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Krömeke A, Shani M. Flourishing in life in patients with Inflammatory Bowel Disease: The role of illness identity and health-related quality of life. J Health Psychol 2024:13591053241260288. [PMID: 39054613 DOI: 10.1177/13591053241260288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024] Open
Abstract
Amidst chronic challenges in Inflammatory Bowel Disease (IBD), including physical symptoms, emotional stress, and social constraints, this study aimed to elucidate how patients' perceptions of their illness and its integration into their self-concept are related to their ability to flourish in life. We hypothesized that having a positive and integrative illness identity and social identification will predict higher flourishing, mediated by enhanced health-related quality of life (HRQoL). In an online survey with 244 German-speaking IBD adults (Mage = 36.62, 85% women), we found that lower engulfment (where the disease dominates one's identity) predicted higher levels of flourishing, mediated by higher HRQoL. Enrichment, reflecting personal growth from illness, directly predicted higher flourishing, while stronger social identification predicted higher subjective well-being, but not flourishing. The results highlight the potential of fostering positive illness identities and social connections to enhance flourishing in individuals with IBD or similar chronic conditions.
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Fu JX, Huang LL, Li XH, Zhao H, Li R. Association between ageing knowledge and willingness to care for older adults among nursing students in China: the mediating role of attitude towards older adults. GERONTOLOGY & GERIATRICS EDUCATION 2024; 45:444-457. [PMID: 37356028 DOI: 10.1080/02701960.2023.2227874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
Little is known about the mediating effect of attitude toward older adults on the relationship between aging knowledge and willingness to care for older adults. We applied the theory of planned behavior (TPB) and the knowledge-attitude-behavior (KAB) model as theoretical frameworks to examine the mediation effect of attitude toward older adults. Data from 388 Chinese nursing students were analyzed. The Willingness to Care for Older People (WCOP) scale, Kogan's Attitude toward Older People scale (KAOP) and Facts on Aging Quiz (FAQ) were utilized to assess willingness, attitude and aging knowledge, respectively. Data were analyzed using SPSS 22. 0 with the PROCESS macro. Bootstrap methods were used to obtain the significance of mediating effects. The study showed that aging knowledge was significantly associated with willingness to care for older adults and that attitude toward older adults mediated the association. Bootstrapping method confirmed the significance of the indirect effect of aging knowledge through attitude, accounting for 18.9% of the total willingness variance. Overall, based on the TPB and the KAB theoretical framework, our data support the notion that improving aging knowledge and attitude may contribute to improve the willingness to aged care among nursing students.
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Affiliation(s)
- Jing-Xia Fu
- School of Nursing, Shanghai Lida University, Shanghai, China
| | - Ling-Ling Huang
- School of Nursing, Shanghai Lida University, Shanghai, China
| | - Xuan-Hua Li
- School of Nursing, Shanghai Lida University, Shanghai, China
| | - Han Zhao
- School of Nursing, Shanghai Lida University, Shanghai, China
| | - Rong Li
- School of Nursing, Shanghai Lida University, Shanghai, China
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Schlander M, van Harten W, Retèl VP, Pham PD, Vancoppenolle JM, Ubels J, López OS, Quirland C, Maza F, Aas E, Crusius B, Escobedo A, Franzen N, Fuentes-Cid J, Hernandez D, Hernandez-Villafuerte K, Kirac I, Paty A, Philip T, Smeland S, Sullivan R, Vanni E, Varga S, Vermeulin T, Eckford RD. The socioeconomic impact of cancer on patients and their relatives: Organisation of European Cancer Institutes task force consensus recommendations on conceptual framework, taxonomy, and research directions. Lancet Oncol 2024; 25:e152-e163. [PMID: 38547899 DOI: 10.1016/s1470-2045(23)00636-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 12/03/2023] [Accepted: 12/05/2023] [Indexed: 04/02/2024]
Abstract
Loss of income and out-of-pocket expenditures are important causes of financial hardship in many patients with cancer, even in high-income countries. The far-reaching consequences extend beyond the patients themselves to their relatives, including caregivers and dependents. European research to date has been limited and is hampered by the absence of a coherent theoretical framework and by heterogeneous methods and terminology. To address these shortages, a task force initiated by the Organisation of European Cancer Institutes (OECI) produced 25 recommendations, including a comprehensive definition of socioeconomic impact from the perspective of patients and their relatives, a conceptual framework, and a consistent taxonomy linked to the framework. The OECI task force consensus statement highlights directions for future research with a view towards policy relevance. Beyond descriptive studies into the dimension of the problem, individual severity and predictors of vulnerability should be explored. It is anticipated that the consensus recommendations will facilitate and enhance future research efforts into the socioeconomic impact of cancer and cancer care, providing a crucial reference point for the development and validation of patient-reported outcome instruments aimed at measuring its broader effects.
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Affiliation(s)
- Michael Schlander
- Division of Health Economics, German Cancer Research Center (DKFZ), Heidelberg, Germany; Mannheim Medical Faculty, University of Heidelberg, Mannheim, Germany; Alfred Weber Institute (AWI), University of Heidelberg, Mannheim, Germany; Institute for Innovation & Valuation (InnoVal(HC)), Wiesbaden, Germany.
| | - Wim van Harten
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands; Department of Health Technology and Services Research, University of Twente, Enschede, Netherlands; Rijnstate Hospital, Arnhem, Netherlands
| | - Valesca P Retèl
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands; Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Phu Duy Pham
- Division of Health Economics, German Cancer Research Center (DKFZ), Heidelberg, Germany; Mannheim Medical Faculty, University of Heidelberg, Mannheim, Germany
| | - Julie M Vancoppenolle
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands; Department of Health Technology and Services Research, University of Twente, Enschede, Netherlands
| | - Jasper Ubels
- Division of Health Economics, German Cancer Research Center (DKFZ), Heidelberg, Germany; Mannheim Medical Faculty, University of Heidelberg, Mannheim, Germany
| | - Olaya Seoane López
- The Support Team, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Camila Quirland
- Health Technology Assessment Unit, Arturo López Perez Foundation, Santiago, Chile; School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Felipe Maza
- Health Technology Assessment Unit, Arturo López Perez Foundation, Santiago, Chile
| | - Eline Aas
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway; Division of Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Agustín Escobedo
- Oncology Care Management, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Nora Franzen
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | - Diego Hernandez
- Division of Health Economics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Iva Kirac
- Genetic Counseling Unit, University Hospital for Tumors, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Artus Paty
- Department of Medical Information, Centre Henri Becquerel, Rouen, France
| | - Thierry Philip
- Organisation of European Cancer Institutes (OECI), Brussels, Belgium; Institut Curie, Paris, France
| | - Sigbjørn Smeland
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Division of Cancer Medicine, Oslo University Hospital Comprehensive Cancer Centre, Oslo, Norway
| | | | - Elena Vanni
- Business Controlling, Humanitas Clinical and Research Center, Milan, Italy; Biomedical Sciences, Humanitas Clinical and Research Center, Milan, Italy
| | - Sinisa Varga
- Institute for Gastroenterological Tumours, Zagreb, Croatia
| | - Thomas Vermeulin
- Department of Medical Information, Centre Henri Becquerel, Rouen, France
| | - Rachel D Eckford
- Division of Health Economics, German Cancer Research Center (DKFZ), Heidelberg, Germany
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4
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Thornton HV, Cornish RP, Lawlor DA. Non-linear associations of maternal pre-pregnancy body mass index with risk of stillbirth, infant, and neonatal mortality in over 28 million births in the USA: a retrospective cohort study. EClinicalMedicine 2023; 66:102351. [PMID: 38125933 PMCID: PMC10730341 DOI: 10.1016/j.eclinm.2023.102351] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/15/2023] [Accepted: 11/17/2023] [Indexed: 12/23/2023] Open
Abstract
Background Higher maternal pre-pregnancy body mass index (BMI) has been associated with higher risk of stillbirth, infant and neonatal mortality. Studies exploring underweight have varied in their conclusions. Our aim was to examine the risk of stillbirth, infant and neonatal mortality across the BMI distribution and establish a likely healthy BMI range. Methods In this retrospective cohort study, we used publicly available datasets (covering 1st January 2014 to 31st December 2021) from the US National Center for Health Statistics National Vital Statistics System. All births were eligible; analyses included those with non-missing data. Fractional polynomial multivariable logistic regression was used to examine the associations of maternal pre-pregnant BMI with stillbirth (birth with no signs of life at ≥24 weeks), infant mortality (death of a live born baby aged <365 days) and neonatal mortality (death of a live born baby aged <28 days). Findings There were 77,896/28,310,154 (2.8 per 1000 births) stillbirths, 143,620/28,231,807 (5.1 per 1000 live births) infant deaths and 94,246/28,231,807 (3.3 per 1000 live births) neonatal deaths among complete cases. Mean (SD) BMI was 27.1 kg/m2 (6.7 kg/m2). We found non-linear associations between BMI and all three outcomes; risk was elevated at both low and high BMIs although, for stillbirth, the increased risk at low BMI was less marked than for infant/neonatal mortality. The lowest risk was at a BMI of 21 kg/m2 for infant and neonatal mortality and 19 kg/m2 for stillbirth. Interpretation Public health messaging for preconception and postnatal care should focus on healthy weight to maximise maternal and child health, and not focus solely on maternal overweight or obesity. Funding European Research Council, US National Institute of Health, UK Medical Research Council and National Institute for Health and Care Research.
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Affiliation(s)
- Hannah V. Thornton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Rosie P. Cornish
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
| | - Deborah A. Lawlor
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Bristol National Institute for Health Research Biomedical Research Centre, University of Bristol, Bristol, UK
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Jia F, Wu W, Chen PY. Testing indirect effect with a complete or incomplete dichotomous mediator. THE BRITISH JOURNAL OF MATHEMATICAL AND STATISTICAL PSYCHOLOGY 2023; 76:539-558. [PMID: 37365442 DOI: 10.1111/bmsp.12313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/29/2023] [Accepted: 06/01/2023] [Indexed: 06/28/2023]
Abstract
Past methodological research on mediation analysis mainly focused on situations where all variables were complete and continuous. When issues of categorical data occur combined with missing data, more methodological considerations are involved. Specifically, appropriate decisions need to be made on estimation methods of the indirect effects and on confidence intervals for testing the indirect effects with accommodations of missing data. We compare strategies that address these issues based on a model with a dichotomous mediator, aiming to provide guidelines for researchers facing such challenges in practice.
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Affiliation(s)
- Fan Jia
- Psychological Sciences, University of California, Merced, Merced, California, USA
| | - Wei Wu
- Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Po-Yi Chen
- National Taiwan Normal University, Taipei City, Taiwan
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Chen J, Wu K, Cao W, Shao J, Huang M. Association between monocyte to high-density lipoprotein cholesterol ratio and multi-vessel coronary artery disease: a cross-sectional study. Lipids Health Dis 2023; 22:121. [PMID: 37553680 PMCID: PMC10408165 DOI: 10.1186/s12944-023-01897-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/31/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Patients with multi-vessel coronary artery disease (MV-CAD) have poorer clinical outcomes than those with single-vessel coronary artery disease (SV-CAD). Solid evidence underlines that high-density lipoprotein cholesterol (HDL-C) plays a protective role and monocyte plays a negative role in coronary artery disease (CAD). However, the monocyte to high-density lipoprotein ratio (MHR) has not been studied in relation to MV-CAD. METHODS In this study, 640 patients underwent coronary angiography, of whom 225 had severe coronary artery disease. Then divide the above two groups of patients into three groups based on the MHR tertiles, respectively. Logistic regression and subgroup analysis were carried out to estimate the association between MHR and MV-CAD. The receiver operating characteristic (ROC) curve analysis was constructed by combining classic CAD risk factors with MHR in response to MV-CAD. In addition, the mediating effect of MHR between smoking and MV-CAD in suspected CAD Patients was analyzed. RESULTS Among the three MHR groups, a statistically discrepant was observed in the number of patients with CAD, Severe-CAD and MV-CAD (PCAD < 0.001; PSevere-CAD < 0.001; PMV-CAD = 0.001) in suspected CAD patients. Furthermore, the number of patients with MV-CAD (P < 0.001) was different in Severe-CAD patients among three MHR groups. Non-CAD and CAD patients showed statistically discrepant in MHR levels (P < 0.001), and this difference also was observed between SV-CAD and MV-CAD patients (P < 0.001). In the analysis of suspected CAD patients, a significantly positive relationship was found between MHR and CAD, Severe-CAD, and MV-CAD (P for trend < 0.001). The effect of MHR on MV-CAD was consistent across all subgroups, with no significant randomized factor-by-subgroup interaction (P-interaction = 0.17-0.89). ROC analysis showed that the model constructed with MHR and classic influencing factors of CAD was superior to the model constructed solely based on classic influencing factors of CAD (0.742 vs.0.682, P = 0.002). In the analysis of Severe-CAD patients, patients with higher MHR levels had a higher risk of MV-CAD [OR (95%CI): 2.90 (1.49, 5.62), P for trend = 0.002] compared to patients with lower MHR. The trends persisted after adjusting for demographic (P for trend = 0.004) and classic influencing factors of CAD (P for trend = 0.009). All subgroup factors for patients with MV-CAD had no interaction with MHR (P-interaction = 0.15-0.86). ROC analysis showed that the model combining MHR and classic influencing factors of CAD was superior to the one including only the classic influencing factors of CAD (0.716 vs.0.650, P = 0.046). Assuming that MHR played a mediating effect between smoking and MV-CAD in suspected CAD patients. The results indicated that MHR played a partial mediating effect of 0.48 (P < 0.001). CONCLUSION A higher MHR was mainly associated with multi-vessel coronary artery disease and MHR partially mediated the association between smoking and MV-CAD.
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Affiliation(s)
- Jiaqi Chen
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Yongzhong Street, Wenzhou, 325000, Zhejiang, China
| | - Kangxiang Wu
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Yongzhong Street, Wenzhou, 325000, Zhejiang, China
| | - Wanchun Cao
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Yongzhong Street, Wenzhou, 325000, Zhejiang, China
| | - Jianan Shao
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Yongzhong Street, Wenzhou, 325000, Zhejiang, China
| | - Mingyuan Huang
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Yongzhong Street, Wenzhou, 325000, Zhejiang, China.
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Bogdan PC, Dolcos F, Moore M, Kuznietsov I, Culpepper SA, Dolcos S. Social Expectations are Primarily Rooted in Reciprocity: An Investigation of Fairness, Cooperation, and Trustworthiness. Cogn Sci 2023; 47:e13326. [PMID: 37548443 DOI: 10.1111/cogs.13326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 06/13/2023] [Accepted: 07/16/2023] [Indexed: 08/08/2023]
Abstract
Social expectations guide people's evaluations of others' behaviors, but the origins of these expectations remain unclear. It is traditionally thought that people's expectations depend on their past observations of others' behavior, and people harshly judge atypical behavior. Here, we considered that social expectations are also influenced by a drive for reciprocity, and people evaluate others' actions by reflecting on their own decisions. To compare these views, we performed four studies. Study 1 used an Ultimatum Game task where participants alternated Responder and Proposer roles. Modeling participants' expectations suggested they evaluated the fairness of received offers via comparisons to their own offers. Study 2 replicated these findings and showed that observing selfish behavior (lowball offers) only promoted acceptance of selfishness if observers started acting selfishly themselves. Study 3 generalized the findings, demonstrating that they also arise in the Public Goods Game, emerge cross-culturally, and apply to antisocial punishment whereby selfish players punish generosity. Finally, Study 4 introduced the Trust Game and showed that participants trusted players who reciprocated their behavior, even if it was selfish, as much as they trusted generous players. Overall, this research shows that social expectations and evaluations are rooted in drives for reciprocity. This carries theoretical implications, speaking to a parallel in the mechanisms driving both decision-making and social evaluations, along with practical importance for understanding and promoting cooperation.
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Affiliation(s)
- Paul C Bogdan
- Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign
- Department of Psychology, University of Illinois at Urbana-Champaign
| | - Florin Dolcos
- Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign
- Department of Psychology, University of Illinois at Urbana-Champaign
- Neuroscience Program, University of Illinois at Urbana-Champaign
| | - Matthew Moore
- Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign
| | - Illia Kuznietsov
- Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign
- Department of Human and Animal Physiology, Lesya Ukrainka Volyn National University
| | - Steven A Culpepper
- Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign
- Department of Statistics, University of Illinois at Urbana-Champaign
| | - Sanda Dolcos
- Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign
- Department of Psychology, University of Illinois at Urbana-Champaign
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Cashin AG, McAuley JH, VanderWeele TJ, Lee H. Understanding how health interventions or exposures produce their effects using mediation analysis. BMJ 2023; 382:e071757. [PMID: 37468141 DOI: 10.1136/bmj-2022-071757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Affiliation(s)
- Aidan G Cashin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - James H McAuley
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Tyler J VanderWeele
- Departments of Epidemiology and Biostatistics, TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Hopin Lee
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
- IQVIA, London, UK
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Alreshidi SM, Rayani AM, Alhumaid AF. Diet Quality as a Mediator in the Relationship Between Perceived Stress and Depression Among Family Caregivers of Patients with Chronic Illness in Saudi Arabia. Int J Psychiatry Med 2023:912174231162749. [PMID: 36871959 DOI: 10.1177/00912174231162749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
OBJECTIVE The aim of this research was to investigate the correlation between caregivers' perceived stress and depression and examine the mediating role of quality of diet on this relationship. METHODS A cross-sectional survey was performed in Medical City from January to August 2022 in the Kingdom of Saudi Arabia. Utilizing the Stress Scale, Anxiety and Depression, the Health Promoting Lifestyle Profile-II questionnaire, and the Patient Health Questionnaire-9, researchers assessed levels of perceived stress, diet quality, and depression. The bootstrap approach and the SPSS PROCESS macro were used to assess the importance of the mediation effect. The target population was family caregivers of patients with chronic illness at Medical City in Saudi Arabia. The researcher conveniently sampled 127 patients, with 119 responding, a response rate of 93.7%. A significant correlation between depression and perceived stress was observed (β = 0.438, p < 0.001). Diet quality mediated the relationship between depression and perceived stress (β = -0.187, p = 0.018). The importance of the indirect effect of perceived stress through diet quality was supported by the outcomes of the non-parametric bootstrapping method (95% bootstrap CI = 0.010, 0.080). The findings revealed that the indirect influence of diet quality explained 15.8% of the overall variation in depression. CONCLUSIONS These findings help clarify the mediating effects of diet quality on the relationship between perceived stress and depression.
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Affiliation(s)
- Salman M Alreshidi
- College of Nursing, 37850University of King Saud, Riyadh City, Saudi Arabia
| | - Ahmad M Rayani
- College of Nursing, 37850University of King Saud, Riyadh City, Saudi Arabia
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Do family characteristics contribute to a socioeconomic gradient in overweight in early childhood? - Single mediation analyses of data on preschool children of Germany. Prev Med Rep 2023; 33:102178. [PMID: 37008454 PMCID: PMC10060745 DOI: 10.1016/j.pmedr.2023.102178] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/31/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023] Open
Abstract
Children's overweight is strongly associated with family socioeconomic position (SEP) and family characteristics (FC). There is limited research on the extent to which FC account for a socioeconomic gradient in childhood overweight. This study examined whether FC explain SEP differences in the prevalence of overweight. The study used baseline data of preschool-aged children from the German 'PReschool INtervention Study'. The sample (n = 872, 48% girls) was recruited at kindergartens in Baden-Württemberg, Germany. Data included children's measured weight status and parents' reports on socioeconomic indicators (e.g., school education, vocational education, income) and FC. Variables represent main determinants of overweight (nutrition: sweets consumption in front of TV, soft drink consumption, regular breakfast, child sets table; physical activity: outdoor sports; parental role model). In single mediation analyses indirect effects of SEP on overweight were analysed (OR[95%CI]). Preschool girls and boys with low parental education had higher odds for overweight than children with high parental education. Among boys, low levels of parental education contributed to the odds of overweight via indirect effects by both factors 'sweets consumption in front of TV' (OR = 1.31[1.05-1.59]) and 'no sports' (OR = 1.14[1.01-1.38]). Among girls, FC measured did not explain SEP differences in overweight. Family nutrition and parental/family physical activity contribute to inequalities in overweight among preschool boys, but not girls. Research is needed to identify FC that explain inequalities in overweight for both.
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11
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Chen F, Hu W, Cai J, Chen S, Si A, Zhang Y, Liu W. Instrumental variable-based high-dimensional mediation analysis with unmeasured confounders for survival data in the observational epigenetic study. Front Genet 2023; 14:1092489. [PMID: 36816039 PMCID: PMC9932046 DOI: 10.3389/fgene.2023.1092489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/16/2023] [Indexed: 02/04/2023] Open
Abstract
Background: High dimensional mediation analysis is frequently conducted to explore the role of epigenetic modifiers between exposure and health outcome. However, the issue of high dimensional mediation analysis with unmeasured confounders for survival analysis in observational study has not been well solved. Methods: In this study, we proposed an instrumental variable based approach for high dimensional mediation analysis with unmeasured confounders in survival analysis for epigenetic study. We used the Sobel's test, the Joint test, and the Bootstrap method to test the mediation effect. A comprehensive simulation study was conducted to decide the best test strategy. An empirical study based on DNA methylation data of lung cancer patients was conducted to illustrate the performance of the proposed method. Results: Simulation study suggested that the proposed method performed well in the identifying mediating factors. The estimation of the mediation effect by the proposed approach is also reliable with less bias compared with the classical approach. In the empirical study, we identified two DNA methylation signatures including cg21926276 and cg26387355 with a mediation effect of 0.226 (95%CI: 0.108-0.344) and 0.158 (95%CI: 0.065-0.251) between smoking and lung cancer using the proposed approach. Conclusion: The proposed method obtained good performance in simulation and empirical studies, it could be an effective statistical tool for high dimensional mediation analysis.
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Affiliation(s)
- Fangyao Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China,Department of Radiology, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Weiwei Hu
- Department of Radiology, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Jiaxin Cai
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Shiyu Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Aima Si
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Yuxiang Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Wei Liu
- Department of Cell Biology and Genetics, School of Basic Medical Science, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China,*Correspondence: Wei Liu,
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12
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Neural Contributions to Reduced Fluid Intelligence across the Adult Lifespan. J Neurosci 2023; 43:293-307. [PMID: 36639907 PMCID: PMC9838706 DOI: 10.1523/jneurosci.0148-22.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 07/27/2022] [Accepted: 10/19/2022] [Indexed: 12/12/2022] Open
Abstract
Fluid intelligence, the ability to solve novel, complex problems, declines steeply during healthy human aging. Using fMRI, fluid intelligence has been repeatedly associated with activation of a frontoparietal brain network, and impairment following focal damage to these regions suggests that fluid intelligence depends on their integrity. It is therefore possible that age-related functional differences in frontoparietal activity contribute to the reduction in fluid intelligence. This paper reports on analysis of the Cambridge Center for Ageing and Neuroscience data, a large, population-based cohort of healthy males and females across the adult lifespan. The data support a model in which age-related differences in fluid intelligence are partially mediated by the responsiveness of frontoparietal regions to novel problem-solving. We first replicate a prior finding of such mediation using an independent sample. We then precisely localize the mediating brain regions, and show that mediation is specifically associated with voxels most activated by cognitive demand, but not with voxels suppressed by cognitive demand. We quantify the robustness of this result to potential unmodeled confounders, and estimate the causal direction of the effects. Finally, exploratory analyses suggest that neural mediation of age-related differences in fluid intelligence is moderated by the variety of regular physical activities, more reliably than by their frequency or duration. An additional moderating role of the variety of nonphysical activities emerged when controlling for head motion. A better understanding of the mechanisms that link healthy aging with lower fluid intelligence may suggest strategies for mitigating such decline.SIGNIFICANCE STATEMENT Global populations are living longer, driving urgency to understand age-related cognitive declines. Fluid intelligence is of prime importance because it reflects performance across many domains, and declines especially steeply during healthy aging. Despite consensus that fluid intelligence is associated with particular frontoparietal brain regions, little research has investigated suggestions that under-responsiveness of these regions mediates age-related decline. We replicate a recent demonstration of such mediation, showing specific association with brain regions most activated by cognitive demand, and robustness to moderate confounding by unmodeled variables. By showing that this mediation model is moderated by the variety of regular physical activities, more reliably than by their frequency or duration, we identify a potential modifiable lifestyle factor that may help promote successful aging.
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Feng X, Long G, Zeng G, Zhang Q, Song B, Wu KH. Association of increased risk of cardiovascular diseases with higher levels of perfluoroalkylated substances in the serum of adults. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:89081-89092. [PMID: 35849234 DOI: 10.1007/s11356-022-22021-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/11/2022] [Indexed: 06/15/2023]
Abstract
Evidence showing the association of perfluoroalkylated substance (PFAS) exposure with CVD risk is scarce. The objective of this study was to explore the relationships of CVD risk with mixed or individual serum PFAS levels among general adults. We analyzed combined data of 7904 adults who participated in the National Health and Nutrition Examination Survey 2003-2012 with a Bayesian kernel machine regression (BKMR) to examine the relationships of individual or mixed PFAS exposure with total CVD risk. A logistic regression model and restricted cubic spline (RCS) regression with multivariate adjustment were conducted to assess the relationships between individual serum PFAS levels and the risk of total CVD or its subtypes. A mediation model was applied to investigate how C-reactive protein (CRP) levels mediate the strength of the association. The BKMR results indicated a positive relationship between mixed PFAS exposure and total CVD risk; among the PFASs, perfluorooctane sulfonic acid (PFOS) had the highest posterior inclusion probability. As determined by logistic regression, a log-unit change in PFOS levels was positively related to a higher risk of heart attack and stroke in males (both P < 0.05). A nonlinear relationship was found between PFOS levels and stroke risk (P for nonlinearity = 0.04), as illustrated in the RCS plot. The mediation analysis showed that CRP levels mediated 8% and 1.2% of the relationship between serum PFOS and PFNA levels, respectively, and the prevalence of stroke. A significant relationship between higher serum PFAS concentrations and an increased risk of CVD was observed, mainly in males.
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Affiliation(s)
- Xinghui Feng
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, China
| | - Guangfeng Long
- Department of Clinical Laboratory, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Guowei Zeng
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, China
| | - Qi Zhang
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, China
| | - Binqian Song
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, China
| | - Kai-Hong Wu
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, China.
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14
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Hu Z, Han L, Liu J, Fowke JH, Han JC, Kakhniashvili D, LeWinn KZ, Bush NR, Mason WA, Zhao Q. Prenatal metabolomic profiles mediate the effect of maternal obesity on early childhood growth trajectories and obesity risk: the Conditions Affecting Neurocognitive Development and Learning in Early Childhood (CANDLE) Study. Am J Clin Nutr 2022; 116:1343-1353. [PMID: 36055779 PMCID: PMC9630879 DOI: 10.1093/ajcn/nqac244] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/26/2022] [Accepted: 08/30/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Maternal prepregnancy obesity is an important risk factor for offspring obesity, which may partially operate through prenatal programming mechanisms. OBJECTIVES The study aimed to systematically identify prenatal metabolomic profiles mediating the intergenerational transmission of obesity. METHODS We included 450 African-American mother-child pairs from the Conditions Affecting Neurocognitive Development and Learning in Early Childhood (CANDLE) Study pregnancy cohort. LC-MS was used to conduct metabolomic profiling on maternal plasma samples of the second trimester. The childhood growth outcomes of interest included BMI trajectories from birth to age 4 y (rising-high-, moderate-, and low-BMI trajectories) as well as overweight/obesity (OWO) risk at age 4 y. Mediation analysis was conducted to identify metabolite mediators linking maternal OWO and childhood growth outcomes. The potential causal effects of maternal OWO on metabolite mediators were examined using the Mendelian randomization (MR) method. RESULTS Among the 880 metabolites detected in the maternal plasma during pregnancy, 14 and 11 metabolites significantly mediated the effects of maternal prepregnancy OWO on childhood BMI trajectories and the OWO risk at age 4 y, respectively, and 5 mediated both outcomes. The MR analysis suggested 6 of the 20 prenatal metabolite mediators might be causally influenced by maternal prepregnancy OWO, most of which are from the pathways related to the metabolism of amino acids (hydroxyasparagine, glutamate, and homocitrulline), sterols (campesterol), and nucleotides (N2,N2-dimethylguanosine). CONCLUSIONS Our study provides further evidence that prenatal metabolomic profiles might mediate the effect of maternal OWO on early childhood growth trajectories and OWO risk in offspring. The metabolic pathways, including identified metabolite mediators, might provide novel intervention targets for preventing the intrauterine development of obesity in the offspring of mothers with obesity.
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Affiliation(s)
- Zunsong Hu
- Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Luhang Han
- Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jiawang Liu
- Medicinal Chemistry Core, Office of Research, University of Tennessee Health Science Center, Memphis, TN, USA; Department of Pharmaceutical Science, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jay H Fowke
- Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Joan C Han
- Departments of Pediatrics and Physiology, University of Tennessee Health Science Center, and Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, TN, USA; Icahn School of Medicine at Mount Sinai, Kravis Children's Hospital, New York, NY, USA
| | - David Kakhniashvili
- Proteomics and Metabolomics Core, Office of Research, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Kaja Z LeWinn
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Nicole R Bush
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA; Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - W Alex Mason
- Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Qi Zhao
- Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.
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15
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High-dimensional causal mediation analysis based on partial linear structural equation models. Comput Stat Data Anal 2022. [DOI: 10.1016/j.csda.2022.107501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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16
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Craighead DH, Freeberg KA, McCarty NP, Rossman MJ, Moreau KL, You Z, Chonchol M, Seals DR. Inspiratory muscle strength training for lowering blood pressure and improving endothelial function in postmenopausal women: comparison with “standard of care” aerobic exercise. Front Physiol 2022; 13:967478. [PMID: 36105300 PMCID: PMC9465043 DOI: 10.3389/fphys.2022.967478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
Background: High blood pressure (BP), particularly systolic BP (SBP), is the major modifiable risk factor for cardiovascular diseases and related disorders of aging. SBP increases markedly with aging in women such that the prevalence of above-normal SBP (i.e., ≥120 mmHg) in postmenopausal women exceeds rates in age-matched men. This increase in SBP is associated with vascular endothelial dysfunction, mediated by excessive reactive oxygen species-induced oxidative stress and consequent reductions in nitric oxide bioavailability. Moderate-intensity aerobic exercise is a recommended lifestyle strategy for reducing SBP. However, adherence to aerobic exercise guidelines among postmenopausal women is low (<30%) and aerobic exercise does not consistently enhance endothelial function in estrogen-deficient postmenopausal women. High-resistance inspiratory muscle strength training (IMST) is a time-efficient, adherable lifestyle intervention that involves inhaling against resistance through a handheld device (30 breaths/day). Here, we present the protocol for a randomized controlled trial investigating the efficacy of 3 months of high-resistance IMST compared to guideline-based, “standard-of-care” aerobic exercise training for decreasing SBP and improving endothelial function in estrogen-deficient postmenopausal women with above-normal SBP (120–159 mmHg) at baseline (ClinicalTrials.gov Identifier: NCT05000515). Methods: A randomized, single-blind, parallel-group design clinical trial will be conducted in 72 (36/group) estrogen-deficient postmenopausal women with above-normal SBP. Participants will complete baseline testing and then be randomized to either 3 months of high-resistance IMST (30 breaths/day, 6 days/week, 75% maximal inspiratory pressure) or moderate-intensity aerobic exercise training (brisk walking 25 min/day, 6 days/week, 40–60% heart rate reserve). Outcome measures will be assessed after 3 months of either intervention. Following end-intervention testing, participants will abstain from their assigned intervention for 6 weeks, after which BP and endothelial function will be assessed to evaluate the potential persistent effects of the intervention on the primary and secondary outcomes. Discussion: This study is designed to compare the effectiveness of time-efficient, high-resistance IMST to guideline-based aerobic exercise training for lowering SBP and improving endothelial function, and interrogating potential mechanisms of action, in estrogen-deficient postmenopausal women. Clinical Trial Registration:ClinicalTrials.gov, Identifier: NCT05000515.
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Affiliation(s)
- Daniel H. Craighead
- Integrative Physiology of Aging Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, United States
| | - Kaitlin A. Freeberg
- Integrative Physiology of Aging Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, United States
| | - Narissa P. McCarty
- Integrative Physiology of Aging Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, United States
| | - Matthew J. Rossman
- Integrative Physiology of Aging Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, United States
| | - Kerrie L. Moreau
- Division of Geriatric Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Veterans Affairs Eastern Colorado Geriatric Research, Educational and Clinical Center, Denver, CO, United States
| | - Zhiying You
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Michel Chonchol
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Douglas R. Seals
- Integrative Physiology of Aging Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, United States
- *Correspondence: Douglas R. Seals,
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17
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Ostolin TLVDP, Gonze BDB, Sperandio EF, Arantes RL, Romiti M, Dourado VZ. Mediator Effect of Cardiorespiratory Fitness on the Association between Physical Activity and Lung Function in Adults: Cross-Sectional Results from the Epimov Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159377. [PMID: 35954734 PMCID: PMC9368432 DOI: 10.3390/ijerph19159377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 11/01/2021] [Accepted: 11/01/2021] [Indexed: 01/27/2023]
Abstract
We investigated whether cardiorespiratory fitness (CRF) mediates the association between moderate-to-vigorous physical activity (MVPA) and lung function in asymptomatic adults. We examined the cross-sectional results of 1362 adults aged 18–80 years from the Epidemiology and Human Movement Study. Participants were submitted to spirometry to obtain forced vital capacity (FVC) and forced expiratory volume in 1s (FEV1). Additionally, we used cardiopulmonary exercise testing to obtain peak oxygen uptake (V˙O2) as a measure of CRF. Participants used a triaxial accelerometer for 4–7 days to obtain MVPA. Mediation analyses were performed considering the CRF as a mediator, MVPA as an independent variable, and FVC and FEV1 as dependent variables with adjustment for age, sex, and cardiovascular risk score. We aimed to investigate the total (path c) and direct (paths a, b, c’) effects through the regression coefficients. We also examined the indirect effect, which was obtained from the product of the coefficients (path ab). Our sample was composed mainly of overweight and middle-aged women. MVPA was positively related to CRF (path a), as well as CRF and lung function (path b). MVPA also presented a significant positive total effect (path c) in the lung function. However, this relationship became non-significant when CRF was included in the model for both FVC and FEV1 (path c’). We did not observe a direct effect of MVPA on the lung function. In contrast, the indirect effect was significant (path ab). Lastly, CRF mediated 60% of the total effect of MVPA on FVC and 61.9% on FEV1. CRF mediates the relationship between lung function and MVPA in asymptomatic adults. Therefore, our results reinforce the need to include CRF assessment in practice clinical routine and suggest that strategies focusing on CRF might be more promising to prevent respiratory diseases in adults.
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Affiliation(s)
| | - Bárbara de Barros Gonze
- Department of Human Movement Sciences, Federal University of São Paulo (UNIFESP), Santos 11015-020, SP, Brazil; (T.L.V.D.P.O.); (B.d.B.G.); (E.F.S.)
| | - Evandro Fornias Sperandio
- Department of Human Movement Sciences, Federal University of São Paulo (UNIFESP), Santos 11015-020, SP, Brazil; (T.L.V.D.P.O.); (B.d.B.G.); (E.F.S.)
| | - Rodolfo Leite Arantes
- Department of Cardiovascular Medicine, Angiocorpore Institute of Cardiovascular Medicine, Santos 11075-350, SP, Brazil; (R.L.A.); (M.R.)
| | - Marcello Romiti
- Department of Cardiovascular Medicine, Angiocorpore Institute of Cardiovascular Medicine, Santos 11075-350, SP, Brazil; (R.L.A.); (M.R.)
| | - Victor Zuniga Dourado
- Department of Human Movement Sciences, Federal University of São Paulo (UNIFESP), Santos 11015-020, SP, Brazil; (T.L.V.D.P.O.); (B.d.B.G.); (E.F.S.)
- Lown Scholars Program–Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
- Correspondence:
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18
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Almeida FR, Ostolin TLVDP, Almeida VR, Gonze BB, Sperandio EF, Simões MSMP, Godoy I, Tanni SE, Romiti M, Arantes RL, Dourado VZ. Cardiorespiratory fitness as a mediator in the relationship between lung function and blood pressure in adults. Braz J Med Biol Res 2022; 55:e11754. [PMID: 35894380 PMCID: PMC9322832 DOI: 10.1590/1414-431x2022e11754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 05/25/2022] [Indexed: 12/03/2022] Open
Abstract
It is unclear whether physical activity and cardiorespiratory fitness (CRF) are
pathways that link low pulmonary function (LPF) to increased blood pressure
(BP). Therefore, we investigated the extent to which CRF and
moderate-to-vigorous physical activity (MVPA) mediate the relationship between
LPF and high BP in adults. We conducted a cross-sectional study with 1,362
participants that underwent cardiopulmonary exercise testing (CPET), spirometry,
and wore an accelerometer to determine physical activity patterns. We performed
mediation analyses using structural equations considering peak oxygen uptake
(V̇O2) and MVPA as mediators, forced vital capacity (FVC) and
forced expiratory volume in the first second (FEV1) as independent variables,
and systolic and diastolic blood pressure (SBP, DBP) as dependent variables. The
probability of alpha error was set at 5%. We found a significant total effect of
FVC on SBP and DBP considering V̇O2 as mediator (P<0.01). Indirect
effects were also significant, with 42.6% of the total effect of FVC on SBP and
77% on DBP mediated by V̇O2 (P<0.01). We did not observe a direct
effect of FVC on SBP and DBP. Considering FEV1 as an independent variable, the
total effect on SBP was also significant, as were the indirect effects, mediated
by V̇O2 at 14.8% for SBP and 7.6% for DBP (P<0.01). We did not
find an indirect effect of FVC or FEV1 considering the MVPA as a mediator. CRF
mediates the pathway that links LPF and elevated BP. Therefore, CRF is more
sensitive to variations in FVC and FEV1 than MVPA.
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Affiliation(s)
- F R Almeida
- Departamento de Ciências do Movimento Humano, Universidade Federal de São Paulo, Santos, SP, Brasil
| | - T L V D P Ostolin
- Departamento de Ciências do Movimento Humano, Universidade Federal de São Paulo, Santos, SP, Brasil
| | - V R Almeida
- Departamento de Ciências do Movimento Humano, Universidade Federal de São Paulo, Santos, SP, Brasil
| | - B B Gonze
- Departamento de Ciências do Movimento Humano, Universidade Federal de São Paulo, Santos, SP, Brasil
| | - E F Sperandio
- Departamento de Ciências do Movimento Humano, Universidade Federal de São Paulo, Santos, SP, Brasil
| | - M S M P Simões
- Departamento de Ciências do Movimento Humano, Universidade Federal de São Paulo, Santos, SP, Brasil
| | - I Godoy
- Disciplina de Pneumologia do Departamento de Clínica Médica da Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - S E Tanni
- Disciplina de Pneumologia do Departamento de Clínica Médica da Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - M Romiti
- Angiocorpore Instituto de Medicina Cardiovascular, Santos, SP, Brasil
| | - R L Arantes
- Angiocorpore Instituto de Medicina Cardiovascular, Santos, SP, Brasil
| | - V Z Dourado
- Departamento de Ciências do Movimento Humano, Universidade Federal de São Paulo, Santos, SP, Brasil.,Lown Scholars Program, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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19
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Tibbe TD, Montoya AK. Correcting the Bias Correction for the Bootstrap Confidence Interval in Mediation Analysis. Front Psychol 2022; 13:810258. [PMID: 35712166 PMCID: PMC9197131 DOI: 10.3389/fpsyg.2022.810258] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 04/05/2022] [Indexed: 11/24/2022] Open
Abstract
The bias-corrected bootstrap confidence interval (BCBCI) was once the method of choice for conducting inference on the indirect effect in mediation analysis due to its high power in small samples, but now it is criticized by methodologists for its inflated type I error rates. In its place, the percentile bootstrap confidence interval (PBCI), which does not adjust for bias, is currently the recommended inferential method for indirect effects. This study proposes two alternative bias-corrected bootstrap methods for creating confidence intervals around the indirect effect: one originally used by Stine (1989) with the correlation coefficient, and a novel method that implements a reduced version of the BCBCI's bias correction. Using a Monte Carlo simulation, these methods were compared to the BCBCI, PBCI, and Chen and Fritz (2021)'s 30% Winsorized BCBCI. The results showed that the methods perform on a continuum, where the BCBCI has the best balance (i.e., having closest to an equal proportion of CIs falling above and below the true effect), highest power, and highest type I error rate; the PBCI has the worst balance, lowest power, and lowest type I error rate; and the alternative bias-corrected methods fall between these two methods on all three performance criteria. An extension of the original simulation that compared the bias-corrected methods to the PBCI after controlling for type I error rate inflation suggests that the increased power of these methods might only be due to their higher type I error rates. Thus, if control over the type I error rate is desired, the PBCI is still the recommended method for use with the indirect effect. Future research should examine the performance of these methods in the presence of missing data, confounding variables, and other real-world complications to enhance the generalizability of these results.
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Affiliation(s)
- Tristan D Tibbe
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Amanda K Montoya
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
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20
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Qin Y, Dai M, Chen L, Zhang T, Zhou N, Chen X. The relationship between ecological executive function and stigma among patients with epilepsy: The mediating effect of social support. Epilepsy Res 2022; 182:106919. [DOI: 10.1016/j.eplepsyres.2022.106919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/24/2022] [Accepted: 03/29/2022] [Indexed: 11/03/2022]
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21
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Kruger ES, Tofighi D, Hsiao YY, MacKinnon DP, Lee Van Horn M, Witkiewitz K. Teacher's Corner: An R Shiny App for Sensitivity Analysis for Latent Growth Curve Mediation. STRUCTURAL EQUATION MODELING : A MULTIDISCIPLINARY JOURNAL 2022; 29:944-952. [PMID: 36439330 PMCID: PMC9683348 DOI: 10.1080/10705511.2022.2045203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/18/2022] [Accepted: 02/18/2022] [Indexed: 06/16/2023]
Abstract
Mechanisms of behavior change are the processes through which interventions are hypothesized to cause changes in outcomes. Latent growth curve mediation models (LGCMM) are recommended for investigating the mechanisms of behavior change because LGCMM models establish temporal precedence of change from the mediator to the outcome variable. The Correlated Augmented Mediation Sensitivity Analyses (CAMSA) App implements sensitivity analysis for LGCMM models to evaluate if a mediating path (mechanism) is robust to potential confounding variables. The CAMSA approach is described and applied to simulated data, and data from a research study exploring a mechanism of change in the treatment of substance use disorder.
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22
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Loeys T, Rodenburg R. Dealing With Autocorrelation in the Single Case AB-Design: A Study Assessing the Mediating Effect of Infant Crying on the Relation Between Responsive Soothing and Infant Sleep. Eval Health Prof 2022; 45:22-35. [PMID: 35259962 DOI: 10.1177/01632787211069678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Mediation analysis is widely adopted by researchers to disentangle the causal pathways by which an intervention affects an outcome. This paper describes a model to estimate the direct and indirect effect from a single subject AB-design with repeated assessments of both the mediator and the outcome. We discuss the plausibility of the modeling assumptions and contrast different approaches to deal with the autocorrelation in the time series data. While there are only small differences between those approaches when the number of timepoints is small (T = 15), the Generalized Least Squares approach performs best in medium (T = 30) to large (T = 90) time series. We apply the proposed methodology to data from a single case AB-design that was conducted with a mother of an excessively crying baby. Daily crying and baby sleep during the night were assessed with online diaries during a baseline phase and intervention phase. Between both phases, the pediatrician instructed the mother how to apply a responsive soothing intervention, the happiest baby (THB) method. We find that the direct effect of THB on sleeping is positive. THB also reduces crying but decreased crying during the day is associated with decreased sleeping during the night and hence a negative indirect effect of THB on sleeping via crying is found.
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Affiliation(s)
- Tom Loeys
- Department of Data Analysis, 129060Ghent University, Gent, Belgium
| | - Roos Rodenburg
- Research Institute of Child Development and Education, 100440University of Amsterdam, Amsterdam, Netherlands.,Research Priority Area Yield, University of Amsterdam, Amsterdam, Netherlands.,Youth Health Service, Public Health Service (GGD) Hollands Noorden, Alkmaar, Netherlands.,Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, Netherlands
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23
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Rizzo RRN, Cashin AG, Bagg MK, Gustin SM, Lee H, McAuley JH. A Systematic Review of the Reporting Quality of Observational Studies That Use Mediation Analyses. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2022; 23:1041-1052. [PMID: 35167030 PMCID: PMC9343342 DOI: 10.1007/s11121-022-01349-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2022] [Indexed: 11/26/2022]
Abstract
Mediation analysis is a common statistical method used to investigate mechanisms of health exposure and interventions. The reporting quality of mediation studies used in randomised controlled trials has been considered heterogeneous and incomplete. The reporting quality of mediation analysis in observational studies is unknown. We conducted a systematic review to describe the reporting standards of recently published observational studies that used mediation analysis to understand the mechanism of health exposures. We searched for studies published between June 2017 and June 2019 indexed in EMBASE, MEDLINE and PsycINFO. Two reviewers screened articles and selected a random sample of 50 eligible studies for inclusion. We included studies across 13 healthcare fields and ten different health conditions. Most studies (74%) collected data on healthy individuals to assess their risk of developing a health disorder. Psychosocial and behavioural factors (self-control, self-esteem, alcohol consumption, pain) were the most prevalent exposures (n = 30, 60%), outcomes (n = 23, 46%) and mediators (n = 29, 58%). Most studies used a cross-sectional design (64%, n = 32), and a few studies reported sample size calculations (4%, n = 8). In 20% (n = 10) of the studies, adjustment for confounders was reported. Only 10% (n = 5) of studies reported the assumptions underlying the mediation analysis, and 14% (n = 7) of studies conducted some sensitivity analysis to assess the degree which unmeasured confounders would affect the estimate of the mediation effect. Mediation analysis is a common method used to investigate mechanisms in prevention research. The reporting of mediation analysis in observational studies is incomplete and may impact reproducibility, evidence synthesis and implementation.
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Affiliation(s)
- Rodrigo R N Rizzo
- School of Health Sciences, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Aidan G Cashin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Matthew K Bagg
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
- New College Village, University of New South Wales, Sydney, Australia
| | - Sylvia M Gustin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Hopin Lee
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK.
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.
| | - James H McAuley
- School of Health Sciences, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
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Is it possible to model the impact of calorie-reduction interventions on childhood obesity at a population level and across the range of deprivation: Evidence from the Avon Longitudinal Study of Parents and Children (ALSPAC). PLoS One 2022; 17:e0263043. [PMID: 35100299 PMCID: PMC8803143 DOI: 10.1371/journal.pone.0263043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 01/11/2022] [Indexed: 11/19/2022] Open
Abstract
Background Simulated interventions using observational data have the potential to inform policy and public health interventions where randomised controlled trials are not feasible. National childhood obesity policy is one such area. Overweight and obesity are primarily caused by energy-rich and low-nutrient diets that contribute to a positive net energy imbalance. Using data from the Avon Longitudinal Study of Parents and Children (ALSPAC), we investigated whether causal modelling techniques could be applied to simulate the potential impact of policy-relevant calorie-reduction interventions on population prevalence and inequalities in obesity in childhood. Methods Predicted probabilities of obesity at age 11 (UK90 cut offs) were estimated from logistic marginal structural models (MSM) accounting for observed calorie consumption at age 7 and confounding, overall and by maternal occupational social class. A series of population intervention scenarios were modelled to simulate daily calorie-reduction interventions that differed in effectiveness, targeting mechanism and programme uptake level. Results The estimated effect of maternal social class on obesity after accounting for confounding and observed calorie intake was provided by the controlled direct effect (CDE), in which, 18.3% of children were living with obesity at age 11 years,. A universal simulation to lower median intake to the estimated average requirement (EAR) (a 6.1% reduction in daily calories) with 75% uptake reduced overall obesity prevalence by 0.6%; there was little impact on inequalities. A targeted intervention to limit consumption to the EAR for children with above average intake reduced population obesity prevalence at 11 years by 1.5% but inequalities remained broadly unchanged. A targeted intervention for children of low-income families reduced prevalence by 0.7% and was found to slightly reduce inequalities. Conclusions MSMs allow estimation of effects of simulated calorie-reduction interventions on childhood obesity prevalence and inequalities, although estimates are limited by the accuracy of reported calorie intake. Further work is needed to understand causal pathways and opportunities for intervention. Nevertheless, simulated intervention techniques have promise for informing national policy where experimental data are not available.
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Tofighi D. Sensitivity Analysis in Nonrandomized Longitudinal Mediation Analysis. Front Psychol 2021; 12:755102. [PMID: 34938233 PMCID: PMC8685264 DOI: 10.3389/fpsyg.2021.755102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 11/12/2021] [Indexed: 11/13/2022] Open
Abstract
Mediation analysis relies on an untestable assumption of the no omitted confounders, which posits that an omitted variable that confounds the relationships between the antecedent, mediator, and outcome variables cannot exist. One common model in alcohol addiction studies is a nonrandomized latent growth curve mediation model (LGCMM), where the antecedent variable is not randomized, the two covarying mediators are latent intercept and slope modeling longitudinal effect of the repeated measures mediator, and an outcome variable that measures alcohol use. An important gap in the literature is lack of sensitivity analysis techniques to assess the effect of the violation of the no omitted confounder assumption in a nonrandomized LGCMM. We extend a sensitivity analysis technique, termed correlated augmented mediation sensitivity analysis (CAMSA), to a nonrandomized LGCMM. We address several unresolved issues in conducting CAMSA for the nonrandomized LGCMM and present: (a) analytical results showing how confounder correlations model a confounding bias, (b) algorithms to address admissible values for confounder correlations, (c) accessible R code within an SEM framework to conduct our proposed sensitivity analysis, and (d) an empirical example. We conclude that conducting sensitivity analysis to ascertain robustness of the mediation analysis is critical.
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Affiliation(s)
- Davood Tofighi
- Department of Psychology, University of New Mexico, Albuquerque, NM, United States
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26
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Rijnhart JJM, Lamp SJ, Valente MJ, MacKinnon DP, Twisk JWR, Heymans MW. Mediation analysis methods used in observational research: a scoping review and recommendations. BMC Med Res Methodol 2021; 21:226. [PMID: 34689754 PMCID: PMC8543973 DOI: 10.1186/s12874-021-01426-3] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 09/21/2021] [Indexed: 12/02/2022] Open
Abstract
Background Mediation analysis methodology underwent many advancements throughout the years, with the most recent and important advancement being the development of causal mediation analysis based on the counterfactual framework. However, a previous review showed that for experimental studies the uptake of causal mediation analysis remains low. The aim of this paper is to review the methodological characteristics of mediation analyses performed in observational epidemiologic studies published between 2015 and 2019 and to provide recommendations for the application of mediation analysis in future studies. Methods We searched the MEDLINE and EMBASE databases for observational epidemiologic studies published between 2015 and 2019 in which mediation analysis was applied as one of the primary analysis methods. Information was extracted on the characteristics of the mediation model and the applied mediation analysis method. Results We included 174 studies, most of which applied traditional mediation analysis methods (n = 123, 70.7%). Causal mediation analysis was not often used to analyze more complicated mediation models, such as multiple mediator models. Most studies adjusted their analyses for measured confounders, but did not perform sensitivity analyses for unmeasured confounders and did not assess the presence of an exposure-mediator interaction. Conclusions To ensure a causal interpretation of the effect estimates in the mediation model, we recommend that researchers use causal mediation analysis and assess the plausibility of the causal assumptions. The uptake of causal mediation analysis can be enhanced through tutorial papers that demonstrate the application of causal mediation analysis, and through the development of software packages that facilitate the causal mediation analysis of relatively complicated mediation models. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-021-01426-3.
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Affiliation(s)
- Judith J M Rijnhart
- Department of Epidemiology and Data Science, Amsterdam UMC, Location VU University Medical Center, Amsterdam Public Health Research Institute, PO Box 7057, 1007, MB, Amsterdam, The Netherlands.
| | - Sophia J Lamp
- Department of Psychology, Arizona State University, Tempe, AZ, USA
| | - Matthew J Valente
- Department of Psychology, Center for Children and Families, Florida International University, Miami, FL, USA
| | | | - Jos W R Twisk
- Department of Epidemiology and Data Science, Amsterdam UMC, Location VU University Medical Center, Amsterdam Public Health Research Institute, PO Box 7057, 1007, MB, Amsterdam, The Netherlands
| | - Martijn W Heymans
- Department of Epidemiology and Data Science, Amsterdam UMC, Location VU University Medical Center, Amsterdam Public Health Research Institute, PO Box 7057, 1007, MB, Amsterdam, The Netherlands
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Zheng HL, Guo ZL, Wang ML, Yang C, An SY, Wu W. Effects of climate variables on the transmission of COVID-19: a systematic review of 62 ecological studies. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:54299-54316. [PMID: 34398375 PMCID: PMC8364942 DOI: 10.1007/s11356-021-15929-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/07/2021] [Indexed: 04/15/2023]
Abstract
The new severe acute respiratory syndrome coronavirus 2 was initially discovered at the end of 2019 in Wuhan City in China and has caused one of the most serious global public health crises. A collection and analysis of studies related to the association between COVID-19 (coronavirus disease 2019) transmission and meteorological factors, such as humidity, is vital and indispensable for disease prevention and control. A comprehensive literature search using various databases, including Web of Science, PubMed, and Chinese National Knowledge Infrastructure, was systematically performed to identify eligible studies from Dec 2019 to Feb 1, 2021. We also established six criteria to screen the literature to obtain high-quality literature with consistent research purposes. This systematic review included a total of 62 publications. The study period ranged from 1 to 8 months, with 6 papers considering incubation, and the lag effect of climate factors on COVID-19 activity being taken into account in 22 studies. After quality assessment, no study was found to have a high risk of bias, 30 studies were scored as having moderate risks of bias, and 32 studies were classified as having low risks of bias. The certainty of evidence was also graded as being low. When considering the existing scientific evidence, higher temperatures may slow the progression of the COVID-19 epidemic. However, during the course of the epidemic, these climate variables alone could not account for most of the variability. Therefore, countries should focus more on health policies while also taking into account the influence of weather.
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Affiliation(s)
- Hu-Li Zheng
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, Liaoning, China
| | - Ze-Li Guo
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, Liaoning, China
| | - Mei-Ling Wang
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, Liaoning, China
| | - Chuan Yang
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, Liaoning, China
| | - Shu-Yi An
- Liaoning Provincial Centers for Disease Control and Prevention, Shenyang, Liaoning, China
| | - Wei Wu
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, Liaoning, China.
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Russell SJ, Hope S, Croker H, Crozier S, Packer J, Inskip H, Viner RM. Modeling the impact of calorie-reduction interventions on population prevalence and inequalities in childhood obesity in the Southampton Women's Survey. Obes Sci Pract 2021; 7:545-554. [PMID: 34631133 PMCID: PMC8488449 DOI: 10.1002/osp4.520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/26/2021] [Accepted: 05/02/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND In the United Kingdom, rates of childhood obesity are high and inequalities in obesity have widened in recent years. Children with obesity face heightened risks of living with obesity as adults and suffering from associated morbidities. Addressing population prevalence and inequalities in childhood obesity is a key priority for public health policymakers in the United Kingdom and elsewhere. Where randomized controlled trials are not possible, potential policy actions can be simulated using causal modeling techniques. OBJECTIVES Using data from the Southampton Women's Survey (SWS), a cohort with high quality dietary and lifestyle data, the potential impact of policy-relevant calorie-reduction interventions on population prevalence and inequalities of childhood obesity was investigated. METHODS Predicted probabilities of obesity (using UK90 cut-offs) at age 6-7 years were estimated from logistic marginal structural models adjusting for observed calorie consumption at age 3 years (using food diaries) and confounding. A series of policy-relevant intervention scenarios were modeled to simulate reductions in energy intake (differing in effectiveness, the targeting mechanisms, and level of uptake). RESULTS At age 6-7 years, 8.3% of children were living with obesity, after accounting for observed energy intake and confounding. A universal intervention to lower median energy intake to the estimated average requirement (a 13% decrease), with an uptake of 75%, reduced obesity prevalence by 1% but relative and absolute inequalities remained broadly unchanged. CONCLUSIONS Simulated interventions substantially reduced population prevalence of obesity, which may be useful in informing policymakers.
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Affiliation(s)
- Simon J. Russell
- Obesity Policy Research UnitPopulation, Policy and PracticeGreat Ormond Street Institute of Child HealthUniversity College LondonLondonUK
| | - Steven Hope
- Obesity Policy Research UnitPopulation, Policy and PracticeGreat Ormond Street Institute of Child HealthUniversity College LondonLondonUK
| | - Helen Croker
- Obesity Policy Research UnitPopulation, Policy and PracticeGreat Ormond Street Institute of Child HealthUniversity College LondonLondonUK
| | - Sarah Crozier
- MRC Lifecourse Epidemiology UnitMedicineUniversity of SouthamptonSouthamptonUK
- NIHR Applied Research Collaboration WessexSouthampton Science ParkInnovation CentreSouthamptonUK
| | - Jessica Packer
- Obesity Policy Research UnitPopulation, Policy and PracticeGreat Ormond Street Institute of Child HealthUniversity College LondonLondonUK
| | - Hazel Inskip
- MRC Lifecourse Epidemiology UnitMedicineUniversity of SouthamptonSouthamptonUK
- NIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation TrustSouthamptonUK
| | - Russell M. Viner
- Obesity Policy Research UnitPopulation, Policy and PracticeGreat Ormond Street Institute of Child HealthUniversity College LondonLondonUK
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Accordini S, Calciano L, Johannessen A, Benediktsdóttir B, Bertelsen RJ, Bråbäck L, Dharmage SC, Forsberg B, Gómez Real F, Holloway JW, Holm M, Janson C, Jõgi NO, Jõgi R, Malinovschi A, Marcon A, Martínez-Moratalla Rovira J, Sánchez-Ramos JL, Schlünssen V, Torén K, Jarvis D, Svanes C. Prenatal and prepubertal exposures to tobacco smoke in men may cause lower lung function in future offspring: a three-generation study using a causal modelling approach. Eur Respir J 2021; 58:2002791. [PMID: 33795316 PMCID: PMC8529197 DOI: 10.1183/13993003.02791-2020] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 03/11/2021] [Indexed: 11/24/2022]
Abstract
Mechanistic research suggests that lifestyle and environmental factors impact respiratory health across generations by epigenetic changes transmitted through male germ cells. Evidence from studies on humans is very limited.We investigated multigeneration causal associations to estimate the causal effects of tobacco smoking on lung function within the paternal line. We analysed data from 383 adult offspring (age 18-47 years; 52.0% female) and their 274 fathers, who had participated in the European Community Respiratory Health Survey (ECRHS)/Respiratory Health in Northern Europe, Spain and Australia (RHINESSA) generation study and had provided valid measures of pre-bronchodilator lung function. Two counterfactual-based, multilevel mediation models were developed with: paternal grandmothers' smoking in pregnancy and fathers' smoking initiation in prepuberty as exposures; fathers' forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC), or FEV1/FVC z-scores as potential mediators (proxies of unobserved biological mechanisms that are true mediators); and offspring's FEV1 and FVC, or FEV1/FVC z-scores as outcomes. All effects were summarised as differences (Δ) in expected z-scores related to fathers' and grandmothers' smoking history.Fathers' smoking initiation in prepuberty had a negative direct effect on both offspring's FEV1 (Δz-score -0.36, 95% CI -0.63- -0.10) and FVC (-0.50, 95% CI -0.80- -0.20) compared with fathers' never smoking. Paternal grandmothers' smoking in pregnancy had a negative direct effect on fathers' FEV1/FVC (-0.57, 95% CI -1.09- -0.05) and a negative indirect effect on offspring's FEV1/FVC (-0.12, 95% CI -0.21- -0.03) compared with grandmothers' not smoking before fathers' birth nor during fathers' childhood.Fathers' smoking in prepuberty and paternal grandmothers' smoking in pregnancy may cause lower lung function in offspring. Our results support the concept that lifestyle-related exposures during these susceptibility periods influence the health of future generations.
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Affiliation(s)
- Simone Accordini
- Unit of Epidemiology and Medical Statistics, Dept of Diagnostics and Public Health, University of Verona, Verona, Italy
- Equal contribution as first authors
| | - Lucia Calciano
- Unit of Epidemiology and Medical Statistics, Dept of Diagnostics and Public Health, University of Verona, Verona, Italy
- Equal contribution as first authors
| | - Ane Johannessen
- Centre for International Health, Dept of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | | | - Randi Jacobsen Bertelsen
- Dept of Clinical Science, University of Bergen, Bergen, Norway
- Oral Health Centre of Expertise in Western Norway/Vestland, Bergen, Norway
| | - Lennart Bråbäck
- Section of Sustainable Health, Dept of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Bertil Forsberg
- Section of Sustainable Health, Dept of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Francisco Gómez Real
- Dept of Clinical Science, University of Bergen, Bergen, Norway
- Dept of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - John W Holloway
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Mathias Holm
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Christer Janson
- Dept of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Nils O Jõgi
- Dept of Clinical Science, University of Bergen, Bergen, Norway
- Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - Rain Jõgi
- Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - Andrei Malinovschi
- Dept of Medical Sciences: Clinical Physiology, Uppsala University, Uppsala, Sweden
| | - Alessandro Marcon
- Unit of Epidemiology and Medical Statistics, Dept of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Jesús Martínez-Moratalla Rovira
- Servicio de Neumología, Complejo Hospitalario Universitario de Albacete (CHUA), Servicio de Salud de Castilla-La Mancha (SESCAM), Albacete, Spain
| | | | | | - Kjell Torén
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Deborah Jarvis
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, UK
- MRC-PHE Centre for Environment and Health, Imperial College London, London, UK
- Equal contribution as last authors
| | - Cecilie Svanes
- Centre for International Health, Dept of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Equal contribution as last authors
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30
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Svanes C, Bertelsen RJ, Accordini S, Holloway JW, Júlíusson P, Boateng E, Krauss-Etchmann S, Schlünssen V, Gómez-Real F, Skulstad SM. Exposures during the prepuberty period and future offspring's health: evidence from human cohort studies†. Biol Reprod 2021; 105:667-680. [PMID: 34416759 PMCID: PMC8444705 DOI: 10.1093/biolre/ioab158] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 07/02/2021] [Accepted: 08/17/2021] [Indexed: 11/13/2022] Open
Abstract
Emerging evidence suggests that exposures in prepuberty, particularly in fathers-to-be, may impact the phenotype of future offspring. Analyses of the RHINESSA cohort find that offspring of father’s exposed to tobacco smoking or overweight that started in prepuberty demonstrate poorer respiratory health in terms of more asthma and lower lung function. A role of prepuberty onset smoking for offspring fat mass is suggested in the RHINESSA and ALSPAC cohorts, and historic studies suggest that ancestral nutrition during prepuberty plays a role for grand-offspring’s health and morbidity. Support for causal relationships between ancestral exposures and (grand-)offspring’s health in humans has been enhanced by advancements in statistical analyses that optimize the gain while accounting for the many complexities and deficiencies in human multigeneration data. The biological mechanisms underlying such observations have been explored in experimental models. A role of sperm small RNA in the transmission of paternal exposures to offspring phenotypes has been established, and chemical exposures and overweight have been shown to influence epigenetic programming in germ cells. For example, exposure of adolescent male mice to smoking led to differences in offspring weight and alterations in small RNAs in the spermatozoa of the exposed fathers. It is plausible that male prepuberty may be a time window of particular susceptibility, given the extensive epigenetic reprogramming taking place in the spermatocyte precursors at this age. In conclusion, epidemiological studies in humans, mechanistic research, and biological plausibility, all support the notion that exposures in the prepuberty of males may influence the phenotype of future offspring.
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Affiliation(s)
- Cecilie Svanes
- Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway.,Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | - Randi J Bertelsen
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Oral Health Centre of Expertise Western Norway, Bergen, Norway
| | - Simone Accordini
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - John W Holloway
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, UK.,Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Pétur Júlíusson
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Health Register Research and Development, National Institute of Public Health, Bergen, Norway
| | - Eistine Boateng
- Early Life Origins of Chronic Lung Disease, Research Center Borstel, Leibniz Lung Center, German Center for Lung Research (DZL), Borstel, Germany
| | - Susanne Krauss-Etchmann
- Early Life Origins of Chronic Lung Disease, Research Center Borstel, Leibniz Lung Center, German Center for Lung Research (DZL), Borstel, Germany.,Institute of Experimental Medicine, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - Vivi Schlünssen
- Department of Public Health-Work, Environment and Health, Danish Ramazzini Centre, Aarhus University, Denmark.,National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Francisco Gómez-Real
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Gynaecology and Obstetrics, Haukeland University Hospital, Bergen, Norway
| | - Svein Magne Skulstad
- Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
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Association between perceived stress and depression among medical students during the outbreak of COVID-19: The mediating role of insomnia. J Affect Disord 2021; 292:89-94. [PMID: 34107425 PMCID: PMC8595067 DOI: 10.1016/j.jad.2021.05.028] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/14/2021] [Accepted: 05/20/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND The purpose of this study was to explore the association between perceived stress and depression among medical students and the mediating role of insomnia in this relationship during the COVID-19 pandemic in China. METHODS A cross-sectional survey was conducted from March to April 2020 in medical university. Levels of perceived stress, insomnia and depression were measured using Perceived Stress Scale (PSS), Insomnia Severity Index (ISI) and Patient Health Questionnaire 9 (PHQ-9). The descriptive analyses of the demographic characteristics and correlation analyses of the three variables were calculated. The significance of the mediation effect was obtained using a bootstrap approach with SPSS PROCESS macro. RESULTS The mean age of medical students was 21.46 years (SD=2.50). Of these medical students, 10,185 (34.3%) were male and 19,478 (65.7%) were female. Perceived stress was significantly associated with depression (β=0.513, P < 0.001). Insomnia mediated the association between perceived stress and depression (β=0.513, P < 0.001). The results of the non-parametric bootstrapping method confirmed the significance of the indirect effect of perceived stress through insomnia (95% bootstrap CI =0.137, 0.149). The indirect effect of insomnia accounted for 44.13% of the total variance in depression. CONCLUSIONS These findings contribute to a better understanding of the interactive mechanisms underlying perceived stress and depression, and elucidating the mediating effects of insomnia on the association. This research provides a useful theoretical and methodological approach for prevention of depression in medical students. Findings from this study indicated that it may be effective to reduce depression among medical students by improving sleep quality and easing perceived stress.
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Browne J, Halverson TF, Vilardaga R. Engagement with a digital therapeutic for smoking cessation designed for persons with psychiatric illness fully mediates smoking outcomes in a pilot randomized controlled trial. Transl Behav Med 2021; 11:1717-1725. [PMID: 34347865 DOI: 10.1093/tbm/ibab100] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Understanding the mechanisms of change of digital therapeutics is a critical step to improve digital health outcomes and optimize their development. Access to and engagement with digital content is arguably a core mechanism of change of these interventions. However, the mediational role of app engagement has been largely unexamined. To evaluate the mediational effect of engaging with a digital therapeutic for smoking cessation designed for adults with psychiatric disorders. Secondary analysis of a pilot clinical trial of 62 adults with serious mental illness who were randomized to receive either a tailored digital therapeutic (Learn to Quit) or a digital therapeutic for the general public (NCI QuitGuide). Engagement was captured using background analytics of app utilization, including (a) number of interactions with app content, (b) minutes/day of app use, and (c) number of days used. The main outcome was reductions in cigarettes per day from baseline to the four-month endpoint. Mediational analysis followed the Preacher and Hayes bootstrap method. Number of application interactions fully mediated reductions in cigarettes per day in the Learn to Quit application but not in QuitGuide (Average Causal Mediation Effect = .31, p = .02). Minutes/day of app use played an uncertain role, and number of days used was not a significant mediator. Results suggest that one of the mechanisms of action of the Learn to Quit device, engagement with theory-based content, functioned as intended. Future research of digital therapeutics should emphasize granular approaches to evaluating apps' mechanisms of action.
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Affiliation(s)
- Julia Browne
- Geriatric Research, Education and Clinical Center, Durham VA Health Care System, Durham, NC 27705, USA.,Durham VA Health Care System, Durham, NC 27705, USA
| | - Tate F Halverson
- Durham VA Health Care System, Durham, NC 27705, USA.,Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Roger Vilardaga
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC 27705, USA
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33
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Smyth HL, Pitpitan EV, MacKinnon DP, Booth RE. Assessing Potential Outcomes Mediation in HIV Interventions. AIDS Behav 2021; 25:2441-2454. [PMID: 33740215 DOI: 10.1007/s10461-021-03207-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2021] [Indexed: 10/21/2022]
Abstract
Knowledge of causal processes through mediation analysis can help improve the effectiveness and reduce costs of public health programs, like HIV prevention and treatment interventions. Advancements in mediation using the potential outcomes framework provide a method for estimating the causal effect of interventions on outcomes via a mediating variable. The purpose of this paper is to provide practical information about mediation and the potential outcomes framework that can enhance data analysis and causal inference for intervention studies. Causal mediation effects are defined and then estimated using data from an HIV intervention randomized trial among people who inject drugs (PWID) in Ukraine. Results from a potential outcomes mediation analysis show that the intervention had a total causal effect on incident HIV infection such that participants in the experimental group were 36% less likely to become infected during the 12-month study than those in the control arm, but that neither self-efficacy nor network communication mediated this effect. Because neither putative mediator was significant, measurement and confounding issues should be investigated to rule out these mediators. Other putative mediators, such as injection frequency, route of administration, or HIV knowledge can be considered. Future research is underway to examine additional, multiple mediators explaining efficacy of the current intervention and sensitivity to confounding effects.
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34
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Hsu C, Tseng P, Tu Y, Lin P, Hung C, Liang C, Hsieh Y, Yang Y, Wang L, Kao H. Month of birth and mental disorders: A population-based study and validation using global meta-analysis. Acta Psychiatr Scand 2021; 144:153-167. [PMID: 33930177 PMCID: PMC8360113 DOI: 10.1111/acps.13313] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 04/27/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Month of birth (MOB) is associated with specified mental disorders (MDs). However, whether these relationships extend to all MDs remains unclear. We investigate the association using a population-based cohort study and a meta-analysis. METHODS First, we examined patients with 34 DSM-5-classified MDs in the Taiwan national database. We estimated the relative risk ratios (RR) of each illness in each MOB relative to that in the general population and assessed the periodicity, with six further sensitivity analyses. Second, we searched PubMed, Embase, and Cochrane for related articles through 31 December 2020. We used a random-effects model, pooled RRs with 95% confidence intervals of each MOB from the identified studies, and transformed them from MOB to relative age in a year or season. RESULTS The cohort included 1,951,777 patients. Except for posttraumatic stress disorder, dissociative disorders, feeding/eating disorders, gender dysphoria, and paraphilic disorders, the other MDs had significant MOB periodicity. The meta-analysis included 51 studies investigating 10 MDs. The youngest age at the start of school owing to MOB was associated with the highest RRs of intellectual disability (1.13), autism (1.05), attention-deficit/hyperactivity disorder (1.13). Winter births had significant risks of schizophrenia (1.04), bipolar I disorder (1.02), and major depressive disorder (1.01), and autumn births had a significant risk of alcohol use disorder (1.02). No significant associations between season of birth and Alzheimer's disease, or eating disorders were found. CONCLUSIONS MOB is related to the risks of certain MDs. This finding provides a reference for future research on the etiology of MDs.
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Affiliation(s)
- Chih‐Wei Hsu
- Department of PsychiatryKaohsiung Chang Gung Memorial Hospital and Chang Gung University College of MedicineKaohsiungTaiwan,Department of Computer Science and Information EngineeringNational Cheng Kung UniversityTainanTaiwan
| | - Ping‐Tao Tseng
- Prospect Clinic for Otorhinolaryngology & NeurologyKaohsiungTaiwan,Institute of Biomedical SciencesNational Sun Yat‐sen UniversityKaohsiungTaiwan,Department of PsychologyCollege of Medical and Health Science, Asia UniversityTaichungTaiwan
| | - Yu‐Kang Tu
- Institute of Epidemiology & Preventive MedicineCollege of Public HealthNational Taiwan UniversityTaipeiTaiwan,Department of DentistryNational Taiwan University HospitalTaipeiTaiwan
| | - Pao‐Yen Lin
- Department of PsychiatryKaohsiung Chang Gung Memorial Hospital and Chang Gung University College of MedicineKaohsiungTaiwan,Institute for Translational Research in Biomedical SciencesKaohsiung Chang Gung Memorial HospitalKaohsiungChina
| | - Chi‐Fa Hung
- Department of PsychiatryKaohsiung Chang Gung Memorial Hospital and Chang Gung University College of MedicineKaohsiungTaiwan
| | - Chih‐Sung Liang
- Department of Psychiatry, Beitou BranchTri‐Service General HospitalSchool of MedicineNational Defense Medical CenterTaipeiTaiwan,Graduate Institute of Medical SciencesNational Defense Medical CenterTaipeiTaiwan
| | - Yun‐Yu Hsieh
- Department of PsychiatryKaohsiung Chang Gung Memorial Hospital and Chang Gung University College of MedicineKaohsiungTaiwan
| | - Yao‐Hsu Yang
- Health Information and Epidemiology LaboratoryChang Gung Memorial HospitalChiayi CountyTaiwan,Department of Traditional Chinese MedicineChang Gung Memorial HospitalChiayi CountyTaiwan,School of Traditional Chinese MedicineCollege of MedicineChang Gung UniversityTaoyuanTaiwan
| | - Liang‐Jen Wang
- Department of Child and Adolescent PsychiatryKaohsiung Chang Gung Memorial Hospital and Chang Gung University College of MedicineKaohsiungTaiwan,Department of Chinese MedicineCollege of MedicineChang Gung UniversityTaoyuanTaiwan
| | - Hung‐Yu Kao
- Department of Computer Science and Information EngineeringNational Cheng Kung UniversityTainanTaiwan
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Alves D, Craveiro I, Basabe N, Gonçalves L. Mixed methods study protocol to explore acculturation, lifestyles and health of immigrants from the Community of Portuguese-Speaking Countries in two Iberian contexts: how to face uncertainties amidst the COVID-19 pandemic. BMJ Open 2021; 11:e048818. [PMID: 34244275 PMCID: PMC8275362 DOI: 10.1136/bmjopen-2021-048818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 06/18/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Studies which focus on the process of acculturation in the lifestyles, nutritional status and health of immigrants from the Community of Portuguese-Speaking Countries (CPLP) in the Iberian Peninsula are still scarce. This study aims to explore the influence of the acculturation process and dietary acculturation on the lifestyle and nutritional and health status of CPLP immigrants in Portugal and Spain, focusing on two Iberian contexts: Lisbon Metropolitan Area and the Basque Country. METHODS AND ANALYSIS A mixed methods sequential explanatory design, combining cross-sectional studies and semistructured interviews. Official data will also be analysed. Primary data will be collected through a questionnaire and assessment of nutritional status and body composition. The estimated samples sizes are 1061 adults (≥18 years old) in the Lisbon Metropolitan Area and 573 in the Basque Country. Time-location sampling will be used for the quantitative component and non-probabilistic sampling for the qualitative component. If safety conditions are not guaranteed due to the COVID-19 pandemic, online studies will be conducted. The semistructured interviews will complement the questionnaire data and extend knowledge about the process of acculturation of CPLP immigrants and their relationship with eating habits and physical activity. Thematic analysis will be used for qualitative data. Triangulation of data derived from different methods will be carried out. An integrative approach will be used to address potential discrepancies in findings and limitations inherent to the study design. As inter-method discrepancies may occur, triangulation protocol will be used, elaborating a 'convergence coding matrix' to display findings emerging from each component of the study. ETHICS AND DISSEMINATION Ethical approval was obtained through the IHMT Ethics Council (Doc No 20/2020), Portugal, and it was submitted to the Ethics Committee of the UPV/EHU (Doc No under revision), Spain.
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Affiliation(s)
- Daniela Alves
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
- Unidade de Saúde Pública Internacional e Bioestatística, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Isabel Craveiro
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
- Unidade de Saúde Pública Internacional e Bioestatística, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Nekane Basabe
- Department of Social Psychology and Methodology of Behavioural Sciences, Faculty of Pharmacy, Universidad del País Vasco, Vitoria, Spain
| | - Luzia Gonçalves
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
- Unidade de Saúde Pública Internacional e Bioestatística, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
- Centro de Estatística e Aplicações da Universidade de Lisboa, Lisboa, Portugal
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36
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Yu Z, Cui Y, Wei T, Ma Y, Luo C. High-Dimensional Mediation Analysis With Confounders in Survival Models. Front Genet 2021; 12:688871. [PMID: 34262599 PMCID: PMC8273300 DOI: 10.3389/fgene.2021.688871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/07/2021] [Indexed: 12/02/2022] Open
Abstract
Mediation analysis is a common statistical method for investigating the mechanism of environmental exposures on health outcomes. Previous studies have extended mediation models with a single mediator to high-dimensional mediators selection. It is often assumed that there are no confounders that influence the relations among the exposure, mediator, and outcome. This is not realistic for the observational studies. To accommodate the potential confounders, we propose a concise and efficient high-dimensional mediation analysis procedure using the propensity score for adjustment. Results from simulation studies demonstrate the proposed procedure has good performance in mediator selection and effect estimation compared with methods that ignore all confounders. Of note, as the sample size increases, the performance of variable selection and mediation effect estimation is as well as the results shown in the method which include all confounders as covariates in the mediation model. By applying this procedure to a TCGA lung cancer data set, we find that lung cancer patients who had serious smoking history have increased the risk of death via the methylation markers cg21926276 and cg20707991 with significant hazard ratios of 1.2093 (95% CI: 1.2019-1.2167) and 1.1388 (95% CI: 1.1339-1.1438), respectively.
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Affiliation(s)
- Zhangsheng Yu
- Department of Bioinformatics and Biostatistics, School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, China
- SJTU-Yale Joint Center for Biostatistics, Shanghai Jiao Tong University, Shanghai, China
- Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yidan Cui
- Department of Bioinformatics and Biostatistics, School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, China
- SJTU-Yale Joint Center for Biostatistics, Shanghai Jiao Tong University, Shanghai, China
| | - Ting Wei
- Department of Bioinformatics and Biostatistics, School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, China
- SJTU-Yale Joint Center for Biostatistics, Shanghai Jiao Tong University, Shanghai, China
| | - Yanran Ma
- Department of Bioinformatics and Biostatistics, School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, China
- SJTU-Yale Joint Center for Biostatistics, Shanghai Jiao Tong University, Shanghai, China
| | - Chengwen Luo
- Department of Bioinformatics and Biostatistics, School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, China
- SJTU-Yale Joint Center for Biostatistics, Shanghai Jiao Tong University, Shanghai, China
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37
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Liu X, Wang L. The impact of measurement error and omitting confounders on statistical inference of mediation effects and tools for sensitivity analysis. Psychol Methods 2021; 26:327-342. [PMID: 32718152 PMCID: PMC8351460 DOI: 10.1037/met0000345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
To make valid statistical inferences from mediation analysis, a number of assumptions need to be assessed. Among the assumptions, 2 frequently discussed ones are (a) the independent variable, mediator, and outcome variables are measured without error; and (b) no confounders of the effects in the mediation model are omitted. The impact of violating either assumption alone on statistical inference of mediation has been discussed in previous literature. In practice, violations of the 2 assumptions often co-occur. In this study, we analytically investigated the effects of measurement error and omitting confounders on statistical inference of mediation effects, including both point estimation and significance testing. Based on the analytical results, we proposed sensitivity analysis techniques for assessing the robustness of mediation inference to the violation of the 2 assumptions. To implement the techniques, we developed R functions and a user-friendly web tool. Simulated-data and real-data examples were provided for illustrations. We hope the developed tools will help researchers conduct sensitivity analyses of mediation inference more conveniently. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Marselle MR, Hartig T, Cox DTC, de Bell S, Knapp S, Lindley S, Triguero-Mas M, Böhning-Gaese K, Braubach M, Cook PA, de Vries S, Heintz-Buschart A, Hofmann M, Irvine KN, Kabisch N, Kolek F, Kraemer R, Markevych I, Martens D, Müller R, Nieuwenhuijsen M, Potts JM, Stadler J, Walton S, Warber SL, Bonn A. Pathways linking biodiversity to human health: A conceptual framework. ENVIRONMENT INTERNATIONAL 2021; 150:106420. [PMID: 33556912 DOI: 10.1016/j.envint.2021.106420] [Citation(s) in RCA: 115] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 01/10/2021] [Accepted: 01/22/2021] [Indexed: 05/05/2023]
Abstract
Biodiversity is a cornerstone of human health and well-being. However, while evidence of the contributions of nature to human health is rapidly building, research into how biodiversity relates to human health remains limited in important respects. In particular, a better mechanistic understanding of the range of pathways through which biodiversity can influence human health is needed. These pathways relate to both psychological and social processes as well as biophysical processes. Building on evidence from across the natural, social and health sciences, we present a conceptual framework organizing the pathways linking biodiversity to human health. Four domains of pathways-both beneficial as well as harmful-link biodiversity with human health: (i) reducing harm (e.g. provision of medicines, decreasing exposure to air and noise pollution); (ii) restoring capacities (e.g. attention restoration, stress reduction); (iii) building capacities (e.g. promoting physical activity, transcendent experiences); and (iv) causing harm (e.g. dangerous wildlife, zoonotic diseases, allergens). We discuss how to test components of the biodiversity-health framework with available analytical approaches and existing datasets. In a world with accelerating declines in biodiversity, profound land-use change, and an increase in non-communicable and zoonotic diseases globally, greater understanding of these pathways can reinforce biodiversity conservation as a strategy for the promotion of health for both people and nature. We conclude by identifying research avenues and recommendations for policy and practice to foster biodiversity-focused public health actions.
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Affiliation(s)
- Melissa R Marselle
- Helmholtz Centre for Environmental Research - UFZ, Department of Ecosystem Services, Permoserstraße 15, 04318 Leipzig, Germany; German Centre for Integrative Biodiversity Research (iDiv) Halle-Jena-Leipzig, Puschstraße 4, 04103 Leipzig, Germany; Institute of Biodiversity, Friedrich Schiller University Jena, Dornburger Straße 159, 07743 Jena, Germany; Institute of Psychological Sciences, De Montfort University, Leicester, United Kingdom.
| | - Terry Hartig
- Institute for Housing and Urban Research, Uppsala University, Box 514, SE-75120 Uppsala, Sweden; Department of Psychology, Uppsala University, Box 1225, SE-75142 Uppsala, Sweden
| | - Daniel T C Cox
- Environment and Sustainability Institute, University of Exeter, Penryn, Cornwall TR10 9FE, United Kingdom
| | - Siân de Bell
- European Centre for Environment and Human Health, University of Exeter, Truro, Cornwall TR1 3HD, United Kingdom
| | - Sonja Knapp
- Helmholtz Centre for Environmental Research - UFZ, Department of Community Ecology, Theodor-Lieser-Str. 4, 06120 Halle, Germany
| | - Sarah Lindley
- Department of Geography, School of Environment, Education and Development, University of Manchester, Oxford Road, Manchester M13 9PL, United Kingdom
| | - Margarita Triguero-Mas
- Universitat Autònoma de Barcelona, Barcelona, Spain; Institute for Environmental Science and Technology, Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Barcelona Lab for Urban Environmental Justice and Sustainability, Barcelona, Spain
| | - Katrin Böhning-Gaese
- German Centre for Integrative Biodiversity Research (iDiv) Halle-Jena-Leipzig, Puschstraße 4, 04103 Leipzig, Germany; Senckenberg Biodiversity and Climate Research Centre (SBiK-F), Senckenberganlage 25, 60325 Frankfurt (Main), Germany; Goethe University Frankfurt am Main, Institute for Ecology, Evolution & Diversity, Max-von-Laue-Str. 13, 60439 Frankfurt (Main), Germany
| | - Matthias Braubach
- WHO Regional Office for Europe, European Centre for Environment and Health, Platz der Vereinten Nationen 1, 53113 Bonn, Germany
| | - Penny A Cook
- School of Health and Society, University of Salford, Salford M6 6PU, United Kingdom
| | - Sjerp de Vries
- Cultural Geography, Wageningen Environmental Research, Wageningen University & Research, P.O. Box 47, 6700 AA Wageningen, the Netherlands
| | - Anna Heintz-Buschart
- German Centre for Integrative Biodiversity Research (iDiv) Halle-Jena-Leipzig, Puschstraße 4, 04103 Leipzig, Germany; Helmholtz Centre for Environmental Research - UFZ, Department of Soil Ecology, Theodor-Lieser-Str. 4, 06120 Halle, Germany
| | - Max Hofmann
- German Centre for Integrative Biodiversity Research (iDiv) Halle-Jena-Leipzig, Puschstraße 4, 04103 Leipzig, Germany; Institute of Biology, Martin Luther University Halle-Wittenberg, Am Kirchtor 1, 06108 Halle (Saale), Germany; Leibniz Institute of Agricultural Development in Transition Economies (IAMO), Theodor-Lieser- Strasse 2, 06120 Halle (Saale), Germany
| | - Katherine N Irvine
- Social, Economic and Geographical Sciences Department, The James Hutton Institute, Aberdeen AB15 8QH, United Kingdom
| | - Nadja Kabisch
- Humboldt-Universität zu Berlin, Geography Department, Unter den Linden 6, 10099 Berlin, Germany; Helmholtz Centre for Environmental Research-UFZ, Department of Urban and Environmental Sociology, Leipzig, Germany
| | - Franziska Kolek
- Chair and Institute of Environmental Medicine, UNIKA-T, Technical University of Munich and Helmholtz Zentrum München, Germany - German Research Centre for Environmental Health, Augsburg, Germany
| | - Roland Kraemer
- Humboldt-Universität zu Berlin, Geography Department, Unter den Linden 6, 10099 Berlin, Germany; Helmholtz Centre for Environmental Research - UFZ, Department of Monitoring and Exploration Technologies, Permoserstraße 15, 04318 Leipzig, Germany
| | - Iana Markevych
- Institute of Psychology, Jagiellonian University, Ingardena 6, 33-332 Krakow, Poland
| | - Dörte Martens
- Eberswalde University for Sustainable Development, Faculty of Landscape Management and Nature Conservation, Eberswalde, Germany
| | - Ruth Müller
- Unit Entomology, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium; Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Theodor-Stern-Kai 7, 60596 Frankfurt (Main), Germany
| | - Mark Nieuwenhuijsen
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Mary MacKillop Institute for Health Research, Melbourne, Australia
| | - Jacqueline M Potts
- Biomathematics and Statistics Scotland, Craigiebuckler, Aberdeen AB15 8QH, United Kingdom
| | - Jutta Stadler
- German Federal Agency for Nature Conservation (BfN), Germany
| | - Samantha Walton
- Department of English Literature, Bath Spa University, Bath, United Kingdom
| | - Sara L Warber
- European Centre for Environment and Human Health, University of Exeter, Truro, Cornwall TR1 3HD, United Kingdom; Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Aletta Bonn
- Helmholtz Centre for Environmental Research - UFZ, Department of Ecosystem Services, Permoserstraße 15, 04318 Leipzig, Germany; German Centre for Integrative Biodiversity Research (iDiv) Halle-Jena-Leipzig, Puschstraße 4, 04103 Leipzig, Germany; Institute of Biodiversity, Friedrich Schiller University Jena, Dornburger Straße 159, 07743 Jena, Germany
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Yan Z, Mansor ZD, Choo WC, Abdullah AR. Mitigating Effect of Psychological Capital on Employees' Withdrawal Behavior in the Presence of Job Attitudes: Evidence From Five-Star Hotels in Malaysia. Front Psychol 2021; 12:617023. [PMID: 33868086 PMCID: PMC8044991 DOI: 10.3389/fpsyg.2021.617023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 02/15/2021] [Indexed: 11/13/2022] Open
Abstract
High turnover rate is one of the striking features of the hotel industry and one of the most significant challenges. High turnover rate causes substantial costs for recruitment, selection and training in hotels, on the other hand, it also leads to negative consequences such as the decline of organizational performance and service quality. Thus, it is necessary to search for the root causes of turnover and put forward solutions. This study was designed to examine the impact of psychological capital (PsyCap), organizational commitment (OC), and job satisfaction (JS) on turnover intention among hotel employees. Additionally, it aimed to test the mediating roles of job satisfaction (JS) and organizational commitment (OC). The data were obtained from 228 hotel customer-contact employees with a time lag of two weeks in three waves in Kuala Lumpur based on convenience sampling. A series of structural equation modeling analyses were utilized to investigate hypothesized relationships. The results reveal that there exists a significant and negative impact of PsyCap on employees' turnover intention and this correlation is partially mediated through two job attitudes. That is to say, to retain hotel talents, five-star hotel management should take proper measures to help employees obtain and maintain positive psychological resources such as PsyCap, on the other hand, how to cultivate positive job attitudes and strengthen their sense of identification and belonging for their organizations is supposed to be more focused on.
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Affiliation(s)
- Zhen Yan
- Faculty of Hotel Management, Qingdao Vocational and Technical College of Hotel Management, Qingdao, China.,School of Business and Economics, Universiti Putra Malaysia, Serdang, Malaysia
| | - Zuraina D Mansor
- School of Business and Economics, Universiti Putra Malaysia, Serdang, Malaysia
| | - Wei C Choo
- School of Business and Economics, Universiti Putra Malaysia, Serdang, Malaysia
| | - Abdul R Abdullah
- Faculty of Hotel Management, Qingdao Vocational and Technical College of Hotel Management, Qingdao, China.,School of Business and Economics, Universiti Putra Malaysia, Serdang, Malaysia
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40
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Fornili M, Perduca V, Fournier A, Jérolon A, Boutron-Ruault MC, Maskarinec G, Severi G, Baglietto L. Association between menopausal hormone therapy, mammographic density and breast cancer risk: results from the E3N cohort study. Breast Cancer Res 2021; 23:47. [PMID: 33865453 PMCID: PMC8053286 DOI: 10.1186/s13058-021-01425-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 04/01/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Menopausal hormone therapy (MHT) is a risk factor for breast cancer (BC). Evidence suggests that its effect on BC risk could be partly mediated by mammographic density. The aim of this study was to investigate the relationship between MHT, mammographic density and BC risk using data from a prospective study. METHODS We used data from a case-control study nested within the French cohort E3N including 453 cases and 453 matched controls. Measures of mammographic density, history of MHT use during follow-up and information on potential confounders were available for all women. The association between MHT and mammographic density was evaluated by linear regression models. We applied mediation modelling techniques to estimate, under the hypothesis of a causal model, the proportion of the effect of MHT on BC risk mediated by percent mammographic density (PMD) for BC overall and by hormone receptor status. RESULTS Among MHT users, 4.2% used exclusively oestrogen alone compared with 68.3% who used exclusively oestrogens plus progestogens. Mammographic density was higher in current users (for a 60-year-old woman, mean PMD 33%; 95% CI 31 to 35%) than in past (29%; 27 to 31%) and never users (24%; 22 to 26%). No statistically significant association was observed between duration of MHT and mammographic density. In past MHT users, mammographic density was negatively associated with time since last use; values similar to those of never users were observed in women who had stopped MHT at least 8 years earlier. The odds ratio of BC for current versus never MHT users, adjusted for age, year of birth, menopausal status at baseline and BMI, was 1.67 (95% CI, 1.04 to 2.68). The proportion of effect mediated by PMD was 34% for any BC and became 48% when the correlation between BMI and PMD was accounted for. These effects were limited to hormone receptor-positive BC. CONCLUSIONS Our results suggest that, under a causal model, nearly half of the effect of MHT on hormone receptor-positive BC risk is mediated by mammographic density, which appears to be modified by MHT for up to 8 years after MHT termination.
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Affiliation(s)
- M Fornili
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - V Perduca
- Laboratoire MAP 5 (UMR CNRS 8145), Université de Paris, Paris, France
| | - A Fournier
- University Paris-Saclay, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP UMR1018, 94805, Villejuif, France
| | - A Jérolon
- Laboratoire MAP 5 (UMR CNRS 8145), Université de Paris, Paris, France
| | - M C Boutron-Ruault
- University Paris-Saclay, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP UMR1018, 94805, Villejuif, France
| | - G Maskarinec
- University of Hawaii Cancer Center, Honolulu, USA
| | - G Severi
- University Paris-Saclay, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP UMR1018, 94805, Villejuif, France.
- Department of Statistics, Computer Science and Applications (DISIA), University of Florence, Florence, Italy.
| | - L Baglietto
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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41
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Fan Y, Li X, Xu Q, Zhang Y, Yang X, Han X, Du G, Xia Y, Wang X, Lu C. Serum albumin mediates the effect of multiple per- and polyfluoroalkyl substances on serum lipid levels. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2020; 266:115138. [PMID: 32717635 DOI: 10.1016/j.envpol.2020.115138] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/21/2020] [Accepted: 06/27/2020] [Indexed: 06/11/2023]
Abstract
Perfluoroalkyl and polyfluoroalkyl substances (PFASs) are synthetically manufactured chemicals recognized to be toxic, bioaccumulative, and persistent. Previous studies on PFAS exposure and serum lipid levels have mainly focused on individual PFASs; however, the influence of multiple-PFAS exposure on the serum lipid profile remains unclear. This study was performed to evaluate the combined effects of multiple PFASs on serum lipid levels. Based on the National Health and Nutrition Examination Survey (NHANES) data (2011-2014), we first established a linear regression model to estimate the association between single-PFAS exposure and the serum lipid profile. Then, a weighted quantile sum (WQS) regression model and a Bayesian kernel machine regression (BKMR) model were used to evaluate the effects of multiple-PFAS exposure on the serum lipid profile. A mediating effect model was used to assess how albumin mediates these effects. We found that PFASs were significantly associated with the levels of serum lipids, including high-density lipoprotein (HDL), low-density lipoprotein (LDL) and total cholesterol (TC). The WQS index was significantly correlated with the levels of HDL (β: 2.03, 95% CI: 0.74-3.32, P-value = 0.002), LDL (β: 4.16, 95% CI: 1.07-7.24, P-value = 0.008) and TC (β: 6.54, 95% CI: 3.00-10.1, P-value < 0.001). In the BKMR analysis, our results demonstrated that the effect of PFASs on serum lipids increased significantly when the concentrations of the PFASs were at their 60th percentiles or above compared to those at their 50th percentile. Mediation analysis showed that albumin mediated the effects of selected PFASs on the levels of serum lipids except for triglycerides (TG). PFAS exposure was correlated with the levels of serum lipids, and this correlation was mediated by albumin. Our results suggest that a comprehensive evaluation of multi-PFAS exposure could better characterize real-life exposure compared with single-PFAS exposure.
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Affiliation(s)
- Yun Fan
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Xiuzhu Li
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Qiaoqiao Xu
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Yuqing Zhang
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Xu Yang
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Xiumei Han
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Guizhen Du
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Yankai Xia
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Xinru Wang
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Chuncheng Lu
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, 211166, China.
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Parenting as a Mediator of Associations between Depression in Mothers and Children’s Functioning: A Systematic Review and Meta-Analysis. Clin Child Fam Psychol Rev 2020; 23:427-460. [DOI: 10.1007/s10567-020-00322-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Interventions for reducing hospital-associated deconditioning: A systematic review and meta-analysis. Arch Gerontol Geriatr 2020; 90:104176. [PMID: 32652367 DOI: 10.1016/j.archger.2020.104176] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/30/2020] [Accepted: 07/02/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine the effectiveness of hospital-based interventions designed to reduce Hospital-Associated Deconditioning (HAD) for people in inpatient hospital settings. MATERIALS & METHODS Systematic literature search of published and unpublished databases was conducted from (inception to 01 June 2020). Randomised and non-randomised controlled trials investigating the effectiveness of enhanced inpatient programmes aimed to reduce HAD in adults admitted to a hospital ward were included. Evidence was appraised using the Cochrane Risk of Bias tool and outcomes evaluated against the GRADE criteria. Where appropriate, data were pooled in meta-analyses and presented as risk difference (RD) or standardised mean difference with 95 % confidence intervals (CI). RESULTS Seven studies recruiting 12,597 participants (7864 enhanced programmes; 4349 usual care) were included. There was low-quality evidence for reduced risk of decline in physical performance for those in the enhanced programmes compared to usual care (RD: -0.04; 95 % CI: -0.08 to -0.01; N = 2085). There was low- or very-low quality evidence reporting no benefit of enhanced programmes for mobility on discharge, length of hospital stay, hospital readmission, and mortality within the first three-months post-admission (p > 0.05). There was low-quality evidence that nursing home placement and mortality at 12-months was superior through enhanced inpatient programmes compared to usual care. CONCLUSION Enhanced inpatient programmes targeted at HAD may offer benefit over usual care for some outcomes. There remain uncertainty in relation to how applicable the findings are to non-North American countries, which elements of an enhanced programme are most important to reduce HAD, and longer-term sequelae.
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Dzhambov AM, Browning MHEM, Markevych I, Hartig T, Lercher P. Analytical approaches to testing pathways linking greenspace to health: A scoping review of the empirical literature. ENVIRONMENTAL RESEARCH 2020; 186:109613. [PMID: 32668553 DOI: 10.1016/j.envres.2020.109613] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 04/26/2020] [Accepted: 04/26/2020] [Indexed: 05/04/2023]
Abstract
BACKGROUND Inadequate translation from theoretical to statistical models of the greenspace - health relationship may lead to incorrect conclusions about the importance of some pathways, which in turn may reduce the effectiveness of public health interventions involving urban greening. In this scoping review we aimed to: (1) summarize the general characteristics of approaches to intervening variable inference (mediation analysis) employed in epidemiological research in the field; (2) identify potential threats to the validity of findings; and (3) propose recommendations for planning, conducting, and reporting mediation analyses. METHODS We conducted a scoping review, searching PubMed, Scopus, and Web of Science for peer-reviewed epidemiological studies published by December 31, 2019. The list of potential studies was continuously updated through other sources until March 2020. Narrative presentation of the results was coupled with descriptive summary of study characteristics. RESULTS We found 106 studies, most of which were cross-sectional in design. Most studies only had a spatial measure of greenspace. Mental health/well-being was the most commonly studied outcome, and physical activity and air pollution were the most commonly tested intervening variables. Most studies only conducted single mediation analysis, even when multiple potentially intertwined mediators were measured. The analytical approaches used were causal steps, difference-of-coefficients, product-of-coefficients, counterfactual framework, and structural equation modelling (SEM). Bootstrapping was the most commonly used method to construct the 95% CI of the indirect effect. The product-of-coefficients method and SEM as used to investigate serial mediation components were more likely to yield findings of indirect effect. In some cases, the causal steps approach thwarted tests of indirect effect, even though both links in an indirect effect were supported. In most studies, sensitivity analyses and proper methodological discussion of the modelling approach were missing. CONCLUSIONS We found a persistent pattern of suboptimal conduct and reporting of mediation analysis in epidemiological studies investigating pathways linking greenspace to health; however, recent years have seen improvements in these respects. Better planning, conduct, and reporting of mediation analyses are warranted.
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Affiliation(s)
- Angel M Dzhambov
- Department of Hygiene and Ecomedicine, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria.
| | - Matthew H E M Browning
- Department of Park, Recreation, and Tourism Management, Clemson University, Clemson, USA
| | - Iana Markevych
- Institute of Psychology, Jagiellonian University, Krakow, Poland
| | - Terry Hartig
- Institute for Housing and Urban Research, Uppsala University, Uppsala, Sweden
| | - Peter Lercher
- Institute for Highway Engineering and Transport Planning, Graz University of Technology, Graz, Austria
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Song W, Guan J, He P, Fan S, Zhi H, Wang L. Mediating effects of lipids on the association between smoking and coronary artery disease risk among Chinese. Lipids Health Dis 2020; 19:149. [PMID: 32576261 PMCID: PMC7313194 DOI: 10.1186/s12944-020-01325-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/16/2020] [Indexed: 02/06/2023] Open
Abstract
Objective The mechanism between smoking and coronary artery disease (CAD) remains unclear. It is likely that lipid (including triglycerides (TG), total cholesterol (TC), low density lipoprotein-cholesterol (LDL-C), high density lipoprotein-cholesterol (HDL-C)) have been functioning as one of the mediators between smoking and the CAD occurrence. The study aimed to investigate the mediating effect of lipid on the relationship between smoking and CAD risk. Methods The case-control study included 2048 subjects. General linear regression analysis was used to corroborate the association between smoking and lipid levels. Univariate and multivariate logistic regression analysis were performed to reveal the relationship between smoking, lipid and the risk of CAD. Mediation analysis was used to investigate whether the association between smoking and CAD risk was mediated by lipid. Results Smoking was found to be associated with the risk of CAD (odds ratio (OR) = 1.34, 95% confidence interval (CI): 1.05–1.71, P = 0.019). Regression analysis showed that TG, TC and HDL-C were associated with CAD (OR = 2.69, 95%CI: 2.12–3.40, P < 0.001; OR = 0.34, 95%CI: 0.29–0.43, P < 0.001; OR = 0.37, 95%CI: 0.30–0.47, P < 0.001). Moreover, the ratio of TG to HDL-C (TG/HDL-C) was also related to CAD (OR = 4.45, 95%CI: 3.52–5.64, P < 0.001). Mediation analysis showed that among the effects of smoking on CAD, 17.52% was mediated by lipid, in which HDL-C accounted for 11.16% and TG accounted for 6.36%. Further analysis showed that the effect was also partially mediated by TG/HDL-C, which was accounted for 28%. Conclusions Lipid plays a partial mediation on the association between smoking and CAD risk. The study provides a clue on the mediation effect of lipids on the relationship between smoking and CAD risks, which is a novel insight to the progression of CAD.
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Affiliation(s)
- Wenjing Song
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, Department of Epidemiology & Biostatistics, School of Public Health, Southeast University, 87 Ding Jiaqiao Rd, Nanjing, 210009, China
| | - Jieqiong Guan
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, Department of Epidemiology & Biostatistics, School of Public Health, Southeast University, 87 Ding Jiaqiao Rd, Nanjing, 210009, China
| | - Pan He
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, Department of Epidemiology & Biostatistics, School of Public Health, Southeast University, 87 Ding Jiaqiao Rd, Nanjing, 210009, China
| | - Siyu Fan
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, Department of Epidemiology & Biostatistics, School of Public Health, Southeast University, 87 Ding Jiaqiao Rd, Nanjing, 210009, China
| | - Hong Zhi
- Department of Cardiology, ZhongDa Hospital, Southeast University, Nanjing, 210009, China
| | - Lina Wang
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, Department of Epidemiology & Biostatistics, School of Public Health, Southeast University, 87 Ding Jiaqiao Rd, Nanjing, 210009, China.
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Samoilenko M, Arrouf N, Blais L, Lefebvre G. Comparing two counterfactual-outcome approaches in causal mediation analysis of a multicategorical exposure: An application for the estimation of the effect of maternal intake of inhaled corticosteroids doses on birthweight. Stat Methods Med Res 2020; 29:2767-2782. [PMID: 32200753 DOI: 10.1177/0962280220902794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Although medical research frequently involves an exposure variable with three or more discrete levels, detailed presentations of mediation techniques for dealing with multicategorical (multilevel) exposures are sparse. In this paper, we study two causal mediation approaches applicable to such a type of exposure for continuous mediator and outcome: the closed-form regression-based approach of Valeri and VanderWeele, and the marginal structural model-based approach of Lange, Vansteelandt, and Bekaert. While the consideration of multicategorical exposures is found explicitly addressed in the literature for the latter approach, this is, to our knowledge, not yet the case for the former. We first illustrate the application of the two aforementioned approaches to assess the dose-response relationship between maternal intake of inhaled corticosteroids and birthweight, where this relationship is potentially mediated by gestational age. More specifically, we provide a precise roadmap for the application of the regression-based approach and of the marginal structural model-based approach on our cohort of pregnancies. Expressions for the natural direct and indirect effects associated with our categorical exposure are provided and, for the regression-based approach, analytic formulas for standard error calculation using the delta method are presented for these effects. Second, a simulation study which mimics our data is presented to add to current knowledge on these causal mediation techniques. Results from this study highlight the relevance to assess robustness of mediation results obtained from multicategorical exposures, most notably for the least prevalent of exposure categories.
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Affiliation(s)
- Mariia Samoilenko
- Département de mathématiques Université du Québec à Montréal, Montreal, Canada
| | - Nadia Arrouf
- Département de mathématiques Université du Québec à Montréal, Montreal, Canada
| | - Lucie Blais
- Faculté de pharmacie, Université de Montréal, Montreal, Canada
| | - Geneviève Lefebvre
- Département de mathématiques Université du Québec à Montréal, Montreal, Canada.,Faculté de pharmacie, Université de Montréal, Montreal, Canada.,Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Canada
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Pelham WE, Page TF, Altszuler AR, Gnagy EM, Molina BSG, Pelham WE. The long-term financial outcome of children diagnosed with ADHD. J Consult Clin Psychol 2020; 88:160-171. [PMID: 31789549 PMCID: PMC6940517 DOI: 10.1037/ccp0000461] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Characterize the early trajectories of financial functioning in adults with history of childhood ADHD and use these trajectories to project earnings and savings over the lifetime. METHOD Data were drawn from a prospective case-control study (PALS) following participants with a rigorous diagnosis of ADHD during childhood (N = 364) and demographically matched controls (N = 240) for nearly 20 years. Participants and their parents reported on an array of financial outcomes when participants were 25 and 30 years old. RESULTS At age 30, adults with a history of ADHD exhibited substantially worse outcomes than controls on most financial indicators, even when they and their parents no longer endorsed any DSM symptoms of ADHD. Between ages 25 and 30, probands had exhibited considerably slower growth than controls in positive financial indicators (e.g., monthly income) and substantially less reduction than controls in indicators of financial dependence (e.g., living with parents), indicating worsening or sustained deficits on nearly all measures. When earnings trajectories from age 25 to age 30 were extrapolated using matched census data, male probands were projected to earn $1.27 million less than controls over their working lifetime, reaching retirement with up to 75% lower net worth. CONCLUSION The financial deficit of adults with history of childhood ADHD grows across early adulthood. Projections based on early financial trajectories suggest very large cumulative differences in earnings and savings. With or without persistence of the DSM symptoms, the adult sequela of childhood ADHD can be conceptualized as a chronic condition often requiring considerable support from others during adulthood. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | - Timothy F. Page
- Health Policy and Management, Florida International University, Miami, FL 33199
- Center for Children and Families, Florida International University, Miami, FL 33199
| | - Amy R. Altszuler
- Center for Children and Families, Florida International University, Miami, FL 33199
| | - Elizabeth M. Gnagy
- Center for Children and Families, Florida International University, Miami, FL 33199
| | | | - William E. Pelham
- Department of Psychology, Florida International University, Miami, FL 33199
- Center for Children and Families, Florida International University, Miami, FL 33199
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Yang N, He L, Li Y, Xu L, Ping F, Li W, Zhang H. Reduced Insulin Resistance Partly Mediated the Association of High Dietary Magnesium Intake with Less Metabolic Syndrome in a Large Chinese Population. Diabetes Metab Syndr Obes 2020; 13:2541-2550. [PMID: 32765033 PMCID: PMC7373413 DOI: 10.2147/dmso.s257884] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/07/2020] [Indexed: 12/26/2022] Open
Abstract
PURPOSE High dietary magnesium intake may reduce insulin resistance (IR) and metabolic syndrome (MetS). The aim of the cross-sectional analysis was to evaluate the association between dietary magnesium intake, IR, and MetS using data from China Health and Nutrition Survey. METHODS Dietary magnesium intake was defined as daily dietary magnesium intake divided by body weight. Logistic regression analysis was used to calculate the odds ratio (OR) for IR and the prevalence of MetS across the quartile categories of dietary magnesium intake. In addition, we used the macro PROCESS to perform the mediation analyses. RESULTS A total of 8120 participants were included in the final analysis. We found a significant negative association between dietary magnesium intake and IR, the multivariable-adjusted OR for HOMA-IR comparing the highest to the lowest quartile of dietary magnesium intake was 0.435 (95% confidence intervals [CI] 0.376 to 0.502). The prevalence of the MetS was 38.6%, 28.9%, 22.5%, and 16.5% for increasing quartiles of dietary magnesium intake (p <0.001). The mediation model analysis displayed that insulin resistance mediated the effect of dietary magnesium on MetS. The direct effect and indirect effect of dietary magnesium on MetS were found significant, and the calculated percentage of mediation by insulin resistance was 19.6%. CONCLUSION Our study demonstrated a significant and independent negative relationship among weight-adjusted dietary magnesium intake, HOMA-IR, and MetS in a large Chinese population. IR partly mediated the relationship between dietary magnesium intake and MetS.
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Affiliation(s)
- Na Yang
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Liyun He
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Yuxiu Li
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Lingling Xu
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Fan Ping
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Wei Li
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Huabing Zhang
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
- Correspondence: Huabing Zhang Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China Tel/Fax +-86-010-69155073 Email
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Kangaslampi S, Peltonen K. Mechanisms of change in psychological interventions for posttraumatic stress symptoms: A systematic review with recommendations. CURRENT PSYCHOLOGY 2019. [DOI: 10.1007/s12144-019-00478-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AbstractPsychological interventions can alleviate posttraumatic stress symptoms (PTSS). However, further development of treatment approaches calls for understanding the mechanisms of change through which diverse interventions affect PTSS. We systematically searched the literature for controlled studies of mechanisms of change in psychological interventions for PTSS. We aimed to detect all empirically studied mechanisms and evaluate the level of evidence for their role in the alleviation of PTSS. We identified 34 studies, of which nine were among children. We found evidence for improvements in maladaptive posttraumatic cognitions as a general mechanism of change involved in diverse interventions, among both adults and children. We also found some preliminary evidence for increases in mindfulness as a mechanism of change in mindfulness- and spiritually-oriented interventions among adults. We found scant, mixed empirical evidence for other mechanisms of change. Notably, studies on changes in traumatic memories as a mechanism of change were lacking, despite clinical emphasis on their importance. A major limitation across reviewed studies was that most could not establish temporal order of changes in mechanisms and PTSS. Including thorough analyses of mechanisms of change beyond cognitions in all future trials and improving the reporting of findings would aid the development and implementation of even more effective interventions.
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Alur-Gupta S, Chemerinski A, Liu C, Lipson J, Allison K, Sammel MD, Dokras A. Body-image distress is increased in women with polycystic ovary syndrome and mediates depression and anxiety. Fertil Steril 2019; 112:930-938.e1. [PMID: 31395311 DOI: 10.1016/j.fertnstert.2019.06.018] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/17/2019] [Accepted: 06/11/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To evaluate differences in body-image distress (BID) scores between women with polycystic ovary syndrome (PCOS) and controls and whether BID mediates anxiety and depression. DESIGN Cross-sectional study. SETTING Academic institution. PATIENT(S) Reproductive-aged women with PCOS (n = 189) and controls (n = 225). INTERVENTION Administering the Multidimensional Body-Self Relations-Appearance Subscale (MBSRQ-AS), Stunkard Figure Rating Scale (FRS), Hospital Anxiety and Depression Scale (HADS), and PCOS quality of life survey (MPCOS-Q). MAIN OUTCOME MEASURE(S) BID, depression, and anxiety scores and mediation of depression and anxiety scores by BID. RESULT(S) Women with PCOS had worse BID scores on all five MBSRQ-AS subscales adjusted for age, body mass index, race, pregnancy history, income, and employment, and larger differences on the FRS compared with the control women. In multivariable regression models, the prevalence of depressive (28% vs. 19.2%) and anxiety (76.5% vs. 56.5%) symptoms were also statistically significantly higher in women with PCOS compared with the controls. Most MBSRQ-AS subscale scores statistically significantly correlated with depression, anxiety, and quality of life scores. The association between PCOS/control status and higher anxiety and depression scores was completely mediated by the appearance evaluation and body areas satisfaction subscales and partially mediated by overweight preoccupation, appearance orientation, and self-classified weight. CONCLUSION(S) Women with PCOS have increased BID and depressive and anxiety symptoms. In our study different aspects of BID either fully or partially mediated the association between PCOS/control status and depression and anxiety scores, suggesting that therapeutic interventions targeted at improving body image may decrease depressive and anxiety symptoms.
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Affiliation(s)
| | - Anat Chemerinski
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Chang Liu
- University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jenna Lipson
- Pennsylvania Hospital, Philadelphia, Pennsylvania
| | - Kelly Allison
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mary D Sammel
- Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anuja Dokras
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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