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Zhang J, Lim YH, Napolitano GM, Backalarz C, Mortensen LH, Cole-Hunter T, Tuffier S, Bergmann M, So R, Brandt J, Ketzel M, Loft S, Andersen ZJ. Long-term exposure to road traffic noise and acute lower respiratory infections in the Danish Nurse Cohort. ENVIRONMENT INTERNATIONAL 2024; 190:108842. [PMID: 38970980 DOI: 10.1016/j.envint.2024.108842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 05/21/2024] [Accepted: 06/20/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND Long-term exposure to road traffic noise is associated with cardiovascular disease, but the evidence on respiratory diseases is just emerging. We aimed to examine the association between long-term exposure to road traffic noise and the incidence of acute lower respiratory infections (ALRIs) in adults. METHODS We followed 23,141 female nurses (age ≥ 44 years) from the Danish Nurse Cohort from baseline (1993 or 1999) to their first hospital contact (inpatient, outpatient, or emergency room) for ALRI, death, emigration or the end of 2015. The residential annual mean levels of road traffic noise (Lden) during the follow-up were estimated using the Nord2000 model. We applied time-varying Cox models to estimate the association of 3-year mean exposure to Lden with ALRIs incidence and piecewise analysis to estimate the threshold of Lden. We examined the robustness of the results by adjusting for residential exposure to air pollution, and the effect modification by attained age, socioeconomic status (SES), comorbidity, and lifestyle. RESULTS During 18.5 years of follow-up, 2,004 nurses developed ALRIs. In a linear model, we detected a statistically significant positive association between Lden and ALRI, with a hazard ratio (HR) of 1.11 (95 % confidence interval (CI): 1.04, 1.17) per 9.2 dB (interquartile range, IQR). We observed non-linear association with a threshold at 57 dB, above which the HR was 1.25 (95 % CI: 1.09, 1.43) per IQR. Further adjustment for PM2.5 reduced the HRs slightly to 1.21 (95 % CI: 1.04, 1.40). The associations were stronger for nurses with asthma, and in those with lowest SES. CONCLUSION We present novel findings in support of the association between long-term exposure to road traffic noise and ALRIs, independent of air pollution, suggesting noise as a risk factor for infectious respiratory diseases.
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Affiliation(s)
- Jiawei Zhang
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Youn-Hee Lim
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - George Maria Napolitano
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Laust H Mortensen
- Denmark Statistic, Copenhagen, Denmark; Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Cole-Hunter
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Stéphane Tuffier
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Marie Bergmann
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Rina So
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; iClimate, interdisciplinary Centre for Climate Change, Aarhus University, Roskilde, Denmark
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; Global Centre for Clean Air Research (GCARE), University of Surrey, Guildford, United Kingdom
| | - Steffen Loft
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Zorana Jovanovic Andersen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Cybulski L, Chilman N, Jewell A, Dewey M, Hildersley R, Morgan C, Huck R, Hotopf M, Stewart R, Pritchard M, Wuerth M, Das-Munshi J. Improving our understanding of the social determinants of mental health: a data linkage study of mental health records and the 2011 UK census. BMJ Open 2024; 14:e073582. [PMID: 38286672 PMCID: PMC10826590 DOI: 10.1136/bmjopen-2023-073582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 11/07/2023] [Indexed: 01/31/2024] Open
Abstract
OBJECTIVES To address the lack of individual-level socioeconomic information in electronic healthcare records, we linked the 2011 census of England and Wales to patient records from a large mental healthcare provider. This paper describes the linkage process and methods for mitigating bias due to non-matching. SETTING South London and Maudsley NHS Foundation Trust (SLaM), a mental healthcare provider in Southeast London. DESIGN Clinical records from SLaM were supplied to the Office of National Statistics for linkage to the census through a deterministic matching algorithm. We examined clinical (International Classification of Disease-10 diagnosis, history of hospitalisation, frequency of service contact) and socio-demographic (age, gender, ethnicity, deprivation) information recorded in Clinical Record Interactive Search (CRIS) as predictors of linkage success with the 2011 census. To assess and adjust for potential biases caused by non-matching, we evaluated inverse probability weighting for mortality associations. PARTICIPANTS Individuals of all ages in contact with SLaM up until December 2019 (N=459 374). OUTCOME MEASURES Likelihood of mental health records' linkage to census. RESULTS 220 864 (50.4%) records from CRIS linked to the 2011 census. Young adults (prevalence ratio (PR) 0.80, 95% CI 0.80 to 0.81), individuals living in more deprived areas (PR 0.78, 95% CI 0.78 to 0.79) and minority ethnic groups (eg, Black African, PR 0.67, 0.66 to 0.68) were less likely to match to census. After implementing inverse probability weighting, we observed little change in the strength of association between clinical/demographic characteristics and mortality (eg, presence of any psychiatric disorder: unweighted PR 2.66, 95% CI 2.52 to 2.80; weighted PR 2.70, 95% CI 2.56 to 2.84). CONCLUSIONS Lower response rates to the 2011 census among people with psychiatric disorders may have contributed to lower match rates, a potential concern as the census informs service planning and allocation of resources. Due to its size and unique characteristics, the linked data set will enable novel investigations into the relationship between socioeconomic factors and psychiatric disorders.
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Affiliation(s)
- Lukasz Cybulski
- Department of Psychological Medicine, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Natasha Chilman
- Department of Psychological Medicine, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Amelia Jewell
- South London & Maudsley NHS Foundation Trust, London, UK
| | - Michael Dewey
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Rosanna Hildersley
- Department of Psychological Medicine, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Craig Morgan
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Matthew Hotopf
- Department of Psychological Medicine, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Robert Stewart
- Department of Psychological Medicine, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Megan Pritchard
- University of East Anglia Norwich Medical School, Norwich, UK
| | - Milena Wuerth
- Department of Psychological Medicine, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Jayati Das-Munshi
- Department of Psychological Medicine, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, UK
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Asfar T, Oluwole OJ, Pan Y, Casas A, Garayua AMH, Schmidt M, Noar SM. Youth Exposure and Response to the FDA Health Warning Label on Electronic Cigarettes Packaging: Policy Implications. Nicotine Tob Res 2024; 26:151-160. [PMID: 37688562 PMCID: PMC10803120 DOI: 10.1093/ntr/ntad175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 07/11/2023] [Accepted: 09/07/2023] [Indexed: 09/11/2023]
Abstract
INTRODUCTION Youth represent a high-priority group for e-cigarette health communication. This study examined youth exposure to the Food and Drug Administration (FDA) e-cigarette warning label over 4 years and its association with change in youth harm perception and intention. AIMS AND METHODS We pooled data from the 2018-2021 National Youth Tobacco Survey (age 10-17; n = 67 159). Participants were divided into four groups: never users (58.5%), susceptible nonusers (16.3%), former users (12.7%), and current users (12.5%). We examined the prevalence, time-trend, correlates, and association of youth exposure to the warning with addictiveness and harm perception, intention to use e-cigarettes, and intention to quit all tobacco products. RESULTS Only 24.5% of youth were exposed to the warning. Exposure increased from 14.9% in 2018 to 30.8% in 2019, then declined to 25.2% in 2021. Hispanic (adjusted odds ratio (aOR) = 0.76 [95% CI = 0.641 to 0.89]) and non-Hispanic black current users (0.53 [0.40 to 0.69]) were less likely to be exposed to the warning than white current users. Youth exposure was positively associated with a higher perception of e-cigarette addictiveness (1.12 [1.04 to 1.19]) and intention to quit all tobacco products (1.28 [1.13 to 1.46]). However, exposure was negatively associated with harm perception (0.91 [0.85 to 0.96]) and the intention to use e-cigarettes among e-cigarette nonusers (2.38 [1.99 to 2.84]). CONCLUSIONS The decline in youth exposure to the warning indicates wear-out effects. Strengthening the label by using compelling designs, adding themes on e-cigarette harm to youth, periodically rotating warning content, and using culturally tailored messaging may improve its impact on youth and address racial/ethnic disparities. IMPLICATIONS The FDA e-cigarette label reached only 24.5% of youth, and exposure to the warning declined to indicate wear-out effects. Exposure was significantly lower among minorities. Exposure was associated with a higher perception of e-cigarette addictiveness and intention to quit all tobacco products. Still, it did not increase harm perception or reduce intention to use e-cigarettes among nonusers. Strengthening the label by using more compelling designs, including diverse themes focusing on e-cigarette harm relevant to youth, and periodically rotating warning content may improve its impact on youth. Continued surveillance of the implementation of e-cigarette policies is needed to ensure that they equally affect youth across racial/ethnic subpopulations.
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Affiliation(s)
- Taghrid Asfar
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Olusanya J Oluwole
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Yue Pan
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Alejandra Casas
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Michael Schmidt
- Department of Art and School of Public Health, University of Memphis, Memphis, TN, USA
| | - Seth M Noar
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Jiang EX, Domingo-Relloso A, Abuawad A, Haack K, Tellez-Plaza M, Fallin MD, Umans JG, Best LG, Zhang Y, Kupsco A, Belsky DW, Cole SA, Navas-Acien A. Arsenic Exposure and Epigenetic Aging: The Association with Cardiovascular Disease and All-Cause Mortality in the Strong Heart Study. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:127016. [PMID: 38133959 PMCID: PMC10743589 DOI: 10.1289/ehp11981] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Inorganic arsenic (As) may increase the risk of cardiovascular disease (CVD) and all-cause mortality through accelerated aging, which can be estimated using epigenetic-based measures. OBJECTIVES We evaluated three DNA methylation-based aging measures (PhenoAge, GrimAge, DunedinPACE) (epigenetic aging measures) as potential mediators of the previously reported association of As exposure with CVD incidence, CVD mortality, and all-cause mortality in the Strong Heart Study (SHS), an epidemiological cohort of American Indian adults. METHODS Blood DNA methylation and urinary As levels were measured in 2,323 SHS participants (41.5% men, mean age of 55 years old). PhenoAge and GrimAge values were calculated using a residual-based method. We tested the association of urinary As with epigenetic aging measures using linear regression, the association of epigenetic aging measures with the three health outcomes using additive hazards models, and the mediation of As-related CVD incidence, CVD mortality, and all-cause mortality by epigenetic aging measures using the product of coefficients method. RESULTS SHS participants with higher vs. lower urinary As levels had similar PhenoAge age, older GrimAge age, and faster DunedinPACE. An interquartile range increase in urinary As was associated with higher of PhenoAge age acceleration [mean difference ( 95 % confidence interval ) = 0.48 (0.17, 0.80) years], GrimAge age acceleration [0.80 (0.60, 1.00) years], and DunedinPACE [0.011 (0.005, 0.018)], after adjusting for age, sex, center location, genetic components, smoking status, and body mass index. Of the 347 incident CVD events per 100,000 person-years associated with a doubling in As exposure, 21.3% (9.1, 57.1) and 22.6% (9.5, 56.9), were attributable to differences in GrimAge and DunedinPACE, respectively. DISCUSSION Arsenic exposure was associated with older GrimAge and faster DunedinPACE measures of biological age. Furthermore, accelerated biological aging measured from DNA methylation accounted for a relevant fraction of As-associated risk for CVD, CVD mortality, and all-cause mortality in the SHS, supporting the role of As in accelerated aging. Research of the biological underpinnings can contribute to a better understanding of the role of aging in arsenic-related disease. https://doi.org/10.1289/EHP11981.
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Affiliation(s)
- Enoch X. Jiang
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Arce Domingo-Relloso
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
- Integrative Epidemiology Group, Department of Chronic Diseases Epidemiology, National Center for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
- Department of Statistics and Operations Research, University of Valencia, Valencia, Spain
| | - Ahlam Abuawad
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Karin Haack
- Population Health Program, Texas Biomedical Research Institute, San Antonio, Texas, USA
| | - Maria Tellez-Plaza
- Integrative Epidemiology Group, Department of Chronic Diseases Epidemiology, National Center for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
| | - M. Danielle Fallin
- Department of Mental Health, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jason G. Umans
- MedStar Health Research Institute, Washington, DC, USA
- Center for Clinical and Translational Sciences, Georgetown/Howard Universities, Washington, DC, USA
| | - Lyle G. Best
- Missouri Breaks Industries Research, Eagle Butte, South Dakota, USA
| | - Ying Zhang
- Center for American Indian Health Research, Department of Biostatistics and Epidemiology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Allison Kupsco
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Daniel W. Belsky
- Department of Epidemiology, Columbia University, New York, USA
- Butler Columbia Aging Center, Columbia University, New York, USA
| | - Shelley A. Cole
- Population Health Program, Texas Biomedical Research Institute, San Antonio, Texas, USA
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
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Adesoye T, Liao K, Peterson S, Li L, Zorzi D, Holmes HM, Chavez‐MacGregor M, Giordano SH. Patient-reported outcomes in older breast cancer survivors with and without prior chemotherapy treatment. Cancer Med 2023; 12:17740-17752. [PMID: 37551136 PMCID: PMC10524015 DOI: 10.1002/cam4.6394] [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: 02/05/2023] [Revised: 07/11/2023] [Accepted: 07/18/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Little is known about long-term treatment-related symptoms in older breast cancer survivors. We characterized long-term patient-reported symptoms and examined factors associated with the presence and severity of symptoms, and symptom interference with daily activities. METHODS Texas Cancer Registry (TCR) Medicare linkage data was used to identify breast cancer patients age 65 and older with local/regional stage disease diagnosed between 2012-2013. Symptom burden was assessed using breast-specific items from the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE™). Demographic and clinical data also were collected. Logistic regression models were used to assess the association between symptom burden and respondent sociodemographic and clinical characteristics. RESULTS Of 4448 eligible patients, 1594 (response-rate 35.8%) completed questionnaires. Of these, 1245 eligible respondents were included in the analysis based on self-reported data. Median time from diagnosis to survey completion was 68 months (IQR: 62-73). Most frequently reported symptoms were fatigue/lack of energy (76.8%), aching muscles (72.1%) and aching joints (72.5%). Receipt of chemotherapy was associated with higher symptom burden. Patients treated with adjuvant chemotherapy had higher risk of numbness/tingling (OR: 3.16; 95% CI: 2.36-4.24), hair loss (OR: 2.72; 95% CI: 2.05-3.60), and fatigue/lack of energy (OR: 1.80; 95% CI: 1.29-2.52). Similarly, patients who received chemotherapy were more likely to report the majority of symptoms as moderate to severe and as interfering with daily activities. CONCLUSION Receipt of chemotherapy is associated with significant symptom burden more than 5 years after breast cancer treatment. Long-term chemotherapy impact should be discussed with patients in a shared-decision making process and approaches to symptom management during survivorship care are needed.
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Affiliation(s)
- Taiwo Adesoye
- Department of Breast Surgical OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Kai‐Ping Liao
- Department of Health Services ResearchThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Susan Peterson
- Department of Behavioral Science, Division of Cancer Prevention and Population SciencesThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Liang Li
- Department of BiostatisticsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Daria Zorzi
- Department of Health Services ResearchThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Holly M. Holmes
- Division of Geriatric and Palliative Medicine, Department of Internal MedicineUniversity of Texas Houston McGovern Medical SchoolHoustonTexasUSA
| | - Mariana Chavez‐MacGregor
- Department of Health Services ResearchThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
- Department of Breast Medical OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Sharon H. Giordano
- Department of Health Services ResearchThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
- Department of Breast Medical OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
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Bakken R, Lien L, Fauske H, Benth JŠ, Landheim AS. Criminal thinking and psychosocial characteristics among young adults entering residential substance use treatment. NORDIC STUDIES ON ALCOHOL AND DRUGS 2023; 40:339-354. [PMID: 37663059 PMCID: PMC10472929 DOI: 10.1177/14550725231160337] [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] [Indexed: 09/05/2023] Open
Abstract
Background and aim: Young adults with substance use (SU) problems face a high risk of co-occurring problems, including criminality. The aim of the present study was to assess the psychosocial characteristics, SU problems, and criminal thinking young adults entering SU treatment have, and whether the SU characteristics, sex and age are associated with criminal thinking scores. Methods: The sample was 407 young adults aged 16-29 years who underwent an entry assessment between January 2011 and December 2016 at a residential SU treatment institution in Norway. All study data were extracted from electronic health records, including survey information from the Achenbach System of Empirically Based Assessment and the Psychological Inventory of Criminal Thinking Styles. Results: In the present sample, severe SU, high rates of psychosocial problems, and criminal thinking were reported. Almost three-quarters (72.67%) of young adults reported high levels of criminal thinking (≥60). However, male participants were more likely to report high levels of criminal thinking compared to female participants (p=0.031). In bivariate regression models, only sex and having stimulants/opioids as primary drug were associated with mean levels of criminal thinking. The same was true in the multiple regression model. Conclusion: Young adults in residential SU treatment are a multi-problem high-risk/high-need group of people. Due to the elevated levels of criminal thinking, we recommend that young adults in SU treatment should be screened for criminogenic treatment needs, such as criminal thinking, regardless of justice involvement.
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Affiliation(s)
- Regine Bakken
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders and Mental Health Division, Innlandet Hospital Trust, Brumunddal, Norway; and
- Department of Public Health, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Lars Lien
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders and Mental Health Division, Innlandet Hospital Trust, Brumunddal, Norway; and
- Department of Public Health, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Halvor Fauske
- Department of Public Health, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Anne Signe Landheim
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders and Mental Health Division, Innlandet Hospital Trust, Brumunddal, Norway; and
- Department of Public Health, Inland Norway University of Applied Sciences, Elverum, Norway
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Katon JG, Bossick AS, Tartaglione EV, Enquobahrie DA, Haeger KO, Johnson AM, Ma EW, Savitz D, Shaw JG, Todd-Stenberg J, Yano EM, Washington DL, Christy AY. Assessing Racial Disparities in Access, Use, and Outcomes for Pregnant and Postpartum Veterans and Their Infants in Veterans Health Administration. J Womens Health (Larchmt) 2023; 32:757-766. [PMID: 37186805 DOI: 10.1089/jwh.2022.0507] [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: 05/17/2023] Open
Abstract
Objective: Limited population-based data examines racial disparities among pregnant and postpartum Veterans. Our objective was to determine whether Black/white racial disparities in health care access, use, and Veteran and infant outcomes are present among pregnant and postpartum Veterans and their infants using Veterans Health Administration (VA) care. Methods: The VA National Veteran Pregnancy and Maternity Care Survey included all Veterans with a VA paid live birth between June 2018 and December 2019. Participants could complete the survey online or by telephone. The independent variable was self-reported race. Outcomes included timely initiation of prenatal care, perceived access to timely prenatal care, attendance at a postpartum check-up, receipt of needed mental health care, cesarean section, postpartum rehospitalization, low birthweight, preterm birth, admission to a neonatal intensive care unit, and breastfeeding. Nonresponse weighted general linear models with a log-link were used to examine associations of race with outcomes. Cox regression was used to examine the association of race with duration of breastfeeding. Models adjusted for age, ethnicity, urban versus rural residence, and parity. Results: The analytic sample consisted of 1,220 Veterans (Black n = 916; white n = 304) representing 3,439 weighted responses (Black n = 1,027; white n = 2,412). No racial disparities were detected for health care access or use. Black Veterans were more likely than white Veterans to have a postpartum rehospitalization (RR 1.67, 95% CI: 1.04-2.68) and a low-birthweight infant (RR 1.67, 95% CI: 1.20-2.33). Conclusion: While no racial disparities were detected for health care access and use, we identified disparities in postpartum rehospitalization and low birthweight, underscoring that access is not sufficient for ensuring health equity.
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Affiliation(s)
- Jodie G Katon
- Health Services Research and Development (HSR&D), Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Andrew S Bossick
- Department of Public Health Sciences, Henry Ford Healthcare System, Detroit, Michigan, USA
| | - Erica V Tartaglione
- U.S. Department of Veterans Affairs (VA) Puget Sound Healthcare System, Center of Innovation for Veteran-Centered and Value-Driven Care, HSR&D, Seattle, Washington, USA
| | | | - Kristin O Haeger
- Office of Women's Health, U.S. Department of Veterans Affairs, Washington, District of Columbia, USA
| | - Amanda M Johnson
- Office of Women's Health, U.S. Department of Veterans Affairs, Washington, District of Columbia, USA
| | - Erica W Ma
- U.S. Department of Veterans Affairs (VA) Puget Sound Healthcare System, Center of Innovation for Veteran-Centered and Value-Driven Care, HSR&D, Seattle, Washington, USA
| | - David Savitz
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Jonathan G Shaw
- VA Palo Alto Healthcare System, Palo Alto, California, USA
- Stanford University School of Medicine, Stanford, California, USA
| | - Jeffery Todd-Stenberg
- U.S. Department of Veterans Affairs (VA) Puget Sound Healthcare System, Center of Innovation for Veteran-Centered and Value-Driven Care, HSR&D, Seattle, Washington, USA
| | - Elizabeth M Yano
- Health Services Research and Development (HSR&D), Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
- Jonathan and Karen Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA
| | - Donna L Washington
- Health Services Research and Development (HSR&D), Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Division of General Internal Medicine & Health Services Research, Department of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Alicia Y Christy
- Office of Women's Health, U.S. Department of Veterans Affairs, Washington, District of Columbia, USA
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Okamoto S, Sakamoto H, Kamimura K, Komamura K, Kobayashi E, Liang J. Economic effects of healthy ageing: functional limitation, forgone wages, and medical and long-term care costs. HEALTH ECONOMICS REVIEW 2023; 13:28. [PMID: 37162614 PMCID: PMC10170784 DOI: 10.1186/s13561-023-00442-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 04/22/2023] [Indexed: 05/11/2023]
Abstract
This study aims to estimate the potential economic benefits of healthy ageing by obtaining estimates of the economic losses generated by functional limitations among middle-aged and older people. Utilising two data sources retrieved from nationally representative samples of the Japanese people, we analysed the association between functional limitation and economic indicators, including labour market outcomes, savings, investment, consumption, and unpaid activities among individuals aged ≥ 60. Using the estimated parameters from our micro-econometric analyses and the official statistics by the Japanese government and a previous study, we calculated the financial costs that can be averted if healthy ageing is achieved as foregone wages and formal medical/long-term care costs incurred by functional limitations. Our micro-econometric analyses found that functional limitation was associated with a 3% point increase in retirement probability, with a stronger association among those aged 60-69. Moreover, functional limitation was linked with higher total health spending and less active involvement in domestic work. Foregone wages generated by functional limitation were estimated to be approximately USD 266.4 million, driven mainly by individuals in their 60s. Long-term care costs, rather than medical care costs, for older people aged ≥ 85 accounted for most of the additional costs, indicating that the estimated medical and long-term costs generated by functional limitations were approximately USD 72.7 billion. Health interventions can yield economic benefits by preventing exits from the labour market due to health issues and reducing medical and long-term care costs.
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Affiliation(s)
- Shohei Okamoto
- Research Team for Social Participation and Healthy Aging, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae- cho, Itabashi-ku, Tokyo, 1730015, Japan.
- Institute of Global Health Policy Research, National Centre for Global Health and Medicine, Tokyo, Japan.
- Research Center for Financial Gerontology, Keio University, Tokyo, Japan.
| | - Haruka Sakamoto
- Department of Hygiene and Public Health, Tokyo Women's Medical University, Tokyo, Japan
| | - Kazuki Kamimura
- Research Center for Financial Gerontology, Keio University, Tokyo, Japan
- Hirao School of Management, Konan University, Hyogo, Japan
| | - Kohei Komamura
- Research Center for Financial Gerontology, Keio University, Tokyo, Japan
- Faculty of Economics, Keio University, Tokyo, Japan
| | - Erika Kobayashi
- Research Team for Social Participation and Healthy Aging, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae- cho, Itabashi-ku, Tokyo, 1730015, Japan
| | - Jersey Liang
- Department of Health Management and Policy, School of Public Health, University of Michigan, Michigan, USA
- Department of Health Care Management and Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
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Khdairi N, Halilah T, Khandakji M, Bartzela T. Rapid Maxillary Expansion Treatment in Patients with Cleft Lip and Palate: A Survey on Clinical Experience in the European Cleft Centers. J Clin Med 2023; 12:jcm12093159. [PMID: 37176600 PMCID: PMC10179601 DOI: 10.3390/jcm12093159] [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: 03/30/2023] [Revised: 04/20/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
Cleft lip and palate patients require complex interdisciplinary treatment, including maxillary expansion and secondary alveolar bone grafting. However, the evidence on these treatment procedures and outcomes is lacking. Therefore, this study aimed to survey the subjective observations of European maxillofacial surgeons and orthodontists on the maxillary expansion and bone grafting treatment protocols and the associated complications. An online questionnaire was sent to 131 centers. The questions assessed the participants' demographic data, maxillary expansion and alveolar bone grafting protocols, and the associated complications. Descriptive statistics and a t-test were used to analyze the data. The response rate was 40.5%. The average age for maxillary expansion was 9-10 years. The secondary alveolar bone grafting was planned 5-10 months after the expansion. The most common complications were asymmetric expansion, relapse, and fistula formation. The protocols and materials used vary widely among centers. Anatomical alterations and developmental processes, like tooth eruption adjacent to the cleft, should be seriously considered for treatment planning. This survey showed that there is still a lack of consensus on these treatment procedures. Further clinical trials should focus on long-term outcome evaluation to identify treatment components for optimal alveolar bone substitution and transversal maxillary expansion treatment in patients with clefts.
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Affiliation(s)
| | | | - Mohannad Khandakji
- Dental Department, Hamad Dental Center, Hamad Medical Cooperation, Doha P.O. Box 3050, Qatar
| | - Theodosia Bartzela
- Department of Orthodontics and Dentofacial Orthopedics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 14197 Berlin, Germany
- Department of Orthodontics, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
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10
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Matson TE, Lapham GT, Bobb JF, Oliver M, Hallgren KA, Williams EC, Bradley KA. Validity of the Single-Item Screen-Cannabis (SIS-C) for Cannabis Use Disorder Screening in Routine Care. JAMA Netw Open 2022; 5:e2239772. [PMID: 36318205 PMCID: PMC9627408 DOI: 10.1001/jamanetworkopen.2022.39772] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 09/16/2022] [Indexed: 11/05/2022] Open
Abstract
Importance Cannabis use is prevalent and increasing, and frequent use intensifies the risk of cannabis use disorder (CUD). CUD is underrecognized in medical settings, but a validated single-item cannabis screen could increase recognition. Objective To evaluate the Single-Item Screen-Cannabis (SIS-C), administered and documented in routine primary care, compared with a confidential reference standard measure of CUD. Design, Setting, and Participants This diagnostic study included a sample of adult patients who completed routine cannabis screening between January 28 and September 12, 2019, and were randomly selected for a confidential survey about cannabis use. Random sampling was stratified by frequency of past-year use and race and ethnicity. The study was conducted at an integrated health system in Washington state, where adult cannabis use is legal. Data were analyzed from May 2021 to March 2022. Exposures The SIS-C asks about frequency of past-year cannabis use with responses (none, less than monthly, monthly, weekly, daily or almost daily) documented in patients' medical records. Main Outcomes and Measures The Diagnostic and Statistical Manual, Fifth Edition (DSM-5) Composite International Diagnostic Interview-Substance Abuse Module (CIDI-SAM) for past-year CUD was completed on a confidential survey and considered the reference standard. The SIS-C was compared with 2 or more criteria on the CIDI-SAM, consistent with CUD. All analyses were weighted, accounting for survey design and nonresponse, to obtain estimates representative of the health system primary care population. Results Of 5000 sampled adult patients, 1688 responded to the cannabis survey (34% response rate). Patients were predominantly middle-aged (weighted mean [SD] age, 50.7 [18.1]), female or women (weighted proportion [SE], 55.9% [4.1]), non-Hispanic (weighted proportion [SE], 96.7% [1.0]), and White (weighted proportion [SE], 74.2% [3.7]). Approximately 6.6% of patients met criteria for past-year CUD. The SIS-C had an area under receiver operating characteristic curve of 0.89 (95% CI, 0.78-0.96) for identifying CUD. A threshold of less than monthly cannabis use balanced sensitivity (0.88) and specificity (0.83) for detecting CUD. In populations with a 6% prevalence of CUD, predictive values of a positive screen ranged from 17% to 34%, while predictive values of a negative screen ranged from 97% to 100%. Conclusions and Relevance In this diagnostic study, the SIS-C had excellent performance characteristics in routine care as a screen for CUD. While high negative predictive values suggest that the SIS-C accurately identifies patients without CUD, low positive predictive values indicate a need for further diagnostic assessment following positive results when screening for CUD in primary care.
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Affiliation(s)
- Theresa E. Matson
- Kaiser Permanente Washington Health Research Institute, Seattle
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle
- Health Services Research & Development Center for Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Gwen T. Lapham
- Kaiser Permanente Washington Health Research Institute, Seattle
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle
| | - Jennifer F. Bobb
- Kaiser Permanente Washington Health Research Institute, Seattle
- Department of Biostatistics, University of Washington School of Public Health, Seattle
| | - Malia Oliver
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Kevin A. Hallgren
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | - Emily C. Williams
- Kaiser Permanente Washington Health Research Institute, Seattle
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle
- Health Services Research & Development Center for Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Katharine A. Bradley
- Kaiser Permanente Washington Health Research Institute, Seattle
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle
- Department of Medicine, University of Washington School of Medicine, Seattle
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11
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Domingo-Relloso A, Makhani K, Riffo-Campos AL, Tellez-Plaza M, Klein KO, Subedi P, Zhao J, Moon KA, Bozack AK, Haack K, Goessler W, Umans JG, Best LG, Zhang Y, Herreros-Martinez M, Glabonjat RA, Schilling K, Galvez-Fernandez M, Kent JW, Sanchez TR, Taylor KD, Craig Johnson W, Durda P, Tracy RP, Rotter JI, Rich SS, Berg DVD, Kasela S, Lappalainen T, Vasan RS, Joehanes R, Howard BV, Levy D, Lohman K, Liu Y, Daniele Fallin M, Cole SA, Mann KK, Navas-Acien A. Arsenic Exposure, Blood DNA Methylation, and Cardiovascular Disease. Circ Res 2022; 131:e51-e69. [PMID: 35658476 PMCID: PMC10203287 DOI: 10.1161/circresaha.122.320991] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/18/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Epigenetic dysregulation has been proposed as a key mechanism for arsenic-related cardiovascular disease (CVD). We evaluated differentially methylated positions (DMPs) as potential mediators on the association between arsenic and CVD. METHODS Blood DNA methylation was measured in 2321 participants (mean age 56.2, 58.6% women) of the Strong Heart Study, a prospective cohort of American Indians. Urinary arsenic species were measured using high-performance liquid chromatography coupled to inductively coupled plasma mass spectrometry. We identified DMPs that are potential mediators between arsenic and CVD. In a cross-species analysis, we compared those DMPs with differential liver DNA methylation following early-life arsenic exposure in the apoE knockout (apoE-/-) mouse model of atherosclerosis. RESULTS A total of 20 and 13 DMPs were potential mediators for CVD incidence and mortality, respectively, several of them annotated to genes related to diabetes. Eleven of these DMPs were similarly associated with incident CVD in 3 diverse prospective cohorts (Framingham Heart Study, Women's Health Initiative, and Multi-Ethnic Study of Atherosclerosis). In the mouse model, differentially methylated regions in 20 of those genes and DMPs in 10 genes were associated with arsenic. CONCLUSIONS Differential DNA methylation might be part of the biological link between arsenic and CVD. The gene functions suggest that diabetes might represent a relevant mechanism for arsenic-related cardiovascular risk in populations with a high burden of diabetes.
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Affiliation(s)
- Arce Domingo-Relloso
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
- Department of Chronic Diseases Epidemiology, National Center for Epidemiology, Carlos III Health Institute, Madrid, Spain
- Department of Statistics and Operations Research, University of Valencia, Spain
| | - Kiran Makhani
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Angela L. Riffo-Campos
- Millennium Nucleus on Sociomedicine (SocioMed) and Vicerrectoría Académica, Universidad de La Frontera, Temuco, Chile
- Department of Computer Science, ETSE, University of Valencia, Valencia, Spain
| | - Maria Tellez-Plaza
- Department of Chronic Diseases Epidemiology, National Center for Epidemiology, Carlos III Health Institute, Madrid, Spain
| | - Kathleen Oros Klein
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Pooja Subedi
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
| | - Jinying Zhao
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
| | - Katherine A. Moon
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Anne K. Bozack
- Department of Environmental Health Sciences, School of Public Health, University of California, Berkeley, USA
| | - Karin Haack
- Population Health Program, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - Walter Goessler
- Institute of Chemistry - Analytical Chemistry for Health and Environment, University of Graz, Austria
| | | | - Lyle G. Best
- Missouri Breaks Industries and Research Inc., Eagle Butte, SD, USA
| | - Ying Zhang
- Department of Biostatistics and Epidemiology, The University of Oklahoma Health Sciences Center, OK, USA
| | | | - Ronald A. Glabonjat
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Kathrin Schilling
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Marta Galvez-Fernandez
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
- Department of Chronic Diseases Epidemiology, National Center for Epidemiology, Carlos III Health Institute, Madrid, Spain
| | - Jack W. Kent
- Population Health Program, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - Tiffany R Sanchez
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Kent D. Taylor
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - W. Craig Johnson
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Peter Durda
- Department of Pathology Laboratory Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Russell P. Tracy
- Department of Pathology Laboratory Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Jerome I. Rotter
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Stephen S. Rich
- Center for Public Health Genomics, Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - David Van Den Berg
- Department of Population and Public Health Sciences, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Silva Kasela
- New York Genome Center, New York, NY, USA
- Department of Systems Biology, Columbia University, New York, NY, USA
| | - Tuuli Lappalainen
- New York Genome Center, New York, NY, USA
- Department of Systems Biology, Columbia University, New York, NY, USA
| | - Ramachandran S Vasan
- National Heart, Lung, and Blood Institute’s and Boston University’s Framingham Heart Study, Framingham, MA; Sections of Preventive Medicine and Epidemiology and Cardiovascular Medicine, Department of Medicine, department of Epidemiology, Boston University Schools of medicine and Public health, Boston, MA, USA
| | - Roby Joehanes
- Population Sciences Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
- Framingham Heart Study, Framingham, MA
| | | | - Daniel Levy
- Population Sciences Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
- Framingham Heart Study, Framingham, MA
| | - Kurt Lohman
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Yongmei Liu
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - M Daniele Fallin
- Departments of Mental Health and Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Shelley A. Cole
- Population Health Program, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - Koren K. Mann
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
- Department of Pharmacology and Therapeutics, McGill University, Montreal, Canada
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
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12
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Verbiest-van Gurp N, Uittenbogaart SB, Lucassen WAM, Erkens PMG, Knottnerus JA, Winkens B, Stoffers HEJH, van Weert HCPM. Detection of atrial fibrillation in primary care with radial pulse palpation, electronic blood pressure measurement and handheld single-lead electrocardiography: a diagnostic accuracy study. BMJ Open 2022; 12:e059172. [PMID: 35768092 PMCID: PMC9244719 DOI: 10.1136/bmjopen-2021-059172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To determine the diagnostic accuracy of three tests-radial pulse palpation, an electronic blood pressure monitor and a handheld single-lead ECG device-for opportunistic screening for unknown atrial fibrillation (AF). DESIGN We performed a diagnostic accuracy study in the intention-to-screen arm of a cluster randomised controlled trial aimed at opportunistic screening for AF in general practice. We performed radial pulse palpation, followed by electronic blood pressure measurement (WatchBP Home A) and handheld ECG (MyDiagnostick) in random order. If one or more index tests were positive, we performed a 12-lead ECG at shortest notice. Similarly, to limit verification bias, a random sample of patients with three negative index tests received this reference test. Additionally, we analysed the dataset using multiple imputation. We present pooled diagnostic parameters. SETTING 47 general practices participated between September 2015 and August 2018. PARTICIPANTS In the electronic medical record system of the participating general practices (n=47), we randomly marked 200 patients of ≥65 years without AF. When they visited the practice for any reason, we invited them to participate. Exclusion criteria were terminal illness, inability to give informed consent or visit the practice or having a pacemaker or an implantable cardioverter-defibrillator. OUTCOMES Diagnostic accuracy of individual tests and test combinations to detect unknown AF. RESULTS We included 4339 patients; 0.8% showed new AF. Sensitivity and specificity were 62.8% (range 43.1%-69.7%) and 91.8% (91.7%-91.8%) for radial pulse palpation, 70.0% (49.0%-80.6%) and 96.5% (96.3%-96.7%) for electronic blood pressure measurement and 90.1% (60.8%-100%) and 97.9% (97.8%-97.9%) for handheld ECG, respectively. Positive predictive values were 5.8% (5.3%-6.1%), 13.8% (12.2%-14.8%) and 25.2% (24.2%-25.8%), respectively. All negative predictive values were ≥99.7%. CONCLUSION In detecting AF, electronic blood pressure measurement (WatchBP Home A), but especially handheld ECG (MyDiagnostick) showed better diagnostic accuracy than radial pulse palpation. TRIAL REGISTRATION NUMBER Netherlands Trial Register No. NL4776 (old NTR4914).
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Affiliation(s)
- Nicole Verbiest-van Gurp
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Steven B Uittenbogaart
- Department of General Practice, Amsterdam UMC Locatie Meibergdreef, Amsterdam, The Netherlands
| | - Wim A M Lucassen
- Department of General Practice, Amsterdam UMC Locatie Meibergdreef, Amsterdam, The Netherlands
| | - Petra M G Erkens
- Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - J André Knottnerus
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Bjorn Winkens
- Department of Methodology and Statistics, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Henri E J H Stoffers
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Henk C P M van Weert
- Department of General Practice, Amsterdam UMC Locatie Meibergdreef, Amsterdam, The Netherlands
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13
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Janah A, Haddy N, Demoor-Goldschmidt C, Bougas N, Clavel J, Poulalhon C, Lacour B, Souchard V, Jackson A, Casagranda L, Berger C, Allodji R, El Fayech C, Fresneau B, De Vathaire F, Dumas A. The Psychological Consequences of the COVID-19 Pandemic in Adults Treated for Childhood Cancer. Curr Oncol 2022; 29:4104-4116. [PMID: 35735436 PMCID: PMC9221954 DOI: 10.3390/curroncol29060327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Compared with the general population, childhood cancer survivors (CCS) could be at greater risk of psychological distress following the emergence of the COVID-19 pandemic. Purpose: This cross-sectional study assessed the psychological consequences of COVID-19 on the mental health of CCS. Design and participants: In December 2020, we interviewed through an online self-report questionnaire, 580 5-year CCS participating in the French Childhood Cancer Survivor Study (FCCSS) cohort. Methods: We first compared the mental health score of CCS with that observed in the French general population of the same age and gender. Subsequently, we studied predictors of the mental health score of CCS. Results: External comparisons revealed that the mental health score of CCS was similar to that of the general population. Among CCS, almost 42% stated that their psychological state had been worse during the lockdown. Predictors of poorer mental health included, among others, female gender, reporting a change in the occupational situation, having a relative who had been hospitalized or had died following COVID-19, and a greater perceived infection risk. Interpretation and Implications: Given the pre-existing vulnerability of some CCS to mental distress, the additional psychological consequences of COVID-19 in vulnerable survivors should receive attention from health care providers.
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Affiliation(s)
- Asmaa Janah
- Université Paris Cité, INSERM, ECEVE, F-75010 Paris, France; (A.J.); (N.B.); (A.D.)
| | - Nadia Haddy
- University of Paris-Saclay, F-94800 Villejuif, France; (N.H.); (C.D.-G.); (V.S.); (A.J.); (R.A.)
- Gustave Roussy, Department of Clinical Research, F-94800 Villejuif, France; (C.E.F.); (B.F.)
- INSERM U 1018, CESP, Radiation Epidemiology Team, F-94800 Villejuif, France
| | - Charlotte Demoor-Goldschmidt
- University of Paris-Saclay, F-94800 Villejuif, France; (N.H.); (C.D.-G.); (V.S.); (A.J.); (R.A.)
- Gustave Roussy, Department of Clinical Research, F-94800 Villejuif, France; (C.E.F.); (B.F.)
- INSERM U 1018, CESP, Radiation Epidemiology Team, F-94800 Villejuif, France
- CHU Angers, Paediatric Oncology Department, F-49100 Angers, France
- François Baclesse Centre, Radiotherapy Department, F-14000 Caen, France
| | - Nicolas Bougas
- Université Paris Cité, INSERM, ECEVE, F-75010 Paris, France; (A.J.); (N.B.); (A.D.)
| | - Jacqueline Clavel
- Centre of Research in Epidemiology and Statistics, INSERM, F-94800 Villejuif, France; (J.C.); (C.P.); (B.L.)
- National Registry of Childhood Cancer, Paul Brousse Hospital (AP-HP), F-94800 Villejuif, France
- Regional University Hospital Centre of Nancy (CHRU Nancy), F-54511 Vandœuvre-lès-Nancy, France
| | - Claire Poulalhon
- Centre of Research in Epidemiology and Statistics, INSERM, F-94800 Villejuif, France; (J.C.); (C.P.); (B.L.)
- National Registry of Childhood Cancer, Paul Brousse Hospital (AP-HP), F-94800 Villejuif, France
- Regional University Hospital Centre of Nancy (CHRU Nancy), F-54511 Vandœuvre-lès-Nancy, France
| | - Brigitte Lacour
- Centre of Research in Epidemiology and Statistics, INSERM, F-94800 Villejuif, France; (J.C.); (C.P.); (B.L.)
- National Registry of Childhood Cancer, Paul Brousse Hospital (AP-HP), F-94800 Villejuif, France
- Regional University Hospital Centre of Nancy (CHRU Nancy), F-54511 Vandœuvre-lès-Nancy, France
| | - Vincent Souchard
- University of Paris-Saclay, F-94800 Villejuif, France; (N.H.); (C.D.-G.); (V.S.); (A.J.); (R.A.)
- Gustave Roussy, Department of Clinical Research, F-94800 Villejuif, France; (C.E.F.); (B.F.)
- INSERM U 1018, CESP, Radiation Epidemiology Team, F-94800 Villejuif, France
| | - Angela Jackson
- University of Paris-Saclay, F-94800 Villejuif, France; (N.H.); (C.D.-G.); (V.S.); (A.J.); (R.A.)
- Gustave Roussy, Department of Clinical Research, F-94800 Villejuif, France; (C.E.F.); (B.F.)
- INSERM U 1018, CESP, Radiation Epidemiology Team, F-94800 Villejuif, France
| | - Leonie Casagranda
- CHU St Etienne, Paediatric Oncology Department, F-42055 St Etienne, France; (L.C.); (C.B.)
- University of Lyon, University of Jean Monnet, INSERM, U 1059, F-42100 Saint-Étienne, France
| | - Claire Berger
- CHU St Etienne, Paediatric Oncology Department, F-42055 St Etienne, France; (L.C.); (C.B.)
- University of Lyon, University of Jean Monnet, INSERM, U 1059, F-42100 Saint-Étienne, France
| | - Rodrigue Allodji
- University of Paris-Saclay, F-94800 Villejuif, France; (N.H.); (C.D.-G.); (V.S.); (A.J.); (R.A.)
- Gustave Roussy, Department of Clinical Research, F-94800 Villejuif, France; (C.E.F.); (B.F.)
- INSERM U 1018, CESP, Radiation Epidemiology Team, F-94800 Villejuif, France
| | - Chiraz El Fayech
- Gustave Roussy, Department of Clinical Research, F-94800 Villejuif, France; (C.E.F.); (B.F.)
- INSERM U 1018, CESP, Radiation Epidemiology Team, F-94800 Villejuif, France
- Gustave Roussy, Department of Children and Adolescents Oncology, F-94805 Villejuif, France
| | - Brice Fresneau
- Gustave Roussy, Department of Clinical Research, F-94800 Villejuif, France; (C.E.F.); (B.F.)
- INSERM U 1018, CESP, Radiation Epidemiology Team, F-94800 Villejuif, France
- Gustave Roussy, Department of Children and Adolescents Oncology, F-94805 Villejuif, France
| | - Florent De Vathaire
- University of Paris-Saclay, F-94800 Villejuif, France; (N.H.); (C.D.-G.); (V.S.); (A.J.); (R.A.)
- Gustave Roussy, Department of Clinical Research, F-94800 Villejuif, France; (C.E.F.); (B.F.)
- INSERM U 1018, CESP, Radiation Epidemiology Team, F-94800 Villejuif, France
- Correspondence:
| | - Agnes Dumas
- Université Paris Cité, INSERM, ECEVE, F-75010 Paris, France; (A.J.); (N.B.); (A.D.)
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14
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Sobel M, Navas-Acien A, Powers M, Grau-Perez M, Goessler W, Best LG, Umans J, Oelsner EC, Podolanczuk A, Sanchez TR. Environmental-level exposure to metals and metal-mixtures associated with spirometry-defined lung disease in American Indian adults: Evidence from the Strong Heart Study. ENVIRONMENTAL RESEARCH 2022; 207:112194. [PMID: 34653410 PMCID: PMC8810711 DOI: 10.1016/j.envres.2021.112194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 10/05/2021] [Accepted: 10/06/2021] [Indexed: 05/03/2023]
Abstract
BACKGROUND American Indians have a higher burden of chronic lung disease compared to the US average. Several metals are known to induce chronic lung disease at high exposure levels; however, less is known about the role of environmental-level metal exposure. We investigated respiratory effects of exposure to single metals and metal-mixtures in American Indians who participated in the Strong Heart Study. METHODS We included 2077 participants with data on 6 metals (As, Cd, Mo, Se, W, Zn) measured from baseline urine samples (1989-1991) and who underwent spirometry testing at follow-up (1993-1995). We used generalized linear regression to assess associations of single metals with spirometry-defined measures of airflow limitation and restrictive ventilatory pattern, and continuous spirometry. We used Bayesian Kernel Machine Regression to investigate the joint effects of the metal-mixture. Sensitivity analyses included stratifying by smoking status and diabetes. RESULTS Participants were 40% male, with median age 55 years. 21% had spirometry-defined airflow limitation, and 14% had a restrictive ventilatory pattern. In individual metal analyses, Cd was associated with higher odds of airflow limitation and lower FEV1 and FEV1/FVC. Mo was associated with higher odds of restrictive ventilatory pattern and lower FVC. Metal-mixtures analyses confirmed these models. In smoking stratified analyses, the overall metal-mixture was linearly and positively associated with airflow limitation among non-smokers; Cd was the strongest contributor. For restrictive ventilatory pattern, the association with the overall metal-mixture was strong and linear among participants with diabetes and markedly attenuated among participants without diabetes. Among those with diabetes, Mo and Zn were the major contributors. CONCLUSIONS Environmental-level exposure to several metals was associated with higher odds of spirometry-defined lung disease in an American Indian population. Exposure to multiple metals, including Cd and Mo, may have an under-recognized adverse role on the respiratory system.
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Affiliation(s)
- Marisa Sobel
- Department of Environmental Health Sciences, Columbia Mailman School of Public Health, 722 West 168th St. NY, NY, 10032, USA.
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Columbia Mailman School of Public Health, 722 West 168th St. NY, NY, 10032, USA.
| | - Martha Powers
- Department of Sociology and Anthropology, Northeastern University, 1135 Tremont Street, 900 Renaissance Park, Boston, MA, 02115, USA.
| | - Maria Grau-Perez
- Biomedical Research Institute of Valencia (INCLIVA), C. de Menéndez y Pelayo, 4, 46010, Valencia, Spain.
| | - Walter Goessler
- Institute of Chemistry, Universität Graz, Universitätsplatz 3, 8010, Graz, Austria.
| | - Lyle G Best
- Missouri Breaks Industries Research, 118 South Willow St, Eagle Butte, SD, 57625, USA.
| | - Jason Umans
- Division of Nephrology and Hypertension, Department of Medicine, Georgetown University Medical Center, 3800 Reservoir Road, N.W, Washington, D.C, USA.
| | - Elizabeth C Oelsner
- Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center, 622 W 168th St, New York, NY, 10032, USA.
| | - Anna Podolanczuk
- Pulmonary Critical Care Medicine, Weill Cornell Medicine, 425 E 61st St, New York, NY, 10065, USA.
| | - Tiffany R Sanchez
- Department of Environmental Health Sciences, Columbia Mailman School of Public Health, 722 West 168th St. NY, NY, 10032, USA.
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15
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Melnikow J, Padovani A, Miller M. Frontline physician burnout during the COVID-19 pandemic: national survey findings. BMC Health Serv Res 2022; 22:365. [PMID: 35303889 PMCID: PMC8933125 DOI: 10.1186/s12913-022-07728-6] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 02/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physician burnout and wellbeing are an ongoing concern. Limited research has reported on the impact of the COVID 19 pandemic on burnout over time among U.S. physicians. METHODS We surveyed U.S. frontline physicians at two time points (wave one in May-June 2020 and wave two in Dec 2020-Jan 2021) using a validated burnout measure. The survey was emailed to a national stratified random sample of family physicians, internists, hospitalists, intensivists, emergency medicine physicians, and infectious disease physicians. Burnout was assessed with the Professional Fulfillment Index Burnout Composite scale (PFI-BC). Responses were weighted to account for sample design and non-response bias. Random effects and quantile regression analyses were used to estimate change in conditional mean and median PFI-BC scores, adjusting for physician, geographic, and pandemic covariates. RESULTS In the random effects regression, conditional mean burnout scores increased in the second wave among all respondents (difference 0.15 (CI: 0.24, 0.57)) and among respondents to both waves (balanced panel) (difference 0.21 (CI: - 0.42, 0.84)). Conditional burnout scores increased in wave 2 among all specialties except for Emergency medicine, with the largest increases among Hospitalists, 0.28 points (CI: - 0.19,0.76) among all respondents and 0.36 (CI: - 0.39,1.11) in the balanced panel, and primary care physicians, 0.21 (CI: - 0.23,0.66) among all respondents and 0.31 (CI: - 0.38,1.00) in the balanced panel. The conditional mean PFI-BC score among hospitalists increased from 1.10 (CI: 0.73,1.46) to 1.38 (CI: 1.02,1.74) in wave 2 in all respondents and from 1.49 (CI: 0.69,2.29) to 1.85 (CI: 1.24,2.46) in the balanced panel, near or above the 1.4 threshold indicating burnout. Findings from quantile regression were consistent with those from random effects. CONCLUSIONS Rates of physician burnout during the first year of the pandemic increased over time among four of five frontline specialties, with greatest increases among hospitalist and primary care respondents. Our findings, while not statistically significant, were consistent with worsening burnout; both the random effects and quantile regressions produced similar point estimates. Impacts of the ongoing pandemic on physician burnout warrant further research.
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Affiliation(s)
- Joy Melnikow
- Center for Healthcare Policy and Research, Department of Family and Community Medicine, University of California, Davis, USA. .,, Sacramento, California, USA.
| | - Andrew Padovani
- Center for Healthcare Policy and Research, Department of Family and Community Medicine, University of California, Davis, USA
| | - Marykate Miller
- Center for Healthcare Policy and Research, University of California, Davis, USA
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16
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Danielson ML, Bitsko RH, Holbrook JR, Charania SN, Claussen AH, McKeown RE, Cuffe SP, Owens JS, Evans SW, Kubicek L, Flory K. Community-Based Prevalence of Externalizing and Internalizing Disorders among School-Aged Children and Adolescents in Four Geographically Dispersed School Districts in the United States. Child Psychiatry Hum Dev 2021; 52:500-514. [PMID: 32734339 PMCID: PMC8016018 DOI: 10.1007/s10578-020-01027-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The Project to Learn About Youth-Mental Health (PLAY-MH; 2014-2018) is a school-based, two-stage study designed to estimate the prevalence of selected mental disorders among K-12 students in four U.S.-based sites (Colorado, Florida, Ohio, and South Carolina). In Stage 1, teachers completed validated screeners to determine student risk status for externalizing or internalizing problems or tics; the percentage of students identified as being at high risk ranged from 17.8% to 34.4%. In Stage 2, parents completed a structured diagnostic interview to determine whether their child met criteria for fourteen externalizing or internalizing disorders; weighted prevalence estimates of meeting criteria for any disorder were similar in three sites (14.8%-17.8%) and higher in Ohio (33.3%). PLAY-MH produced point-in-time estimates of mental disorders in K-12 students, which may be used to supplement estimates from other modes of mental disorder surveillance and inform mental health screening and healthcare and educational services.
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Affiliation(s)
- Melissa L. Danielson
- Division of Human Development and Disability, National Center On Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway NE MS S106-4, Atlanta, GA 30341-3717, USA
| | - Rebecca H. Bitsko
- Division of Human Development and Disability, National Center On Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway NE MS S106-4, Atlanta, GA 30341-3717, USA
| | - Joseph R. Holbrook
- Division of Human Development and Disability, National Center On Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway NE MS S106-4, Atlanta, GA 30341-3717, USA
| | - Sana N. Charania
- Division of Human Development and Disability, National Center On Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway NE MS S106-4, Atlanta, GA 30341-3717, USA,Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Angelika H. Claussen
- Division of Human Development and Disability, National Center On Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway NE MS S106-4, Atlanta, GA 30341-3717, USA
| | - Robert E. McKeown
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Steven P. Cuffe
- Department of Psychiatry, University of Florida College of Medicine–Jacksonville, Jacksonville, FL, USA
| | | | | | - Lorraine Kubicek
- Department of Pediatrics and Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kate Flory
- Department of Psychology, University of South Carolina, Columbia, SC, USA
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17
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Roberts E, Hotopf M, Strang J, Marsden J, White M, Eastwood B, Drummond C. The hospital admission profile of people presenting to specialist addiction services with problematic use of alcohol or opioids: A national retrospective cohort study in England. THE LANCET REGIONAL HEALTH. EUROPE 2021; 3:100036. [PMID: 33969334 PMCID: PMC8080891 DOI: 10.1016/j.lanepe.2021.100036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND Over the past decade in England the rate of alcohol and opioid-related hospitalisation has increased alongside a simultaneous reduction in people accessing specialist addiction treatment. We aimed to determine the hospitalisation patterns of people presenting to addiction treatment with problematic use of alcohol or opioids, and estimate how individual sociodemographic characteristics and hospital admission diagnoses are associated with the rate of hospitalisation, death and successful completion of addiction treatment. METHODS A national record linkage between Hospital Episode Statistics (HES) and the National Drug Treatment Monitoring System (NDTMS) captured lifetime hospital admission profiles of people presenting to addiction services in England in 2018/19. Latent class analysis assigned individuals to clusters based on the ICD-10 diagnosis coded as primary reason for admission. Negative binomial, and multilevel logistic regression models determined if outcomes differed due to sociodemographic characteristics or assigned diagnostic clusters. FINDINGS Inpatient data were available for 64,840 alcohol patients, and 107,296 opioid patients. The most common reasons for admission were alcohol withdrawal (n = 20,024 (5.3% of alcohol-cohort admissions)), and unspecified illness (n = 11,387 (2.1% of opioid-cohort admissions)). Seven diagnostic clusters were identified for each substance cohort. People with admissions predominantly relating to mental and behavioural disorders, and injuries or poisonings had significantly higher hospitalisation rates (adjusted IRR 7.06 (95%CI 6.72-7.42);p < 0.001), higher odds of death during addiction treatment (adjusted OR 2.71 (95%CI 2.29-3.20);p < 0.001) and lower odds of successful treatment completion (adjusted OR 0.72 (95%CI 0.68-0.76);p < 0.001). INTERPRETATION This is the first study to interrogate national hospitalisation patterns within people presenting to addiction services with problematic use of alcohol or opioids. Having identified high-risk, high-cost individuals with increased hospital usage, and increased odds of death, future work should focus on targeting appropriate interventions, to improve their health outcomes and prevent unnecessary hospital readmission. FUNDING The work was funded by the Medical Research Council (MRC).
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Affiliation(s)
- Emmert Roberts
- National Addiction Centre and the Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, South London and the Maudsley NHS Foundation Trust and Public Health England, United Kingdom
| | - Matthew Hotopf
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London and South London and the Maudsley NHS Foundation Trust, United Kingdom
| | - John Strang
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London and South London and the Maudsley NHS Foundation Trust, United Kingdom
| | - John Marsden
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London and South London and the Maudsley NHS Foundation Trust, United Kingdom
| | - Martin White
- Alcohol, Drugs, Tobacco and Justice division, Public Health England, United Kingdom
| | - Brian Eastwood
- Alcohol, Drugs, Tobacco and Justice division, Public Health England, United Kingdom
| | - Colin Drummond
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London and South London and the Maudsley NHS Foundation Trust, United Kingdom
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18
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Alcohol-related Outcomes and All-cause Mortality in the Health 2000 Survey by Participation Status and Compared with the Finnish Population. Epidemiology 2021; 31:534-541. [PMID: 32483066 PMCID: PMC7269017 DOI: 10.1097/ede.0000000000001200] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In the context of declining levels of participation, understanding differences between participants and non-participants in health surveys is increasingly important for reliable measurement of health-related behaviors and their social differentials. This study compared participants and non-participants of the Finnish Health 2000 survey, and participants and a representative sample of the target population, in terms of alcohol-related harms (hospitalizations and deaths) and all-cause mortality. METHODS We individually linked 6,127 survey participants and 1,040 non-participants, aged 30-79, and a register-based population sample (n = 496,079) to 12 years of subsequent administrative hospital discharge and mortality data. We estimated age-standardized rates and rate ratios for each outcome for non-participants and the population sample relative to participants with and without sampling weights by sex and educational attainment. RESULTS Harms and mortality were higher in non-participants, relative to participants for both men (rate ratios = 1.5 [95% confidence interval = 1.2, 1.9] for harms; 1.6 [1.3, 2.0] for mortality) and women (2.7 [1.6, 4.4] harms; 1.7 [1.4, 2.0] mortality). Non-participation bias in harms estimates in women increased with education and in all-cause mortality overall. Age-adjusted comparisons between the population sample and sampling weighted participants were inconclusive for differences by sex; however, there were some large differences by educational attainment level. CONCLUSIONS Rates of harms and mortality in non-participants exceed those in participants. Weighted participants' rates reflected those in the population well by age and sex, but insufficiently by educational attainment. Despite relatively high participation levels (85%), social differentiating factors and levels of harm and mortality were underestimated in the participants.
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19
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Ersson K, Mallmin E, Malinovschi A, Norlander K, Johansson H, Nordang L. Prevalence of exercise-induced bronchoconstriction and laryngeal obstruction in adolescent athletes. Pediatr Pulmonol 2020; 55:3509-3516. [PMID: 33002318 PMCID: PMC7702091 DOI: 10.1002/ppul.25104] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 09/25/2020] [Accepted: 09/26/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To study the prevalence of exercise-induced bronchoconstriction (EIB) and exercise-induced laryngeal obstruction (EILO) in adolescent athletes. METHODS All adolescents (n = 549) attending first year at a sports high school in 2016 and 2017, were invited to answer a questionnaire on respiratory symptoms. The 367 responding participants were divided into two groups based on whether they reported exercise-induced dyspnea (dyspnea group) or not (nondyspnea group). Randomly selected participants in each group were invited to undergo two standardized exercise tests, an EIB test and a continuous laryngoscopy exercise (CLE) test, to investigate EILO. RESULTS In total, 98 participants completed an EIB test, 75 of whom also completed a CLE test. Positive EIB tests: eight of 41 in the dyspnea group and 16 of 57 in the nondyspnea group. Positive CLE tests: 5 of 34 in the dyspnea group and three of 41 in the nondyspnea group. The estimated prevalence of EIB was 23.1% (95% confidence interval [CI]: 14.5-33.8) and of EILO 8.1% (95% CI: 2.5-18.5) in the whole study population. No differences in prevalence of EIB or EILO were found between the dyspnea and the nondyspnea groups. CONCLUSION EIB was highly prevalent in this cohort of adolescent athletes. EILO was less prevalent, but represents an important differential diagnosis to EIB. Self-reported exercise-induced dyspnea is a weak indicator for both EIB and EILO and standardized testing should be provided.
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Affiliation(s)
- Karin Ersson
- Department of Medical Sciences, Uppsala University, Sweden.,Department of Neuroscience, Uppsala University, Sweden
| | | | | | | | - Henrik Johansson
- Department of Medical Sciences, Uppsala University, Sweden.,Department of Neuroscience, Uppsala University, Sweden
| | - Leif Nordang
- Department of Surgical Sciences, Uppsala University, Sweden
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20
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Roberts E, Doidge JC, Harron KL, Hotopf M, Knight J, White M, Eastwood B, Drummond C. National administrative record linkage between specialist community drug and alcohol treatment data (the National Drug Treatment Monitoring System (NDTMS)) and inpatient hospitalisation data (Hospital Episode Statistics (HES)) in England: design, method and evaluation. BMJ Open 2020; 10:e043540. [PMID: 33243818 PMCID: PMC7692978 DOI: 10.1136/bmjopen-2020-043540] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The creation and evaluation of a national record linkage between substance misuse treatment, and inpatient hospitalisation data in England. DESIGN A deterministic record linkage using personal identifiers to link the National Drug Treatment Monitoring System (NDTMS) curated by Public Health England (PHE), and Hospital Episode Statistics (HES) Admitted Patient Care curated by National Health Service (NHS) Digital. SETTING AND PARTICIPANTS Adults accessing substance misuse treatment in England between 1 April 2018 and 31 March 2019 (n=268 251) were linked to inpatient hospitalisation records available since 1 April 1997. OUTCOME MEASURES Using a gold-standard subset, linked using NHS number, we report the overall linkage sensitivity and precision. Predictors for linkage error were identified, and inverse probability weighting was used to interrogate any potential impact on the analysis of length of hospital stay. RESULTS 79.7% (n=213 814) people were linked to at least one HES record, with an estimated overall sensitivity of between 82.5% and 83.3%, and a precision of between 90.3% and 96.4%. Individuals were more likely to link if they were women, white and aged between 46 and 60. Linked individuals were more likely to have an average length of hospital stay ≥5 days if they were men, older, had no fixed residential address or had problematic opioid use. These associations did not change substantially after probability weighting, suggesting they were not affected by bias from linkage error. CONCLUSIONS Linkage between substance misuse treatment and hospitalisation records offers a powerful new tool to evaluate the impact of treatment on substance related harm in England. While linkage error can produce misleading results, linkage bias appears to have little effect on the association between substance misuse treatment and length of hospital admission. As subsequent analyses are conducted, potential biases associated with the linkage process should be considered in the interpretation of any findings.
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Affiliation(s)
- Emmert Roberts
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, United Kingdom
- Deaprtment of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, United Kingdom
- South London and the Maudsley NHS Foundation Trust, London, United Kingdom
- Public Health England, London, United Kingdom
| | - James C Doidge
- Intensive Care National Audit & Research Centre, London, United Kingdom
| | - Katie L Harron
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Matthew Hotopf
- Deaprtment of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, United Kingdom
- South London and the Maudsley NHS Foundation Trust, London, United Kingdom
| | | | | | | | - Colin Drummond
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, United Kingdom
- South London and the Maudsley NHS Foundation Trust, London, United Kingdom
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21
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De Silva AP, De Livera AM, Lee KJ, Moreno-Betancur M, Simpson JA. Multiple imputation methods for handling missing values in longitudinal studies with sampling weights: Comparison of methods implemented in Stata. Biom J 2020; 63:354-371. [PMID: 33103307 DOI: 10.1002/bimj.201900360] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 12/18/2022]
Abstract
Many analyses of longitudinal cohorts require incorporating sampling weights to account for unequal sampling probabilities of participants, as well as the use of multiple imputation (MI) for dealing with missing data. However, there is no guidance on how MI and sampling weights should be implemented together. We simulated a target population based on the Australian Bureau of Statistics Estimated Resident Population and drew 1000 random samples dependent on three design variables to mimic the Longitudinal Study of Australian Children. The target analysis was the weighted prevalence of overweight/obesity over childhood. We evaluated the performance of several MI approaches available in Stata, based on multivariate normal imputation (MVNI), fully conditional specification (FCS) and twofold FCS: a weighted imputation model, imputing missing data separately for each quintile sampling weight grouping, including the design stratum indicator in the imputation model, and using sampling weights as a covariate in the imputation model. Approaches based on available cases and inverse probability weighting (IPW), with time-varying weights, were also compared. We observed severe issues of convergence with FCS and twofold FCS. All MVNI-based approaches performed similarly, producing minimal bias and nominal coverage, except for when imputation was conducted separately for each quintile sampling weight group. IPW performed equally as well as MVNI-based approaches in terms of bias, however, was less precise. In similar longitudinal studies, we recommend using MVNI with the design stratum as a covariate in the imputation model. If this is unknown, including the sampling weight as a covariate is an appropriate alternative.
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Affiliation(s)
- Anurika P De Silva
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Alysha M De Livera
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Katherine J Lee
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Margarita Moreno-Betancur
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.,Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Julie A Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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22
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Gagné T, Frohlich KL, Quesnel-Vallée A. The role of education and other transition milestones in the progression of social inequalities in cigarette smoking between the ages of 18 and 25: Evidence from the Canadian National Population Health Survey. Addict Behav 2020; 109:106476. [PMID: 32485548 DOI: 10.1016/j.addbeh.2020.106476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 04/21/2020] [Accepted: 05/15/2020] [Indexed: 11/26/2022]
Abstract
Young adulthood is now considered a sensitive period in the progression of health inequalities over the life-course. This age group experiences highly dynamic and socially patterned life-course events that require nuanced modelling choices compared to those commonly used in public health sciences. To illustrate this, we estimate changes in the risk of smoking according to student status, employment status, living arrangements, and relationship status at different ages across education categories. We used longitudinal data in 1,243 young adults followed every two years between the ages of 18-19 and 24-25 in the Canadian National Population Health Survey (1994-95 to 2010-11). We examined the age-graded associations of occasional and daily smoking with educational attainment and transition statuses using random-effects multinomial logistic regression models with interaction terms. Post-secondary education, living with parents, studying, and being in a relationship were associated with a lower risk of daily smoking in main models, with some of these associations significantly varying in magnitude by age. The risk associated with living without parents at ages 18-19 disappeared by ages 24-25. Being single was both a protective factor at ages 18-19 and a risk factor at ages 24-25. Finally, the risk associated with being single was also stronger among those who did not pursue post-secondary education. These findings support the argument that the simple conceptualization of young adults' circumstances - independent from age and social context - provides a limited understanding of the progression of health inequalities over the life-course. Research needs to consider the dynamic and intersecting nature of transition milestones during this intensive life period.
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23
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Shu D, Young JG, Toh S, Wang R. Variance estimation in inverse probability weighted Cox models. Biometrics 2020; 77:1101-1117. [DOI: 10.1111/biom.13332] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 06/26/2020] [Accepted: 07/09/2020] [Indexed: 12/25/2022]
Affiliation(s)
- Di Shu
- Department of Population Medicine Harvard Medical School and Harvard Pilgrim Health Care Institute Boston Massachusetts
| | - Jessica G. Young
- Department of Population Medicine Harvard Medical School and Harvard Pilgrim Health Care Institute Boston Massachusetts
| | - Sengwee Toh
- Department of Population Medicine Harvard Medical School and Harvard Pilgrim Health Care Institute Boston Massachusetts
| | - Rui Wang
- Department of Population Medicine Harvard Medical School and Harvard Pilgrim Health Care Institute Boston Massachusetts
- Department of Biostatistics Harvard T.H. Chan School of Public Health Boston Massachusetts
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24
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Betancourt TS, Thomson DL, Brennan RT, Antonaccio CM, Gilman SE, VanderWeele TJ. Stigma and Acceptance of Sierra Leone's Child Soldiers: A Prospective Longitudinal Study of Adult Mental Health and Social Functioning. J Am Acad Child Adolesc Psychiatry 2020; 59:715-726. [PMID: 31176749 PMCID: PMC6908764 DOI: 10.1016/j.jaac.2019.05.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 04/26/2019] [Accepted: 05/30/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the associations of war and postconflict factors with mental health among Sierra Leone's former child soldiers as adults. METHOD In 2002, we recruited former child soldiers from lists of soldiers (aged 10-17 years) served by Disarmament, Demobilization, Reintegration centers and from a random door-to-door sample in 5 districts of Sierra Leone. In 2004, self-reintegrated child soldiers were recruited in an additional district. At 2016/2017, 323 of the sample of 491 former child soldiers were reassessed. Subjects reported on war exposures and postconflict stigma, family support, community support, anxiety/depression, and posttraumatic stress symptoms. RESULTS Of the subjects, 72% were male, with a mean age of 28 years. In all, 26% reported killing or injuring others; 67% reported being victims of life-threatening violence; 45% of female subjects and 5% of male subjects reported being raped; and 32% reported death of a parent. In 2016/2017 (wave 4), 47% exceeded the threshold for anxiety/depression, and 28% exceeded the likely posttraumatic stress disorder threshold. Latent class growth analysis yielded 3 trajectory groups based on changes in stigma and family/community acceptance; "Improving Social Integration" (n = 77) fared nearly as well as the "Socially Protected" (n = 213). The "Socially Vulnerable" group (n = 33) had increased risk of anxiety/depression above the clinical threshold and possible PTSD, and were around 3 times more likely to attempt suicide. CONCLUSION Former child soldiers had elevated rates of mental health problems. Postconflict risk and protective factors related to outcomes long after the end of conflict. Targeted social inclusion and family interventions could benefit the long-term mental health of former child soldiers.
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Affiliation(s)
- Theresa S Betancourt
- Research Program on Children and Adversity, Boston College School of Social Work, Newton, Massachusetts.
| | | | - Robert T Brennan
- Research Program on Children and Adversity, Boston College School of Social Work, Newton, Massachusetts
| | - Cara M Antonaccio
- Research Program on Children and Adversity, Boston College School of Social Work, Newton, Massachusetts
| | - Stephen E Gilman
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, and the Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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25
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Rao R, Bakolis I, Das-Munshi J, Poulter D, Votruba N, Thornicroft G. Alcohol consumption of UK members of parliament: cross-sectional survey. BMJ Open 2020; 10:e034929. [PMID: 32127352 PMCID: PMC7053260 DOI: 10.1136/bmjopen-2019-034929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 11/30/2019] [Accepted: 01/15/2020] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES This study examined the prevalence of risky drinking by members of parliament (MPs), as well as the relationship between risky drinking and age, years spent as an MP, working outside parliament, awareness of the Parliamentary Health and Wellbeing Service, and probable mental ill health. DESIGN A survey questionnaire assessed alcohol consumption using the Alcohol Use Disorders Identification Test (AUDIT). Risky drinking was identified by combining categories of increasing (hazardous), higher (harmful) and probable dependent drinking for those with a total score of 8 or more. Comparator groups from the 2014 Adult Psychiatric Morbidity Survey (APMS) were used as controls. SETTING UK House of Commons. PARTICIPANTS 650 MPs. RESULTS Compared with all 650 MPs, participants (n=146) were more likely to be female (p<0.05) or have an educational qualification (p<0.05). Weighted proportions on AUDIT items were higher than the APMS comparator group for participants who had a drink four or more times a week, 10 or more drinks on a typical drinking day, six or more drinks in one occasion, or felt guilty because of drinking (p<0.01). Weighted percentages for risky drinking were higher in MPs compared with the whole English population (p<0.05), but similar when compared with socioeconomic comparator groups. The odds of risky drinking were 2.74 times greater for MPs who had an additional work role outside parliament compared with those who did not (95% CI 0.98 to 7.65) and 2.4 times greater for MPs with probable mental ill health compared with those with no evidence of probable mental ill health (95% CI 0.78 to 7.43). CONCLUSIONS A low level of awareness of the Parliamentary Health and Wellbeing Service has implications for improving the detection of risky drinking and improving access to this service by MPs. Possible increased likelihood of risky drinking in MPs who also had an additional work role outside Parliament and among those with probable mental ill health requires further exploration.
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Affiliation(s)
- Rahul Rao
- Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | | | - Jayati Das-Munshi
- Section of Epidemiology, Department of Health Service & Population Research, King's College London, Institute of Psychiatry, London, UK
| | - Daniel Poulter
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Nicole Votruba
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Graham Thornicroft
- Health Service and Population Research, Institute of Psychiatry, London, UK
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Taylor LK, Tong X, Maxwell SE. Evaluating Supplemental Samples in Longitudinal Research: Replacement and Refreshment Approaches. MULTIVARIATE BEHAVIORAL RESEARCH 2020; 55:277-299. [PMID: 31264449 DOI: 10.1080/00273171.2019.1628694] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Despite the wide application of longitudinal studies, they are often plagued by missing data and attrition. The majority of methodological approaches focus on participant retention or modern missing data analysis procedures. This paper, however, takes a new approach by examining how researchers may supplement the sample with additional participants. First, refreshment samples use the same selection criteria as the initial study. Second, replacement samples identify auxiliary variables that may help explain patterns of missingness and select new participants based on those characteristics. A simulation study compares these two strategies for a linear growth model with five measurement occasions. Overall, the results suggest that refreshment samples lead to less relative bias, greater relative efficiency, and more acceptable coverage rates than replacement samples or not supplementing the missing participants in any way. Refreshment samples also have high statistical power. The comparative strengths of the refreshment approach are further illustrated through a real data example. These findings have implications for assessing change over time when researching at-risk samples with high levels of permanent attrition.
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Powers M, Sanchez TR, Grau-Perez M, Yeh F, Francesconi KA, Goessler W, George CM, Heaney C, Best LG, Umans JG, Brown RH, Navas-Acien A. Low-moderate arsenic exposure and respiratory in American Indian communities in the Strong Heart Study. Environ Health 2019; 18:104. [PMID: 31779614 PMCID: PMC6883619 DOI: 10.1186/s12940-019-0539-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 10/28/2019] [Indexed: 05/18/2023]
Abstract
BACKGROUND Arsenic exposure through drinking water is an established lung carcinogen. Evidence on non-malignant lung outcomes is less conclusive and suggests arsenic is associated with lower lung function. Studies examining low-moderate arsenic (< 50 μg/L), the level relevant for most populations, are limited. We evaluated the association of arsenic exposure with respiratory health in American Indians from the Northern Plains, the Southern Plains and the Southwest United States, communities with environmental exposure to inorganic arsenic through drinking water. METHODS The Strong Heart Study is a prospective study of American Indian adults. This analysis used urinary arsenic measurements at baseline (1989-1991) and spirometry at Visit 2 (1993-1995) from 2132 participants to evaluate associations of arsenic exposure with airflow obstruction, restrictive pattern, self-reported respiratory disease, and symptoms. RESULTS Airflow obstruction was present in 21.5% and restrictive pattern was present in 14.4%. The odds ratio (95% confidence interval) for obstruction and restrictive patterns, based on the fixed ratio definition, comparing the 75th to 25th percentile of arsenic, was 1.17 (0.99, 1.38) and 1.27 (1.01, 1.60), respectively, after adjustments, and 1.28 (1.02, 1.60) and 1.33 (0.90, 1.50), respectively, based on the lower limit of normal definition. Arsenic was associated with lower percent predicted FEV1 and FVC, self-reported emphysema and stopping for breath. CONCLUSION Low-moderate arsenic exposure was positively associated with restrictive pattern, airflow obstruction, lower lung function, self-reported emphysema and stopping for breath, independent of smoking and other lung disease risk factors. Findings suggest that low-moderate arsenic exposure may contribute to restrictive lung disease.
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Affiliation(s)
- Martha Powers
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, USA.
| | - Tiffany R Sanchez
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Maria Grau-Perez
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, USA
| | - Fawn Yeh
- Center for American Indian Health Research, University of Oklahoma Health Sciences Center, College of Public Health, Oklahoma City, OK, USA
| | | | - Walter Goessler
- Institute of Chemistry - Analytical Chemistry, Graz, Austria
| | - Christine M George
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Christopher Heaney
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lyle G Best
- Missouri Breaks Industries Research, Inc., Eagle Butte, SD, USA
| | - Jason G Umans
- MedStar Health Research Institute, Hyattsville, MD, USA, Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC, USA
| | - Robert H Brown
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, USA
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ana Navas-Acien
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, USA
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Poulter D, Votruba N, Bakolis I, Debell F, Das-Munshi J, Thornicroft G. Mental health of UK Members of Parliament in the House of Commons: a cross-sectional survey. BMJ Open 2019; 9:e027892. [PMID: 31262804 PMCID: PMC6609039 DOI: 10.1136/bmjopen-2018-027892] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 05/15/2019] [Accepted: 05/17/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The purpose of this study was to assess (1) the overall mental health of Members of Parliament (MPs) and (2) awareness among MPs of the mental health support services available to them in Parliament. DESIGN An anonymous self-completed online cross-sectional survey was conducted in December 2016. SETTING 56th UK House of Commons. PARTICIPANTS All 650 members of the 56th UK House of Commons were invited to participate; 146 MPs (23%) completed the survey. OUTCOMES The General Health Questionnaire-12 was used to assess age- and sex-standardised prevalence of probable common mental disorders (CMD). Results were compared with a nationally representative survey, the Health Survey for England (HSE) 2014. Core demographic questions, MPs' awareness of available mental health services, their willingness to discuss mental health issues with party Whips and fellow MPs and the effects of employment outside Parliament were assessed. RESULTS Comparison of MP respondents with HSE comparator groups found that MPs have higher rates of mental health problems (age- and sex-standardised prevalence of probable CMD in 49 surveyed MPs 34% (95% CI 27% to 42%) versus 17% (95% CI 13% to 21%) in the high-income comparison group). Survey respondents were younger, more likely to be female and more educated compared with all MPs. 77% of MPs (n=112) did not know how to access in-house mental health support. 52% (n=76) would not discuss their mental health with party Whips or other MPs (48%; n=70). CONCLUSIONS MPs in the study sample had higher rates of mental health problems than rates seen in the whole English population or comparable occupational groups. Most surveyed MPs are unaware of mental health support services or how to access them. Our findings represent a relatively small sample of MPs. There is a need for MPs to have better awareness of, and access to, mental health support.
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Affiliation(s)
| | - Nicole Votruba
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ioannis Bakolis
- Department of Biostatistics and Health Informatics/ Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Frances Debell
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Jayati Das-Munshi
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neurosciences, King's College London, Institute of Psychiatry, London, UK
| | - Graham Thornicroft
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Daeem R, Mansbach-Kleinfeld I, Farbstein I, Apter A, Elias R, Ifrah A, Chodick G, Fennig S. Barriers to help-seeking in Israeli Arab minority adolescents with mental health problems: results from the Galilee study. Isr J Health Policy Res 2019; 8:45. [PMID: 31122285 PMCID: PMC6532130 DOI: 10.1186/s13584-019-0315-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 05/13/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The Galilee Study assessed mental health service needs among Israeli Muslim and Druze adolescents and their mothers. Studies show that mothers of adolescents belonging to the Arab minority have much lower help-seeking rates than Jewish mothers. This paper examines mothers' structural and cultural barriers to help-seeking. METHODS All 9th grade students living in 5 towns representative of Muslim and Druze localities in northern Israel, were eligible for the study and 1639 (69.3%) obtained parental agreement and participated. Emotional or behavioral problem were assessed in the classroom using the Strengths and Difficulties Questionnaire. A total of 704 adolescent-mother dyads participated in the follow-up, and were interviewed at home, using the Development and Well Being Assessment inventory, the Composite Barriers to Help-Seeking Questionnaire, the General Health Questionnaire - 12, the Subjective Feelings of Discrimination Index and socio-demographic questions. Pearson χ2 test and multivariate binary logistic regressions were performed to analyze mothers' consultation rates by risk factors. Exploratory factor analysis was performed to identify underlying factors and assess construct validity of the Composite Barriers to Help-Seeking Questionnaire, and also mean scores and standard deviations for the distinct scales were calculated. RESULTS More mothers of adolescents with a mental disorder than those without a mental disorder consulted a professional or school source (39.7% vs. 20.5%; χ2 = 45.636; p = < 0.001). The most important barriers to help-seeking were those related to "Accessibility", followed by barriers related to the belief that "Treatment is detrimental" and to the possibility of "Reprisal by authorities". Barriers related to "Stigma" and "Distrust of professionals" had the lowest means scores. Differences by ethnicity/religion were found. CONCLUSIONS Structural barriers related to lack of access, were considered the main obstacle to help-seeking in this Israeli Arab minority population. Cultural barriers such as stigma were considered of secondary importance. Structural barriers could be reduced by increasing the number of accessible public mental health clinics in the minority localities, a responsibility of the Ministry of Health and the HMOs. Information campaigns and psychoeducation for parents would help reduce other barriers to mental health treatment.
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Affiliation(s)
- Raida Daeem
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Child and Adolescent Mental Health Department, Ziv Medical Center, 13100 Zefat, Israel
| | - Ivonne Mansbach-Kleinfeld
- The Feinberg Child Study Center, Schneider Medical Center for Children in Israel, 49202 Petach Tikvah, Israel
| | - Ilana Farbstein
- Child and Adolescent Mental Health Department, Ziv Medical Center, 13100 Zefat, Israel
| | - Alan Apter
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Psychiatry, Schneider Children’s Medical Center of Israel, 49202 Petach Tikva, Israel
- Ruppin Academic Center, Netanya, Israel
- Inter-Disciplinary Center, Herzliya, Israel
| | - Rasha Elias
- Child and Adolescent Mental Health Department, Ziv Medical Center, 13100 Zefat, Israel
| | - Anneke Ifrah
- Israel Center for Disease Control, Gertner Institute, Sheba Medical Center, 5265601 Tel Hashomer, Israel
| | - Gabriel Chodick
- School of Public Health, Tel Aviv University, Tel Aviv, Israel
- Epidemiology and Data Base, MaccabiTech, Tel Aviv, Israel
| | - Silvana Fennig
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Psychiatry, Schneider Children’s Medical Center of Israel, 49202 Petach Tikva, Israel
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Downs JM, Ford T, Stewart R, Epstein S, Shetty H, Little R, Jewell A, Broadbent M, Deighton J, Mostafa T, Gilbert R, Hotopf M, Hayes R. An approach to linking education, social care and electronic health records for children and young people in South London: a linkage study of child and adolescent mental health service data. BMJ Open 2019; 9:e024355. [PMID: 30700480 PMCID: PMC6352796 DOI: 10.1136/bmjopen-2018-024355] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES Creation of linked mental health, social and education records for research to support evidence-based practice for regional mental health services. SETTING The Clinical Record Interactive Search (CRIS) system was used to extract personal identifiers who accessed psychiatric services between September 2007 and August 2013. PARTICIPANTS A clinical cohort of 35 509 children and young people (aged 4-17 years). DESIGN Multiple government and ethical committees approved the link of clinical mental health service data to Department for Education (DfE) data on education and social care services. Under robust governance protocols, fuzzy and deterministic approaches were used by the DfE to match personal identifiers (names, date of birth and postcode) from National Pupil Database (NPD) and CRIS data sources. OUTCOME MEASURES Risk factors for non-matching to NPD were identified, and the potential impact of non-match biases on International Statistical Classification of Diseases, 10th Revision (ICD-10) classifications of mental disorder, and persistent school absence (<80% attendance) were examined. Probability weighting and adjustment methods were explored as methods to mitigate the impact of non-match biases. RESULTS Governance challenges included developing a research protocol for data linkage, which met the legislative requirements for both National Health Service and DfE. From CRIS, 29 278 (82.5%) were matched to NPD school attendance records. Presenting to services in late adolescence (adjusted OR (aOR) 0.67, 95% CI 0.59 to 0.75) or outside of school census timeframes (aOR 0.15, 95% CI 0.14 to 0.17) reduced likelihood of matching. After adjustments for linkage error, ICD-10 mental disorder remained significantly associated with persistent school absence (aOR 1.13, 95% CI 1.07 to 1.22). CONCLUSIONS The work described sets a precedent for education data being used for medical benefit in England. Linkage between health and education records offers a powerful tool for evaluating the impact of mental health on school function, but biases due to linkage error may produce misleading results. Collaborative research with data providers is needed to develop linkage methods that minimise potential biases in analyses of linked data.
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Affiliation(s)
- Johnny M Downs
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
- NIHR South London and Maudsley NHS Foundation Trust Biomedical Research Centre, London, UK
| | - Tamsin Ford
- University of Exeter Medical School, Exeter, UK
| | - Robert Stewart
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
- NIHR South London and Maudsley NHS Foundation Trust Biomedical Research Centre, London, UK
| | - Sophie Epstein
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
- NIHR South London and Maudsley NHS Foundation Trust Biomedical Research Centre, London, UK
| | - Hitesh Shetty
- NIHR South London and Maudsley NHS Foundation Trust Biomedical Research Centre, London, UK
| | - Ryan Little
- University of Exeter Medical School, Exeter, UK
| | - Amelia Jewell
- NIHR South London and Maudsley NHS Foundation Trust Biomedical Research Centre, London, UK
| | - Matthew Broadbent
- NIHR South London and Maudsley NHS Foundation Trust Biomedical Research Centre, London, UK
| | - Jessica Deighton
- Evidence Based Practice Unit, UCL and Anna Freud Centre, London, UK
| | - Tarek Mostafa
- UCL Institute of Education, University College London, London, UK
| | - Ruth Gilbert
- Administrative Data Research Centre for England, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Matthew Hotopf
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
- NIHR South London and Maudsley NHS Foundation Trust Biomedical Research Centre, London, UK
| | - Richard Hayes
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
- NIHR South London and Maudsley NHS Foundation Trust Biomedical Research Centre, London, UK
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Daeem R, Mansbach-Kleinfeld I, Farbstein I, Goodman R, Elias R, Ifrah A, Chodick G, Khamaisi R, Fennig S, Apter A. Correlates of mental disorders among minority Arab adolescents in Israel: results from the Galilee Study. Isr J Health Policy Res 2019; 8:14. [PMID: 30665458 PMCID: PMC6340179 DOI: 10.1186/s13584-018-0281-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 12/20/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Galilee Study is the first large epidemiological study to compare correlates of mental disorders between two Arab Palestinian minority groups of adolescents in Israel. METHODS A two-stage cross-sectional study, carried out between 2012 and 2014, included all 9th grade students from 5 Arab localities, representative of 77% of the Muslim and 100% of Druze citizens in Israel. During the screening stage, 1639 students completed the Strengths and Difficulties Questionnaire in the classroom (response rate = 69.3%). During the follow-up stage, 704 adolescent-mother dyads were interviewed at home; using the Development and Well-Being Assessment, the General Health Questionnaire (GHQ)-12, the Subjective Feeling of Discrimination Index (FDI), and socio-demographic questions (response rate = 84.4%). RESULTS Prevalence of any disorder, internalizing or externalizing disorders among Muslim adolescents were 19.2, 15.8 and 4.2%, respectively and among Druze adolescents 10.9, 5.9 and 5.5%, respectively. Muslim adolescents were 3.2 times more likely than Druze adolescents to have an internalizing disorder, while Druze were 2 times more likely than Muslim to have an externalizing disorder. Males were at higher risk than females for externalizing disorders in both populations, though among Druze the risk was more striking. Learning disabilities increased the likelihood of having an externalizing disorder in both populations. Risk factors for internalizing disorders among Muslim adolescents were female gender, a very low socio-economic level, few siblings, LD, high maternal GHQ-12 score and high FDI; and for externalizing disorders, male gender, a relatively low socio-economic level but not the lowest, learning disability and high maternal GHQ-12 score. CONCLUSIONS We found an association between religion/ethnicity and internalizing and externalizing disorders as well as a strong correlation between religion/ethnicity and socio-economic variables. Therefore, we tend to conclude that not religion per se but the multifaceted socio-cultural and economic factors that characterize religious groups are associated with mental disorders. Very low socio-economic level and feeling discriminated which were traits connected only to Muslim adolescents, were associated with internalizing disorders. When preparing preventive measures aimed at furthering mental health among minority adolescents, authorities should focus on improving the socio-economic status of minorities and reducing institutional and personal discrimination. The educational and mental health establishments could undertake measures to improve resilience and coping strategies of Muslim families living in the most adverse conditions, such as providing special support through the school counseling services and coordinating, at the ministerial levels, school and community health services in order to carry out joint preventive programs and referrals to specialist services when needed.
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Affiliation(s)
- Raida Daeem
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Child and Adolescent Mental Health Department, Ziv Medical Center, 13100, Zefat, Israel
| | - Ivonne Mansbach-Kleinfeld
- The Feinberg Child Study Center, Schneider Medical Center for Children in Israel, 49202, Petach Tikvah, Israel.
| | - Ilana Farbstein
- Child and Adolescent Mental Health Department, Ziv Medical Center, 13100, Zefat, Israel
| | - Robert Goodman
- Department of Child and Adolescent Psychiatry, King College London Institute of Psychology, Psychiatry & Neuroscience, London, UK
| | - Rasha Elias
- Child and Adolescent Mental Health Department, Ziv Medical Center, 13100, Zefat, Israel
| | - Anneke Ifrah
- Israel Center for Disease Control, Gertner Institute, Sheba Medical Center, 5265601, Tel Hashomer, Israel
| | - Gabriel Chodick
- School of Public Health, Tel Aviv University, Tel Aviv, Israel.,Epidemiology and Data Base, MaccabiTech, Tel Aviv, Israel
| | - Rassem Khamaisi
- Department of Geography and Environmental Studies, University of Haifa, 31905, Haifa, Israel
| | - Silvana Fennig
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Psychiatry, Schneider Children's Medical Center of Israel, 49202, Petach Tikva, Israel
| | - Alan Apter
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Psychiatry, Schneider Children's Medical Center of Israel, 49202, Petach Tikva, Israel.,Ruppin Academic Center, Netanya, Israel.,Inter-Disciplinary Center, Herzliya, Israel
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Warren RB, Marsden A, Tomenson B, Mason KJ, Soliman MM, Burden AD, Reynolds NJ, Stocken D, Emsley R, Griffiths CEM, Smith C. Identifying demographic, social and clinical predictors of biologic therapy effectiveness in psoriasis: a multicentre longitudinal cohort study. Br J Dermatol 2018; 180:1069-1076. [PMID: 30155885 PMCID: PMC6519065 DOI: 10.1111/bjd.16776] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2018] [Indexed: 01/28/2023]
Abstract
Background Biologic therapies have revolutionized the treatment of moderate‐to‐severe psoriasis. However, for reasons largely unknown, many patients do not respond or lose response to these drugs. Objectives To evaluate demographic, social and clinical factors that could be used to predict effectiveness and stratify response to biologic therapies in psoriasis. Methods Using a multicentre, observational, prospective pharmacovigilance study (BADBIR), we identified biologic‐naive patients starting biologics with outcome data at 6 (n = 3079) and 12 (n = 3110) months. Associations between 31 putative predictors and outcomes were investigated in univariate and multivariable regression analyses. Potential stratifiers of treatment response were investigated with statistical interactions. Results Eight factors associated with reduced odds of achieving ≥ 90% improvement in Psoriasis Area and Severity Index (PASI 90) at 6 months were identified (described as odds ratio and 95% confidence interval): demographic (female sex, 0·78, 0·66–0·93); social (unemployment, 0·67, 0·45–0·99); unemployment due to ill health (0·62, 0·48–0·82); ex‐ and current smoking (0·81, 0·66–0·99 and 0·79, 0·63–0·99, respectively); clinical factors (high weight, 0·99, 0·99–0·99); psoriasis of the palms and/or soles (0·75, 0·61–0·91); and presence of small plaques only compared with small and large plaques (0·78, 0·62–0·96). White ethnicity (1·48, 1·12–1·97) and higher baseline PASI (1·04, 1·03–1·04) were associated with increased odds of achieving PASI 90. The findings were largely consistent at 12 months. There was little evidence for predictors of differential treatment response. Conclusions Psoriasis phenotype and potentially modifiable factors are associated with poor outcomes with biologics, underscoring the need for lifestyle management. Effect sizes suggest that these factors alone cannot inform treatment selection. What's already known about this topic? Biologic therapy used in the treatment of moderate‐to‐severe psoriasis differs in its effectiveness across patients. Previous research has indicated that patients with a higher body mass index, who smoke or who have smoked, and with a lower baseline Psoriasis Area and Severity Index (PASI) are less likely to have a good outcome with biologic therapy for the treatment of moderate‐to‐severe psoriasis.
What does this study add? This large‐scale study in a real‐world setting confirms that weight, smoking status and baseline PASI are associated with effectiveness of biologic therapy. There is evidence that non‐white ethnicity, female sex, unemployment, psoriasis of the palms and soles and the presence of small chronic plaques are associated with poor outcomes with biologics. There is some evidence that men have a comparatively worse response to etanercept, relative to adalimumab, than women. Otherwise, most factors do not appear to be predictors of differential treatment response.
Respond to this article
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Affiliation(s)
- R B Warren
- Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester, U.K
| | - A Marsden
- Centre for Biostatistics, School of Health Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, U.K
| | - B Tomenson
- Centre for Biostatistics, School of Health Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, U.K
| | - K J Mason
- Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, U.K
| | - M M Soliman
- Department of Pharmacy Practice, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt
| | - A D Burden
- Department of Dermatology, Royal Infirmary of Edinburgh, Edinburgh, U.K
| | - N J Reynolds
- Dermatological Sciences, Institute of Cellular Medicine, Medical School, Newcastle University, NIHR Newcastle Biomedical Research Centre and Department of Dermatology, Royal Victoria Infirmary, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, U.K
| | - D Stocken
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, U.K
| | - R Emsley
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, U.K
| | - C E M Griffiths
- Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester, U.K
| | - C Smith
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, U.K
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Abstract
BACKGROUND Most longitudinal studies do not address potential selection biases due to selective attrition. Using empirical data and simulating additional attrition, we investigated the effectiveness of common approaches to handle missing outcome data from attrition in the association between individual education level and change in body mass index (BMI). METHODS Using data from the two waves of the French RECORD Cohort Study (N = 7,172), we first examined how inverse probability weighting (IPW) and multiple imputation handled missing outcome data from attrition in the observed data (stage 1). Second, simulating additional missing data in BMI at follow-up under various missing-at-random scenarios, we quantified the impact of attrition and assessed how multiple imputation performed compared to complete case analysis and to a perfectly specified IPW model as a gold standard (stage 2). RESULTS With the observed data in stage 1, we found an inverse association between individual education and change in BMI, with complete case analysis, as well as with IPW and multiple imputation. When we simulated additional attrition under a missing-at-random pattern (stage 2), the bias increased with the magnitude of selective attrition, and multiple imputation was useless to address it. CONCLUSIONS Our simulations revealed that selective attrition in the outcome heavily biased the association of interest. The present article contributes to raising awareness that for missing outcome data, multiple imputation does not do better than complete case analysis. More effort is thus needed during the design phase to understand attrition mechanisms by collecting information on the reasons for dropout.
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Cleland VJ, Patterson K, Breslin M, Schmidt MD, Dwyer T, Venn AJ. Longitudinal associations between TV viewing and BMI not explained by the 'mindless eating' or 'physical activity displacement' hypotheses among adults. BMC Public Health 2018; 18:797. [PMID: 29940922 PMCID: PMC6019267 DOI: 10.1186/s12889-018-5674-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 06/05/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The mechanisms explaining the positive relationship between television (TV) viewing and body mass index (BMI) are unclear. 'Mindless eating' and 'physical activity displacement' theories have been suggested, but have not been tested longitudinally among young adults. This study aimed to determine whether longitudinal associations between young adults' TV viewing and BMI are explained by changes in TV-related food and beverage consumption (FBC) and/or leisure-time physical activity (LTPA) over 5 years among young adults. METHODS A cohort of young Australian adults (n = 1068) was assessed in 2004-6 (T1) and 2009-2011 (T2), height and weight were measured (T1) or self-reported (T2), and participants self-reported TV viewing time (hours/day), weekly TV-related FBC and LTPA (mins/week). Linear regression was used to examine direct pathways between TV viewing and BMI, adjusting for TV-related FBC and LTPA to examine indirect pathways. RESULTS The association between TV viewing time and BMI (β: 0.41, 95% CI 0.03, 0.78 for > 1-h increase in TV viewing/day) was not explained by TV-related FBC (β: 0.37, 95% CI -0.18, 0.91) or LTPA (β: 0.38, 95% CI -0.17, 0.93) hypotheses. Increased TV-related FBC was associated with increased TV viewing (0.39 ± 1.54 h/day) and greater increases in BMI (0.92 ± 2.28 kg/m2, p = 0.16). LTPA increases were not associated with changes in TV viewing (- 0.07 ± 1.42 h/day), and increases in BMI were smallest when LTPA increased (0.44 ± 2.25 kg/m2) and greatest when LTPA decreased (0.82 ± 2.30 kg/m2) (p = 0.13). CONCLUSIONS Factors other than changes in TV-related FBC or LTPA may explain the longitudinal relationship between TV viewing and increasing BMI among young adults. Findings confirm that TV viewing is a risk factor for weight gain in young adults but the underlying causal mechanisms remain unclear.
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Affiliation(s)
- Verity J Cleland
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS, 7001, Australia.
| | - Kira Patterson
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS, 7001, Australia.,Faculty of Education, University of Tasmania, Launceston, TAS, Australia
| | - Monique Breslin
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS, 7001, Australia
| | | | - Terence Dwyer
- The George Institute for Global Health, University of Oxford, Oxford, England
| | - Alison J Venn
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS, 7001, Australia
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The Associations of Multimorbidity With Health-Related Productivity Loss in a Large and Diverse Public Sector Setting: A Cross-Sectional Survey. J Occup Environ Med 2017; 60:528-535. [PMID: 29200192 DOI: 10.1097/jom.0000000000001243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate absenteeism, presenteeism, and total lost productive time (LPT) associated with multimorbidity. METHODS Cross-sectional data from 3228 state-government employees from Tasmania were collected in 2013. The validated measures of absenteeism, presenteeism, and LPT were obtained from employees' self-reported data over a 28-day period. Analyses were stratified by sex. Negative binomial models were used to estimate the associations between multimorbidity and LPT. RESULTS The average health-related total LPT was 1.2 (standard deviation [SD] = 2.4) and 1.7 (SD = 3.5) days for men and women with multimorbidity, respectively. Women (rate ratio [RR] = 2.9, 95% confidence interval [CI] 1.8 to 4.9) and men (RR = 4.4, 95%CI 3.0 to 6.2) with 4+ chronic conditions were significantly more likely to report LPT compared with those without any chronic conditions. CONCLUSION We found multimorbidity is of concern within the workforce, with a positive association of multimorbidity and LPT observed, and significant differences in LPT between men and women reporting multimorbidity.
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Contactable Non-responders Show Different Characteristics Compared to Lost to Follow-Up Participants: Insights from an Australian Longitudinal Birth Cohort Study. Matern Child Health J 2017; 20:1472-84. [PMID: 26976281 DOI: 10.1007/s10995-016-1946-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective This research aims to identify predictors of attrition in a longitudinal birth cohort study in Australia and assess differences in baseline characteristics and responses in subsequent follow-up phases between contactable non-responders and uncontactable non-responders deemed "lost to follow-up (LTF)". Methods 3368 women recruited from three public hospitals in Southeast Queensland and Northern New South Wales during antenatal visits in 2006-2011 completed a baseline questionnaire to elicit information on multiple domains of exposures. A follow-up questionnaire was posted to each participant at 1 year after birth to obtain mother's and child's health and development information. Multivariate logistic regression was used to model the association between exposures and respondents' status at 1 year. The effect of an inverse-probability-weighting method to adjust for non-response was studied. Results Overall attrition at 1-year was 35.4 %; major types of attrition were "contactable non-response" (27.6 %) and "LTF" (6.7 %). These two attrition types showed different responses at the 3-year follow-up and involved different predictors. Besides shared predictors (first language not English, higher risk of psychological distress, had smoked during pregnancy, higher levels of family conflict), distinguishable predictors of contactable non-responders were younger age, having moved home in the past year and having children under 16 in the household. Attrition rates increased substantially from 20 % in 2006 to 54 % in 2011. Conclusions This observed trend of increased attrition rates raises concern about the use of traditional techniques, such as "paper-based" questionnaires, in longitudinal cohort studies. The supplementary use of electronic communications, such as online survey tools and smart-device applications, could provide a better alternative.
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Kilpatrick M, Blizzard L, Sanderson K, Teale B, Jose K, Venn A. Barriers and facilitators to participation in workplace health promotion (WHP) activities: results from a cross-sectional survey of public-sector employees in Tasmania, Australia. Health Promot J Austr 2017; 28:225-232. [DOI: 10.1071/he16052] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 11/11/2016] [Indexed: 11/23/2022] Open
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Hüsers J, Hübner U, Esdar M, Ammenwerth E, Hackl WO, Naumann L, Liebe JD. Innovative Power of Health Care Organisations Affects IT Adoption: A bi-National Health IT Benchmark Comparing Austria and Germany. J Med Syst 2017; 41:33. [PMID: 28054195 DOI: 10.1007/s10916-016-0671-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 12/07/2016] [Indexed: 10/20/2022]
Abstract
Multinational health IT benchmarks foster cross-country learning and have been employed at various levels, e.g. OECD and Nordic countries. A bi-national benchmark study conducted in 2007 revealed a significantly higher adoption of health IT in Austria compared to Germany, two countries with comparable healthcare systems. We now investigated whether these differences still persisted. We further studied whether these differences were associated with hospital intrinsic factors, i.e. the innovative power of the organisation and hospital demographics. We thus performed a survey to measure the "perceived IT availability" and the "innovative power of the hospital" of 464 German and 70 Austrian hospitals. The survey was based on a questionnaire with 52 items and was given to the directors of nursing in 2013/2014. Our findings confirmed a significantly greater IT availability in Austria than in Germany. This was visible in the aggregated IT adoption composite score "IT function" as well as in the IT adoption for the individual functions "nursing documentation" (OR = 5.98), "intensive care unit (ICU) documentation" (OR = 2.49), "medication administration documentation" (OR = 2.48), "electronic archive" (OR = 2.27) and "medication" (OR = 2.16). "Innovative power" was the strongest factor to explain the variance of the composite score "IT function". It was effective in hospitals of both countries but significantly more effective in Austria than in Germany. "Hospital size" and "hospital system affiliation" were also significantly associated with the composite score "IT function", but they did not differ between the countries. These findings can be partly associated with the national characteristics. Indicators point to a more favourable financial situation in Austrian hospitals; we thus argue that Austrian hospitals may possess a larger degree of financial freedom to be innovative and to act accordingly. This study is the first to empirically demonstrate the effect of "innovative power" in hospitals on health IT adoption in a bi-national health IT benchmark. We recommend directly including the financial situation into future regression models. On a political level, measures to stimulate the "innovative power" of hospitals should be considered to increase the digitalisation of healthcare.
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Affiliation(s)
- Jens Hüsers
- Health Informatics Research Group, Hochschule Osnabrück - UAS, Caprivistraße 30A, D-49076, Osnabrück, Germany
| | - Ursula Hübner
- Health Informatics Research Group, Hochschule Osnabrück - UAS, Caprivistraße 30A, D-49076, Osnabrück, Germany.
| | - Moritz Esdar
- Health Informatics Research Group, Hochschule Osnabrück - UAS, Caprivistraße 30A, D-49076, Osnabrück, Germany
| | - Elske Ammenwerth
- Institute of Biomedical Informatics, Medical Informatics and Technology, UMIT - University for Health Sciences, Hall in Tyrol, Austria
| | - Werner O Hackl
- Institute of Biomedical Informatics, Medical Informatics and Technology, UMIT - University for Health Sciences, Hall in Tyrol, Austria
| | - Laura Naumann
- Health Informatics Research Group, Hochschule Osnabrück - UAS, Caprivistraße 30A, D-49076, Osnabrück, Germany
| | - Jan David Liebe
- Health Informatics Research Group, Hochschule Osnabrück - UAS, Caprivistraße 30A, D-49076, Osnabrück, Germany
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Sun Z, Gilbert L, Ciampi A, Kaufman JS, Basso O. Estimating the Prevalence of Ovarian Cancer Symptoms in Women Aged 50 Years or Older: Problems and Possibilities. Am J Epidemiol 2016; 184:670-680. [PMID: 27737840 DOI: 10.1093/aje/kww086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 02/02/2016] [Indexed: 02/05/2023] Open
Abstract
Diagnostic testing is recommended in women with "ovarian cancer symptoms." However, these symptoms are nonspecific. The ongoing Diagnosing Ovarian Cancer Early (DOVE) Study in Montreal, Quebec, Canada, provides diagnostic testing to women aged 50 years or older with symptoms lasting for more than 2 weeks and less than 1 year. The prevalence of ovarian cancer in DOVE is 10 times that of large screening trials, prompting us to estimate the prevalence of these symptoms in this population. We sent a questionnaire to 3,000 randomly sampled women in 2014-2015. Overall, 833 women responded; 81.5% reported at least 1 symptom, and 59.7% reported at least 1 symptom within the duration window specified in DOVE. We explored whether such high prevalence resulted from low survey response by applying inverse probability weighting to correct the estimates. Older women and those from deprived areas were less likely to respond, but only age was associated with symptom reporting. Prevalence was similar in early and late responders. Inverse probability weighting had a minimal impact on estimates, suggesting little evidence of nonresponse bias. This is the first study investigating symptoms that have proven to identify a subset of women with a high prevalence of ovarian cancer. However, the high frequency of symptoms warrants further refinements before symptom-triggered diagnostic testing can be implemented.
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The Four-Dimensional Symptom Questionnaire (4DSQ) in the general population: scale structure, reliability, measurement invariance and normative data: a cross-sectional survey. Health Qual Life Outcomes 2016; 14:130. [PMID: 27629535 PMCID: PMC5024427 DOI: 10.1186/s12955-016-0533-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 09/07/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Four-Dimensional Symptom Questionnaire (4DSQ) is a self-report questionnaire measuring distress, depression, anxiety and somatization with separate scales. The 4DSQ has extensively been validated in clinical samples, especially from primary care settings. Information about measurement properties and normative data in the general population was lacking. In a Dutch general population sample we examined the 4DSQ scales' structure, the scales' reliability and measurement invariance with respect to gender, age and education, the scales' score distributions across demographic categories, and normative data. METHODS 4DSQ data were collected in a representative Dutch Internet panel. Confirmatory factor analysis was used to examine the scales' structure. Reliability was examined by Cronbach's alpha, and coefficients omega-total and omega-hierarchical. Differential item functioning (DIF) analysis was used to evaluate measurement invariance across gender, age and education. RESULTS The total response rate was 82.4 % (n = 5273/6399). The depression scale proved to be unidimensional. The other scales were best represented as bifactor models consisting of a large general factor and one or more smaller specific factors. The general factors accounted for more than 95 % of the reliable variance of the scales. Reliability was high (≥0.85) by all estimates. The distress-, depression- and anxiety scales were invariant across gender, age and education. The somatization scale demonstrated some lack of measurement invariance as a result of decreased thresholds for some of the items in young people (16-24 years) and increased thresholds in elderly people (65+ years). The somatization scale was invariant regarding gender and education. The 4DSQ scores varied significantly across demographic categories, but the explained variance was small (<6 %). Normative data were generated for gender and age categories. Approximately 17 % of the participants scored above average on de distress scale, whereas 12 % scored above average on de somatization scale. Percentages of people scoring high enough on depression or anxiety as to suspect the presence of depressive or anxiety disorder were 4.1 and 2.5 respectively. CONCLUSIONS Evidence supports reliability and measurement invariance of the 4DSQ in the general Dutch population. The normative data provided in this study can be used to compare a subject's 4DSQ scores with a general population reference group.
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Palmquist E, Petrie KJ, Nordin S. Psychometric Properties and Normative Data for a Swedish Version of the Modern Health Worries Scale. Int J Behav Med 2016; 24:54-65. [PMID: 27324490 DOI: 10.1007/s12529-016-9576-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Doyle O, McGlanaghy E, O’Farrelly C, Tremblay RE. Can Targeted Intervention Mitigate Early Emotional and Behavioral Problems?: Generating Robust Evidence within Randomized Controlled Trials. PLoS One 2016; 11:e0156397. [PMID: 27253184 PMCID: PMC4890862 DOI: 10.1371/journal.pone.0156397] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 05/13/2016] [Indexed: 11/18/2022] Open
Abstract
UNLABELLED This study examined the impact of a targeted Irish early intervention program on children's emotional and behavioral development using multiple methods to test the robustness of the results. Data on 164 Preparing for Life participants who were randomly assigned into an intervention group, involving home visits from pregnancy onwards, or a control group, was used to test the impact of the intervention on Child Behavior Checklist scores at 24-months. Using inverse probability weighting to account for differential attrition, permutation testing to address small sample size, and quantile regression to characterize the distributional impact of the intervention, we found that the few treatment effects were largely concentrated among boys most at risk of developing emotional and behavioral problems. The average treatment effect identified a 13% reduction in the likelihood of falling into the borderline clinical threshold for Total Problems. The interaction and subgroup analysis found that this main effect was driven by boys. The distributional analysis identified a 10-point reduction in the Externalizing Problems score for boys at the 90th percentile. No effects were observed for girls or for the continuous measures of Total, Internalizing, and Externalizing problems. These findings suggest that the impact of this prenatally commencing home visiting program may be limited to boys experiencing the most difficulties. Further adoption of the statistical methods applied here may help to improve the internal validity of randomized controlled trials and contribute to the field of evaluation science more generally. TRIAL REGISTRATION ISRCTN Registry ISRCTN04631728.
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Affiliation(s)
- Orla Doyle
- UCD School of Economics and UCD Geary Institute for Public Policy, University College Dublin, Ireland
| | - Edel McGlanaghy
- Clinical Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Richard E. Tremblay
- Departments of Psychology and Pediatrics, University of Montreal, Montreal, Canada
- UCD School of Public Health, Physiotherapy and Sport Science, University College Dublin, Dublin, Ireland
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Kilpatrick M, Blizzard L, Sanderson K, Teale B, Nelson M, Chappell K, Venn A. Investigating Employee-Reported Benefits of Participation in a Comprehensive Australian Workplace Health Promotion Program. J Occup Environ Med 2016; 58:505-13. [DOI: 10.1097/jom.0000000000000713] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abrahamsen R, Svendsen MV, Henneberger PK, Gundersen GF, Torén K, Kongerud J, Fell AKM. Non-response in a cross-sectional study of respiratory health in Norway. BMJ Open 2016; 6:e009912. [PMID: 26739738 PMCID: PMC4716229 DOI: 10.1136/bmjopen-2015-009912] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Declining participation in epidemiological studies has been reported in recent decades and may lead to biased prevalence estimates and selection bias. The aim of the study was to identify possible causes and effects of non-response in a population-based study of respiratory health in Norway. DESIGN The Telemark study is a longitudinal study that began with a cross-sectional survey in 2013. SETTING In 2013, a random sample of 50,000 inhabitants aged 16-50 years, living in Telemark county, received a validated postal questionnaire. The response rate was 33%. In this study, a random sample of 700 non-responders was contacted first by telephone and then by mail. OUTCOME MEASURES Response rates, prevalence and OR of asthma and respiratory symptoms based on exposure to vapours, gas, dust or fumes (VGDF) and smoking. Causes of non-response. RESULTS A total of 260 non-responders (37%) participated. Non-response was associated with younger age, male sex, living in a rural area and past smoking. The prevalence was similar for responders and non-responders for physician-diagnosed asthma and several respiratory symptoms. The prevalence of chronic cough and use of asthma medication was overestimated in the Telemark study, and adjusted prevalence estimates were 17.4% and 5%, respectively. Current smoking was identified as a risk factor for respiratory symptoms among responders and non-responders, while occupational VGDF exposure was a risk factor only among responders. The Breslow-Day test detected heterogeneity between productive cough and occupational VGDF exposure among responders. CONCLUSIONS The Telemark study provided valid estimates for physician-diagnosed asthma and several respiratory symptoms, while it was necessary to adjust prevalence estimates for chronic cough and use of asthma medication. Reminder letters had little effect on risk factor associations. Selection bias should be considered in future investigations of the relationship between respiratory outcomes and exposures.
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Affiliation(s)
- Regine Abrahamsen
- Department of Occupational and Environmental Medicine, Telemark Hospital, Skien, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Martin Veel Svendsen
- Department of Occupational and Environmental Medicine, Telemark Hospital, Skien, Norway
| | - Paul K Henneberger
- National Institute for Occupational Safety and Health (NIOSH), Morgantown, West Virginia, USA
| | | | - Kjell Torén
- Department of Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Johny Kongerud
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Respiratory Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
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Factors Associated With Availability of, and Employee Participation in, Comprehensive Workplace Health Promotion in a Large and Diverse Australian Public Sector Setting. J Occup Environ Med 2015; 57:1197-206. [DOI: 10.1097/jom.0000000000000538] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Marx FM, Fiebig L, Hauer B, Brodhun B, Glaser-Paschke G, Magdorf K, Haas W. Higher Rate of Tuberculosis in Second Generation Migrants Compared to Native Residents in a Metropolitan Setting in Western Europe. PLoS One 2015; 10:e0119693. [PMID: 26061733 PMCID: PMC4465484 DOI: 10.1371/journal.pone.0119693] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 05/14/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In Western Europe, migrants constitute an important risk group for tuberculosis, but little is known about successive generations of migrants. We aimed to characterize migration among tuberculosis cases in Berlin and to estimate annual rates of tuberculosis in two subsequent migrant generations. We hypothesized that second generation migrants born in Germany are at higher risk of tuberculosis compared to native (non-migrant) residents. METHODS A prospective cross-sectional study was conducted. All tuberculosis cases reported to health authorities in Berlin between 11/2010 and 10/2011 were eligible. Interviews were conducted using a structured questionnaire including demographic data, migration history of patients and their parents, and language use. Tuberculosis rates were estimated using 2011 census data. RESULTS Of 314 tuberculosis cases reported, 154 (49.0%) participated. Of these, 81 (52.6%) were first-, 14 (9.1%) were second generation migrants, and 59 (38.3%) were native residents. The tuberculosis rate per 100,000 individuals was 28.3 (95CI: 24.0-32.6) in first-, 10.2 (95%CI: 6.1-16.6) in second generation migrants, and 4.6 (95%CI: 3.7-5.6) in native residents. When combining information from the standard notification variables country of birth and citizenship, the sensitivity to detect second generation migration was 28.6%. CONCLUSIONS There is a higher rate of tuberculosis among second generation migrants compared to native residents in Berlin. This may be explained by presumably frequent contact and transmission within migrant populations. Second generation migration is insufficiently captured by the surveillance variables country of birth and citizenship. Surveillance systems in Western Europe should allow for quantifying the tuberculosis burden in this important risk group.
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Affiliation(s)
- Florian M. Marx
- Department of Pediatric Pneumology and Immunology, Charité –Universitätsmedizin, Berlin, Germany
- Division of Global Health Equity, Brigham and Women’s Hospital and Harvard Medical School, Boston, United States of America
- * E-mail:
| | - Lena Fiebig
- Respiratory Infections Unit, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Barbara Hauer
- Respiratory Infections Unit, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Bonita Brodhun
- Respiratory Infections Unit, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | | | - Klaus Magdorf
- Department of Pediatric Pneumology and Immunology, Charité –Universitätsmedizin, Berlin, Germany
| | - Walter Haas
- Respiratory Infections Unit, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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Beesdo-Baum K, Knappe S, Asselmann E, Zimmermann P, Brückl T, Höfler M, Behrendt S, Lieb R, Wittchen HU. The 'Early Developmental Stages of Psychopathology (EDSP) study': a 20-year review of methods and findings. Soc Psychiatry Psychiatr Epidemiol 2015; 50:851-66. [PMID: 25982479 DOI: 10.1007/s00127-015-1062-x] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 04/27/2015] [Indexed: 01/03/2023]
Abstract
PURPOSE The "Early Developmental Stages of Psychopathology (EDSP)" study is a prospective-longitudinal study program in a community sample (Munich, Germany) of adolescents and young adults. The program was launched in 1994 to study the prevalence and incidence of psychopathological syndromes and mental disorders, to describe the natural course and to identify vulnerability and risk factors for onset and progression as well as psychosocial consequences. This paper reviews methods and core outcomes of this study program. METHODS The EDSP is based on an age-stratified random community sample of originally N = 3021 subjects aged 14-24 years at baseline, followed up over 10 years with up to 3 follow-up waves. The program includes a family genetic supplement and nested cohorts with lab assessments including blood samples for genetic analyses. Psychopathology was assessed with the DSM-IV/M-CIDI; embedded dimensional scales and instruments assessed vulnerability and risk factors. RESULTS Beyond the provision of age-specific prevalence and incidence rates for a wide range of mental disorders, analyses of their patterns of onset, course and interrelationships, the program identified common and diagnosis-specific distal and proximal vulnerability and risk factors including critical interactions. CONCLUSIONS The EDSP study advanced our knowledge on the developmental pathways and trajectories, symptom progression and unfolding of disorder comorbidity, highlighting the dynamic nature of many disorders and their determinants. The results have been instrumental for defining more appropriate diagnostic thresholds, led to the derivation of symptom progression models and were helpful to identify promising targets for prevention and intervention.
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Affiliation(s)
- Katja Beesdo-Baum
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany,
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Jørgensen MJ, Maindal HT, Christensen KS, Olesen F, Andersen B. Sexual behaviour among young Danes aged 15-29 years: a cross-sectional study of core indicators. Sex Transm Infect 2015; 91:171-7. [PMID: 25609258 PMCID: PMC4413866 DOI: 10.1136/sextrans-2014-051814] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 12/28/2014] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Sexually transmitted infections and unwanted pregnancies occur at high rates among youth. Understanding sexual behaviour is essential for planning and implementing future effective preventive interventions. The present study examines the sexual behaviour in the general Danish population aged 15-29 years using the core indicators recommended by the European Centre for Disease Prevention and Control. METHODS A nationwide cross-sectional study was conducted in Denmark among a random sample of 20 000 men and women in 2012. Respondents completed a web-based sexual behaviour questionnaire and data were linked to a nationally held demographic database. Core indicators for sexual behaviour frequency stratified by gender are presented as unweighted and weighted data after consideration of sociodemographic differences between respondents and non-respondents. RESULTS Response rate was 20.4%. Condoms were used at sexual debut by 69.9% of women and 62.3% of men, while 14.3% of women and 15.1% of men used no contraceptives at sexual debut. Half of the respondents used condom alone at the latest sexual encounter with a steady partner (women 51.8%, men 55.2%), while 10% used no contraceptives. Having a sexual encounter with a casual partner decreased the likelihood of using condoms (women 43.7%, men 49.5%) and increased the likelihood of using no contraceptives (women 14.8%, men 20.9%). Data on sexual behaviour characteristics showed only minor changes when weighted for non-response. CONCLUSIONS The findings call for interventions addressing the use of appropriate contraception at sexual debut and at last sexual encounter; this seems particularly important when the sexual partner is a casual partner.
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Affiliation(s)
- Marianne Johansson Jørgensen
- Department of Public Health Programs, Randers Regional Hospital, Randers OE, Denmark Department of Public Health, Research Unit for General Practice, Aarhus University, Aarhus C, Denmark
| | - Helle Terkildsen Maindal
- Department of Public Health, Section for Health Promotion and Health Services, Aarhus University, Aarhus C, Denmark
| | - Kaj Sparle Christensen
- Department of Public Health, Research Unit for General Practice, Aarhus University, Aarhus C, Denmark
| | - Frede Olesen
- Department of Public Health, Research Unit for General Practice, Aarhus University, Aarhus C, Denmark
| | - Berit Andersen
- Department of Public Health Programs, Randers Regional Hospital, Randers OE, Denmark
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Baxter S, Sanderson K, Venn A, Otahal P, Palmer AJ. Construct validity of SF-6D health state utility values in an employed population. Qual Life Res 2014; 24:851-70. [PMID: 25304960 DOI: 10.1007/s11136-014-0823-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Health utility values permit cost utility analysis in workplace health promotion; however, utility measures of working populations have not been validated. AIM To investigate construct validity of SF-6D health utility in a public service workforce. METHODS SF-12v2 Health Survey was administered to 3,408 randomly selected public service employees in Australia in 2010. SF-12 scores were converted to SF-6D health utility values. Associations and correlates of SF-6D with health, socio-demographic and work characteristics [comorbidities, body mass index (BMI), Kessler-10 psychological distress (K10), education, salary, effort-reward imbalance (ERI), absenteeism] were explored. Ceiling effects were analysed. Nationally representative employee SF-6D values from the Household, Income and Labour Dynamics in Australia (HILDA) survey (n = 11,234) were compared. All analyses were stratified by sex. RESULTS Mean (SE) age was 45.7 (0.35) males; 44.5 (0.22) females. Females represented 72 % of the sample. Mean (SE) health utility 0.792 (0.004); 0.771 (0.003) was higher in males. SF-6D demonstrated both a significant inverse association (p < 0.01) and negative correlations (female; male) with K10 (r = -0.63; r = -0.66), comorbidity count (r = -0.40; r = -0.33), ERI (r = -0.37; r = -0.34) and absenteeism (p < 0.005, r = -0.25; r = -0.21). Mean (SE) SF-6D in HILDA was 0.792 (0.002); 0.775 (0.003) males; females. Correlates and associations in all samples were similar. The general employed demonstrated a significant inverse association with age and positive association with salary. SF-6D was independent of BMI. CONCLUSIONS Psychological distress, comorbidity, effort-reward imbalance and absenteeism are negatively associated with employee health. SF-6D is a valid measure of perceived health states in working populations.
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Affiliation(s)
- Siyan Baxter
- Menzies Research Institute Tasmania, University of Tasmania, Medical Science 2 Building, 17 Liverpool St, Private Bag 23, Hobart, TAS, 7000, Australia,
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Agrez U, Zimprich D, Steinhausen HC. Messinvarianz zwischen den Geschlechtern in der deutschen Version des Young Adult Self-Report (YASR). ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2014. [DOI: 10.1026/1616-3443/a000267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Die vorliegende Studie testete die Messinvarianz (MI) zwischen den Geschlechtern des 8-Faktoren Modells, welches der Deutsch-Schweizerischen Version des Young Adult Self-Report (YASR) unterliegt. Verschiedene Stufen der MI wurden an den Daten von jungen Schweizer Erwachsenen (N = 951, Durchschnittsalter = 19.8 Jahre, 56.3 % Frauen) aus einer repräsentativen epidemiologischen Stichprobe untersucht. Die Ergebnisse zeigen, dass die gemessenen Konstrukte zwischen den Geschlechtern invariant sind. Es bestand eine partielle starke Invarianz der Messung, da manche Indikatoren des aggressiven Verhaltens zwischen den Gruppen unterschiedlich wirkten. Ferner wurden Geschlechtsunterschiede zwischen einigen Faktor-Interkorrelationen gefunden. Die Unterschiede zwischen Faktorenmittelwerten bei sechs der acht Faktoren bestätigten die bekannte höhere Prävalenz von internalisierenden Störungen bei jungen Frauen und die höhere Prävalenz von externalisierenden Störungen bei jungen Männern.
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