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Lee BEC, Ling M, Boyd L, Olsson CA, Sheen J. Key predictors of psychological distress and wellbeing in Australian frontline healthcare workers during COVID-19 (Omicron wave). Front Psychol 2023; 14:1200839. [PMID: 37484084 PMCID: PMC10361570 DOI: 10.3389/fpsyg.2023.1200839] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/12/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction The COVID-19 pandemic has led to significant challenges for frontline healthcare workers' (FHW), raising many mental health and wellbeing concerns for this cohort. To facilitate identification of risk and protective factors to inform treatment and interventions, this study investigated key predictors of psychological distress and subjective wellbeing in FHWs. Methods During the Omicron wave of the COVID-19 pandemic (January 2022), Victorian (Australia) doctors, nurses, allied health and non-medical staff from Emergency Departments, Intensive Care units, Aged Care, Hospital In The Home, and COVID Wards completed a cross-sectional survey consisting of the Kessler 6 item (Psychological Distress), Personal Wellbeing Index (Subjective Wellbeing), Coronavirus Health Impact Survey tool (COVID-19 related factors) and occupational factors. Multivariable linear regressions were used to evaluate unadjusted and adjusted associations. Relative weight analysis was used to compare and identify key predictors. Results Out of 167 participants, 18.1% screened positive for a probable mental illness and a further 15.3% screened positive for low wellbeing. Key risk factors for greater psychological distress included COVID infection worries, relationship stress and younger age. For both psychological distress and lower wellbeing, health status and supervisor support were key protective factors, while infection risks were key risk factors. Only positive changes in relationship quality was protective of lower wellbeing. Conclusion This study highlights the significance of social determinants and individual level factors alongside work related factors, in influencing FHWs' mental health and wellbeing during public health crises, such as the COVID-19 pandemic. Findings suggest that future interventions and supports should take a more holistic approach that considers work, social and individual level factors when supporting FHWs' mental health and wellbeing.
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Affiliation(s)
- Brian En Chyi Lee
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Mathew Ling
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University, Geelong, VIC, Australia
- Neami National, Preston, VIC, Australia
| | | | - Craig A. Olsson
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University, Geelong, VIC, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
- Centre for Adolescent Health, Murdoch Children’s Research Institute, Parkville, VIC, Australia
| | - Jade Sheen
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University, Geelong, VIC, Australia
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202
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Kim M, Park C, Sakong J, Ye S, Son SY, Baek K. Association of heavy metal complex exposure and neurobehavioral function of children. Ann Occup Environ Med 2023; 35:e23. [PMID: 37614334 PMCID: PMC10442582 DOI: 10.35371/aoem.2023.35.e23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/26/2023] [Accepted: 05/20/2023] [Indexed: 08/25/2023] Open
Abstract
Background Exposure to heavy metals is a public health concern worldwide. Previous studies on the association between heavy metal exposure and neurobehavioral functions in children have focused on single exposures and clinical manifestations. However, the present study evaluated the effects of heavy metal complex exposure on subclinical neurobehavioral function using a Korean Computerized Neurobehavior Test (KCNT). Methods Urinary mercury, lead, cadmium analyses as well as symbol digit substitution (SDS) and choice reaction time (CRT) tests of the KCNT were conducted in children aged between 10 and 12 years. Reaction time and urinary heavy metal levels were analyzed using partial correlation, linear regression, Bayesian kernel machine regression (BKMR), the weighted quantile sum (WQS) regression and quantile G-computation analysis. Results Participants of 203 SDS tests and 198 CRT tests were analyzed, excluding poor cooperation and inappropriate urine sample. Partial correlation analysis revealed no association between neurobehavioral function and exposure to individual heavy metals. The result of multiple linear regression shows significant positive association between urinary lead, mercury, and CRT. BMKR, WQS regression and quantile G-computation analysis showed a statistically significant positive association between complex urinary heavy metal concentrations, especially lead and mercury, and reaction time. Conclusions Assuming complex exposures, urinary heavy metal concentrations showed a statistically significant positive association with CRT. These results suggest that heavy metal complex exposure during childhood should be evaluated and managed strictly.
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Affiliation(s)
- Minkeun Kim
- Department of Occupational and Environmental Medicine, Yeungnam University Medical Center, Daegu, Korea
| | - Chulyong Park
- Department of Occupational and Environmental Medicine, Yeungnam University Medical Center, Daegu, Korea
- Department of Preventive Medicine and Public Health, College of Medicine, Yeungnam University, Daegu, Korea
| | - Joon Sakong
- Department of Occupational and Environmental Medicine, Yeungnam University Medical Center, Daegu, Korea
- Department of Preventive Medicine and Public Health, College of Medicine, Yeungnam University, Daegu, Korea
| | - Shinhee Ye
- Occupational Safety and Health Research Institute, Korea Occupational Safety and Health Agency, Incheon, Korea
| | - So young Son
- Department of Occupational and Environmental Medicine, Yeungnam University Medical Center, Daegu, Korea
| | - Kiook Baek
- Department of Occupational and Environmental Medicine, Yeungnam University Medical Center, Daegu, Korea
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203
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Salvatte K, Farias DR, Normando P, Berti TL, Castro IRRD, Kac G. High Serum Folate Concentration, Vitamin B12 Deficiency, and Anthropometric Nutritional Status in Brazilian Children Aged 6-59 Months: Data from the Brazilian National Survey of Child Nutrition. J Nutr 2023; 153:2094-2104. [PMID: 37220857 DOI: 10.1016/j.tjnut.2023.05.020] [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: 02/09/2023] [Revised: 05/11/2023] [Accepted: 05/19/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Vitamin B12 and folate are key nutrients that help children reach their full potential in growth and development; however, little is known about the status of these vitamins in Brazilian children. OBJECTIVES To describe the serum concentrations of vitamin B12 and folate, to investigate the association between high folate concentration (HFC) and vitamin B12 deficiency, and to evaluate the association between vitamin B12 and stunting/underweight in Brazilian children aged 6-59 mo. METHODS Data from 7417 children aged 6-59 mo collected during the Brazilian National Survey on Child Nutrition were used. Serum concentrations of vitamin B12 of <150 pmol/L and folate of <10 nmol/L were classified as deficient, and folate concentrations of >45.3 nmol/L were classified as HFC. Children with length/height-for-age z-score of less than -2 were considered stunted, and those with weight-for-age z-score of less than -2 were underweight. Logistic regression models were performed. RESULTS In Brazil, 14.2% (95% CI: 12.2, 16.1) of children aged 6-59 mo had vitamin B12 deficiency, 1.1% (95% CI: 0.5, 1.6) had folate deficiency, and 36.9% (95% CI: 33.4, 40.3) had HFC. Vitamin B12 deficiency was higher in children from the northern region of Brazil (28.5%), between 6 and 24 mo (25.3%), whose mothers had lower formal education (0-7 y; 18.7%). Children with HFC had 62% lower odds (OR: 0.38; 95% CI: 0.27, 0.54) of vitamin B12 deficiency than those with normal/deficient folate. Children with vitamin B12 deficiency and normal/deficient folate had higher odds of stunting (OR: 1.58; 95% CI: 1.02, 2.43) than children without vitamin B12 deficiency and normal/deficient folate. CONCLUSIONS Vitamin B12 deficiency is a public health problem among Brazilian children aged <2 y with vulnerable socioeconomic status. HFC was inversely associated with vitamin B12 deficiency, and lower odds of stunting were observed in children with HFC and vitamin B12 deficiency than in those with vitamin B12 deficiency and normal/deficient folate.
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Affiliation(s)
- Keronlainy Salvatte
- Department of Social and Applied Nutrition, Nutritional Epidemiology Observatory, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Dayana Rodrigues Farias
- Department of Social and Applied Nutrition, Nutritional Epidemiology Observatory, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Paula Normando
- Department of Social and Applied Nutrition, Nutritional Epidemiology Observatory, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Talita Lelis Berti
- Department of Social and Applied Nutrition, Nutritional Epidemiology Observatory, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Inês Rugani Ribeiro de Castro
- Department of Social Nutrition, Nutrition Institute, State University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Gilberto Kac
- Department of Social and Applied Nutrition, Nutritional Epidemiology Observatory, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil.
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204
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Iwata H, Wakabayashi T, Kato R. The dawn of directed acyclic graphs in primary care research and education. J Gen Fam Med 2023; 24:274-275. [PMID: 37484130 PMCID: PMC10357082 DOI: 10.1002/jgf2.627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/14/2023] [Accepted: 04/30/2023] [Indexed: 07/25/2023] Open
Abstract
Dramatical increase in articles mentioning "directed acyclic graph."
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Affiliation(s)
- Hiroyoshi Iwata
- Center for Environmental and Health SciencesHokkaido UniversitySapporoJapan
| | - Takao Wakabayashi
- Department of General and Emergency MedicineJapan Community Health‐care Organization Sapporo Hokushin HospitalSapporoJapan
| | - Rika Kato
- Department of Family MedicineTeine Family Medicinal ClinicSapporoJapan
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205
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Vickers AJ, Assel M, Dunn RL, Zabor EC, Kattan MW, van Smeden M, Dahly D. Guidelines for Reporting Observational Research in Urology: The Importance of Clear Reference to Causality. Urology 2023; 177:1-5. [PMID: 37085050 PMCID: PMC10524387 DOI: 10.1016/j.urology.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 04/05/2023] [Indexed: 04/23/2023]
Affiliation(s)
- Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY.
| | - Melissa Assel
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Rodney L Dunn
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - Emily C Zabor
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Mike W Kattan
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Maarten van Smeden
- Julius Center for Health Sciences and Primary Care, Utrecht University Medical Center, Utrecht, Netherlands
| | - Darren Dahly
- School of Public Health, University College Cork, Cork, Ireland
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206
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Daif A, Glazik R, Checchi F, Khan P. The effect of internal displacement due to armed conflict on tuberculosis treatment outcomes in northwest Syria, 2019-2020. J Migr Health 2023; 8:100195. [PMID: 37448909 PMCID: PMC10336245 DOI: 10.1016/j.jmh.2023.100195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 01/27/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023] Open
Abstract
Background Northwest Syria accounts for over 4 million people of whom more than half are internally displaced persons (IDPs). More than 1 million IDPs reside in camps and many more live in settings which are overcrowded and poorly ventilated. Suboptimal social living conditions leave these populations susceptible to tuberculosis (TB) morbidity and mortality. This study aimed to assess the effect of internal displacement due to armed conflict on the risk of unsuccessful treatment outcomes among TB patients in northwest Syria. Methods All patients registered to start TB treatment at three centres in northwest Syria between the 1st June 2019 to the 31st December 2020 were included. Unsuccessful TB treatment outcome was defined as a composite outcome combining the WHO TB treatment outcomes of treatment failure, loss to follow-up, and death. We assessed the association between internal displacement and unsuccessful TB treatment outcomes using multivariable logistic regression. We also explored the risk of an unsuccessful treatment outcome by internal displacement setting (camp, village or city). Results Of the total 737 registered patients included in the analysis, 400 (54%) were documented as internally displaced. The median age of IDPs was 30 (IQR: 21.5-48) and the median age of residents was 34 (IQR:22-50). A significantly higher percentage of those who were IDPs had an unsuccessful treatment outcome compared to residents (40% vs 18%, p<0.001). After adjustment for confounders, the relative risk of having unsuccessful TB treatment was two-fold higher in internally displaced TB patients compared to residents (95% CI: 1.5-2.6). IDPs living in villages had a 30% lower risk of an unsuccessful treatment outcome compared to IDPs living in camps (RR 95% CI: 0.50-0.91), and IDPs living in cities had a 13% lower risk of an unsuccessful treatment outcome (RR 95% CI: 0.57-1.18). Conclusion This is one of few studies which aims to quantify the effect of internal displacement on TB treatment outcomes during times of conflict. Our findings starkly highlight how social determinants contribute to poor TB outcomes and act as a starting point for much needed research on how best to manage TB in humanitarian crisis settings.
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Affiliation(s)
| | - Rosanna Glazik
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Francesco Checchi
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Palwasha Khan
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
- Africa Health Research Institute, South Africa
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207
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Remy VFM, Guseva Canu I. Healthy Bus Drivers, Sustainable Public Transport: A Three-Time Repeated Cross-Sectional Study in Switzerland. Int J Public Health 2023; 68:1605925. [PMID: 37416803 PMCID: PMC10319994 DOI: 10.3389/ijph.2023.1605925] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/02/2023] [Indexed: 07/08/2023] Open
Abstract
Objectives: To study the change in the prevalence of bus drivers' health outcomes between 2010 and 2022 and their relationship with working conditions. Method: Unionized bus drivers completed a self-administered questionnaire in 2010, 2018, and 2022 on 13 health outcomes, sick leaves, and accidents and working conditions and their change during SARS-CoV-2 crisis. For outcomes which prevalence increased since 2010, we performed logistic regression models adjusted for covariates. Results: The study sample included 772 participants in 2010, 393 in 2018, and 916 in 2022. The most prevalent health problem (≥50%) was shoulder or neck muscle pain. The most tedious working conditions were working days over 10 h. Shoulder or neck pain, sleep disorders, sick leaves, and accidents increased since 2010 and were associated with working conditions, and co-morbidity. The SARS-CoV-2 pandemic had additional negative consequences. Conclusion: Most bus drivers' working and health conditions worsened in the last 12 years. Given the study design, the results deserve a cautious interpretation and generalization. Cohort studies should confirm these results and inform interventions targeting the most tedious and harmful working conditions.
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208
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Malec SA, Taneja SB, Albert SM, Elizabeth Shaaban C, Karim HT, Levine AS, Munro P, Callahan TJ, Boyce RD. Causal feature selection using a knowledge graph combining structured knowledge from the biomedical literature and ontologies: A use case studying depression as a risk factor for Alzheimer's disease. J Biomed Inform 2023; 142:104368. [PMID: 37086959 PMCID: PMC10355339 DOI: 10.1016/j.jbi.2023.104368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 03/03/2023] [Accepted: 04/17/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND Causal feature selection is essential for estimating effects from observational data. Identifying confounders is a crucial step in this process. Traditionally, researchers employ content-matter expertise and literature review to identify confounders. Uncontrolled confounding from unidentified confounders threatens validity, conditioning on intermediate variables (mediators) weakens estimates, and conditioning on common effects (colliders) induces bias. Additionally, without special treatment, erroneous conditioning on variables combining roles introduces bias. However, the vast literature is growing exponentially, making it infeasible to assimilate this knowledge. To address these challenges, we introduce a novel knowledge graph (KG) application enabling causal feature selection by combining computable literature-derived knowledge with biomedical ontologies. We present a use case of our approach specifying a causal model for estimating the total causal effect of depression on the risk of developing Alzheimer's disease (AD) from observational data. METHODS We extracted computable knowledge from a literature corpus using three machine reading systems and inferred missing knowledge using logical closure operations. Using a KG framework, we mapped the output to target terminologies and combined it with ontology-grounded resources. We translated epidemiological definitions of confounder, collider, and mediator into queries for searching the KG and summarized the roles played by the identified variables. We compared the results with output from a complementary method and published observational studies and examined a selection of confounding and combined role variables in-depth. RESULTS Our search identified 128 confounders, including 58 phenotypes, 47 drugs, 35 genes, 23 collider, and 16 mediator phenotypes. However, only 31 of the 58 confounder phenotypes were found to behave exclusively as confounders, while the remaining 27 phenotypes played other roles. Obstructive sleep apnea emerged as a potential novel confounder for depression and AD. Anemia exemplified a variable playing combined roles. CONCLUSION Our findings suggest combining machine reading and KG could augment human expertise for causal feature selection. However, the complexity of causal feature selection for depression with AD highlights the need for standardized field-specific databases of causal variables. Further work is needed to optimize KG search and transform the output for human consumption.
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Affiliation(s)
- Scott A Malec
- Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sanya B Taneja
- Intelligent Systems Program, University of Pittsburgh, Pittsburgh, PA, USA
| | - Steven M Albert
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - C Elizabeth Shaaban
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Helmet T Karim
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Arthur S Levine
- Department of Neurobiology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; The Brain Institute, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Paul Munro
- School of Computing and Information, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tiffany J Callahan
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - Richard D Boyce
- Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Intelligent Systems Program, University of Pittsburgh, Pittsburgh, PA, USA
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209
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Zambrano LD, Wu MJ, Martin L, Malloch L, Chen S, Newhams MM, Kucukak S, Son MB, Sanders C, Patterson K, Halasa N, Fitzgerald JC, Leroue MK, Hall M, Irby K, Rowan CM, Wellnitz K, Sahni LC, Loftis L, Bradford TT, Staat M, Babbitt C, Carroll CL, Pannaraj PS, Kong M, Schuster JE, Chou J, Patel MM, Randolph AG, Campbell AP, Hobbs CV. Risk Factors for Multisystem Inflammatory Syndrome in Children: A Case-control Investigation. Pediatr Infect Dis J 2023; 42:e190-e196. [PMID: 37000922 PMCID: PMC10265536 DOI: 10.1097/inf.0000000000003900] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
BACKGROUND In a 2020 pilot case-control study using medical records, we reported that non-Hispanic Black children were more likely to develop multisystem inflammatory syndrome in children (MIS-C) after adjustment for sociodemographic factors and underlying medical conditions. Using structured interviews, we investigated patient, household, and community factors underlying MIS-C likelihood. METHODS MIS-C case patients hospitalized in 2021 across 14 US pediatric hospitals were matched by age and site to outpatient controls testing positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within 3 months of the admission date. Caregiver interviews queried race/ethnicity, medical history, and household and potential community exposures 1 month before MIS-C hospitalization (case-patients) or after SARS-CoV-2 infection (controls). We calculated adjusted odds ratios (aOR) using mixed-effects multivariable logistic regression. RESULTS Among 275 case patients and 496 controls, race/ethnicity, social vulnerability and patient or family history of autoimmune/rheumatologic disease were not associated with MIS-C. In previously healthy children, MIS-C was associated with a history of hospitalization for an infection [aOR: 4.8; 95% confidence interval (CI): 2.1-11.0]. Household crowding (aOR: 1.7; 95% CI: 1.2-2.6), large event attendance (aOR: 1.7; 95% CI: 1.3-2.1), school attendance with limited masking (aOR: 2.6; 95% CI: 1.1-6.6), public transit use (aOR: 1.8; 95% CI: 1.4-2.4) and co-resident testing positive for SARS-CoV-2 (aOR: 2.2; 95% CI: 1.3-3.7) were associated with increased MIS-C likelihood, with risk increasing with the number of these factors. CONCLUSIONS From caregiver interviews, we clarify household and community exposures associated with MIS-C; however, we did not confirm prior associations between sociodemographic factors and MIS-C.
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Affiliation(s)
- Laura D. Zambrano
- COVID-19 Response Team, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael J. Wu
- COVID-19 Response Team, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lora Martin
- Division of Infectious Disease, Department of Pediatrics, Children’s of Mississippi, University of Mississippi Medical Center, Jackson, Mississippi
| | - Lacy Malloch
- Division of Infectious Disease, Department of Pediatrics, Children’s of Mississippi, University of Mississippi Medical Center, Jackson, Mississippi
| | - Sabrina Chen
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Margaret M. Newhams
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Suden Kucukak
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Mary Beth Son
- Division of Immunology, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Cameron Sanders
- Division of Infectious Disease, Department of Pediatrics, Children’s of Mississippi, University of Mississippi Medical Center, Jackson, Mississippi
| | - Kayla Patterson
- Division of Infectious Disease, Department of Pediatrics, Children’s of Mississippi, University of Mississippi Medical Center, Jackson, Mississippi
| | - Natasha Halasa
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Julie C. Fitzgerald
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Matthew K. Leroue
- Department of Pediatrics, Section of Critical Care Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Mark Hall
- Division of Pediatric Critical Care Medicine, Nationwide Children’s Hospital Columbus, Ohio
| | - Katherine Irby
- Section of Pediatric Critical Care, Department of Pediatrics, Arkansas Children’s Hospital, Little Rock, Arkansas
| | - Courtney M. Rowan
- Division of Pediatric Critical Care, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana
| | - Kari Wellnitz
- Division of Critical Care, Stead Family Department of Pediatrics, University of Iowa Hospitals & Clinics, Iowa City, Iowa
| | - Leila C. Sahni
- Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas
| | - Laura Loftis
- Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas
| | - Tamara T. Bradford
- Division of Cardiology, Department of Pediatrics, Louisiana State University Health Sciences Center and Children’s Hospital of New Orleans, New Orleans, Louisiana
| | - Mary Staat
- Department of Pediatrics, University of Cincinnati College of Medicine, Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Christopher Babbitt
- Miller Children’s and Women’s Hospital of Long Beach, Long Beach, California
| | - Christopher L. Carroll
- Division of Pediatric Critical Care, Connecticut Children’s Hospital, Hartford, Connecticut
| | - Pia S. Pannaraj
- Division of Infectious Diseases, Children’s Hospital Los Angeles and Departments of Pediatrics and Molecular Microbiology and Immunology, University of Southern California, Los Angeles, California
| | - Michele Kong
- Department of Pediatrics, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Jennifer E. Schuster
- Department of Pediatrics, Children’s Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Janet Chou
- Division of Immunology, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Manish M. Patel
- COVID-19 Response Team, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Adrienne G. Randolph
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Department of Anesthesia, Harvard Medical School, Boston, Massachusetts
| | - Angela P. Campbell
- COVID-19 Response Team, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Charlotte V. Hobbs
- Division of Infectious Disease, Department of Pediatrics, Children’s of Mississippi, University of Mississippi Medical Center, Jackson, Mississippi
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Tanaka T, Jones MP. Letter: deciphering the complexities of chronic liver disease epidemiology through a directed acyclic graph (DAG). Aliment Pharmacol Ther 2023; 57:1207-1209. [PMID: 37094313 DOI: 10.1111/apt.17427] [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: 02/07/2023] [Revised: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 04/26/2023]
Affiliation(s)
- Tomohiro Tanaka
- Division of Gastroenterology and Hepatology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Michael P Jones
- Department of Biostatistics, University of Iowa College of Public Health, Iowa City, Iowa, USA
- Center for Access and Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa, USA
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211
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Noyd DH, Janitz A, Baker A, Beasley W, Etzold N, Kendrick D, Oeffinger K. Rural, Large Town, and Urban Differences in Optimal Subspecialty Follow-up and Survivorship Care Plan Documentation among Childhood Cancer Survivors. Cancer Epidemiol Biomarkers Prev 2023; 32:634-641. [PMID: 36827210 PMCID: PMC11082834 DOI: 10.1158/1055-9965.epi-22-0966] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/14/2022] [Accepted: 02/21/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Children with cancer from rural and nonurban areas face unique challenges. Health equity for this population requires attention to geographic disparities in optimal survivorship-focused care. METHODS The Oklahoma Childhood Cancer Survivor Cohort was based on all patients reported to the institutional cancer registry and ≤ 18 years old at diagnosis between January 1, 2005, and September 24, 2014. Suboptimal follow-up was defined as no completed oncology-related clinic visit five to 7 years after their initial diagnosis (survivors were 7-25 years old at end of the follow-up period). The primary predictor of interest was rurality. RESULTS Ninety-four (21%) of the 449 eligible survivors received suboptimal follow-up. There were significant differences (P = 0.01) as 36% of survivors from large towns (n = 28/78) compared with 21% (n = 20/95) and 17% (n = 46/276) of survivors from small town/isolated rural and urban areas received suboptimal follow-up, respectively. Forty-five percent of adolescents at diagnosis were not seen in the clinic compared with 17% of non-adolescents (P < 0.01). An adjusted risk ratio of 2.2 (95% confidence interval, 1.5, 3.2) was observed for suboptimal follow-up among survivors from large towns, compared with survivors from urban areas. Seventy-three percent of survivors (n = 271/369) had a documented survivorship care plan with similar trends by rurality. CONCLUSIONS Survivors from large towns and those who were adolescents at the time of diagnosis were more likely to receive suboptimal follow-up care compared with survivors from urban areas and those diagnosed younger than thirteen. IMPACT Observed geographic disparities in survivorship care will inform interventions to promote equitable care for survivors from nonurban areas.
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Affiliation(s)
- David H. Noyd
- The University of Oklahoma Health Sciences Center, College of Medicine, Department of Pediatrics
- The University of Oklahoma School of Community Medicine, Department of Medical Informatics
| | - Amanda Janitz
- The University of Oklahoma Health Sciences Center, College of Public Health, Department of Epidemiology and Biostatistics
| | - Ashley Baker
- The University of Oklahoma Health Sciences Center, College of Medicine, Department of Pediatrics
| | - William Beasley
- The University of Oklahoma Health Sciences Center, College of Medicine, Department of Pediatrics
| | - Nancy Etzold
- The University of Oklahoma Health Sciences Center
| | - David Kendrick
- The University of Oklahoma School of Community Medicine, Department of Medical Informatics
| | - Kevin Oeffinger
- Duke University Medical Center, School of Medicine, Department of Medicine
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Cordoba E, Garofalo R, Kuhn LM, Pearson CR, Batey DS, Bruce J, Radix A, Belkind U, Hidalgo MA, Hirshfield S, Schnall R. A Cross-sectional Study of Perceived Stress and Racial Discrimination Among a National Sample of Young Men Who Have Sex With Men. J Assoc Nurses AIDS Care 2023; 34:226-237. [PMID: 37129475 PMCID: PMC11262710 DOI: 10.1097/jnc.0000000000000407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
ABSTRACT Research regarding the impact of racism on stress among young men who have sex with men (YMSM) is sparse. Secondary data were assessed from a 2018-2020 national mHealth prevention trial for YMSM aged 13-18 years (N = 542). Linear regression models examined associations between perceived stress and interpersonal and vicarious racism, adjusting for covariates. Stratified models by race/ethnicity were included. A subanalysis (n = 288) examined associations between nine interpersonal racial discriminatory events and perceived stress. Over 50% of participants experienced racial discrimination. In the multivariable models, exposure to interpersonal (β = 1.43, p-value: .038) and vicarious (β = 1.77, p-value: .008) racism was associated with perceived stress because there were four interpersonal racial discriminatory events. Stratified analysis by race/ethnicity found significant associations between interpersonal and vicarious racism and perceived stress among some racial/ethnic groups. Racial discrimination was common among YMSM, making them susceptible to the possible effects of vicarious and interpersonal racism on stress.
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Affiliation(s)
- Evette Cordoba
- School of Nursing, Columbia University, New York, NY 10032
| | - Robert Garofalo
- Division of Adolescent & Young Adult Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 East Chicago Avenue, Chicago, IL 60611
- Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611
| | - Lisa M. Kuhn
- Division of Adolescent & Young Adult Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 East Chicago Avenue, Chicago, IL 60611
- Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611
| | - Cynthia R. Pearson
- Indigenous Wellness Research Institute, School of Social Work, University of Washington, 4101 15 Avenue Northeast, Seattle, Washington, 98105
| | - D. Scott Batey
- School of Social Work, Tulane University, 127 Elk Place, New Orleans, LA 70112
| | - Josh Bruce
- Birmingham AIDS Outreach, 205 32 Street, Birmingham, AL 35233
| | - Asa Radix
- Birmingham AIDS Outreach, 205 32 Street, Birmingham, AL 35233
- Callen-Lorde Community Health Center, 356 West 18 Street, New York, NY 10011
| | - Uri Belkind
- Birmingham AIDS Outreach, 205 32 Street, Birmingham, AL 35233
- Callen-Lorde Community Health Center, 356 West 18 Street, New York, NY 10011
| | - Marco A. Hidalgo
- University of California Los Angeles, David Geffen School of Medicine, Department of Medicine, 911 Broxton Avenue, Los Angeles, CA 90024
| | - Sabina Hirshfield
- STAR Program, Department of Medicine, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, MSC 1240, Brooklyn, NY 11203
| | - Rebecca Schnall
- School of Nursing, Columbia University, New York, NY 10032
- Columbia University, Mailman School of Public Health, Department of Population and Family Health, New York, NY 10032
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213
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Vinke PC, Combalia M, de Bock GH, Leyrat C, Spanjaart AM, Dalle S, Gomes da Silva M, Fouda Essongue A, Rabier A, Pannard M, Jalali MS, Elgammal A, Papazoglou M, Hacid MS, Rioufol C, Kersten MJ, van Oijen MG, Suazo-Zepeda E, Malhotra A, Coquery E, Anota A, Preau M, Fauvernier M, Coz E, Puig S, Maucort-Boulch D. Monitoring multidimensional aspects of quality of life after cancer immunotherapy: protocol for the international multicentre, observational QUALITOP cohort study. BMJ Open 2023; 13:e069090. [PMID: 37105689 PMCID: PMC10151860 DOI: 10.1136/bmjopen-2022-069090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
INTRODUCTION Immunotherapies, such as immune checkpoint inhibitors and chimeric antigen receptor T-cell therapy, have significantly improved the clinical outcomes of various malignancies. However, they also cause immune-related adverse events (irAEs) that can be challenging to predict, prevent and treat. Although they likely interact with health-related quality of life (HRQoL), most existing evidence on this topic has come from clinical trials with eligibility criteria that may not accurately reflect real-world settings. The QUALITOP project will study HRQoL in relation to irAEs and its determinants in a real-world study of patients treated with immunotherapy. METHODS AND ANALYSIS This international, observational, multicentre study takes place in France, the Netherlands, Portugal and Spain. We aim to include about 1800 adult patients with cancer treated with immunotherapy in a specifically recruited prospective cohort, and to additionally obtain data from historical real-world databases (ie, databiobanks) and medical administrative registries (ie, national cancer registries) in which relevant data regarding other adult patients with cancer treated with immunotherapy has already been stored. In the prospective cohort, clinical health status, HRQoL and psychosocial well-being will be monitored until 18 months after treatment initiation through questionnaires (at baseline and 3, 6, 12 and 18 months thereafter), and by data extraction from electronic patient files. Using advanced statistical methods, including causal inference methods, artificial intelligence algorithms and simulation modelling, we will use data from the QUALITOP cohort to improve the understanding of the complex relationships among treatment regimens, patient characteristics, irAEs and HRQoL. ETHICS AND DISSEMINATION All aspects of the QUALITOP project will be conducted in accordance with the Declaration of Helsinki and with ethical approval from a suitable local ethics committee, and all patients will provide signed informed consent. In addition to standard dissemination efforts in the scientific literature, the data and outcomes will contribute to a smart digital platform and medical data lake. These will (1) help increase knowledge about the impact of immunotherapy, (2) facilitate improved interactions between patients, clinicians and the general population and (3) contribute to personalised medicine. TRIAL REGISTRATION NUMBER NCT05626764.
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Affiliation(s)
- Petra C Vinke
- Epidemiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Marc Combalia
- Institut d'Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain
- Dermatology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Geertruida H de Bock
- Epidemiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Clémence Leyrat
- Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Anne Mea Spanjaart
- Hematology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
- LYMMCARE, Amsterdam, The Netherlands
| | - Stephane Dalle
- Dermatology, Cancer Research Center of Lyon, Lyon Sud Hospital, Pierre-Bénite, France
- University Claude Bernard Lyon 1, Villeurbanne, France
- ImmuCare, Cancer Institute of the Hospices Civils de Lyon, Lyon, France
| | | | | | - Aurélie Rabier
- ImmuCare, Cancer Institute of the Hospices Civils de Lyon, Lyon, France
| | - Myriam Pannard
- INSERM Unit U1296 Radiation: Defence, Health, Environment, Lumière University Lyon 2 Psychology Institute, Bron, France
| | - Mohammad S Jalali
- MGH Institute for Technology Assessment, Harvard Medical School, Boston, Massachusetts, USA
| | - Amal Elgammal
- Scientific Academy for Service Technology e.V. (ServTech), Potsdam, Germany
- Egypt University of Informatics, Cairo, Egypt
| | - Mike Papazoglou
- Scientific Academy for Service Technology e.V. (ServTech), Potsdam, Germany
- School of Computer Science and Engineering, University of New South Wales, Sydney, New South Wales, Australia
- School of Computing, Macquarie University, Sydney, New South Wales, Australia
| | - Mohand-Said Hacid
- LIRIS, CNRS UMR 5205, Universite Claude Bernard Lyon 1, Villeurbanne, France
| | - Catherine Rioufol
- Clinical Oncology Pharmacy Department, Hospital Lyon-South, Cancer Institute of the Hospices Civils de Lyon, Pierre-Benite, France
| | - Marie-José Kersten
- Hematology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
- LYMMCARE, Amsterdam, The Netherlands
| | - Martijn Gh van Oijen
- Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - Erick Suazo-Zepeda
- Epidemiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Ananya Malhotra
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Emmanuel Coquery
- LIRIS, CNRS UMR 5205, Universite Claude Bernard Lyon 1, Villeurbanne, France
| | - Amélie Anota
- Direction of Clinical Research and Innovation & Human and Social Sciences, Centre Léon Bérard, Lyon, France
- French National platform Quality of Life and Cancer, Lyon, France
| | - Marie Preau
- INSERM Unit U1296 Radiation: Defence, Health, Environment, Lumière University Lyon 2 Psychology Institute, Bron, France
| | - Mathieu Fauvernier
- University Claude Bernard Lyon 1, Villeurbanne, France
- Service de Biostatistique et Bioinformatique, Hospices Civils de Lyon, Pôle Santé Publique, Lyon, France
- UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, CNRS, Villeurbanne, France
| | - Elsa Coz
- University Claude Bernard Lyon 1, Villeurbanne, France
- Service de Biostatistique et Bioinformatique, Hospices Civils de Lyon, Pôle Santé Publique, Lyon, France
- UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, CNRS, Villeurbanne, France
| | - Susana Puig
- Institut d'Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain
- Dermatology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Enfermedades Raras, Barcelona, Spain
| | - Delphine Maucort-Boulch
- University Claude Bernard Lyon 1, Villeurbanne, France
- Service de Biostatistique et Bioinformatique, Hospices Civils de Lyon, Pôle Santé Publique, Lyon, France
- UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, CNRS, Villeurbanne, France
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Freitas-Costa NC, Andrade P, Normando P, Salvatte Nunes KS, Raymundo CE, Ribeiro de Castro IR, Maria de Aquino Lacerda E, Farias DR, Kac G. Association of development quotient with nutritional status of vitamins B6, B12, and folate in 6-59-month-old children: Results from the Brazilian National Survey on Child Nutrition (ENANI-2019). Am J Clin Nutr 2023:S0002-9165(23)47384-4. [PMID: 37105522 DOI: 10.1016/j.ajcnut.2023.04.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 03/28/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Vitamins B6, B12, and folate are essential for the formation and maintenance of the human brain, but studies evaluating these vitamins with early childhood development (ECD) in children under five are limited and controversial. OBJECTIVE To evaluate the association between vitamins B6, B12, and folate concentrations/status and ECD. METHODS Data regarding 6,520 children aged 6-59 months (from the Brazilian National Survey on Child Nutrition [ENANI-2019]) were analyzed. ECD was assessed using the Survey of Well-being of Young Children's milestones questionnaire. Vitamin B6 concentration (nmol/L) was classified according to the tertile of the distribution and with the cutoff <20 nmol/L. Folate concentrations >45.3 nmol/L were classified as high, and vitamin B12 <150 pmol/L as deficient. The graded response model was used to estimate developmental age, and the developmental quotient (DQ) was calculated as the developmental age divided by chronological age. Multiple linear regression models were adjusted for confounders. RESULTS The DQ mean (95% confidence interval) for Brazilian children was 0.99 (0.97-1.01). Children aged 6-23 months (1.13 [1.10-1.16]) had a higher DQ mean than those aged 24-35 (0.99 [0.95-1.03]) and 36-59 months (0.89 [0.86-0.92]). Child age was inversely associated with DQ (β=-0.007; p<0.001). An interaction between child age and vitamin B12 deficiency in the DQ (β=-0.005; p<0.001) indicated that, in children aged 36-59 months, the DQ was markedly lower in children with B12 deficiency than in those without B12 deficiency. Vitamin B6 concentrations were directly associated with the DQ (β=0.0004; p=0.031) among children aged 24-59 months in the adjusted model. No association was observed between folate status and DQ. CONCLUSIONS In Brazil, the DQ is lower among older children, and those with vitamin B12 deficiency. Vitamin B6 status was directly associated with the DQ in children aged 24-59 months.
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Affiliation(s)
- Nathalia Cristina Freitas-Costa
- Nutritional Epidemiology Observatory, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Pedro Andrade
- Institute of Applied Economic Research, Rio de Janeiro, Brazil
| | - Paula Normando
- Nutritional Epidemiology Observatory, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Keronlainy Silva Salvatte Nunes
- Nutritional Epidemiology Observatory, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Carlos Eduardo Raymundo
- Institute of Collective Health, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Elisa Maria de Aquino Lacerda
- Nutritional Epidemiology Observatory, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Dayana Rodrigues Farias
- Nutritional Epidemiology Observatory, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Gilberto Kac
- Nutritional Epidemiology Observatory, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
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215
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Mallinson DC, Elwert F, Ehrenthal DB. Spillover Effects of Prenatal Care Coordination on Older Siblings Beyond the Mother-Infant Dyad. Med Care 2023; 61:206-215. [PMID: 36893405 PMCID: PMC10009763 DOI: 10.1097/mlr.0000000000001822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
BACKGROUND Pregnancy care coordination increases preventive care receipt for mothers and infants. Whether such services affect other family members' health care is unknown. OBJECTIVE To estimate the spillover effect of maternal exposure to Wisconsin Medicaid's Prenatal Care Coordination (PNCC) program during pregnancy with a younger sibling on the preventive care receipt for an older child. RESEARCH DESIGN Gain-score regressions-a sibling fixed effects strategy-estimated spillover effects while controlling for unobserved family-level confounders. SUBJECTS Data came from a longitudinal cohort of linked Wisconsin birth records and Medicaid claims. We sampled 21,332 sibling pairs (one older; one younger) who were born during 2008-2015, who were <4 years apart in age, and whose births were Medicaid-covered. In all, 4773 (22.4%) mothers received PNCC during pregnancy with the younger sibling. MEASURES The exposure was maternal PNCC receipt during pregnancy with the younger sibling (none; any). The outcome was the older sibling's number of preventive care visits or preventive care services in the younger sibling's first year of life. RESULTS Overall, maternal exposure to PNCC during pregnancy with the younger sibling did not affect older siblings' preventive care. However, among siblings who were 3 to <4 years apart in age, there was a positive spillover on the older sibling's receipt of care by 0.26 visits (95% CI: 0.11, 0.40 visits) and by 0.34 services (95% CI: 0.12, 0.55 services). CONCLUSION PNCC may only have spillover effects on siblings' preventive care in selected subpopulations but not in the broader population of Wisconsin families.
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Affiliation(s)
- David C. Mallinson
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, United States
| | - Felix Elwert
- Department of Sociology, College of Letters and Sciences, University of Wisconsin-Madison, United States
- Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin-Madison, United States
- Center for Demography and Ecology, University of Wisconsin-Madison, United States
| | - Deborah B. Ehrenthal
- Department of Biobehavioral Health, College of Health and Human Development, Pennsylvania State University, University Park, Pennsylvania, United States
- Social Science Research Institute, Pennsylvania State University, University Park, Pennsylvania, United States
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216
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Smew AI, Lundholm C, Gong T, Sävendahl L, Lichtenstein P, Brew BK, Almqvist C. Maternal depression or anxiety during pregnancy and offspring type 1 diabetes: a population-based family-design cohort study. BMJ Open Diabetes Res Care 2023; 11:11/2/e003303. [PMID: 37080595 PMCID: PMC10124198 DOI: 10.1136/bmjdrc-2023-003303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 04/07/2023] [Indexed: 04/22/2023] Open
Abstract
INTRODUCTION To investigate the association between maternal depression/anxiety during pregnancy and offspring type 1 diabetes, to assess the specific importance of exposure during pregnancy by comparing across different exposure periods before and/or after pregnancy, and to explore potential unmeasured familial confounding. RESEARCH DESIGN AND METHODS This was a population-based cohort including 1 807 809 offspring born in Sweden 2002-2019. From national registers, data were available on diagnosis or medication prescription for depression/anxiety in and around pregnancy, as well as incident cases of type 1 diabetes defined through diagnosis or insulin treatment. Associations were examined using flexible parametric and Cox regression models. Familial confounding was explored using paternal exposure as a negative control and by comparing offspring exposed to maternal depression/anxiety with their unexposed siblings. RESULTS For exposure during pregnancy, maternal depression/anxiety was associated with an increased risk of offspring type 1 diabetes onset after, but not before, 8 years of age (adjusted HR (aHR) 1.21 (95% CI 1.03 to 1.42]). Exposure occurring only during pregnancy was similarly associated to type 1 diabetes (aHR 1.24 (0.96 to 1.60)), whereas exposure occurring only before pregnancy was not (aHR 0.91 (0.64 to 1.30)). Associations were close to the null for paternal depression/anxiety (aHR 0.95 (0.72 to 1.25)), and point estimates were above 1 in sibling comparisons, although with wide CIs (aHR 1.36 (0.82 to 2.26)). CONCLUSIONS Maternal depression/anxiety specifically during pregnancy seems to be associated with offspring type 1 diabetes. Paternal negative control and sibling comparisons indicate that the results cannot entirely be explained by familial confounding.
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Affiliation(s)
- Awad I Smew
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Lundholm
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Tong Gong
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Lars Sävendahl
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Pediatric Endocrinology Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Bronwyn K Brew
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health and School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Pediatric Allergy and Pulmonology Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
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Mohamed MR, Mohile SG, Juba KM, Awad H, Wells M, Loh KP, Flannery M, Culakova E, Tylock RG, Ramsdale EE. Association of polypharmacy and potential drug-drug interactions with adverse treatment outcomes in older adults with advanced cancer. Cancer 2023; 129:1096-1104. [PMID: 36692475 PMCID: PMC10958985 DOI: 10.1002/cncr.34642] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/15/2022] [Accepted: 11/18/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Polypharmacy is common in older adults who are starting cancer treatment and is associated with an increased risk of potentially inappropriate medications (PIMs) and potential drug-drug interactions (PDIs). The authors evaluated the association of medication measures with adverse outcomes in older adults with advanced cancer who were receiving systemic therapy. METHODS This secondary analysis from GAP 70+ Trial (ClinicalTrials.gov identifier NCT02054741; principal investigator, Supriya G. Mohile) enrolled patients aged 70 years and older with advanced cancer who planned to start a new treatment regimen (n = 718). Polypharmacy was assessed before the initiation of treatment and was defined as the concurrent use of eight or more medications. PIMs were categorized using 2019 Beers Criteria and the Screening Tool of Older Persons' Prescriptions. PDIs were evaluated using Lexi-Interact Online. Study outcomes were assessed within 3 months of treatment and included: (1) the number of grade ≥2 and ≥3 toxicities according to the National Cancer Institute Common Toxicity Criteria, (2) treatment-related unplanned hospitalization, and (3) early treatment discontinuation. Multivariable regression models examined the association of medication measures with outcomes. RESULTS The mean patient age was 77 years, and 57% had lung or gastrointestinal cancers. The median number of medications was five (range, 0-24 medications), 28% of patients received eight or more medications, 67% received one or more PIM, and 25% had one or more major PDI. The mean number of grade ≥2 toxicities in patients with polypharmacy was 9.8 versus 7.7 in those without polypharmacy (adjusted β = 1.87; standard error, 0.71; p <.01). The mean number of grade ≥3 toxicities in patients with polypharmacy was 2.9 versus 2.2 in patients without polypharmacy (adjusted β = 0.59; standard error, 0.29; p = .04). Patients with who had one or more major PDI had 59% higher odds of early treatment discontinuation (odds ratio, 1.59; 95% confidence interval, 1.03-2.46; p = .03). CONCLUSIONS In a cohort of older adults with advanced cancer, polypharmacy and PDIs were associated with an increased risk of adverse treatment outcomes. Providing meaningful screening and interventional tools to optimize medication use may improve treatment-related outcomes in these patients.
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Affiliation(s)
- Mostafa R Mohamed
- Department of Medicine, University of Rochester, Rochester, New York, USA
| | - Supriya G Mohile
- Department of Medicine, University of Rochester, Rochester, New York, USA
| | - Katherine M Juba
- Department of Pharmacy Practice, Wegmans School of Pharmacy, Rochester, New York, USA
- Department of Pharmacy, University of Rochester, Rochester, New York, USA
| | - Hala Awad
- Department of Medicine, University of Rochester, Rochester, New York, USA
| | - Megan Wells
- Department of Medicine, University of Rochester, Rochester, New York, USA
| | - Kah Poh Loh
- Department of Medicine, University of Rochester, Rochester, New York, USA
| | - Marie Flannery
- School of Nursing, University of Rochester, Rochester, New York, USA
| | - Eva Culakova
- Department of Surgery, University of Rochester, Rochester, New York, USA
| | - Rachael G Tylock
- Department of Medicine, University of Rochester, Rochester, New York, USA
| | - Erika E Ramsdale
- Department of Medicine, University of Rochester, Rochester, New York, USA
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Baek K, Sakong J, Park C. Association of serum polyfluoroalkyl substances (PFAS) with anemia and erythrocytosis in Korean adults: Data from Korean National Environmental Health Survey cycle 4 (2018–2020). Int J Hyg Environ Health 2023. [DOI: 10.1016/j.ijheh.2023.114136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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219
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Yang T, Wang J, Huang J, Kelly FJ, Li G. Long-term Exposure to Multiple Ambient Air Pollutants and Association With Incident Depression and Anxiety. JAMA Psychiatry 2023; 80:305-313. [PMID: 36723924 PMCID: PMC10077109 DOI: 10.1001/jamapsychiatry.2022.4812] [Citation(s) in RCA: 41] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 11/18/2022] [Indexed: 02/02/2023]
Abstract
Importance Air pollution is increasingly recognized as an important environmental risk factor for mental health. However, epidemiologic evidence on long-term exposure to low levels of air pollutants with incident depression and anxiety is still very limited. Objectives To investigate the association of long-term joint exposure to multiple air pollutants with incident depression and anxiety. Design, Setting, and Participants This prospective, population-based cohort study used data from the UK Biobank. The participants were recruited between March 13, 2006, and October 1, 2010, and included individuals who had never been diagnosed with depression or anxiety at baseline and had full information on exposure and covariates. Data were analyzed from May 1 to October 10, 2022. Exposures Annual mean air pollution concentrations of particulate matter (PM) with aerodynamic diameter of 2.5 μm or less (PM2.5) and PM with aerodynamic diameter between 2.5 μm and 10 μm (PM2.5-10). Nitrogen dioxide (NO2) and nitric oxide (NO) were estimated for each participant's residential address using the land use regression model, and joint exposure to air pollution reflected by air pollution score was calculated by principal components analysis. Main Outcomes and Measures Incidence of diagnosed depression (F32-F33) and anxiety (F40-F48) were ascertained with International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes. Results During a median (IQR) follow-up of 10.9 (10.1-11.6) years, among 389 185 participants (mean [SD] age, 56.7 [8.1] years, 205 855 female individuals [52.9%]), a total of 13 131 and 15 835 patients were diagnosed with depression and anxiety, respectively. The median (IQR) concentration of pollutants was as follows: PM2.5, 9.9 (9.3-10.6) μg/m3; PM2.5-10, 6.1 (5.8-6.6) μg/m3; NO2, 26.0 (21.3-31.1) μg/m3; and NO, 15.9 (11.6-20.6) μg/m3. Long-term estimated exposure to multiple air pollutants was associated with increased risk of depression and anxiety, and the exposure-response curves were nonlinear, with steeper slopes at lower concentrations and plateauing trends at higher exposure. The hazard ratios (HRs) and 95% CIs for depression and anxiety were 1.16 (95% CI, 1.09-1.23; P < .001) and 1.11 (95% CI, 1.05-1.17; P < .001) in the highest quartile compared with the lowest quartile of air pollution score, respectively. Similar trends were shown for PM2.5, NO2, and NO. Subgroup analysis showed the association between PM2.5 and anxiety tended to be higher in male individuals than in female individuals (quartile 4: male individuals, 1.18; 95% CI, 1.08-1.29; female individuals, 1.07; 95% CI, 1.00-1.14; P = .009). Conclusions and Relevance Study results suggest that estimates of long-term exposure to multiple air pollutants was associated with increased risk of depression and anxiety. The nonlinear associations may have important implications for policy making in air pollution control. Reductions in joint exposure to multiple air pollutants may alleviate the disease burden of depression and anxiety.
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Affiliation(s)
- Teng Yang
- Department of Occupational and Environmental Health Sciences, Peking University School of Public Health, Beijing, China
| | - Jiawei Wang
- Department of Occupational and Environmental Health Sciences, Peking University School of Public Health, Beijing, China
| | - Jing Huang
- Department of Occupational and Environmental Health Sciences, Peking University School of Public Health, Beijing, China
- Deep Medicine, Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Frank J. Kelly
- Environmental Research Group, Faculty of Medicine, School of Public Health, Imperial College London, London, United Kingdom
| | - Guoxing Li
- Department of Occupational and Environmental Health Sciences, Peking University School of Public Health, Beijing, China
- Environmental Research Group, Faculty of Medicine, School of Public Health, Imperial College London, London, United Kingdom
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Checchi F. Inferring the impact of humanitarian responses on population mortality: methodological problems and proposals. Confl Health 2023; 17:16. [PMID: 36998020 PMCID: PMC10061806 DOI: 10.1186/s13031-023-00516-x] [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: 11/29/2022] [Accepted: 03/24/2023] [Indexed: 04/01/2023] Open
Abstract
Reducing excess population mortality caused by crises due to armed conflict and natural disasters is an existential aim of humanitarian assistance, but the extent to which these deaths are averted in different humanitarian responses is mostly unknown. This information gap arguably weakens governance and accountability. This paper considers methodological challenges involved in making inferences about humanitarian assistance's effect on excess mortality, and outlines proposed approaches. Three possible measurement questions, each of which contributes some inferential evidence, are presented: (1) whether mortality has remained within an acceptable range during the crisis (for which different direct estimation options are presented); (2) whether the humanitarian response is sufficiently appropriate and performant to avert excess mortality (a type of contribution analysis requiring in-depth audits of the design of humanitarian services and of their actual availability, coverage and quality); and (3) the actual extent to which humanitarian assistance has reduced excess deaths (potentially the most complex question to answer, requiring application of causal thinking and careful specification of the exposure, and for which either quasi-experimental statistical modelling approaches or a combination of verbal and social autopsy methods are proposed). The paper concludes by considering possible 'packages' of the above methods that could be implemented at different stages of a humanitarian response, and calls for investment in improved methods and actual measurement.
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Affiliation(s)
- Francesco Checchi
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
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Mascaro S, Wu Y, Woodberry O, Nyberg EP, Pearson R, Ramsay JA, Mace AO, Foley DA, Snelling TL, Nicholson AE. Modeling COVID-19 disease processes by remote elicitation of causal Bayesian networks from medical experts. BMC Med Res Methodol 2023; 23:76. [PMID: 36991342 PMCID: PMC10050813 DOI: 10.1186/s12874-023-01856-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 01/30/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND COVID-19 is a new multi-organ disease causing considerable worldwide morbidity and mortality. While many recognized pathophysiological mechanisms are involved, their exact causal relationships remain opaque. Better understanding is needed for predicting their progression, targeting therapeutic approaches, and improving patient outcomes. While many mathematical causal models describe COVID-19 epidemiology, none have described its pathophysiology. METHODS In early 2020, we began developing such causal models. The SARS-CoV-2 virus's rapid and extensive spread made this particularly difficult: no large patient datasets were publicly available; the medical literature was flooded with sometimes conflicting pre-review reports; and clinicians in many countries had little time for academic consultations. We used Bayesian network (BN) models, which provide powerful calculation tools and directed acyclic graphs (DAGs) as comprehensible causal maps. Hence, they can incorporate both expert opinion and numerical data, and produce explainable, updatable results. To obtain the DAGs, we used extensive expert elicitation (exploiting Australia's exceptionally low COVID-19 burden) in structured online sessions. Groups of clinical and other specialists were enlisted to filter, interpret and discuss the literature and develop a current consensus. We encouraged inclusion of theoretically salient latent (unobservable) variables, likely mechanisms by extrapolation from other diseases, and documented supporting literature while noting controversies. Our method was iterative and incremental: systematically refining and validating the group output using one-on-one follow-up meetings with original and new experts. 35 experts contributed 126 hours face-to-face, and could review our products. RESULTS We present two key models, for the initial infection of the respiratory tract and the possible progression to complications, as causal DAGs and BNs with corresponding verbal descriptions, dictionaries and sources. These are the first published causal models of COVID-19 pathophysiology. CONCLUSIONS Our method demonstrates an improved procedure for developing BNs via expert elicitation, which other teams can implement to model emergent complex phenomena. Our results have three anticipated applications: (i) freely disseminating updatable expert knowledge; (ii) guiding design and analysis of observational and clinical studies; (iii) developing and validating automated tools for causal reasoning and decision support. We are developing such tools for the initial diagnosis, resource management, and prognosis of COVID-19, parameterized using the ISARIC and LEOSS databases.
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Affiliation(s)
- Steven Mascaro
- Faculty of Information Technology, Monash University, Clayton, VIC 3168, Australia
- Bayesian Intelligence Pty Ltd, Upwey, VIC 3158, Australia
| | - Yue Wu
- School of Public Health, University of Sydney, Camperdown, NSW 2006, Australia
| | - Owen Woodberry
- Faculty of Information Technology, Monash University, Clayton, VIC 3168, Australia
- Bayesian Intelligence Pty Ltd, Upwey, VIC 3158, Australia
| | - Erik P Nyberg
- Faculty of Information Technology, Monash University, Clayton, VIC 3168, Australia
| | - Ross Pearson
- Faculty of Information Technology, Monash University, Clayton, VIC 3168, Australia
| | - Jessica A Ramsay
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, WA 6009, Australia
| | - Ariel O Mace
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, WA 6009, Australia
- Department of General Paediatrics, Perth Children's Hospital, Nedlands, WA 6009, Australia
- Department of Paediatrics, Fiona Stanley Hospital, Murdoch, WA 6150, Australia
| | - David A Foley
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, WA 6009, Australia
- Microbiology, PathWest Laboratory Medicine, Nedlands, WA 6909, Australia
| | - Thomas L Snelling
- School of Public Health, University of Sydney, Camperdown, NSW 2006, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, WA 6009, Australia
- School of Public Health, Curtin University, Bentley, WA 6102, Australia
- Menzies School of Health Research, Charles Darwin University, Darwin, NT 0815, Australia
| | - Ann E Nicholson
- Faculty of Information Technology, Monash University, Clayton, VIC 3168, Australia.
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222
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Yang T, Gu T, Xu Z, He T, Li G, Huang J. Associations of residential green space with incident type 2 diabetes and the role of air pollution: A prospective analysis in UK Biobank. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 866:161396. [PMID: 36608823 DOI: 10.1016/j.scitotenv.2023.161396] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/20/2022] [Accepted: 01/01/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Green space is a newly modifiable environmental factor which would bring health benefits, and identifying potential pathways is important to better promote public health. Nowadays, limited evidence is available on residential green space and risk of incident type 2 diabetes (T2D). To evaluate the longitudinal association between residential green space and incident T2D, and further illustrate the role of air pollution, we conducted a prospective analysis in UK Biobank. METHODS Incident cases of T2D were ascertained through medical linkage of hospital admissions. Residential green space indicated by percentage of green space at 300 m buffer was estimated using land use data. Annual average air pollution was modelled using Land Use Regression model. Cox proportional hazard regression models were used to determine the association between the exposure and incident T2D. Effect modification of air pollution was assessed using log-likelihood tests. Casual mediation analysis including interaction of green space and air pollution was used to quantity pure natural indirect effect of air pollution. RESULTS Of 379,238 participants at baseline, 15564 incident T2D cases were identified with 12.4 years of follow-up. In main models, individuals who exposed to residential green space at 300 m buffer in high level (≥75 %) had 14.4 % (95 % CI: 8.0 %, 20.3 %) lower risk of incident T2D compared with those in low level (<25 %). This association was modified by NO2, with green space indicating higher protective effect in low NO2 level (Pinteraction = 0.098). PM2.5 had a high mediation effect of 37.0 % in the association. CONCLUSION Elevated residential green space level was associated with lower risk of incident T2D, and air pollution played an important role in this association. These findings would contribute to policy making and healthy city construction to take air pollution into consideration while planning green space, which would maximize public health benefits.
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Affiliation(s)
- Teng Yang
- Department of Occupational and Environmental Health Sciences, Peking University School of Public Health, Beijing 100191, China
| | - Tiantian Gu
- Department of Occupational and Environmental Health Sciences, Peking University School of Public Health, Beijing 100191, China
| | - Zhihu Xu
- Department of Occupational and Environmental Health Sciences, Peking University School of Public Health, Beijing 100191, China
| | - Tianfeng He
- Department of Occupational and Environmental Health Sciences, Peking University School of Public Health, Beijing 100191, China; Ningbo Municipal Center for Disease Control and Prevention, Ningbo 315010, China
| | - Guoxing Li
- Department of Occupational and Environmental Health Sciences, Peking University School of Public Health, Beijing 100191, China; Environmental Research Group, School of Public Health, Imperial College London, Sir Michael Uren Building, White City Campus, 80-92 Wood Lane, London W12 0BZ, United Kingdom.
| | - Jing Huang
- Department of Occupational and Environmental Health Sciences, Peking University School of Public Health, Beijing 100191, China; Institute for Global Health and Development, Peking University, Beijing 100871, China.
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223
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Zhu W, Marchant R, Morris RW, Baur LA, Simpson SJ, Cripps S. Bayesian network modelling to identify on-ramps to childhood obesity. BMC Med 2023; 21:105. [PMID: 36944999 PMCID: PMC10031893 DOI: 10.1186/s12916-023-02789-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 02/15/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND When tackling complex public health challenges such as childhood obesity, interventions focused on immediate causes, such as poor diet and physical inactivity, have had limited success, largely because upstream root causes remain unresolved. A priority is to develop new modelling frameworks to infer the causal structure of complex chronic disease networks, allowing disease "on-ramps" to be identified and targeted. METHODS The system surrounding childhood obesity was modelled as a Bayesian network, using data from The Longitudinal Study of Australian Children. The existence and directions of the dependencies between factors represent possible causal pathways for childhood obesity and were encoded in directed acyclic graphs (DAGs). The posterior distribution of the DAGs was estimated using the Partition Markov chain Monte Carlo. RESULTS We have implemented structure learning for each dataset at a single time point. For each wave and cohort, socio-economic status was central to the DAGs, implying that socio-economic status drives the system regarding childhood obesity. Furthermore, the causal pathway socio-economic status and/or parental high school levels → parental body mass index (BMI) → child's BMI existed in over 99.99% of posterior DAG samples across all waves and cohorts. For children under the age of 8 years, the most influential proximate causal factors explaining child BMI were birth weight and parents' BMI. After age 8 years, free time activity became an important driver of obesity, while the upstream factors influencing free time activity for boys compared with girls were different. CONCLUSIONS Childhood obesity is largely a function of socio-economic status, which is manifest through numerous downstream factors. Parental high school levels entangle with socio-economic status, and hence, are on-ramp to childhood obesity. The strong and independent causal relationship between birth weight and childhood BMI suggests a biological link. Our study implies that interventions that improve the socio-economic status, including through increasing high school completion rates, may be effective in reducing childhood obesity prevalence.
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Affiliation(s)
- Wanchuang Zhu
- Human Technology Institute, University of Technology, Sydney, Australia.
- Data61, CSIRO, Sydney, Australia.
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia.
| | - Roman Marchant
- Data61, CSIRO, Sydney, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Richard W Morris
- School of Psychology and Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Louise A Baur
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- The Children's Hospital at Westmead, The University of Sydney, Sydney, Australia
| | - Stephen J Simpson
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
- School of Life and Environmental Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Sally Cripps
- Human Technology Institute, University of Technology, Sydney, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
- School of Mathematics and Physical Sciences, University of Technology Sydney, Sydney, NSW, Australia
- School of Aerospace, Mechanical and Mechatronic Engineering, The University of Sydney, Sydney, Australia
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Calderón-Larrañaga S, Greenhalgh T, Clinch M, Robson J, Dostal I, Eto F, Finer S. Unravelling the potential of social prescribing in individual-level type 2 diabetes prevention: a mixed-methods realist evaluation. BMC Med 2023; 21:91. [PMID: 36907857 PMCID: PMC10008720 DOI: 10.1186/s12916-023-02796-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 02/20/2023] [Indexed: 03/13/2023] Open
Abstract
BACKGROUND Social prescribing (SP) usually involves linking patients in primary care with services provided by the voluntary and community sector. Preliminary evidence suggests that SP may offer a means of connecting patients with community-based health promotion activities, potentially contributing to the prevention of long-term conditions, such as type 2 diabetes (T2D). METHODS Using mixed-methods realist evaluation, we explored the possible contribution of SP to individual-level prevention of T2D in a multi-ethnic, socio-economically deprived population in London, UK. We made comparisons with an existing prevention programme (NHS Diabetes Prevention Programme (NDPP)) where relevant and possible. Anonymised primary care electronic health record data of 447,360 people 18+ with an active GP registration between December 2016 and February 2022 were analysed using quantitative methods. Qualitative data (interviews with 11 primary care clinicians, 11 social prescribers, 13 community organisations and 8 SP users at high risk of T2D; 36 hours of ethnographic observations of SP and NDPP sessions; and relevant documents) were analysed thematically. Data were integrated using visual means and realist methods. RESULTS People at high risk of T2D were four times more likely to be referred into SP than the eligible general population (RR 4.31 (95% CI 4.17-4.46)), with adjustment for socio-demographic variables resulting in attenuation (RR 1.33 (95% CI 1.27-1.39)). More people at risk of T2D were referred to SP than to NDPP, which could be explained by the broad referral criteria for SP and highly supportive (proactive, welcoming) environments. Holistic and sustained SP allowed acknowledgement of patients' wider socio-economic constraints and provision of long-term personalised care. The fact that SP was embedded within the local community and primary care infrastructure facilitated the timely exchange of information and cross-referrals across providers, resulting in enhanced service responsiveness. CONCLUSIONS Our study suggests that SP may offer an opportunity for individual-level T2D prevention to shift away from standardised, targeted and short-term strategies to approaches that are increasingly personalised, inclusive and long-term. Primary care-based SP seems most ideally placed to deliver such approaches where practitioners, providers and commissioners work collectively to achieve holistic, accessible, sustained and integrated services.
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Affiliation(s)
- Sara Calderón-Larrañaga
- Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, UK. .,Bromley By Bow Health Partnership, XX Place Health Centre, Mile End Hospital, Bancroft Rd, Bethnal Green, London, E1 4DG, UK.
| | - Trish Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Rd, Oxford, OX2 6GG, UK
| | - Megan Clinch
- Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, UK
| | - John Robson
- Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, UK
| | - Isabel Dostal
- Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, UK
| | - Fabiola Eto
- Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, UK
| | - Sarah Finer
- Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, UK.,Barts Health NHS Trust, Newham University Hospital, Glen Rd, London, E13 8SL, UK
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Remmen LN, Christiansen DH, Herttua K, Klakk H, Berg-Beckhoff G. The risk of an incident hospital contact with a musculoskeletal disorder in Danish occupational fishers: a register-based study. BMC Musculoskelet Disord 2023; 24:168. [PMID: 36879225 PMCID: PMC9987051 DOI: 10.1186/s12891-023-06274-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 02/27/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND The prevalence of musculoskeletal disorders (MSDs) among occupational fishers is high, yet knowledge of the risk factors is scarce and inconsistent. The aim of this study was to investigate the risk from various work-related characteristics on incident hospital contact due to a musculoskeletal disorders and other pain disorders among Danish occupational fishers. METHODS This register-based study comprised data from the Danish Occupational Cohort with eXposure (DOC*X) for all persons registered as occupational fishers between 1994 and 2017. Time-to-event analysis with Cox regression model was used with age as the time scale. RESULTS Among the 15,739 fishers, 40% (n = 5,669 cases) had an incident hospital contact with an MSD during follow-up. Back disorders were the dominant complaint. Male fishers working less than 5 years or more than 15 years had higher risks of MSD (HR 2.40 (95% CI: 2.06, 2.80), HR: 2.04 (95% CI: 1.76, 2.35), respectively, than those working for over 20 years. Period effects confounded and reduced the risk from occupational seniority. CONCLUSION Fishers occupational seniority vary in risk of MSDs across working life. Results showed a nonlinear relationship between the highest risk for fishers working less than 5 years and the lowest risk working more than 20 years as occupational fisher. More years in the workforce, a captain education, and primarily working part time significantly reduced the risk of experiencing a first MSDs for men. Healthy worker effect was documented.
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Affiliation(s)
- Line Nørgaard Remmen
- Department of Public Health, Research Unit for Health Promotion, University of Southern Denmark, Esbjerg, Denmark. .,Research Unit of Applied Health Science (SUPRA), University College South Denmark (UCSYD), Esbjerg, Denmark.
| | - David Høyrup Christiansen
- Department of Occupational Medicine, University Research Clinic, Danish Ramazzini Centre Goedstrup Hospital, Herning, Denmark.,Department of Clinical Medicine, Aarhus University, Health, Aarhus, Denmark.,Center for Health and Nursing Research, Regional Hospital Central Jutland, Research, Viborg, Denmark.,Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Kimmo Herttua
- Department of Public Health, Center for Maritime Health and Society, University of Southern Demark, Esbjerg, Denmark
| | - Heidi Klakk
- Research Unit of Applied Health Science (SUPRA), University College South Denmark (UCSYD), Esbjerg, Denmark.,Research Unit for Exercise Epidemiology (EXE), Department of Sports Science and Clinical Biomechanics (IOB), University of Southern Denmark, Odense M, Denmark.,Center for Clinical Research and Prevention, Section for Health Promotion and Prevention, The Capital Region, Frederiksberg, Denmark
| | - Gabriele Berg-Beckhoff
- Department of Public Health, Research Unit for Health Promotion, University of Southern Denmark, Esbjerg, Denmark.,Hospital South West Jutland, University Hospital of Southern Denmark, Esbjerg, Denmark
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The association between meat consumption and muscle strength index in young adults: the mediating role of total protein intake and lean mass percentage. Eur J Nutr 2023; 62:673-683. [PMID: 36184663 DOI: 10.1007/s00394-022-03014-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 09/22/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE The aim of this study was to analyse the associations between the consumption of different types of meat and the muscle strength index (MSI) and to examine whether this relationship is mediated by total protein intake (TPI) and lean mass percentage (LM%) in young adults. METHODS We conducted a cross-sectional study with first-year university students from Castilla-La Mancha, Spain. Different types of meat consumption (total, red, processed, and white and fish) were separately evaluated using a Food-Frequency Questionnaire. MSI was determined from the handgrip and standing long jump tests. ANCOVA models were used to test the mean differences in MSI by categories of meat consumption. Serial multiple mediation models were used to explore the mediating role of TPI and LM% in the relationship between meat consumption and MSI. All analyses were adjusted for age, sex, and socioeconomic level, identified through a directed acyclic graph. Additional analyses were performed with a small subsample including alcohol intake, tobacco smoking, physical activity, cardiorespiratory fitness, and total energy intake as covariates in the multiple mediation models. RESULTS A total of 230 students (mean age 21.1 ± 2.1 years, 66.5% women) were included in the analysis. Young adults with higher meat consumption (total, red, and white and fish) had higher MSI adjusted means than their peers with lower meat consumption (p < 0.05). These associations did not remain after controlling for TPI and LM%. In adjusted mediation analyses, a significant indirect effect was observed through TPI and LM% in the associations between each of the types of meat consumption and MSI. In the additional analyses, a greater effect of white and fish meat consumption on muscle strength through mediation of TPI and LM% was reported compared to red or processed meat consumption, and no significant effects were observed between processed meat consumption and MSI. CONCLUSION Higher consumption of total, red, and white and fish meat was associated with increased MSI in young adults. TPI and LM% mediated this relationship.
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Kupka E, Hesselman S, Hastie R, Lomartire R, Wikström AK, Bergman L. Low-dose aspirin use in pregnancy and the risk of preterm birth: a Swedish register-based cohort study. Am J Obstet Gynecol 2023; 228:336.e1-336.e9. [PMID: 36096185 DOI: 10.1016/j.ajog.2022.09.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/11/2022] [Accepted: 09/02/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Preterm birth is the leading cause of neonatal mortality and morbidity. Women who have had a previous preterm birth are at increased risk for preterm birth in their subsequent pregnancies. Low-dose aspirin use reduces the risk for preterm birth among women at risk of developing preeclampsia, however, it is unclear whether low-dose aspirin may reduce the risk of recurrent preterm birth. OBJECTIVE This study aimed to investigate the association between low-dose aspirin use and preterm birth among women with a previous preterm birth. STUDY DESIGN We conducted a Swedish register-based cohort study and included women who had a first and second pregnancy between 2006 and 2019, with the first pregnancy ending in preterm birth (medically indicated or with spontaneous onset <37 weeks of gestation). The association between low-dose aspirin use and preterm birth in the second pregnancy was estimated via logistic regression via standardization and expressed as marginal relative risks with the 95% confidence interval. RESULTS Among the study cohort (N=22,127), 3057 women (14%) were prescribed low-dose aspirin during their second pregnancy and 3703 women (17%) gave birth prematurely. Low-dose aspirin use was associated with a reduced risk for preterm birth, (marginal relative risk, 0.87; 95% confidence interval, 0.77-0.99). There were no statistically significant associations between low-dose aspirin use and an altered risk for moderate preterm birth, defined as birth between 32 and 36 weeks' gestation (marginal relative risk, 0.90; 95% confidence interval, 0.78-1.03), or very preterm birth, defined as birth <32 weeks' gestation (marginal relative risk, 0.75; 95% confidence interval, 0.54-1.04). Regarding the onset of preterm birth, low-dose aspirin use was associated with a reduced risk for spontaneous preterm birth (marginal relative risk, 0.70; 95% confidence interval, 0.57-0.86) but no reduction in the risk for medically indicated preterm birth (marginal relative risk, 1.09; 95% confidence interval, 0.91-1.30) was observed. CONCLUSION Among women with a previous preterm birth, low-dose aspirin use was associated with a reduced risk for preterm birth. When investigating preterm birth by onset in the second pregnancy, low-dose aspirin use was associated with a reduced risk for spontaneous preterm birth. Our results suggest that low-dose aspirin may be an effective prophylaxis for recurrent preterm birth.
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Affiliation(s)
- Ellen Kupka
- Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Research and Higher Education, Center for Clinical Research, Dalarna, Uppsala University, Falun, Sweden.
| | - Susanne Hesselman
- Department of Research and Higher Education, Center for Clinical Research, Dalarna, Uppsala University, Falun, Sweden; Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Roxanne Hastie
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Mercy Perinatal, Mercy Hospital for Women, Melbourne, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Heidelberg, Australia
| | - Riccardo Lomartire
- Department of Research and Higher Education, Center for Clinical Research, Dalarna, Uppsala University, Falun, Sweden
| | - Anna Karin Wikström
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Lina Bergman
- Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Department of Obstetrics and Gynaecology, Stellenbosch University, Cape Town, South Africa
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Zhou J, Cattaneo G, Yu W, Lo OY, Gouskova NA, Delgado-Gallén S, Redondo-Camós M, España-Irla G, Solana-Sánchez J, Tormos JM, Lipsitz LA, Bartrés-Faz D, Pascual-Leone A, Manor B. The age-related contribution of cognitive function to dual-task gait in middle-aged adults in Spain: observations from a population-based study. THE LANCET. HEALTHY LONGEVITY 2023; 4:e98-e106. [PMID: 36870341 PMCID: PMC9992865 DOI: 10.1016/s2666-7568(23)00009-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND Poor dual-task gait performance is associated with a risk of falls and cognitive decline in adults aged 65 years or older. When and why dual-task gait performance begins to deteriorate is unknown. This study aimed to characterise the relationships between age, dual-task gait, and cognitive function in middle age (ie, aged 40-64 years). METHODS We conducted a secondary analysis of data from community-dwelling adults aged 40-64 years that took part in the Barcelona Brain Health Initiative (BBHI) study, an ongoing longitudinal cohort study in Barcelona, Spain. Participants were eligible for inclusion if they were able to walk independently without assistance and had completed assessments of both gait and cognition at the time of analysis and ineligble if they could not understand the study protocol, had any clinically diagnosed neurological or psychiatric diseases, were cognitively impaired, or had lower-extremity pain, osteoarthritis, or rheumatoid arthritis that could cause abnormal gait. Stride time and stride time variability were measured under single-task (ie, walking only) and dual-task (ie, walking while performing serial subtractions) conditions. Dual-task cost (DTC; the percentage increase in the gait outcomes from single-task to dual-task conditions) to each gait outcome was calculated and used as the primary measure in analyses. Global cognitive function and composite scores of five cognitive domains were derived from neuropsychological testing. We used locally estimated scatterplot smoothing to characterise the relationship between age and dual-task gait, and structural equation modelling to establish whether cognitive function mediated the association between observed biological age and dual tasks. FINDINGS 996 people were recruited to the BBHI study between May 5, 2018, and July 7, 2020, of which 640 participants completed gait and cognitive assessments during this time (mean 24 days [SD 34] between first and second visit) and were included in our analysis (342 men and 298 women). Non-linear associations were observed between age and dual-task performance. Starting at 54 years, the DTC to stride time (β=0·27 [95% CI 0·11 to 0·36]; p<0·0001) and stride time variability (0·24 [0·08 to 0·32]; p=0·0006) increased with advancing age. In individuals aged 54 years or older, decreased global cognitive function correlated with increased DTC to stride time (β=-0·27 [-0·38 to -0·11]; p=0·0006) and increased DTC to stride time variability (β=-0·19 [-0·28 to -0·08]; p=0·0002). INTERPRETATION Dual-task gait performance begins to deteriorate in the sixth decade of life and, after this point, interindividual variance in cognition explains a substantial portion of dual-task performance. FUNDING La Caixa Foundation, Institut Guttmann, and Fundació Abertis.
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Affiliation(s)
- Junhong Zhou
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, MA, USA; Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| | - Gabriele Cattaneo
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Wanting Yu
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, MA, USA
| | - On-Yee Lo
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, MA, USA; Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Natalia A Gouskova
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, MA, USA; Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Selma Delgado-Gallén
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria Redondo-Camós
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Goretti España-Irla
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Javier Solana-Sánchez
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Josep M Tormos
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lewis A Lipsitz
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, MA, USA; Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - David Bartrés-Faz
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain; Department of Medicine, Faculty of Medicine and Health Sciences, Institute of Neurosciences and August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain
| | - Alvaro Pascual-Leone
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, MA, USA; Deanna and Sidney Wolk Center for Memory Health, Hebrew SeniorLife, Roslindale, MA, USA; Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Brad Manor
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, MA, USA; Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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MENENDEZ GARCIA M, OTERMIN MAYA I, LIBRERO LOPEZ J, GUTIERREZ DUBOIS J, MANRIQUE CUEVAS D, ALAEZ CRUZ JI, AZCONA SALVATIERRA L, AYECHU DIAZ I, HIDALGO OVEJERO AM. Effects of extended oral antibiotic prophylaxis on surgical site infections after instrumented spinal fusion: a cohort study of 901 patients with a minimum follow-up of 1 year. Acta Orthop 2023; 94:80-86. [PMID: 36802177 PMCID: PMC9942604 DOI: 10.2340/17453674.2023.9409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND AND PURPOSE We aimed to determine whether an extended oral antibiotic prophylaxis protocol may reduce the rate of surgical site infection (SSI) in patients undergoing instrumented spinal fusion. PATIENTS AND METHODS This retrospective cohort study comprise 901 consecutive patients subjected to spinal fusion between September 2011 and December 2018 with a minimum 1-year follow-up. 368 patients operated on between September 2011 and August 2014 were administered standard intravenous prophylaxis. 533 patients operated on between September 2014 and December 2018 were administered an extended protocol with 500 mg of oral cefuroxime axetil every 12 hours (clindamycin or levofloxacin in allergic individuals) until the removal of sutures. SSI was defined following the Centers for Disease Control and Prevention criteria. The association between risk factors and the incidence of SSI was evaluated by odds ratio (OR) with a multiple logistic regression model. RESULTS The bivariate analysis showed a statistically significant association between SSI and the type of prophylaxis used ("extended"' = 1.7% vs. "standard" = 6.2%, p= 0.001), with a lower proportion of superficial SSIs with the extended regimen (0.8% vs. 4.1%, p = 0.001). The multiple logistic regression model showed an OR = 0.25 (95% confidence interval [CI] 0.10-0.53) for extended prophylaxis and an OR = 3.5 (CI 1.3-8.1) for non-beta-lactams antibiotics. CONCLUSION Extended antibiotic prophylaxis seems to be associated with a reduction in the incidence of superficial SSI in instrumented spine surgery.
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Affiliation(s)
- Miguel MENENDEZ GARCIA
- Spine Surgery Unit, Department of Trauma and Orthopaedics, Hospital Universitario de Navarra, Pamplona (Navarra)
| | - Iñaki OTERMIN MAYA
- Internal Medicine Department, Hospital Universitario de Navarra, Pamplona (Navarra)
| | | | | | - Diego MANRIQUE CUEVAS
- Spine Surgery Unit, Department of Trauma and Orthopaedics, Hospital Universitario de Navarra, Pamplona (Navarra)
| | | | - Leyre AZCONA SALVATIERRA
- Spine Surgery Unit, Department of Trauma and Orthopaedics, Hospital Universitario de Navarra, Pamplona (Navarra)
| | - Isabel AYECHU DIAZ
- Spine Surgery Unit, Department of Trauma and Orthopaedics, Hospital Universitario de Navarra, Pamplona (Navarra)
| | - Angel M HIDALGO OVEJERO
- Spine Surgery Unit, Department of Trauma and Orthopaedics, Hospital Universitario de Navarra, Pamplona (Navarra)
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Kamga Fogno AW, Rouquette A, Gronfier C, Bernard JY, Plancoulaine S. Associations between screen use, outdoor time/daylight exposure and sleep changes during the first COVID-19 lockdown in French children from the ELFE and EPIPAGE2 birth cohorts. CNS Neurosci Ther 2023; 29:1649-1656. [PMID: 36807866 PMCID: PMC10173720 DOI: 10.1111/cns.14128] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/08/2023] [Accepted: 02/08/2023] [Indexed: 02/22/2023] Open
Abstract
AIMS To investigate associations between outdoor and screen time and changes in sleep patterns in children from two nationwide birth-cohorts in the SAPRIS project. METHODS During the first French COVID-19 pandemic lockdown, volunteer parents of children enrolled in the ELFE and EPIPAGE2 birth-cohorts completed online questions about their child's outdoor time, screen time, and changes in sleep duration and quality compared with the pre-lockdown situation. In 5700 children (aged 8-9 years, 52% boys) with available data, we assessed associations between outdoor time, screen time, and sleep changes using multinomial logistic regression models adjusted for confounders. RESULTS Children spent on average 3 h08 outdoors and 4 h34 using screens/day (3 h27 for leisure, 1 h07 for class-work). Sleep duration increased in 36% of children and decreased in 13.4%; sleep difficulties appeared/increased in 22.5% and decreased/disappeared/remained stable in 18.3%. After adjustment, increased screen time, especially for leisure, was associated with increased and decreased sleep duration (OR(95%CI) = 1.03(1.00-1.06) and OR = 1.06(1.02-1.10), respectively). No association was observed between outdoor time and sleep changes after adjustment. CONCLUSIONS Our study adds evidence for the association between high leisure-time screen time and shorter sleep time. It supports current screen guidelines for children, especially during leisure time and for those whose sleep duration is short.
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Affiliation(s)
- Alex Wilfried Kamga Fogno
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), Paris, France
| | - Alexandra Rouquette
- Université Paris-Saclay, UVSQ, Inserm U1018, CESP, Paris, France.,AP-HP Paris-Saclay, Hôpital du Kremlin Bicêtre, Service de Santé Publique et d'Epidemiologie, Le Kremlin Bicêtre, France
| | - Claude Gronfier
- Université Claude Bernard Lyon 1, INSERM, CRNS, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, Bron, France
| | - Jonathan Y Bernard
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), Paris, France.,Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Sabine Plancoulaine
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), Paris, France.,Université Claude Bernard Lyon 1, INSERM, CRNS, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, Bron, France
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Watson ML, Hickman SHM, Dreesbeimdiek KM, Kohler K, Stubbs DJ. Directed acyclic graphs in perioperative observational research-A systematic review and critique against best practice recommendations. PLoS One 2023; 18:e0281259. [PMID: 36758007 PMCID: PMC9910726 DOI: 10.1371/journal.pone.0281259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/18/2023] [Indexed: 02/10/2023] Open
Abstract
The Directed Acyclic Graph (DAG) is a graph representing causal pathways for informing the conduct of an observational study. The use of DAGs allows transparent communication of a causal model between researchers and can prevent over-adjustment biases when conducting causal inference, permitting greater confidence and transparency in reported causal estimates. In the era of 'big data' and increasing number of observational studies, the role of the DAG is becoming more important. Recent best-practice guidance for constructing a DAG with reference to the literature has been published in the 'Evidence synthesis for constructing DAGs' (ESC-DAG) protocol. We aimed to assess adherence to these principles for DAGs constructed within perioperative literature. Following registration on the International Prospective Register of Systematic Reviews (PROSPERO) and with adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting framework for systematic reviews, we searched the Excerpta Medica dataBASE (Embase), the Medical Literature Analysis and Retrieval System Online (MEDLINE) and Cochrane databases for perioperative observational research incorporating a DAG. Nineteen studies were included in the final synthesis. No studies demonstrated any evidence of following the mapping stage of the protocol. Fifteen (79%) fulfilled over half of the translation and integration one stages of the protocol. Adherence with one stage did not guarantee fulfilment of the other. Two studies (11%) undertook the integration two stage. Unmeasured variables were handled inconsistently between studies. Only three (16%) studies included unmeasured variables within their DAG and acknowledged their implication within the main text. Overall, DAGs that were constructed for use in perioperative observational literature did not consistently adhere to best practice, potentially limiting the benefits of subsequent causal inference. Further work should focus on exploring reasons for this deviation and increasing methodological transparency around DAG construction.
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Affiliation(s)
- Matthew Lamont Watson
- Clinical School of Medicine, University of Cambridge School of Clinical Medicine, Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - Sebastian H. M. Hickman
- Yusuf Hamied Department of Chemistry, University of Cambridge, Cambridge, United Kingdom
- The Alan Turing Institute, London, United Kingdom
| | - Kaya Marlen Dreesbeimdiek
- Department of Engineering, Health Systems Design Group, University of Cambridge, Cambridge, United Kingdom
| | - Katharina Kohler
- University Division of Anaesthesia, University of Cambridge, Cambridge, Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - Daniel J. Stubbs
- Department of Engineering, Health Systems Design Group, University of Cambridge, Cambridge, United Kingdom
- Wellcome Trust Research Fellow, University Division of Anaesthesia, Addenbrooke’s Hospital, Cambridge, United Kingdom
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Gleadhill C, Lee H, Kamper SJ, Cashin A, Hansford H, Traeger AC, Viana Da Silva P, Nolan E, Davidson SRE, Wilczynska M, Robson E, Williams CM. Mixed messages: most spinal pain and osteoarthritis observational research is unclear or misaligned. J Clin Epidemiol 2023; 155:39-47. [PMID: 36736708 DOI: 10.1016/j.jclinepi.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 12/17/2022] [Accepted: 01/19/2023] [Indexed: 02/05/2023]
Abstract
OBJECTIVES We assessed authors' language and methods to determine alignment between reported aims, methods, intent, and interpretations in observational studies in spinal pain or osteoarthritis. STUDY DESIGN AND SETTING We searched five databases for observational studies that included people with spinal pain or osteoarthritis published in the last 5 years. We randomized 100 eligible studies, and classified study intent (aims and methods) and interpretations as causal, non-causal, unclear, or misaligned. RESULTS Overall, 38% of studies were aligned regarding their intent and interpretation (either causally (22%) or non-causally (16%)). 29% of studies' aims and 29% of study methods were unclear. Intent was misaligned in 16% of studies (where aim differed to method) and 23% of studies had misaligned interpretations (where there were multiple conflicting claims). The most common kind of aim was non-causal (38%), and the most common type of method (39%), intent (38%), and interpretations (35%) was causal. CONCLUSIONS Misalignment and mixed messages are common in observational research of spinal pain and osteoarthritis. More than 6 in 10 observational studies may be uninterpretable, because study intent and interpretations do not align. While causal methods and intent are most common in observational research, authors commonly shroud causal intent in non-causal terminology.
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Affiliation(s)
- Connor Gleadhill
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia; Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, 2287, Australia.
| | - Hopin Lee
- Centre for Statistics in Medicine, Rehabilitation Research in Oxford, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Steven J Kamper
- School of Health Sciences, University of Sydney, PO Box M179, Camperdown, NSW, 2050, Australia; Allied Health Department, Nepean Blue Mountains Local Health District, Nepean Hospital, Penrith, NSW, 2750, Australia
| | - Aidan Cashin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia; School of Health Sciences, Faculty of Medicine & Health, University of New South Wales, Sydney, Australia
| | - Harrison Hansford
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia; School of Health Sciences, Faculty of Medicine & Health, University of New South Wales, Sydney, Australia
| | - Adrian C Traeger
- Faculty of Medicine and Health, Institute for Musculoskeletal Health, Sydney School of Public Health, The University of Sydney, King George V Building, Camperdown, NSW, 2050, Australia
| | - Priscilla Viana Da Silva
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia; Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, 2287, Australia
| | - Erin Nolan
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Simon R E Davidson
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia; Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, 2287, Australia
| | - Magdalena Wilczynska
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia; Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, 2287, Australia
| | - Emma Robson
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia; Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, 2287, Australia
| | - Christopher M Williams
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, 2287, Australia; School of Health Sciences, University of Sydney, PO Box M179, Camperdown, NSW, 2050, Australia; Research and Knowledge Translation Directorate, Mid North Coast Local Health District, Port Macquarie, Australia
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Hoerger K, Hue JJ, Elshami M, Ammori JB, Hardacre JM, Winter JM, Ocuin LM. Facility Volume Thresholds for Optimization of Short- and Long-Term Outcomes in Patients Undergoing Hepatectomy for Primary Liver Tumors. J Gastrointest Surg 2023; 27:273-282. [PMID: 36443556 DOI: 10.1007/s11605-022-05541-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 11/13/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Volume-outcome relationships have been described for a variety of surgical procedures. We aimed to define the facility volume threshold at which postoperative mortality after hepatectomy was optimal. METHODS We determined volume percentiles for institutions performing hepatectomy for any primary liver tumor within the National Cancer Database (2004-2017). Marginal structural logistic regression defined the volume percentile (Vmin) at which the odds of 90-day mortality were optimally reduced in patients with hepatocellular carcinoma (HCC) or intrahepatic cholangiocarcinoma (ICC). Short-term postoperative and survival outcomes were compared between patients treated at facilities above and below Vmin. RESULTS Thresholds for the 10th/25th/50th/75th/90th percentiles were 2/7/26/46/59 hepatectomies/year. A total of 17,833 patients underwent resection of HCC or ICC. The 90-day postoperative mortality was optimized at the 75th percentile for all hepatectomies (IP-weighted OR = 0.67, 95% CI = 0.52-0.87) and major hepatectomy (IP-weighted OR = 0.62, 95% CI = 0.49-0.80). Seven of 446 facilities met the Vmin threshold. The odds of 30-day mortality were also reduced for all hepatectomies (IP-weighted OR = 0.55, 95% CI = 0.42-0.73) and major hepatectomy (IP-weighted OR = 0.58, 95% CI = 0.41-0.75). There were no differences in length of stay or 30-day readmission rate. Patients with HCC or ICC treated at facilities ≥ 10th percentile had an associated improvement in overall survival. CONCLUSIONS Resection of HCC and ICC is performed at a large number of facilities. Postoperative mortality is optimally reduced at facilities performing at least 46 liver operations annually. Regionalization of surgical care among patients with primary liver malignancies to high-volume centers may result in improved outcomes.
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Affiliation(s)
- Kelly Hoerger
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave., Cleveland, OH, 44106, USA
| | - Jonathan J Hue
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave., Cleveland, OH, 44106, USA
| | - Mohamedraed Elshami
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave., Cleveland, OH, 44106, USA
| | - John B Ammori
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave., Cleveland, OH, 44106, USA
| | - Jeffrey M Hardacre
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave., Cleveland, OH, 44106, USA
| | - Jordan M Winter
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave., Cleveland, OH, 44106, USA
| | - Lee M Ocuin
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave., Cleveland, OH, 44106, USA.
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Elshami M, Ahmed FA, Hue JJ, Kakish H, Hoehn RS, Rothermel LD, Bajor D, Mohamed A, Selfridge JE, Ammori JB, Hardacre JM, Winter JM, Ocuin LM. Average treatment effect of facility hepatopancreatobiliary malignancy case volume on survival of patients with nonoperatively managed hepatobiliary malignancies. Surgery 2023; 173:289-298. [PMID: 36402613 DOI: 10.1016/j.surg.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/01/2022] [Accepted: 10/10/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Surgical volume-outcome relationships have been described for a variety of procedures. There is scant literature on total institutional volume and outcomes in patients who are nonoperatively managed. We examined the average treatment effect of total hepatopancreatobiliary malignancy case volume on survival outcomes of patients with nonresected hepatobiliary malignancies. METHODS We identified patients with hepatopancreatobiliary malignancies [pancreatic adenocarcinoma, pancreatic neuroendocrine neoplasms, hepatocellular carcinoma, biliary tract cancers] within the National Cancer Database (2004-2018). We determined percentile thresholds based on the total annual hepatopancreatobiliary malignancy case volume. We then identified nonoperatively managed patients with hepatocellular carcinoma or biliary tract cancers. We used inverse probability-weighted Cox regression to estimate the effect of facility volume on overall survival. RESULTS We identified 710,988 patients with hepatopancreatobiliary malignancies. Total annual hepatopancreatobiliary malignancy case volume of 32, 71, and 177 cases/year corresponded to the 25th, 50th, and 75th percentiles. A total of 96,420 with hepatocellular carcinoma and 52,627 patients with biliary tract cancers were managed nonoperatively. In patients with hepatocellular carcinoma or biliary tract cancer, treatment at ≥25th, ≥50th, and ≥75th percentile facilities was associated with improved median, 1-, 2-, and 3-year overall survival compared with treatment at lower-percentile facilities. On inverse probability-weighted Cox analysis, treatment at higher-percentile facilities resulted in a lower hazard of death. Consistent findings were observed in patients with early or intermediate/advanced hepatocellular carcinoma or metastatic biliary tract cancers. CONCLUSION Patients with nonoperatively managed hepatocellular carcinoma or biliary tract cancer who receive treatment at higher-volume facilities have improved survival outcomes. These data suggest regionalization of care for patients with hepatocellular carcinoma or biliary tract cancer to high-volume centers may improve survival.
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Affiliation(s)
- Mohamedraed Elshami
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH. https://twitter.com/MElshamiMD
| | - Fasih Ali Ahmed
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH. https://twitter.com/ali_fasih
| | - Jonathan J Hue
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH. https://twitter.com/jj_hue
| | - Hanna Kakish
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH. https://twitter.com/HannaKakish
| | - Richard S Hoehn
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH. https://twitter.com/Richard_Hoehn
| | - Luke D Rothermel
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH. https://twitter.com/LukeRothermel
| | - David Bajor
- Division of Hematology/Oncology, Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH. https://twitter.com/dlbajor
| | - Amr Mohamed
- Division of Hematology/Oncology, Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH. https://twitter.com/AmmoriJohn
| | - J Eva Selfridge
- Division of Hematology/Oncology, Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH. https://twitter.com/JordanMWinterMD
| | - John B Ammori
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Jeffrey M Hardacre
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Jordan M Winter
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Lee M Ocuin
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH.
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Freeman JR, Whitcomb BW, Bertone-Johnson ER, Balzer LB, O'Brien LM, Dunietz GL, Purdue-Smithe AC, Kim K, Silver RM, Schisterman EF, Mumford SL. Preconception sleep duration, sleep timing, and shift work in association with fecundability and live birth among women with a history of pregnancy loss. Fertil Steril 2023; 119:252-263. [PMID: 36586812 PMCID: PMC9899515 DOI: 10.1016/j.fertnstert.2022.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To evaluate the associations between preconception sleep characteristics and shift work with fecundability and live birth. DESIGN Secondary analysis of the Effects of Aspirin in Gestation and Reproduction study, a preconception cohort. SETTING Four US academic medical centers. PATIENT(S) Women aged 18-40 with a history of 1-2 pregnancy losses who were attempting to conceive again. INTERVENTION(S) Not applicable. MAIN OUTCOME MEASURES(S) We evaluated baseline, self-reported sleep duration, sleep midpoint, social jetlag, and shift work among 1,228 women who were observed for ≤6 cycles of pregnancy attempts to ascertain fecundability. We ascertained live birth at the end of follow up via chart abstraction. We estimated fecundability odds ratios (FORs) using discrete, Cox proportional hazards models and risk ratios (RRs) for live birth using log-Poisson models. RESULT(S) Sleep duration ≥9 vs. 7 to <8 hours (FOR: 0.81, 95% confidence interval [CI], 0.61; 1.08), later sleep midpoints (3rd tertile vs. 2nd tertile: FOR: 0.85; 95% CI, 0.69, 1.04) and social jetlag (continuous per hour; FOR: 0.93, 95% CI: 0.86, 1.00) were not associated with reduced fecundability. In sensitivity analyses, excluding shift workers, sleep duration ≥9 vs. 7 to <8 hours (FOR: 0.62; 95% CI, 0.42; 0.93) was associated with low fecundability. Night shift work was not associated with fecundability (vs. non-night shift work FOR: 1.17, 95% CI, 0.96; 1.42). Preconception sleep was not associated with live birth. CONCLUSION(S) Overall, there does not appear to be a strong association between sleep characteristics, fecundability, and live birth. Although these findings may suggest weak and imprecise associations with some sleep characteristics, our findings should be evaluated in larger cohorts of women with extremes of sleep characteristics. CLINICAL TRIAL REGISTRATION NUMBER Clinicaltrials.gov NCT00467363.
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Affiliation(s)
- Joshua R Freeman
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts; Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
| | - Brian W Whitcomb
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Elizabeth R Bertone-Johnson
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts; Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Laura B Balzer
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Louise M O'Brien
- Division of Sleep Medicine, Department of Neurology, University of Michigan, Ann Arbor, Michigan; Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | - Galit L Dunietz
- Division of Sleep Medicine, Department of Neurology, University of Michigan, Ann Arbor, Michigan
| | - Alexandra C Purdue-Smithe
- Division of Women's Health, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Keewan Kim
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Robert M Silver
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Enrique F Schisterman
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sunni L Mumford
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Elshami M, Ahmed FA, Kakish H, Hue JJ, Hoehn RS, Rothermel LD, Bajor D, Mohamed A, Selfridge JE, Ammori JB, Hardacre JM, Winter JM, Ocuin LM. Trends and disparities in the utilization of systemic chemotherapy in patients with metastatic hepato-pancreato-biliary cancers. HPB (Oxford) 2023; 25:239-251. [PMID: 36411233 DOI: 10.1016/j.hpb.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 10/12/2022] [Accepted: 11/02/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND We described trends and disparities in utilization of systemic chemotherapy in metastatic hepato-pancreato-biliary (HPB) cancers. METHODS We queried the National Cancer Database for metastatic HPB cancers [hepatocellular carcinoma (HCC), biliary tract cancers (BTC), pancreatic adenocarcinoma (PDAC)]. We used multivariable analysis to examine the factors associated with utilization of systemic chemotherapy. We utilized marginal structural logistic models to estimate the effect of health insurance, facility type, or facility volume on utilization of systemic chemotherapy. RESULTS We identified 162,283 patients with metastatic HPB cancers: 23,923 (14.7%) had HCC, 26,766 (16.5%) had BTC, and 111,594 (68.8%) had PDAC. A total of 37.2% patients with HCC, 55.6% with BTC, and 56.4% with PDAC received chemotherapy. Age ≥70 years and Charlson-Deyo score ≥2 were associated with lower likelihood of receiving chemotherapy across all cancers. Patients with private health insurance had higher receipt of chemotherapy. Receiving treatment at academic facilities had no effect on the receipt of chemotherapy. Treatment of patients with HCC or PDAC at high-volume facilities resulted in higher receipt of chemotherapy. CONCLUSION A significant proportion of patients with metastatic HPB cancers do not receive systemic chemotherapy. Several disparities in administration of chemotherapy for metastatic HPB cancers exist.
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Affiliation(s)
- Mohamedraed Elshami
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Fasih A Ahmed
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Hanna Kakish
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jonathan J Hue
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Richard S Hoehn
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Luke D Rothermel
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - David Bajor
- Division of Hematology/Oncology, Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Amr Mohamed
- Division of Hematology/Oncology, Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jennifer E Selfridge
- Division of Hematology/Oncology, Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - John B Ammori
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jeffrey M Hardacre
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jordan M Winter
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Lee M Ocuin
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
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237
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Raittio E, Torppa‐Saarinen E, Sokka T, Lahti S, Suominen A, Suominen AL, Heikkinen AM. Association of service use with subjective oral health indicators in a freedom of choice pilot. Clin Exp Dent Res 2023; 9:134-141. [PMID: 36263738 PMCID: PMC9932228 DOI: 10.1002/cre2.680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/23/2022] [Accepted: 10/01/2022] [Indexed: 02/17/2023] Open
Abstract
OBJECTIVES A freedom of choice pilot provided access to private oral health care services without queuing and with fixed public service-fees for participants in Tampere region, Finland in 2018-2019. The aim of this study was to investigate how use of oral health care services differed by demographics, socioeconomic status, dental fear, and self-reported oral health in this pilot. MATERIAL AND METHODS SMS-messages including a link to online questionnaire were sent to participants who had booked an appointment, and to those who had not booked an appointment despite registering to pilot. We categorized participants to (1) those who had booked their first appointment before receiving SMS (visitors), (2) those who booked an appointment after receiving the SMS-message (late-visitors), and (3) those who had not booked an appointment during pilot (nonvisitors). We used regression analysis to estimate the association of age, gender, dental fear, economic situation, Oral Health Impact Profile-14-severity (oral health-related quality of life [OHRQoL]), self-reported oral health and need for oral health care (exposures) with oral health care service use during the pilot (outcome). RESULTS Out of 2300 participants, 636 (28%) responded. Late-visitors were more likely older and reported more likely need for oral health care, poorer oral health and OHRQoL than visitors or nonvisitors. Nonvisitors were younger and had better OHRQoL than the others. The differences in the service use by gender, economic situation, and dental fear were small. CONCLUSIONS Service use during the pilot depended on the subjective oral health. Our findings highlight the potential of reminders in increasing care use among those with perceived need for services.
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Affiliation(s)
- Eero Raittio
- Oral Health Care ServicesTampereFinland
- Institute of DentistryUniversity of Eastern FinlandKuopioFinland
- Department of Dentistry and Oral HealthAarhus UniversityAarhusDenmark
| | | | - Taru Sokka
- The Council of Tampere RegionTampereFinland
| | - Satu Lahti
- Department of Community DentistryUniversity of TurkuTurkuFinland
| | - Auli Suominen
- Department of Community DentistryUniversity of TurkuTurkuFinland
| | - Anna Liisa Suominen
- Institute of DentistryUniversity of Eastern FinlandKuopioFinland
- Oral Health Teaching Clinic, Kuopio University HospitalKuopioFinland
| | - Anna Maria Heikkinen
- Oral Health Care ServicesTampereFinland
- Faculty of Medicine and Health TechnologyTampere UniversityTampereFinland
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238
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Gongola A, Bradshaw JC. Directed Acyclic Graphs in Surgical Research. J Surg Res 2023; 282:285-288. [PMID: 36045022 DOI: 10.1016/j.jss.2022.07.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/28/2022] [Accepted: 07/29/2022] [Indexed: 11/25/2022]
Abstract
Surgical research often utilizes multivariable regression to evaluate causal relationships between variables, but there is usually little explanation of the decision-making regarding which variables were controlled for. We propose that directed acyclic graphs (DAGs)-a formal logic tool that illustrates connections between variables-should be used to define and communicate variable relationships to readers and other audiences. While literature in epidemiology and other medical fields has recently started to incorporate DAGs more, they are still seldom seen in surgical publications. In this review, we describe the background and need for DAGs and argue for their use. Next, we explain how bias can be introduced without a thoughtful approach to control variable selection. Finally, we recommend that researchers communicate their choices and rationale when selecting control variables in published surgical research.
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Affiliation(s)
- AlleaBelle Gongola
- Department of Surgery, Medstar Georgetown University Hospital, Washington, District of Columbia.
| | - Jace C Bradshaw
- Departments of Emergency Medicine and Anesthesiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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239
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Thurin NH, Jové J, Lassalle R, Rouyer M, Lamarque S, Bosco-Levy P, Segalas C, Schneeweiss S, Blin P, Droz-Perroteau C. Strong instrumental variables biased propensity scores in comparative effectiveness research: A case study in oncology. J Clin Epidemiol 2023; 155:31-38. [PMID: 36657590 DOI: 10.1016/j.jclinepi.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/10/2022] [Accepted: 01/11/2023] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND OBJECTIVES Some medications require specific medical procedures in the weeks before their start. Such procedures may meet the definition of instrumental variables (IVs). We examined how they may influence treatment effect estimation in propensity score (PS)-adjusted comparative studies, and how to remedy. STUDY DESIGN AND SETTING Different covariate assessment periods (CAPs) did and did not include the month preceding treatment start were used to compute PS in the French claims database (Sytème National des Données de Santé-SNDS), and 1:1 match patients with metastatic castration resistant prostate cancer initiating abiraterone acetate or docetaxel. The 36-month survival was assessed. RESULTS Among 1, 213 docetaxel and 2, 442 abiraterone initiators, the PS distribution resulting from the CAP [-12; 0 months] distinctly separated populations (c = 0.93; 273 matched pairs). The CAPs [-12;-1 months] identified 765 pairs (c = 0.81). Strong docetaxel treatment predictors during the month before treatment start were implantable delivery systems (1% vs. 59%), which fulfilled IV conditions. The 36-month survival was not meaningfully different under the [-12; 0 months] CAP but differed by 10% points (38% vs. 28%) after excluding month -1. CONCLUSION In the setting of highly predictive pretreatment procedures, excluding the immediate pre-exposure time from the CAP will reduce the risk of including potential IVs in PS models and may reduce bias.
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Affiliation(s)
- Nicolas H Thurin
- University of Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, Bordeaux, France.
| | - Jérémy Jové
- University of Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, Bordeaux, France
| | - Régis Lassalle
- University of Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, Bordeaux, France
| | - Magali Rouyer
- University of Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, Bordeaux, France
| | - Stéphanie Lamarque
- University of Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, Bordeaux, France
| | - Pauline Bosco-Levy
- University of Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, Bordeaux, France
| | - Corentin Segalas
- University of Paris Cité, Centre of Epidemiology and Statistics (CRESS) INSERM, Paris, France
| | - Sebastian Schneeweiss
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Patrick Blin
- University of Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, Bordeaux, France
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Radtke T, Kriemler S, Stein L, Karila C, Urquhart DS, Orenstein DM, Lands LC, Schindler C, Eber E, Haile SR, Hebestreit H. Cystic fibrosis related diabetes is not associated with maximal aerobic exercise capacity in cystic fibrosis: a cross-sectional analysis of an international multicenter trial. J Cyst Fibros 2023; 22:31-38. [PMID: 35803884 DOI: 10.1016/j.jcf.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/24/2022] [Accepted: 06/27/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Previous studies have reported differences in aerobic exercise capacity, expressed as peak oxygen uptake (VO2peak), between people with and without cystic fibrosis (CF) related diabetes (CFRD). However, none of the studies controlled for the potential influence of physical activity on VO2peak. We investigated associations between CFRD and VO2peak following rigorous control for confounders including objectively measured physical activity. METHODS Baseline data from the international multicenter trial ACTIVATE-CF with participants ≥12 years performing up to 4 h per week of vigorous physical activity were used for this project. Multivariable models were computed to study associations between CFRD and VO2peak (mL.min-1) adjusting for a set of pre-defined covariates: age, sex, weight, forced expiratory volume in 1 s (FEV1), breathing reserve index, Pseudomonas aeruginosa infection, and physical activity (aerobic step counts from pedometry). Variables were selected based on their potential confounding effect on the association between VO2peak and CFRD. RESULTS Among 117 randomized individuals, 103 (52% female) had a maximal exercise test and were included in the analysis. Participants with (n = 19) and without (n = 84) CFRD did not differ in FEV1, physical activity, nutritional status, and other clinical characteristics. There were also no differences in VO2peak (mL.min-1 or mL.kg-1.min-1 or% predicted). In the final multivariable model, all pre-defined covariates were significant predictors of VO2peak (mL.min-1), however CFRD [coefficient 82.1, 95% CI -69.5 to 233.8, p = 0.28] was not. CONCLUSIONS This study suggests no meaningful differences in VO2peak between people with and without CFRD given comparable levels of physical activity.
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Affiliation(s)
- Thomas Radtke
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
| | - Susi Kriemler
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Lothar Stein
- Hannover Medical School, Institute of Sports Medicine, Hannover, Germany
| | - Chantal Karila
- Service de pneumologie et allergologie pédiatriques - Hôpital Necker Enfants malades - APHP - Université Paris Descartes, Paris, France
| | - Don S Urquhart
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children and Young People, Edinburgh, UK
| | - David M Orenstein
- Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, USA
| | - Larry C Lands
- Montreal Children's Hospital - McGill University Health, Montreal, QC, Canada
| | - Christian Schindler
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Ernst Eber
- Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Sarah R Haile
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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Wang Y, Wei J, Zhang Y, Guo T, Chen S, Wu W, Chen S, Li Z, Qu Y, Xiao J, Deng X, Liu Y, Du Z, Zhang W, Hao Y. Estimating causal links of long-term exposure to particulate matters with all-cause mortality in South China. ENVIRONMENT INTERNATIONAL 2023; 171:107726. [PMID: 36638656 DOI: 10.1016/j.envint.2022.107726] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/03/2022] [Accepted: 12/29/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The association between long-term particulate matter (PM) exposure and all-cause mortality has been well-documented. However, evidence is still limited from high-exposed cohorts, especially for PM1 which is smaller while more toxic than other commonly investigated particles. We aimed to examine the potential casual links of long-term PMs exposure with all-cause mortality in high-exposed areas. METHODS A total of 580,757 participants in southern China were enrolled during 2009-2015 and followed up to 2020. The annual average concentration of PM1, PM2.5, and PM10 at 1 km2 spatial resolution was assessed for each residential address through validated spatiotemporal models. We used marginal structural Cox models to estimate the PM-mortality associations which were further stratified by sociodemographic, lifestyle factors and general exposure levels. RESULTS 37,578 deaths were totally identified during averagely 8.0 years of follow-up. Increased exposure to all 3 PM size fractions were significantly associated with increased risk of all-cause mortality, with hazard ratios (HRs) of 1.042 (95 % confidence interval (CI): 1.037-1.046), 1.031 (95 % CI: 1.028-1.033), and 1.029 (95 % CI: 1.027-1.031) per 1 μg/m3 increase in PM1, PM2.5, and PM10 concentrations, respectively. We observed greater effect estimates among the elderly (age ≥ 65 years), unmarried participants, and those with low education attainment. Additionally, the effect of PM1, PM2.5, and PM10 tend to be higher in the low-exposure group than in the general population. CONCLUSIONS We provided comprehensive evidence for the potential causal links betweenlong-term PM exposureand all-cause mortality, and suggested stronger links for PM1compared to large particles and among certain vulnerable subgroups.
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Affiliation(s)
- Ying Wang
- Department of Medical Statistics, School of Public Health & Center for Health Information Research & Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China
| | - Jing Wei
- Department of Atmospheric and Oceanic Science, Earth System Science Interdisciplinary Center, University of Maryland, College Park, USA
| | - Yuqin Zhang
- Department of Medical Statistics, School of Public Health & Center for Health Information Research & Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China
| | - Tong Guo
- Department of Medical Statistics, School of Public Health & Center for Health Information Research & Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China
| | - Shirui Chen
- Department of Medical Statistics, School of Public Health & Center for Health Information Research & Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China
| | - Wenjing Wu
- Department of Medical Statistics, School of Public Health & Center for Health Information Research & Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China
| | - Shimin Chen
- Department of Medical Statistics, School of Public Health & Center for Health Information Research & Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China
| | - Ziqiang Li
- Department of Preventive Medicine, School of Basic Medicine and Public Health, Jinan University, Guangzhou, China
| | - Yanji Qu
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Jianpeng Xiao
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Xinlei Deng
- Epidemiology Branch, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, NC, USA
| | - Yu Liu
- Department of Medical Statistics, School of Public Health & Center for Health Information Research & Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China
| | - Zhicheng Du
- Department of Medical Statistics, School of Public Health & Center for Health Information Research & Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China.
| | - Wangjian Zhang
- Department of Medical Statistics, School of Public Health & Center for Health Information Research & Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China.
| | - Yuantao Hao
- Peking University Center for Public Health and Epidemic Preparedness & Response, Peking, Beijing, China.
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Kanthimathinathan HK, Cromie KJ, Feltbower RG. The case for causal inference methods in resuscitation research. Resuscitation 2023; 182:109666. [PMID: 36563955 DOI: 10.1016/j.resuscitation.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022]
Affiliation(s)
| | - Kirsten J Cromie
- Leeds Institute for Data Analytics, School of Medicine, University of Leeds, UK
| | - Richard G Feltbower
- Leeds Institute for Data Analytics, School of Medicine, University of Leeds, UK
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Hockey M, Mohebbi M, Tolmunen T, Hantunen S, Tuomainen TP, Macpherson H, Jacka FN, Virtanen JK, Rocks T, Ruusunen A. Associations between total dairy, high-fat dairy and low-fat dairy intake, and depressive symptoms: findings from a population-based cross-sectional study. Eur J Nutr 2023; 62:227-237. [PMID: 35947163 PMCID: PMC9899713 DOI: 10.1007/s00394-022-02950-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 06/24/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE Evidence on the association between dairy intake and depression is conflicting. Given numerous dietary guidelines recommend the consumption of low-fat dairy products, this study examined associations between total dairy, high-fat dairy, and low-fat dairy intake and the prevalence of elevated depressive symptoms. Associations between dairy products, which differed in both fat content and fermentation status, and depressive symptoms were also explored. METHODS This cross-sectional study included 1600 Finnish adults (mean age 63 ± 6 years; 51% female) recruited as part of the Kuopio Ischaemic Heart Disease Risk Factor Study. Dairy intake was assessed using 4-day food records. Elevated depressive symptoms were defined as having a score ≥ 5 on the Diagnostic and Statistical Manual of Mental Disorders-III Depression Scale, and/or regularly using one or more prescription drugs for depressive symptoms. RESULTS In total, 166 participants (10.4%) reported having elevated depressive symptoms. Using multivariate logistic regression models, intake in the highest tertile of high-fat dairy products (OR 0.64, 95% CI 0.41-0.998, p trend = 0.04) and high-fat non-fermented dairy products (OR 0.60, 95% CI 0.39-0.92, p trend = 0.02) were associated with reduced odds for having elevated depressive symptoms. Whereas no significant association was observed between intake of total dairy, low-fat dairy, or other dairy products, and depressive symptoms. CONCLUSION Higher intake of high-fat dairy and high-fat non-fermented dairy products were associated with reduced odds for having elevated depressive symptoms in middle-aged and older Finnish adults. Given the high global consumption of dairy products, and widespread burden of depression, longitudinal studies that seek to corroborate these findings are required.
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Affiliation(s)
- Meghan Hockey
- IMPACT (The Institute for Mental and Physical Health and Clinical Translation), Food & Mood Centre, Deakin University, Geelong, Australia.
| | | | - Tommi Tolmunen
- Department of Adolescent Psychiatry, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine / Psychiatry, University of Eastern Finland, Kuopio, Finland
| | - Sari Hantunen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Tomi-Pekka Tuomainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Helen Macpherson
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Felice N Jacka
- IMPACT (The Institute for Mental and Physical Health and Clinical Translation), Food & Mood Centre, Deakin University, Geelong, Australia
- Murdoch Children's Research Institute, Centre for Adolescent Health, Melbourne, Australia
- Black Dog Institute, Sydney, Australia
| | - Jyrki K Virtanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Tetyana Rocks
- IMPACT (The Institute for Mental and Physical Health and Clinical Translation), Food & Mood Centre, Deakin University, Geelong, Australia
| | - Anu Ruusunen
- IMPACT (The Institute for Mental and Physical Health and Clinical Translation), Food & Mood Centre, Deakin University, Geelong, Australia
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland
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Bellavia A, Zou R, Björvang RD, Roos K, Sjunnesson Y, Hallberg I, Holte J, Pikki A, Lenters V, Portengen L, Koekkoek J, Lamoree M, Van Duursen M, Vermeulen R, Salumets A, Velthut-Meikas A, Damdimopoulou P. Association between chemical mixtures and female fertility in women undergoing assisted reproduction in Sweden and Estonia. ENVIRONMENTAL RESEARCH 2023; 216:114447. [PMID: 36181890 PMCID: PMC9729501 DOI: 10.1016/j.envres.2022.114447] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/07/2022] [Accepted: 09/25/2022] [Indexed: 05/07/2023]
Abstract
OBJECTIVE Women of reproductive age are exposed to ubiquitous chemicals such as phthalates, parabens, and per- and polyfluoroalkyl substances (PFAS), which have potential endocrine disrupting properties and might affect fertility. Our objective was to investigate associations between potential endocrine-disrupting chemicals (EDCs) and female fertility in two cohorts of women attending fertility clinics. METHODS In a total population of 333 women in Sweden and Estonia, we studied the associations between chemicals and female fertility, evaluating ovarian sensitivity index (OSI) as an indicator of ovarian response, as well as clinical pregnancy and live birth from fresh and frozen embryo transfers. We measured 59 chemicals in follicular fluid samples and detected 3 phthalate metabolites, di-2-ethylhexyl phthalate (DEHP) metabolites, 1 paraben, and 6 PFAS in >90% of the women. Associations were evaluated using multivariable-adjusted linear or logistic regression, categorizing EDCs into quartiles of their distributions, as well as with Bayesian Kernel Machine Regression. RESULTS We observed statistically significant lower OSI at higher concentrations of the sum of DEHP metabolites in the Swedish cohort (Q4 vs Q1, β = -0.21, 95% CI: -0.38, -0.05) and methylparaben in the Estonian cohort (Q3 vs Q1, β = -0.22, 95% CI: -0.44, -0.01). Signals of potential associations were also observed at higher concentrations of PFUnDA in both the combined population (Q2 vs. Q1, β = -0.16, 95% CI -0.31, -0.02) and the Estonian population (Q2 vs. Q1, β = -0.27, 95% CI -0.45, -0.08), and for PFOA in the Estonian population (Q4 vs. Q1, β = -0.31, 95% CI -0.61, -0.01). Associations of chemicals with clinical pregnancy and live birth presented wide confidence intervals. CONCLUSIONS Within a large chemical mixture, we observed significant inverse associations levels of DEHP metabolites and methylparaben, and possibly PFUnDA and PFOA, with OSI, suggesting that these chemicals may contribute to altered ovarian function and infertility in women.
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Affiliation(s)
- Andrea Bellavia
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Runyu Zou
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Richelle D Björvang
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Kristine Roos
- Department of Chemistry and Biotechnology, Tallinn University of Technology, Tallinn, Estonia; Nova Vita Clinic AS, Tallinn, Estonia
| | - Ylva Sjunnesson
- Department of Clinical Sciences, Division of Reproduction, The Center for Reproductive Biology in Uppsala, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Ida Hallberg
- Department of Clinical Sciences, Division of Reproduction, The Center for Reproductive Biology in Uppsala, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Jan Holte
- Carl von Linnékliniken, Uppsala, Sweden; Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Anne Pikki
- Carl von Linnékliniken, Uppsala, Sweden; Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Virissa Lenters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Lützen Portengen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Jacco Koekkoek
- Amsterdam Institute for Life and Environment, Section Environment and Health, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Marja Lamoree
- Amsterdam Institute for Life and Environment, Section Environment and Health, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Majorie Van Duursen
- Amsterdam Institute for Life and Environment, Section Environment and Health, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Andres Salumets
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Competence Center on Health Technologies, Tartu, Estonia; Department of Obstetrics and Gynaecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Agne Velthut-Meikas
- Department of Chemistry and Biotechnology, Tallinn University of Technology, Tallinn, Estonia.
| | - Pauliina Damdimopoulou
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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School-age outcomes among IVF-conceived children: A population-wide cohort study. PLoS Med 2023; 20:e1004148. [PMID: 36693021 PMCID: PMC9873192 DOI: 10.1371/journal.pmed.1004148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 11/23/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND In vitro fertilisation (IVF) is a common mode of conception. Understanding the long-term implications for these children is important. The aim of this study was to determine the causal effect of IVF conception on primary school-age childhood developmental and educational outcomes, compared with outcomes following spontaneous conception. METHODS AND FINDINGS Causal inference methods were used to analyse observational data in a way that emulates a target randomised clinical trial. The study cohort comprised statewide linked maternal and childhood administrative data. Participants included singleton infants conceived spontaneously or via IVF, born in Victoria, Australia between 2005 and 2014 and who had school-age developmental and educational outcomes assessed. The exposure examined was conception via IVF, with spontaneous conception the control condition. Two outcome measures were assessed. The first, childhood developmental vulnerability at school entry (age 4 to 6), was assessed using the Australian Early Developmental Census (AEDC) (n = 173,200) and defined as scoring <10th percentile in ≥2/5 developmental domains (physical health and wellbeing, social competence, emotional maturity, language and cognitive skills, communication skills, and general knowledge). The second, educational outcome at age 7 to 9, was assessed using National Assessment Program-Literacy and Numeracy (NAPLAN) data (n = 342,311) and defined by overall z-score across 5 domains (grammar and punctuation, reading, writing, spelling, and numeracy). Inverse probability weighting with regression adjustment was used to estimate population average causal effects. The study included 412,713 children across the 2 outcome cohorts. Linked records were available for 4,697 IVF-conceived cases and 168,503 controls for AEDC, and 8,976 cases and 333,335 controls for NAPLAN. There was no causal effect of IVF-conception on the risk of developmental vulnerability at school-entry compared with spontaneously conceived children (AEDC metrics), with an adjusted risk difference of -0.3% (95% CI -3.7% to 3.1%) and an adjusted risk ratio of 0.97 (95% CI 0.77 to 1.25). At age 7 to 9 years, there was no causal effect of IVF-conception on the NAPLAN overall z-score, with an adjusted mean difference of 0.030 (95% CI -0.018 to 0.077) between IVF- and spontaneously conceived children. The models were adjusted for sex at birth, age at assessment, language background other than English, socioeconomic status, maternal age, parity, and education. Study limitations included the use of observational data, the potential for unmeasured confounding, the presence of missing data, and the necessary restriction of the cohort to children attending school. CONCLUSIONS In this analysis, under the given causal assumptions, the school-age developmental and educational outcomes for children conceived by IVF are equivalent to those of spontaneously conceived children. These findings provide important reassurance for current and prospective parents and for clinicians.
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246
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Diong J, Lee H, Reed D. The effect of face-to-face versus online learning on student performance in anatomy: an observational study using a causal inference approach. DISCOVER EDUCATION 2023; 2:3. [PMID: 36619253 PMCID: PMC9811866 DOI: 10.1007/s44217-022-00027-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/26/2022] [Indexed: 01/06/2023]
Abstract
Introduction This study aimed to estimate the causal effect of face-to-face learning on student performance in anatomy, compared to online learning, by analysing examination marks under a causal structure. Methods We specified a causal graph to indicate how the mode of learning affected student performance. We sampled purposively to obtain end-semester examination marks of undergraduate and postgraduate students who learned using face-to-face (pre-COVID, 2019) or online modes (post-COVID, 2020). The analysis was informed by the causal graph. Marks were compared using linear regression, and sensitivity analyses were conducted to assess if effects were robust to unmeasured confounding. Results On average, face-to-face learning improved student performance in the end-semester examination in undergraduate students (gain of mean 8.3%, 95% CI 3.3 to 13.4%; E-value 2.77, lower limit of 95% CI 1.80) but lowered performance in postgraduate students (loss of 8.1%, 95% CI 3.6 to 12.6%; E-value 2.89, lower limit of 95% CI 1.88), compared to online learning. Discussion Under the assumed causal graph, we found that compared to online learning, face-to-face learning improved student performance in the end-semester examination in undergraduate students, but worsened student performance in postgraduate students. These findings suggest that different modes of learning may suit different types of students. Importantly, this is the first attempt to estimate causal effects of the mode of learning on student performance under a causal structure. This approach makes our assumptions transparent, informs data analysis, and is recommended when using observational data to make causal inferences.
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Affiliation(s)
- Joanna Diong
- grid.1013.30000 0004 1936 834XSchool of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Hopin Lee
- grid.4991.50000 0004 1936 8948Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Darren Reed
- grid.1013.30000 0004 1936 834XSchool of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
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Letzen JE, Hunt C, Kuwabara H, McGill LS, Reid MJ, Hamilton KR, Buenaver LF, Burton E, Sheinberg R, Wong DF, Smith MT, Campbell CM. Preliminary Evidence for the Sequentially Mediated Effect of Racism-Related Stress on Pain Sensitivity Through Sleep Disturbance and Corticolimbic Opioid Receptor Function. THE JOURNAL OF PAIN 2023; 24:1-18. [PMID: 36167231 PMCID: PMC10863672 DOI: 10.1016/j.jpain.2022.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/10/2022] [Accepted: 09/01/2022] [Indexed: 02/08/2023]
Abstract
Sleep disturbance predicts worse pain outcomes. Because sleep disturbance inequitably impacts Black adults - with racism as the upstream cause - understanding how racism-related stress impacts pain through sleep might help minimize racialized pain inequities. This preliminary study examined sequential mediation of the effect of racism-related stress on experimental pain through sleep disturbance and corticolimbic μOR function in pain-free non-Hispanic Black (NHB) and White (NHW) adults. Participants completed questionnaires, actigraphy, positron emission tomography, and sensory testing. We reproduced findings showing greater sleep disturbance and pain sensitivity among NHB participants; greater sleep disturbance (r = .35) and lower pain tolerance (r=-.37) were significantly associated with greater racism-related stress. In a sequential mediation model, the total effect of racism-related stress on pain tolerance (β=-.38, P = .005) weakened after adding sleep disturbance and ventromedial prefrontal cortex (vmPFC) μOR binding potential (BPND) as mediators (β = -.18, P = .16). The indirect effect was statistically significant [point estimate = -.003, (-.007, -.0003). Findings showed a potential sequentially mediated effect of racism-related stress on pain sensitivity through sleep disturbance and vmPFC μOR BPND. As policy efforts are enacted to eliminate the upstream cause of systemic racism, these results cautiously suggest that sleep interventions within racism-based trauma informed therapy might help prevent downstream effects on pain. PERSPECTIVE: This preliminary study identified the effect of racism-related stress on pain through sleep disturbance and mu-opioid receptor binding potential in the ventromedial prefrontal cortex. Findings cautiously support the application of sleep interventions within racism-based trauma-informed therapy to prevent pain inequities as policy changes function to eliminate all levels of racism.
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Affiliation(s)
- Janelle E Letzen
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland..
| | - Carly Hunt
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Hiroto Kuwabara
- Department of Radiology, Johns Hopkins University, Baltimore, Maryland
| | - Lakeya S McGill
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland
| | - Matthew J Reid
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Katrina R Hamilton
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Luis F Buenaver
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Emily Burton
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Rosanne Sheinberg
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Dean F Wong
- Departments of Radiology, Psychiatry, Neurology, Neurosciences, Washington University School of Medicine, Mallinckrodt Institute of Radiology, St, Louis Missouri
| | - Michael T Smith
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Claudia M Campbell
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland
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Kurth T, Rohmann JL. Studying migraine as a risk factor for stroke: The importance of working with an explicit causal framework. Cephalalgia 2023; 43:3331024221132007. [PMID: 36622875 DOI: 10.1177/03331024221132007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Tobias Kurth
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jessica L Rohmann
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Clarke NA, Akeroyd MA, Henshaw H, Hall DA, Mohamad WNW, Hoare DJ. The executive disruption model of tinnitus distress: Model validation in two independent datasets using factor score regression. Front Psychol 2023; 14:1006349. [PMID: 36844272 PMCID: PMC9950568 DOI: 10.3389/fpsyg.2023.1006349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 01/06/2023] [Indexed: 02/12/2023] Open
Abstract
This study presents the executive disruption model (EDM) of tinnitus distress and subsequently validates it statistically using two independent datasets (the Construction Dataset: n = 96 and the Validation Dataset: n = 200). The conceptual EDM was first operationalised as a structural causal model (construction phase). Then multiple regression was used to examine the effect of executive functioning on tinnitus-related distress (validation phase), adjusting for the additional contributions of hearing threshold and psychological distress. For both datasets, executive functioning negatively predicted tinnitus distress score by a similar amount (the Construction Dataset: β = -3.50, p = 0.13 and the Validation Dataset: β = -3.71, p = 0.02). Theoretical implications and applications of the EDM are subsequently discussed; these include the predictive nature of executive functioning in the development of distressing tinnitus, and the clinical utility of the EDM.
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Affiliation(s)
- Nathan A Clarke
- Hearing Sciences, Mental Health and Clinical Neurosciences, University of Nottingham, Nottingham, United Kingdom.,National Institute for Health and Care Research (NIHR) Biomedical Research Centre, Nottingham, United Kingdom
| | - Michael A Akeroyd
- Hearing Sciences, Mental Health and Clinical Neurosciences, University of Nottingham, Nottingham, United Kingdom
| | - Helen Henshaw
- National Institute for Health and Care Research (NIHR) Biomedical Research Centre, Nottingham, United Kingdom
| | - Deborah A Hall
- Hearing Sciences, Mental Health and Clinical Neurosciences, University of Nottingham, Nottingham, United Kingdom.,School of Social Sciences, Heriot-Watt University Malaysia, Putrajaya, Malaysia
| | - Wan Najibah Wan Mohamad
- Audiology Programme, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Derek J Hoare
- Hearing Sciences, Mental Health and Clinical Neurosciences, University of Nottingham, Nottingham, United Kingdom.,National Institute for Health and Care Research (NIHR) Biomedical Research Centre, Nottingham, United Kingdom
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250
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Riseberg E, Melamed RD, James KA, Alderete TL, Corlin L. Development and application of an evidence-based directed acyclic graph to evaluate the associations between metal mixtures and cardiometabolic outcomes. EPIDEMIOLOGIC METHODS 2023; 12:20220133. [PMID: 37377511 PMCID: PMC10292771 DOI: 10.1515/em-2022-0133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 06/05/2023] [Indexed: 06/29/2023]
Abstract
Objectives Specifying causal models to assess relationships among metal mixtures and cardiometabolic outcomes requires evidence-based models of the causal structures; however, such models have not been previously published. The objective of this study was to develop and evaluate a directed acyclic graph (DAG) diagraming metal mixture exposure and cardiometabolic outcomes. Methods We conducted a literature search to develop the DAG of metal mixtures and cardiometabolic outcomes. To evaluate consistency of the DAG, we tested the suggested conditional independence statements using linear and logistic regression analyses with data from the San Luis Valley Diabetes Study (SLVDS; n=1795). We calculated the proportion of statements supported by the data and compared this to the proportion of conditional independence statements supported by 1,000 DAGs with the same structure but randomly permuted nodes. Next, we used our DAG to identify minimally sufficient adjustment sets needed to estimate the association between metal mixtures and cardiometabolic outcomes (i.e., cardiovascular disease, fasting glucose, and systolic blood pressure). We applied them to the SLVDS using Bayesian kernel machine regression, linear mixed effects, and Cox proportional hazards models. Results From the 42 articles included in the review, we developed an evidence-based DAG with 74 testable conditional independence statements (43 % supported by SLVDS data). We observed evidence for an association between As and Mn and fasting glucose. Conclusions We developed, tested, and applied an evidence-based approach to analyze associations between metal mixtures and cardiometabolic health.
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Affiliation(s)
- Emily Riseberg
- Department of Public Health and Community Medicine, Tufts University, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Katherine A. James
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Tanya L. Alderete
- Department of Integrative Physiology, University of Colorado, Boulder, CO, USA
| | - Laura Corlin
- Department of Public Health and Community Medicine, Tufts University, Boston, MA, USA
- Department of Civil and Environmental Engineering, Tufts University, Medford, MA, USA
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