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Frank HA, Karim ME. Physical comorbidity is associated with overnight hospitalization in U.S. adults with asthma: an assessment of the 2005-2018 National Health and Nutrition Examination Surveys. J Asthma 2024:1-12. [PMID: 39155766 DOI: 10.1080/02770903.2024.2393677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 07/17/2024] [Accepted: 08/14/2024] [Indexed: 08/20/2024]
Abstract
OBJECTIVE Identifying the effects of comorbidity on healthcare utilization is critical for understanding the benefits of improved comorbidity management. Asthma is a common respiratory condition, associated with gastrointestinal, metabolic, psychiatric, and other respiratory conditions. Adults with asthma represent a key population in understanding comorbidity and its consequences. The objective was to explore the relationship between comorbidity and overnight hospitalizations in U.S. adults with asthma. STUDY DESIGN AND METHODS A cross-sectional sample of 3,887 subjects aged 20-79 was aggregated from seven cycles (2005-2018) of the National Health and Nutrition Examination Survey (NHANES). The survey design was created using the full seven cycles, then a subpopulation was used for the analysis. Design-based modified Poisson regression with robust standard errors compared the prevalence of overnight hospitalizations in subjects with and without comorbidities. Comorbidity was defined as the presence of one or more additional chronic conditions. RESULTS Over half (61.6%) of patients with asthma reported having comorbidities. The overnight hospitalization prevalence was higher in those with comorbidities (21.6%) than those without (7.4%). The adjusted prevalence ratio of overnight hospitalizations in those with comorbidities vs. those without was 2.02 (95% CI: 1.54-2.66). Conclusions from sensitivity analyses remained the same. CONCLUSIONS Comorbidity in U.S. adult asthma patients is associated with increased overnight hospitalizations. Study results concur with examinations of other healthcare utilization outcomes, revealing how comorbidity influences healthcare utilization patterns in patients with asthma. The reduction of overnight hospitalizations should be a targeted goal when developing and evaluating interventions to manage comorbidities in patients with asthma.
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Affiliation(s)
- Hanna A Frank
- School of Population and Public Health, The University of British Columbia, Vancouver, Canada
| | - Mohammad Ehsanul Karim
- School of Population and Public Health, The University of British Columbia, Vancouver, Canada
- Centre for Advancing Health Outcomes, University of British Columbia, Vancouver, Canada
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Wiehn J, Kurth T, Ravens-Sieberer U, Prugger C, Piccininni M, Reiss F. Effect of elevated depressive symptoms during adolescence on health-related quality of life in young adulthood-a six-year cohort study with repeated exposure measurements. Front Pediatr 2024; 12:1252964. [PMID: 39055620 PMCID: PMC11269264 DOI: 10.3389/fped.2024.1252964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 06/21/2024] [Indexed: 07/27/2024] Open
Abstract
Objectives Depression is a major contributor of young people's burden of disease. In this study we aim to estimate the effect of elevated depressive symptoms on physical health-related quality of life. Design We used self-reported information from the prospective BELLA cohort study, which included adolescents selected from the general population in Germany. The baseline assessment (2003-2006) and the 1-, 2-, and 6-year follow-up waves provide the data basis. Participants The baseline study population consisted of 1,460 adolescents between the ages of 12 and 17 who, according to their caregivers, did not suffer from depression. Variables The primary outcome, as measured by the physical component score (PCS) of the SF-36 at a 6-year follow-up (range: 0-100), is physical health-related quality of life. The exposure of interest is depressive symptoms, as measured by the Center for Epidemiological Studies Depression Scale for Children (CES-DC) at baseline, 1-year follow-up and 2-year follow-ups (range: 0-60). We dichotomized the exposure into subthreshold (≤15) and elevated depressive symptoms (>15). For the main analyses we considered a cumulative index for elevated depressive symptoms across the three time points (range: 0-3). Considered confounders are sex, age, socioeconomic status, migrant background, social support, anxiety symptoms, physical activity, chronic diseases, and sleeping problems. Statistical methods We used multiple imputation to account for missing values. Within each imputed dataset, we applied inverse probability weighting (IPW) to estimate the effect of the cumulative index for elevated depressive symptoms at baseline, 1- and 2-year follow-up on physical health-related quality of life at 6-year follow-up. We derived 95% confidence intervals by bootstrapping. Results After adjusting with IPW, the effect of the cumulative index per one unit increase of elevated depressive symptoms on the physical component score was -1.71 (95% CI: -3.51 to -0.04). The adjusted effect estimates of single exposure of elevated depressive symptoms on physical health-related quality of life were -0.83 (95% CI: -3.69 to 1.87) at baseline, -2.96 (95% CI: -4.94 to -0.52) at 1-year follow-up and -1.32 (95% CI: -3.85 to 1.15) at 2-year follow-up. Conclusion Findings suggest that elevated depressive symptoms during adolescence decrease physical health-related quality of life in young adulthood.
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Affiliation(s)
- Jascha Wiehn
- Institute of Public Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Kurth
- Institute of Public Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrike Ravens-Sieberer
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christof Prugger
- Institute of Public Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Marco Piccininni
- Institute of Public Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Franziska Reiss
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Salles FJ, Diaz-Quijano FA, Luz MS, de Almeida GA, Akiba N, de Oliveira AP, Elias ADC, Rogero MM, Olympio KPK. Low levels of potentially toxic elements in workers are associated with self-reported health outcomes. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 947:174510. [PMID: 38977094 DOI: 10.1016/j.scitotenv.2024.174510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 07/02/2024] [Accepted: 07/03/2024] [Indexed: 07/10/2024]
Abstract
Occupational exposure to toxic elements can adversely affect health. The current study evaluated blood concentrations of potentially toxic elements (PTE) including As, Cd, Cr, Cu, Hg, Mn, Ni, Pb, Sb, Sn, and Zn in formal and informal workers. Additionally, the study investigated the associations between blood PTE concentrations and reported health outcomes in the study population. The exposed group included women engaged in informal jewelry welding within their homes in Limeira, São Paulo state, Brazil (n = 36) and men who worked at a steel company in Volta Redonda, Rio de Janeiro state, Brazil (n = 22). The control group comprised residents of the same neighborhoods as the workers but without occupational exposure to chemicals (n = 28 in Limeira; n = 27 in Volta Redonda). Triple Quadrupole Inductively Coupled Plasma Mass Spectrometry (TQ ICP-MS) was used to determine PTE concentrations in blood samples. Glycemia, insulin, and lipid profile tests were performed. All participants completed questionnaires on household risk and reported morbidity. The blood concentrations of Cd, As, and Pb, as well as glycemia, were higher in informal workers than in control subjects. No significant differences were observed between formal workers and control subjects. A robust Poisson regression model, adjusted for variables suggested by a Directed Acyclic Graph, disclosed associations of blood lead and arsenic concentrations with the prevalence of neurological manifestations in Limeira. Blood lead levels > 2.6 μg dL-1 were associated with 2.3 times the prevalence of self-reported neurological manifestations (95 % CI: 1.17-4.58; p = 0.02) than lower blood lead concentrations. Furthermore, a positive association between blood cadmium concentrations and glycemia was observed. Informal occupational exposure to these elements may indicate an increased risk of developing diseases. Monitoring exposure and implementing interventions to reduce PTE exposure in the work environment represent significant steps toward prevention.
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Affiliation(s)
- Fernanda Junqueira Salles
- Department of Environmental Health, School of Public Health, University of Sao Paulo, Av. Dr. Arnaldo, 715, Cerqueira Cesar, CEP 01246-904 Sao Paulo, SP, Brazil; The Human Exposome Research Group/ Expossoma e Saúde do Trabalhador - eXsat, School of Public Health, University of Sao Paulo, Av. Dr. Arnaldo, 715, Cerqueira César, SP, 01246-000, Brazil.
| | - Fredi Alexander Diaz-Quijano
- University of Sao Paulo, School of Public Health, Department of Epidemiology - Laboratório de Inferência Causal em Epidemiologia (LINCE-USP), Av. Dr. Arnaldo, 715, Cerqueira Cesar, CEP 01246-904, Sao Paulo, SP, Brazil.
| | - Maciel Santos Luz
- Laboratory of Metallurgical Process, Institute for Technological Research, Sao Paulo, SP, Brazil.
| | - Gilmar Alves de Almeida
- Laboratory of Metallurgical Process, Institute for Technological Research, Sao Paulo, SP, Brazil.
| | - Naomi Akiba
- Laboratory of Metallurgical Process, Institute for Technological Research, Sao Paulo, SP, Brazil.
| | | | - Aline de Carvalho Elias
- Laboratory of Metallurgical Process, Institute for Technological Research, Sao Paulo, SP, Brazil.
| | - Marcelo Macedo Rogero
- Nutritional Genomics and Inflammation Laboratory, Department of Nutrition, School of Public Health, University of Sao Paulo, 01246-904 São Paulo, Brazil.
| | - Kelly Polido Kaneshiro Olympio
- Department of Environmental Health, School of Public Health, University of Sao Paulo, Av. Dr. Arnaldo, 715, Cerqueira Cesar, CEP 01246-904 Sao Paulo, SP, Brazil; The Human Exposome Research Group/ Expossoma e Saúde do Trabalhador - eXsat, School of Public Health, University of Sao Paulo, Av. Dr. Arnaldo, 715, Cerqueira César, SP, 01246-000, Brazil.
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Nombera-Aznaran N, Guevara-Lazo D, Fernandez-Guzman D, Taype-Rondán A. Statistical characteristics of analytical studies published in Peruvian medical journals from 2021 to 2022: A methodological study. PLoS One 2024; 19:e0306334. [PMID: 38959247 PMCID: PMC11221636 DOI: 10.1371/journal.pone.0306334] [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: 04/20/2024] [Accepted: 06/15/2024] [Indexed: 07/05/2024] Open
Abstract
OBJECTIVE While statistical analysis plays a crucial role in medical science, some published studies might have utilized suboptimal analysis methods, potentially undermining the credibility of their findings. Critically appraising analytical approaches can help elevate the standard of evidence and ensure clinicians and other stakeholders have trustworthy results on which to base decisions. The aim of the present study was to examine the statistical characteristics of original articles published in Peruvian medical journals in 2021-2022. DESIGN AND SETTING We performed a methodological study of articles published between 2021 and 2022 from nine medical journals indexed in SciELO-Peru, Scopus, and Medline. We included original articles that conducted analytical analyses (i.e., association between variables). The statistical variables assessed were: statistical software used for analysis, sample size, and statistical methods employed (measures of effect), controlling for confounders, and the method employed for confounder control or epidemiological approaches. RESULTS We included 313 articles (ranging from 11 to 77 across journals), of which 67.7% were cross-sectional studies. While 90.7% of articles specified the statistical software used, 78.3% omitted details on sample size calculation. Descriptive and bivariate statistics were commonly employed, whereas measures of association were less common. Only 13.4% of articles (ranging from 0% to 39% across journals) presented measures of effect controlling for confounding and explained the criteria for selecting such confounders. CONCLUSION This study revealed important statistical deficiencies within analytical studies published in Peruvian journals, including inadequate reporting of sample sizes, absence of measures of association and confounding control, and suboptimal explanations regarding the methodologies employed for adjusted analyses. These findings highlight the need for better statistical reporting and researcher-editor collaboration to improve the quality of research production and dissemination in Peruvian journals.
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Affiliation(s)
| | - David Guevara-Lazo
- Facultad de Medicina Humana, Universidad Peruana Cayetano Heredia, Lima, Perú
| | | | - Alvaro Taype-Rondán
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Perú
- EviSalud—Evidencias en Salud, Lima, Perú
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Diaz-Quijano FA, Santos de Melo LR. The total effect of ethnicity on COVID-19 outcomes is underestimated when conditioning for comorbidities: response to Learoyd et al. J Clin Epidemiol 2024; 170:111261. [PMID: 38242370 DOI: 10.1016/j.jclinepi.2024.111261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/09/2024] [Indexed: 01/21/2024]
Affiliation(s)
- Fredi Alexander Diaz-Quijano
- University of São Paulo, School of Public Health, Department of Epidemiology - Laboratório de Inferência Causal em Epidemiologia (LINCE-USP), São Paulo, Brazil.
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Wu Y, Deng YL, Zhang M, Miao Y, Cui FP, Zeng JY, Liu XY, Li CR, Liu AX, Zhu JQ, Li YJ, Liu C, Zeng Q. Urinary haloacetic acid concentrations and thyroid function among women: Results from the TREE study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 927:172368. [PMID: 38614346 DOI: 10.1016/j.scitotenv.2024.172368] [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: 02/06/2024] [Revised: 04/08/2024] [Accepted: 04/08/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Disinfection byproducts (DBPs) have been shown to impair thyroid function in experimental models. However, epidemiological evidence is scarce. METHODS This study included 1190 women undergoing assisted reproductive technology (ART) treatment from the Tongji Reproductive and Environmental (TREE) cohort from December 2018 to August 2021. Serum thyrotropin (TSH), free triiodothyronine (FT3), and free thyroxine (FT4) were measured as indicators of thyroid function. FT4/FT3 and TSH/FT4 ratios were calculated as markers of thyroid hormone homeostasis. Dichloroacetic acid (DCAA) and trichloroacetic acid (TCAA), the two most abundant HAAs, in urine were detected to assess individual DBP exposures. RESULTS After adjusting for relevant covariates, positive associations were observed between urinary TCAA concentrations and serum TSH and TSH/FT4 levels (e.g., percent change = 5.82 %, 95 % CI: 0.70 %, 11.21 % for TSH), whereas inverse associations were found for serum FT3 and FT4 (e.g., percent change = -1.29 %, 95 % CI: -2.49 %, -0.07 % for FT3). There also was a negative association between urinary DCAA concentration and serum FT4/FT3 (percent change = -2.49 %, 95 % CI: -4.71 %, -0.23 %). These associations were further confirmed in the restricted cubic spline and generalized additive models with linear or U-shaped dose-response relationships. CONCLUSION Urinary HAAs were associated with altered thyroid hormone homeostasis among women undergoing ART treatment.
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Affiliation(s)
- Yang Wu
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Yan-Ling Deng
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Min Zhang
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Yu Miao
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Fei-Peng Cui
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Jia-Yue Zeng
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Xiao-Ying Liu
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Cheng-Ru Li
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - A-Xue Liu
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Jin-Qin Zhu
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Yang-Juan Li
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Chong Liu
- Department of Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China..
| | - Qiang Zeng
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China.
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Chen Y, Van Deventer D, Nianogo R, Vinceti M, Kang W, Cockburn M, Federman N, Heck JE. Maternal residential exposure to solvents from industrial sources during pregnancy and childhood cancer risk in California. Int J Hyg Environ Health 2024; 259:114388. [PMID: 38704950 PMCID: PMC11127780 DOI: 10.1016/j.ijheh.2024.114388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 04/09/2024] [Accepted: 04/23/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Maternal solvent exposure has been suspected to increase offspring cancer risk. The study aimed to evaluate the associations between maternal residential exposure to solvents from industrial pollution during pregnancy and childhood cancer. METHODS The present study included 15,744 cancer cases (aged 0-19 years at diagnosis) identified from California Cancer Registry and 283,141 controls randomly selected from California Birth Registry (20:1 frequency-matched by birth year: 1998-2016). We examined industrial releases of tetrachloroethylene and 1,1,1-trichloroethane within 3 km of the birth address, while we used a 5 km buffer for carbon disulfide. We calculated the total exposure from all linked Toxic Release Inventory sites during each index pregnancy and assigned "ever/never" and "high/low exposed/unexposed" exposure, using median values. We performed quadratic decay models to estimate cancer risks associated with maternal solvent exposure in pregnancy. RESULTS 1,1,1-Trichloroethane was associated with rhabdomyosarcoma (adjusted Odds Ratio (aOR): 1.96; 95% Confidence Interval (CI): 1.16, 3.32) in the "ever exposed" group. Ever exposure to carbon disulfide was associated with increased risks of medulloblastoma (OR = 1.85, 95% CI 1.01, 3.40) and ependymoma (OR = 1.63, 95% CI 0.97, 2.74). CONCLUSIONS Overall, our findings suggested maternal residential exposure to solvents from industrial sources might be associated with elevated childhood cancer risks.
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Affiliation(s)
- Yixin Chen
- Department of Epidemiology, Fielding School of Public Health, University of California, UCLA, Los Angeles, CA, 90095-1772, USA
| | - Darcy Van Deventer
- Department of Epidemiology, Fielding School of Public Health, University of California, UCLA, Los Angeles, CA, 90095-1772, USA
| | - Roch Nianogo
- Department of Epidemiology, Fielding School of Public Health, University of California, UCLA, Los Angeles, CA, 90095-1772, USA; California Center for Population Research, University of California, UCLA, Los Angeles, CA, USA
| | - Marco Vinceti
- CREAGEN - Environmental, Genetic and Nutritional Epidemiology Research Center, Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Department of Epidemiology, School of Public Health, Boston University, Boston, MA, USA
| | - Wei Kang
- Department of Geography and the Environment, University of North Texas, Denton, TX, 76203-5017, USA
| | - Myles Cockburn
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Noah Federman
- Department of Pediatrics, Geffen School of Medicine, University of California, UCLA, Los Angeles, CA, USA
| | - Julia E Heck
- Department of Epidemiology, Fielding School of Public Health, University of California, UCLA, Los Angeles, CA, 90095-1772, USA; College of Health and Public Service, University of North Texas, Denton, TX, 76203-5017, USA.
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Meehan AA, Milazzo KE, Bien M, Nall SK, Vickery KD, Mosites E, Barocas JA. Involuntary displacement and self-reported health in a cross-sectional survey of people experiencing homelessness in Denver, Colorado, 2018-2019. BMC Public Health 2024; 24:1159. [PMID: 38664800 PMCID: PMC11044435 DOI: 10.1186/s12889-024-18681-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 04/22/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND The number of people experiencing unsheltered homelessness in the U.S. is increasing. Municipalities have responded with punitive responses such as involuntary displacement (i.e., encampment sweeps, move along orders), but little is known about the impact of involuntary displacement on health. The purpose of this study was to investigate the association between broadly defined experiences of involuntary displacement and self-reported health conditions among people experiencing homelessness. METHODS We used logistic regression models to generate odds ratios using publicly available data from a cross-sectional sample of people experiencing homelessness in Denver, Colorado, during September 2018-February 2019. Hosmer-Lemeshow Goodness of Fit tests were used to assess model fit. RESULTS Among 397 people experiencing homelessness, involuntary displacement was significantly associated with self-reported infectious diseases (adjusted odds ratio (aOR) 2.09, 95% CI 1.27, 3.41), substance and alcohol use (aOR 2.83; 95% CI 1.70, 4.73), climate-related conditions (aOR 2.27; 95% CI 1.35, 3.83), and worsening mental health (aOR 2.00; 95% CI 1.24, 3.24) after controlling for potential confounders. No statistically significant associations were identified between involuntary displacement and injuries, musculoskeletal issues, chronic conditions, and chronic mental and emotional issues. CONCLUSIONS This research quantifies the association between involuntary displacement and multiple infectious and non-infectious health outcomes. While city officials attempt to grapple with increasing unsheltered homelessness, it is important to understand what harms are occurring that are associated with current policies. Our research adds to the growing body of literature that involuntary displacement is a harmful response to unsheltered homelessness. Alternative approaches focused on connections to housing and social services should be prioritized.
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Affiliation(s)
- Ashley A Meehan
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA.
| | | | - Michael Bien
- National Foundation for the Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Samantha K Nall
- Divisions of General Internal Medicine and Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, USA
| | - Katherine Diaz Vickery
- Health, Homelessness, & Criminal Justice Lab, Hennepin Health Care Research Institute, Minneapolis, MN, USA
| | - Emily Mosites
- Office of Readiness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Joshua A Barocas
- Divisions of General Internal Medicine and Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, USA
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Cristi-Montero C, Martínez-Flores R, Espinoza-Puelles JP, Favero-Ramirez L, Zurita-Corvalan N, Cañete IC, Leppe J, Ferrari G, Sadarangani KP, Cancino-López J, Hernandez-Jaña S, Farias TY, Lemes VB, Rodríguez-Rodríguez F, Brand C. Study protocol and rationale of "the UP project": evaluating the effectiveness of active breaks on health indicators in desk-based workers. Front Public Health 2024; 12:1363015. [PMID: 38566792 PMCID: PMC10985339 DOI: 10.3389/fpubh.2024.1363015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 03/07/2024] [Indexed: 04/04/2024] Open
Abstract
Background Excessive sedentary time has been negatively associated with several health outcomes, and physical activity alone does not seem to fully counteract these consequences. This panorama emphasizes the essential of sedentary time interruption programs. "The Up Project" seeks to assess the effectiveness of two interventions, one incorporating active breaks led by a professional and the other utilizing a computer application (self-led), of both equivalent duration and intensity. These interventions will be compared with a control group to evaluate their impact on physical activity levels, sedentary time, stress perception, occupational pain, and cardiometabolic risk factors among office workers. Methods This quasi-experimental study includes 60 desk-based workers from universities and educational institutes in Valparaiso, Chile, assigned to three groups: (a) booster breaks led by professionals, (b) computer prompts that are unled, and (c) a control group. The intervention protocol for both experimental groups will last 12 weeks (only weekdays). The following measurements will be performed at baseline and post-intervention: cardiometabolic risk based on body composition (fat mass, fat-free mass, and bone mass evaluated by DXA), waist circumference, blood pressure, resting heart rate, and handgrip strength. Physical activity and sedentary time will be self-reported and device-based assessed using accelerometry. Questionnaires will be used to determine the perception of stress and occupational pain. Discussion Governments worldwide are addressing health issues associated with sedentary behavior, particularly concerning individuals highly exposed to it, such as desk-based workers. Despite implementing certain strategies, there remains a noticeable gap in comprehensive research comparing diverse protocols. For instance, studies that contrast the outcomes of interventions led by professionals with those prompted by computers are scarce. This ongoing project is expected to contribute to evidence-based interventions targeting reduced perceived stress levels and enhancing desk-based employees' mental and physical well-being. The implications of these findings could have the capacity to lay the groundwork for future public health initiatives and government-funded programs.
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Affiliation(s)
- Carlos Cristi-Montero
- IRyS Group, Physical Education School, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile
| | - Ricardo Martínez-Flores
- IRyS Group, Physical Education School, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile
| | | | - Laura Favero-Ramirez
- IRyS Group, Physical Education School, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile
| | - Natalia Zurita-Corvalan
- IRyS Group, Physical Education School, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile
| | - Ignacio Castillo Cañete
- IRyS Group, Physical Education School, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile
| | - Jaime Leppe
- School of Physical Therapy Faculty of Medicine, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Gerson Ferrari
- Universidad de Santiago de Chile (USACH), Escuela de Ciencias de la Actividad Física, el Deporte y la Salud, Santiago, Chile
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Providencia, Santiago, Chile
| | - Kabir P. Sadarangani
- Universidad Autónoma de Chile, Santiago, Chile
- Escuela de Kinesiología, Facultad de Salud Y Odontología, Universidad Diego Portales, Santiago, Chile
| | - Jorge Cancino-López
- Laboratorio de Fisiología del Ejercicio y Metabolismo, Escuela de Kinesiología, Facultad de Medicina, Universidad Finis Terrae. Santiago, Santiago, Chile
| | - Sam Hernandez-Jaña
- IRyS Group, Physical Education School, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile
| | | | - Vanilson Batista Lemes
- Universidade Federal do Rio Grande do Sul, Escola de Educação Física, Fisioterapia e Dança, Porto Alegre, Brazil
| | | | - Caroline Brand
- IRyS Group, Physical Education School, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile
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10
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Alwan NA, Stannard S, Berrington A, Paranjothy S, Hoyle RB, Owen RK, Fraser SDS. Risk factors for ill health: How do we specify what is 'modifiable'? PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002887. [PMID: 38437177 PMCID: PMC10911600 DOI: 10.1371/journal.pgph.0002887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Affiliation(s)
- Nisreen A. Alwan
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Seb Stannard
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Ann Berrington
- Department of Social Statistics and Demography, Faculty of Social Science, University of Southampton, Southampton, United Kingdom
| | - Shantini Paranjothy
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
| | - Rebecca B. Hoyle
- School of Mathematical Sciences, University of Southampton, Southampton, United Kingdom
| | - Rhiannon K. Owen
- Swansea University Medical School, Faculty of Medicine, Health and Life Sciences, Swansea University, Swansea, United Kingdom
| | - Simon D. S. Fraser
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
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11
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Abdallah A, Francoz D, Berman J, Dufour S, Buczinski S. Veal calves management in Québec, Canada: Part I. Association between passive immunity transfer at arrival and health disorders. Prev Vet Med 2024; 224:106118. [PMID: 38271922 DOI: 10.1016/j.prevetmed.2024.106118] [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: 06/14/2023] [Revised: 11/27/2023] [Accepted: 01/08/2024] [Indexed: 01/27/2024]
Abstract
Morbidity and mortality remain important concerns for veal production which traditionally involves very young calves being transported directly from dairy farms to calf-raising facilities or sold through auction markets from dairy farms. There are few studies that examine the relationship between transfer of passive immunity and health outcomes in veal production in Québec. The objective of this study was to investigate the risk factors associated with morbidity and mortality in milk and grain-fed veal facilities in Québec. Between October 2017 and December 2018, a prospective cohort study was conducted on 59 batches of milk- and grain-fed veal calves from Montérégie and Centre du Québec regions in Québec, Canada. A total of 30 calves per batch were randomly sampled for the transfer of passive immunity (TPI) status using the Brix refractometer (serum threshold ≥ 8.4%). Throughout the production cycle, arrival, treatment, mortality, and slaughter records of each batch of calves were extracted and used to quantify individual- and group-level risk factors. Morbidity and mortality were modelled through generalized linear mixed models (GLMMs) using a logit link, as function of categorical variables (individual inadequate TPI, arrival season, purchasing sites, and arrival weights) and a continuous variable (proportion of inadequate TPI in the batch). Given that the health and performance data are usually collected retrospectively under commercial settings, incomplete data was recognized as a potential issue. Thus, multiple imputation models were used. From 59 batches where 1729 calves were sampled for measuring TPI, 1084 calves had a serum Brix% < 8.4% giving a prevalence of 62.7% of inadequate TPI. The prevalence of morbidity and mortality in those 59 batches were not associated with the batch-level inadequate TPI prevalence. On the other hand, individual calves with inadequate TPI had higher odds of morbidity (OR: 1.56; 95% CI: 1.2-2.05, P = 0.001) compared to those calves with adequate TPI. Odds of mortality, on the other hand, were not significantly affected by inadequate TPI (OR:1.27; 95% CI: 0.74-2.18, P = 0.3). Calves arriving to the facility during the winter season had lower odds of mortality than those arriving in fall (OR:0.16; 95% CI: 0.03-0.78, P = 0.02). In conclusion, this study suggests that inadequate TPI, as assessed upon arrival in veal farms, remains an important concern for negative health outcomes in veal calves.
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Affiliation(s)
- Abdelmonem Abdallah
- Département des Sciences Cliniques, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-Hyacinthe, QC, Canada; Department of Animal Medicine, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Egypt; Regroupement Op+lait, Saint-Hyacinthe, QC, Canada.
| | - David Francoz
- Département des Sciences Cliniques, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-Hyacinthe, QC, Canada; Regroupement Op+lait, Saint-Hyacinthe, QC, Canada
| | - Julie Berman
- Département des Sciences Cliniques, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-Hyacinthe, QC, Canada; Regroupement Op+lait, Saint-Hyacinthe, QC, Canada
| | - Simon Dufour
- Regroupement Op+lait, Saint-Hyacinthe, QC, Canada; Département de Pathologie et Microbiologie, Faculté de Médecine Vétérinaire, Université de Montréal, QC, Canada
| | - Sébastien Buczinski
- Département des Sciences Cliniques, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-Hyacinthe, QC, Canada; Regroupement Op+lait, Saint-Hyacinthe, QC, Canada
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12
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Gibas KM, Rebeiro PF, Brantley M, Mathieson S, Maurer L, Pettit AC. Geographic disparities in late HIV diagnoses in Tennessee: Opportunities for interventions in the rural Southeast. J Rural Health 2024. [PMID: 38361431 PMCID: PMC11324855 DOI: 10.1111/jrh.12829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 01/15/2024] [Accepted: 02/02/2024] [Indexed: 02/17/2024]
Abstract
PURPOSE Incident HIV remains an important public health issue in the US South, the region leading the nation in HIV incidence, rural HIV cases, and HIV-related deaths. Late diagnoses drive incident HIV and understanding factors driving late diagnoses is critical for developing locally relevant HIV testing and prevention interventions, decreasing HIV transmission, and ending the HIV epidemic. METHODS Retrospective cohort study utilizing Tennessee Department of Health (TDH) surveillance data and US Census Bureau data. Adults of ≥18-year old with a new HIV diagnosis between January 1, 2015 and December 31, 2019 identified in the TDH electronic HIV/AIDS Reporting System were included. Individuals were followed from initial HIV diagnosis until death, 90 days of follow-up for outcome assessment, or administrative censoring 90 days after study enrollment closed. FINDINGS We included 3652 newly HIV-diagnosed individuals; median age was 31 years (IQR: 25, 42), 2909 (79.7%) were male, 2057 (56.3%) were Black, 246 (6.7%) were Hispanic, 408 (11.2%) were residing in majority-rural areas at diagnosis, and 642 (17.6%) individuals received a late HIV diagnosis. Residents of majority-rural counties (adjusted risk ratios [aRR] = 1.39, 95% confidence intervals [CI]: 1.16-1.67) and Hispanic individuals (aRR = 1.87, 95% CI: 1.50-2.33) had an increased likelihood of receiving a late diagnosis after controlling for race/ethnicity, age, and year of HIV diagnosis. CONCLUSIONS Rural residence and Hispanic ethnicity were associated with an increased risk of receiving a late HIV diagnosis in Tennessee. Future HIV testing and prevention efforts should be adapted to the needs of these vulnerable populations.
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Affiliation(s)
- Kevin M Gibas
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Epidemiology & Infection Prevention, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Peter F Rebeiro
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Department of Medicine and Department of Biostatistics, Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Meredith Brantley
- Section of HIV, Sexually Transmitted Infections, and Viral Hepatitis, Tennessee Department of Health, Nashville, Tennessee, USA
| | - Samantha Mathieson
- Section of HIV, Sexually Transmitted Infections, and Viral Hepatitis, Tennessee Department of Health, Nashville, Tennessee, USA
| | - Laurie Maurer
- Section of HIV, Sexually Transmitted Infections, and Viral Hepatitis, Tennessee Department of Health, Nashville, Tennessee, USA
| | - April C Pettit
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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13
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Fernainy P, Cohen AA, Murray E, Losina E, Lamontagne F, Sourial N. Rethinking the pros and cons of randomized controlled trials and observational studies in the era of big data and advanced methods: a panel discussion. BMC Proc 2024; 18:1. [PMID: 38233894 PMCID: PMC10795211 DOI: 10.1186/s12919-023-00285-8] [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: 01/19/2024] Open
Abstract
Randomized controlled trials (RCTs) have traditionally been considered the gold standard for medical evidence. However, in light of emerging methodologies in data science, many experts question the role of RCTs. Within this context, experts in the USA and Canada came together to debate whether the primacy of RCTs as the gold standard for medical evidence, still holds in light of recent methodological advances in data science and in the era of big data. The purpose of this manuscript, aims to raise awareness of the pros and cons of RCTs and observational studies in order to help guide clinicians, researchers, students, and decision-makers in making informed decisions on the quality of medical evidence to support their work. In particular, new and underappreciated advantages and disadvantages of both designs are contrasted. Innovations taking place in both of these research methodologies, which can blur the lines between the two, are also discussed. Finally, practical guidance for clinicians and future directions in assessing the quality of evidence is offered.
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Affiliation(s)
- Pamela Fernainy
- Department of Health Management, Evaluation and Policy, School of Public Health, University of Montreal, Montreal, QC, Canada.
- Research Centre of the Centre Hospitalier de L'Université de Montréal (CHUM), Montreal, QC, Canada.
| | - Alan A Cohen
- Department of Family and Emergency Medicine, Faculty of Medicine and Health Sciences, University of Sherbrooke, Montreal, QC, Canada
- CHUS Research Centre, Montreal, QC, Canada
- Centre de Recherche Sur Le Vieillissement, Montreal, QC, Canada
- Butler Columbia Aging Center, New York, NY, USA
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University New York, New York, USA
| | - Eleanor Murray
- School of Public Health, Boston University, Boston, MA, USA
| | - Elena Losina
- Harvard Medical School Department of Orthopedic Surgery, Cambridge, MA, USA
| | - Francois Lamontagne
- CHUS Research Centre, Montreal, QC, Canada
- Departement de Medicine, University of Sherbrooke, Montreal, QC, Canada
| | - Nadia Sourial
- Department of Health Management, Evaluation and Policy, School of Public Health, University of Montreal, Montreal, QC, Canada
- Research Centre of the Centre Hospitalier de L'Université de Montréal (CHUM), Montreal, QC, Canada
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14
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El Chamieh C, Larabi IA, Alencar De Pinho N, Lambert O, Combe C, Fouque D, Frimat L, Jacquelinet C, Laville M, Laville S, Lange C, Alvarez JC, Massy ZA, Liabeuf S. Study of the association between serum levels of kynurenine and cardiovascular outcomes and overall mortality in chronic kidney disease. Clin Kidney J 2024; 17:sfad248. [PMID: 38186868 PMCID: PMC10768787 DOI: 10.1093/ckj/sfad248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Indexed: 01/09/2024] Open
Abstract
Background Kynurenine is a protein-bound uremic toxin. Its circulating levels are increased in chronic kidney disease (CKD). Experimental studies showed that it exerted deleterious cardiovascular effects. We sought to evaluate an association between serum kynurenine levels and adverse fatal or nonfatal cardiovascular events and all-cause mortality in CKD patients. Methods The CKD-REIN study is a prospective cohort of people with CKD having an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m². Baseline frozen samples of total and free fractions of kynurenine and tryptophan were measured using a validated liquid chromatography tandem mass spectrometry technique. Cause-specific Cox models were used to estimate hazard ratios (HRs) for each outcome. Results Of the 2406 included patients (median age: 68 years; median eGFR: 25 ml/min/1.73 m2), 52% had a history of cardiovascular disease. A doubling of serum-free kynurenine levels was associated with an 18% increased hazard of cardiovascular events [466 events, HR (95%CI):1.18(1.02,1.33)], independently of eGFR, serum-free tryptophan level or other uremic toxins, cardioprotective drugs, and traditional cardiovascular risk factors. Serum-free kynurenine was significantly associated with non-atheromatous cardiovascular events [HR(95%CI):1.26(1.03,1.50)], but not with atheromatous cardiovascular events [HR(95%CI):1.15(0.89,1.50)]. The association of serum-free kynurenine with cardiovascular mortality was also independently significant [87 events; adjusted HR(95%CI):1.64(1.10,2.40)]. However, the association of serum-free kynurenine with all-cause mortality was no more significant after adjustment on serum-free tryptophan [311 events, HR(95%CI):1.12(0.90, 1.40)]. Conclusions Our findings imply that serum-free kynurenine, independently of other cardiovascular risk factors (including eGFR), is associated with fatal or nonfatal cardiovascular outcomes, particularly non-atheromatous cardiovascular events; in patients with CKD. Strategies to reduce serum kynurenine levels should be evaluated in further studies.
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Affiliation(s)
- Carolla El Chamieh
- Centre for Research in Epidemiology and Population Health (CESP), INSERM UMRS 1018, Université Paris-Saclay, Université Versailles Saint Quentin, Villejuif, France
| | - Islam Amine Larabi
- Department of Pharmacology and Toxicology, Raymond Poincaré Hospital, AP-HP, Garches, France
- UVSQ, Université Paris-Saclay, Inserm U1018, CESP, Équipe MOODS, MasSpecLab, Montigny-le-Bretonneux, France
| | - Natalia Alencar De Pinho
- Centre for Research in Epidemiology and Population Health (CESP), INSERM UMRS 1018, Université Paris-Saclay, Université Versailles Saint Quentin, Villejuif, France
| | - Oriane Lambert
- Centre for Research in Epidemiology and Population Health (CESP), INSERM UMRS 1018, Université Paris-Saclay, Université Versailles Saint Quentin, Villejuif, France
| | - Christian Combe
- Service de Néphrologie Transplantation Dialyse Aphérèse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- INSERM, U1026, University Bordeaux, Bordeaux, France
| | - Denis Fouque
- Nephrology Dept, Centre Hospitalier Lyon Sud, Université de Lyon, Carmen, Pierre-Bénite, France
- Université de Lyon, CarMeN INSERM 1060, Lyon, France
| | - Luc Frimat
- Nephrology Department, CHRU de Nancy, Vandoeuvre-lès-Nancy, France
- Lorraine University, APEMAC, Vandoeuvre-lès-Nancy, France
| | - Christian Jacquelinet
- Centre for Research in Epidemiology and Population Health (CESP), INSERM UMRS 1018, Université Paris-Saclay, Université Versailles Saint Quentin, Villejuif, France
- Biomedecine Agency, Saint Denis La Plaine, France
| | | | - Solène Laville
- Pharmacoepidemiology Unit, Department of Clinical Pharmacology, Amiens-Picardie University Medical Center, Amiens, France
- MP3CV Laboratory, Jules Verne University of Picardie, Amiens, France
| | - Céline Lange
- Centre for Research in Epidemiology and Population Health (CESP), INSERM UMRS 1018, Université Paris-Saclay, Université Versailles Saint Quentin, Villejuif, France
| | - Jean-Claude Alvarez
- Department of Pharmacology and Toxicology, Raymond Poincaré Hospital, AP-HP, Garches, France
- UVSQ, Université Paris-Saclay, Inserm U1018, CESP, Équipe MOODS, MasSpecLab, Montigny-le-Bretonneux, France
| | - Ziad A Massy
- Centre for Research in Epidemiology and Population Health (CESP), INSERM UMRS 1018, Université Paris-Saclay, Université Versailles Saint Quentin, Villejuif, France
- Department of Nephrology, Ambroise Paré University Hospital, APHP, Boulogne-Billancourt, France
| | - Sophie Liabeuf
- Pharmacoepidemiology Unit, Department of Clinical Pharmacology, Amiens-Picardie University Medical Center, Amiens, France
- MP3CV Laboratory, Jules Verne University of Picardie, Amiens, France
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15
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Pitts AJ, Fowler CR. Comparison of open-source software for producing directed acyclic graphs. JOURNAL OF CAUSAL INFERENCE 2024; 12:20230031. [PMID: 38361970 PMCID: PMC10869111 DOI: 10.1515/jci-2023-0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Many software packages have been developed to assist researchers in drawing directed acyclic graphs (DAGs), each with unique functionality and usability. We examine five of the most common software to generate DAGs: TikZ, DAGitty, ggdag, dagR, and igraph. For each package, we provide a general description of its background, analysis and visualization capabilities, and user-friendliness. Additionally in order to compare packages, we produce two DAGs in each software, the first featuring a simple confounding structure, while the second includes a more complex structure with three confounders and a mediator. We provide recommendations for when to use each software depending on the user's needs.
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Affiliation(s)
- Amy J. Pitts
- Department of Biostatistics, Columbia University
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16
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Li L, Etminan M, Kaplan GG, Tremlett H, Xie H, Aviña-Zubieta JA. Multiple Sclerosis Risk Among Anti-tumor Necrosis Factor Alpha Users: A Methodological Review of Observational Studies Based on Real-world Data. Curr Drug Saf 2024; 19:200-207. [PMID: 37496244 DOI: 10.2174/1574886318666230726162245] [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: 03/14/2023] [Revised: 06/12/2023] [Accepted: 06/27/2023] [Indexed: 07/28/2023]
Abstract
Epidemiologic studies on the risk of multiple sclerosis (MS) or demyelinating events associated with anti-tumor necrosis factor alpha (TNFα) use among patients with rheumatic diseases or inflammatory bowel diseases have shown conflicting results. Causal directed acyclic graphs (cDAGs) are useful tools for understanding the differing results and identifying the structure of potential contributing biases. Most of the available literature on cDAGs uses language that might be unfamiliar to clinicians. This article demonstrates how cDAGs can be used to determine whether there is a confounder, a mediator or collider-stratification bias and when to adjust for them appropriately. We also use a case study to show how to control for potential biases by drawing a cDAG depicting anti-TNFα use and its potential to contribute to MS onset. Finally, we describe potential biases that might have led to contradictory results in previous studies that examined the effect of anti-TNFα and MS, including confounding, confounding by contraindication, and bias due to measurement error. Clinicians and researchers should be cognizant of confounding, confounding by contraindication, and bias due to measurement error when reviewing future studies on the risk of MS or demyelinating events associated with anti-TNFα use. cDAGs are a useful tool for selecting variables and identifying the structure of different biases that can affect the validity of observational studies.
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Affiliation(s)
- Lingyi Li
- Experimental Medicine Program, University of British Columbia, Vancouver, British Columbia, Canada
- Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Mahyar Etminan
- Experimental Medicine Program, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Ophthalmology and Visual Sciences, Medicine and Pharmacology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gilaad G Kaplan
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Helen Tremlett
- Division of Neurology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- The Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada
| | - Hui Xie
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - J Antonio Aviña-Zubieta
- Experimental Medicine Program, University of British Columbia, Vancouver, British Columbia, Canada
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- Division of Rheumatology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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17
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Ramos JS, Villettaz-Robichaud M, Arsenault J, Chorfi Y, Costa M, Dubuc J, Ferraro S, Francoz D, Rousseau M, Fecteau G, Buczinski S. Health indicators in surplus calves at the time of arrival at auction markets: Associations with distance from farms of origin in Québec, Canada. J Dairy Sci 2023; 106:7089-7103. [PMID: 37210360 DOI: 10.3168/jds.2022-22827] [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: 09/26/2022] [Accepted: 04/02/2023] [Indexed: 05/22/2023]
Abstract
This study evaluated the associations between estimated distance from farms' locations to auction markets, and health indicators of surplus dairy calves sold during summer 2019 and winter 2020 in Québec, Canada. A total of 3,610 animals from 1,331 different farms were used in this cross-sectional cohort study. Geographic coordinates (latitude and longitude) were obtained for each farm and the 2 participating livestock auction markets. Calves' abnormal physical signs (APS) were noted upon arrival at the auction market as they were examined by trained research staff. The haversine distance between the farm and the auction market was evaluated using geographic coordinates and categorized. Generalized linear mixed models were used for statistical analyses. The main APS observed were ocular discharge (34.9%), abnormal hide cleanliness (21.2%), swollen navel (17.2%), dehydration score 1 (at least one of the 2 following clinical signs: persistent skin tent or sunken eye, 12.9%), and dehydration score 2 (both clinical signs mentioned above, 6.5%). Calves from farms located at greater distances from the auction markets (≥110 km) had a higher risk ratio [RR = 1.08; 95% confidence internal (CI) = 1.03, 1.13] for dehydration than those from lesser distances (0-25 km). During the summertime, a RR of 1.18 (95% CI = 1.15, 1.22) was observed for dehydration compared with wintertime. A 2-way interaction between estimated distance and season showed a higher prevalence of ocular discharge for calves from farms at distances greater than or equal to 110 km during the summer (RR = 1.11; 95% CI: 1.04, 1.20) than for calves from farms located at lesser distances (0-25 km). These results demonstrate that calves from farms located at greater distances from the auction markets had more APS, mainly during the summer. A better understanding of the transport conditions and interaction with management at the farm of origin is determinant to mitigate the impact of the journey on surplus calf health.
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Affiliation(s)
- Jean Silva Ramos
- Département des Sciences Cliniques, Faculté de Médecine Vétérinaire, Université de Montréal, St-Hyacinthe, QC, J2S 2M2 Canada
| | - Marianne Villettaz-Robichaud
- Département des Sciences Cliniques, Faculté de Médecine Vétérinaire, Université de Montréal, St-Hyacinthe, QC, J2S 2M2 Canada
| | - Julie Arsenault
- Département de Pathologie et Microbiologie, Faculté de Médecine Vétérinaire, Université de Montréal, St-Hyacinthe, QC, J2S 2M2 Canada
| | - Younès Chorfi
- Département de Biomédecine Vétérinaire, Faculté de Médecine Vétérinaire, Université de Montréal, St-Hyacinthe, QC, J2S 2M2 Canada
| | - Marcio Costa
- Département de Biomédecine Vétérinaire, Faculté de Médecine Vétérinaire, Université de Montréal, St-Hyacinthe, QC, J2S 2M2 Canada
| | - Jocelyn Dubuc
- Département des Sciences Cliniques, Faculté de Médecine Vétérinaire, Université de Montréal, St-Hyacinthe, QC, J2S 2M2 Canada
| | - Salvatore Ferraro
- Département des Sciences Cliniques, Faculté de Médecine Vétérinaire, Université de Montréal, St-Hyacinthe, QC, J2S 2M2 Canada
| | - David Francoz
- Département des Sciences Cliniques, Faculté de Médecine Vétérinaire, Université de Montréal, St-Hyacinthe, QC, J2S 2M2 Canada
| | - Marjolaine Rousseau
- Département des Sciences Cliniques, Faculté de Médecine Vétérinaire, Université de Montréal, St-Hyacinthe, QC, J2S 2M2 Canada
| | - Gilles Fecteau
- Département des Sciences Cliniques, Faculté de Médecine Vétérinaire, Université de Montréal, St-Hyacinthe, QC, J2S 2M2 Canada
| | - Sébastien Buczinski
- Département des Sciences Cliniques, Faculté de Médecine Vétérinaire, Université de Montréal, St-Hyacinthe, QC, J2S 2M2 Canada.
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18
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Kuzma LH, Miller AM, Harvey E, McDonald MF. Association of Provider Recommendation and Receipt of Influenza Vaccine Among Pregnant Women by Race and Ethnicity. J Womens Health (Larchmt) 2023; 32:1052-1061. [PMID: 37582216 PMCID: PMC10623458 DOI: 10.1089/jwh.2023.0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023] Open
Abstract
Background: All pregnant women and those who may become pregnant are recommended by the Advisory Committee on Immunization Practices to receive the flu vaccine to prevent severe illness in the woman and infant. Despite the increased risk for complications in this population, flu vaccine uptake in pregnant women was 68.1% in the 2020-2021 flu season, with disparities by race and ethnicity. We sought to describe associations between provider recommendation with flu vaccine uptake by race and ethnicity in Tennessee women with a recent live birth. Materials and Methods: Weighted analysis used data from the 2016 to 2020 Tennessee Pregnancy Risk Assessment Monitoring System complex survey analysis procedures. Uptake was measured as receipt of flu vaccine in the 12 months before the most recent live birth, and positive recall of receiving provider advice to get the shot was the independent variable; for both we estimated 5-year averages stratified by race/ethnicity. Differences were assessed using chi-square tests. We modeled receipt of flu vaccine and estimated marginal predicted prevalence ratios (PRs); stratified models by race/ethnicity were constructed to estimate unadjusted and adjusted PRs. Results: The 5-year average for vaccine uptake before or during pregnancy was 56.7% but varied by race and ethnicity. Stratified bivariate analyses yielded different magnitudes of association by race/ethnicity between provider recommendation and flu vaccine receipt. After adjustment for payment source at delivery, marital status, age group, urbanicity, and maternal education, receiving a provider recommendation was strongly associated with flu vaccine uptake for all stratified models of pregnant women included in the study. The effect size was of a larger magnitude among non-Hispanic Black women, a population with a lower vaccine uptake. Conclusions: Given the association between provider recommendation and vaccine uptake in all groups, attention should be focused on increasing rates of provider recommendation.
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Affiliation(s)
- Lauren H. Kuzma
- Divisions of Population Health Assessment, Tennessee Department of Health, Nashville, Tennessee, USA
| | - Angela. M. Miller
- Divisions of Population Health Assessment, Tennessee Department of Health, Nashville, Tennessee, USA
| | - Elizabeth Harvey
- Divisions of Population Health Assessment, Tennessee Department of Health, Nashville, Tennessee, USA
- Divisions of Family Health and Wellness, Tennessee Department of Health, Nashville, Tennessee, USA
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Morgan F. McDonald
- Divisions of Population Health Assessment, Tennessee Department of Health, Nashville, Tennessee, USA
- Divisions of Family Health and Wellness, Tennessee Department of Health, Nashville, Tennessee, USA
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19
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Musumeci MM, Pinheiro BV, Chiavegato LD, Phillip DSA, Machado FR, Freires F, Beppu OS, Arakaki JSO, Ramos RP. Predictors of prolonged ventilator weaning and mortality in critically ill patients with COVID-19. J Bras Pneumol 2023; 49:e20230131. [PMID: 37729336 PMCID: PMC10578941 DOI: 10.36416/1806-3756/e20230131] [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: 04/12/2023] [Accepted: 07/01/2023] [Indexed: 09/22/2023] Open
Abstract
OBJECTIVE To identify factors associated with prolonged weaning and mortality in critically ill COVID-19 patients admitted to ICUs and under invasive mechanical ventilation. METHODS Between March of 2020 and July of 2021, we retrospectively recorded clinical and ventilatory characteristics of critically ill COVID-19 patients from the day of intubation to the outcome. We classified the patients regarding the weaning period in accordance with established criteria. A logistic regression analysis was performed to identify variables associated with prolonged weaning and mortality. RESULTS The study involved 303 patients, 100 of whom (33.0%) had a prolonged weaning period. Most of the patients were male (69.6%), 136 (44.8%) had more than 50% of pulmonary involvement on chest CT, and 93 (30.6%) had severe ARDS. Within the prolonged weaning group, 62% died within 60 days. Multivariate analysis revealed that lung involvement greater than 50% on CT and delay from intubation to the first separation attempt from mechanical ventilation were significantly associated with prolonged weaning, whereas age and prolonged weaning were significantly associated with mortality. CONCLUSIONS Prolonged weaning can be used as a milestone in predicting mortality in critically ill COVID-19 patients. Lung involvement greater than 50% on CT and delay from intubation to the first separation attempt from mechanical ventilation were identified as significant predictors of prolonged weaning. These results might provide valuable information for healthcare professionals when making clinical decisions regarding the management of critically ill COVID-19 patients who are on mechanical ventilation.
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Affiliation(s)
- Marcella M Musumeci
- . Disciplina de Pneumologia, Departamento de Medicina, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo (SP) Brasil
| | - Bruno Valle Pinheiro
- . Disciplina de Pneumologia, Universidade Federal de Juiz de Fora, Juiz de Fora (MG) Brasil
| | - Luciana Dias Chiavegato
- . Disciplina de Pneumologia, Departamento de Medicina, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo (SP) Brasil
| | - Danielle Silva Almeida Phillip
- . Disciplina de Pneumologia, Departamento de Medicina, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo (SP) Brasil
| | - Flavia R Machado
- . Disciplina de Medicina Intensiva, Departamento de Anestesiologia, Dor e Medicina Intensiva, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo (SP) Brasil
| | - Fabrício Freires
- . Disciplina de Medicina Intensiva, Departamento de Anestesiologia, Dor e Medicina Intensiva, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo (SP) Brasil
| | - Osvaldo Shigueomi Beppu
- . Disciplina de Pneumologia, Departamento de Medicina, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo (SP) Brasil
| | - Jaquelina Sonoe Ota Arakaki
- . Disciplina de Pneumologia, Departamento de Medicina, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo (SP) Brasil
| | - Roberta Pulcheri Ramos
- . Disciplina de Pneumologia, Departamento de Medicina, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo (SP) Brasil
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20
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Zhang G, Basna R, Mathur MB, Lässer C, Mincheva R, Ekerljung L, Wennergren G, Rådinger M, Lundbäck B, Kankaanranta H, Nwaru BI. Exogenous female sex steroid hormones and new-onset asthma in women: a matched case-control study. BMC Med 2023; 21:337. [PMID: 37667254 PMCID: PMC10478448 DOI: 10.1186/s12916-023-03038-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 08/17/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Evidence on the role of exogenous female sex steroid hormones in asthma development in women remains conflicting. We sought to quantify the potential causal role of hormonal contraceptives and menopausal hormone therapy (MHT) in the development of asthma in women. METHODS We conducted a matched case-control study based on the West Sweden Asthma Study, nested in a representative cohort of 15,003 women aged 16-75 years, with 8-year follow-up (2008-2016). Data were analyzed using Frequentist and Bayesian conditional logistic regression models. RESULTS We included 114 cases and 717 controls. In Frequentist analysis, the odds ratio (OR) for new-onset asthma with ever use of hormonal contraceptives was 2.13 (95% confidence interval [CI] 1.03-4.38). Subgroup analyses showed that the OR increased consistently with older baseline age. The OR for new-onset asthma with ever MHT use among menopausal women was 1.17 (95% CI 0.49-2.82). In Bayesian analysis, the ORs for ever use of hormonal contraceptives and MHT were, respectively, 1.11 (95% posterior interval [PI] 0.79-1.55) and 1.18 (95% PI 0.92-1.52). The respective probability of each OR being larger than 1 was 72.3% and 90.6%. CONCLUSIONS Although use of hormonal contraceptives was associated with an increased risk of asthma, this may be explained by selection of women by baseline asthma status, given the upward trend in the effect estimate with older age. This indicates that use of hormonal contraceptives may in fact decrease asthma risk in women. Use of MHT may increase asthma risk in menopausal women.
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Affiliation(s)
- Guoqiang Zhang
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Rani Basna
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maya B Mathur
- Quantitative Sciences Unit, Stanford University, Palo Alto, CA, USA
| | - Cecilia Lässer
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Roxana Mincheva
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Linda Ekerljung
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Göran Wennergren
- Department of Pediatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Madeleine Rådinger
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bo Lundbäck
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hannu Kankaanranta
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | - Bright I Nwaru
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
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21
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Gondwe J, Ndovie M, Khuluza F, Banda CG. Association between HIV and treatment-resistant hypertension in Malawian adults: a protocol for a case-control study. BMJ Open 2023; 13:e069280. [PMID: 37532483 PMCID: PMC10401204 DOI: 10.1136/bmjopen-2022-069280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 07/04/2023] [Indexed: 08/04/2023] Open
Abstract
INTRODUCTION Treatment-resistant hypertension (RH), defined as uncontrolled blood pressure (≥140/90 mm Hg) despite treatment with ≥3 medications of different classes (including diuretics) at optimal doses, is associated with poor prognosis and an elevated risk of end-organ damage. In areas where HIV is endemic, such as sub-Saharan Africa, the risk of hypertension is high in people living with HIV. It remains unknown if HIV infection further increases the risk of RH. This study seeks to determine the association between HIV and RH as well as investigate other factors associated with RH in hypertensive Malawian adults. METHODS AND ANALYSIS A case-control study will be conducted among adult hypertensive patients attending a clinic at a referral hospital in Malawi. The cases will be hypertensive patients with a confirmed diagnosis of RH. For each case, two controls (hypertensive patients without RH), frequency matched for age group and sex, will be selected from among hospital clients attending the same hypertension clinic as the case. In both groups, HIV status will be ascertained. Additionally, information on other potential risk factors of RH, such as chronic kidney disease, obesity, hypercholesteraemia, diabetes, smoking, alcohol use, antiretroviral therapy regimen and duration, will be collected in both cases and controls. For each of the potential risk factors, ORs will be calculated to quantify the strength of their association with RH. In a multivariate analysis, conditional logistic regression will be used to assess the independent association between HIV and RH as well as the influence of the other potential drivers of RH. ETHICS AND DISSEMINATION This protocol has been approved by the College of Medicine Research Ethics Committee (COMREC) in Malawi (P.05/22/3637). Findings from this study will be disseminated through a peer-reviewed publication in an open-access international journal. Furthermore, anonymised data will be available on request from the authors.
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Affiliation(s)
- Josephine Gondwe
- Population Health Theme, Malawi-Liverpool-Wellcome Research Programme, Blantyre, Malawi
| | - Maclean Ndovie
- Department of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Felix Khuluza
- Department of Pharmacy, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Clifford George Banda
- Population Health Theme, Malawi-Liverpool-Wellcome Research Programme, Blantyre, Malawi
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22
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Marconi N, Raja EA, Bhattacharya S, Maheshwari A. Perinatal outcomes in singleton live births after blastocyst transfer: an analysis of 60,926 in vitro fertilization cycles from the United Kingdom. Fertil Steril 2023; 120:312-320. [PMID: 37080510 DOI: 10.1016/j.fertnstert.2023.04.018] [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: 08/30/2022] [Revised: 03/28/2023] [Accepted: 04/11/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVE To compare perinatal outcomes between singleton live births after blastocyst-stage and cleavage-stage fresh embryo transfer using data from all United Kingdom licensed fertility clinics. DESIGN A cohort study. SETTING Not applicable. PATIENT(S) A total of 60,926 in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles resulting in a singleton live birth after blastocyst-stage and cleavage-stage fresh embryo transfer between 2012 and 2018. INTERVENTION(S) Baseline characteristics between IVF/ICSI blastocyst and cleavage-stage transfer groups were compared using the χ2 test for categorical/dichotomized variables and the Mann-Whitney test for continuous variables. Statistical significance was set at <.05. Association between perinatal outcomes and blastocyst transfer compared with cleavage-stage transfer was assessed using multinomial logistic regression, adjusting for confounders selected using directed acyclic graphs (95% confidence interval [CI], adjusted relative risk ratio [aRRR]). A subgroup analysis included cycles in women undergoing their first IVF/ICSI cycle. MAIN OUTCOMES MEASURE(S) Gestational age at birth and birth weight. RESULT(S) The blastocyst group comprised 42,677 IVF/ICSI cycles and cleavage-stage group 18,249 cycles. There was likely little to no difference in the risk of preterm (aRRR, 1.07; 95% CI, 1.00-1.15) and very preterm birth (aRRR, 1.05; 95% CI, 0.91-1.21) in singleton live births after fresh blastocyst and cleavage-stage transfer. Risks of low birth weight (aRRR, 1.02; 95% CI, 0.95-1.09), very low birth weight (aRRR 0.96; 95% CI, 0.83-1.11), high birth weight (aRRR, 0.97; 95% CI, 0.90-1.04), and very high birth weight (aRRR, 0.91; 95% CI, 0.77-1.08) were likely similar between the groups. The findings were consistent in the subgroup analysis. CONCLUSION(S) Fresh blastocyst transfer does not appear to have a negative impact on gestational age at birth and birth weight in singleton live births compared with fresh cleavage-stage transfer.
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Affiliation(s)
- Nicola Marconi
- Aberdeen Fertility Centre, Aberdeen Maternity Hospital, Aberdeen, Scotland, United Kingdom.
| | - Edwin-Amalraj Raja
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, United Kingdom
| | - Siladitya Bhattacharya
- School of Medicine and Dentistry, University of Aberdeen, Aberdeen, Scotland, United Kingdom
| | - Abha Maheshwari
- School of Medicine and Dentistry, University of Aberdeen, Aberdeen, Scotland, United Kingdom
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23
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Carvalho EV, Pinto SPS, Gomes EP, Peñuelas Ó, Stohler CG, Arantes GC, Carvalho LL, Oliveira RMF, Martins PN, Reboredo MM, Pinheiro BV. Adherence to protective mechanical ventilation in COVID-19 versus non-COVID-19-associated acute respiratory distress syndrome: Comparison between two prospective cohorts. Med Intensiva 2023; 47:445-453. [PMID: 36813658 DOI: 10.1016/j.medine.2023.01.004] [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: 11/27/2022] [Revised: 01/02/2023] [Accepted: 01/08/2023] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To compare adherence to protective mechanical ventilation (MV) parameters in patients with acute respiratory distress syndrome (ARDS) caused by COVID-19 with patients with ARDS from other etiologies. DESIGN Multiple prospective cohort study. SETTING Two Brazilian cohorts of ARDS patients were evaluated. One with COVID-19 patients admitted to two Brazilian intensive care units (ICUs) in 2020 and 2021 (C-ARDS, n=282), the other with ARDS-patients from other etiologies admitted to 37 Brazilian ICUs in 2016 (NC-ARDS, n=120). PATIENTS ARDS patients under MV. INTERVENTIONS None. MAIN VARIABLES OF INTEREST Adherence to protective MV (tidal volume ≤8mL/kg PBW; plateau pressure ≤30cmH2O; and driving pressure ≤15cmH2O), adherence to each individual component of the protective MV, and the association between protective MV and mortality. RESULTS Adherence to protective MV was higher in C-ARDS than in NC-ARDS patients (65.8% vs. 50.0%, p=0.005), mainly due to a higher adherence to driving pressure ≤15cmH2O (75.0% vs. 62.4%, p=0.02). Multivariable logistic regression showed that the C-ARDS cohort was independently associated with adherence to protective MV. Among the components of the protective MV, only limiting driving pressure was independently associated with lower ICU mortality. CONCLUSIONS Higher adherence to protective MV in patients with C-ARDS was secondary to higher adherence to limiting driving pressure. Additionally, lower driving pressure was independently associated with lower ICU mortality, which suggests that limiting exposure to driving pressure may improve survival in these patients.
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Affiliation(s)
- E V Carvalho
- Pulmonary and Critical Care Division, University Hospital of Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil; School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - S P S Pinto
- Pulmonary and Critical Care Division, University Hospital of Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - E P Gomes
- Pulmonary and Critical Care Division, University Hospital of Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil; School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Ó Peñuelas
- Intensive Care Unit, Hospital Universitario de Getafe, Madrid, Spain; CIBER de Enfermedades Respiratorias, CIBERES, Madrid, Spain
| | - C G Stohler
- Pulmonary and Critical Care Division, University Hospital of Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - G C Arantes
- Pulmonary and Critical Care Division, University Hospital of Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - L L Carvalho
- Pulmonary and Critical Care Division, University Hospital of Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - R M F Oliveira
- Pulmonary and Critical Care Division, University Hospital of Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - P N Martins
- Pulmonary and Critical Care Division, University Hospital of Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - M M Reboredo
- Pulmonary and Critical Care Division, University Hospital of Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil; School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - B V Pinheiro
- Pulmonary and Critical Care Division, University Hospital of Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil; School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil.
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24
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Buhl Borgstrøm MB, Ahrendt Bjerregaard A, Olsen SF, Gabrielsen A, Humaidan P, Kesmodel US. Food & Fertility Study: study protocol for a Danish multicentre prospective cohort study investigating the association between food intake and semen quality, pregnancy and birth outcomes in infertile women and men. BMJ Open 2023; 13:e068354. [PMID: 37407049 DOI: 10.1136/bmjopen-2022-068354] [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: 07/07/2023] Open
Abstract
INTRODUCTION Worldwide infertility is highly prevalent, and lifestyle factors, such as food intake, could have an essential role in the success of a fertility treatment. The literature is not consistent and adequate for recommendations to the increasing number of women and men of reproductive age who ask for lifestyle guidance. Therefore, the aims of the Food & Fertility Study will be to investigate the possible association between food intake and semen quality in men, and pregnancy and live birth rates in women undergoing intrauterine insemination or assisted reproductive technology treatment. METHODS AND ANALYSIS The Food & Fertility Study is a multicentre prospective cohort study which plans to enrol a total of 4000 women and men between 2022 and 2024. Data collection will take place in four fertility clinics through a web-based Food Frequency Questionnaire. Data on sperm quality and pregnancy and live birth rates will be obtained from medical records and national registers. ETHICS AND DISSEMINATION The study is registered with and approved by the Danish Data Protection Agency, the North Denmark Region (j.nr: 2019-055298). Further, a Statement of Work and a Master Collaboration Agreement have been submitted and approved by the regional legal departments (AGR-2019-731-9667). Dissemination of the results will be through national and international conferences, in scientific environments, in the form of lectures to the broader public, and by peer-reviewed publications in international scientific journals. TRIAL REGISTRATION NUMBER NCT05454046.
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Affiliation(s)
| | - Anne Ahrendt Bjerregaard
- Section of Epidemiology, Frederiksberg Hospital Center for Klinisk Forskning og Forebyggelse, Frederiksberg, Denmark
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Sjurdur F Olsen
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | | | - Peter Humaidan
- The Fertility Clinic, Skive Regional Hospital, Skive, Denmark
| | - Ulrik Schiøler Kesmodel
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- The Fertility Unit, Aalborg University Hospital, Aalborg, Denmark
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25
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Hu F, Chen AA, Horng H, Bashyam V, Davatzikos C, Alexander-Bloch A, Li M, Shou H, Satterthwaite TD, Yu M, Shinohara RT. Image harmonization: A review of statistical and deep learning methods for removing batch effects and evaluation metrics for effective harmonization. Neuroimage 2023; 274:120125. [PMID: 37084926 PMCID: PMC10257347 DOI: 10.1016/j.neuroimage.2023.120125] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/12/2023] [Accepted: 04/19/2023] [Indexed: 04/23/2023] Open
Abstract
Magnetic resonance imaging and computed tomography from multiple batches (e.g. sites, scanners, datasets, etc.) are increasingly used alongside complex downstream analyses to obtain new insights into the human brain. However, significant confounding due to batch-related technical variation, called batch effects, is present in this data; direct application of downstream analyses to the data may lead to biased results. Image harmonization methods seek to remove these batch effects and enable increased generalizability and reproducibility of downstream results. In this review, we describe and categorize current approaches in statistical and deep learning harmonization methods. We also describe current evaluation metrics used to assess harmonization methods and provide a standardized framework to evaluate newly-proposed methods for effective harmonization and preservation of biological information. Finally, we provide recommendations to end-users to advocate for more effective use of current methods and to methodologists to direct future efforts and accelerate development of the field.
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Affiliation(s)
- Fengling Hu
- Penn Statistics in Imaging and Visualization Endeavor (PennSIVE), Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Dr, Philadelphia, PA 19104, United States.
| | - Andrew A Chen
- Penn Statistics in Imaging and Visualization Endeavor (PennSIVE), Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Dr, Philadelphia, PA 19104, United States
| | - Hannah Horng
- Penn Statistics in Imaging and Visualization Endeavor (PennSIVE), Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Dr, Philadelphia, PA 19104, United States
| | - Vishnu Bashyam
- Center for Biomedical Image Computing and Analytics (CBICA), Perelman School of Medicine, United States
| | - Christos Davatzikos
- Center for Biomedical Image Computing and Analytics (CBICA), Perelman School of Medicine, United States
| | - Aaron Alexander-Bloch
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States; Penn-CHOP Lifespan Brain Institute, United States; Department of Child and Adolescent Psychiatry and Behavioral Science, Children's Hospital of Philadelphia, United States
| | - Mingyao Li
- Statistical Center for Single-Cell and Spatial Genomics, Perelman School of Medicine, University of Pennsylvania, United States
| | - Haochang Shou
- Penn Statistics in Imaging and Visualization Endeavor (PennSIVE), Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Dr, Philadelphia, PA 19104, United States; Center for Biomedical Image Computing and Analytics (CBICA), Perelman School of Medicine, United States
| | - Theodore D Satterthwaite
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States; Penn-CHOP Lifespan Brain Institute, United States; The Penn Lifespan Informatics and Neuroimaging Center, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States
| | - Meichen Yu
- Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, United States
| | - Russell T Shinohara
- Penn Statistics in Imaging and Visualization Endeavor (PennSIVE), Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Dr, Philadelphia, PA 19104, United States; Center for Biomedical Image Computing and Analytics (CBICA), Perelman School of Medicine, United States
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Eerola V, Sallinen V, Lempinen M, Helanterä I. Association of Procurement Time With Pancreas Transplant Outcomes in Brain-Dead Donors. Transpl Int 2023; 36:11332. [PMID: 37470064 PMCID: PMC10353260 DOI: 10.3389/ti.2023.11332] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 06/12/2023] [Indexed: 07/21/2023]
Abstract
A brain-death-induced cytokine storm damages organs in an organ donor. However, a longer time period between declaration of brain death and organ procurement (procurement interval) is associated with improved outcomes in kidney, liver, heart, and lung transplantation. The aim of this study was to find the optimal procurement interval for pancreas transplantation. Association of procurement interval with pancreas graft outcomes was analyzed using multivariable models adjusted for variables possibly affecting procurement interval and outcomes. Altogether 10,119 pancreas transplantations were included from the Scientific Registry of Transplant Recipients. The median follow-up was 3.2 (IQR 1.01-6.50) years. During the first year, 832 (9.0%) grafts were lost, including 555 (6.0%) within the first 30 days. Longer procurement interval was associated with increased death-censored graft survival in a multivariable model (HR 0.944 95% CI 0.917-0.972, per 10-h increase, p < 0.001). A decreasing hazard of graft loss was observed also with 1-year, but not with 30-day graft survival. During 1-year follow-up, 953 (12.1%) patients had an acute rejection, and longer procurement interval was also associated with less acute rejections (OR 0.937 95% CI 0.900-0.976, per 10-h increase, p = 0.002) in the multivariable model. In conclusion, longer procurement interval is associated with improved long-term outcomes in pancreas transplantation.
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Loughran KJ, Tough D, Ryan CG, Wellburn S, Martin D, Dixon J, Harrison SL. The Association of Pain with Incident Falls in People with Chronic Obstructive Pulmonary Disease: Evidence from the English Longitudinal Study of Ageing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6236. [PMID: 37444084 PMCID: PMC10341239 DOI: 10.3390/ijerph20136236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/28/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023]
Abstract
People with chronic obstructive pulmonary disease (COPD) have a higher prevalence of pain and a greater risk of falls than their healthy peers. As pain has been associated with an increased risk of falls in older adults, this study investigated the association between pain and falls in people with COPD compared to healthy controls. Data from the English Longitudinal Study of Ageing were used to establish an association between pain and falls when modelled with a generalised ordinal logistic regression and adjusted for sex, age, wealth, and education (complete case analysis only; n = 806 COPD, n = 3898 healthy controls). The odds were then converted to the predicted probabilities of falling. The predicted probability of falling for people with COPD was greater across all pain categories than for healthy controls; for COPD with (predicted probability % [95%CI]), no pain was 20% [17 to 25], with mild pain was 28% [18 to 38], with moderate pain was 28% [22 to 34] with severe pain was 39% [30 to 47] and for healthy controls with no pain was 17% [16 to 18], mild pain 22% [18 to 27], moderate pain 25% [20 to 29] and severe pain 27% [20 to 35]. The probability of falling increased across pain categories in individuals with COPD, with the most severe pain category at a nearly 40% probability of falling, indicating a potential interaction between COPD and pain.
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Affiliation(s)
- Kirsti J. Loughran
- Centre for Rehabilitation, School of Health & Life Science, Teesside University, Middlesbrough TS1 3BX, UK
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Wambiya EOA, Gourlay AJ, Mulwa S, Magut F, Mthiyane N, Orindi B, Chimbindi N, Kwaro D, Shahmanesh M, Floyd S, Birdthistle I, Ziraba A. Impact of DREAMS interventions on experiences of violence among adolescent girls and young women: Findings from population-based cohort studies in Kenya and South Africa. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001818. [PMID: 37163514 PMCID: PMC10171651 DOI: 10.1371/journal.pgph.0001818] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/16/2023] [Indexed: 05/12/2023]
Abstract
DREAMS aims to reduce HIV incidence among adolescent girls and young women (AGYW) by tackling drivers of HIV risk including gender-based violence. We evaluate the impact of DREAMS on recent experiences of violence perpetuated by men against AGYW. AGYW cohorts were randomly selected from demographic platforms in South Africa (rural KwaZulu-Natal) and Kenya (Nairobi informal settlements and rural Gem sub-county). AGYW aged 13-22 years were enrolled in 2017 (Nairobi, KwaZulu-Natal) or 2018 (Gem), with annual follow-up to 2019. We described proportions of AGYW who self-reported experiences of violence perpetrated by males in the 12 months preceding the interview, overall and by form (physical, sexual, emotional). We investigated associations with DREAMS (invitation to participate during 2017-2018) through multivariable propensity score-adjusted logistic regression and estimated the causal effect of DREAMS on experiences of violence, under counter-factual scenarios in which all versus no AGYW were DREAMS beneficiaries. Among 852, 1018 and 1712 AGYW followed-up in 2019 in Nairobi, Gem and KZN, respectively, proportions reporting any violence in 2019 were higher in Nairobi (29%) than Gem (18%) and KwaZulu-Natal (19%). By sub-type, emotional and physical violence were more frequently reported than sexual violence. We found no evidence of an impact attributable to DREAMS on overall levels of violence, in any setting. Nor was there evidence of impact on sub-types of violence, with one exception: an increase in physical violence in Nairobi if all, versus no, AGYW were DREAMS beneficiaries (16% vs 11%; +5% difference [95% CI: +0.2%, +10.0%]). Experiences of gender-based violence were common among AGYW, especially in urban settings, and DREAMS had no measurable impact on reducing violence within three years of implementation. Violence prevention programming that reaches more men and the broader community, sustained for longer periods, may yield greater gains in violence reduction than AGYW-focused programming. Additionally, more investment in implementation research is needed to bridge trial-based study findings from efficacy to population-level effectiveness.
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Affiliation(s)
- Elvis Omondi Achach Wambiya
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom
- Health and Systems for Health, African Population and Health Research Center, Nairobi, Kenya
| | - Annabelle J. Gourlay
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sarah Mulwa
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Faith Magut
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Nondumiso Mthiyane
- Clinical Research Department, Africa Health Research Institute, Durban, South Africa
- Institute for Global Health, University College London, London, United Kingdom
| | - Benedict Orindi
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Center for Geographic Medicine Research, Kilifi, Kenya
| | - Natsayi Chimbindi
- Clinical Research Department, Africa Health Research Institute, Durban, South Africa
- Institute for Global Health, University College London, London, United Kingdom
- University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Daniel Kwaro
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Maryam Shahmanesh
- Clinical Research Department, Africa Health Research Institute, Durban, South Africa
- Institute for Global Health, University College London, London, United Kingdom
- University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Sian Floyd
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Isolde Birdthistle
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Abdhalah Ziraba
- Health and Systems for Health, African Population and Health Research Center, Nairobi, Kenya
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Li W, Zhang H, Xiao Y, Tao Y, Chen W, Wang D. Association between occupational noise exposure duration and heart rate variability among Chinese adults: The role of plasma miRNAs. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2023; 323:121324. [PMID: 36813098 DOI: 10.1016/j.envpol.2023.121324] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 01/31/2023] [Accepted: 02/18/2023] [Indexed: 06/18/2023]
Abstract
We aimed to explore the association between occupational noise exposure duration and heart rate variability (HRV) and the underlying mechanism. A total of 449 subjects in a manufacturing company in Wuhan, China were included in our study and six candidate miRNAs (miR-200a-3p, miR-200b-3p, miR-200c-3p, miR-1-3p, miR-92a-3p and miR-21-5p) were tested among 200 individuals. Information combining the work histories and the occupational noise monitoring records were used to calculate the exposure of occupational noise, HRV indices were measured by using 3-channel digital Holter monitors, including the standard deviation of all normal R-R intervals (SDNN), the root mean of the square of successive differences between adjacent normal NN intervals (r-MSSD), SDNN index, low-frequency power (LF), high-frequency power (HF) and TP (total power). We found a significant linear negative dose-response relationship between occupational noise exposure duration and HRV indices (P for overall <0.05, P for nonlinear >0.05), including SDNN, r-MSSD, SDNN index, LF and HF. In the continuous models, the β (95% CIs) for each 1-year occupational noise exposure were -0.002 (-0.004, -0.001) for SDNN, -0.002 (-0.004, -0.001) for r-MSSD, -0.002 (-0.004, -0.001) for SDNN index, and -0.006 (-0.012, -0.001) for HF. Meanwhile, we also found that occupational noise exposure duration was significantly associated with lower expression of five miRNAs, when adjusting for other covariates. The β (95% CIs) were -0.039 (-0.067, -0.011) for miRNA-200c-3p, -0.053 (-0.083, -0.022) for miRNA-200a-3p, -0.044 (-0.070, -0.019) for miRNA-200b-3p, -0.032 (-0.048, -0.017) for miRNA-92a-3p, and -0.063 (-0.089, -0.038) for miRNA-21-5p in the continuous models. In addition, we found a positive association between miRNA-1-3p and LF (β = 0.039, 95% CI = 0.002, 0.080). Our study suggests that occupational noise exposure duration is associated with cardiac autonomic dysfunction, and the role of miRNAs in noise induced HRV reduction needs to be confirmed in future studies.
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Affiliation(s)
- Wenzhen Li
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China; Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Haozhe Zhang
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Yang Xiao
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Yueqing Tao
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China
| | - Weihong Chen
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Dongming Wang
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China.
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Longitudinal uric acid has nonlinear association with kidney failure and mortality in chronic kidney disease. Sci Rep 2023; 13:3952. [PMID: 36894586 PMCID: PMC9998636 DOI: 10.1038/s41598-023-30902-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/03/2023] [Indexed: 03/11/2023] Open
Abstract
We investigated the shape of the relationship between longitudinal uric acid (UA) and the hazard of kidney failure and death in chronic kidney disease (CKD) patients, and attempted to identify thresholds associated with increased hazards. We included CKD stage 3-5 patients from the CKD-REIN cohort with one serum UA measurement at cohort entry. We used cause-specific multivariate Cox models including a spline function of current values of UA (cUA), estimated from a separate linear mixed model. We followed 2781 patients (66% men, median age, 69 years) for a median of 3.2 years with a median of five longitudinal UA measures per patient. The hazard of kidney failure increased with increasing cUA, with a plateau between 6 and 10 mg/dl and a sharp increase above 11 mg/dl. The hazard of death had a U-shape relationship with cUA, with a hazard twice higher for 3 or 11 mg/dl, compared to 5 mg/dl. In CKD patients, our results indicate that UA above 10 mg/dl is a strong risk marker for kidney failure and death and that low UA levels below 5 mg/dl are associated with death before kidney failure.
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Jackson EE, Janitz AE, Carabin H. A Method to Create Directed Acyclic Graphs from Cycles of Transmission of Zoonotic and Vector-Borne Infectious Agents. Vector Borne Zoonotic Dis 2023; 23:129-135. [PMID: 36847355 PMCID: PMC11074630 DOI: 10.1089/vbz.2022.0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
Background: The life cycles of zoonotic and vector-borne diseases can be complex. This complexity makes it challenging to identify factors that confound the association between an exposure of interest and infection in one of the susceptible hosts. In epidemiology, directed acyclic graphs (DAGs) can be used to visualize the relationships between exposures and outcomes and also to identify which factors confound the association between exposure and the outcome of interest. However, DAGs can only be used in situations where no cycle exists in the causal relationships being represented. This is problematic for infectious agents that cycle between hosts. Zoonoses and vector-borne diseases pose additional challenges with DAG construction since multiple required or optional hosts of different species may be part of the cycle. Methods: We review the existing examples of DAGs created for nonzoonotic infectious agents. We then demonstrate how to cut the transmission cycle to create DAGs where infection of a specific host species is the outcome of interest. We adapt our method to create DAGs using examples of transmission and host characteristics common to many zoonotic and vector-borne infectious agents. Results: We demonstrate our method using the transmission cycle of West Nile virus to create a simple transmission DAG that lacks a cycle. Conclusions: Using our work, investigators can create DAGs to help identify confounders of the relationships between modifiable risk factors and infection. Ultimately, a better understanding and control of confounding in measuring the impact of such risk factors can be used to inform health policy, guide public health and animal health interventions, and uncover gaps needing further research attention.
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Affiliation(s)
- Ellen E. Jackson
- Département de pathologie et microbiologie, Faculté de médecine vétérinaire, Université de Montréal, Saint-Hyacinthe, Québec, Canada
- Centre de recherche en santé publique (CReSP), Université de Montréal and Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, Québec, Canada
- Groupe de recherche en épidémiologie des zoonoses et santé publique (GREZOSP), Université de Montréal, Saint-Hyacinthe, Québec, Canada
- Centre de recherche en infectiologie porcine et avicole (CRIPA), Faculté de Médecine Vétérinaire, Université de Montréal, Saint-Hyacinthe, Québec, Canada
| | - Amanda E. Janitz
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Hélène Carabin
- Département de pathologie et microbiologie, Faculté de médecine vétérinaire, Université de Montréal, Saint-Hyacinthe, Québec, Canada
- Centre de recherche en santé publique (CReSP), Université de Montréal and Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, Québec, Canada
- Groupe de recherche en épidémiologie des zoonoses et santé publique (GREZOSP), Université de Montréal, Saint-Hyacinthe, Québec, Canada
- Département de médecine sociale et préventive, École de santé publique, Université de Montréal, Montréal, Québec, Canada
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Successful thrombectomy is beneficial in patients with pre-stroke disability: Results from an international multicenter cohort study. J Neuroradiol 2023; 50:59-64. [PMID: 35341899 DOI: 10.1016/j.neurad.2022.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 03/18/2022] [Accepted: 03/19/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patients with pre-stroke disability, defined as a modified Rankin Scale (mRS) ≥3, were excluded from most trials of endovascular thrombectomy (EVT) for acute stroke. We sought to evaluate the prognostic factors associated with favorable outcome in stroke patients with known disability undergoing EVT, and the impact of successful reperfusion. METHODS Consecutive acute stroke patients with pre-stroke disability, undergoing EVT, were retrospectively collected between 2016 to 2019 from a Canadian cohort and a multicenter French cohort (Endovascular Treatment in Ischemic Stroke registry-ETIS). Favorable outcome was defined as an mRS equal to pre-stroke mRS. Patients achieving successful reperfusion (defined as a modified Thrombolysis in Cerebral Infarction score of 2b/3) were compared with patients without successful reperfusion to determine if successful EVT was associated with better functional outcomes. RESULTS Among 6220 patients treated with EVT, 280 (4.5%) patients with a pre-stroke mRS ≥3 were included. Sixty-one patients (21.8%) had a favorable outcome and 146 (52.1%) died at 3 months. Patients with successful reperfusion had a higher proportion of favorable 90-day mRS (27.6% versus 19.6%, p = 0.025) and a lower mortality (48.3% versus 69.6%, p = 0.008) than patients without successful reperfusion. After adjusting for baseline prognostic factors, successful reperfusion defined by TICI ≥2b was associated with favorable functional outcome (OR 3.16 CI95% [1.11-11.5]; p 0.048). CONCLUSION In patients with pre-stroke disability, successful reperfusion is associated with a greater proportion of favorable outcome and lower mortality.
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Gongola A, Bradshaw JC. Directed Acyclic Graphs in Surgical Research. J Surg Res 2023; 282:285-288. [PMID: 36045022 DOI: 10.1016/j.jss.2022.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/28/2022] [Accepted: 07/29/2022] [Indexed: 11/25/2022]
Abstract
Surgical research often utilizes multivariable regression to evaluate causal relationships between variables, but there is usually little explanation of the decision-making regarding which variables were controlled for. We propose that directed acyclic graphs (DAGs)-a formal logic tool that illustrates connections between variables-should be used to define and communicate variable relationships to readers and other audiences. While literature in epidemiology and other medical fields has recently started to incorporate DAGs more, they are still seldom seen in surgical publications. In this review, we describe the background and need for DAGs and argue for their use. Next, we explain how bias can be introduced without a thoughtful approach to control variable selection. Finally, we recommend that researchers communicate their choices and rationale when selecting control variables in published surgical research.
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Affiliation(s)
- AlleaBelle Gongola
- Department of Surgery, Medstar Georgetown University Hospital, Washington, District of Columbia.
| | - Jace C Bradshaw
- Departments of Emergency Medicine and Anesthesiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Delclòs-Alió X, Rodríguez DA, Olmedo NL, Ferrer CP, Moore K, Stern D, de Menezes MC, de Oliveira Cardoso L, Wang X, Guimaraes JM, Miranda JJ, Sarmiento OL. Is city-level travel time by car associated with individual obesity or diabetes in Latin American cities? Evidence from 178 cities in the SALURBAL project. CITIES (LONDON, ENGLAND) 2022; 131:103899. [PMID: 36277810 PMCID: PMC7613723 DOI: 10.1016/j.cities.2022.103899] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
There is growing evidence that longer travel time by private car poses physical and mental risks. Individual-level obesity and diabetes, two of the main public health challenges in low- and middle-income contexts, could be associated to city-level travel times by car. We used individual obesity and diabetes data from national health surveys from individuals in 178 Latin American cities, compiled and harmonized by the SALURBAL project. We calculated city-level travel times by car using the Google Maps Distance Matrix API. We estimated associations between peak hour city-level travel time by car and obesity and diabetes using multilevel logistic regression models, while adjusting for individual characteristics and other city-level covariates. In our study we did not observe a relationship between city-level peak-hour travel time by car and individual obesity and diabetes, as reported in previous research for individual time spent in vehicles in high-income settings. Our results suggest that this relationship may be more complex in Latin America compared to other settings, especially considering that cities in the region are characterized by high degrees of population density and compactness and by a higher prevalence of walking and public transportation use.
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Affiliation(s)
- Xavier Delclòs-Alió
- Institute of Urban and Regional Development, University of California, Berkeley, CA, USA
- Research Group on Territorial Analysis and Tourism Studies (GRATET), Department of Geography, Universitat Rovira i Virgili, Spain
| | - Daniel A. Rodríguez
- Department of City and Regional Planning & Institute for Transportation Studies, University of California, Berkeley, 228 Wurster Hall, Berkeley, CA 94720, USA
| | - Nancy López Olmedo
- Instituto Nacional de Salud Pública, Mexico, Avenida Universidad 655, 62100 Cuernavaca, Morelos, Mexico
| | - Carolina Pérez Ferrer
- CONACyT-Instituto Nacional de Salud Pública, Cerrada de Fray Pedro de Gante 50, 14080 Mexico City, Mexico
| | - Kari Moore
- Dornsife School of Public Health, Drexel University, 3600 Market Street, Philadelphia, PA 19104, USA
| | - Dalia Stern
- CONACyT-Instituto Nacional de Salud Pública, Cerrada de Fray Pedro de Gante 50, 14080 Mexico City, Mexico
| | - Mariana Carvalho de Menezes
- Department of Clinical and Social Nutrition, Federal University of Ouro Preto, Av. Pres. Antônio Carlos, 6627, Belo Horizonte 31270-901, Minas Gerais, Brazil
| | - Letícia de Oliveira Cardoso
- Oswaldo Cruz Foundation, National School of Public Health, Av. Brasil 4365, Rio de Janeiro, 21040-900, Rio de Janeiro, Brazil
| | - Xize Wang
- Department of Real Estate, National University of Singapore, 4 Architecture Dr, 117566, Singapore
| | - Joanna M.N. Guimaraes
- Oswaldo Cruz Foundation, National School of Public Health, Av. Brasil 4365, Rio de Janeiro, 21040-900, Rio de Janeiro, Brazil
| | - J. Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendariz 445, 15074 Lima, Peru
| | - Olga L. Sarmiento
- School of Medicine, Universidad de Los Andes, Carrera 1, 111711 Bogotá, Colombia
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Broman J, Aarnio K, But A, Marinkovic I, Rodríguez-Pardo J, Kaste M, Tatlisumak T, Putaala J. Association of post-stroke-initiated antidepressants with long-term outcomes in young adults with ischaemic stroke. Ann Med 2022; 54:1757-1766. [PMID: 35786079 PMCID: PMC9258433 DOI: 10.1080/07853890.2022.2089729] [Citation(s) in RCA: 2] [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] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE We examined the association between initiation of antidepressants within the first year after ischaemic stroke (IS) in young adults and long-term fatal and non-fatal cardiovascular events, as well as all-cause mortality. PATIENTS AND METHODS The Helsinki Young Stroke Registry (HYSR) includes patients aged 15-49 years with their first-ever IS occurring 1994-2007. From nationwide registers, we obtained data on prescriptions (1993-2011) and outcomes of interest (1994-2011). Time of initiating post-stroke antidepressants (PSADs) was defined as time of the first filled prescription for antidepressants within the first year from IS. To account for non-random assignment of PSADs, we performed propensity score matching and studied the relationship between PSAD initiation and outcomes using Cox regression models with time-varying coefficients. RESULTS Of all patients (n = 888), 206 (23.2%) initiated PSADs within the first year, of which 203 (98.5%) could be matched to 406 non-initiators. In this matched sample of 609 patients, the median follow-up time was 8.1 (interquartile range [IQR] 5.0-12.6) years and 169 (28.9%) patients had any cardiovascular events, 95 (15.8%) had recurrent ischaemic or haemorrhagic strokes and 106 (17.4%) died. Adjusted for sociodemographics and cardiovascular comorbidities, PSAD initiation was associated with recurrent ischaemic or haemorrhagic stroke 5-10 years after IS (hazard ratio [HR] 3.07, 95% confidence interval [CI] 1.32-7.12). No association emerged between PSAD initiation and other outcomes. CONCLUSIONS In young adults, PSAD initiation within the first year after IS was associated with a heightened hazard of recurrent ischaemic or haemorrhagic stroke in the long term. Future studies are needed to verify the results and to further study the nature of this finding.KEY MESSAGESInitiation of post-stroke antidepressants (PSADs) within the first year after ischaemic stroke (IS) was associated with a heightened hazard of recurrent ischaemic or haemorrhagic stroke in the long term.Patients starting antidepressants after IS should be followed up more closely in case of recurrent events.Future studies are needed to verify the results and to further study the nature of this finding.
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Affiliation(s)
- Jenna Broman
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Karoliina Aarnio
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Anna But
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Ivan Marinkovic
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Markku Kaste
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Turgut Tatlisumak
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Oh GY, Moga DC, Fardo DW, Abner EL. The association of gabapentin initiation and neurocognitive changes in older adults with normal cognition. Front Pharmacol 2022; 13:910719. [PMID: 36506564 PMCID: PMC9732650 DOI: 10.3389/fphar.2022.910719] [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: 04/01/2022] [Accepted: 11/08/2022] [Indexed: 11/26/2022] Open
Abstract
Background: Gabapentin is increasingly prescribed to older adults, which raises concerns about its potential to cause neurocognitive changes. Therefore, we aimed to examine the association of gabapentin use with neurocognitive changes (i.e., cognitive decline, functional status decline, and motor function change) in older adults. Methods: We conducted a retrospective cohort study using the National Alzheimer's Coordinating Center Uniform Data Set (UDS; September 2005-March 2021 data freeze). From the eligible sample (≥age 65 years), we identified cognitively normal new-users of gabapentin and the visit they initiated gabapentin (i.e., index visit). Initiators were matched to randomly selected nonusers on year of UDS enrollment and visit number from enrollment to index. Cognitive decline was defined as any increase in the Clinical Dementia Rating global score (CDRGLOB) and as a 1-point increase in CDR sum of boxes (CDR-SB). Functional status decline was defined as a 3-point increase in the sum of the Functional Activities Questionnaire (FAQ) and as 0.3-point increase in mean FAQ. Decline in motor function was defined as new clinician reports of gait disorder, falls, and slowness. To mitigate confounding and selection bias, we used joint stabilized inverse probability of treatment weights and stabilized inverse probability of censoring weights. All analyses were conducted comparing index to index+1 and index+2 visits. Results: From the eligible UDS participants (N = 23,059), we included 480 initiators (mean age [SD]: 78.7 [6.9]; male 34.4%); 4,320 nonusers (78.3 [7.0]; 34.4%). Gabapentin initiation was significantly associated with cognitive/functional status decline: worsening CDRGLOB at index+1 visit (odds ratio [95% confidence interval]: 1.55 [1.07, 2.25]); CDR-SB at index+1 visit (1.94 [1.22, 3.09]); and mean of FAQ at index+2 visit (1.78 [1.12, 2.83]). After excluding initiators with extant motor dysfunction (n = 21), we identified 459 initiators (78.7 [6.9]; 34.0%) and 4,131 nonusers (78.2 [6.9]; 34.7%); in this sample, gabapentin initiation was associated with increased falls at the index+2 visit (2.51 [1.19, 5.31]). Conclusion: Gabapentin initiation was significantly associated with deleterious neurocognitive changes among older adults with initially normal cognition. Further studies are needed to examine the risk/benefit of prescribing gabapentin in older adults.
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Affiliation(s)
- GYeon Oh
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, United States,*Correspondence: GYeon Oh,
| | - Daniela C. Moga
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, United States,Department of Epidemiology and Environmental Health, University of Kentucky, Lexington, KY, United States,Department of Pharmacy Practice and Science, University of Kentucky, Lexington, KY, United States,Institute for Pharmaceutical Outcomes and Policy, University of Kentucky, Lexington, KY, United States
| | - David W. Fardo
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, United States,Department of Biostatistics, University of Kentucky, Lexington, KY, United States
| | - Erin L. Abner
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, United States,Department of Epidemiology and Environmental Health, University of Kentucky, Lexington, KY, United States,Department of Biostatistics, University of Kentucky, Lexington, KY, United States
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Terra e Souza LH, Diaz-Quijano FA, de Azevedo Barros MB, Lima MG. Race (black-white) and sex inequalities in tooth loss: A population-based study. PLoS One 2022; 17:e0276103. [PMID: 36228031 PMCID: PMC9560604 DOI: 10.1371/journal.pone.0276103] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 09/05/2022] [Indexed: 11/07/2022] Open
Abstract
The effect of health inequalities is determined by different socioeconomic, sex, and race conditions. This study aimed to analyze the association of tooth loss with race (defined by self-reported skin color) and sex. Based on the hypothesis that the association between tooth loss and race may be modified by sex, we also aimed to evaluate possible interactions between race and sex in association with this event, in a population-based study in the city of Campinas, Brazil. A directed acyclic graph was used to select covariates. The prevalence, of tooth loss was 19% higher in black women compared to white men (Prevalence ratio [PR]: 1.19; 95%CI: 1.05–1.34). Moreover, the prevalence of tooth loss in black women was 26% higher than in white women (PR: 1.26; 95%CI: 1.13–1.42); and, within the strata of black people, black women had 14% higher dental loss (PR: 1.14; 95%CI: 1.02–1.27) compared to black men. This study found a significant interaction between race and sex in tooth loss, with a disadvantage for black women. In addition, this work contributes to the discussion of health inequities and can support policies for the provision of universal dental care.
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Affiliation(s)
- Lívia Helena Terra e Souza
- Department of Collective Health, Collaborating Center for Health Situation Analysis (CCAS), School of Medical Science, University of Campinas, Campinas, São Paulo, Brazil
- * E-mail:
| | - Fredi Alexander Diaz-Quijano
- Department of Epidemiology, Laboratory of Causal Inference in Epidemiology [Laboratório de Inferência Causal em Epidemiologia], School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Marilisa Berti de Azevedo Barros
- Department of Collective Health, Collaborating Center for Health Situation Analysis (CCAS), School of Medical Science, University of Campinas, Campinas, São Paulo, Brazil
| | - Margareth Guimarães Lima
- Department of Collective Health, Collaborating Center for Health Situation Analysis (CCAS), School of Medical Science, University of Campinas, Campinas, São Paulo, Brazil
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Do HP, Vo TV, Murray L, Baker PRA, Murray A, Valdebenito S, Eisner M, Tran BX, Luong-Thanh BY, Nguyen LH, Dunne MP. The influence of childhood abuse and prenatal intimate partner violence on childbirth experiences and breastfeeding outcomes. CHILD ABUSE & NEGLECT 2022; 131:105743. [PMID: 35738070 DOI: 10.1016/j.chiabu.2022.105743] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 06/08/2022] [Accepted: 06/12/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Despite the detrimental effects and life-course health consequences of violence exposure, relatively few studies have adequate capacity to investigate the evolution of violence from childhood to motherhood. OBJECTIVE This study aims to examine the cyclical nature of childhood abuse and prenatal inter-partner violent victimization (p-IPV) and its adverse impact on childbirth trauma and exclusive breastfeeding (EBF) practice in Vietnam. METHOD Using a prospective birth cohort, 150 pregnant women were recruited in the third trimester of pregnancy in Hue city in central Vietnam (Wave 1-Baseline) and re-interviewed approximately three months after delivery (Wave 2-Follow-up). The direct and indirect effects of violent victimization on subsequent childbirth experience (measured by Birth Memories and Recall Questionnaire) and EBF practice were estimated by using augmented-inverse-probability-weighted models, sensitivity analysis, and structural equation model. RESULTS Detrimental and prolonged effects of the inter-generational cycle of violence transverse childhood to motherhood. Women who experienced either childhood abuse or p-IPV violence were more likely to experience negative emotional childbirth memories [ARR 1.21, 95 % CI (1.04, 1.39)]. Evidence also suggested that not continuing to exclusively breastfeed at 3 months post-partum was strongly associated with prenatal depression, young age, and perceived low social status during pregnancy. Perceived strong connectedness among extended family members and social networks (i.e. nexus among family, friends, and neighborhood) provided a buffering effect by preventing EBF termination. CONCLUSION This research provides insights into the protective role of social connectedness in improving breastfeeding practice. It is vital to establish wholistic antenatal care and social service system to offer specialized support and response for victims of violence and mitigate the long-term sequelae of traumatic events.
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Affiliation(s)
- Huyen Phuc Do
- Queensland University of Technology (QUT), Faculty of Health, School of Public Health and Social Work, Brisbane, Australia; Institute of Health Economics and Technology, Hanoi, Viet Nam.
| | - Thang Van Vo
- Institute for Community Health Research, University of Medicine and Pharmacy, Hue University, Hue City, Viet Nam; Faculty of Public Health, University of Medicine and Pharmacy, Hue University, Hue city, Viet Nam.
| | - Linda Murray
- College of Health Sciences, Massey University, New Zealand.
| | - Philip R A Baker
- Queensland University of Technology (QUT), Faculty of Health, School of Public Health and Social Work, Brisbane, Australia.
| | - Aja Murray
- Department of Psychology, University of Edinburgh, United Kingdom.
| | - Sara Valdebenito
- Institute of Criminology, University of Cambridge, United Kingdom.
| | - Manuel Eisner
- Institute of Criminology, University of Cambridge, United Kingdom.
| | - Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Viet Nam; Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Bao-Yen Luong-Thanh
- Institute for Community Health Research, University of Medicine and Pharmacy, Hue University, Hue City, Viet Nam; Faculty of Public Health, University of Medicine and Pharmacy, Hue University, Hue city, Viet Nam.
| | - Lan Hoang Nguyen
- Institute for Community Health Research, University of Medicine and Pharmacy, Hue University, Hue City, Viet Nam; Faculty of Public Health, University of Medicine and Pharmacy, Hue University, Hue city, Viet Nam.
| | - Michael P Dunne
- Institute for Community Health Research, University of Medicine and Pharmacy, Hue University, Hue City, Viet Nam; Australian Centre for Health Law Research, Faculty of Business and Law, Queensland University of Technology (QUT), Australia.
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Eerola V, Helanterä I, Åberg F, Lempinen M, Mäkisalo H, Nordin A, Isoniemi H, Sallinen V. Timing of Organ Procurement From Brain-Dead Donors Associates With Short- and Long-Term Outcomes After Liver Transplantation. Transpl Int 2022; 35:10364. [PMID: 36118016 PMCID: PMC9472133 DOI: 10.3389/ti.2022.10364] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 07/12/2022] [Indexed: 11/13/2022]
Abstract
Brain death-induced cytokine storm is thought to harm transplantable organs. However, longer procurement times have been associated with non-inferior or better outcomes in kidney, heart, and lung transplants, while optimal procurement time for liver allografts is unknown. Our aim was to analyze the association of time interval from brain death to organ procurement with liver allograft outcomes in two nationwide cohorts. The association of procurement interval with graft survival and short-term complications was analysed in multivariable models. Altogether 643 and 58,017 orthotopic liver transplantations from brain-dead donors were included from Finland between June 2004 and December 2017 and the US between January 2008 and August 2018, respectively. Median time from brain death to organ procurement was 10.5 h in Finland and 34.6 h in the US. Longer interval associated with better graft survival (non-linearly, p = 0.016) and less acute rejections (OR 0.935 95% CI 0.894–0.978) in the US cohort, and better early allograft function (p = 0.005; Beta −0.048 95% CI −0.085 −(−0.011)) in the Finnish cohort, in multivariable models adjusted with Donor Risk Index, recipient age, Model for End-Stage Liver Disease and indication for transplantation. Progressive liver injury after brain death is unlikely. Rushing to recover seems unnecessary; rest and repair might prove beneficial.
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Uldbjerg CS, Lim YH, Krause M, Frederiksen H, Andersson AM, Bräuner EV. Sex-specific associations between maternal exposure to parabens, phenols and phthalates during pregnancy and birth size outcomes in offspring. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 836:155565. [PMID: 35508231 DOI: 10.1016/j.scitotenv.2022.155565] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 04/22/2022] [Accepted: 04/24/2022] [Indexed: 06/14/2023]
Abstract
Current evidence on the effects of prenatal exposure to endocrine disrupting chemicals on birth size remains largely inconclusive. We aimed to investigate sex-specific associations between maternal exposure to parabens, phenols and phthalates during pregnancy and birth weight, length and head/abdominal circumferences. We performed a prospective study of 88 pregnant women who underwent amniocentesis in the period 2012 to 2014. Maternal urine samples were collected during pregnancy in weeks 12 to 36 (median: 18 weeks). The concentrations of parabens, phenols and individual phthalate diester metabolites were analyzed by isotope-diluted liquid chromatography-tandem mass spectrometry and osmolality adjusted. Linear regression models estimated the associations between urinary levels of selected compounds (tertile(T2-T3)medium/high versus T1low exposure) and birth size, stratified by offspring sex. A total of three parabens, two phenols, four individual phthalate metabolites and four sums of diester metabolites were detectable above limits of detection in at least 60% of urine samples. Overall, we observed few statistically significant associations, but medium/high exposure to bisphenol A (BPA) in male offspring was associated with statistically significant lower birth size across most outcomes [birth weight: -428 g (95% CI -756 to -99.4); birth length: -1.76 cm (95% CI -3.28 to -0.25); abdominal circumference: -1.97 cm (95% CI -3.55 to -0.39)]. Similarly, medium/high exposure to methyl paraben (MeP) in male offspring was associated with lower birth weight (-661 g, 95% CI -1251 to -70.7) and length (-3.11 cm, 95% CI -5.76 to -0.46) compared to low exposure. None of these associations were statistically significant in female offspring. Across all compounds, individual exposures were associated with more negative estimates of birth weight for male than for female offspring. Our study indicates that prenatal exposure to BPA and MeP may negatively affect birth size outcomes, with a possible sex effect. Given the small sample size, these findings need to be replicated in future larger studies.
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Affiliation(s)
- Cecilie S Uldbjerg
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, University of Copenhagen, Denmark; The International Research and Research Training Centre in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Denmark
| | - Youn-Hee Lim
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Marianna Krause
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, University of Copenhagen, Denmark; The International Research and Research Training Centre in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Denmark
| | - Hanne Frederiksen
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, University of Copenhagen, Denmark; The International Research and Research Training Centre in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Denmark
| | - Anna-Maria Andersson
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, University of Copenhagen, Denmark; The International Research and Research Training Centre in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Denmark
| | - Elvira V Bräuner
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, University of Copenhagen, Denmark; The International Research and Research Training Centre in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Denmark.
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Zhao L, Liu M, Liu L, Guo W, Yang H, Chen S, Yu J, Li M, Fang Q, Lai X, Yang L, Zhang X. The association of co-exposure to polycyclic aromatic hydrocarbon and phthalates with blood cell-based inflammatory biomarkers in children: A panel study. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2022; 307:119479. [PMID: 35598818 DOI: 10.1016/j.envpol.2022.119479] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 05/11/2022] [Accepted: 05/12/2022] [Indexed: 06/15/2023]
Abstract
The association of co-exposure to polycyclic aromatic hydrocarbons (PAHs) and phthalates (PAEs) with blood cell-based inflammatory biomarkers is largely unknown. We conducted a panel study of 144 children aged 4-12 years, with up to 3 repeated visits across 3 seasons. For each visit, we collected the first-morning urine for 4 consecutive days and fasting blood on the day of physical examination. We developed a gas chromatography/tandem mass spectrometry method to detect the metabolites of 10 PAHs (OH-PAHs) and 10 PAEs (mPAEs) in urine samples. We employed linear mixed-effects models to evaluate the individual associations of each OH-PAH and mPAE with blood cell-based inflammatory biomarkers over different lag times. Bayesian kernel machine regression (BKMR) and quantile g-computation were used to evaluate the overall associations of OH-PAHs and mPAEs mixtures with blood cell-based inflammatory biomarkers. After multiple adjustments, we found positive associations of summed hydroxylphenanthrene (∑OHPHE), summed OH-PAHs, and mono-n-butyl phthalate with inflammatory biomarkers such as neutrophil count, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and the systemic immune-inflammation index (SII) at lag 0 (the day of physical examination). Each 1% increase in ∑OHPHE was related to a 0.18% (95% confidence interval: 0.10%, 0.25%) increase in SII, which was the strongest among the above associations. The results of BKMR and quantile g-computation suggested that co-exposure to PAHs and PAEs mixture was associated with an elevated white blood cell count, neutrophil count, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and SII, to which ∑OHPHE and 1-hydroxypyrene (1-OHPYR) might be the major contributors. In addition, gender and age modified the associations of ∑OHPHE and 1-OHPYR with inflammatory biomarkers, where girls and younger children were more susceptible. In conclusion, co-exposure to PAHs and PAEs was associated with elevated inflammation in children, in which ∑OHPHE and 1-OHPYR might play important roles.
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Affiliation(s)
- Lei Zhao
- Department of Occupational and Environmental Health, Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Department of Public Health, Medical College of Qinghai University, Xining, Qinghai, China
| | - Miao Liu
- Department of Occupational and Environmental Health, Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Linlin Liu
- Department of Occupational and Environmental Health, Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wenting Guo
- Department of Occupational and Environmental Health, Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Huihua Yang
- Department of Occupational and Environmental Health, Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shuang Chen
- Department of Occupational and Environmental Health, Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jie Yu
- Department of Occupational and Environmental Health, Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Meng Li
- Department of Occupational and Environmental Health, Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qin Fang
- Department of Medical Affairs, Zhuhai People's Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, Guangdong, China
| | - Xuefeng Lai
- Department of Occupational and Environmental Health, Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Liangle Yang
- Department of Occupational and Environmental Health, Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaomin Zhang
- Department of Occupational and Environmental Health, Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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Association between Health-Related Quality of Life and Completion of First-Line Treatment among Lung Cancer Patients. Cancers (Basel) 2022; 14:cancers14143343. [PMID: 35884404 PMCID: PMC9324359 DOI: 10.3390/cancers14143343] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/05/2022] [Accepted: 07/08/2022] [Indexed: 11/17/2022] Open
Abstract
Simple Summary The aim of this study was to investigate how health-related quality of life at time of diagnosis is associated with the completion of planned first-line oncological treatment among lung cancer patients. Patients with reduced function and patients who reported fatigue, pain, appetite loss, and financial difficulties at time of diagnosis had significantly increased adjusted odds ratios for not completing the planned first-line oncological treatment. Measures of lung cancer patients’ self-reported HRQOL as part of the diagnostic evaluation at time of diagnosis may contribute to the optimization of planned oncological treatment. Abstract Experts recommend assessing lung cancer patients’ health-related quality of life (HRQOL) in the diagnostic evaluation. We investigated the association between HRQOL and completion of first-line treatment among lung cancer patients in a prospective cohort study. Clinical information on lung cancer patients was obtained from medical records, and information on quality of life and lung cancer-related symptoms was obtained through questionnaires at time of diagnosis. We used directed acyclic graphs to identify potential confounders and mediators between HRQOL and completion of first-line treatment. The association between functioning levels and symptoms and completion of first-line oncological treatment was estimated as odds ratios, with 95% confidence intervals, in logistic regression models. In all, 137 patients (52% men, mean age: 69 years) participated, out of 216 invited. Patients who reported reduced functioning had significantly increased ORs for not completing first-line treatment: poor physical function (OR 4.44), role function (OR 6.09), emotional function (OR 5.86), and social function (OR 3.13). Patients with fatigue (OR 7.55), pain (OR 6.07), appetite loss (OR 4.66), and financial difficulties (OR 17.23) had significantly increased ORs for not completing the first-line treatment. Reduced functioning and presence of symptoms were associated with not completing first-line treatment. An assessment of HRQOL could potentially aid the diagnostic evaluation and treatment planning for lung cancer patients.
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Hooper L, Puhl R, Eisenberg ME, Reicks M, Neumark-Sztainer D. How is weight teasing cross-sectionally and longitudinally associated with health behaviors and weight status among ethnically/racially and socioeconomically diverse young people? Int J Behav Nutr Phys Act 2022; 19:71. [PMID: 35739552 PMCID: PMC9219184 DOI: 10.1186/s12966-022-01307-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 05/31/2022] [Indexed: 11/24/2022] Open
Abstract
Background Weight stigma is prevalent among young people and harmful to health. The current study used a health equity lens to examine cross-sectional and longitudinal associations between experiencing weight teasing (a form of weight stigma) with a range of weight-related health behaviors and weight status in an ethnically/racially and socioeconomically diverse sample of young people. We also assessed whether ethnicity/race and adolescent socioeconomic status (SES) operated as effect modifiers in these relationships. Methods Adolescents (n = 1568) were enrolled in EAT 2010–2018 (Eating and Activity over Time) and followed into young adulthood. Weight teasing; screen time; moderate-to-vigorous physical activity (MVPA); sleep duration; breakfast frequency; fruit, vegetable, sugar-sweetened beverage (SSB), and fast-food intake; and body mass index (BMI) were assessed at baseline (mean age = 14.4 years) and eight-year follow-up (mean age = 22.2 years). Multivariate linear regression estimated marginal means and 95% confidence intervals. All analyses adjusted for BMI and sociodemographic characteristics. Results Weight teasing was cross-sectionally associated with longer screen time, shorter sleep duration, and higher BMI during adolescence; and cross-sectionally associated with shorter sleep duration, lower breakfast frequency, higher fast-food intake, higher SSB intake, and higher BMI during young adulthood. In the longitudinal analyses, weight teasing was not associated with health behaviors but did predict higher BMI (teased: 28.2 kg/m2, not teased: 26.4 kg/m2, p < 0.001). White and higher adolescent SES subgroups had higher MVPA, more frequent breakfast intake, lower fast-food intake, and lower BMI than their respective counterparts. The relationships between weight teasing and health behaviors and weight status were largely consistent across ethnic/racial and adolescent SES subgroups. Conclusions Findings add to growing evidence that weight-based mistreatment poses a threat to weight-related health and that young people across ethnic/racial and SES subgroups are vulnerable to the negative effects of weight teasing. Limitations include attrition at follow-up and the self-reported nature of many measures. Results suggest a need for increased attention to existing recommendations to reduce weight stigma in young people from diverse ethnic/racial and socioeconomic backgrounds including training for healthcare providers to better equip them to address the harms of weight teasing and foster more compassionate care to promote health-supporting behaviors in young people. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-022-01307-y.
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Affiliation(s)
- Laura Hooper
- Division of Epidemiology and Community Health, University of Minnesota, Suite 300, 1300 S, 2nd St., Minneapolis, MN, 55454-1015, USA. .,Department of Food Science and Nutrition, University of Minnesota, 225 Food Science and Nutrition, 1334 Eckles Ave, St. Paul, MN, 55108, USA.
| | - Rebecca Puhl
- Department of Human Development & Family Sciences, College of Liberal Arts and Sciences, University of Connecticut, 348 Mansfield Road, U-1058, Storrs, CT, 06269-1058, USA
| | - Marla E Eisenberg
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, 717 Delaware Street SE, 3rd Floor, Minneapolis, MN, 55414, USA
| | - Marla Reicks
- Department of Food Science and Nutrition, University of Minnesota, 225 Food Science and Nutrition, 1334 Eckles Ave, St. Paul, MN, 55108, USA
| | - Dianne Neumark-Sztainer
- Division of Epidemiology and Community Health, University of Minnesota, Suite 300, 1300 S, 2nd St., Minneapolis, MN, 55454-1015, USA
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Wendlandt B, Olm-Shipman C, Ceppe A, Hough CL, White DB, Cox CE, Carson SS. Surrogates of Patients With Severe Acute Brain Injury Experience Persistent Anxiety and Depression Over the 6 Months After ICU Admission. J Pain Symptom Manage 2022; 63:e633-e639. [PMID: 35595376 PMCID: PMC9179180 DOI: 10.1016/j.jpainsymman.2022.02.336] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/17/2022] [Accepted: 02/18/2022] [Indexed: 10/18/2022]
Abstract
CONTEXT Severe Acute Brain Injury (SABI) is neurologically devastating, and surrogates for these patients may struggle with particularly complex decisions due to substantial prognostic uncertainty. OBJECTIVES To compare anxiety and depression symptoms over time between SABI surrogates and non-SABI surrogates for patients requiring prolonged mechanical ventilation (PMV). METHODS We conducted a secondary analysis of the data from a multicenter randomized trial of a decision aid intervention for surrogates of adults experiencing PMV. Eligible patients were enrolled from medical, surgical, trauma, cardiac, and neurologic intensive care units (ICUs). ICU admitting diagnoses were used to identify patients experiencing SABI. We compared anxiety and depression symptoms as measured by the Hospital Anxiety and Depression Scale score 6 months after trial enrollment between surrogates of patients with SABI and surrogates of patients experiencing PMV for other reasons. RESULTS Our analysis included 206 patients, 60 (29%) with SABI and 146 (71%) without SABI, and their primary surrogate decision makers. After adjusting for potential confounders including surrogate demographics, surrogate financial distress, patient severity of illness baseline GCS, and patient health status at 6 months, we found that surrogates of patients experiencing SABI had higher symptoms of anxiety and depression than surrogates of non-SABI patients (adjusted mean difference 3.6, 95% CI 1.2-6.0). CONCLUSION Surrogates of PMV patients with SABI experience persistently elevated anxiety and depression symptoms over 6 months compared to surrogates of PMV patients without SABI. Further work is needed to understand contributors to prolonged distress in this higher risk population.
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Affiliation(s)
- Blair Wendlandt
- Division of Pulmonary Diseases and Critical Care Medicine (B.W., A.C., S.S.C.), University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
| | - Casey Olm-Shipman
- Division of Neurocritical Care (C.O.-S.), Departments of Neurology and Neurosurgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Agathe Ceppe
- Division of Pulmonary Diseases and Critical Care Medicine (B.W., A.C., S.S.C.), University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Catherine L Hough
- Department of Critical Care Medicine (D.B.W.), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Douglas B White
- Division of Pulmonary, Allergy, and Critical Care Medicine (C.E.C.), Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Christopher E Cox
- Division of Pulmonary and Critical Care (C.L.H.), Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Shannon S Carson
- Division of Pulmonary Diseases and Critical Care Medicine (B.W., A.C., S.S.C.), University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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Carvalho JV, Souza LS, Moreira EC. Association between cannabis use and suicidal behavior: A systematic review of cohort studies. Psychiatry Res 2022; 312:114555. [PMID: 35461121 DOI: 10.1016/j.psychres.2022.114555] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 04/02/2022] [Accepted: 04/12/2022] [Indexed: 12/24/2022]
Abstract
The use of cannabis is highly prevalent worldwide, with known short and long-term adverse effects. However, the relationship between cannabis use and suicidal behavior remains relatively unexplored and this paper aims to unify existing literature on the topic. A systematic review was conducted using MEDLINE, Embase, PsycINFO and LILACS databases with a supplementary search to identify cohort articles published up to January 2020, with no age delimitation for the samples. This review aimed to address the relationship between cannabis use and suicidal behavior, defined as suicidal ideation, attempted suicide or completed suicide. Twenty-two articles were identified, with no clear consensus, irrespective of the outcome being investigated. This was the case even when taking into consideration only those studies with a sound methodology (according to the Newcastle-Ottawa scale). Studies that identified an association explored the importance of the endocannabinoid system as well as the psychosocial context of the individual while developing suicidal behavior, with certain studies demonstrating that greater intensity or precocity of cannabis use increases the strength of this association. The relationship between cannabis use and suicidal behavior is complex, with no consensus in the literature. Further studies with standardized definitions for cannabis use, including frequency of use, along with improved controls for confounding variables are needed.
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Affiliation(s)
- João Victor Carvalho
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia, Brazil.
| | - Lucca S Souza
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Esdras Cabus Moreira
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia, Brazil; Departamento de Neurociências e Saúde Mental, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia, Brazil; Centro de Estudos e Terapia do Abuso de Drogas (CETAD), Universidade Federal da Bahia, Salvador, Bahia, Brazil
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Wurth R, Hajdenberg M, Barrera FJ, Shekhar S, Copacino CE, Moreno-Peña PJ, Gharib OAM, Porter F, Hiremath S, Hall JE, Schiffrin EL, Eisenhofer G, Bornstein SR, Brito JP, González-González JG, Stratakis CA, Rodríguez-Gutiérrez R, Hannah-Shmouni F. Scoping review of COVID-19-related systematic reviews and meta-analyses: can we really have confidence in their results? Postgrad Med J 2022; 98:372-379. [PMID: 33637639 PMCID: PMC7918809 DOI: 10.1136/postgradmedj-2020-139392] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 12/12/2020] [Indexed: 12/22/2022]
Abstract
AIM The aim of this study was to systematically appraise the quality of a sample of COVID-19-related systematic reviews (SRs) and discuss internal validity threats affecting the COVID-19 body of evidence. DESIGN We conducted a scoping review of the literature. SRs with or without meta-analysis (MA) that evaluated clinical data, outcomes or treatments for patients with COVID-19 were included. MAIN OUTCOME MEASURES We extracted quality characteristics guided by A Measurement Tool to Assess Systematic Reviews-2 to calculate a qualitative score. Complementary evaluation of the most prominent published limitations affecting the COVID-19 body of evidence was performed. RESULTS A total of 63 SRs were included. The majority were judged as a critically low methodological quality. Most of the studies were not guided by a pre-established protocol (39, 62%). More than half (39, 62%) failed to address risk of bias when interpreting their results. A comprehensive literature search strategy was reported in most SRs (54, 86%). Appropriate use of statistical methods was evident in nearly all SRs with MAs (39, 95%). Only 16 (33%) studies recognised heterogeneity in the definition of severe COVID-19 as a limitation of the study, and 15 (24%) recognised repeated patient populations as a limitation. CONCLUSION The methodological and reporting quality of current COVID-19 SR is far from optimal. In addition, most of the current SRs fail to address relevant threats to their internal validity, including repeated patients and heterogeneity in the definition of severe COVID-19. Adherence to proper study design and peer-review practices must remain to mitigate current limitations.
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Affiliation(s)
- Rachel Wurth
- NICHD, National Institutes of Health, Bethesda, Maryland, USA
| | - Michelle Hajdenberg
- College of Arts and Sciences, Washington University in St Louis, St Louis, Missouri, USA
| | - Francisco J Barrera
- Endocrinology Division, Department of Internal Medicine, University Hospital "Dr. Jose E. González", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo León, Mexico
- Knowledge and Evaluation Research, Mayo Clinic, Rochester, Minnesota, USA
- Plataforma INVEST-KER Unit Mayo Clinic (KER Unit Mexico), School of Medicine, Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo León, Mexico
| | - Skand Shekhar
- NICHD, National Institutes of Health, Bethesda, Maryland, USA
- Clinical Research Branch, NIEHS, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Pablo J Moreno-Peña
- Plataforma INVEST-KER Unit Mayo Clinic (KER Unit Mexico), School of Medicine, Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo León, Mexico
| | - Omar A M Gharib
- NICHD, National Institutes of Health, Bethesda, Maryland, USA
| | - Forbes Porter
- NICHD, National Institutes of Health, Bethesda, Maryland, USA
| | - Swapnil Hiremath
- University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Janet E Hall
- Clinical Research Branch, NIEHS, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Graeme Eisenhofer
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Stefan R Bornstein
- Department of Medicine III, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Juan P Brito
- Knowledge and Evaluation Research, Mayo Clinic, Rochester, Minnesota, USA
| | - José Gerardo González-González
- Endocrinology Division, Department of Internal Medicine, University Hospital "Dr. Jose E. González", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo León, Mexico
- Plataforma INVEST-KER Unit Mayo Clinic (KER Unit Mexico), School of Medicine, Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo León, Mexico
| | | | - René Rodríguez-Gutiérrez
- Endocrinology Division, Department of Internal Medicine, University Hospital "Dr. Jose E. González", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo León, Mexico
- Knowledge and Evaluation Research, Mayo Clinic, Rochester, Minnesota, USA
- Plataforma INVEST-KER Unit Mayo Clinic (KER Unit Mexico), School of Medicine, Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo León, Mexico
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Frampton G, Whaley P, Bennett M, Bilotta G, Dorne JLCM, Eales J, James K, Kohl C, Land M, Livoreil B, Makowski D, Muchiri E, Petrokofsky G, Randall N, Schofield K. Principles and framework for assessing the risk of bias for studies included in comparative quantitative environmental systematic reviews. ENVIRONMENTAL EVIDENCE 2022; 11:1-23. [PMID: 38264537 PMCID: PMC10805236 DOI: 10.1186/s13750-022-00264-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 03/05/2022] [Indexed: 01/25/2024]
Abstract
The internal validity of conclusions about effectiveness or impact in systematic reviews, and of decisions based on them, depends on risk of bias assessments being conducted appropriately. However, a random sample of 50 recently-published articles claiming to be quantitative environmental systematic reviews found 64% did not include any risk of bias assessment, whilst nearly all that did omitted key sources of bias. Other limitations included lack of transparency, conflation of quality constructs, and incomplete application of risk of bias assessments to the data synthesis. This paper addresses deficiencies in risk of bias assessments by highlighting core principles that are required for risk of bias assessments to be fit-for-purpose, and presenting a framework based on these principles to guide review teams on conducting risk of bias assessments appropriately and consistently. The core principles require that risk of bias assessments be Focused, Extensive, Applied and Transparent (FEAT). These principles support risk of bias assessments, appraisal of risk of bias tools, and the development of new tools. The framework follows a Plan-Conduct-Apply-Report approach covering all stages of risk of bias assessment. The scope of this paper is comparative quantitative environmental systematic reviews which address PICO or PECO-type questions including, but not limited to, topic areas such as environmental management, conservation, ecosystem restoration, and analyses of environmental interventions, exposures, impacts and risks.
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Affiliation(s)
- Geoff Frampton
- Southampton Health Technology Assessments Centre (SHTAC), Faculty of Medicine, University of Southampton, Southampton, UK
| | - Paul Whaley
- Lancaster Environment Centre, Lancaster University, Lancaster, UK
- Evidence-Based Toxicology Collaboration at Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Micah Bennett
- U.S. Environmental Protection Agency, Region 5, Chicago, IL 60604, USA
| | - Gary Bilotta
- School of Environment and Technology, University of Brighton, Brighton, UK
| | - Jean-Lou C. M. Dorne
- Scientific Committee and Emerging Risks Unit, European Food Safety Authority, Via Carlo Magno 1A, 43121 Parma, Italy
| | - Jacqualyn Eales
- European Centre for Environment and Human Health, College of Medicine and Health, University of Exeter, Knowledge Spa, Truro TR1 3HD, UK
| | - Katy James
- Centre for Evidence-Based Agriculture, Harper Adams University, Newport, Shropshire TF10 8NB, UK
| | - Christian Kohl
- Institute for Biosafety in Plant Biotechnology (SB), Julius Kühn Institute (JKI) - Federal Research Centre for Cultivated Plants, Berlin, Germany
| | | | | | - David Makowski
- UMR518, University Paris-Saclay, INRAE, AgroParistech, 16 rue Claude Bernard, 75231 Paris, France
| | - Evans Muchiri
- Centre for Anthropological Research, University of Johannesburg, Johannesburg, South Africa
| | - Gillian Petrokofsky
- Oxford Long-Term Ecology Lab, Department of Zoology, University of Oxford, Oxford, UK
| | - Nicola Randall
- Centre for Evidence-Based Agriculture, Harper Adams University, Newport, Shropshire TF10 8NB, UK
| | - Kate Schofield
- Office of Research and Development, U.S. Environmental Protection Agency, Washington, DC 20460, USA
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Philibert A, Fillion M, Da Silva J, Lena TS, Mergler D. Past mercury exposure and current symptoms of nervous system dysfunction in adults of a First Nation community (Canada). Environ Health 2022; 21:34. [PMID: 35292021 PMCID: PMC8925187 DOI: 10.1186/s12940-022-00838-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 02/08/2022] [Indexed: 05/06/2023]
Abstract
BACKGROUND The watershed in Asubpeeschoseewagong Netum Anishinabek (Grassy Narrows First Nation) territory has been contaminated by mercury (Hg) since 1962, resulting in very high Hg concentrations in fish, central to the community's culture, traditions, economy and diet. Biomarkers of Hg exposure (umbilical cord blood and hair/blood samples), monitored between 1970 and 1997, decreased over time. A recent Grassy Narrows Community Health Assessment (GN-CHA) survey included current symptoms of nervous system dysfunction. The present study aimed to cluster self-reported symptoms and examine their associations with past Hg exposure. METHODS The GN-CHA included 391 adults. Symptom clustering used a two-step segmentation approach. Umbilical cord Hg and/or yearly measurements of equivalent hair Hg were available for 242 participants. Structural Equation Models (SEM) displayed the associations between Hg exposure and clusters, with Hg exposure modelled as a latent variable or in separate variables (prenatal, childhood and having had hair Hg ≥ 5 μg/g at least once over the sampling period). Longitudinal Mixed Effects Models (LMEM) served to examine past hair Hg with respect to clusters. RESULTS A total of 37 symptoms bonded into 6 clusters, representing Extrapyramidal impairment, Sensory impairment, Cranial nerve disturbances, Gross motor impairment, Neuro-cognitive deficits and Affect/Mood disorders. Median Hg concentrations were 5 μg/L (1-78.5) and 1.1 μg/g (0.2-16) for umbilical cord and childhood hair, respectively. More than one-third (36.6%) had hair Hg ≥ 5 μg/g at least once. In SEM, latent Hg was directly associated with Extrapyramidal and Sensory impairment, Cranial nerve disturbances and Affect/Mood disorders. Direct associations were observed for prenatal exposure with Affect/Mood disorders, for childhood exposure with Extrapyramidal impairment and Cranial nerve disturbances, and for hair Hg ≥ 5 μg/g with Extrapyramidal and Sensory impairment. For all clusters, a further association between past Hg exposure and symptom clusters was mediated by diagnosed nervous system disorders. LMEM showed higher past hair Hg among those with higher scores for all clusters, except Affect/Mood disorders. CONCLUSION Our findings provide evidence that in this First Nation community, past Hg exposure from fish consumption was associated with later-life clusters of coexisting symptoms of nervous system dysfunction.
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Affiliation(s)
- Aline Philibert
- Université du Québec à Montréal, Centre de recherche interdisciplinaire sur le bien-être, la santé, la société et l'environnement (Cinbiose), CP 8888, Succ. Centreville, Montréal, Québec, H3C 3P8, Canada
| | - Myriam Fillion
- Université du Québec à Montréal, Centre de recherche interdisciplinaire sur le bien-être, la santé, la société et l'environnement (Cinbiose), CP 8888, Succ. Centreville, Montréal, Québec, H3C 3P8, Canada
- Département Science et Technologie, Université TÉLUQ, 5800 Saint Denis St, Montréal, Québec, H2S 3L4, Canada
| | - Judy Da Silva
- Grassy Narrows First Nation, General Delivery, P0X 1B0, Grassy Narrows, Ontario, Canada
| | | | - Donna Mergler
- Université du Québec à Montréal, Centre de recherche interdisciplinaire sur le bien-être, la santé, la société et l'environnement (Cinbiose), CP 8888, Succ. Centreville, Montréal, Québec, H3C 3P8, Canada.
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Schmiege D, Falkenberg T, Moebus S, Kistemann T, Evers M. Associations between socio-spatially different urban areas and knowledge, attitudes, practices and antibiotic use: A cross-sectional study in the Ruhr Metropolis, Germany. PLoS One 2022; 17:e0265204. [PMID: 35271648 PMCID: PMC8912211 DOI: 10.1371/journal.pone.0265204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 02/18/2022] [Indexed: 12/02/2022] Open
Abstract
Inappropriate and excessive antibiotic use fuels the development of antibiotic resistance. Determinants of antibiotic use, including knowledge and attitudes, are manifold and vary on different spatial scales. The objective of this study was to examine the associations between socio-spatially diverse urban areas and knowledge, attitudes, practices and antibiotic use within a metropolitan city. A cross-sectional survey was conducted in the general population in socio-spatially different areas in Dortmund, Germany, in February and March 2020. Three urban areas were chosen to represent diverse socio-spatial contexts (socio-spatially disadvantaged: A, intermediate: B, socio-spatially disadvantaged: C). Participants were selected via simple random sampling. The questionnaire comprised knowledge and attitude statements and questions around antibiotic use and handling practices. Differences between the areas were examined by estimating odds ratios (OR) and corresponding 95% confidence intervals by multiple logistic regression. Overall, 158 participants were included. Participants of Area C showed the lowest proportions of correct knowledge statements, indicated more often attitudes contrary to common recommendations, lower risk awareness and reported more often antibiotic use (C: 40.8%; A: 32.7%; B: 26.5%) and potential mishandling practices (C: 30.4%; A: 9.6%; B: 17.3%). The multiple logistic regression confirmed these differences. Around 42.3% (C), 33.3% (A) and 20.0% (B) of the diseases mentioned for which an antibiotic was used are mainly caused by viral pathogens. A common misconception across all areas was the perception of antibiotic resistance as an individual rather than a universal issue. This study reveals distinct differences between socio-spatially diverse urban areas within a metropolitan city, regarding knowledge, attitudes and practices around antibiotics and ABR. Our findings confirm that enhanced efforts are required to better inform the population about the adequate use and handling of antibiotics. This study emphasizes the need for future interventions to be tailored to the specific local socio-economic context.
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Affiliation(s)
- Dennis Schmiege
- Department of Geography, University of Bonn, Bonn, Germany
- Institute for Hygiene and Public Health, GeoHealth Centre, University Hospital Bonn, Bonn, Germany
- Institute for Urban Public Health, Essen University Hospital, University of Duisburg-Essen, Duisburg, Germany
- Center for Development Research, University of Bonn, Bonn, Germany
- * E-mail:
| | - Timo Falkenberg
- Institute for Hygiene and Public Health, GeoHealth Centre, University Hospital Bonn, Bonn, Germany
- Center for Development Research, University of Bonn, Bonn, Germany
| | - Susanne Moebus
- Institute for Urban Public Health, Essen University Hospital, University of Duisburg-Essen, Duisburg, Germany
| | - Thomas Kistemann
- Department of Geography, University of Bonn, Bonn, Germany
- Institute for Hygiene and Public Health, GeoHealth Centre, University Hospital Bonn, Bonn, Germany
- Center for Development Research, University of Bonn, Bonn, Germany
| | - Mariele Evers
- Department of Geography, University of Bonn, Bonn, Germany
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50
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Wendlandt B, Ceppe A, Gaynes BN, Cox CE, Hanson LC, Nelson JE, Carson SS. Posttraumatic Stress Disorder Symptom Clusters in Surrogate Decision Makers of Patients Experiencing Chronic Critical Illness. Crit Care Explor 2022; 4:e0647. [PMID: 35261980 PMCID: PMC8893298 DOI: 10.1097/cce.0000000000000647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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