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Hardman K, Davies A, Demetri A, Clayton G, Bakhbakhi D, Birchenall K, Barnfield S, Fraser A, Burden C, McGuinness S, Miller R, Merriel A. Maternity healthcare professionals' experiences of supporting women in decision-making for labour and birth: a qualitative study. BMJ Open 2024; 14:e080961. [PMID: 38684269 PMCID: PMC11057275 DOI: 10.1136/bmjopen-2023-080961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 03/05/2024] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVES To explore and characterise maternity healthcare professionals' (MHCPs) experience and practice of shared decision-making (SDM), to inform policy, research and practice development. DESIGN Qualitative focus group study. SETTING Large Maternity Unit in the Southwest of England. PARTICIPANTS MHCPs who give information relating to clinical procedures and pregnancy care relating to labour and birth and are directly involved in decision-making conversations were purposively sampled to ensure representation across MHCP groups. DATA COLLECTION A semistructured topic guide was used. DATA ANALYSIS Reflexive thematic analysis was undertaken. RESULTS Seven focus groups were conducted, comprising a total of 24 participants (3-5 per group). Two themes were developed: contextualising decision-making and controversies in current decision-making. Contextual factors that influenced decision-making practices included lack of time and challenges faced in intrapartum care. MHCPs reported variation in how they approach decision-making conversations and asked for more training on how to consistently achieve SDM. There were communication challenges with women who did not speak English. Three controversies were explored: the role of prior clinical experience, the validity of informed consent when women were in pain and during life-threatening emergencies and instances where women declined medical advice. CONCLUSIONS We found that MHCPs are committed to SDM but need better support to deliver it. Structured processes including Core Information Sets, communication skills training and decision support aids may help to consistently deliver SDM in maternity care.
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Affiliation(s)
- Kitty Hardman
- Centre for Academic Women's Health, University of Bristol, Bristol, UK
- North Bristol NHS Trust, Westbury on Trym, UK
| | - Anna Davies
- Centre for Academic Child Health, University of Bristol, Bristol, UK
| | - Andrew Demetri
- Centre for Academic Women's Health, University of Bristol, Bristol, UK
- North Bristol NHS Trust, Westbury on Trym, UK
| | - Gemma Clayton
- Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Danya Bakhbakhi
- Centre for Academic Women's Health, University of Bristol, Bristol, UK
| | | | | | - Abigail Fraser
- Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Christy Burden
- Centre for Academic Women's Health, University of Bristol, Bristol, UK
- North Bristol NHS Trust, Westbury on Trym, UK
| | | | | | - Abi Merriel
- Centre for Academic Women's Health, University of Bristol, Bristol, UK
- Institute of Life Course and Medical Sciences, Department of Women's and Children's Health, Centre for Women's Health Research, University of Liverpool, Liverpool, UK
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Bandara P, Wickrama P, Sivayokan S, Knipe D, Rajapakse T. Reflections on the trends of suicide in Sri Lanka, 1997-2022: The need for continued vigilance. PLOS Glob Public Health 2024; 4:e0003054. [PMID: 38630779 PMCID: PMC11023397 DOI: 10.1371/journal.pgph.0003054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 03/03/2024] [Indexed: 04/19/2024]
Abstract
Despite reductions in suicide rates in Sri Lanka during the past decades, largely by introduction of national bans on highly hazardous pesticides, the country continues to record a higher than global average rate of suicide. With the changing availability of methods of suicide over time, we aimed to examine the age-standardized suicide rates in Sri Lanka by sex, age, and method between 1997 to 2022 using national police suicide data to identify trends. The rate of suicide in Sri Lanka in 2022 was 27/100,000 and 5/100,000, in males and females respectively, with an overall suicide rate of 15/100,000 population. When considering the previous decades, the overall rate of suicide has declined from 1997 until about 2015, in both sexes, driven by a drop in the numbers of suicides due to pesticide ingestion. In females the overall rates of suicide plateaued around 2015, but in males there has been an upward trend in overall suicide that started in 2016, mostly due to an increase in rates of hanging. Since 2016 rates of suicide by hanging have increased among older males, and young females (17-25 years). Whilst the current suicide rate in Sri Lanka is substantially lower than it was during the 1990s, the upward trend in hanging seen in the last few years, particularly among older men and young women, is of concern. Ongoing monitoring of suicide rates should be a priority during the next few years, to detect and respond to changes as soon as possible. There is an urgent need to address current risk factors for suicide in Sri Lanka, such as significant financial insecurity, unemployment, depression, alcohol misuse, and domestic violence, and to minimize media glamourization of hanging by suicide.
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Affiliation(s)
- Piumee Bandara
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Prabath Wickrama
- Department of Psychiatry, University of Jaffna, Jaffna, Sri Lanka
| | | | - Duleeka Knipe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Thilini Rajapakse
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Psychiatry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
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Pierotti L, Cooper J, James C, Cassels K, Gara E, Denholm R, Wood R. Can computer simulation support strategic service planning? Modelling a large integrated mental health system on recovery from COVID-19. Int J Ment Health Syst 2024; 18:12. [PMID: 38448987 PMCID: PMC10918932 DOI: 10.1186/s13033-024-00623-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 02/01/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND COVID-19 has had a significant impact on people's mental health and mental health services. During the first year of the pandemic, existing demand was not fully met while new demand was generated, resulting in large numbers of people requiring support. To support mental health services to recover without being overwhelmed, it was important to know where services will experience increased pressure, and what strategies could be implemented to mitigate this. METHODS We implemented a computer simulation model of patient flow through an integrated mental health service in Southwest England covering General Practice (GP), community-based 'talking therapies' (IAPT), acute hospital care, and specialist care settings. The model was calibrated on data from 1 April 2019 to 1 April 2021. Model parameters included patient demand, service-level length of stay, and probabilities of transitioning to other care settings. We used the model to compare 'do nothing' (baseline) scenarios to 'what if' (mitigation) scenarios, including increasing capacity and reducing length of stay, for two future demand trajectories from 1 April 2021 onwards. RESULTS The results from the simulation model suggest that, without mitigation, the impact of COVID-19 will be an increase in pressure on GP and specialist community based services by 50% and 50-100% respectively. Simulating the impact of possible mitigation strategies, results show that increasing capacity in lower-acuity services, such as GP, causes a shift in demand to other parts of the mental health system while decreasing length of stay in higher acuity services is insufficient to mitigate the impact of increased demand. CONCLUSION In capturing the interrelation of patient flow related dynamics between various mental health care settings, we demonstrate the value of computer simulation for assessing the impact of interventions on system flow.
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Affiliation(s)
- Livia Pierotti
- NIHR Bristol Biomedical Research Centre, University of Bristol, Bristol, UK.
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK.
| | - Jennifer Cooper
- NIHR Bristol Biomedical Research Centre, University of Bristol, Bristol, UK
| | - Charlotte James
- NIHR Bristol Biomedical Research Centre, University of Bristol, Bristol, UK
- Bristol, North Somerset and South Gloucestershire Integrated Care Board, UK National Health Service, Bristol, UK
| | - Kenah Cassels
- Bristol, North Somerset and South Gloucestershire Integrated Care Board, UK National Health Service, Bristol, UK
| | - Emma Gara
- Bristol, North Somerset and South Gloucestershire Integrated Care Board, UK National Health Service, Bristol, UK
| | - Rachel Denholm
- NIHR Bristol Biomedical Research Centre, University of Bristol, Bristol, UK
- HDR UK Southwest, Bristol, UK
| | - Richard Wood
- Bristol, North Somerset and South Gloucestershire Integrated Care Board, UK National Health Service, Bristol, UK
- HDR UK Southwest, Bristol, UK
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Taruvinga T, Chingono RS, Marambire E, Larsson L, Olaru ID, Sibanda S, Nzvere F, Redzo N, Ndhlovu CE, Rusakaniko S, Mujuru H, Sibanda E, Chonzi P, Siamuchembu M, Chikodzore R, Mahomva A, Ferrand RA, Dixon J, Kranzer K. Exploring COVID-19 vaccine uptake among healthcare workers in Zimbabwe: A mixed methods study. PLOS Glob Public Health 2023; 3:e0002256. [PMID: 38127934 PMCID: PMC10734954 DOI: 10.1371/journal.pgph.0002256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/02/2023] [Indexed: 12/23/2023]
Abstract
With COVID-19 no longer categorized as a public health emergency of international concern, vaccination strategies and priority groups for vaccination have evolved. Africa Centres for Diseases Prevention and Control proposed the '100-100-70%' strategy which aims to vaccinate all healthcare workers, all vulnerable groups, and 70% of the general population. Understanding whether healthcare workers were reached during previous vaccination campaigns and what can be done to address concerns, anxieties, and other influences on vaccine uptake, will be important to optimally plan how to achieve these ambitious targets. In this mixed-methods study, between June 2021 and July 2022 a quantitative survey was conducted with healthcare workers accessing a comprehensive health check in Zimbabwe to determine whether and, if so, when they had received a COVID-19 vaccine. Healthcare workers were categorized as those who had received the vaccine 'early' (before 30.06.2021) and those who had received it 'late' (after 30.06.2021). In addition, 17 in-depth interviews were conducted to understand perceptions and beliefs about COVID-19 vaccines. Of the 3,086 healthcare workers employed at 43 facilities who participated in the study, 2,986 (97%, 95% CI [92%-100%]) reported that they had received at least one vaccine dose. Geographical location, older age, higher educational attainment and having a chronic condition was associated with receiving the vaccine early. Qualitatively, (mis)information, infection risk perception, quasi-mandatory vaccination requirements, and legitimate concerns such as safety and efficacy influenced vaccine uptake. Meeting the proposed 100-100-70 target entails continued emphasis on strong communication while engaging meaningfully with healthcare workers' concerns. Mandatory vaccination may undermine trust and should not be a substitute for sustained engagement.
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Affiliation(s)
- Tinotenda Taruvinga
- The Health Research Unit Zimbabwe, Biomedical Research & Training Institute, Harare, Zimbabwe
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Africa Centres for Diseases Prevention and Control (Africa CDC), Addis Ababa, Ethiopia
| | - Rudo S. Chingono
- The Health Research Unit Zimbabwe, Biomedical Research & Training Institute, Harare, Zimbabwe
| | - Edson Marambire
- The Health Research Unit Zimbabwe, Biomedical Research & Training Institute, Harare, Zimbabwe
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital, LMU Munich, Germany
| | - Leyla Larsson
- The Health Research Unit Zimbabwe, Biomedical Research & Training Institute, Harare, Zimbabwe
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital, LMU Munich, Germany
| | - Ioana D. Olaru
- The Health Research Unit Zimbabwe, Biomedical Research & Training Institute, Harare, Zimbabwe
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sibusisiwe Sibanda
- The Health Research Unit Zimbabwe, Biomedical Research & Training Institute, Harare, Zimbabwe
| | - Farirai Nzvere
- The Health Research Unit Zimbabwe, Biomedical Research & Training Institute, Harare, Zimbabwe
| | - Nicole Redzo
- The Health Research Unit Zimbabwe, Biomedical Research & Training Institute, Harare, Zimbabwe
| | - Chiratidzo E. Ndhlovu
- Internal Medicine Unit, University of Zimbabwe Faculty of Medicine and Health Sciences, Harare, Zimbabwe
| | - Simbarashe Rusakaniko
- Department of Community Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Hilda Mujuru
- Department of Paediatrics and Child Health, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Edwin Sibanda
- Bulawayo City Council Health Department, Bulawayo, Zimbabwe
| | | | - Maphios Siamuchembu
- Ministry of Health and Child Care, Provincial Medical Directorate, Bulawayo, Zimbabwe
| | - Rudo Chikodzore
- Ministry of Health and Child Care, Department of Epidemiology and Diseases Control, Harare, Zimbabwe
| | - Agnes Mahomva
- National Response to the COVID-19 Pandemic, Office of the President, and Cabinet, Harare, Zimbabwe
| | - Rashida A. Ferrand
- The Health Research Unit Zimbabwe, Biomedical Research & Training Institute, Harare, Zimbabwe
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Justin Dixon
- The Health Research Unit Zimbabwe, Biomedical Research & Training Institute, Harare, Zimbabwe
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Katharina Kranzer
- The Health Research Unit Zimbabwe, Biomedical Research & Training Institute, Harare, Zimbabwe
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital, LMU Munich, Germany
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Sinclair LI, Mohr A, Morisaki M, Edmondson M, Chan S, Bone-Connaughton A, Turecki G, Love S. Is later-life depression a risk factor for Alzheimer's disease or a prodromal symptom: a study using post-mortem human brain tissue? Alzheimers Res Ther 2023; 15:153. [PMID: 37700368 PMCID: PMC10496415 DOI: 10.1186/s13195-023-01299-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 08/24/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND Depression and dementia are both common diseases. Although new cases of depression are more common in younger adults, there is a second peak at the age of 50 years suggesting a different pathological process. Late-life depression (LLD) is associated with dementia. However, it remains unclear whether depression represents a dementia prodrome or is a true risk factor for its development. LLD is thought to have a vascular component and this may be a possible link between depression and dementia. We hypothesised that later-life depression is a prodromal manifestation of dementia and would therefore be associated with more AD, and/or ischaemic brain abnormalities that are present in earlier-life depression or in age- and sex-matched controls. METHODS We assessed post-mortem orbitofrontal cortex and dorsolateral pre-frontal cortex from 145 individuals in 4 groups: 28 18-50-year-olds with depression, 30 older individuals (ages 51-90) with depression, 28 with early AD (Braak tangle stages III-IV) and 57 matched controls (17 early-life, 42 later-life). Levels of Aβ, phospho-tau and α-synuclein were assessed by immunohistochemistry and ELISA. To quantify chronic ischaemia, VEGF, MAG and PLP1 were measured by ELISA. To assess pericyte damage, PDGFRB was measured by ELISA. For blood-brain barrier leakiness, JAM-A, claudin 5 and fibrinogen were measured by ELISA. To quantity endothelial activation, the ratio of ICAM1:collagen IV was assessed by immunohistochemistry. RESULTS There was no evidence of chronic cerebral hypoperfusion or increased Aβ/tau in either depression group. There was also no indication of pericyte damage, increased blood-brain barrier leakiness or endothelial activation in the OFC or DLPFC in the depression groups. CONCLUSIONS Contrary to some previous findings, we have not found evidence of impaired vascular function or increased Aβ in LLD. Our study had a relatively small sample size and limitations in the availability of clinical data. These results suggest that depression is a risk factor for dementia rather than an early manifestation of AD or a consequence of cerebral vascular insufficiency.
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Affiliation(s)
- Lindsey I Sinclair
- Dementia Research Group, Faculty of Health Sciences, University of Bristol, Southmead Hospital, Level 1 Learning & Research Building, Bristol, BS10 5NB, UK.
| | - Asher Mohr
- Dementia Research Group, Faculty of Health Sciences, University of Bristol, Southmead Hospital, Level 1 Learning & Research Building, Bristol, BS10 5NB, UK
| | - Mizuki Morisaki
- Dementia Research Group, Faculty of Health Sciences, University of Bristol, Southmead Hospital, Level 1 Learning & Research Building, Bristol, BS10 5NB, UK
| | - Martin Edmondson
- Dementia Research Group, Faculty of Health Sciences, University of Bristol, Southmead Hospital, Level 1 Learning & Research Building, Bristol, BS10 5NB, UK
| | - Selina Chan
- Dementia Research Group, Faculty of Health Sciences, University of Bristol, Southmead Hospital, Level 1 Learning & Research Building, Bristol, BS10 5NB, UK
- Douglas Institute, Department of Psychiatry, McGill University, Montreal, Canada
| | - A Bone-Connaughton
- Dementia Research Group, Faculty of Health Sciences, University of Bristol, Southmead Hospital, Level 1 Learning & Research Building, Bristol, BS10 5NB, UK
| | - Gustavo Turecki
- Department of Life Sciences, Warwick University, Warwick, UK
| | - Seth Love
- Dementia Research Group, Faculty of Health Sciences, University of Bristol, Southmead Hospital, Level 1 Learning & Research Building, Bristol, BS10 5NB, UK
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Al-Talib M, Bailey PK, Zhou Q, Wong K. The experiences of UK-Chinese individuals during the COVID-19 pandemic: A qualitative interview study. PLoS One 2023; 18:e0280341. [PMID: 36649253 PMCID: PMC9844865 DOI: 10.1371/journal.pone.0280341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 12/27/2022] [Indexed: 01/18/2023] Open
Abstract
Infectious disease outbreaks have historically been associated with stigmatisation towards minority groups, specifically those associated with the geographical region that the disease was first identified. We aimed to investigate how the emerging COVID-19 pandemic was experienced by UK-resident individuals of Chinese ethnicity: how their perceived cultural and ethnic identity influenced their experiences, and how early insights into the pandemic in China influenced attitudes and behaviours. We undertook in-depth semi-structured interviews with individuals who self-identified as UK-Chinese. Participants were recruited from three cities in the UK. Interviews were undertaken over the telephone between 9th April 2020 and 16th July 2020. Interviews were digitally recorded and transcribed verbatim. Transcripts were coded using NVivo software and analysed using inductive thematic analysis. Sixteen individuals were interviewed. Three main themes were identified: (1) Attribution of stigma, (2) Pandemic legacies, and (3) Individual versus societal responses. These reflected six sub-themes: (1) Stigmatisation through (mis)identity, (2) Markers of pandemic awareness, (3) Legacies of previous pandemics, (4) Ascription of blame, (5) Extent of freedom, and (6) Implicit faith in government. Experiences of xenophobia included accounts of physical violence. UK-Chinese individuals experienced and perceived widespread xenophobia, in the context of media representations that ascribed blame and exacerbated stigmatisation. Prior experience of respiratory epidemics, and insight into the governmental and societal response in China, contributed to the early adoption of face masks. This in turn marked UK-Chinese individuals as targets for abuse. Awareness is needed to safeguard stigmatized groups from social and economic harm in future infectious disease pandemics.
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Affiliation(s)
- Mohammed Al-Talib
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, United Kingdom
- Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | - Pippa K. Bailey
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, United Kingdom
- Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | - Qiaoling Zhou
- Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | - Katie Wong
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, United Kingdom
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Rubin CJ, Enbody ED, Dobreva MP, Abzhanov A, Davis BW, Lamichhaney S, Pettersson M, Sendell-Price AT, Sprehn CG, Valle CA, Vasco K, Wallerman O, Grant BR, Grant PR, Andersson L. Rapid adaptive radiation of Darwin's finches depends on ancestral genetic modules. Sci Adv 2022; 8:eabm5982. [PMID: 35857449 PMCID: PMC9269886 DOI: 10.1126/sciadv.abm5982] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 05/25/2022] [Indexed: 05/21/2023]
Abstract
Recent adaptive radiations are models for investigating mechanisms contributing to the evolution of biodiversity. An unresolved question is the relative importance of new mutations, ancestral variants, and introgressive hybridization for phenotypic evolution and speciation. Here, we address this issue using Darwin's finches and investigate the genomic architecture underlying their phenotypic diversity. Admixture mapping for beak and body size in the small, medium, and large ground finches revealed 28 loci showing strong genetic differentiation. These loci represent ancestral haplotype blocks with origins predating speciation events during the Darwin's finch radiation. Genes expressed in the developing beak are overrepresented in these genomic regions. Ancestral haplotypes constitute genetic modules for selection and act as key determinants of the unusual phenotypic diversity of Darwin's finches. Such ancestral haplotype blocks can be critical for how species adapt to environmental variability and change.
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Affiliation(s)
- Carl-Johan Rubin
- Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
- Institute of Marine Research, Nordnesgaten 50, 5005 Bergen, Norway
| | - Erik D. Enbody
- Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Mariya P. Dobreva
- Department of Life Sciences, Imperial College London, Silwood Park Campus, SL5 7PY Ascot, UK
| | - Arhat Abzhanov
- Department of Life Sciences, Imperial College London, Silwood Park Campus, SL5 7PY Ascot, UK
| | - Brian W. Davis
- Department of Veterinary Integrative Biosciences, Texas A&M University, College Station, TX, USA
| | | | - Mats Pettersson
- Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Ashley T. Sendell-Price
- Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
- Edward Grey Institute, Department of Zoology, University of Oxford, Oxford, UK
| | - C. Grace Sprehn
- Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Carlos A. Valle
- Colegio de Ciencias Biológicas y Ambientales, Galápagos Science Center GSC, Universidad San Francisco de Quito USFQ, Quito, Ecuador
| | - Karla Vasco
- Colegio de Ciencias Biológicas y Ambientales, Galápagos Science Center GSC, Universidad San Francisco de Quito USFQ, Quito, Ecuador
| | - Ola Wallerman
- Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - B. Rosemary Grant
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA
| | - Peter R. Grant
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA
| | - Leif Andersson
- Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
- Department of Veterinary Integrative Biosciences, Texas A&M University, College Station, TX, USA
- Department of Animal Breeding and Genetics, Swedish University of Agricultural Sciences, Uppsala, Sweden
- Corresponding author.
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O’Keeffe LM, Bell JA, O’Neill KN, Lee MA, Woodward M, Peters SAE, Smith GD, Kearney PM. Sex-specific associations of adiposity with cardiometabolic traits in the UK: A multi-life stage cohort study with repeat metabolomics. PLoS Med 2022; 19:e1003636. [PMID: 34990449 PMCID: PMC8735621 DOI: 10.1371/journal.pmed.1003636] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 11/05/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Sex differences in cardiometabolic disease risk are commonly observed across the life course but are poorly understood and may be due to different associations of adiposity with cardiometabolic risk in females and males. We examined whether adiposity is differently associated with cardiometabolic trait levels in females and males at 3 different life stages. METHODS AND FINDINGS Data were from 2 generations (offspring, Generation 1 [G1] born in 1991/1992 and their parents, Generation 0 [G0]) of a United Kingdom population-based birth cohort study, the Avon Longitudinal Study of Parents and Children (ALSPAC). Follow-up continues on the cohort; data up to 25 y after recruitment to the study are included in this analysis. Body mass index (BMI) and total fat mass from dual-energy X-ray absorptiometry (DXA) were measured at mean age 9 y, 15 y, and 18 y in G1. Waist circumference was measured at 9 y and 15 y in G1. Concentrations of 148 cardiometabolic traits quantified using nuclear magnetic resonance spectroscopy were measured at 15 y, 18 y, and 25 y in G1. In G0, all 3 adiposity measures and the same 148 traits were available at 50 y. Using linear regression models, sex-specific associations of adiposity measures at each time point (9 y, 15 y, and 18 y) with cardiometabolic traits 3 to 6 y later were examined in G1. In G0, sex-specific associations of adiposity measures and cardiometabolic traits were examined cross-sectionally at 50 y. A total of 3,081 G1 and 4,887 G0 participants contributed to analyses. BMI was more strongly associated with key atherogenic traits in males compared with females at younger ages (15 y to 25 y), and associations were more similar between the sexes or stronger in females at 50 y, particularly for apolipoprotein B-containing lipoprotein particles and lipid concentrations. For example, a 1 standard deviation (SD) (3.8 kg/m2) higher BMI at 18 y was associated with 0.36 SD (95% confidence interval [CI] = 0.20, 0.52) higher concentrations of extremely large very-low-density lipoprotein (VLDL) particles at 25 y in males compared with 0.15 SD (95% CI = 0.09, 0.21) in females, P value for sex difference = 0.02. By contrast, at 50 y, a 1 SD (4.8 kg/m2) higher BMI was associated with 0.33 SD (95% CI = 0.25, 0.42) and 0.30 SD (95% CI = 0.26, 0.33) higher concentrations of extremely large VLDL particles in males and females, respectively, P value for sex difference = 0.42. Sex-specific associations of DXA-measured fat mass and waist circumference with cardiometabolic traits were similar to findings for BMI and cardiometabolic traits at each age. The main limitation of this work is its observational nature, and replication in independent cohorts using methods that can infer causality is required. CONCLUSIONS The results of this study suggest that associations of adiposity with adverse cardiometabolic risk begin earlier in the life course among males compared with females and are stronger until midlife, particularly for key atherogenic lipids. Adolescent and young adult males may therefore be high priority targets for obesity prevention efforts.
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Affiliation(s)
- Linda M. O’Keeffe
- School of Public Health, University College Cork, Cork, Ireland
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- * E-mail:
| | - Joshua A. Bell
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Kate N. O’Neill
- School of Public Health, University College Cork, Cork, Ireland
| | - Matthew A. Lee
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Mark Woodward
- The George Institute for Global Health, School of Public Health, Imperial College, London, United Kingdom
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Sanne A. E. Peters
- The George Institute for Global Health, School of Public Health, Imperial College, London, United Kingdom
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - George Davey Smith
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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