Participation Rates in Epidemiologic Studies

Alcohol habits and alcohol-related health conditions of self-defined lifetime abstainers and never binge drinkers

BACKGROUND

Prior research has shown that using lifetime abstainers as the reference group to examine the association between alcohol use and health-related consequences has several disadvantages. The aim of the present study was to examine the consistency of self-reported lifetime abstention and never-binge drinking, respectively, using national, longitudinal data collected in 2019 and 2020. Additionally, the prevalence of alcohol-related morbidity among lifetime abstainers was examined by linking survey data to alcohol-related morbidity data in a national patient register.

METHODS

Data come from the Danish Health and Wellbeing Survey in 2019 and from a follow-up survey of the same individuals in 2020. A random sample of 14,000 individuals aged 15 years or older was drawn in mid-August 2019. Data were collected between September and December 2019. All those who were invited to the survey in 2019 and who were still alive and living in Denmark were invited to participate in a follow-up survey in 2020. Data in both waves were collected by self-administered questionnaires. Both questionnaires included the standard questions on alcohol consumption from the European Health Interview Survey model questionnaire. Information on alcohol-related morbidity was obtained from the Danish National Patient Register.

RESULTS

In all, 5000 individuals completed the questionnaire in both waves. Approximately half (44.4%) of the individuals who declared that they were lifetime abstainers in 2020 (n = 252) had reported in 2019 to have drunk at some point in their life. Moreover, 39.7% contradicted earlier reported binge drinking. Furthermore, 2.4% of the respondents who defined themselves as lifetime abstainers in 2020 had earlier been diagnosed with an alcohol-related health condition.

CONCLUSION

The present research reaffirms previous studies which have found self-reported lifetime abstainers to be unreliable as a consistent reference group. Additionally, the results indicated that a non-negligible proportion of lifetime abstainers had been diagnosed with an alcohol-related health condition.

Reproducibility and comparison of a digital food frequency questionnaire (DIGIKOST-FFQ) assessing adherence to national diet and lifestyle recommendations

Background

We have developed a digital semi-quantitative food frequency and lifestyle questionnaire, the DIGIKOST-FFQ, based on the validated paper-based NORDIET-FFQ.

Objective

The study aims to investigate the reproducibility of the DIGIKOST-FFQ and to compare the DIGIKOST-FFQ against the NORDIET-FFQ for the adjusted questions for intakes of fruits, vegetables, whole grains, fish, meat, and dairy products.

Design

Participants were recruited from May to September 2021 through a random sample from the National Population Register and advertisements on Facebook in Norway. In the reproducibility study, the DIGIKOST-FFQ was completed twice by the participants, 1-2 months apart. In the comparison study, the DIGIKOST-FFQ was completed 1-2 months prior to the NORDIET-FFQ.

Results

In the reproducibility study, 317 individuals were included. For 12 out of 16 food groups there were no significant differences in intake estimations between the first and second DIGIKOST-FFQ administrations. A small but significant median difference was observed for fruits (6 g/day) and vegetables (24 g/day). Correlations were satisfactory for all items (r = 0.60-1.00), and in the cross-classification 85% of the participants were classified into the same or adjacent quartile for all items. The comparison study included 81 individuals. Compared to the NORDIET-FFQ a significant median difference was observed for fruits 29 g/day, vegetables 36 g/day, whole grains -10 g/day, and red meat -11 g/day, but not for fish, processed meat, or dairy products.

Conclusion

The DIGIKOST-FFQ was able to reproduce diet and lifestyle at the group level. An intended difference for the food groups where questions had been adjusted, was observed between DIGIKOST-FFQ and NORDIET-FFQ in the comparison study.

Sexual Assault Research in the Military: Is Oversampling Necessary for Representativeness?

INTRODUCTION

Sexual assault in the U.S. Military is a serious concern. Recruiting representative samples of service members to participate in sexual assault research is essential for understanding the scope of the problem and generating data that can inform prevention and intervention efforts. Accordingly, the current study aims to examine response and completion rates of an anonymous survey of sexual assault and alcohol use among active duty sailors aged 18 to 24 with the overarching goal of achieving a representative sample and informing future recruitment efforts.

MATERIALS AND METHODS

This study was approved by the Institutional Review Board at the Naval Health Research Center. The study involved an anonymous survey of sexual assault and alcohol use among 612 active duty sailors aged 18 to 24. Since 79.6% of Navy service members are men and 20.4% are women, women were oversampled to achieve sufficient representation. Survey invitations were emailed to 12,031 active duty sailors: 64.3% (n = 7,738) men and 35.7% (n = 4,293) women.

RESULTS

Response rates were disproportionate, with 3.0% (n = 234) of male and 8.8% (n = 377) of female sailors responding to the study invitation. Survey completion rates, however, were similar between male and female sailors (81.2% and 80.1% for male and female personnel, respectively).

CONCLUSION

Results demonstrated that female sailors were significantly more likely than male sailors to participate in a study of sexual assault and alcohol use. However, once enrolled in the study, male and female sailors completed the 234-item questionnaire at a similar rate. Study findings highlight the challenges of engaging male service members in sexual assault-related research. Despite the disproportionately high representation of men in the military, sexual assault researchers may need to sample according to the overall distribution of gender in the military or perhaps even oversample men to achieve a representative sample.

Self-rated health and its bidirectional relationship with burnout, sleep quality and somatic symptoms in a general adult population

The aim of this study was to investigate how self-rated health (SRH) reflects ongoing ill-health and how SRH is associated with previous ill-health and/or predicts future ill-health such as burnout, disturbed sleep, and somatic symptoms. The study used two waves from the population-based Västerbotten Environmental and Health Study in which 2 336 adult persons participated by answering a questionnaire at two time points three years apart. Hierarchical and logistic regression analyses were conducted, thus treating all variables both continuously (degree) and categorically (case). The analyses were performed both cross-sectionally and longitudinally. The results showed bidirectionality between suboptimal SRH and burnout, disturbed sleep and somatic severity caseness. Moreover, degree of poor SRH was more likely to occur simultaneously to high degrees of burnout and somatic severity than to degree of poor sleep quality. Also, caseness of burnout, disturbed sleep and somatic severity increased the risk of simultaneous suboptimal SRH. Finally, the results showed that degree of burnout three years earlier, predicted degree of poor SRH, and that degree of poor SRH predicted degree of sleep three years later. In conclusion, in a population-based, normal adult sample there is a bidirectional relationship between suboptimal SRH and caseness of burnout, disturbed sleep quality and somatic symptoms, but not between degree of these symptoms. The results can have implications for health care meeting patients complaining about poor general health.

The Danish National Survey of Diet and Physical Activity (DANSDA) 1995-2011-2013: Study design, study participants, participation rate and underreporting

AIM

This study describes the study design, study participants, participation rate and underreporting in the Danish National Surveys of Diet and Physical Activity (DANSDA) from 1995 to 2011-2013.

METHODS

DANSDA are government-funded surveys of food and nutrient intake, physical activity and lifestyle, undertaken to support nutritional policy, risk assessment and public health research. The surveys are cross-sectional based on primarily simple random samples (ages 1-80 years in 1995, 4-75 years in 2000-2013) drawn from the Danish Civil Registration System. Approximately 4800 individuals in 1995, 8200 in 2000-2002, 8400 in 2003-2008 and 7300 in 2011-2013 were invited to participate. Participants completed a seven-day food diary, a physical activity questionnaire (2000-2008), a step diary (2011-2013) and a face-to-face interview. Self-reported anthropometrics (1995-2013) were supplemented with device-based measures (2011-2013). Pedometers were included in 2011-2013.

RESULTS

The number of participants included per survey round was 3100-4400. Participant rates decreased from 66% (1995) to 54% (2011-2013). Non-participation was primarily refusal. Ages 18-30 years, 61-75 years (2000-2013), 61-80 years (1995) and low educated and individuals living alone were underrepresented. Underreporting of energy intake among adults ranged from 14% (1995) to 26% (2008).

CONCLUSIONS

The methods in DANSDA have been developed to include device-based measures on physical activity and anthropometrics. This has improved the applicability of the results of the survey. The participation rate has fallen, which has affected sample representativity, and underreporting has increased. Future DANSDA surveys should explore and consider new initiatives to counteract non-response and underreporting, with the aim of enhancing data representativeness and applicability.

Access to Care Considerations for the Endodontic Treatment of Immature Permanent Teeth: A National Survey of Pediatric Dentists and Endodontists

INTRODUCTION

This study aimed to investigate access to care and financial considerations associated with the endodontic treatment of immature permanent teeth.

METHODS

Surveys were distributed to endodontists (n = 2,457) and pediatric dentists (n = 3,974) in the United States. Data were analyzed using X2 analysis and logistic regression. The level of significance was set to 0.05.

RESULTS

The response rate was 13% (n = 840). Respondent specialist groups were similar by age and years since specialty residency completion, but significantly different with regard to primary practice setting (eg private practice, Federally Qualified Health Center, hospital), (P = .001). The majority (91%) of respondents reported participation with dental insurance. Pediatric dentists (69%) were significantly more likely than endodontists (17%) to participate with public-payer dental insurance (P < .001). The majority of respondents (82%) indicated that patients reported economic factors (time or money) as a barrier to accessing endodontic treatment. Pediatric dentists were significantly more likely to consider economic factors when planning for treatment (P < .001). Pediatric dentists were more likely than endodontists to have the opinion that endodontic procedures for treatment of necrotic immature permanent teeth should cost less than root canal therapy (apexification, P < .001; regenerative endodontic procedures, P = .002). Pediatric dentists (33%) reported encountering barriers when attempting to refer their patients to an endodontist. Inability to find an endodontist that participates with dental insurance was the most frequently cited barrier.

CONCLUSIONS

Limited clinician participation with dental insurance and gaps in insurance coverage for endodontic procedures appear to contribute to access to care barriers for pediatric patients.

Assessment of Psychosocial Stress and Mental Health Disorders in Parents and Their Children in Early Childhood: Cross-Sectional Results from the SKKIPPI Cohort Study

BACKGROUND/OBJECTIVES

Early childhood can be a stressful period for families with a significant impact on parents' mental health, the child's healthy development, and the development of a secure mother-child attachment. The goal of the cross-sectional study part of SKKIPPI was to assess the occurrence of psychosocial stress and mental health disorders in parents as well as in their offspring in early childhood in three German regions.

METHODS

Based on random samples from three residents' registration offices, parents with infants aged up to 12 months were invited to participate. An online screening questionnaire was developed in four languages to assess common psychosocial stressors and mental health problems of parents with small children.

RESULTS

The study enrolled 4984 mothers and 962 fathers. The most common potential psychosocial stressors were professional problems (mothers 22%, fathers 33%), lack of social support (20%, 14%), and severe, negative experiences in childhood (22%, 16%). Obsessive-compulsive thoughts (21%, 16%) and depressive (9%, 9%) and anxiety symptoms (11%, 7%) were the most frequently reported mental health problems by both parents. Regulatory problems of the child were reported by between 1.5% and 5.1% of parents.

CONCLUSIONS

The study showed that a substantial proportion of parents are burdened by psychosocial problems and suffer from mental health problems in the first years after the birth of their children. Early preventive and low-threshold support measures should be available in the health and social care system. Low-threshold questionnaires, which cover a wide range of possible stress factors, should be further developed for the practical healthcare of this group of people.

Recruitment strategies and consent rates in a national prospective colorectal cancer screening cohort: results from year 1 of the Voyage Study

OBJECTIVE

To identify the optimal incentive protocol for maximising participation while managing study costs during the Voyage trial.

DESIGN

Prospective cohort (Voyage trial) of colorectal cancer (CRC) incidence and mortality outcomes in individuals screened with multitarget stool DNA (mt-sDNA) served as the population. A subset was randomised to receive postage stamps as a pre-consent incentive, or as a post-consent incentive after completion of the consent and questionnaire. Descriptive statistics from year 1 are reported.

RESULTS

During year 1 of the Voyage trial, a total of 600 258 individuals with mt-sDNA orders received at Exact Sciences Laboratories were randomly selected and invited to participate. Of those, 26 429 (4.4%) opted in, 14 365 of whom (54.3%) consented. The opt-in and consent samples were similar to the target population with respect to sex but differed by geographic residence and age (p<0.001). For the embedded incentive experiment, 2333 were randomised to the pre-incentive arm, while 2342 were randomised to the post-incentive arm. Overall consent rate in the incentive trial was 56.4% (60.9% for the pre-consent incentive arm (1421/2333) vs 52.0% for the post-consent incentive arm (1217/2342), p<0.001). Cost reduction was observed for the pre-consent incentive group, and higher response rates were seen among older versus younger individuals.

CONCLUSIONS

Pre-consent incentive option was associated with a higher participation rate and lower costs and was used for the remainder of study recruitment. CRC incidence and mortality vary with age; thus, adjusting for differential participation by age and region will be important in analyses of Voyage data.

TRIAL REGISTRATION NUMBER

NCT04124406.

Comparative Effectiveness of Three Digital Interventions for Adults Seeking Psychiatric Services: A Randomized Clinical Trial

Importance

There is a substantial gap between demand for and availability of mental health services. Digital mental health interventions (DMHIs) are promising tools for bridging this gap, yet little is known about their comparative effectiveness.

Objective

To assess whether patients randomized to a cognitive behavioral therapy (CBT)-based or mindfulness-based DMHI had greater improvements in mental health symptoms than patients randomized to the enhanced personalized feedback (EPF)-only DMHI.

DESIGN,

SETTING, AND PARTICIPANTS This randomized clinical trial was conducted between May 13, 2020, and December 12, 2022, with follow-up at 6 weeks. Adult patients of outpatient psychiatry services across various clinics within the University of Michigan Health System with a scheduled or recent outpatient psychiatry appointment were recruited. Eligible patients were randomized to an intervention arm. All analyses followed the intent-to-treat principle.

Interventions

Participants were randomized to 1 of 5 intervention arms: (1) EPF only; (2) Silvercloud only, a mobile application designed to deliver CBT strategies; (3) Silvercloud plus EPF; (4) Headspace only, a mobile application designed to train users in mindfulness practices; and (5) Headspace plus EPF.

Main Outcomes and Measures

The primary outcome was change in depressive symptoms as measured by the Patient Health Questionnaire-9 (PHQ-9; score range: 0-27, with higher scores indicating greater depression symptoms). Secondary outcomes included changes in anxiety, suicidality, and substance use symptoms.

Results

A total of 2079 participants (mean [SD] age, 36.8 [14.3] years; 1423 self-identified as women [68.4%]) completed the baseline survey. The baseline mean (SD) PHQ-9 score was 12.7 (6.4) and significantly decreased for all 5 intervention arms at 6 weeks (from -2.1 [95% CI, -2.6 to -1.7] to -2.9 [95% CI, -3.4 to -2.4]; n = 1885). The magnitude of change was not significantly different across the 5 arms (F4,1879 = 1.19; P = .31). Additionally, the groups did not differ in decrease in anxiety or substance use symptoms. However, the Headspace arms reported significantly greater improvements on a suicidality measure subscale compared with the Silvercloud arms (mean difference in mean change = 0.63; 95% CI, 0.20-1.06; P = .004).

Conclusions and Relevance

This randomized clinical trial found decreases in depression and anxiety symptoms across all DMHIs and minimal evidence that specific applications were better than others. The findings suggest that DMHIs may provide support for patients during waiting list-related delays in care.

Trial Registration

ClinicalTrials.gov Identifier: NCT04342494.

The costs of chronic pain-Long-term estimates

BACKGROUND

Chronic pain is a condition with severe impact on many aspects of life, including work, functional ability and quality of life, thereby reducing physical, mental and social well-being. Despite the high prevalence and burden of chronic pain, it has received disproportionally little attention in research and public policy and the societal costs of chronic pain remain largely unknown. This study aimed to describe the long-term healthcare and work absence costs of individuals with and without self-identified chronic pain.

METHODS

The study population were participants in two Norwegian population health studies (HUNT3 and Tromsø6). Participants were defined as having chronic pain based on a self-reported answer to a question on chronic pain in the health studies in 2008. Individuals in the study population were linked to four national register databases on healthcare resource use and work absence.

RESULTS

In our study, 36% (n = 63,782) self-reported to have chronic pain and the average years of age was 56.6. The accumulated difference in costs between those with and without chronic pain from 2010 to 2016 was €55,003 (CI: 54,414-55,592) per individual. Extrapolating this to the entire population suggests that chronic pain imposes a yearly burden of 4% of GDP. Eighty per cent of the costs were estimated to be productivity loss.

CONCLUSION

Insights from this study can provide a greater understanding of the extent of healthcare use and productivity loss by those with chronic pain and serve as an important basis for improvements in rehabilitation and quality of care, and the education of the public on the burden of chronic pain.

SIGNIFICANCE

This was the first study to estimate the economic burden associated with chronic pain in the general population using linked individual-level administrative data and self-reported survey answers. We provide calculations showing that annual costs of chronic pain may be as high as €12 billion or 4% of GDP. Findings from this study highlight the need for a greater understanding of the substantial healthcare use and productivity losses among individuals with chronic pain.

Chronic fatigue in the general population: Prevalence, natural course and associations with chronic pain (the HUNT pain study)

BACKGROUND

Fatigue and pain are both prevalent and frequently co-occur. No standard measure of fatigue exists, but most definitions include a continuum between high levels of energy and fatigue. There is limited knowledge about the course of fatigue in the general population and its association with functioning and other health outcomes. Our main aim was to identify trajectories of energy and fatigue in the general population and to investigate whether chronic pain is related to a negative prognosis of chronic fatigue.

METHODS

Longitudinal latent class analysis was performed to classify 4771 individuals into trajectory groups based on five quarterly repeated measures.

RESULTS

A five-cluster solution was identified: 'much energy' (n = 1471, [31%]), 'varying energy' (n = 1445, [30%]), 'some energy' (n = 921, [19%]), 'low energy' [chronic moderate fatigue] (n = 852, [18%]) and 'no energy' [chronic severe fatigue] (n = 82, [2%]). Individuals with chronic moderate fatigue who reported chronic pain had reduced probability of improvement over the following 3 years (OR = 0.67, 95% CI [0.52, 0.88]).

CONCLUSIONS

Chronic fatigue is highly prevalent in the general population and a small proportion have chronic severe fatigue. When chronic pain co-occurs with chronic fatigue, improvement of chronic fatigue is less likely, indicating that these symptoms may perpetuate each other.

SIGNIFICANCE STATEMENT

Understanding the close relationship between chronic pain and chronic fatigue is important as they both contribute to suffering and loss of functioning, may be related to the same underlying diseases, or in the absence of disease, may share common mechanisms. This study highlights the important role of chronic pain in relation to chronic fatigue, both by showing a strong association between the prevalence of the two conditions, and by showing that chronic pain is associated with a negative prognosis of chronic fatigue.

Recruitment, data collection, participation rate, and representativeness of the international cross-sectional PRICOV-19 study across 38 countries

BACKGROUND

Recruitment for surveys has been a great challenge, especially in general practice.

METHODS

Here, we reported recruitment strategies, data collection, participation rates (PR) and representativeness of the PRICOV-19 study, an international comparative, cross-sectional, online survey among general practices (GP practices) in 37 European countries and Israel.

RESULTS

Nine (24%) countries reported a published invitation; 19 (50%) had direct contact with all GPs/GP practices; 19 (50%) contacted a sample of GPs /GP practices; and 7 (18%) used another invitation strategy. The median participation rate was 22% (IQR = 10%, 28%). Multiple invitation strategies (P-value 0.93) and multiple strategies to increase PR (P-value 0.64) were not correlated with the PR. GP practices in (semi-) rural areas, GP practices serving more than 10,000 patients, and group practices were over-represented (P-value < 0.001). There was no significant correlation between the PR and strength of the primary care (PC) system [Spearman's r 0.13, 95% CI (-0.24, 0.46); P-value 0.49]; the COVID-19 morbidity [Spearman's r 0.19, 95% CI (-0.14, 0.49); P-value 0.24], or COVID-19 mortality [Spearman's r 0.19, 95% CI (-0.02, 0.58); P-value 0.06] during the three months before country-specific study commencement.

CONCLUSION

Our main contribution here was to describe the survey recruitment and representativeness of PRICOV-19, an important and novel study.

Participation and engagement in online cognitive testing

Web-based testing of cognitive abilities allows for large-scale assessments without geographical constraints. Yet, the extent to which it can reach populations beyond the typical demographic groups recruited for cognitive studies is unclear. This study focused on comparing the characteristics of individuals from a general population study (HUNT4) who chose to participate in a cognitive study (HUNT4-Hjernetrim) with those who did not. Additionally, we investigated participants' engagement and user experience. We obtained data on socio-demographics, health conditions (both physical and mental), self-reported cognitive or learning difficulties, and lifestyle factors of Hjernetrim participants and non-participants from the HUNT4 database. Hjernetrim involved 13 cognitive tests, administered through the online platform Memoro. We used logistic regressions to assess participation biases and linear regressions to assess participants' engagement and user experience. Of 65,851 HUNT4 participants invited via regular mail to Hjernetrim, 5634 (9.4%, aged 13-97, 54% women) participated. The best represented in the sample were 50-79-year-olds, women, tertiary educated, living alone, from urban areas, not occupationally active, and reporting memory complaints. Individuals who were aged 80+, had motor or vision impairments, and teenagers with learning disabilities, were underrepresented. Participants were more likely to have mental health problems, have or survived cancer and less likely to have cardiovascular disease. Participants logged on mainly during weekdays, the preferred time of day varied by age. On average, participants used 42 min and completed 78% of the tasks. Using PCs provided the most complete data. In terms of user experiences, 65% were positive while 14% were negative or reported technical difficulties. Overall, the study demonstrated that web-based methodology allowed for a relatively well-represented sample that included groups typically difficult to reach. The presence of somatic and mental diseases had a variable influence on participation. Participants finished most tests and reported positive experiences overall.

Age 19-30 Union Formation Trajectories across the Past 30 Years within the U.S.: Delineating Heterogeneity in Trajectories and its Historical and Sociodemographic Variation

Using data from Monitoring the FutureStudy that include 31 cohorts of high school seniors (1976 to 2006) who were followed from ages 19-30, weidentified heterogeneity in union formation trajectories andits covariates (cohort, sex, race/ethnicity, and parental education). We identified nine trajectorieswith approximately 40% following a single to married sequence (with variation in the timing of the sequence), about 35% remaining single, and the remaining respondents showing considerable heterogeneity.Recent cohortswere more likely to remain single and experience more transitions, women made earlier transitions, and Blackrespondents were less likely to follow pathways entailing marriage.

Association between COMMD1 gene polymorphism rs11125908 and rheumatoid arthritis in the Cuban population

OBJECTIVE

To evaluate the association of the rs11125908 polymorphism in the COMMD1 gene in the Cuban population with rheumatoid arthritis (RA).

METHODS

In this case-control study, 161 RA patients and 150 control subjects were genotyped for rs11125908 by the allele-specific polymerase chain reaction method. DNA sequencing was used to verify the assignation of the polymorphism. The odds ratios (OR) and their 95% confidence interval were calculated by logistic regression to determine the associations between genotypes and RA using the SNPStats software.

RESULTS

An association of the single nucleotide polymorphism with the disease was found in the overdominant model (p=0.025; OR=1.91) for the AG genotype. Our analyses revealed an association between rs11125908 and the subgroup of patients with swollen joints < median under the codominant model for AG (p=0.034; OR=2.30) and GG genotype (p=0.034; OR=0.82) and with the overdominant model (p=0.01; OR=2.38). The subgroup of patients with an age of onset lower than the mean and AG genotype showed an association in the overdominant model (p=0.027; OR=2.27). Disease activity score 28 with erythrocyte sedimentation rate and disease duration variables were not associated with the rs11125908 polymorphism.

CONCLUSIONS

rs11125908 was associated with RA and with the number of swollen joints and age of onset subgroup analyses. We provide concepts for treatments for RA, based on pharmacological management of COMMD1 expression.

Heterogeneous trajectories of depression and resilience following limb amputation

OBJECTIVE

To identify longitudinal trajectories of depression in the first 6 months following limb loss and to explore baseline predictors of trajectories, including pain and demographic factors. A secondary aim was to evaluate whether trajectories of depression were associated with elevated symptoms of posttraumatic stress (PTS) at 6 months.

DESIGN

Secondary longitudinal data analysis of an inception cohort study of persons with new-onset limb loss. Participants completed assessments at three intervals (initial, 3 months, and 6 months).

SETTING

Hospitalized care, acute rehabilitation, ambulatory care, and community.

PARTICIPANTS

Participants were recruited from consecutive cases of amputation surgery in a metropolitan hospital system over a period of 4 years (2002-2007). The final sample (n = 203) was predominantly White (79.3%) and male (78.8%) with an average age of 49.4 years (standard deviation [SD] = 14.6).

MAIN OUTCOME MEASURE(S)

Depression was assessed via the Patient Health Questionnaire-9 (PHQ-9); posttraumatic stress symptoms were measured via the PTSD checklist- Civilian Version (PCL-C).

RESULTS

Four trajectories of depression were identified via Latent Growth Mixture Modeling: Resilience (73.2%), Chronic Depression (11.2%), Emerging Depression (8.9%), and Recovery (6.7%). Average pain intensity significantly predicted trajectory membership. Membership in the Chronic Depression class predicted elevated 6-month PTS compared to all other classes; membership in the Resilience class predicted lower PTS than in the Chronic and Emerging Depression classes but did not differentiate from the Recovery trajectory.

CONCLUSIONS

Findings reveal that the course of depression post-amputation is heterogenous, with varying profiles of symptom development, maintenance, and remission. A majority of individuals were classified as Resilient, whereas a substantial minority of individuals developed clinically significant depression between 3 and 6 months (Emerging Depression), suggesting that early screening during acute care may be insufficient. We detected a significant prospective relation between depression trajectories and distal PTS, advancing the potential clinical utility of trajectory modeling as a risk surveillance tool.

The complex association between drinking water consumption and endemic gastrointestinal illness as shown by Swedish cohort studies

It is well known that municipal drinking water may be the cause of gastrointestinal illness (GII) outbreaks, but it is still unclear to what extent drinking water contributes to endemic GII. To explore this, we conducted a prospective cohort study among 6,955 adults in five municipalities in Sweden, collecting monthly GII episodes and mean daily cold drinking water consumption through SMS (Short Message Service). When the association between drinking water consumption and GII (all symptoms) and acute gastrointestinal illness (AGI, vomiting and/or three loose stools during a 24-h period) were assessed, there were indications that the association departed from linearity, following a unimodal shape. Among consumers in surface water areas, the highest risk of GII and AGI was generally seen among the average consumers, while the opposite was seen among groundwater consumers. The association however also seemed to be affected by neighbouring communities. The results of the study indicate that there is indeed an association between drinking water consumption and endemic GII, but the nature of this association is complex and likely affected by multiple factors, for example, water source type in the home and degree of exposure to drinking water from additional sources.

Strategies to increase survey participation: A randomized controlled study in a population of breast cancer survivors

BACKGROUND

Data collection by mailing questionnaires to the study population is one of the main research methods in epidemiologic studies. As participation rates are decreasing, easy-to-implement and cost-effective strategies to increase survey participation are needed. In this study, we tested the effect of a pragmatic combination of evidence-based interventions.

METHODS

We conducted a two-armed randomized controlled trial, nested in a cohort of breast cancer survivors (n = 1000) in the setting of a health outcomes survey. The intervention arm received a postal pre-notification, a non-monetary incentive (ballpoint with the study logo) and an alternative invitation letter in which several lay-out and textual adjustments were implemented according to behavioural science techniques. The alternative invitation letter also contained a QR-code through which an information video about the study could be accessed. The control arm was invited according to standard practice. Participants had the option to fill-out a questionnaire either on paper or online. A questionnaire with more than 50% of the questions answered classified as participation.

RESULTS

Overall participation rate was 62.9%. No significant difference in participation rate was observed between intervention and control arm (64.5% vs 61.3%, Risk Ratio (RR) 1.05, 95% CI [0.96 - 1.16]). Older age at study (>65 vs <51 years), and high socio-economic status (highest vs lowest quartile) were associated with higher participation rates (RR 1.30, 95% CI [1.07 - 1.57] and 1.24, 95% CI [1.09 - 1.42] respectively). In-situ carcinoma compared to invasive cancer and longer interval since treatment were associated with lower participation (RR 0.86, 95% CI [0.74 - 0.99] and RR 0.92, 95% CI [0.87 - 0.99] per 5 year increase, respectively).

CONCLUSION

Overall, the combination of four interventions tested in this study did not improve survey participation among breast cancer survivors. The overall participation rate was relatively high, possibly due to the study population of cancer survivors.

Missingness mechanisms and generalizability of patient reported outcome measures in colorectal cancer survivors - assessing the reasonableness of the "missing completely at random" assumption

BACKGROUND

Patient-Reported Outcome Measures (PROM) provide important information, however, missing PROM data threaten the interpretability and generalizability of findings by introducing potential bias. This study aims to provide insight into missingness mechanisms and inform future researchers on generalizability and possible methodological solutions to overcome missing PROM data problems during data collection and statistical analyses.

METHODS

We identified 10,236 colorectal cancer survivors (CRCs) above 18y, diagnosed between 2014 and 2018 through the Danish Clinical Registries. We invited a random 20% (2,097) to participate in a national survey in May 2023. We distributed reminder e-mails at day 10 and day 20, and compared Initial Responders (response day 0-9), Subsequent Responders (response day 10-28) and Non-responders (no response after 28 days) in demographic and cancer-related characteristics and PROM-scores using linear regression.

RESULTS

Of the 2,097 CRCs, 1,188 responded (57%). Of these, 142 (7%) were excluded leaving 1,955 eligible CRCs. 628 (32%) were categorized as initial responders, 418 (21%) as subsequent responders, and 909 (47%) as non-responders. Differences in demographic and cancer-related characteristics between the three groups were minor and PROM-scores only marginally differed between initial and subsequent responders.

CONCLUSION

In this study of long-term colorectal cancer survivors, we showed that initial responders, subsequent responders, and non-responders exhibit comparable demographic and cancer-related characteristics. Among respondents, Patient-Reported Outcome Measures were also similar, indicating generalizability. Assuming Patient-Reported Outcome Measures of subsequent responders represent answers by the non-responders (would they be available), it may be reasonable to judge the missingness mechanism as Missing Completely At Random.

Perceived Need for Mental Health Care in a Cohort of Persons With Inflammatory Bowel Disease

BACKGROUND

Psychiatric comorbidity is common in inflammatory bowel disease (IBD) and can negatively affect disease outcomes. We explored the perceived need for mental health care among persons with IBD.

STUDY

Persons with IBD completed self-report questionnaires, including the Hospital Anxiety and Depression Scale (HADS), and reported whether they wanted help with their mood. Each was also assessed using the Structured Clinical Interview for DSM-IV-TR Axis-I Disorders (SCIDs). We used logistic regression analyses to determine factors associated with the perceived need for mental health care.

RESULTS

Of 245 participants, 28% met the criteria for a past diagnosis of depression or anxiety disorder by SCID, and nearly 23% met the criteria for a current diagnosis of depression or anxiety disorder. One-third (n = 74) reported a perceived need for mental health care. Among those meeting criteria for a current SCID diagnosis of depression or anxiety, only 58% reported needing mental health care. Need for mental health care was reported by 79% of persons currently treated for either depression or 71% treated for anxiety. Persons with a perceived need for mental health care had higher mean HADS for depression and HADS for anxiety scores and also higher IBD symptom activity scores. Of those reporting no perceived need for mental health care, 13% had a current diagnosis of depression or anxiety disorder by SCID; even fewer had symptoms of depression or anxiety.

CONCLUSIONS

Symptoms of depression or anxiety are more important than a formal diagnosis of depression or anxiety in predicting which persons with IBD will perceive a need for mental health care.

Online Health Information-Seeking Behaviour among People of African Descent in the United Kingdom: A Qualitative Study

Effective public health interventions rely on understanding how individuals access, interpret, and utilise health information. Studying the health information-seeking behaviour (HISB) of a community can provide valuable insights to inform strategies that address community health needs and challenges. This study explored the online HISBs of People of African Descent (PoAD) in the United Kingdom (UK), a demographic that comprises four percent of the UK population and has a 92.8% active Internet usage rate. Data on the HISB were collected from 21 PoAD across various UK regions through online semi-structured interviews before being analysed using reflexive Thematic Analysis (TA). The participants ranged in age from 20 to 70 years and had a mean age of 42.8 (SD ± 11.4). Our analysis of the interview transcripts revealed five key themes: Internet usage and preferences, attitudes toward social media, barriers to seeking health information online, trust in online health information, and cultural influences on online HISB. Our findings indicate a proactive engagement among PoAD in seeking health information online that is underscored by a preference for professional sources over ethnic congruence. However, concerns about misinformation exist, and there are barriers to accessing health information online, including data privacy, unreliable information, and information relevance and overload. We also found that cultural factors and traditional beliefs impact the adoption of Internet-based interventions among PoAD, highlighting the need for culturally sensitive approaches. Preferences regarding the frequency and delivery of online health information varied among participants, with a majority preferring a weekly update. This study emphasises the critical need for accessible, culturally appropriate, secure, and reliable online health resources tailored to the needs and preferences of the PoAD.

Pulmonary tuberculosis epidemiology and genetics in Kazakhstan

Background

Tuberculosis (TB) is a major public health emergency in many countries, including Kazakhstan. Despite the decline in the incidence rate and having one of the highest treatment effectiveness in the world, the incidence rate of TB remains high in Kazakhstan. Social and environmental factors along with host genetics contribute to pulmonary tuberculosis (PTB) incidence. Due to the high incidence rate of TB in Kazakhstan, our research aimed to study the epidemiology and genetics of PTB in Kazakhstan.

Materials and methods

1,555 participants were recruited to the case-control study. The epidemiology data was taken during an interview. Polymorphisms of selected genes were determined by real-time PCR using pre-designed TaqMan probes.

Results

Epidemiological risk factors like diabetes (χ2 = 57.71, p < 0.001), unemployment (χ2 = 81.1, p < 0.001), and underweight-ranged BMI (<18.49, χ2 = 206.39, p < 0.001) were significantly associated with PTB. VDR FokI (rs2228570) and VDR BsmI (rs1544410) polymorphisms were associated with an increased risk of PTB. A/A genotype of the TLR8 gene (rs3764880) showed a significant association with an increased risk of PTB in Asians and Asian males. The G allele of the rs2278589 polymorphism of the MARCO gene increases PTB susceptibility in Asians and Asian females. VDR BsmI (rs1544410) polymorphism was significantly associated with PTB in Asian females. A significant association between VDR ApaI polymorphism and PTB susceptibility in the Caucasian population of Kazakhstan was found.

Conclusion

This is the first study that evaluated the epidemiology and genetics of PTB in Kazakhstan on a relatively large cohort. Social and environmental risk factors play a crucial role in TB incidence in Kazakhstan. Underweight BMI (<18.49 kg/m2), diabetes, and unemployment showed a statistically significant association with PTB in our study group. FokI (rs2228570) and BsmI (rs1544410) polymorphisms of the VDR gene can be used as possible biomarkers of PTB in Asian males. rs2278589 polymorphism of the MARCO gene may act as a potential biomarker of PTB in Kazakhs. BsmI polymorphism of the VDR gene and rs2278589 polymorphism of the MARCO gene can be used as possible biomarkers of PTB risk in Asian females as well as VDR ApaI polymorphism in Caucasians.

Describing the content of trial recruitment interventions using the TIDieR reporting checklist: a systematic methodology review

BACKGROUND

Recruiting participants to clinical trials is an ongoing challenge, and relatively little is known about what recruitment strategies lead to better recruitment. Recruitment interventions can be considered complex interventions, often involving multiple components, targeting a variety of groups, and tailoring to different groups. We used the Template for Intervention Description and Replication (TIDieR) reporting checklist (which comprises 12 items recommended for reporting complex interventions) to guide the assessment of how recruitment interventions are described. We aimed to (1) examine to what extent we could identify information about each TIDieR item within recruitment intervention studies, and (2) observe additional detail for each item to describe useful variation among these studies.

METHODS

We identified randomized, nested recruitment intervention studies providing recruitment or willingness to participate rates from two sources: a Cochrane review of trials evaluating strategies to improve recruitment to randomized trials, and the Online Resource for Research in Clinical triAls database. First, we assessed to what extent authors reported information about each TIDieR item. Second, we developed descriptive categorical variables for 7 TIDieR items and extracting relevant quotes for the other 5 items.

RESULTS

We assessed 122 recruitment intervention studies. We were able to extract information relevant to most TIDieR items (e.g., brief rationale, materials, procedure) with the exception of a few items that were only rarely reported (e.g., tailoring, modifications, planned/actual fidelity). The descriptive variables provided a useful overview of study characteristics, with most studies using various forms of informational interventions (55%) delivered at a single time point (90%), often by a member of the research team (59%) in a clinical care setting (41%).

CONCLUSIONS

Our TIDieR-based variables provide a useful description of the core elements of complex trial recruitment interventions. Recruitment intervention studies report core elements of complex interventions variably; some process elements (e.g., mode of delivery, location) are almost always described, while others (e.g., duration, fidelity) are reported infrequently, with little indication of a reason for their absence. Future research should explore whether these TIDieR-based variables can form the basis of an approach to better reporting of elements of successful recruitment interventions.

Do somatic symptom distress and attribution predict symptoms associated with environmental factors?

OBJECTIVE

Not much is known on the development of symptoms associated with environmental factors (SAEF), also known as (idiopathic) environmental intolerances. Findings from qualitative studies suggest that appearance of symptoms might be the first step, followed by the acquisition of a specific attribution. The current study investigated cross-sectional and longitudinal (three years) associations between attribution and symptoms with respect to symptoms associated with chemical substances, certain indoor environments (buildings), sounds, and electromagnetic fields (EMFs).

METHODS

We used data from the first two waves of the population-based Västerbotten Environmental Health Study (n = 2336). Participants completed the Patient Health Questionnaire Somatic Symptom Scale (PHQ-15), the Environmental Symptom-Attribution Scale, and answered single questions on the four aforementioned SAEFs.

RESULTS

Using binary logistic regression analyses, all four SAEFs showed significant cross-sectional associations with somatic symptom distress and the respective attribution. In the longitudinal analysis, development of SAEF-Sound and SAEF-Chemicals were predicted by both somatic symptom distress and attribution. SAEF-EMFs was predicted only by attribution, whereas neither somatic symptom distress nor attribution forecasted SAEF-Buildings.

CONCLUSION

Overall, these findings suggest that attribution (i.e., a specific expectation) plays a substantial role in the development and maintenance of many SAEFs.

Life's Essential 8 in relation to self-rated health and health-related quality of life in a large population-based sample: the SCAPIS project

PURPOSE

To monitor cardiovascular health, in 2022, the American Heart Association (AHA) updated the construct "Life's Simple 7" (LS7) to "Life's Essential 8" (LE8). This study aims to analyze the associations and capacity of discrimination of LE8 and LS7 in relation to self-rated health (SRH) and health-related quality of life (HRQoL).

METHODS

This study from the Swedish CArdioPulmonary bioImage Study (SCAPIS) included 28 731 Swedish participants, aged 50-64 years. Three different scores were derived from the SF-12 questionnaire: 1-item question SRH ("In general, would you say your health is …?"), mental-HRQoL and physical-HRQoL. Logistic regression, restricted cubic splines, and ROC analysis were used to study the associations between the AHA scores in relation to SRH and HRQoL.

RESULTS

Compared to those with a LE8 score of 80, participants with a LE8 score of 40 were 14.8 times more likely to report poor SRH (OR: 14.8, 95% CI: 13.0-17.0), after adjustments. Moreover, they were more likely to report a poor mental-HRQoL (OR: 4.9, 95% CI: 4.2-5.6) and a poor physical-HRQoL (OR: 8.0, 95% CI: 7.0-9.3). Area under curves for discriminating poor SRH were 0.696 (95% CI: 0.687-0.704), 0.666 (95% CI: 0.657-0.674), and 0.643 (95% CI: 0.634-0.651) for LE8, LS7 (0-14), and LS7 (0-7), respectively, all p values < 0.001 in the DeLong's tests.

CONCLUSION

LE8 and LS7 had strong and inverse associations with SRH, mental-HRQoL, and physical-HRQoL, though LE8 had a somewhat higher capacity of discrimination than LS7. The novel LE8, a construct initially conceived to monitor cardiovascular health, also conveys SRH and HRQoL.

Longitudinal study of endodontic and periapical status of an adult Danish population examined in 2009, 2014, and 2019: a repeated cohort study

OBJECTIVE

To describe endodontic changes in an adult Danish population (C2;2009-2014-2019) and compare them with a similar cohort (C1;1997-2003-2008).

MATERIAL AND METHODS

A randomly selected cohort (C2) with three full-mouth radiographic examinations. The frequencies of teeth, apical periodontitis (AP), root filled teeth, and lost teeth in C2 were compared to a similar cohort (C1) using regression analyses; effect of age, cohort, and period was assessed.

RESULTS

C1 had 330 and C2, 170 participants (mean age, C1: 42.9; C2: 47.3 years, p < .001). The proportion of individuals with no AP was similar in C1 and C2 (p = .46). C2 had a higher proportion of individuals with no root filled teeth (p < .001) and no tooth loss (p = .02) than C1. The proportion of AP and root filled teeth increased with age in both cohorts. C2 had fewer root filled teeth and lost teeth, fewest lost teeth in the youngest age groups.

CONCLUSIONS

In C2, the prevalence of teeth with AP and root fillings increased with age, and few teeth were lost. Change in proportion of AP was similar in two cohorts; fewer root filled teeth and lost teeth in C2. The proportion of lost teeth in C2 showed cohort effect for older age groups.

To Remind or Not to Remind During Recruitment? An Analysis of an Online Panel in Germany

Objective: To explore the role of reminders in recruiting and maintaining participation in an online panel. Methods: 50,045 individuals from five German federal states were invited by regular mail to participate in the online study "Health-Related Beliefs and Healthcare Experiences in Germany." Those who did not respond to the first attempt received a postal reminder. Comparisons of sociodemographic characteristics and responses were made between first-attempt respondents and those who enrolled after the second letter. Results: After the initial letter, 2,216 (4.4%, 95%CI: 4.3%-4.6%) registered for the study; after a reminder 1,130 (2.5%, 2.3%-2.6% of those reminded) enrolled. Minor sociodemographic differences were observed between the groups and the content of the responses did not differ. Second-attempt respondents were less likely to participate in subsequent questionnaires: 67.3% of first-attempt vs. 43.3% of second-attempt respondents participated in their fourth survey. Recruitment costs were 79% higher for second-attempt respondents. Conclusion: While reminders increased the number of participants, lower cost-effectiveness and higher attrition of second-attempt respondents support the use of single invitation only for studies with a similar design to ours when the overall participation is low.

The change of psychosocial stress factors in families with infants and toddlers during the COVID-19 pandemic. A longitudinal perspective on the CoronabaBY study from Germany

Background

Over nearly three years, the COVID-19 pandemic has had a lasting impact on people's lives and mental health worldwide with its far-reaching restrictions and concerns about infections and other personal consequences. Families were particularly affected and showed increased stress and psychological problems. Long-term effects cannot be ruled out. So far, data on young families are sparse. The present longitudinal analysis (n = 932) of the CoronabaBY study investigated the development of parenting stress, parental affective symptoms, and child's mental health in young families with children aged 0-3 years in Germany as well as potential influencing factors.

Methods

The observational study includes two measurement points over the course of the pandemic (baseline and follow-up). Data was collected by app using standardized questionnaires.

Results

N = 932 participants, mainly mothers (94.7%) born in Germany (93.1%) with higher education (61.3% with at least high school diploma) and a comfortable financial situation participated in the longitudinal study. Children were on average 14.7 months old at baseline (SD: 12, range: 1-39 months). While the proportion of parents who perceived the pandemic as stressful decreased significantly from baseline (60%) to follow-up (52.3%), the proportion with parenting stress increased significantly (from 40.1% to 45.4%). Both parental and child mental health problems remained constant over time, with infants crying/feeding/sleeping problems ranging above pre-pandemic comparative data. Most predictive for high parenting stress at follow-up was high parenting stress at baseline. This was also true for parental affective symptoms (depression/anxiety) and child mental health problems.

Conclusions

Despite faded pandemic restrictions, parents remained burdened. Support services do not appear to have been sufficient to help families out of their stressful situation. Our results indicate a need for action regarding low-threshold services that effectively reach affected families.

Trial registration

The study was pre-registered in OSF (https://osf.io/search/?q=tksh5&page=1).

Hand eczema and skin complaints in particulate matter-exposed occupations - firefighters, chimney sweepers, and ferrosilicon smelter workers in Norway

BACKGROUND

The objective was to investigate self-reported hand eczema, and skin complaints at other skin locations among workers exposed to particulate matter, especially ultrafine particles.

METHOD

We conducted a cross-sectional study on workers from one ferro-silicon smelter plant, eight chimney sweeper stations and one firefighter station across Norway. Participants answered an extended version of the Nordic Occupational Skin Questionnaire (NOSQ-2022), with additional questions about whole-body skin complaints and visible dust deposition. Results are presented as descriptive data using firefighters as reference group. Odds ratio (OR) was calculated using logistic regression on lifetime prevalence of hand eczema adjusted for potential confounders and mediators. P-values were calculated using likelihood ratio test against the crude OR.

RESULTS

A total of 186 participants answered the questionnaire: 74 chimney sweepers, 52 firefighters and 60 smelter workers. Participation rate was 95.0, 94.5 and 63.6%, respectively. Lifetime prevalence of hand eczema was 9.5, 9.6, and 28.3%, respectively. The point prevalence of hand eczema was 1.4, 1.9 and 10.0%, respectively. We estimated OR for lifetime hand eczema in smelter workers to 4.36 [95% CI: 1.31-14.43, p = 0.016] and for lifetime skin complaints in other locations to 2.25 [95% CI: 0.98-5.18, p = 0.058]. The lifetime prevalence of skin complaints at other locations was 18.9, 23.1 and 40.0%, respectively. The point prevalence was 14.9, 9.6 and 16.7%, respectively. These estimates were not statistically significant but indicates that smelter workers have more skin complaints also at other locations.

CONCLUSION

This study reports a more than four-fold increased risk of hand eczema in smelter workers, and possibly a higher risk of skin complaints in other body locations, compared to the other occupations. Longitudinal studies with larger population are needed to verify the marked increased risk of eczema among smelters and establish causation.

Trends in inequalities in childhood overweight and obesity prevalence: a repeat cross-sectional analysis of the Health Survey for England

OBJECTIVE

To examine trends in socio-economic and ethnic inequalities in childhood overweight and obesity in the England between 1995 and 2019 in survey data and to compare these to administrative data.

DESIGN

Observational repeated cross-sectional study using the Health Survey for England (HSE) and National Child Measurement Programme (NCMP).

OUTCOME

Age and sex standardised overweight, obesity and overweight including obesity.

ANALYSIS

Inequalities assessed by parental education, family structure, ethnicity (binary non-white vs white) and area-level Index of Multiple Deprivation. Estimates stratified by age and sex. Trends compared against NCMP data (age 4-5 and 10-11 years).

RESULTS

Prevalence of childhood overweight including obesity increased from 26.0% in 1995 to 31.7% in 2019, with the highest and fastest growing levels in those aged 11-15 years, rising from 29.7% to 38.0%. Despite a plateau in overall childhood obesity since 2004, differences between groups demonstrated widening inequalities over time. Inequalities widened by area-level deprivation, household educational attainment, household structure and ethnicity driven primarily by increased prevalence among socioeconomically disadvantaged children. For example, the gap between children from households with no qualifications versus degree-level qualifications increased from -1.1% to 13.2%, and the gap between single-parent households and couple households increased from 0.5% to 5.3%. HSE trends in prevalence of childhood overweight and obesity by deprivation quintile were consistent with those in NCMP.

CONCLUSION

Overall levels of child overweight and obesity increased between 1995 and 2004. Since then, increases in prevalence among less advantaged groups have driven widening of inequalities.

Vitamin D Status, VDR, and TLR Polymorphisms and Pulmonary Tuberculosis Epidemiology in Kazakhstan

BACKGROUND

Tuberculosis (TB) and vitamin D deficiency remain major public health problems in Kazakhstan. Due to the high incidence of pulmonary tuberculosis in the country and based on the importance of vitamin D in the modulation of the immune response and the association of its deficiency with many health conditions, the aim of our research was to study the vitamin D status, VDR and TLR gene polymorphisms, and pulmonary tuberculosis epidemiology in Kazakhstan.

METHODS

A case-control study included 411 individuals diagnosed with pulmonary TB and 686 controls with no family history of pulmonary tuberculosis. Concentrations of serum vitamin D (25-(OH)D) levels were measured by electrochemiluminescence immunoassay. The gene polymorphisms were determined by real-time polymerase chain reaction (PCR) allelic discrimination assay using TaqMan probes. The association between the risk of pulmonary TB and polymorphisms was evaluated using multimodal logistic regression and assessed with the ORs, corresponding to 95% Cis, and the significance level was determined as p < 0.05.

RESULTS

1097 individuals were recruited from 3 different regions of Kazakhstan. Biochemical data showed vitamin D deficiency (25-(OH)D < 20 ng/mL) was present in both groups, with the case group accounting for almost 95% and 43.7% in controls. Epidemiological data revealed that socioeconomic factors such as BMI < 25 kg/m2 (p < 0.001), employment (p < 0.001), diabetes (p < 0.001), and vitamin D deficiency (p < 0.001) were statistically different between case and control groups. Logistic regression analysis, adjusted by sex, age, BMI, residence, employment, smoking, alcohol consumption, and diabetes, showed that T/T polymorphism of the VDR gene (rs1544410, OR = 1.97, 95% CI: 1.04-3.72, p = 0.03) and A/A polymorphism of the TLR8 gene (rs3764880, OR = 2.44, 95% CI: 1.20-4.98, p = 0.01) were associated with a high risk of developing pulmonary tuberculosis.

CONCLUSIONS

Vitamin D deficiency remains prevalent in our study cohort and is associated with TB progression. Socioeconomic determinants such as unemployment, BMI under 25 kg/m2, and diabetes are the main risk factors for the development of pulmonary TB in our study. A/A polymorphism of TLR8 (rs3764880) and T/T polymorphism (BsmI, rs1544410) of VDR genes may act as biomarkers for pulmonary tuberculosis in the Kazakh population.

How gender and low mental health literacy are related to unmet need for mental healthcare: a cross-sectional population-based study in Sweden

BACKGROUND

Men are more likely to have unmet need for mental healthcare than women. However, an under-investigated aspect of the gender difference is the role of mental health literacy. This study investigated how combinations of gender and mental health literacy were related to two indicators of unmet need: not perceiving a need for mental healthcare despite poor mental health, and refraining from seeking mental healthcare.

METHODS

This cross-sectional study was based on a questionnaire sent to a general population sample, aged 16-84 years, in Stockholm County, Sweden, in 2019. Of the 1863 respondents (38%), 1563 were included (≥18 years). The sample was stratified into four groups, men and women with low or high mental health literacy, using the third quartile of the Mental Health Knowledge Schedule. The likelihood of not perceiving a need for mental healthcare and refraining from seeking mental healthcare, at any time in life, were investigated by calculating odds ratios with 95% confidence intervals.

RESULTS

Men with low mental health literacy were most likely to not perceive a need for mental healthcare, also when adjusting for age, education, and poor mental health (OR 5.3, 95% CI 3.6-7.7), and to refrain from seeking mental healthcare, also when adjusting for age and education (OR 3.3, 95% CI 1.7-6.4), followed by men with high mental health literacy (OR 1.9, 95% CI 1.5-2.4, and OR 1.5, 95% CI 1.0-2.2) and women with low mental health literacy (OR 1.9, 95% CI 1.2-2.9, and OR 2.1, 95% CI 1.1-3.9). Women with high mental health literacy were least likely (reference group).

CONCLUSION

The results show differences in the likelihood of unmet need for mental healthcare based on combinations of gender and mental health literacy level, with men having low mental health literacy being most at risk, and women with high mental health literacy being least at risk. This challenges generalisations of a gender difference in unmet need by showing heterogeneity among men and women based on mental health literacy. Men with low mental health literacy may be particularly in need of targeted interventions to reduce potential individual and societal consequences of their unmet need.

Reasons for non-participation of children and adolescents in a large-scale school-based mental health project

Background

Non-participation in mental health studies is an under-explored but very important topic. Investigating reasons for non-participation holds promise for the planning of future study designs and recruitment strategies. This study aimed at investigating reasons for children and adolescents (C&A) not participating in a school-based mental health research project.

Methods

Data collection took place within the school-based recruitment of a large-scale multi-site project ("ProHEAD-Promoting Help-seeking using E-technology for Adolescents") in Germany. Participants were N = 534 C&A aged ≥ 12 years attending secondary schools. The present cross-sectional study analyzed anonymous survey data of C&A who themselves or whose parents, respectively, did not provide written consent to participate in the mental health research project. The questionnaire consisted of 14 items covering potential reasons for non-participation, and four free text fields. Besides descriptive statistics, free text field answers were analyzed using qualitative content analysis.

Results

Students indicated an average of M = 2.94 (SD = 1.75) reasons for their non-participation in the project. In the descriptive analysis of indicated items, the three most frequently reported reasons for non-participation included students reporting to not be concerned by the topic "mental health" (n = 290, 54.3%), not having returned the consent form to the teacher (n = 175, 32.8%), and not having time for participation (n = 149, 27.9%). In the qualitative content analysis, the most frequently assigned categories were organizational reasons (n = 216, 57.1%), general disinterest in study participation (n = 139, 36.8%), and personal attitudes toward the topic "mental health" (n = 84, 22.2%), such as not being concerned with the topic "mental health" (n = 23, 6.1%) or being too concerned with the topic "mental health" (n = 16, 4.2%).

Conclusion

The study provides unique insights into reasons for C&A and their caregivers not participating in a large federally funded mental health research project. The results suggest that in order to increase participation rates, stigma should be reduced, parents as well as teachers should be involved where possible, and the use of incentives might be helpful. The study highlights the importance of assessing reasons for non-participation, especially in online intervention studies on mental health.

Post-traumatic growth in parents of long-term childhood cancer survivors compared to the general population: A report from the Swiss childhood cancer survivor study-Parents

OBJECTIVE

Post-traumatic growth (PTG) describes perceived positive changes following a traumatic event. We describe (i) PTG in parents of long-term childhood cancer survivors (CCS-parents) compared to parents of similar-aged children of the general population (comparison-parents), (ii) normative data for the Swiss population, and (iii) psychological, socio-economic, and event-related characteristics associated with PTG.

METHODS

CCS-parents (aged ≤16 years at diagnosis, ≥20 years old at study, registered in the Childhood Cancer Registry Switzerland (ChCR), and the Swiss population responded to a paper-based survey, including the PTG-Inventory (total score 0-105). We carried out (i) t-tests, (ii) descriptive statistics, and (iii) multilevel regression models with survivor/household as the cluster variable.

RESULTS

In total, 746 CCS-parents (41.7% fathers, response-rate = 42.3%) of 494 survivors (median time since diagnosis 24 (7-40) years), 411 comparison-parents (42.8% fathers, 312 households), and 1069 individuals of the Swiss population (40.7% male, response-rate = 20.1%) participated. Mean [M] total PTG was in CCS-parents M = 52.3 versus comparison-parents M = 50.4, p = 0.078; and in the Swiss population M = 44.5). CCS-parents showed higher 'relating-to-others' (18.4 vs. 17.3, p = 0.010), 'spiritual-change' (3.3 vs. 3.0, p = 0.038) and 'appreciation-of-life' (9.3 vs. 8.4, p = 0.027) than comparison-parents, but not in 'new-possibilities' and 'personal-strength'. Female gender, older age, higher post-traumatic stress, and higher resilience were positively associated with PTG. Individuals reporting events not typically classified as traumatic also reported growth.

CONCLUSIONS

Our findings highlight that mothers and fathers can experience heightened growth many years after their child's illness. Being able to sensitively foreshadow the potential for new-possibilities and personal development may help support parents in developing a sense of hope.

Use of Socioeconomic Demographic Data in Studies on Pediatric Unilateral Hearing Loss: A Scoping Review

OBJECTIVES

Social determinants of health (SDOH) (healthcare access and quality, education access and quality, socioeconomic status, social and cultural context, neighborhood and built environment) ( Healthy People 2030 ) have been shown to impact a wide range of health-related outcomes and access to care. Given the medical and nonmedical costs associated with children with unilateral hearing loss (UHL), the varied insurance coverage for hearing healthcare services, and the differences in hearing aid utilization rates between children of different sociodemographic classes, the sociodemographic information of children with UHL enrolled in research studies should be collected to ensure the generalizability of hearing healthcare interventions. Therefore, the objective of this scoping review is to assess the reporting of SDOH data for participants in studies of pediatric UHL and its comparison to population trends.

DESIGN

Two searches of published literature were conducted by a qualified medical librarian. Two reviewers then evaluated all candidate articles. Study inclusion parameters were from 2010 to present, peer-reviewed studies with prospective study design, and participant population including children (age 0 to 18 years old) with UHL.

RESULTS

Two literature searches using PubMed Medline and Embase found 442 and 3058 studies each for review. After abstract and paper review, 87 studies were included in final qualitative review, with 22 of these studies reporting race distribution of participants, 15 reporting insurance status or family income, and 12 reporting the maternal education level.

CONCLUSIONS

Sociodemographic data are not commonly reported in research studies of children with UHL. In reported samples, research participants are more likely to have private insurance and higher family income compared with overall population distribution. These demographic biases may affect the generalizability of study results to all children with UHL. Further evaluation is warranted to evaluate whether participant recruitment affects outcomes that reflect the overall population.

Feeling Safe in the Perioperative Period: Experiences from Patients Undergoing Orthopedic Day Surgery

Introduction

Day surgery is often preferred by patients, but it can pose challenges in self-management after discharge. In addition, patients undergoing orthopedic surgery report poorer rates of postoperative recovery than patients undergoing general surgery. Understanding patients' perceptions of feeling safe while undergoing surgery facilitates individualized care and is important since it may affect their recovery.

Objective

The aim of this study was to describe patients' perceptions of feeling safe in the perioperative period when undergoing orthopedic day surgery under regional anesthesia.

Methods

The design was qualitative and descriptive. Data were collected through a cross-sectional questionnaire containing open-ended questions. Qualitative content analysis with an inductive approach was used for data analysis. Participants' characteristics were presented descriptively. The study population consisted of a consecutive sample of 97 patients who had undergone orthopedic day surgery under regional anesthesia between March and October 2022.

Results

The categorization process resulted in the development of two categories describing participants' experience of perioperative feelings of safety when undergoing orthopedic day surgery: having someone near and having a sense of control. The results indicate that the relationship between patients and staff and the perceived feeling of control and participation are factors influencing patients' perception of feeling safe in the perioperative period.

Conclusions

In perioperative care, nurses play a vital role in fostering patients' sense of safety by establishing relationships. This ensures that patients can be actively engaged in their own care. Patients also need access to professional and competent staff who strives to add a personal touch and considers their perspective. Since patients undergoing orthopedic day surgery might face a more demanding postoperative recovery than they had initially anticipated, further research is suggested to explore the association between a perceived feeling of safety and postoperative recovery.

An overview of the use of psychoactive substances among students at the University of Lille during the COVID-19 health crisis: Results of the PETRA study

OBJECTIVES

Students represent a population at risk for substance abuse. That risk may have been exacerbated by the COVID-19 pandemic. We aimed to describe substance abuse among students and to compare consumption according to the university field.

METHODS

A self-administered questionnaire was sent by email to all students at the University of Lille, France, between March and July 2021. This anonymous questionnaire included questions about sociodemographic characteristics, university courses and the use of psychoactive substances (frequency, reasons, routes of administration) since the first university year.

RESULTS

Among the 4431 students who responded (response rate 6.1%), eighty percent declared having used alcohol since the first university year, 34% cannabis, 15.4% benzodiazepines, 14.7% opioid drugs, 7.5% cocaine, 6.8% nitrous oxide and 6.5% MDMA. More than 20% of the users of cannabis, benzodiazepines, amphetamines and cocaine reported having already felt dependent. Recreational use was described by more than 10% of benzodiazepine or opioid drug users. Nitrous oxide use was significantly more frequent in the health and sport field (p < 0.001). Tobacco, benzodiazepine, cannabis and MDMA uses were significantly more frequent in the humanities and social sciences/art, language and literature fields (p < 0.001).

CONCLUSION

Prevention measures focusing on alcohol, cannabis, illicit psychostimulants, nitrous oxide and prescription drugs are required in the student population.

Association between participation in the Northern Finland Birth Cohorts and cardiometabolic disorders

BACKGROUND

We studied the association between participation in the longitudinal follow-up study and cardiometabolic disorders in two longitudinal studies which started prospectively in the antenatal period: the Northern Finland Cohort 1966 (NFBC1966) and the Northern Finland Birth Cohort 1986 (NFBC1986). Both birth cohorts have been followed up since birth with multiple follow-ups including questionnaires, and clinical examinations.

METHODS

The NFBC studies were compared to comparison cohorts of individuals who were born in the same area as the study cohorts, but in different years. The data for the comparison cohort were obtained from registers. The cumulative incidence rates of hospital-treated cardiometabolic disorders were calculated for study and comparison cohorts covering the age of 7-50 years in NFBC1966 and the age of 0-29 years in NFBC1986. Cardiometabolic-related causes of death were analysed in NFBC1966 and the comparison cohort from the age of 0-50 years. The analysed cardiometabolic disorders were diabetes mellitus, coronary artery disease, hyperlipidaemia, obesity, hypertension, and cerebrovascular disorders. The risk ratio (RR) with 95% confidence intervals (CI) was calculated by sex.

RESULTS

In NFBC1966, no differences in cumulative incidences of cardiometabolic disorders or cardiometabolic-related deaths compared to the comparison cohort were found. Male members of NFBC1986 had decreased risk of obesity (RR: 0.45, 95% CI: 0.27-0.75) and any cardiometabolic disorders (RR: 0.75, 95% CI: 0.59-0.95) compared to the comparison cohort.

CONCLUSIONS

The results suggest that participation in the NFBC1986 may have a weak positive health effect among men. Agreement to follow-up studies focusing on diet, substance use, and physical activity, may slightly decrease the incident risk of cardiometabolic disorders in the study population.KEY MESSAGESEven mild interventions, such as follow-up studies in the prospective follow-up studies, might affect participants' behaviour and consequently the incidence of cardiometabolic disordersThe fact that follow-up itself might affect the study population in terms of risk factors, has to be taken into account when estimating the representativeness of the followed population.

Arts and culture engagement for health: a Danish population-based study

OBJECTIVES

Global health challenges are complex and new approaches are pivotal. Engagement in arts and cultural activities is commonplace across different cultures, and research shows associations with benefits for health and wellbeing. Using the arts for health promotion and prevention of illness has increased worldwide.

STUDY DESIGN

A population-based study.

METHODS

Data were obtained from the Danish Health and Wellbeing Survey in 2019. A self-administered questionnaire was sent to 14,000 randomly selected adults (aged ≥15 years). The questionnaire included items on self-rated health and frequency of participation in various cultural activities (concerts or musical events; participation in a choir, band, or orchestra; theatre show or other performing arts; cinema; art museum or exhibition; library). A cultural participation index was calculated based on the six questions on cultural activities. Logistic regression models were fitted to examine the associations between the index and good self-rated health, adjusting for relevant covariates.

RESULTS

In total, 6629 individuals completed the questionnaire (47.4%). The most frequent activity, used at least once a month, was visiting a library. A strong association between the cultural participation index and self-reported health was observed. A one-point-higher index score was associated with a 10% higher likelihood of having good self-reported health (adjusted odds ratio: 1.10; 95% confidence interval: 1.08-1.12).

CONCLUSIONS

This study supports the understanding that engagement in arts and cultural activities is beneficial for self-rated good health. Individuals with higher frequency of arts and culture engagement were more likely to report good health than those with lower engagement.

The Use of Machine Translation for Outreach and Health Communication in Epidemiology and Public Health: Scoping Review

BACKGROUND

Culturally and linguistically diverse groups are often underrepresented in population-based research and surveillance efforts, leading to biased study results and limited generalizability. These groups, often termed "hard-to-reach," commonly encounter language barriers in the public health (PH) outreach material and information campaigns, reducing their involvement with the information. As a result, these groups are challenged by 2 effects: the medical and health knowledge is less tailored to their needs, and at the same time, it is less accessible for to them. Modern machine translation (MT) tools might offer a cost-effective solution to PH material language accessibility problems.

OBJECTIVE

This scoping review aims to systematically investigate current use cases of MT specific to the fields of PH and epidemiology, with a particular interest in its use for population-based recruitment methods.

METHODS

PubMed, PubMed Central, Scopus, ACM Digital Library, and IEEE Xplore were searched to identify articles reporting on the use of MT in PH and epidemiological research for this PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews)-compliant scoping review. Information on communication scenarios, study designs and the principal findings of each article were mapped according to a settings approach, the World Health Organization monitoring and evaluation framework and the service readiness level framework, respectively.

RESULTS

Of the 7186 articles identified, 46 (0.64%) were included in this review, with the earliest study dating from 2009. Most of the studies (17/46, 37%) discussed the application of MT to existing PH materials, limited to one-way communication between PH officials and addressed audiences. No specific article investigated the use of MT for recruiting linguistically diverse participants to population-based studies. Regarding study designs, nearly three-quarters (34/46, 74%) of the articles provided technical assessments of MT from 1 language (mainly English) to a few others (eg, Spanish, Chinese, or French). Only a few (12/46, 26%) explored end-user attitudes (mainly of PH employees), whereas none examined the legal or ethical implications of using MT. The experiments primarily involved PH experts with language proficiencies. Overall, more than half (38/70, 54% statements) of the summarizing results presented mixed and inconclusive views on the technical readiness of MT for PH information.

CONCLUSIONS

Using MT in epidemiology and PH can enhance outreach to linguistically diverse populations. The translation quality of current commercial MT solutions (eg, Google Translate and DeepL Translator) is sufficient if postediting is a mandatory step in the translation workflow. Postediting of legally or ethically sensitive material requires staff with adequate content knowledge in addition to sufficient language skills. Unsupervised MT is generally not recommended. Research on whether machine-translated texts are received differently by addressees is lacking, as well as research on MT in communication scenarios that warrant a response from the addressees.

Non-participation in a health examination survey in a rural-provincial area of Denmark - results from the Lolland-Falster Health Study (LOFUS)

BACKGROUND

Lolland-Falster Health Study (LOFUS) was a health examination survey that included self-administered questionnaires, clinical examinations, and the collection of biological samples, undertaken in 2016-2020 in a rural, socioeconomically deprived area with the lowest life expectancy in Denmark. The aim of this study was to examine the determinants of non-participation in LOFUS to evaluate the extent to which LOFUS data reflected the general population of the area.

METHODS

LOFUS invited randomly selected subjects together with their entire household. As determinants of non-participation, we analyzed age, sex, municipality of residency, citizenship, residency status, socioeconomic status, invitation type, and year of invitation. Relative risk regression was used to estimate the association between determinants and non-participation rate, mutually adjusted for other determinants.

RESULTS

In total, 53,313 subjects were invited of whom 18,949 (36%) participated. In the multivariable analysis, men had a 3% higher non-participation rate than women; subjects with citizenship other than Danish had a 3% higher non-participation rate than Danes. In-migrants had 6% higher non-participation than long-term residents. Compared with self-supported subjects aged 30-64, both publicly supported subjects of this age and younger and older subjects had higher non-participation rates: 16%, 16%, and 13%, respectively. Compared with self-supported, long-term residents, publicly supported in-migrants had 23% higher non-participation.

CONCLUSIONS

Only about one third of subjects invited to LOFUS participated. Yet, this is a relatively high participation rate compared with other recent health examination surveys in Denmark. Furthermore, there was a relatively flat social gradient in the non-participation rate across the studied determinants.

Using linked administrative data to aid the handling of non-response and restore sample representativeness in cohort studies: the 1958 national child development study and hospital episode statistics data

BACKGROUND

There is growing interest in whether linked administrative data have the potential to aid analyses subject to missing data in cohort studies.

METHODS

Using linked 1958 National Child Development Study (NCDS; British cohort born in 1958, n = 18,558) and Hospital Episode Statistics (HES) data, we applied a LASSO variable selection approach to identify HES variables which are predictive of non-response at the age 55 sweep of NCDS. We then included these variables as auxiliary variables in multiple imputation (MI) analyses to explore the extent to which they helped restore sample representativeness of the respondents together with the imputed non-respondents in terms of early life variables (father's social class at birth, cognitive ability at age 7) and relative to external population benchmarks (educational qualifications and marital status at age 55).

RESULTS

We identified 10 HES variables that were predictive of non-response at age 55 in NCDS. For example, cohort members who had been treated for adult mental illness had more than 70% greater odds of bring non-respondents (odds ratio 1.73; 95% confidence interval 1.17, 2.51). Inclusion of these HES variables in MI analyses only helped to restore sample representativeness to a limited extent. Furthermore, there was essentially no additional gain in sample representativeness relative to analyses using only previously identified survey predictors of non-response (i.e. NCDS rather than HES variables).

CONCLUSIONS

Inclusion of HES variables only aided missing data handling in NCDS to a limited extent. However, these findings may not generalise to other analyses, cohorts or linked administrative datasets. This work provides a demonstration of the use of linked administrative data for the handling of missing cohort data which we hope will act as template for others.

Investigating a Paradox: Toward a Better Understanding of the Relationships Between Racial Group Membership, Stress, and Major Depressive Disorder

Epidemiologic studies in the United States routinely report a lower or equal prevalence of major depressive disorder (MDD) for Black people relative to White people. Within racial groups, individuals with greater life stressor exposure experience greater prevalence of MDD; however, between racial groups this pattern does not hold. Informed by theoretical and empirical literature seeking to explain this "Black-White depression paradox," we outline 2 proposed models for the relationships between racial group membership, life stressor exposure, and MDD: an effect modification model and an inconsistent mediator model. Either model could explain the paradoxical within- and between-racial group patterns of life stressor exposure and MDD. We empirically estimated associations under each of the proposed models using data from 26,960 self-identified Black and White participants in the National Epidemiologic Survey on Alcohol and Related Conditions III (United States, 2012-2013). Under the effect modification model, we estimated relative risk effect modification using parametric regression with a cross-product term, and under the inconsistent mediation model, we estimated interventional direct and indirect effects using targeted minimum loss-based estimation. We found evidence of inconsistent mediation (i.e., direct and indirect effects operating in opposite directions), suggesting a need for greater consideration of explanations for racial patterns in MDD that operate independent of life stressor exposure. This article is part of a Special Collection on Mental Health.

Estimated prevalence of DSM-5 eating disorders in Norwegian adolescents: A community based two-phase study

OBJECTIVE

Little is known about the prevalence of DSM-5 eating disorders (EDs) in adolescents. In Norway, the most recent community-based prevalence study in adolescents was published more than 20 years ago. The aim of this study was to assess the prevalence of DSM-5 EDs in Norwegian adolescents using a two-phase design.

METHOD

A total of 1558 upper secondary school students (827 girls and 730 boys) (ages 16-19) were screened for at-risk ED pathology using the Eating Disorder Examination-Questionnaire short version (EDE-QS). A sub-sample of 99 adolescents (87 girls and 12 boys) subsequently participated in a clinical interview using the Eating Disorder Assessment for DSM-5 (EDA-5).

RESULTS

Eating pathology was common, with 19.9% of participants scoring at or above the applied EDE-QS cut-off. The estimated prevalence of any ED was 9.4% in the total sample, and 16.4% in girls. The number of boys who took part in the diagnostic interview was low, thus, diagnostic data from boys were not analyzed separately. Prevalence estimates of AN, BN, BED, and OSFED in girls were 2.7%, 1.1%, 1.9%, and 10.7%. Atypical AN was the most frequently assigned diagnosis in girls.

DISCUSSION

Sampling biases limit generalizability of results. Additional population-based studies are warranted to assess the prevalence of EDs in Norwegian youth.

PUBLIC SIGNIFICANCE STATEMENT

In this study, 1558 adolescents, aged 16-19, were screened for ED pathology. A subsample completed a diagnostic interview using DSM-5 criteria. Results showed that one in five adolescents displayed problematic eating behaviors and cognitions. The estimated prevalence rate of any ED was 9.4%. Sampling biases limit generalizability of results. Additional population-based studies are warranted to assess the prevalence of EDs in Norwegian youth.

The association between the incidence of postmenopausal breast cancer and occupational exposure to selected organic solvents, Montreal, Canada, 2008-2011

BACKGROUND

Breast cancer is the most diagnosed cancer among women and recognized risk factors explain 25%-47% of cases. Organic solvents are used widely in the workplace and exposure may increase the risk of developing breast cancer, yet there are insufficient data to confirm this hypothesis. We sought to determine whether past occupational exposures to selected organic solvents were associated with the incidence of invasive breast cancer in postmenopausal women in Montréal, Canada.

METHODS

From a population-based case-control study (2008-2011), using in-depth interviews we elicited information on risk factors and lifetime occupational histories. Industrial hygienists and chemists translated job descriptions into specific chemical and physical exposures. We assessed 11 individual solvents and four solvent groups. Unconditional logistic regression was used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for metrics of past exposures to selected solvents. Exposure metrics included any previous exposure, average frequency in hours per week, duration in years, and average cumulative concentration weighted by hours per workweek exposed.

RESULTS

We enrolled 695 cases and 608 controls. We found increased ORs for average cumulative concentration of exposure to mononuclear aromatic hydrocarbons (OR: 1.52, 95% CI: 1.04, 2.28), chlorinated alkanes (OR: 2.42, 95% CI: 1.23, 5.68), toluene (OR: 1.59, 95% CI: 1.02, 2.59), and a group of organic solvents with reactive metabolites (OR: 1.53, 95% CI: 1.08, 2.24). Positive associations were found across all exposure metrics and were higher among women with estrogen-positive/progesterone-negative tumors.

CONCLUSION

Our findings suggest occupational exposure to certain organic solvents may increase the risk of incident postmenopausal breast cancer.

Exposure to low levels of hydrogen sulphide and its impact on chronic obstructive pulmonary disease and lung function in the geothermal area of Mt. Amiata in Italy: The cross-sectional InVETTA study

BACKGROUND

The geothermal power plants for electricity production currently active in Italy are all located in Mt. Amiata area in the Tuscany region. A cross-sectional survey was conducted in the framework of the regional project "InVETTA-Biomonitoring Survey and Epidemiological Evaluations for the Protection of Health in the Amiata Territories", using objective measures of lung function to investigate the role of hydrogen sulphide (H2S) in affecting the respiratory health of the population living in this area.

METHODS

2018 adults aged 18-70 were enrolled during 2017-2019. Home and workplace addresses of participants were geocoded. Dispersion modelling was used to evaluate the spatial variability of exposure to H2S from the geothermal power plants' emissions. We estimated average long-term historical exposure to H2S and more recent exposure indicators. Chronic Obstructive Pulmonary Disease (COPD) was defined according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD). Multivariable logistic regressions were performed to investigate associations between outcome and exposure.

RESULTS

Our findings did not showed any evidence of an association between increasing H2S exposure and lung function impairments. Some risk reductions were observed: a -32.8% (p = 0.003) for FEV1<80% and a -51.7% (p = 0.001) risk decrease for FVC<80% were associated with interquartile increase (13.8 μg/m3) of H2S levels.

CONCLUSION

Our study provides no evidence that chronic exposure to low levels of H2S is associated with decrements in pulmonary function, suggesting that ambient H2S exposure may benefit lung function.

Mexican Americans agree to participate in longitudinal clinical research more than non-Hispanic whites

BACKGROUND

The National Institutes of Health has advocated for improved minority participation in clinical research, including clinical trials and observational epidemiologic studies since 1993. An understanding of Mexican Americans (MAs) participation in clinical research is important for tailoring recruitment strategies and enrollment techniques for MAs. However, contemporary data on MA participation in observational clinical stroke studies are rare. We examined differences between Mexican Americans (MAs) and non-Hispanic whites (NHWs) participation in a population-based stroke study.

METHODS

We included 3,594 first ever stroke patients (57.7% MAs, 48.7% women, median [IQR] age 68 [58-79]) from the Brain Attack Surveillance in Corpus Christi Project, 2009-2020 in Texas, USA, who were approached and invited to participate in a structured baseline interview. We defined participation as completing a baseline interview by patient or proxy. We used log-binomial models adjusting for prespecified potential confounders to estimate prevalence ratios (PR) of participation comparing MAs with NHWs. We tested interactions of ethnicity with age or sex to examine potential effect modification in the ethnic differences in participation. We also included an interaction between year and ethnicity to examine ethnic-specific temporal trends in participation.

RESULTS

Baseline participation was 77.0% in MAs and 64.2% in NHWs (Prevalence Ratio [PR] 1.20; 95% CI, 1.14-1.25). The ethnic difference remained after multivariable adjustment (1.17; 1.12-1.23), with no evidence of significant effect modification by age or sex (Pinteraction by age = 0.68, Pinteraction by sex = 0.83). Participation increased over time for both ethnic groups (Ptrend < 0.0001), but the differences in participation between MAs and NHWs remained significantly different throughout the 11-year time period.

CONCLUSION

MAs were persistently more likely to participate in a population-based stroke study in a predominantly MA community despite limited outreach efforts towards MAs during study enrollment. This finding holds hope for future research studies to be inclusive of the MA population.

Can non-participants in a follow-up be used to draw conclusions about incidences and prevalences in the full population invited at baseline? An investigation based on the Swedish MDC cohort

BACKGROUND

Participants in epidemiological cohorts may not be representative of the full invited population, limiting the generalizability of prevalence and incidence estimates. We propose that this problem can be remedied by exploiting data on baseline participants who refused to participate in a re-examination, as such participants may be more similar to baseline non-participants than what baseline participants who agree to participate in the re-examination are.

METHODS

We compared background characteristics, mortality, and disease incidences across the full population invited to the Malmö Diet and Cancer (MDC) study, the baseline participants, the baseline non-participants, the baseline participants who participated in a re-examination, and the baseline participants who did not participate in the re-examination. We then considered two models for estimating characteristics and outcomes in the full population: one ("the substitution model") assuming that the baseline non-participants were similar to the baseline participants who refused to participate in the re-examination, and one ("the extrapolation model") assuming that differences between the full group of baseline participants and the baseline participants who participated in the re-examination could be extended to infer results in the full population. Finally, we compared prevalences of baseline risk factors including smoking, risky drinking, overweight, and obesity across baseline participants, baseline participants who participated in the re-examination, and baseline participants who did not participate in the re-examination, and used the above models to estimate the prevalences of these factors in the full invited population.

RESULTS

Compared to baseline non-participants, baseline participants were less likely to be immigrants, had higher socioeconomic status, and lower mortality and disease incidences. Baseline participants not participating in the re-examination generally resembled the full population. The extrapolation model often generated characteristics and incidences even more similar to the full population. The prevalences of risk factors, particularly smoking, were estimated to be substantially higher in the full population than among the baseline participants.

CONCLUSIONS

Participants in epidemiological cohorts such as the MDC study are unlikely to be representative of the full invited population. Exploiting data on baseline participants who did not participate in a re-examination can be a simple and useful way to improve the generalizability of prevalence and incidence estimates.

Examining the continuum of resistance model in two population-based screening studies in Sweden

In studies recruited on a voluntary basis, lack of representativity may impair the ability to generalize findings to the target population. Previous studies, primarily based on surveys, have suggested that generalizability may be improved by exploiting data on individuals who agreed to participate only after receiving one or several reminders, as such individuals may be more similar to non-participants than what early participants are. Assessing this idea in the context of screenings, we compared sociodemographic characteristics and health across early, late, and non-participants in two large population-based screening studies in Sweden: STROKESTOP II (screening for atrial fibrillation; 6,867 participants) and SCREESCO (screening for colorectal cancer; 39,363 participants). We also explored the opportunities to reproduce the distributions of characteristics in the full invited populations, either by assuming that the non-participants were similar to the late participants, or by applying a linear extrapolation model based on both early and late participants. Findings showed that early and late participants exhibited similar characteristics along most dimensions, including civil status, education, income, and health examination results. Both these types of participants in turn differed from the non-participants, with fewer married, lower educational attainments, and lower incomes. Compared to early participants, late participants were more likely to be born outside of Sweden and to have comorbidities, with non-participants similar or even more so. The two empirical models improved representativity in some cases, but not always. Overall, we found mixed support that data on late participation may be useful for improving representativeness of screening studies.