Critical windows of exposure to air pollution and gestational diabetes: assessing effect modification by maternal pre-existing conditions and environmental factors

BACKGROUND

Ambient air pollution has been associated with gestational diabetes (GD), but critical windows of exposure and whether maternal pre-existing conditions and other environmental factors modify the associations remains inconclusive.

METHODS

We conducted a retrospective cohort study of all singleton live birth that occurred between April 1^st 2006 and March 31^st 2018 in Ontario, Canada. Ambient air pollution data (i.e., fine particulate matter with a diameter ≤ 2.5 μm (PM_2.5), nitrogen dioxide (NO₂) and ozone (O₃)) were assigned to the study population in spatial resolution of approximately 1 km × 1 km. The Normalized Difference Vegetation Index (NDVI) and the Green View Index (GVI) were also used to characterize residential exposure to green space as well as the Active Living Environments (ALE) index to represent the active living friendliness. Multivariable Cox proportional hazards regression models were used to evaluate the associations.

RESULTS

Among 1,310,807 pregnant individuals, 68,860 incident cases of GD were identified. We found the strongest associations between PM_2.5 and GD in gestational weeks 7 to 18 (HR = 1.07 per IQR (2.7 µg/m³); 95% CI: 1.02 - 1.11)). For O₃, we found two sensitive windows of exposure, with increased risk in the preconception period (HR = 1.03 per IQR increase (7.0 ppb) (95% CI: 1.01 - 1.06)) as well as gestational weeks 9 to 28 (HR 1.08 per IQR (95% CI: 1.04 -1.12)). We found that women with asthma were more at risk of GD when exposed to increasing levels of O₃ (p- value for effect modification = 0.04). Exposure to air pollutants explained 20.1%, 1.4% and 4.6% of the associations between GVI, NDVI and ALE, respectively.

CONCLUSION

An increase of PM_2.5 exposure in early pregnancy and of O₃ exposure during late first trimester and over the second trimester of pregnancy were associated with gestational diabetes whereas exposure to green space may confer a protective effect.

Association between mood disorders and frequent emergency department use: a cross-sectional study

OBJECTIVES

Frequent emergency department (ED) use is a growing problem that is associated with poor patient outcomes and increased health care costs. Our objective was to analyze the association between mood disorders and the incidence of frequent ED use.

METHODS

We used the Canadian Community Health Survey conducted by Statistics Canada, 2015-2016. Mood disorder was defined as depression, bipolar disorder, mania, or dysthymia. Frequent ED use was defined as 4 or more visits in the year preceding the interview. Multivariable log-binomial regression models were used to determine the associations between mood disorders and frequent ED use.

RESULTS

Among the 99,009 participants, 8.4% had mood disorders, 80.3% were younger than 65, and 2.2% were frequent ED users. Mood disorders were significantly associated with the 1-year cumulative incidence of frequent ED use (RR = 2.5, 95% CI 2.2-2.7), after adjusting for several potential confounders.

CONCLUSIONS

This national survey showed that people with a mood disorder had a three-fold risk of frequent ED use, compared to people without mood disorder. These results can inform the development of policies and targeted interventions aimed at identifying and supporting ED patients with mood disorder.

Une langue différente, une expérience différente de la santé

Il est estimé qu’environ 8 millions des Canadiens, soit 23% de la population canadienne, s’identifient comme francophones (1). De ces 8 millions, près d’un million vivent en situation minoritaire, dispersés dans des régions majoritairement anglophones tels que l’Ontario, les maritimes, les provinces de l’ouest et les régions du nord canadien (1). En tant que minorités linguistiques, les Franco-canadiens ne sont pas étrangers aux inégalités qui assaillent le tissu social au Canada. Bien qu’il existe peu de recherche récente à ce sujet, il est bien connu que les communautés francophones dans un contexte minoritaire ont tendance à être moins scolarisées, moins nombreuses sur le marché du travail, ont un revenu moyen moins élevé que la population anglophone et se concentrent souvent à des endroits marqués par une économie instable (2).  Étant donné le faible statut socioéconomique des Canadiens français en situation minoritaire, il n’est pas surprenant de constater que ces individus rapportent une perception individuelle de leur santé plus basse que les anglophones majoritaires (3).

Impact of reduced incubation times on culture and susceptibility testing of urine cultures incubated in the BD Kiestra ReadA Compact incubators

We determined the impact of reducing incubation times for urine cultures incubated in BD Kiestra ReadA Compact incubators. Urine samples (n = 348) were inoculated to solid media, incubated in the ReadA Compacts and processed at 12, 15, and 18 h. Colony size and identification by MALDI-TOF, growth, semi-quantitation, Vitek and disk diffusion susceptibilities from cultures incubated at 12 and 15 h were compared to 18 h. There was no impact on MALDI-TOF performed after 12 and 15 versus 18 h of incubation. Interpretation for 99% of urine cultures was identical at 15 and 18 h. There was no major or very major error for VitekII or disk diffusion testing with >94% and >92% overall agreement for Gram-negative and positives organisms, respectively. Therefore, reducing the maximum incubation times of primary cultures incubated in the ReadA Compacts from 18 h to 15 h did not impact outcomes.

Content Reporting in Post-Stroke Therapeutic Circuit-Class Exercise Programs in randomized control trials

BACKGROUND

Therapeutic exercise in the form of group circuit-class training can improve mobility and gait while being cost-effective among patients who survived a stroke. Accurate clinical replication of interventions, especially when they are effective, is needed to advance research and treatment. However, replication is difficult when reporting is not detailed.

OBJECTIVE

The objective of this study was to assess the quality of reporting of interventions within the selected studies using three different scales and to assess the criterion validity between the scales.

METHODS

Two independent assessors used the CERT, the CONTENT scale, and TIDieR checklist to review the quality of reporting of 16 randomized controlled trials (RCTs) from a recent Cochrane Review. Assessments were done independently before a consensus was reached with an experienced third reviewer mediating any disagreements. Criterion validity between the three quality reporting tools was measured using weighted Cohen's kappa coefficients.

RESULTS

The mean (±SD) for the CERT was 9.31 (±1.66) out of 19 points; the TIDieR checklist was 8.81 (±1.33) out of 12 points; and the CONTENT was 4.82 (±1.22) out of 9 points for the 16 included RCTs. The CERT and CONTENT scale had a fair agreement (k = 0.455, p = 0.064), while both CERT and CONTENT had only slight agreement with TIDieR (k = 0.143, p = 0.267; k = 0.200, p = 0.182, respectively).

CONCLUSIONS

The results of this study indicate a lack of reporting from the 16 RCTs on post-stroke therapeutic circuit-class exercise programs. This presents a major barrier to knowledge translation and clinical implementation of effective exercise programs for stroke rehabilitation.