Pregnant and postpartum women's experiences of the indirect impacts of the COVID-19 pandemic in high-income countries: a qualitative evidence synthesis

BACKGROUND

Pregnant and postpartum women's experiences of the COVID-19 pandemic, as well as the emotional and psychosocial impact of COVID-19 on perinatal health, has been well-documented across high-income countries. Increased anxiety and fear, isolation, as well as a disrupted pregnancy and postnatal period are widely described in many studies. The aim of this study was to explore, describe and synthesise studies that addressed the experiences of pregnant and postpartum women in high-income countries during the first two years of the pandemic.

METHODS

A qualitative evidence synthesis of studies relating to women's experiences in high-income countries during the pandemic were included. Two reviewers extracted the data using a thematic synthesis approach and NVivo 20 software. The GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) was used to assess confidence in review findings.

RESULTS

Sixty-eight studies were eligible and subjected to a sampling framework to ensure data richness. In total, 36 sampled studies contributed to the development of themes, sub-themes and review findings. There were six over-arching themes: (1) dealing with public health restrictions; (2) navigating changing health policies; (3) adapting to alternative ways of receiving social support; (4) dealing with impacts on their own mental health; (5) managing the new and changing information; and (6) being resilient and optimistic. Seventeen review findings were developed under these themes with high to moderate confidence according to the GRADE-CERQual assessment.

CONCLUSIONS

The findings from this synthesis offer different strategies for practice and policy makers to better support women, babies and their families in future emergency responses. These strategies include optimising care delivery, enhancing communication, and supporting social and mental wellbeing.

How do postnatal care guidelines in Australia compare to international standards? A scoping review and comparative analysis

BACKGROUND

There is no single national guideline in Australia on the provision of postnatal care, which means there is potential for significant variation in the standard and quality of care. This review aimed to systematically identify, synthesise, and assess the quality of postnatal care guidelines produced for use in Australia. A second aim was to compare postnatal care recommendations in Australian guidelines to the National Institute for Health and Care Excellence's (NICE) and the World Health Organization's (WHO) postnatal care recommendations, to identify gaps and areas of disagreement. We focussed on recommendations regarding postnatal assessment of the woman or newborn, infant feeding, discharge planning, or community-based care.

METHODS

A scoping review was undertaken informed by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews. A database search and a manual search of state and national government health departments, professional associations and research institute websites was performed to identify relevant guidelines and recommendations. Guideline quality was assessed using the AGREE II tool. Guideline recommendations from Australia were mapped to 67 NICE/WHO recommendations. Recommendations that partially agreed, were modified, or in disagreement underwent further analysis.

RESULTS

A total of 31 Australian postnatal guidelines were identified and overall, these were of moderate- to high-quality. Of the 67 NICE/WHO recommendations, most agreed with the recommendations contained in Australian guidelines. There were five NICE/WHO recommendations with which corresponding Australian recommendations disagreed. There were 12 NICE/WHO recommendations that were commonly modified within Australia's guidelines. There were three NICE/WHO recommendations that did not appear in any Australian guideline.

CONCLUSIONS

Recommendations from postnatal guidelines in Australia have a high level of agreement with corresponding NICE/WHO recommendations. The few disagreements and modifications found in guideline recommendations - both across Australia's guidelines and between Australia's and the NICE/WHO guidelines - are worrying and warrant further examination, as they may result in different standards of care across Australia. Identified gaps in guidance should be prioritised for inclusion in new or updated guidelines where appropriate.

Instrumental Color Measurements Have Relationships to Fat Smearing in Fresh Sausage

Fat smearing, or poor fat particle definition, impacts the visual quality of sausage. However, objective methods of assessing fat smearing have not been identified. Therefore, the objective of this experiment was to determine the relationship between fat smearing and instrumental color analysis for fresh sausages to create a standard method for using instrumental color in fat smearing analysis. Meat blocks of pork (PK), beef (BF), and a mixture of pork and beef (P/B) were formed and processed at three different temperatures to create varying degrees of fat smearing. The average fat smearing score of each sausage was used to determine if a relationship existed with instrumental color measurements (CIE L*, a*, b*, and reflectance percentage at 580 nm and 630 nm) and color calculations. A correlation was observed for L* (R = -0.704) and the reflectance at 580 nm (R = -0.775) to PK fat smearing (p < 0.05). In P/B sausage, both reflectances at ratios between 630 nm and 580 nm were correlated to P/B fat smearing. No measurement or calculation was correlated with BF fat smearing (p > 0.05). Therefore, it is possible to use instrumental color analysis for the evaluation of fat smearing in pork and pork/beef blended sausage products, but not in beef sausage products.

4 Developing a Dry Matter Intake Prediction Equation for Grazing Animals based on Real-Time Enteric Emissions Measurements

Cattle dry matter intake (DMI) is an essential component of calculating cattle stocking rates, determining nutrient requirements, and evaluating grazing efficiency. Cattle DMI and digestion of forages impact enteric greenhouse gas (CO2e) emissions. Enteric emissions include methane (CH4) and carbon dioxide (CO2), that are eructated by ruminants. The amount of methane produced is affected by consumption, quality, and type of feedstuffs. Intake of grazing animals varies on environmental factors and physiological stage. Additionally, increased GHG levels indicate energy loss during the rumen fermentation process. However, there may be a silver lining to enteric GHG emissions to predict DMI of grazing animals since they are highly correlated with DMI and forage composition. There is limited data on the relationship of DMI and GHG on extensive rangeland systems. Obtaining data for beef cattle DMI and enteric emissions on forage-based diets similar to extensive rangelands is needed to develop an equation capable of predicting DMI for grazing cattle. Therefore, our objective was to determine the relationship between CH4, CO2, oxygen (O2), and hydrogen (H2) emissions and DMI of dry beef cows to develop a mathematical model that predicts grazing DMI from enteric emissions. The predictive equation or precision system model (PSM; Menendez et al., 2022) was developed using data from two feeding trials that were conducted using GreenFeed, SmartFeed Pro, and SmartScale (C-Lock Inc. Rapid City, SD). This study was conducted at the SDSU Cottonwood Field Station (Cottonwood, SD). The two feeding trials consisted of dry beef cows (n=10) receiving low (8% CP) or high (15% CP) quality grass hay using a 14-day adaptation period and a 14-day period of data collection. Regression, artificial neural network, and dynamic-mechanistic models were developed using these data and assessed to identify a model that accurately and precisely predicts forage DMI for dry beef cows on pasture. Model evaluation of the machine learning algorithms used a training, testing, and cross-validation scheme to determine model accuracy. Evaluation of mechanistic models used the Model Evaluation System (MES; Tedeschi, 2006) to measure accuracy (mean bias, Cb, RMSEP), precision (R2, MEF, CCC), and screening for systematic errors. This study successfully integrated three precision technologies which improve research capabilities on extensive rangeland systems through precision enhanced data collection. Deploying a precision-based DMI algorithm enhances research-based capabilities to manage range beef cattle on an individual level by more precisely setting stocking rates, providing supplementation, and evaluating individual animal efficiency; ultimately leading to lower cost, optimized resources, and enhanced environmental sustainability. Further, the enteric emissions data collected fills a gap for missing GHG data of dry beef cows in maintenance phase in semi-arid western South Dakota rangelands.

PSVII-1 Carcass weight and quality grade impact the rate of internal temperature decline in beef primals

Beef carcass weights (HCW) and quality grades (QG) have increased in the United States the last 30 years, yet chilling systems have not drastically changed. The objective was to examine the influence of HCW and QG [USDA select, low choice (LC), upper 2/3 choice (UC), and prime)] on internal temperature decline of the chuck, loin, and round. Carcasses (n=309) were selected by weight [light (LW) = 295.5–341 kg; middle (MW) = 386.4–431.8 kg; heavy (HW) = 465.9–522.7 kg]. Data loggers were placed 20.32 cm deep in the chuck and round and 10.16 cm deep in the loin to record internal temperature for 26 h. Data were analyzed using the PROC MIXED procedure in SAS using HCW and QG as the main effects. A HCW×QG interaction was observed in the chuck (P=0.0286) and round (P&lt; 0.0001), but not the loin (P=0.0689). Chuck temperatures from LC HW carcasses were 1.8°C higher at 0 h compared to LC LW, LC MW, and select MW carcasses (P&lt; 0.05). At 26 h, all LW, select MW, and LC MW chucks had final temperatures at 6.1°C-7.7°C, followed by UC and prime MW at 9.1°C-9.5°C, then all HW chucks at 10.7°C-11.6°C (P&lt; 0.05). At 0 h, select and prime LW rounds had lower temperatures compared to other rounds (P&lt; 0.03). Round temperatures began to decline at 1.75 h in LW and 2.25 h in MW and HW carcasses. Final temperatures for LW and MW were 3.7-5.9⁰C and 1.6-3.0⁰C cooler, respectively, compared to HW rounds at 26 hr (P&lt; 0.04). Loins started with similar temperatures (39.2-40.7⁰C; P &gt;0.05). Elevated temperatures were observed in HW loins, compared to LW and MW loins (P&lt; 0.05), until 26 h when similar temperatures were achieved (P &gt;0.05). Carcass weight and quality grade interact during chilling and this relationship requires further research.

Serum concentrations of DDE, PCBs, and other persistent organic pollutants and mammographic breast density in Triana, Alabama, a highly exposed population

INTRODUCTION

Although some persistent organic pollutants (POPs) are considered human carcinogens, results from studies evaluating exposures and breast cancer risk have been inconsistent, potentially related to varying ages at exposure. Additionally, few studies evaluated the association between POPs exposure and mammographic breast density (MBD), an intermediate biomarker of breast cancer risk. We carried out a cross-sectional study to investigate associations between serum POPs concentrations and MBD measured in 1998 in female residents of Triana, Alabama, in a predominately African American population with high POPs exposures, particularly to p,p'-DDT (1,1,1-trichloro-2,2-bis(p-chlorophenyl)ethane).

METHODS

We measured lipid-adjusted serum concentrations (ng/g lipid) of p,p'-DDT and its main metabolite p,p'-DDE (1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene), polychlorinated biphenyls (PCBs), β-hexachlorocyclohexane (β-HCCH), heptachlor epoxide, oxychlordane, trans-nonachlor, mirex, and aldrin for each woman in our study (n = 210). We also measured two MBD metrics, percent MBD (%MBD) and area of MBD (aMBD). Using adjusted Spearman correlation coefficients (rs) we evaluated correlations between %MBD and aMBD with individual POPs in the overall population and by age group (19-40, 41-54, and 55-91 years) and also estimated adjusted mean measures of MBD with 95% confidence intervals across tertiles of analytes using generalized linear models (GLM). We calculated p-values for multiplicative interaction by age group using GLM. Additional analyses excluded women with current hormone replacement therapy (HRT) use and evaluated early-life exposure (prior to age 18) during the heaviest contamination period in Triana (1947-90).

RESULTS

Among all women, we found no correlation between p,p'-DDE and %MBD, but after age stratification and exclusion of HRT users, there was a suggestion of a difference by age group, with younger women having a weak positive correlation (rs = 0.12, p = 0.37) and older women having a weak negative correlation (rs = -0.12, p = 0.43); pinteraction = 0.06. In contrast, PCBs were weakly positively correlated with %MBD among all women, with the correlation magnitudes increasing after excluding current HRT users (rs-total PCBs = 0.17, p = 0.03). After age stratification and exclusion of HRT users, correlations for PCBs were higher among younger and middle-age women, with only a handful of these correlations being statistically significant. For β-HCCH, the strongest finding was a negative correlation among older women (rs = -0.26, p = 0.07). Correlations were positive predominantly in the younger age group for heptachlor epoxide (rs = 0.27, p = 0.04), oxychlordane (rs = 0.35, p = 0.006), and trans-nonachlor (rs = 0.37, p = 0.003), and largely null for the middle and older age groups; pinteraction range: 0.03-0.05. Similar patterns were found in GLM analyses using tertiles of exposure and aMBD as the metric for MBD. Women exposed during the heaviest chemical contamination period in Triana prior to age 18 had positive correlations between %MBD and PCBs, heptachlor epoxide, mirex, oxychlordane, and trans-nonachlor.

CONCLUSIONS

In this population, despite high exposures to p,p'-DDT and thus high serum concentrations of its main metabolite, p,p'-DDE, we did not find strong evidence of a positive association with MBD. In fact, there was some evidence of a negative association among older women for p,p'-DDE; a similar pattern was found for β-HCCH. However, younger women with higher serum levels of PCBs, heptachlor epoxide, oxychlordane, and trans-nonachlor, who were likely exposed in early life, had higher MBD. These findings should be replicated in larger studies.

PSV-34 Carcass characteristics of Criollo and Criollo crossbred steers raised on Chihuahuan Desert rangeland

We compared carcass characteristics of 11 Raramuri Criollo (RC) and 8 Criollo x Brangus crossbred (XC) steers raised together on Chihuahuan Desert rangeland. Steers entered the trial (completely randomized design) at approximately 5 months of age (December, 2015). Initial weights of RC and XC steers were 233.7 ± 7.8 and 231.4 ± 9.2 kg, respectively. Steers weighed 423.1 ± 7.8 (RC) and 483.0 ± 9.2 (XC) kg at 29 months of age (February 1, 2018), before being shipped to South Dakota where they were fed hay for approximately one month until slaughter (February 28, 2018). Carcass characteristics, such as hot (HCW) and cold carcass weights (CCW), preliminary yield grade (PYG), ribeye area (REA), marbling score (MS), and quality grade (QG) were assessed. Breed effects for all variables (excluding QG) were analyzed using SAS Proc Mixed; SAS Proc Npar1way was used to evaluate QG. Compared to XC, RC steers had lighter (P &lt; 0.01) HCW (220 ± 5 vs. 265 ± 6 kg) and CCW (210 ± 5 vs. 254 ± 6 kg), and smaller (P &lt; 0.01) REA (56 ± 1.4 vs. 61.7 ± 1.6 cm2). No differences (P &gt; 0.05) were observed between RC and XC steers in PYG (2.3 ± 0 vs. 2.4 ± 0.2) or MS (452 ± 31 vs. 456 ± 36). Average QG for all carcasses was between high standard and low choice and was not different (P &gt; 0.05) for RC versus XC carcasses. Our preliminary results show no major difference in carcass quality parameters of RC and XC steers developed on Chihuahuan Desert rangeland.

Impact of Two Levels of Low Voltage Electrical Stimulation on Beef Quality

ObjectivesElectrical stimulation (ES) prior to rigor mortis accelerates postmortem glycolysis, resulting in rapid postmortem depletion of glycogen and can partially simulate the physiological conditions created by stress. The objective of this study was to evaluate the influence of two levels of high voltage electrical stimulation on incidence of dark cutters, temperature decline, muscle pH, glycolytic potential, and meat quality.Materials and MethodsFifty beef carcasses were chosen at 3 collection times over 7 h; 14 at collection 1, 18 at collection 2, and 18 at collection 3. One side of each carcass received either 40 (E40) or 80 (E80) volts of ES. The paired side of each carcass served as a control and did not receive ES (C40 or C80). Temperature data loggers were placed into the sirloin of both sides of the first 4 carcasses from each collection period to monitor temperature decline. Muscle pH was measured on the longissimus muscle at 1, 12, 24, and 72 h postmortem. Steaks were fabricated from the longissimus lumborum for determination of WBSF, cook loss, glycolytic potential (GP), and objective color. Data were analyzed using PROC Mixed of SAS with fixed effect of treatment and random effect of carcass. Analysis of carcass temperature decline was conducted with control carcasses pooled to one treatment to better evaluate the effect of ES on temperature decline. Temperature data, WBSF, and pH were considered repeated measures. Significance was determined at P < 0.05.ResultsNo dark cutting carcasses were observed in this study. A time by treatment interaction was observed for carcass temperature decline (P < 0.001) where ES sides stayed warmer for longer than control sides. A treatment by time interaction was observed for pH decline (P < 0.001) with C40 sides having an increased pH at 1 h postmortem compared to E80 sides. Carcass characteristics did not differ among treatments (P > 0.05). A treatment effect was observed for WBSF values (P = 0.006) with ES sides being more tender than C40 sides. A day effect was observed (P = 0.009) with steaks aged for 7 d being less tender than steaks aged for 14 d (P = 0.007). Cook loss did not differ among treatments (P > 0.05). A difference in cook loss by aging period (P = 0.014) was observed. Steaks aged for 3 d had less cook loss than steaks aged for 7 d (17.3% vs. 18.8% respectively; (P = 0.017) and tended to have less cook loss than steaks aged for 14 d (18.3%; P = 0.065). Glucose, lactate, and overall GP measurements did not differ among treatments (P > 0.05). Objective L* values for E80 sides were greater than C40 (P = 0.0009) and C80 (P < 0.0001), and E40 values were greater than C40 (P < 0.0001). Objective a* values for E80 sides were greater than C40 (P = 0.002) and C80 (P = 0.035), and E40 values were greater than C40 (P < 0.0001). Objective b* values were greater for E80 than C80 (P = 0.005) and C40 (P = 0.001), and E40 was greater than C40 (P < 0.0001).ConclusionThese data suggest ES does not influence the incidence of dark cutters. However, utilization of an ES system can improve tenderness of steaks in addition to producing brighter, more red beef products. The results of this study indicate that similar quality characteristics can be obtained using 40 or 80 V of ES. Therefore, beef packing plants applying ES to carcasses may be able to reduce voltage without sacrificing quality.

Validation of a nomogram to predict the risk of cancer in patients with intraductal papillary mucinous neoplasm and main duct dilatation of 10 mm or less

BACKGROUND

Intraductal papillary mucinous neoplasm (IPMN) is premalignant pancreatic lesion. International guidelines offer limited predictors of individual risk. A nomogram to predict individual IPMN malignancy risk was released, with good diagnostic performance based on a large cohort of Asian patients with IPMN. The present study validated a nomogram to predict malignancy risk and invasiveness of IPMN using both Eastern and Western cohorts.

METHODS

Clinicopathological and radiological data from patients who underwent pancreatic resection for IPMN at four centres each in Eastern and Western countries were collected. After excluding patients with missing data for at least one malignancy predictor in the nomogram (main pancreatic duct diameter, cyst size, presence of mural nodule, serum carcinoembryonic antigen and carbohydrate antigen (CA) 19-9 levels, and age).

RESULTS

In total, data from 393 patients who fit the criteria were analysed, of whom 265 were from Eastern and 128 from Western institutions. Although mean age, sex, log value of serum CA19-9 level, tumour location, main duct diameter, cyst size and presence of mural nodule differed between the Korean/Japanese, Eastern and Western cohorts, rates of malignancy and invasive cancer did not differ significantly. Areas under the receiver operating characteristic (ROC) curve values for the nomogram predicting malignancy were 0·745 for Eastern, 0·856 for Western and 0·776 for combined cohorts; respective values for the nomogram predicting invasiveness were 0·736, 0·891 and 0·788.

CONCLUSIONS

External validation of the nomogram showed good performance in predicting cancer in both Eastern and Western patients with IPMN lesions.

Area-level income disparities in colorectal screening in Canada: evidence to inform future surveillance

Background

Participation in colorectal screening remains low even in countries with universal health coverage. Area-level determinants of low screening participation in Canada remain poorly understood.

Methods

We assessed the association between area-level income and two indicators of colorectal screening (having never been screened, having not been screened recently) by linking census-derived local area-level income data with self-reported screening data from urban-dwelling respondents to the Canadian Community Health Survey (50-75 years of age, cycles 2005 and 2007, n = 18,362) who reported no known risk factors for colorectal cancer. Generalized estimating equation Poisson models estimated the prevalence ratios and differences for having never been screened and having not been screened recently, adjusting for individual-level income, education, marital status, having a regular physician, age, and sex.

Results

About 53% of the study population had never been screened. Among individuals who had ever been screened, 35% had been screened recently. Adjusting for covariates, lower area-level income was associated with having never been screened [covariate-adjusted prevalence ratios: 1.24 for quartile 1; 95% confidence limits (cl): 1.16, 1.34; 1.25 for quartile 2; 95% cl: 1.15, 1.33; 1.15 for quartile 3; 95% cl: 1.08, 1.23]. Among individuals who had been screened in their lifetime, area-level income was not associated with having not been screened recently.

Conclusions

Lower area-level income is associated with having never been screened for colorectal cancer even after adjusting for individual socioeconomic factors. Those findings highlight the potential importance of socioeconomic contexts for colorectal screening initiation and merit attention in both future research and surveillance efforts.

A Winter Survey of Domestic Heating among Elderly Patients

Elderly people have a greater need for domestic heating given the time they spend at home and the decline in the body thermoregulation that occurs with ageing. The use of domestic heating by 200 mentally competent newly admitted elderly in patients was evaluated by means of a questionnaire survey. Most patients (69%) were aware of the addition of value added tax (VAT) to their fuel bill and 31 % said they had reduced the amount of heating they use because of this. A third of patients (29.5%) said they had difficulty keeping warm prior to this admission. The majority of patients said they could not manage to keep warm in the winter without financial hardship. In addition, 29% said they had reduced the amount spent on food in order to pay for fuel bills. This study suggests that cold may contribute to hospital admissions in elderly patients. This should have implications for government spending and taxation policy on domestic heating.

Metagenomic characterization of the effect of feed additives on the gut microbiome and antibiotic resistome of feedlot cattle

In North America, antibiotic feed additives such as monensin and tylosin are added to the finishing diets of feedlot cattle to counter the ill-effects of feeding diets with rapidly digestible carbohydrates. While these feed additives have been proven to improve feed efficiency and reduce liver abscess incidence, how these products impact the gastrointestinal microbiota is not completely understood. In this study, we analyzed the impact of providing antibiotic feed additives to feedlot cattle using metagenome sequencing of treated and control animals. Our results indicate that use of antibiotic feed additives does not produce discernable changes at the phylum level. However, treated cattle had reduced abundance of gram-positive bacteria at the genus level. The abundance of Ruminococcus, Erysipelotrichaceae and Lachnospiraceae in the gut of treated steers was reduced. Functional analysis of the data indicates that there was only minimal impact due to the treatment in the rumen. Genes involved in detoxification were significantly increased in the rumen of AB steers. But the relative abundance of these genes was < 0.3%. However, our results did not show any correlation between the presence of antimicrobial resistance genes in the gut microbiota and the administration of antibiotic feed additives.

Interventional therapies and in-hospital outcomes in acute coronary syndromes complicated by von Willebrand disease

INTRODUCTION

von Willebrand disease (VWD) is one of the most common inherited bleeding disorders.

AIM

Investigate the impact of the VWD bleeding tendency on in-hospital management of acute coronary syndromes (ACS).

METHODS

Using discharge data from the National Inpatient Sample (NIS), the features of presentation and in-hospital treatment among ACS hospital discharges with and without a VWD diagnosis were investigated. A total of 264 case discharges and 705 860 control discharges were identified.

RESULTS AND CONCLUSIONS

There was a significantly higher percentage of women among the case discharges compared to the control discharges (59.5% and 39.4%, respectively; P < 0.001). The rate of medical therapy alone [i.e. avoidance of percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG)] was significantly higher among unstable angina cases than controls (55.0% vs. 46.4%; P = 0.01), and among cases undergoing PCI, bare-metal stents (BMS) were utilized in preference to drug-eluting stents (DES) (adjusted OR = 3.5); P < 0.001). No difference in in-hospital death was identified, but reported bleeding among discharges that underwent CABG was higher in cases compared to controls (12.9% vs. 5.2%; P = 0.047). Although medical and interventional management of ACS appears to be well tolerated in the majority of hospitalized patients with VWD, the gender ratio is reversed, interventions and DES are utilized less frequently and procedure-related bleeding may be increased, calling for further study.

Place and health in diabetes: the neighbourhood environment and risk of depression in adults with type 2 diabetes

BACKGROUND

Depression is a common co-illness in people with diabetes. Evidence suggests that the neighbourhood environment impacts the risk of depression, but few studies have investigated this effect in those with diabetes. We examined the effect of a range of neighbourhood characteristics on depression in people with Type 2 diabetes.

METHODS

This cohort study used five waves of data from 1298 participants with Type 2 diabetes from the Diabetes Health Study (2008-2013). We assessed depression using the Patient Health Questionnaire. We measured neighbourhood deprivation using census data; density of services using geospatial data; level of greenness using satellite imagery; and perceived neighbourhood characteristics using survey data. The effect of neighbourhood factors on risk of depression was estimated using survival analysis, adjusting for sociodemographic variables. We tested effect modification by age, sex and socio-economic characteristics using interaction terms.

RESULTS

More physical activity facilities, cultural services and a greater level of greenness in the neighbourhood were associated with a lower risk of depression in our sample, even after adjusting for confounders. Material deprivation was associated with increased risk of depression, particularly in participants who were older or retired.

CONCLUSIONS

Characteristics of neighbourhoods were associated with the risk of depression in people with Type 2 diabetes and there were vulnerable subgroups within this association. Clinicians are encouraged to consider the neighbourhood environment of their patients when assessing the risk of depression. Future intervention research is need for health policy recommendations.

The longitudinal effects of neighbourhood social and material deprivation change on psychological distress in urban, community-dwelling Canadian adults

OBJECTIVE

The purpose of this study was to assess how longitudinal changes in neighbourhood material and social deprivation affect distress outcomes in adult Canadians.

STUDY DESIGN

This study used a prospective cohort approach.

METHODS

We paired data from 2745 urban participants of Canada's National Population Health Survey-who completed the Kessler 6-Item psychological distress screening tool at baseline and follow-up-with neighbourhood social and material deprivation data from the census-based Pampalon Deprivation Index. Data were paired using participants' postal code. We conducted multiple linear regression models, which were stratified by baseline deprivation level and controlled for key confounders.

RESULTS

Most participants lived in neighbourhoods that did not change drastically in social or material deprivation level during the six years between baseline and follow-up. We found that a worsening of material settings was significantly associated with worsening distress scores at follow-up. This finding is discussed in the context of existing literature, and made relevant for urban health research and policy.

Investing in prospective cohorts for etiologic study of occupational exposures

Prospective cohorts have played a major role in understanding the contribution of diet, physical activity, medical conditions, and genes to the development of many diseases, but have not been widely used for occupational exposures. Studies in agriculture are an exception. We draw upon our experience using this design to study agricultural workers to identify conditions that might foster use of prospective cohorts to study other occupational settings. Prospective cohort studies are perceived by many as the strongest epidemiologic design. It allows updating of information on exposure and other factors, collection of biologic samples before disease diagnosis for biomarker studies, assessment of effect modification by genes, lifestyle, and other occupational exposures, and evaluation of a wide range of health outcomes. Increased use of prospective cohorts would be beneficial in identifying hazardous exposures in the workplace. Occupational epidemiologists should seek opportunities to initiate prospective cohorts to investigate high priority, occupational exposures.

Impacts of Coastal Development on the Ecology of Tidal Creek Ecosystems of the US Southeast including Consequences to Humans

Upland areas of southeastern U.S. tidal creek watersheds are popular locations for development, and they form part of the estuarine ecosystem characterized by high economic and ecological value. The primary objective of this work was to define the relationships between coastal development, with its concomitant land use changes and associated increases in nonpoint source pollution loading, and the ecological condition of tidal creek ecosystems including related consequences to human populations and coastal communities. Nineteen tidal creek systems, located along the southeastern United States coast from southern North Carolina to southern Georgia, were sampled during summer, 2005 and 2006. Within each system, creeks were divided into two primary segments based upon tidal zoning: intertidal (i.e., shallow, narrow headwater sections) and subtidal (i.e., deeper and wider sections) and then watersheds were delineated for each segment. Relationships between coastal development, concomitant land use changes, nonpoint source pollution loading, the ecological condition of tidal creek ecosystems, and the potential impacts to human populations and coastal communities were evaluated. In particular, relationships were identified between the amount of impervious cover (indicator of coastal development) and a range of exposure and response measures including increased chemical contamination of the sediments, increased pathogens in the water, increased nitrate/nitrite levels, increased salinity range, decreased biological productivity of the macrobenthos, alterations to the food web, increased flooding potential, and increased human risk of exposure to pathogens and harmful chemicals. The integrity of tidal creeks, particularly the headwaters or intertidally-dominated sections, were impaired by increases in nonpoint source pollution associated with sprawling urbanization (i.e., increases in impervious cover). This finding suggests these habitats are valuable early warning sentinels of ensuing ecological impacts and potential public health and flooding risk from sprawling coastal development. Results also validate the use of a conceptual model with impervious cover thresholds for tidal creek systems in the southeast region.

Assessing copy number from exome sequencing and exome array CGH based on CNV spectrum in a large clinical cohort

PURPOSE

Detection of copy-number variation (CNV) is important for investigating many genetic disorders. Testing a large clinical cohort by array comparative genomic hybridization provides a deep perspective on the spectrum of pathogenic CNV. In this context, we describe a bioinformatics approach to extract CNV information from whole-exome sequencing and demonstrate its utility in clinical testing.

METHODS

Exon-focused arrays and whole-genome chromosomal microarray analysis were used to test 14,228 and 14,000 individuals, respectively. Based on these results, we developed an algorithm to detect deletions/duplications in whole-exome sequencing data and a novel whole-exome array.

RESULTS

In the exon array cohort, we observed a positive detection rate of 2.4% (25 duplications, 318 deletions), of which 39% involved one or two exons. Chromosomal microarray analysis identified 3,345 CNVs affecting single genes (18%). We demonstrate that our whole-exome sequencing algorithm resolves CNVs of three or more exons.

CONCLUSION

These results demonstrate the clinical utility of single-exon resolution in CNV assays. Our whole-exome sequencing algorithm approaches this resolution but is complemented by a whole-exome array to unambiguously identify intragenic CNVs and single-exon changes. These data illustrate the next advancements in CNV analysis through whole-exome sequencing and whole-exome array.Genet Med 17 8, 623-629.

Insight, duration of untreated psychosis and attachment in first-episode psychosis: prospective study of psychiatric recovery over 12-month follow-up

BACKGROUND

Increasing evidence shows attachment security influences symptom expression and adaptation in people diagnosed with schizophrenia and other psychoses.

AIMS

To describe the distribution of secure and insecure attachment in a cohort of individuals with first-episode psychosis, and to explore the relationship between attachment security and recovery from positive and negative symptoms in the first 12 months.

METHOD

The study was a prospective 12-month cohort study. The role of attachment, duration of untreated psychosis (DUP), baseline symptoms and insight in predicting and mediating recovery from symptoms was investigated using multiple regression analysis and path analysis.

RESULTS

Of the 79 participants, 54 completed the Adult Attachment Interview (AAI): 37 (68.5%) were classified as insecure, of which 26 (48.1%) were insecure/dismissing and 11 (20.4%) insecure preoccupied. Both DUP and insight predicted recovery from positive symptoms at 12 months. Attachment security, DUP and insight predicted recovery from negative symptoms at 12 months.

CONCLUSIONS

Attachment is an important construct contributing to understanding and development of interventions promoting recovery following first-episode psychosis.

Occupational exposure to trichloroethylene and risk of non-Hodgkin lymphoma and its major subtypes: a pooled InterLymph [correction of IinterLlymph] analysis

OBJECTIVES

We evaluated the association between occupational exposure to trichloroethylene (TCE) and risk of non-Hodgkin lymphoma (NHL) in a pooled analysis of four international case-control studies.

METHODS

Overall, the pooled study population included 3788 NHL cases and 4279 controls. Risk of NHL and its major subtypes associated with TCE exposure was calculated with unconditional logistic regression and polytomous regression analysis, adjusting by age, gender and study.

RESULTS

Risk of follicular lymphoma (FL), but not NHL overall or other subtypes, increased by probability (p=0.02) and intensity level (p=0.04), and with the combined analysis of four exposure metrics assumed as independent (p=0.004). After restricting the analysis to the most likely exposed study subjects, risk of NHL overall, FL and chronic lymphocytic leukaemia (CLL) were elevated and increased by duration of exposure (p=0.009, p=0.04 and p=0.01, respectively) and with the combined analysis of duration, frequency and intensity of exposure (p=0.004, p=0.015 and p=0.005, respectively). Although based on small numbers of exposed, risk of all the major NHL subtypes, namely diffuse large B-cell lymphoma, FL and CLL, showed increases in risk ranging 2-3.2-fold in the highest category of exposure intensity. No significant heterogeneity in risk was detected by major NHL subtypes or by study.

CONCLUSIONS

Our pooled analysis apparently supports the hypothesis of an increase in risk of specific NHL subtypes associated with occupational exposure to TCE.

Priority issues in occupational cancer research: Ontario stakeholder perspectives

INTRODUCTION

Workers are potentially exposed to known and suspected carcinogens in the workplace, many of which have not been fully evaluated. Despite persistent need, research on occupational cancer appears to have declined in recent decades. The formation of the Occupational Cancer Research Centre (OCRC) is an effort to counter this downward trend in Ontario. The OCRC conducted a survey of the broad stakeholder community to learn about priority issues on occupational cancer research.

METHODS

The OCRC received 177 responses to its survey from academic, health care, policy, industry, and labour-affiliated stakeholders. Responses were analyzed based on workplace exposures, at-risk occupations and cancers by organ system, stratified by respondents' occupational role.

DISCUSSION

Priority issues identified included workplace exposures such as chemicals, respirable dusts and fibres (e.g. asbestos), radiation (e.g. electromagnetic fields), pesticides, and shift work; and occupations such as miners, construction workers, and health care workers. Insufficient funding and a lack of exposure data were identified as the central barriers to conducting occupational cancer research.

CONCLUSION

The results of this survey underscore the great need for occupational cancer research in Ontario and beyond. They will be very useful as the OCRC develops its research agenda.

Physical activities and future risk of Parkinson disease

OBJECTIVE

To prospectively investigate the relationship between physical activity and Parkinson disease (PD).

METHODS

We evaluated physical activity in relation to PD among 213,701 participants of the NIH-AARP Diet and Health Study cohort. Physical activities over 4 periods (ages 15-18, 19-29, and 35-39, and in the past 10 years) were noted in 1996-1997, and physician-diagnosed PD was reported on the 2004-2006 follow-up questionnaire. Only cases diagnosed after 2000 (n = 767) were included in the analyses.

RESULTS

Higher levels of moderate to vigorous activities at ages 35-39 or in the past 10 years as reported in 1996-1997 were associated with lower PD occurrence after 2000 with significant dose-response relationships. The multivariate odds ratios (OR) between the highest vs the lowest levels were 0.62 (95% CI confidence interval [CI] 0.48-0.81, p for trend 0.005) for ages 35-39 and 0.65 (95% CI 0.51-0.83, p for trend 0.0001) for in the past 10 years. Further analyses showed that individuals with consistent and frequent participation in moderate to vigorous activities in both periods had approximately a 40% lower risk than those who were inactive in both periods. Moderate to vigorous activities at earlier ages or light activities were not associated with PD. Finally, the association between higher moderate to vigorous physical activities and lower PD risk was demonstrated in a metaanalysis of prospective studies.

CONCLUSIONS

Although we cannot exclude the possibility that less participation in physical activity is an early marker of PD, epidemiologic evidence suggests that moderate to vigorous exercise may protect against PD.

Differential effects of smoking on lung cancer mortality before and after household stove improvement in Xuanwei, China

Background:

In Xuanwei County, Yunnan Province, China, lung cancer mortality rates in both males and females are among the highest in China.

Methods:

We evaluated differential effects of smoking on lung cancer mortality before and after household stove improvement with chimney to reduce exposure to smoky coal emissions in the unique cohort in Xuanwei, China. Effects of independent variables on lung cancer mortality were measured as hazard ratios and 95% confidence intervals using a multivariable Cox regression model that included separate time-dependent variables for smoking duration (years) before and after stove improvement.

Results and conclusion:

We found that the effect of smoking on lung cancer risk becomes considerably stronger after chimney installation and consequent reduction of indoor coal smoke exposure.

Smoking duration, intensity, and risk of Parkinson disease

OBJECTIVE

To evaluate the relative importance of smoking duration vs intensity in reducing the risk of Parkinson disease (PD).

METHODS

The study included 305,468 participants of the NIH-AARP Diet and Health cohort, of whom 1,662 had a PD diagnosis after 1995. We estimated odds ratios (OR) and 95% confidence intervals from multivariate logistic regression models.

RESULTS

Compared with never smokers, the multivariate ORs were 0.78 for past smokers and 0.56 for current smokers. Among past smokers, a monotonic trend toward lower PD risk was observed for all indicators of more smoking. Stratified analyses indicated that smoking duration was associated with lower PD risk within fixed intensities of smoking. For example, compared with never smokers, the ORs among past smokers who smoked >20 cigarettes/day were 0.96 for 1-9 years of smoking, 0.78 for 10-19 years, 0.64 for 20-29 years, and 0.59 for 30 years or more (p for trend = 0.001). In contrast, at fixed duration, the typical number of cigarettes smoked per day in general was not related to PD risk. Close examination of smoking behaviors in early life showed that patients with PD were less likely to be smokers at each age period, but if they smoked, they smoked similar numbers of cigarettes per day as individuals without PD.

CONCLUSIONS

This large study suggests that long-term smoking is more important than smoking intensity in the smoking-Parkinson disease relationship.

Residential proximity to industrial facilities and risk of non-Hodgkin lymphoma

Industrial pollution has been suspected as a cause of non-Hodgkin lymphoma (NHL), based on associations with chemical exposures in occupational studies. We conducted a case-control study of NHL in four SEER regions of the United States, in which residential locations of 864 cases and 684 controls during the 10 years before recruitment were used to characterize proximity to industrial facilities reporting chemical releases to the Environmental Protection Agency's Toxics Release Inventory (TRI). For each of 15 types of industry (by 2-digit SIC code), we evaluated the risk of NHL associated with having lived within 2 miles of a facility, the distance to the nearest facility (miles categories of < or =0.5, >0.5-1.0, >1.0-2.0, >2 [referent]), and the duration of residence within 2miles (years categories of 10, 1-9, 0 [referent]), using logistic regression. Increased risk of NHL was observed in relation to lumber and wood products facilities (SIC 24) for the shortest distance of residential proximity (< or =0.5 mile: odds ratio [OR]=2.2, 95% confidence interval [CI]: 0.4-11.8) or the longest duration (10 years: OR=1.9, 95% CI: 0.8-4.8); the association with lumber facilities was more apparent for diffuse large B-cell lymphoma (lived within 2 miles: OR=1.7, 95% CI: 1.0-3.0) than for follicular lymphoma (OR=1.1, 95% CI: 0.5-2.2). We also observed elevated ORs for the chemical (SIC 28, 10 years: OR=1.5, 95% CI: 1.1-2.0), petroleum (SIC 29, 10 years: OR=1.9, 95% CI: 1.0-3.6), rubber/miscellaneous plastics products (SIC 30, < or =0.5mile: OR=2.7, 95% CI: 1.0-7.4), and primary metal (SIC 33, lived within 2miles: OR=1.3, 95% CI: 1.0-1.6) industries; however, patterns of risk were inconsistent between distance and duration metrics. This study does not provide strong evidence that living near manufacturing industries increases NHL risk. However, future studies designed to include greater numbers of persons living near specific types of industries, along with fate-transport modeling of chemical releases, would be informative.

Portable stove use is associated with lower lung cancer mortality risk in lifetime smoky coal users

Domestic fuel combustion from cooking and heating, to which about 3 billion people worldwide are exposed, is associated with increased lung cancer risk. Lung cancer incidence in Xuanwei is the highest in China, and the attributable risk of lung cancer from unvented smoky coal burning is greater than 90%. To evaluate any lung cancer mortality reduction after changing from unvented stoves to portable stoves, we used lifetime smoky coal users in a retrospective cohort of all farmers born during 1917–1951 and residing in Xuanwei in 1976. Of the 42 422 enrolled farmers, 4054 lifetime smoky coal users changed to portable stoves, 4364 did not change, and 1074 died of lung cancer. Lung cancer morality associated with stove change was assessed by product-limit survival curves and multivariate Cox regression models. Both men (P<0.0001) and women (P<0.0001) who changed to portable stoves had a significantly increased probability of survival compared with those who did not change. Portable stoves were associated with decreased risk of lung cancer mortality in male participants (hazard ratio (HR)=0.62, 95% confidence interval (CI)=0.46–0.82) and female participants (HR=0.41, 95% CI=0.29–0.57). Portable stove use is associated with reduced lung cancer mortality risk, highlighting a cost-effective intervention that could substantially benefit health in developing countries.

Degreasing and risk of non-Hodgkin lymphoma

OBJECTIVE

To investigate the relationship between selected solvent-related workplace tasks (degreasing, painting, gluing, stripping paint, staining) and risk of non-Hodgkin lymphoma (NHL).

METHODS

We analysed occupational data from a large population-based case-control study of NHL conducted in the USA. For participants reporting occupations with possible exposure to organic solvents, job-specific interview modules were administered to elicit in-depth information on solvent-related workplace tasks and other exposure-related factors (225 cases, 189 controls). Unconditional logistic regression models were fit to calculate odds ratios (ORs) and 95% CI for average frequency, maximal frequency and cumulative number of hours having performed each task. Individuals with jobs rated as unexposed to organic solvents in the workplace (180 cases, 213 controls) were used as a reference group.

RESULTS

We observed an increased risk of NHL among subjects in the highest category of maximal degreasing frequency (>520 h/year: OR 2.1, 95% CI 0.9 to 4.9, trend test p = 0.02). We found similar associations for the highest levels of average frequency and, among men, cumulative number of hours. Other solvent-related tasks were not associated with NHL.

CONCLUSION

Findings from this case-control analysis of solvent-related tasks suggest that frequent degreasing work may be associated with an elevated risk of NHL.

Occupation/industry and risk of non-Hodgkin's lymphoma in the United States

AIMS

To identify occupations and industries associated with non-Hodgkin's lymphoma (NHL) in a large population-based, case-control study in the USA.

METHODS

Cases (n = 1189) of histologically confirmed malignant NHL ages 20-74 were prospectively identified in four geographic areas covered by the National Cancer Institute SEER Program. Controls (n = 982) were selected from the general population by random digit dialling (<65 years of age) and from residents listed in Medicare files (65-74 years of age). Odds ratios and 95% confidence intervals for occupations and industries were calculated by unconditional logistic regression analyses, adjusting for age, gender, ethnicity and study centre. Further analyses stratified for gender and histological subtype were also performed.

RESULTS

Risk of NHL was increased for a few occupations and industries. Several white collar occupations, with no obvious hazardous exposures, had elevated risks, including purchasing agents and buyers, religious workers, physical therapists and information clerks. Occupations with excesses that may have exposures of interest include launderers and ironers, service occupations, food/beverage preparation supervisors, hand packers and packagers, roofing and siding, leather and leather products, transportation by air, nursing and personal care facilities, and specialty outpatient clinics. Significantly decreased risks of NHL were found for a number of occupations and industries including post-secondary teachers and chemical and allied products.

CONCLUSIONS

The results of this study suggest that several occupations and industries may alter the risk of NHL. Our results support previously reported increased risks among farmers, printers, medical professionals, electronic workers and leather workers. These findings should be evaluated further in larger studies that have the power to focus on specific exposures and histological subtypes of NHL.

Multicenter study on in vitro characterization of dendritic cells

BACKGROUND

There is growing interest in the use of in vitro-expanded dendritic cells (DC) in cancer immunotherapy as cellular-based vaccines. However, the methods used for in vitro preparation vary widely between institutions. Therefore, a strong need exists for standardization, characterization and quality control (QC) of such vaccines. A first prospective multicenter pilot study was performed to investigate basic QC parameters of frozen/thawed DC. The study design was focused on comparison of test results for cell counts, immunophenotyping and cell viability.

METHODS

CD14+ monocytes were isolated from three healthy volunteers. The cells were expanded in vitro, matured and cryopreserved using a standardized protocol in one laboratory. The aliquots of cryopreserved DC and a panel of reagents were shipped to eight laboratories worldwide. The objective was to compare the results of non-functional QC assays between sites by testing identical DC vaccines and using a pre-defined test protocol.

RESULTS

Measurements of nucleated cell (NC) content of thawed DC vaccines with different types of hematology analyzers (HA) gave similar results for the majority of sites. Immunophenotyping using identical clones of monoclonal antibodies for the detection of surface antigens (i.e. CD1a, CD14, CD16, CD83, CD86 and HLA-DR) provided mostly comparable results between laboratories with an acceptable level of variation. In contrast, highly different results between study sites were generated for measuring the viability of thawed DC by flow cytometry using 7-amino-actinomycin D (7-AAD) dye exclusion.

DISCUSSION

In characterizing frozen/thawed DC vaccines, NC counts generated by HA yielded similar results between different laboratories. Furthermore, immunophenotyping of DC vaccines can be standardized between centers, i.e. by using identical reagents. Because of highly variable results between laboratories, 7-AAD viability testing of thawed DC needs to be studied further to identify potential causes for the observed variability.