the technological advances in health care, creating a much larger disparity in health outcomes. IMPLICATIONS Health service providers should not assume that Indigenous cancer patients will not follow their recommendations when referred to genetic counselling/investigation services.
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Affiliation(s)
- Christina M Bernardes
- Epidemiology and Health Systems Division, Menzies School of Health Research, Charles Darwin University, Queensland
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Silva VSD, Souza I, Silva DAS, Petroski EL, Fonseca MDJMD. Correspondence between overweight and socioeconomic and demographic indicators in the adult Brazilian population. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2015; 18:476-89. [DOI: 10.1590/1980-5497201500020015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 11/22/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE: To verify the correlation between overweight and socioeconomic and demographic indicators among Brazilian adults, using data from the Brazilian Household Budget Survey from 2008/2009. METHODS: We analyzed the joint relationships between overweight and socioeconomic and demographic indicators in the Brazilian adult population (99,532,672 individuals), through the multiple correspondence analysis technique. RESULTS: The featured profile of the Brazilian adult population with regard to overweight was correlated with ages from 30 years of the most developed and economically social geographic regions of Brazil; however between genders, the correlation was in the opposite direction in the variables income, education, and subjective issues about life conditions related to food and nutrition security. CONCLUSION: By the joint relationship between overweight and selected demographic and socioeconomic indicators, the urgency of the development of strategies and/or preventive public health programs of health problems with overweight in the Brazilian adult population is suggested.
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Affiliation(s)
| | - Israel Souza
- Universidade Federal Rural do Rio de Janeiro, Brazil; Instituto Federal de Educação, Ciência e Tecnologia do Rio de Janeiro, Brazil; Fundação Oswaldo Cruz, Brazil
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Khera R, Vaughan-Sarrazin M, Rosenthal GE, Girotra S. Racial disparities in outcomes after cardiac surgery: the role of hospital quality. Curr Cardiol Rep 2015; 17:29. [PMID: 25894800 PMCID: PMC4780328 DOI: 10.1007/s11886-015-0587-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Patients from racial and ethnic minorities experience higher mortality after cardiac surgery compared to white patients, both during the early postoperative phase as well as long term. A number of factors likely explain poor outcomes in black and minority patients, which include differences in biology, comorbid health conditions, socioeconomic background, and quality of hospital care. Recent evidence suggests that a major factor underlying excess mortality in these groups is due to their over-representation in low-quality hospitals, where all patients regardless of race have worse outcomes. In this review, we examine the factors underlying racial disparities in outcomes after cardiac surgery, with a primary focus on the role of hospital quality.
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Affiliation(s)
- Rohan Khera
- Department of Internal Medicine, University of Iowa Hospitals & Clinics, 200 Hawkins Drive, E325 GH, Iowa City, IA, 52242, USA,
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Piccolo RS, Pearce N, Araujo AB, McKinlay JB. The contribution of biogeographical ancestry and socioeconomic status to racial/ethnic disparities in type 2 diabetes mellitus: results from the Boston Area Community Health Survey. Ann Epidemiol 2014; 24:648-54, 654.e1. [PMID: 25088753 PMCID: PMC4145472 DOI: 10.1016/j.annepidem.2014.06.098] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 06/17/2014] [Accepted: 06/19/2014] [Indexed: 11/23/2022]
Abstract
PURPOSE Racial/ethnic disparities in the incidence of type 2 diabetes mellitus (T2DM) are well documented, and many researchers have proposed that biogeographical ancestry (BGA) may play a role in these disparities. However, studies examining the role of BGA on T2DM have produced mixed results to date. Therefore, the objective of this research was to quantify the contribution of BGA to racial/ethnic disparities in T2DM incidence controlling for the mediating influences of socioeconomic factors. METHODS We analyzed data from the Boston Area Community Health Survey, a prospective cohort with approximately equal numbers of black, Hispanic, and white participants. We used 63 ancestry-informative markers to calculate the percentages of participants with West African and Native American ancestry. We used logistic regression with G-computation to analyze the contribution of BGA and socioeconomic factors to racial/ethnic disparities in T2DM incidence. RESULTS We found that socioeconomic factors accounted for 44.7% of the total effect of T2DM attributed to black race and 54.9% of the effect attributed to Hispanic ethnicity. We found that BGA had almost no direct association with T2DM and was almost entirely mediated by self-identified race/ethnicity and socioeconomic factors. CONCLUSIONS It is likely that nongenetic factors, specifically socioeconomic factors, account for much of the reported racial/ethnic disparities in T2DM incidence.
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Affiliation(s)
- Rebecca S Piccolo
- Department of Epidemiology, New England Research Institutes, 480 Pleasant Street, Watertown, MA; Department of Medical Statistics, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK.
| | - Neil Pearce
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Andre B Araujo
- Department of Epidemiology, New England Research Institutes, 480 Pleasant Street, Watertown, MA
| | - John B McKinlay
- Department of Epidemiology, New England Research Institutes, 480 Pleasant Street, Watertown, MA
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34
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Bond CJ, Spurling GK, Askew DA. A different kind of treatment. Med J Aust 2014; 201:10. [DOI: 10.5694/mja14.00794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 06/12/2014] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Deborah A Askew
- Inala Indigenous Health Service, Queensland Health, Brisbane, QLD
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Abstract
It is known that mortality of Jews is different from the mortality of the populations that surround them. However, the existence of commonalities in mortality of different Jewish communities across the world has not received scholarly attention. This paper aims to identify common features of the evolution of Jewish mortality among Jews living in Israel and the Diaspora. In the paper the mortality of Jews in Israel is systematically compared with the mortality of the populations of developed countries, and the findings from the earlier studies of mortality of Jews in selected Diaspora communities are re-examined. The outcome is a re-formulation and extension of the notion of the 'Jewish pattern of mortality'. The account of this pattern is based on the consistently low level of behaviourally induced mortality, the migration history of Jewish populations and the enduring influence of early-life conditions on mortality at older ages.
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Abstract
This article discusses the clinical utility of genomic information for personalized preventive care of a healthy adult. Family health history is currently the most applicable genomic predictor for common, multifactorial diseases, and can also show patterns that suggest an inherited high susceptibility to a particular form of cancer or other disease. Both bloodline ancestry and shared environmental factors are important predictors for many disease states. DNA and family history analyses give information that is probabilistic, not deterministic. Therefore, family history can highlight behavioral, social, or cultural risk factors that can be modified to prevent diseases.
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Affiliation(s)
- Kathryn Teng
- Internal Medicine, Center for Personalized Healthcare (Cleveland Clinic), 9500 Euclid Avenue, NE5-203, Cleveland, OH 44195, USA.
| | - Louise S Acheson
- Departments of Family Medicine, Oncology, and Reproductive Biology, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106-5036, USA
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Mohamad T, Panaich SS, Alani A, Badheka A, Shenoy M, Mohamad B, Kanaan E, Ali O, Elder M, Schreiber TL. Racial disparities in left main stenting: insights from a real world inner city population. J Interv Cardiol 2013; 26:43-8. [PMID: 23330830 DOI: 10.1111/j.1540-8183.2013.12012.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Left main coronary artery (LMCA) disease is associated with significant cardiovascular mortality. The data on patient characteristics' predicting outcomes after LMCA revascularization is sparse. METHODS A retrospective study of 227 patients with LMCA disease documented on coronary angiography from March 2000 to December 2008. Data included demographic variables, co-morbidities, cardiac function, and medications. Race was self-identified. The study outcome was a composite end-point including myocardial infarction (MI) and all-cause mortality. Cox proportional hazard analysis was performed to study the effect of various patient attributes including race and gender on the composite end-point. RESULTS Baseline characteristics were specifically compared between individuals who had the study outcome versus those who did not. Mean age was higher in the group with study outcomes when compared to the group without any outcomes (64.3 ± 11.8 years versus 59.2 ± 13.6 years; p = 0.013). After the final multivariate regression analysis, only African American (AA) race and age were found to be independent predictors of adverse cardiac outcome at the end of the first year (race-hazard ratio (HR) 3.82, 95% confidence interval (CI) 1.38-10.62, p = 0.010; age-HR 1.08, 95% CI 1.04-1.13, p < 0.001) and at the end of the study (race-HR 2.71, 95% CI 1.44-5.10, p = 0.002; age-HR 1.03, 95% CI 1.01-1.08, p = 0.017). CONCLUSION In our study of patients with unprotected LMCA disease, AA race, and age were significantly predictive of poor prognosis following revascularization, while gender had no predictive value in prognosticating cardiovascular mortality.
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Affiliation(s)
- Tamam Mohamad
- Department of Cardiology, Detroit Medical Center, Detroit, Michigan 48823, USA.
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Robinson S, Yardy K, Carter V. A narrative literature review of the development of obesity in infancy and childhood. J Child Health Care 2012; 16:339-54. [PMID: 22984168 DOI: 10.1177/1367493512443908] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This narrative review explains the development of excess weight gain in babies and children. It takes a life course approach which includes genetics, pre-conception, pregnancy, infancy and childhood. The paper focuses on feeding behaviours, physical activity, parental influences and the wider social and environmental context. Risk factors which can cumulatively lead to excess childhood weight gain include: under- or overweight during pregnancy; the presence of diabetes during pregnancy; low or high birth weight; having obese parents; early weaning; prolonged formula feeding; rapid weight gain in the first year; disinhibited eating patterns and the consistent availability of energy dense food at home; feeding practices which are not responsive to the child's cues; insufficient sleep among preschool children; sedentary parents; low parental education; living in poor socio-economic circumstances; absence, or perceived absence, of safe play areas; parents who lack time or confidence to authoritatively parent; environments where there is poor access to affordable lower energy dense foods; and parents who do not accept that excess weight is a health problem. Recommendations for health professionals are made.
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Affiliation(s)
- Sally Robinson
- Department of Health, Wellbeing and the Family, Canterbury Christ Church University, Canterbury, Kent, UK.
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Kowal E, Pearson G, Rouhani L, Peacock CS, Jamieson SE, Blackwell JM. Genetic research and aboriginal and Torres Strait Islander Australians. JOURNAL OF BIOETHICAL INQUIRY 2012; 9:419-432. [PMID: 23188401 DOI: 10.1007/s11673-012-9391-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 08/27/2012] [Indexed: 05/28/2023]
Abstract
While human genetic research promises to deliver a range of health benefits to the population, genetic research that takes place in Indigenous communities has proven controversial. Indigenous peoples have raised concerns, including a lack of benefit to their communities, a diversion of attention and resources from non-genetic causes of health disparities and racism in health care, a reinforcement of "victim-blaming" approaches to health inequalities, and possible misuse of blood and tissue samples. Drawing on the international literature, this article reviews the ethical issues relevant to genetic research in Indigenous populations and considers how some of these have been negotiated in a genomic research project currently under way in a remote Aboriginal community. We consider how the different levels of Indigenous research governance operating in Australia impacted on the research project and discuss whether specific guidelines for the conduct of genetic research in Aboriginal and Torres Strait Islander communities are warranted.
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Affiliation(s)
- Emma Kowal
- School of Social and Political Sciences, University of Melbourne, Melbourne, Victoria, 3010, Australia.
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Sukala WR, Page RA, Rowlands DS, Lys I, Krebs JD, Leikis MJ, Cheema BS. Exercise intervention in New Zealand Polynesian peoples with type 2 diabetes: Cultural considerations and clinical trial recommendations. Australas Med J 2012; 5:429-35. [PMID: 23024717 PMCID: PMC3442187 DOI: 10.4066/amj.2012.1311] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The Maori and Pacific Islands peoples of New Zealand suffer a greater burden of type 2 diabetes mellitus (T2DM) and associated comorbidities than their European counterparts. Empirical evidence supports the clinical application of aerobic and resistance training for effective diabetes management and potential remission, but few studies have investigated the effectiveness of these interventions in specific ethnic cohorts. We recently conducted the first trial to investigate the effect of prescribed exercise training in Polynesian people with T2DM. This article presents the cultural considerations undertaken to successfully implement the study. The research procedures were accepted and approved by cultural liaisons and potential participants. The approved methodology involved a trial evaluating and comparing the effects of two, 16-week exercise regimens (i.e. aerobic training and resistance training) on glycosylated haemoglobin (HbA1c), related diabetes markers (i.e. insulin resistance, blood lipids, relevant cytokines and anthropometric and hemodynamic indices) and health-related quality of life. Future exercise-related research or implementation strategies in this cohort should focus on cultural awareness and techniques to enhance participation and compliance. Our approach to cultural consultation could be considered by researchers undertaking trials in this and other ethnic populations suffering an extreme burden of T2DM, including indigenous Australians and Americans.
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Affiliation(s)
- William R. Sukala
- Institute of Food, Nutrition & Human Health, Massey University, Wellington, New Zealand
- School of Health and Human Sciences, Southern Cross University, Lismore, Australia
| | - Rachel A. Page
- Institute of Food, Nutrition & Human Health, Massey University, Wellington, New Zealand
| | - David S. Rowlands
- School of Sport and Exercise, Massey University, Wellington, New Zealand
| | - Isabelle Lys
- Faculty of Engineering, Health, Science and the Environment, Charles Darwin University, Australia
| | - Jeremy D. Krebs
- Faculty of Medicine, University of Otago, Wellington, New Zealand
| | - Murray J. Leikis
- Wellington Hospital, Capital and Coast District Health Board, Wellington, New Zealand
| | - Birinder S. Cheema
- School of Science and Health, University of Western Sydney, Campbelltown, Australia
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Baer RD, Arteaga E, Dyer K, Eden A, Gross R, Helmy H, Karnyski M, Papadopoulos A, Reeser D. Concepts of race and ethnicity among health researchers: patterns and implications. ETHNICITY & HEALTH 2012; 18:211-225. [PMID: 22900633 DOI: 10.1080/13557858.2012.713091] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES This study adds to the discussion of appropriate categories of analysis in health research. We contribute data based on actual interviews about the concepts of race and ethnicity, conducted among a broad range of US health researchers. DESIGN In-person qualitative interviews were conducted with 73 scientists at two health research institutions, one that focused on public health research, and one that focused on research about a specific disease. This represents a larger and more interdisciplinary sample of health researchers than has been previously interviewed about these topics. RESULTS We identify a core model of how race and ethnicity are understood. The respondents were confused about the concepts of race and ethnicity and their link to genetic differences between populations; many treated these concepts as interchangeable and genetically based. Although ethnicity was considered somewhat more socially constructed, it was often felt to cause unhealthy behavior. In addition, the situation is not improving; the younger health researchers tended to put a stronger emphasis on the genetic aspects of race than did the older health researchers. CONCLUSION Unlike reviews of how these concepts are used in scientific publications in which race and ethnicity are often undefined, our face-to-face interviews with these researchers allowed an understanding of their concepts of race and ethnicity. Building on their actual perspectives, these data suggest alternative approaches to formal and continuing educational training for health researchers. We recommend beginning with discussions of human diversity, and then moving on to what race and ethnicity are - and are not.
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Affiliation(s)
- Roberta D Baer
- Department of Anthropology, University of South Florida, Tampa, FL, USA.
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Brewer N, Pearce N, Jeffreys M, White P, Ellison-Loschmann L. Demographic differences in stage at diagnosis and cervical cancer survival in New Zealand, 1994-2005. J Womens Health (Larchmt) 2012; 18:955-63. [PMID: 19580365 DOI: 10.1089/jwh.2008.1163] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To investigate ethnic, socioeconomic, and urban/rural differences in stage at diagnosis and cervical cancer survival in New Zealand. METHODS The study involved 1594 cervical cancer cases registered during 1994-2005. Cox regression was used to estimate adjusted cervical cancer mortality hazard ratios (HRs). RESULTS Māori and Pacific women had higher death rates than Other (predominantly European) women, with age and year of diagnosis adjusted HRs of 2.15 (95% CI 1.68-2.75) and 1.98 (95% CI 1.25-3.13), respectively, whereas Asian women had a lower (nonstatistically significant) risk (0.81, 95% CI 0.47-1.42). Adjustment for stage reduced the HR in Māori to 1.62 (95% CI 1.25-2.09), but there was little change for Pacific or Asian women. These patterns varied over time: for cases diagnosed during 1994-1997, the HR for Māori women was 2.34 (95% CI 1.68-3.27), which reduced to 1.83 (95% CI 1.29-2.60) when adjusted for stage; for cases diagnosed during 2002-2005, the corresponding estimates were 1.54 (95% CI 0.75-3.13) and 0.90 (95% CI 0.43-1.89). Socioeconomic status and urban/rural residence had only marginal effects. CONCLUSIONS There were major ethnic differences in cervical cancer survival in New Zealand that were only partly explained by stage at diagnosis. These patterns varied over time, with postdiagnostic factors playing an important role in the high Māori mortality rates in the 1990s, but in more recent years, the excess mortality in Māori women appeared to be almost entirely due to stage at diagnosis, indicating that ethnic differences in access to and uptake of screening and treatment of premalignant lesions may have been playing a major role.
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Affiliation(s)
- Naomi Brewer
- Centre for Public Health Research, Massey University, Wellington, New Zealand.
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Grant CC, Emery D, Milne T, Coster G, Forrest CB, Wall CR, Scragg R, Aickin R, Crengle S, Leversha A, Tukuitonga C, Robinson EM. Risk factors for community-acquired pneumonia in pre-school-aged children. J Paediatr Child Health 2012; 48:402-12. [PMID: 22085309 DOI: 10.1111/j.1440-1754.2011.02244.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To identify risk factors for children developing and being hospitalised with community-acquired pneumonia. METHODS Children <5 years old residing in urban Auckland, New Zealand were enrolled from 2002 to 2004. To assess the risk of developing pneumonia, children hospitalised with pneumonia (n= 289) plus children with pneumonia discharged from the Emergency Department (n= 139) were compared with a random community sample of children without pneumonia (n= 351). To assess risk of hospitalisation, children hospitalised with pneumonia were compared with the children discharged from the Emergency Department. Adjusted odds ratio (OR) with 95% confidence intervals (CIs) were used to estimate the risk of pneumonia and hospitalisation with pneumonia. RESULTS After adjustment for season, age and ethnicity there was an increased risk of pneumonia associated with lower weight for height (OR 1.28, 95% CI 1.10-1.51), spending less time outside (1.96, 1.11-3.47), previous chest infections (2.31, 1.55-3.43) and mould in the child's bedroom (1.93, 1.24-3.02). There was an increased risk of pneumonia hospitalisation associated with maternal history of pneumonia (4.03, 1.25-16.18), living in a more crowded household (2.87, 1.33-6.41) and one with cigarette smokers (1.99, 1.05-3.81), and mould in the child's bedroom (2.39, 1.25-4.72). CONCLUSIONS Lower quality living environments increase the risk of pneumonia and hospitalisation with pneumonia in New Zealand. Poorer nutritional status may also increase the risk of pneumonia. Improving housing quality, decreased cigarette smoke exposure and early childhood nutrition may reduce pneumonia disease burden in New Zealand.
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Affiliation(s)
- Cameron C Grant
- Department of Paediatrics: Child and Youth Health, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand.
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Lee MS, Chen RCY, Chang YH, Huang YC, Wahlqvist ML. Physical function mitigates the adverse effects of being thin on mortality in a free-living older Taiwanese cohort. J Nutr Health Aging 2012; 16:776-83. [PMID: 23131820 DOI: 10.1007/s12603-012-0379-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To examine the significance of underweight and physical function as well as their interaction on mortality in the aged. DESIGN Prospective cohort. SETTING The Elderly Nutrition and Health Survey in Taiwan during 1999-2000. PARTICIPANTS Total of 1435 representative free-living elders (739 men and 696 women). MEASUREMENTS Body composition was assessed by various anthropometrics. Physical function score (PF, ranged 0-100) was derived from the SF-36(®). Death by December 31, 2006 was the outcome measure. RESULTS After 7.9 (median: 7.0) years follow-up, 381 (223 men, 158 women) of 1435 eligible participants had died. Those with the lowest PF (<45) had 3.43 (hazards ratio (HR), 95% confidence interval (CI) = 2.20-5.36) times the all-cause mortality risk of the highest PF (≥58). Interactions for PF and BMI (P =0.02) and for PF and wrist circumference (P =0.09) on death were found after controlling for potential confounders. Jointly, compared to normal-BMI-highest-PF, the greatest HR for death occurred where BMI <18.5 kg/m2 was combined with the lowest-PF after covariate adjustments (HR = 8.67, 95% CI = 3.77-20.0). Similarly, the lowest arm muscle circumference (MAMC)-PF had a HR of 5.22 compared to mid-MAMC-highest-PF. However, percent and absolute body fat, estimated by bioelectrical impedance, was comparable to non-sarcopenic individuals. CONCLUSION Thin elderly Taiwanese with sarcopenia, and less skeleton, are at the most risk of death, especially if physical function is limited.
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Affiliation(s)
- M-S Lee
- School of Public Health, National Defense Medical Center, 161 Minchuan East Road, Sec. 6, Taipei 114, Taiwan, ROC.
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Lee MS, Huang YC, Su HH, Lee MZ, Wahlqvist ML. A simple food quality index predicts mortality in elderly Taiwanese. J Nutr Health Aging 2011; 15:815-21. [PMID: 22159767 DOI: 10.1007/s12603-011-0081-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To assess the relative predictive ability for mortality of the Overall Dietary Index-Revised (ODI-R) and the Dietary Diversity Score (DDS) among representative Taiwanese aged 65 and older. DESIGN Prospective cohort. SETTING The Elderly Nutrition and Health Survey in Taiwan during 1999-2000. PARTICIPANTS One thousand seven hundred forty three (860 men and 883 women). MEASUREMENTS Dietary quality measures, the ODI-R (0-100) and DDS (0-6) were based on 24-hour dietary recall and a food frequency questionnaire at baseline. Death by National Death Registry up to 2008 was the outcome measure. RESULTS During follow-up, 624 subjects died. The survivors had both significantly higher (P <0.001) ODI-R (66.9 vs. 63.6) and DDS (4.69 vs. 4.30) than the deceased. The two indices were correlated (r=0.46). After adjustment for potential covariates, the hazard ratios (HR) (95% CI) were 0.63 (0.42-0.97), 0.71 (0.49-1.04) and 0.53 (0.37-0.76) for those whose ODI-R scores were 60-65, 65-70, >70, respectively, compared to those whose ODI-R scores were > 50 (P for trend <0.001). For DDS, the multi-variable HRs (95% CI) were 0.74 (0.55-1.00), 0.52 (0.38-0.72) and 0.50 (0.31-0.81) for those whose DDS were 4, 5, 6, respectively, compared to those whose DDS were ≤3 (P for trend<0.001). Total cancer, diabetes mortalities and pneumonia were similarly benefited according to trends. CONCLUSION ODI-R ≥ 60, and DDS ≥ 4 are predictors of all-cause and cause-specific mortalities. Of the two, DDS is the more predictive. Nutrition policy could be informed and clinical practice enhanced by these population relevant food-health relationships.
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Affiliation(s)
- M-S Lee
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC.
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Copland RJ, Denny SJ, Robinson EM, Crengle S, Ameratunga S, Dixon R. Self-reported pregnancy and access to primary health care among sexually experienced New Zealand high school students. J Adolesc Health 2011; 49:518-24. [PMID: 22018567 DOI: 10.1016/j.jadohealth.2011.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Revised: 03/18/2011] [Accepted: 04/01/2011] [Indexed: 11/16/2022]
Abstract
PURPOSE To determine the prevalence of self-reported pregnancy among sexually experienced high school students, and the association between teenage pregnancy and access to primary health care. METHODS Between March and October 2007, 96 high schools throughout New Zealand participated in Youth'07, a cross-sectional Health and Wellbeing survey. The dataset included 2,620 (1,217 females and 1,403 males) year 9 through 13 students who reported ever having sexual intercourse and responded to a question about whether they had ever been pregnant or ever caused a pregnancy. RESULTS Nationwide, 10.6% of sexually experienced high school students self-reported that they had been pregnant (11.6%) or caused a pregnancy (9.9%). Māori (15.3%) and Pacific Island (14.1%) students had the highest self-reports of pregnancy. Foregone health care was reported by 24.2% of sexually experienced students. Students who self-reported pregnancy reported greater difficulty accessing health care (41.7% vs. 20.6%; odds ratio: 2.6); however, when they accessed care, the majority received confidential care (67.4%) as compared with pregnancy-inexperienced peers (51.6%). Concern about privacy was the most common reason for not accessing health care. Other barriers included uncertainty about how to access care and lack of transportation (all p values < .05). CONCLUSIONS Self-reported pregnancy among sexually active high school students in New Zealand is high and ethnic disparities exist. Being pregnant or causing a pregnancy is associated with difficulty accessing health care. Further research is needed to identify drivers for ethnic differences and determine what the cause-and-effect relationship between teenage pregnancy and access to health care looks like.
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Affiliation(s)
- Rachel J Copland
- Department of Community Paediatrics, School of Population Health, The University of Auckland, Auckland, New Zealand
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Zervou MI, Vazgiourakis VM, Yilmaz N, Kontaki E, Trouw LA, Toes RE, Bicakcigil M, Boumpas DT, Yavuz S, Goulielmos GN. TRAF1/C5, eNOS, C1q, but not STAT4 and PTPN22 gene polymorphisms are associated with genetic susceptibility to systemic lupus erythematosus in Turkey. Hum Immunol 2011; 72:1210-3. [PMID: 21968398 DOI: 10.1016/j.humimm.2011.09.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Revised: 09/06/2011] [Accepted: 09/19/2011] [Indexed: 12/31/2022]
Abstract
A significant source of variability in the literature on systemic lupus erythematosus (SLE) susceptibility genes has been the inability to replicate genetic findings across different racial or ethnic groups. We investigated whether a single nucleotide polymorphism (SNP) of the STAT4 (rs7574865), PTPN22 (rs2476601), TRAF1/C5 (rs10818488), and C1q (rs292001) genes as well as the 27-bp VNTR polymorphism on intron 4 of eNOS, previously associated with SLE in other populations, are also associated with SLE risk in Turkey. A group of 158 SLE patients and 155 healthy controls were included in this study. A genetic association of the TRAF1/C5, C1q, and eNOS gene polymorphism, but not of STAT4 and PTPN22, was found to confer a degree of risk for SLE. These data highlight the importance of comparative studies in different populations to confirm the previously detected genetic associations.
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Affiliation(s)
- Maria I Zervou
- Laboratory of Molecular Medicine and Human Genetics, Department of Medicine, Medical School, University of Crete, and Department of Rheumatology, Clinical Immunology and Allergy, University Hospital of Heraklion, Heraklion, Greece
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Levy A, Chargari C, Desrez G, Leroux S, Sneyd MJ, Mozer P, Comperat E, Feuvret L, Lang P, Lopez S, Assouline A, Hemery C, Mazeron JJ, Simon JM. Poorer outcome in Polynesian patients with prostate cancer treated with definitive conformational radiation therapy. Radiother Oncol 2011; 101:502-7. [PMID: 21723636 DOI: 10.1016/j.radonc.2011.05.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 05/19/2011] [Accepted: 05/26/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE To compare freedom from biochemical failure (FFBF) of French Polynesian (FP) and Native European (NE) prostate cancer patients after definitive conformal radiotherapy (RT). PATIENTS AND METHODS Data were reviewed from medical records of 152 consecutive patients (46 FP and 106 NE) with clinically localised prostate cancer treated with definitive RT. Neoadjuvant androgen deprivation therapy (ADT) was used in 22% of cases. Definition for biochemical failure was a rise by 2 ng/mL or more above the nadir prostate-specific antigen (PSA) level. The median follow-up was 34 months. RESULTS In comparison to NE patients, FP patients were younger (p=0.002) with a higher low-risk proportion (p=0.06). Probability of 5-year FFBF was 77% in the NE cohort and 58.0% in the FP cohort (p=0.017). Univariate analysis showed that FP ethnicity was associated with worse prognosis in high-risk tumours (p=0.004). Cox multivariate analysis showed that factors associated with FFBF were risk category (p<0.017), and FP origin (p=0.03), independently of ADT and radiation dose. CONCLUSION FP ethnicity was an independent prognostic factor for biochemical relapse after definitive conformal RT for prostate cancer.
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Affiliation(s)
- Antonin Levy
- Department of Radiation Oncology, Pitie-Salpetriere University Hospital, Paris, France
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de Araújo EM, Costa MDCN, de Oliveira NF, Santana FDS, Barreto ML, Hogan V, de Araújo TM. Spatial distribution of mortality by homicide and social inequalities according to race/skin color in an intra-urban Brazilian space. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2011; 13:549-60. [PMID: 21180845 DOI: 10.1590/s1415-790x2010000400001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2009] [Accepted: 05/22/2010] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION In Brazil, deaths by external causes rank first in the mortality statistics. Nevertheless, studies which investigate the relationship between mortality by external causes and race/skin color are scarce. OBJECTIVES To evaluate the relative contribution of race/skin color to the spatial distribution of mortality by homicide in Salvador, state of Bahia, Brazil, in the period 1998 - 2003. MATERIAL AND METHODS This is a spatial aggregate study including secondary data on 5,250 subjects, using a unit of analysis called the "weighting area" (WA). Annual average death rates by homicide were estimated. The Global and Local Moran Index were used to evaluate the presence of spatial autocorrelation and the Conditional Auto Regressive (CAR) model was employed to evaluate the referred effect, using the R statistical package. RESULTS Global and Local Moran's I tests were significant. CAR regression showed that the predicted mortality rate increases when there is a growth in the proportion of black males aged between 15 and 49 years. Geometrically weighted regression (GWR) showed a very small variation of the local coefficients for all predictors. CONCLUSION We demonstrated that the interrelation between race, violence and space is a phenomenon which results from a long process of social inequality. Understanding these interactions requires interdisciplinary efforts that contribute to advancement of knowledge that leads to more specific Public Health interventions.
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Muennig P, Murphy M. Does racism affect health? Evidence from the United States and the United Kingdom. JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2011; 36:187-214. [PMID: 21498800 DOI: 10.1215/03616878-1191153] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Blacks have worse overall health than whites in both the United States and the United Kingdom. However, the relative difference in health between the two groups within each cultural context differs between each context. In this article, we attempt to glean insights into these health disparities. We do so by first examining what is currently known about differences in morbidity and mortality for blacks and whites in the United States and the United Kingdom. We then turn to medical examination data by race and country of birth in an attempt to further untangle the complex interplay of socioeconomic status (SES), race, and racism as determinants of health in the United States and the United Kingdom. We find that (1) longer exposure of blacks to the recipient country is a risk for mortality in the United States but not in the United Kingdom; (2) adjustment for SES matters a good deal for mortality in the United States, but less so in the United Kingdom; (3) morbidity indicators do not paint a clear picture of black disadvantage relative to whites in either context; and (4) were one to consider medical examination data alone, differences between the two groups exist only in the United States. Taken together, we conclude that it is possible that the "less racist" United Kingdom provides a healthier environment for blacks than the United States. However, there remain many mysteries that escape simple explanation. Our findings raise more questions than they answer, and the health risks and health status of blacks in the United States are much more complex than previously thought.
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