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Ayuso-Álvarez A, Ortiz C, Fontán J, Rodríguez-Blázquez C, Damián J, López-Cuadrado T, Galán I. Predictive value of the Global Activity Limitation Indicator (GALI) on all-cause mortality. Public Health 2024; 230:6-11. [PMID: 38460397 DOI: 10.1016/j.puhe.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/24/2024] [Accepted: 02/08/2024] [Indexed: 03/11/2024]
Abstract
OBJECTIVES The Global Activity Limitation Indicator (GALI) is an instrument that measures long-term overall disability. The objective of this study was to evaluate GALI's predictive value on mortality while examining variations according to sex, age, and educational level. STUDY DESIGN Longitudinal study. METHODS This longitudinal study was based on 42,991 individuals aged ≥15 years who participated in the 2011-2012 National Health Survey and the 2014 European Health Survey in Spain. These records were linked to mortality data up to December 2021. GALI assessed self-reported functional limitation in the past 6 months and classified individuals into three categories: severely limited, limited but not severely, and not limited. Incidence rate ratios (IRR) were calculated using Poisson regression models, adjusting for sociodemographic, lifestyle, and health status variables. RESULTS Compared to individuals with no limitations, those with non-severe limitations had an IRR for mortality of 1.27 (95% CI: 1.16-1.38), and 2.04 (95% CI: 1.81-2.31) in those with severe limitations. Women with severe limitations exhibited a higher IRR (2.32; 95% CI: 1.98-2.71) compared to men (1.73; 95% CI: 1.45-2.08) (P for interaction = 0.005). Individuals <65 years with severe limitations showed a greater association (2.22; 95% CI: 1.58-3.10) than those ≥65 (1.49; 95% CI: 1.32-1.69) (P for interaction <0.001). Among individuals with lower educational attainment, the IRR was 2.08 (95% CI: 1.83-2.37), and 1.87 (95% CI: 1.37-2.56) for the higher education group (P for interaction = 0.017). CONCLUSIONS GALI is a robust predictor of all-cause mortality in the general population and subgroups. The association is stronger in women, individuals <65 years, and those with lower educational levels.
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Affiliation(s)
- A Ayuso-Álvarez
- National Centre for Epidemiology, Institute of Health Carlos III, Spain; Department of Sociology, School of Economics, Universidad Autónoma de Madrid, Spain
| | - C Ortiz
- National Centre for Epidemiology, Institute of Health Carlos III, Spain
| | - J Fontán
- National Centre for Epidemiology, Institute of Health Carlos III, Spain
| | | | - J Damián
- National Centre for Epidemiology, Institute of Health Carlos III, Spain; Consortium for Biomedical Research in Neurodegenerative Diseases (CIBERNED), Spain
| | - T López-Cuadrado
- National Centre for Epidemiology, Institute of Health Carlos III, Spain; Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Spain
| | - I Galán
- National Centre for Epidemiology, Institute of Health Carlos III, Spain; Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Spain.
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Qi J, Bhatti P, Spinelli JJ, Murphy RA. Antihypertensive medications and risk of colorectal cancer in British Columbia. Front Pharmacol 2023; 14:1301423. [PMID: 38026942 PMCID: PMC10662292 DOI: 10.3389/fphar.2023.1301423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction: There is conflicting evidence for the association between antihypertensive medications and colorectal cancer risk, possibly reflecting methodological limitations of previously conducted studies. Here, we aimed to clarify associations between commonly prescribed antihypertensive medication classes and colorectal cancer risk in a large, retrospective, cohort study. Methods: Using linked administrative data between 1996 and 2017 from British Columbia, we identified a cohort of 1,693,297 men and women who were 50 years of age or older, initially cancer-free and nonusers of antihypertensive medications. Medication use was parameterized as ever use, cumulative duration, and cumulative dose. Cox proportional hazard models were used to estimate hazard ratios (HRs) and associated 95% confidence intervals (95% CIs) for associations of time-varying medication use [angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), beta-blockers (BBs), calcium channel blockers (CCBs), and diuretics] with colorectal cancer risk. Results: There were 28,460 incident cases of colorectal cancer identified over the follow-up period (mean = 12.9 years). When medication use was assessed as ever/never, diuretics were associated with increased risk of colorectal cancer (HR 1.08, 95% CI 1.04-1.12). However, no similar association was observed with cumulative duration or cumulative dose of diuretics. No significant associations between the other four classes of medications and colorectal cancer risk were observed. Conclusion: No compelling evidence of associations between antihypertensive medications and colorectal cancer were observed.
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Affiliation(s)
- Jia Qi
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Cancer Control Research, BC Cancer, Vancouver, BC, Canada
| | - Parveen Bhatti
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Cancer Control Research, BC Cancer, Vancouver, BC, Canada
| | - John J. Spinelli
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Rachel A. Murphy
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Cancer Control Research, BC Cancer, Vancouver, BC, Canada
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Rich-Edwards JW, Stuart JJ, Becene IA, Largier LF, Rexrode KM, Cantonwine DE, Carpenter MO, McElrath TF, Gray KJ. Validation of parental recall questionnaire to classify preterm delivery subtypes: Spontaneous preterm labour, preterm premature rupture of membranes and clinician-initiated preterm delivery. Paediatr Perinat Epidemiol 2023; 37:710-718. [PMID: 37770068 PMCID: PMC10840943 DOI: 10.1111/ppe.13009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/24/2023] [Accepted: 09/14/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Preterm delivery (PTD) includes three main presenting subtypes: spontaneous preterm labour (sPTL), preterm premature rupture of membranes (pPROM) and clinician-initiated preterm delivery (ciPTD). PTD subtype data are rarely available from birth registries and are onerous to derive from medical records. OBJECTIVES To develop and test the validity of a questionnaire to classify PTD subtype based on birthing parent recall of labour and delivery events. METHODS The questionnaire was sent in 2022 to 581 patients with PTD history documented in the LIFECODES study, a hospital-based birth cohort in Boston, Massachusetts. Eighty-two respondents reported 94 PTDs that could be linked to medical records. Data on PTD subtype were extracted from medical records as the reference standard. RESULTS Medical records indicated 47 spontaneous (24 sPTL, 23 pPROM) and 47 ciPTD deliveries occurring a median eight years earlier. The sensitivity and specificity of the recall questionnaire were 88% (95% confidence interval: 68, 97%) and 89% (79, 95%) for sPTL; 96% (78, 100%) and 94% (86, 98%) for pPROM; and 83% (69, 92%) and 100% (92, 100%) for ciPTD, respectively. Greater time since pregnancy did not degrade the sensitivity or specificity of the parental recall questionnaire. CONCLUSIONS Although derived from a modest sample, the moderate-to-high sensitivity and specificity of the parental recall questionnaire to classify sPTL, pPROM and ciPTD demonstrates its potential for large studies of PTD and for correction of misclassification bias. Future studies are required to test the questionnaire in a variety of populations.
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Affiliation(s)
- Janet W Rich-Edwards
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Jennifer J Stuart
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Iris A Becene
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Louise F Largier
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kathryn M Rexrode
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - David E Cantonwine
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Thomas F McElrath
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kathryn J Gray
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Oltramare C, Mediouni Z, Shoman Y, Hopf NB, Graczyk H, Berthet A. Determinants of Pesticide Exposure in Occupational Studies: A Meta-Analysis. TOXICS 2023; 11:623. [PMID: 37505588 PMCID: PMC10386710 DOI: 10.3390/toxics11070623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/13/2023] [Accepted: 07/15/2023] [Indexed: 07/29/2023]
Abstract
Few epidemiological studies use exposure determinants specifically tailored to assess pesticide or plant protection product (PPP) exposures when assessing presumed association between occupational exposure and health outcomes among agricultural workers. This lack of exposure specificity could lead to results that fail to detect an association. It could be related to the lack of consensus on exposure assessment methods and the choice of exposure determinants. We conducted a meta-analysis following the PRISMA checklist to identify PPP exposure determinants used in occupational studies and identified exposure determinants that best characterized agricultural exposures to PPPs. Out of 1436 studies identified, 71 were included. The exposure determinants identified were active ingredients, chemical classes, types of PPP, crops, tasks, frequencies, duration, lifetime exposure days, and intensity-weighted exposure days. Only six over 17 associations between exposure determinants and health outcomes were found with moderate quality of evidence. Overall, epidemiological studies had difficulty defining relevant determinants to characterize PPP exposures for agricultural workers. We recommend that a standardized list of determinants for PPP exposures in occupational exposure studies should include information on formulations, intensity, duration, and frequency of PPP exposure. Harmonized data collection on exposure and health outcomes are required as well as standard units for each exposure determinant.
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Affiliation(s)
- Christelle Oltramare
- Center for Primary Care and Public Health (Unisanté), Department of Occupational and Environmental Health (DSTE), University of Lausanne, 1066 Epalinges-Lausanne, Switzerland
| | - Zakia Mediouni
- Center for Primary Care and Public Health (Unisanté), Department of Occupational and Environmental Health (DSTE), University of Lausanne, 1066 Epalinges-Lausanne, Switzerland
| | - Yara Shoman
- Center for Primary Care and Public Health (Unisanté), Department of Occupational and Environmental Health (DSTE), University of Lausanne, 1066 Epalinges-Lausanne, Switzerland
| | - Nancy B Hopf
- Center for Primary Care and Public Health (Unisanté), Department of Occupational and Environmental Health (DSTE), University of Lausanne, 1066 Epalinges-Lausanne, Switzerland
| | - Halshka Graczyk
- International Labour Organization (ILO), 1211 Geneva, Switzerland
| | - Aurélie Berthet
- Center for Primary Care and Public Health (Unisanté), Department of Occupational and Environmental Health (DSTE), University of Lausanne, 1066 Epalinges-Lausanne, Switzerland
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Zhou H, Nie C, Tian W, Han X, Wang J, Du X, Wang Q, Zhu X, Xiang G, Zhao Y. Joint Effects Between CDKN2B/P15 Methylation and Environmental Factors on the Susceptibility to Gastric Cancer. Dig Dis Sci 2023:10.1007/s10620-023-07917-1. [PMID: 36961670 DOI: 10.1007/s10620-023-07917-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 11/14/2022] [Indexed: 03/25/2023]
Abstract
BACKGROUND The incidence of gastric cancer has long been at a high level in China, seriously affecting the health of Chinese people. AIMS This case‒control study was performed to identify gene methylation biomarkers of gastric cancer susceptibility. METHODS A total of 393 gastric cancer cases and 397 controls were included in this study. Gene methylation in peripheral blood leukocytes was detected by a methylation-sensitive high-resolution melting method, and the Helicobacter pylori antibody presence was semi-quantified in serum by ELISA. RESULTS Individuals with total methylation of CDKN2B/P15 had a 1.883-fold (95%CI: 1.166-3.040, P = 0.010) risk of gastric cancer compared with unmethylated individuals. Individuals with both CDKN2B/P15 and NEUROG1 methylation had a higher risk of gastric cancer (OR = 2.147, 95% CI: 1.137-4.073, P = 0.019). The interaction between CDKN2B/P15 and NEUROG1 total methylation on gastric cancer risk was affected by the pattern of adjustment. In addition, the joint effects between CDKN2B/P15 total methylation and environmental factors, such as freshwater fish intake (OR = 6.403, 95% CI = 2.970-13.802, P < 0.001), irregular diet (OR = 5.186, 95% CI = 2.559-10.510, P < 0.001), unsanitary water intake (OR = 2.238, 95% CI = 1.144-4.378, P = 0.019), smoking (OR = 2.421, 95% CI = 1.456-4.026, P = 0.001), alcohol consumption(OR = 2.163, 95% CI = 1.309-3.576, P = 0.003), and garlic intake(OR = 0.373, 95% CI = 0.196-0.709, P = 0.003) on GC risk were observed, respectively. However, CDKN2B/P15 and NEUROG1 total methylation were not associated with gastric cancer prognosis. CONCLUSION CDKN2B/P15 methylation in peripheral blood may be a potential biomarker for evaluating susceptibility to gastric cancer. The joint effects between CDKN2B/P15 methylation and environmental factors may also contribute to gastric cancer susceptibility.
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Affiliation(s)
- Haibo Zhou
- Department of Epidemiology, College of Public Health, Harbin Medical University, 197 Xuefu Road, Harbin, 150081, Heilongjiang Province, People's Republic of China
| | - Chuang Nie
- Department of Epidemiology, College of Public Health, Harbin Medical University, 197 Xuefu Road, Harbin, 150081, Heilongjiang Province, People's Republic of China
| | - Wenjing Tian
- Department of Epidemiology, College of Public Health, Harbin Medical University, 197 Xuefu Road, Harbin, 150081, Heilongjiang Province, People's Republic of China
| | - Xu Han
- Department of Epidemiology, College of Public Health, Harbin Medical University, 197 Xuefu Road, Harbin, 150081, Heilongjiang Province, People's Republic of China
| | - Jing Wang
- Department of Epidemiology, College of Public Health, Harbin Medical University, 197 Xuefu Road, Harbin, 150081, Heilongjiang Province, People's Republic of China
| | - Xinyu Du
- Department of Epidemiology, College of Public Health, Harbin Medical University, 197 Xuefu Road, Harbin, 150081, Heilongjiang Province, People's Republic of China
| | - Qi Wang
- Department of Epidemiology, College of Public Health, Harbin Medical University, 197 Xuefu Road, Harbin, 150081, Heilongjiang Province, People's Republic of China
| | - Xiaojie Zhu
- Department of Epidemiology, College of Public Health, Harbin Medical University, 197 Xuefu Road, Harbin, 150081, Heilongjiang Province, People's Republic of China
| | - Guanghui Xiang
- Department of Epidemiology, College of Public Health, Harbin Medical University, 197 Xuefu Road, Harbin, 150081, Heilongjiang Province, People's Republic of China
| | - Yashuang Zhao
- Department of Epidemiology, College of Public Health, Harbin Medical University, 197 Xuefu Road, Harbin, 150081, Heilongjiang Province, People's Republic of China.
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Brookmeyer R, Morrison D. Estimating Vaccine Effectiveness by Linking Population-Based Health Registries: Some Sources of Bias. Am J Epidemiol 2022; 191:1975-1980. [PMID: 35938874 PMCID: PMC9384684 DOI: 10.1093/aje/kwac145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 07/01/2022] [Accepted: 08/02/2022] [Indexed: 02/01/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has underscored the importance of observational studies of real-world vaccine effectiveness (VE) to help answer urgent public health questions. One approach to rapidly answering questions about real-world VE relies on linking data from a population-based registry of vaccinations with a population-based registry of health outcomes. Here we consider some potential sources of bias in linked registry studies, including incomplete reporting to the registries, errors in linking individuals between registries, and errors in the assumed population size of the catchment area of the registries. We show that the direction of the bias resulting from one source of error by itself is predictable. However, if multiple sources of error are present, the direction of the bias can be either upward or downward. The biases can be so strong as to make harmful vaccines appear effective. We provide explicit formulas with which to quantify and adjust for multiple biases in estimates of VE which could be used in sensitivity analyses. While this work was motivated by COVID-19 vaccine questions, the results are generally applicable to studies that link population-based exposure registries with population-based case registries to estimate relative risks of exposures.
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Affiliation(s)
- Ron Brookmeyer
- Correspondence Address: Correspondence to Dr. Ron Brookmeyer, Department of Biostatistics, UCLA Fielding School of Public Health, Box 951772, Los Angeles, CA 90095 (e-mail:
| | - Doug Morrison
- Department of Public Health Sciences, University of California, Davis, California, United States
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Xu M, Ho V, Lavoue J, Richardson L, Siemiatycki J. Concordance of Occupational Exposure Assessment between the Canadian Job-Exposure Matrix (CANJEM) and Expert Assessment of Jobs Held by Women. Ann Work Expo Health 2022; 66:728-740. [PMID: 35258522 PMCID: PMC9250288 DOI: 10.1093/annweh/wxac008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 01/14/2022] [Accepted: 02/01/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To compare the exposure data generated by using the Canadian job-exposure matrix (CANJEM) with data generated by expert assessment, for jobs held by women. METHODS We selected 69 occupational agents that had been assessed by experts for each of 3403 jobs held by 998 women in a population-based case-control study of lung cancer. We then assessed the same agents among the same jobs by linking their occupation codes to CANJEM and thereby derived probability of exposure to each of the agents in each job. To create binary exposure variables, we dichotomized probability of exposure using two cutpoints: 25 and 50% (referred to as CANJEM-25% and CANJEM-50%). Using jobs as units of observation, we estimated the prevalence of exposure to each selected agent using CANJEM-25% and CANJEM-50%, and using expert assessment. Further, using expert assessment as the gold standard, for each agent, we estimated CANJEM's sensitivity, specificity, and kappa. RESULTS CANJEM-based prevalence estimates correlated well with the prevalences assessed by the experts. When comparing CANJEM-based exposure estimates with expert-based exposure estimates, sensitivity, specificity, and kappa varied greatly among agents, and between CANJEM-25% and CANJEM-50% probability of exposure. With CANJEM-25%, the median sensitivity, specificity, and kappa values were 0.49, 0.99, and 0.46, respectively. Analogously, with CANJEM-50%, the corresponding values were 0.26, 1.00, and 0.35, respectively. For the following agents, we observed high concordance between CANJEM- and expert-based assessments (sensitivity ≥0.70 and specificity ≥0.99): fabric dust, cotton dust, synthetic fibres, cooking fumes, soldering fumes, calcium carbonate, and tin compounds. We present concordance estimates for each of 69 agents. CONCLUSIONS Concordance between CANJEM and expert assessment varied greatly by agents. Our results indicate which agents provide data that mimic best those obtained with expert assessment.
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Affiliation(s)
- Mengting Xu
- Health Innovation and Evaluation Hub, CRCHUM (Centre de recherche du CHUM), University of Montreal, Montreal, QC, Canada.,Department of Social and Preventive Medicine, University of Montreal, Montreal, QC, Canada
| | - Vikki Ho
- Health Innovation and Evaluation Hub, CRCHUM (Centre de recherche du CHUM), University of Montreal, Montreal, QC, Canada.,Department of Social and Preventive Medicine, University of Montreal, Montreal, QC, Canada
| | - Jerome Lavoue
- Health Innovation and Evaluation Hub, CRCHUM (Centre de recherche du CHUM), University of Montreal, Montreal, QC, Canada.,Department of Environmental and Occupational Health, University of Montreal, Montreal, QC, Canada
| | - Lesley Richardson
- Health Innovation and Evaluation Hub, CRCHUM (Centre de recherche du CHUM), University of Montreal, Montreal, QC, Canada
| | - Jack Siemiatycki
- Health Innovation and Evaluation Hub, CRCHUM (Centre de recherche du CHUM), University of Montreal, Montreal, QC, Canada.,Department of Social and Preventive Medicine, University of Montreal, Montreal, QC, Canada
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Manuel C, Sinha S, Wang S. Reducing bias due to misclassified exposures using instrumental variables. CAN J STAT 2022. [DOI: 10.1002/cjs.11705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Christopher Manuel
- Department of Statistics Texas A&M University College Station TX 77843 U.S.A
| | - Samiran Sinha
- Department of Statistics Texas A&M University College Station TX 77843 U.S.A
| | - Suojin Wang
- Department of Statistics Texas A&M University College Station TX 77843 U.S.A
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Flegal KM. A Female Career in Research. Annu Rev Nutr 2022; 42:1-19. [PMID: 35363538 DOI: 10.1146/annurev-nutr-062220-103411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
After a long career at the National Center for Health Statistics, I retired and joined the Stanford Prevention Research Center as an unpaid associate. I was once described by a former US Food and Drug Administration commissioner as "one of the great epidemiologists." The chair of the Harvard nutrition department, speaking on National Public Radio, once described my research as "rubbish." Both may be exaggerations. Here I address some of the events that led to these contrasting descriptions. I also address the extent to which the so-called Matilda effect may have influenced my career. Are women in science on an equal footing with men? The Matilda effect suggests not. Unlike the Matthew effect for scientists, whereby those of higher prestige accrue a disproportionate share of recognition and rewards, the Matilda effect proposes that women scientists are systematically undervalued and underrecognized. I could never get a faculty job and was often treated like an underling. Nonetheless I persevered to publish highly cited research on several high-profile and sometimes controversial topics. Though overt sexism in science and workplaces has diminished over the course of my career, progress toward eliminating unconscious bias has been slower. The Matthew and Matilda effects are still powerful forces that distort incentives and rewards in science. Expected final online publication date for the Annual Review of Nutrition, Volume 42 is August 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Katherine M Flegal
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA;
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The Impact of Genital Ulcers on HIV Transmission Has Been Underestimated—A Critical Review. Viruses 2022; 14:v14030538. [PMID: 35336945 PMCID: PMC8953520 DOI: 10.3390/v14030538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 02/01/2023] Open
Abstract
In the early 1990s, several observational studies determined that genital ulcer disease (GUD), in either the index or the exposed person, facilitates HIV transmission. Several meta-analyses have since presented associated risk ratios (RR) over the baseline per-act transmission probability (PATP) usually in the range of 2–5. Here we review all relevant observational studies and meta-analyses, and show that the estimation of RRs was, in most cases, biased by assuming the presence of GUD at any time during long follow-up periods, while active genital ulcers were present in a small proportion of the time. Only two studies measured the GUD co-factor effect in PATPs focusing on acts in which ulcers were present, and both found much higher RRs (in the range 11–112). We demonstrate that these high RRs can be reconciled with the studies on which currently accepted low RRs were based, if the calculations are restricted to the actual GUD episodes. Our results indicate that the effect of genital ulcers on the PATP of HIV might be much greater than currently accepted. We conclude that the medical community should work on the assumption that HIV risk is very high during active genital ulcers.
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Hempenius M, Groenwold RHH, de Boer A, Klungel OH, Gardarsdottir H. Drug exposure misclassification in pharmacoepidemiology: Sources and relative impact. Pharmacoepidemiol Drug Saf 2021; 30:1703-1715. [PMID: 34396634 PMCID: PMC9292927 DOI: 10.1002/pds.5346] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 08/03/2021] [Accepted: 08/12/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Drug exposure assessment based on dispensing data can be misclassified when patients do not adhere to their therapy or when information about over-the-counter drugs is not captured in the study database. Previous research has considered hypothetical sensitivity and specificity values, whereas this study aims to assess the impact of literature-based real values of exposure misclassification. METHODS A synthetic cohort study was constructed based on the proportion of exposure theoretically captured in a database (range 0.5-1.0) and the level of adherence (0.5-1.0). Three scenarios were explored: nondifferential misclassification, differential misclassification (misclassifications dependent on an unmeasured risk factor doubling the outcome risk), and nondifferential misclassification in a comparative effectiveness study (RRA and RRB both 2.0 compared to nonuse, RRA-B 1.0). RESULTS For the scenarios with nondifferential misclassification, 25% nonadherence or 25% uncaptured exposure changed the RR from 2.0 to 1.75, and 1.95, respectively. Applying different proportions of nonadherence or uncaptured use (20% vs. 40%) for subgroups with and without the risk factor, an RR of 0.95 was observed in the absence of a true effect (i.e., true RR = 1). In the comparative effectiveness study, no effect on RR was seen for different proportions of uncaptured exposure; however, different levels of nonadherence for the drugs (20% vs. 40%) led to an underestimation of RRA-B (0.89). DISCUSSION All scenarios led to biased estimates, but the magnitude of the bias differed across scenarios. When testing the robustness of findings of pharmacoepidemiologic studies, we recommend using realistic values of nonadherence and uncaptured exposure based on real-world data.
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Affiliation(s)
- Mirjam Hempenius
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical SciencesUtrecht UniversityUtrechtThe Netherlands
| | - Rolf H. H. Groenwold
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Anthonius de Boer
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical SciencesUtrecht UniversityUtrechtThe Netherlands
| | - Olaf H. Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical SciencesUtrecht UniversityUtrechtThe Netherlands
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Helga Gardarsdottir
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical SciencesUtrecht UniversityUtrechtThe Netherlands
- Department of Clinical Pharmacy, Division Laboratory and PharmacyUniversity Medical Center UtrechtUtrechtThe Netherlands
- Faculty of Pharmaceutical SciencesUniversity of IcelandReykjavikIceland
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Nie C, Han X, Wei R, Leonteva A, Hong J, Du X, Wang J, Zhu L, Zhao Y, Xue Y, Zhou H, Tian W. Association of ZNF331 and WIF1 methylation in peripheral blood leukocytes with the risk and prognosis of gastric cancer. BMC Cancer 2021; 21:551. [PMID: 33992091 PMCID: PMC8126111 DOI: 10.1186/s12885-021-08199-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/14/2021] [Indexed: 12/19/2022] Open
Abstract
Background Peripheral blood leukocyte (PBL) DNA methylation may serve as a surrogate marker to evaluate the susceptibility to and prognosis of gastric cancer (GC). In this study, blood-derived DNA methylation levels of two tumour-related genes, namely, ZNF331 and WIF1, and their impacts on the risk and prognosis of GC were evaluated. Methods In total, 398 GC cases and 397 controls were recruited for the study. Then, all cases were followed up for 5 years. ZNF331 and WIF1 promoter methylation status in PBLs was measured using a methylation-sensitive high-resolution melting method. Logistic and Cox regression models were used to analyse the correlation between gene methylation and the risk and prognosis of GC. Confounders were balanced through propensity score (PS) matching. Results High ZNF331 methylation significantly decreased GC risk after PS adjustment (OR = 0.580, 95% CI: 0.375–0.898, P = 0.015), which also presented in males (OR = 0.577, 95% CI: 0.343–0.970, P = 0.038). However, WIF1 methylation was not associated with GC risk. Additionally, significant combined effects between ZNF331 methylation and the intake of green vegetables and garlic were observed (OR = 0.073, 95% CI: 0.027–0.196, P < 0.001 and OR = 0.138, 95% CI: 0.080–0.238, P < 0.001, respectively). Furthermore, ZNF331 and WIF1 methylation had no impact on the prognosis of GC. Conclusion ZNF331 methylation in PBLs may affect GC risk in combination with the consumption of green vegetables and garlic and may act as a potential biomarker of GC. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08199-4.
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Affiliation(s)
- Chuang Nie
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, 157 Baojian Road, Harbin, 150081, Heilongjiang Province, People's Republic of China
| | - Xu Han
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, 157 Baojian Road, Harbin, 150081, Heilongjiang Province, People's Republic of China
| | - Rongrong Wei
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, 157 Baojian Road, Harbin, 150081, Heilongjiang Province, People's Republic of China
| | - Anastasiia Leonteva
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, 157 Baojian Road, Harbin, 150081, Heilongjiang Province, People's Republic of China
| | - Jia Hong
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, 157 Baojian Road, Harbin, 150081, Heilongjiang Province, People's Republic of China
| | - Xinyu Du
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, 157 Baojian Road, Harbin, 150081, Heilongjiang Province, People's Republic of China
| | - Jing Wang
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, 157 Baojian Road, Harbin, 150081, Heilongjiang Province, People's Republic of China
| | - Lin Zhu
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, 157 Baojian Road, Harbin, 150081, Heilongjiang Province, People's Republic of China
| | - Yashuang Zhao
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, 157 Baojian Road, Harbin, 150081, Heilongjiang Province, People's Republic of China
| | - Yingwei Xue
- Department of Gastroenterological Surgery, Third Affiliated Hospital of Harbin Medical University, 150 Haping Road, Harbin, 150081, Heilongjiang Province, People's Republic of China
| | - Haibo Zhou
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, 157 Baojian Road, Harbin, 150081, Heilongjiang Province, People's Republic of China.
| | - Wenjing Tian
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, 157 Baojian Road, Harbin, 150081, Heilongjiang Province, People's Republic of China.
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Cho J, Scragg R, Petrov MS. Postpancreatitis Diabetes Confers Higher Risk for Pancreatic Cancer Than Type 2 Diabetes: Results From a Nationwide Cancer Registry. Diabetes Care 2020; 43:2106-2112. [PMID: 32616613 DOI: 10.2337/dc20-0207] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 05/25/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Pancreatitis and diabetes are established risk factors for pancreatic cancer. However, to date, studies have investigated only the risk associated with either of them alone. The aim of this study was to investigate the effect of pancreatitis and diabetes combined, as well as their temporal relationship, on the risk of pancreatic cancer. RESEARCH DESIGN AND METHODS Nationwide cancer registry was linked to hospital discharge and mortality data from 1998 to 2015 in New Zealand. Incidence of primary pancreatic cancer in the four study groups (type 2 diabetes [T2D] alone, pancreatitis alone, T2D followed by pancreatitis, and postpancreatitis diabetes mellitus [PPDM]) was identified. Multivariable Cox regression analyses were conducted, with T2D as the reference group. A head-to-head comparison between the T2D followed by pancreatitis and PPDM groups was also performed. RESULTS Among 139,843 individuals (735,541 person-years), 913 (0.7%) were diagnosed with pancreatic cancer. The proportion of pancreatic cancer was 3.1%, 2.3%, 2.0%, and 0.6% in individuals with PPDM, T2D followed by pancreatitis, pancreatitis alone, and T2D alone, respectively. PPDM (hazard ratio [HR] 6.94; 95% CI 4.09-11.77) and T2D followed by pancreatitis (HR 5.35; 95% CI 3.52-8.14) were associated with significantly higher risks of pancreatic cancer compared with T2D alone. In the head-to-head comparison, PPDM was associated with a higher risk of pancreatic cancer compared with T2D followed by pancreatitis (HR 2.35; 95% CI 1.12-4.93). CONCLUSIONS Pancreatitis significantly increases the risk of pancreatic cancer in individuals with diabetes. In particular, PPDM poses the highest risk for pancreatic cancer.
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Affiliation(s)
- Jaelim Cho
- School of Medicine, University of Auckland, Auckland, New Zealand
| | - Robert Scragg
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Maxim S Petrov
- School of Medicine, University of Auckland, Auckland, New Zealand
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14
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Cohen JM, Selmer R, Furu K, Karlstad Ø. Interrupted time series analysis to assess changes in prescription filling around conception and implications for exposure misclassification. Pharmacoepidemiol Drug Saf 2020; 29:745-749. [PMID: 32128905 DOI: 10.1002/pds.4974] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/31/2020] [Accepted: 02/02/2020] [Indexed: 11/07/2022]
Abstract
PURPOSE Medication exposures in pregnancy are often defined by one or more prescription fills. Harmful effects could be underestimated if rapid discontinuation of use after pregnancy recognition is common. We used conception, a critical biological period, as an intervention in a novel application of interrupted time series analysis (ITSA). METHODS Among 645 049 pregnancies from the Medical Birth Registry (2005-2015) linked to the Norwegian Prescription Database, we modeled the total number of prescription fills in the 12 weeks before and after estimated conception date with ITSA. We examined psychostimulants, antidepressants, antipsychotics, and antiepileptics (AEDs; separated by use for epilepsy or other indications). We used relative measures (%) to compare model coefficients. We also compared number of pregnancies defined as exposed when the earliest fill considered was 30 days before the last menstrual period (LMP -30 days), LMP, or estimated conception date (LMP +14 days). RESULTS We observed a sudden decline in prescription fills from 2 weeks after conception and decreasing fills thereafter for psychostimulants, antidepressants, AEDs for other indications, and antipsychotics excluding incident users. Fills for AEDs for epilepsy did not fall after conception. Only 77% of pregnancies with fills for psychostimulants from LMP and 58% with fills from LMP -30 days had fills from conception. Similar figures for AEDs for epilepsy were 99% and 96%. CONCLUSIONS This application shows that ITSA can help researchers understand rapid changes in patient behavior around conception that have consequences for exposure misclassification in pregnancy drug safety studies. ITSA results can help pharmacoepidemiologists guide study exposure definitions.
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Affiliation(s)
- Jacqueline M Cohen
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Randi Selmer
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Kari Furu
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Øystein Karlstad
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
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15
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Ahern TP, Collin LJ, Baurley JW, Kjærsgaard A, Nash R, Maliniak ML, Damkier P, Zwick ME, Isett RB, Christiansen PM, Ejlertsen B, Lauridsen KL, Christensen KB, Silliman RA, Sørensen HT, Tramm T, Hamilton-Dutoit S, Lash TL, Cronin-Fenton D. Metabolic Pathway Analysis and Effectiveness of Tamoxifen in Danish Breast Cancer Patients. Cancer Epidemiol Biomarkers Prev 2020; 29:582-590. [PMID: 31932415 PMCID: PMC7060091 DOI: 10.1158/1055-9965.epi-19-0833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 11/15/2019] [Accepted: 12/20/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Tamoxifen and its metabolites compete with estrogen to occupy the estrogen receptor. The conventional dose of adjuvant tamoxifen overwhelms estrogen in this competition, reducing breast cancer recurrence risk by nearly half. Phase I metabolism generates active tamoxifen metabolites, and phase II metabolism deactivates them. No earlier pharmacogenetic study has comprehensively evaluated the metabolism and transport pathways, and no earlier study has included a large population of premenopausal women. METHODS We completed a cohort study of 5,959 Danish nonmetastatic premenopausal breast cancer patients, in whom 938 recurrences occurred, and a case-control study of 541 recurrent cases in a cohort of Danish predominantly postmenopausal breast cancer patients, all followed for 10 years. We collected formalin-fixed paraffin-embedded tumor blocks and genotyped 32 variants in 15 genes involved in tamoxifen metabolism or transport. We estimated conventional associations for each variant and used prior information about the tamoxifen metabolic path to evaluate the importance of metabolic and transporter pathways. RESULTS No individual variant was notably associated with risk of recurrence in either study population. Both studies showed weak evidence of the importance of phase I metabolism in the clinical response to adjuvant tamoxifen therapy. CONCLUSIONS Consistent with prior knowledge, our results support the role of phase I metabolic capacity in clinical response to tamoxifen. Nonetheless, no individual variant substantially explained the modest phase I effect on tamoxifen response. IMPACT These results are consistent with guidelines recommending against genotype-guided prescribing of tamoxifen, and for the first time provide evidence supporting these guidelines in premenopausal women.
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Affiliation(s)
- Thomas P Ahern
- Department of Surgery, Larner College of Medicine at The University of Vermont, Burlington, Vermont
| | - Lindsay J Collin
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | | | - Anders Kjærsgaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Rebecca Nash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Maret L Maliniak
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Per Damkier
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Michael E Zwick
- Department of Human Genetics, Emory University School of Medicine, Atlanta, Georgia
- Emory Integrated Genomics Core, Emory University, Atlanta, Georgia
| | - R Benjamin Isett
- Emory Integrated Genomics Core, Emory University, Atlanta, Georgia
| | - Peer M Christiansen
- Breast Unit, Aarhus University Hospital/Randers Regional Hospital, Aarhus, Denmark
- Danish Breast Cancer Group, Copenhagen University Hospital, Copenhagen, Denmark
| | - Bent Ejlertsen
- Danish Breast Cancer Group, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | | | - Rebecca A Silliman
- Boston University School of Medicine, Boston University, Boston, Massachusetts
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Trine Tramm
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Timothy L Lash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Winship Cancer Institute, Emory University, Atlanta, Georgia
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16
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Leon ME, Schinasi LH, Lebailly P, Beane Freeman LE, Nordby KC, Ferro G, Monnereau A, Brouwer M, Tual S, Baldi I, Kjaerheim K, Hofmann JN, Kristensen P, Koutros S, Straif K, Kromhout H, Schüz J. Pesticide use and risk of non-Hodgkin lymphoid malignancies in agricultural cohorts from France, Norway and the USA: a pooled analysis from the AGRICOH consortium. Int J Epidemiol 2019; 48:1519-1535. [PMID: 30880337 PMCID: PMC6857760 DOI: 10.1093/ije/dyz017] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Pesticides are commonly used in agriculture, and previous studies endorsed the need to further investigate the possible association between their use and risk of lymphoid malignancies in agricultural workers. METHODS We investigated the relationship of ever use of 14 selected pesticide chemical groups and 33 individual active chemical ingredients with non-Hodgkin lymphoid malignancies (NHL) overall or major subtypes, in a pooled analysis of three large agricultural worker cohorts. Pesticide use was derived from self-reported history of crops cultivated combined with crop-exposure matrices (France and Norway) or self-reported lifetime use of active ingredients (USA). Cox regression models were used to estimate cohort-specific hazard ratios (HRs) and 95% confidence intervals (CIs), which were combined using random effects meta-analysis to calculate meta-HRs. RESULTS During follow-up, 2430 NHL cases were diagnosed in 316 270 farmers accruing 3 574 815 person-years under risk. Most meta-HRs suggested no association. Moderately elevated meta-HRs were seen for: NHL and ever use of terbufos (meta-HR = 1.18, 95% CI: 1.00-1.39); chronic lymphocytic leukaemia/small lymphocytic lymphoma and deltamethrin (1.48, 1.06-2.07); and diffuse large B-cell lymphoma and glyphosate (1.36, 1.00-1.85); as well as inverse associations of NHL with the broader groups of organochlorine insecticides (0.86, 0.74-0.99) and phenoxy herbicides (0.81, 0.67-0.98), but not with active ingredients within these groups, after adjusting for exposure to other pesticides. CONCLUSIONS Associations of pesticides with NHL appear to be subtype- and chemical-specific. Non-differential exposure misclassification was an important limitation, showing the need for refinement of exposure estimates and exposure-response analyses.
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Affiliation(s)
- Maria E Leon
- Section of Environment and Radiation, International Agency for Research on Cancer (IARC), Lyon, France
| | - Leah H Schinasi
- Section of Environment and Radiation, International Agency for Research on Cancer (IARC), Lyon, France
- Department of Environmental and Occupational Health, Drexel University, Philadelphia, PA, USA
| | - Pierre Lebailly
- ANTICIPE, U1086 INSERM, Université de Caen Normandie, and Centre de Lutte Contre le Cancer François Baclesse, Caen, France
| | - Laura E Beane Freeman
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute (NCI), Bethesda, MD, USA
| | - Karl-Christian Nordby
- Department of Occupational Medicine and Epidemiology, National Institute of Occupational Health (STAMI), Oslo, Norway
| | - Gilles Ferro
- Section of Environment and Radiation, International Agency for Research on Cancer (IARC), Lyon, France
| | - Alain Monnereau
- Hematological Malignancies Registry of Gironde, Bergonie Institute, Comprehensive Cancer Centre, Bordeaux, France
- University of Bordeaux, INSERM U1219 Center - EPICENE Team, CHU de Bordeaux, Bordeaux, France
| | - Maartje Brouwer
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands
| | - Séverine Tual
- ANTICIPE, U1086 INSERM, Université de Caen Normandie, and Centre de Lutte Contre le Cancer François Baclesse, Caen, France
| | - Isabelle Baldi
- CHU de Bordeaux, Service de Médecine du Travail et Pathologie Professionnelle, Bordeaux, France
| | | | - Jonathan N Hofmann
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute (NCI), Bethesda, MD, USA
| | - Petter Kristensen
- Department of Occupational Medicine and Epidemiology, National Institute of Occupational Health (STAMI), Oslo, Norway
| | - Stella Koutros
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute (NCI), Bethesda, MD, USA
| | - Kurt Straif
- Section of Evidence Synthesis and Classification, International Agency for Research on Cancer (IARC), Lyon, France
| | - Hans Kromhout
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands
| | - Joachim Schüz
- Section of Environment and Radiation, International Agency for Research on Cancer (IARC), Lyon, France
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Zhou H, Sun H, Liu X, Chen J, Zhang L, Lin S, Han X, Nie C, Liu Y, Tian W, Zhao Y. Combined effect between WT1 methylation and Helicobacter pylori infection, smoking, and alcohol consumption on the risk of gastric cancer. Helicobacter 2019; 24:e12650. [PMID: 31361067 DOI: 10.1111/hel.12650] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 06/24/2019] [Accepted: 06/27/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Peripheral blood leukocyte DNA methylation status has been proposed to be a surrogate marker for evaluating susceptibility to gastric cancer (GC). Helicobacter pylori (H pylori) infection, smoking, and alcohol consumption are known to induce gene methylation. A case-control study was performed to investigate the interactions between the methylation of two candidate genes and H pylori infection, smoking, and alcohol consumption in the risk of GC. METHODS A total of 400 GC cases and 402 controls were included in this study. The methylation status of WT1 and IGF2 was semiquantitatively determined by using methylation-sensitive high-resolution melting assays. H pylori IgG antibodies were detected by ELISA method. RESULTS Based on the area under the curve (AUC), 0% methylated DNA and 0.5% methylated DNA were used as the cutoff values for WT1 and IGF2, respectively. WT1 methylation was significantly associated with increased GC risk (OR = 1.65, 95% CI = 1.09-2.51, P = .019), especially in males (OR = 1.80, 95% CI: 1.10-2.95, P = .019) and older individuals (≥60 years) (OR = 2.03, 95% CI: 1.15-3.57, P = .014). A significant combination was observed between WT1 methylation and H pylori infection, alcohol consumption, and smoking for the risk of GC (ORc = 2.28, 95% CI = 1.47-3.55, P = .003, ORc = 2.19, 95% CI = 1.37-3.51, P = .001, ORc = 2.21, 95% CI = 1.39-3.51, P = .001, respectively). However, no association between IGF2 methylation and the risk of GC was found in this study. CONCLUSIONS WT1 methylation may serve as a new potential biomarker for GC susceptibility and can combine with H pylori infection, smoking, and alcohol consumption to influence GC risk.
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Affiliation(s)
- Haibo Zhou
- Department of Epidemiology, College of Public Health, Harbin Medical University, Harbin, Heilongjiang, China
| | - Hongru Sun
- Department of Epidemiology, College of Public Health, Harbin Medical University, Harbin, Heilongjiang, China
| | - Xinyan Liu
- Department of Epidemiology, College of Public Health, Harbin Medical University, Harbin, Heilongjiang, China
| | - Jie Chen
- Department of Epidemiology, College of Public Health, Harbin Medical University, Harbin, Heilongjiang, China
| | - Lei Zhang
- Department of Epidemiology, College of Public Health, Harbin Medical University, Harbin, Heilongjiang, China
| | - Shangqun Lin
- Department of Epidemiology, College of Public Health, Harbin Medical University, Harbin, Heilongjiang, China
| | - Xu Han
- Department of Epidemiology, College of Public Health, Harbin Medical University, Harbin, Heilongjiang, China
| | - Chuang Nie
- Department of Epidemiology, College of Public Health, Harbin Medical University, Harbin, Heilongjiang, China
| | - Yupeng Liu
- Department of Epidemiology, College of Public Health, Harbin Medical University, Harbin, Heilongjiang, China
| | - Wenjing Tian
- Department of Epidemiology, College of Public Health, Harbin Medical University, Harbin, Heilongjiang, China
| | - Yashuang Zhao
- Department of Epidemiology, College of Public Health, Harbin Medical University, Harbin, Heilongjiang, China
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18
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Dart RC, Bush SP, Heard K, Arnold TC, Sutter M, Campagne D, Holstege CP, Seifert SA, Lo JC, Quan D, Borron S, Meurer DA, Burnham RI, McNally J, Garcia-Ubbelohde W, Anderson VE. The Efficacy of Antivenin Latrodectus (Black Widow) Equine Immune F(abʹ)2 Versus Placebo in the Treatment of Latrodectism: A Randomized, Double-Blind, Placebo-Controlled, Clinical Trial. Ann Emerg Med 2019; 74:439-449. [DOI: 10.1016/j.annemergmed.2019.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 01/26/2019] [Accepted: 02/05/2019] [Indexed: 10/27/2022]
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DeMatteo R, DeMatteo D. Workers' Fight for Justice: A Retrospective Exposure Profile Study of the GE Factory in Peterborough, Ontario. New Solut 2019; 29:138-166. [PMID: 31142206 DOI: 10.1177/1048291119850779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Occupational disease recognition is often hampered by lack of historical exposure data. This paper describes research documenting major chemical exposures of Canadian General Electric workers in a plant in Peterborough between 1945 and 2000. Workers’ experiences with diseases over forty years, and their frustration with the continual denial that these were work-related, drove this study. Researchers used qualitative methods, participatory action research, hazard mapping, and risk assessment. A report that incorporates this study’s findings documents extremely toxic exposures that placed Canadian General Electric workers at a disproportionate risk of occupational diseases. Since the report’s release, the Ontario Workplace Safety and Insurance Board reconsidered 233 previously denied claims in the light of “new evidence” and overturned one half of those it reviewed. The retrospective exposure profile methods used in this study may serve as a useful model for workers and their organization when plants close.
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Affiliation(s)
- Robert DeMatteo
- 1 Occupational Health Clinic for Ontario Workers, Toronto, ON, Canada
| | - Dale DeMatteo
- 1 Occupational Health Clinic for Ontario Workers, Toronto, ON, Canada
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20
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Abstract
PURPOSE OF REVIEW To discuss recent progress in sarcopenia research and to highlight controversies in the field particularly around reaching consensus on a definition of sarcopenia. RECENT FINDINGS Accordingly, this review begins with a discussion of the increasing awareness of this condition; briefly describes evolving definitions of sarcopenia; suggests a framework for consistent terminology for sarcopenia; discusses outstanding issues in the definition of sarcopenia; and reviews the association between sarcopenia and adverse outcome in older adults. In addition, the role of sarcopenia in other diseases is discussed. The field of sarcopenia continues to hold considerable promise and work continues to resolve outstanding concerns in this field with a unifying consensus definition on the horizon.
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Affiliation(s)
- Peggy M Cawthon
- San Francisco Coordinating Center, 550 16th Street, 2nd Floor, Box #0560, San Francisco, CA, 94143, USA.
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21
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Gordon T, Balakrishnan K, Dey S, Rajagopalan S, Thornburg J, Thurston G, Agrawal A, Collman G, Guleria R, Limaye S, Salvi S, Kilaru V, Nadadur S. Air pollution health research priorities for India: Perspectives of the Indo-U.S. Communities of Researchers. ENVIRONMENT INTERNATIONAL 2018; 119:100-108. [PMID: 29944987 PMCID: PMC6489448 DOI: 10.1016/j.envint.2018.06.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 06/11/2018] [Accepted: 06/12/2018] [Indexed: 05/20/2023]
Affiliation(s)
- Terry Gordon
- Department of Environmental Medicine, New York University School of Medicine, Tuxedo, NY, 10987, United States of America
| | - Kalpana Balakrishnan
- Department of Environmental Health Engineering, Faculty of Public Health, Sri Ramachandra University, Porur, Chennai, 600116, India
| | - Sagnik Dey
- Centre for Atmospheric Sciences, Indian Institute of Technology Delhi, Hauz Khas, New Delhi 110016, India
| | - Sanjay Rajagopalan
- Department of Internal Medicine, Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH 44106, United States of America
| | | | - George Thurston
- Department of Environmental Medicine, New York University School of Medicine, Tuxedo, NY, 10987, United States of America
| | - Anurag Agrawal
- CSIR Institute of Genomics and Integrative Biology, Delhi University, New Delhi, India
| | - Gwen Collman
- Division of Extramural Research and Training, National Institute of Environmental Health Sciences, Research Triangle Park, NC 27709, United States of America
| | | | | | | | - Vasu Kilaru
- Office of Research and Development, U.S. E.P.A., Research Triangle Park, NC 27711, United States of America
| | - Srikanth Nadadur
- Division of Extramural Research and Training, National Institute of Environmental Health Sciences, Research Triangle Park, NC 27709, United States of America.
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De Roos AJ, Spinelli J, Brown EB, Atanackovic D, Baris D, Bernstein L, Bhatti P, Camp NJ, Chiu BC, Clavel J, Cozen W, De Sanjosé S, Dosman JA, Hofmann JN, McLaughlin JR, Miligi L, Monnereau A, Orsi L, Purdue MP, Schinasi LH, Tricot GJ, Wang SS, Zhang Y, Birmann BM, Cocco P. Pooled study of occupational exposure to aromatic hydrocarbon solvents and risk of multiple myeloma. Occup Environ Med 2018; 75:798-806. [PMID: 30121582 DOI: 10.1136/oemed-2018-105154] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 06/27/2018] [Accepted: 07/07/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To investigate the association between occupational exposure to aromatic hydrocarbon solvents and risk of multiple myeloma (MM) in a large, consortium-based study. METHODS We pooled data on 2854 cases and 10 743 controls from nine studies participating in the InterLymph consortium. Occupational exposures to benzene, toluene and xylene were assigned by a job-exposure matrix, coupled with 'correction' of exposure probability by self-reported or expert-assessed exposure from the individual studies. Cumulative intensity was calculated as the job-specific exposure intensity multiplied by job duration, summed across jobs. Associations were estimated using logistic regression, with inclusion of covariates for study matching factors and other potential confounders. We repeated our main analysis using random-effects meta-analysis to evaluate heterogeneity of effect. RESULTS Benzene, toluene and xylene were each associated with MM. For the three solvents, the highest quartile of high-probability cumulative intensity exposure (vs unexposed) was associated with 42% to 63% increased risks of MM. Associations with toluene and xylene exposures were fairly consistent and robust to sensitivity analyses. The estimated effect for benzene was moderately heterogeneous between the studies. Each solvent's association with MM was stronger for exposure occurring within 20 years of diagnosis than with exposure lagged by more than 20 years. CONCLUSIONS Our study adds important evidence for a role of aromatic hydrocarbon solvents in causation of MM. The difficulty in disentangling individual compounds in this group and a lack of data on potential carcinogenicity of toluene and xylene, in widespread current use, underscore a need for further epidemiological evaluation.
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Affiliation(s)
- Anneclaire J De Roos
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - John Spinelli
- Population Oncology, BC Cancer Agency, Vancouver, British Columbia, Canada.,School of Population and Public Health, UBC, Vancouver, Canada
| | - Elizabeth B Brown
- Department of Pathology, University of Alabama, Birmingham, Alabama, USA
| | - Djordje Atanackovic
- Division of Hematology and Hematological Malignancies, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Dalsu Baris
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Leslie Bernstein
- Department of Population Sciences, Beckman Research Institute, City of Hope, Duarte, California, USA
| | - Parveen Bhatti
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Cancer Control Research, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Nicola J Camp
- Division of Hematology and Hematological Malignancies, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Brian C Chiu
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois, USA
| | - Jacqueline Clavel
- INSERM U1153, Epidemiology and Biostatistics Sorbonne Paris Cité (CRESS), Paris, France.,Epidemiology of Childhood and Adolescent Cancers Team (EPICEA), Paris-Descartes University, Villejuif, France
| | - Wendy Cozen
- Departments of Preventive Medicine and Pathology, USC Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Silvia De Sanjosé
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, Barcelona, Spain
| | - James A Dosman
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Canada
| | - Jonathan N Hofmann
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | | | - Lucia Miligi
- Unit of Environmental and Occupational Epidemiology, Oncological Network, Prevention, Research Institute, Florence, Italy
| | - Alain Monnereau
- INSERM U1153, Epidemiology and Biostatistics Sorbonne Paris Cité (CRESS), Paris, France.,Epidemiology of Childhood and Adolescent Cancers Team (EPICEA), Paris-Descartes University, Villejuif, France.,Inserm Team EPICENE U1219, Hematological Malignancies Registry of Gironde, Bergonie Institute, Bordeaux, France
| | - Laurent Orsi
- INSERM U1153, Epidemiology and Biostatistics Sorbonne Paris Cité (CRESS), Paris, France.,Epidemiology of Childhood and Adolescent Cancers Team (EPICEA), Paris-Descartes University, Villejuif, France
| | - Mark P Purdue
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Leah H Schinasi
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | | | - Sophia S Wang
- Department of Population Sciences, Beckman Research Institute, City of Hope, Duarte, California, USA
| | - Yawei Zhang
- School of Public Health, Yale University, New Haven, Connecticut, USA.,School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Brenda M Birmann
- Channing Division of Network Medicine, Division of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Pierluigi Cocco
- Department of Public Health and Clinical Molecular Medicine, University of Cagliari, Cagliari, Italy
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23
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De Smedt T, Merrall E, Macina D, Perez-Vilar S, Andrews N, Bollaerts K. Bias due to differential and non-differential disease- and exposure misclassification in studies of vaccine effectiveness. PLoS One 2018; 13:e0199180. [PMID: 29906276 PMCID: PMC6003693 DOI: 10.1371/journal.pone.0199180] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 06/01/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Studies of vaccine effectiveness (VE) rely on accurate identification of vaccination and cases of vaccine-preventable disease. In practice, diagnostic tests, clinical case definitions and vaccination records often present inaccuracies, leading to biased VE estimates. Previous studies investigated the impact of non-differential disease misclassification on VE estimation. METHODS We explored, through simulation, the impact of non-differential and differential disease- and exposure misclassification when estimating VE using cohort, case-control, test-negative case-control and case-cohort designs. The impact of misclassification on the estimated VE is demonstrated for VE studies on childhood seasonal influenza and pertussis vaccination. We additionally developed a web-application graphically presenting bias for user-selected parameters. RESULTS Depending on the scenario, the misclassification parameters had differing impacts. Decreased exposure specificity had greatest impact for influenza VE estimation when vaccination coverage was low. Decreased exposure sensitivity had greatest impact for pertussis VE estimation for which high vaccination coverage is typically achieved. The impact of the exposure misclassification parameters was found to be more noticeable than that of the disease misclassification parameters. When misclassification is limited, all study designs perform equally. In case of substantial (differential) disease misclassification, the test-negative design performs worse. CONCLUSIONS Misclassification can lead to significant bias in VE estimates and its impact strongly depends on the scenario. We developed a web-application for assessing the potential (joint) impact of possibly differential disease- and exposure misclassification that can be modified by users to their own study scenario. Our results and the simulation tool may be used to guide better design, conduct and interpretation of future VE studies.
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Affiliation(s)
- Tom De Smedt
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
| | | | | | - Silvia Perez-Vilar
- FISABIO-Public Health, Valencia, Spain
- Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Nick Andrews
- Statistics, Modelling, and Economics Department, Public Health England, Colindale, London, United Kingdom
| | - Kaatje Bollaerts
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
- * E-mail:
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24
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Bruce A, Kelly B, Chambers B, Barrett BT, Bloj M, Bradbury J, Sheldon TA. The effect of adherence to spectacle wear on early developing literacy: a longitudinal study based in a large multiethnic city, Bradford, UK. BMJ Open 2018; 8:e021277. [PMID: 29895654 PMCID: PMC6009541 DOI: 10.1136/bmjopen-2017-021277] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To determine the impact of adherence to spectacle wear on visual acuity (VA) and developing literacy following vision screening at age 4-5 years. DESIGN Longitudinal study nested within the Born in Bradford birth cohort. SETTING AND PARTICIPANTS Observation of 944 children: 432 had failed vision screening and were referred (treatment group) and 512 randomly selected (comparison group) who had passed (<0.20 logarithm of the minimum angle of resolution (logMAR) in both eyes). Spectacle wear was observed in school for 2 years following screening and classified as adherent (wearing spectacles at each assessment) or non-adherent. MAIN OUTCOME MEASURES Annual measures of VA using a crowded logMAR test. Literacy was measured by Woodcock Reading Mastery Tests-Revised subtest: letter identification. RESULTS The VA of all children improved with increasing age, -0.009 log units per month (95% CI -0.011 to -0.007) (worse eye). The VA of the adherent group improved significantly more than the comparison group, by an additional -0.008 log units per month (95% CI -0.009 to -0.007) (worse eye) and -0.004 log units per month (95% CI -0.005 to -0.003) in the better eye.Literacy was associated with the VA, letter identification (ID) reduced by -0.9 (95% CI -1.15 to -0.64) for every one line (0.10 logMAR) fall in VA (better eye). This association remained after adjustment for socioeconomic and demographic factors (-0.33, 95% CI -0.54 to -0.12). The adherent group consistently demonstrated higher letter-ID scores compared with the non-adherent group, with the greatest effect size (0.11) in year 3. CONCLUSIONS Early literacy is associated with the level of VA; children who adhere to spectacle wear improve their VA and also have the potential to improve literacy. Our results suggest failure to adhere to spectacle wear has implications for the child's vision and education.
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Affiliation(s)
- Alison Bruce
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Trust, Bradford, UK
| | - Brian Kelly
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Trust, Bradford, UK
| | - Bette Chambers
- Institute for Effective Education, University of York, York, UK
| | - Brendan T Barrett
- School of Optometry and Vision Science, University of Bradford, Bradford, UK
| | - Marina Bloj
- School of Optometry and Vision Science, University of Bradford, Bradford, UK
| | - John Bradbury
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
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25
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Haine D, Dohoo I, Dufour S. Selection and Misclassification Biases in Longitudinal Studies. Front Vet Sci 2018; 5:99. [PMID: 29892604 PMCID: PMC5985700 DOI: 10.3389/fvets.2018.00099] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 04/20/2018] [Indexed: 01/19/2023] Open
Abstract
Using imperfect tests may lead to biased estimates of disease frequency and measures of association. Many studies have looked into the effect of misclassification on statistical inferences. These evaluations were either within a cross-sectional study framework, assessing biased prevalence, or for cohort study designs, evaluating biased incidence rate or risk ratio estimates based on misclassification at one of the two time-points (initial assessment or follow-up). However, both observations at risk and incident cases can be wrongly identified in longitudinal studies, leading to selection and misclassification biases, respectively. The objective of this paper was to evaluate the relative impact of selection and misclassification biases resulting from misclassification, together, on measures of incidence and risk ratio. To investigate impact on measure of disease frequency, data sets from a hypothetical cohort study with two samples collected one month apart were simulated and analyzed based on specific test and disease characteristics, with no elimination of disease during the sampling interval or clustering of observations. Direction and magnitude of bias due to selection, misclassification, and total bias was assessed for diagnostic test sensitivity and specificity ranging from 0.7 to 1.0 and 0.8 to 1.0, respectively, and for specific disease contexts, i.e., disease prevalences of 5 and 20%, and disease incidences of 0.01, 0.05, and 0.1 cases/animal-month. A hypothetical exposure with known strength of association was also generated. A total of 1,000 cohort studies of 1,000 observations each were simulated for these six disease contexts where the same diagnostic test was used to identify observations at risk at beginning of the cohort and incident cases at its end. Our results indicated that the departure of the estimates of disease incidence and risk ratio from their true value were mainly a function of test specificity, and disease prevalence and incidence. The combination of the two biases, at baseline and follow-up, revealed the importance of a good to excellent specificity relative to sensitivity for the diagnostic test. Small divergence from perfect specificity extended quickly to disease incidence over-estimation as true prevalence increased and true incidence decreased. A highly sensitive test to exclude diseased subjects at baseline was of less importance to minimize bias than using a highly specific one at baseline. Near perfect diagnostic test attributes were even more important to obtain a measure of association close to the true risk ratio, according to specific disease characteristics, especially its prevalence. Low prevalent and high incident disease lead to minimal bias if disease is diagnosed with high sensitivity and close to perfect specificity at baseline and follow-up. For more prevalent diseases we observed large risk ratio biases towards the null value, even with near perfect diagnosis.
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Affiliation(s)
- Denis Haine
- Faculté de médecine vétérinaire, Université de Montréal, Montreal, QC, Canada.,Canadian Bovine Mastitis and Milk Quality Research Network, St-Hyacinthe, QC, Canada
| | - Ian Dohoo
- Canadian Bovine Mastitis and Milk Quality Research Network, St-Hyacinthe, QC, Canada.,Centre for Veterinary Epidemiological Research, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, PE, Canada
| | - Simon Dufour
- Faculté de médecine vétérinaire, Université de Montréal, Montreal, QC, Canada.,Canadian Bovine Mastitis and Milk Quality Research Network, St-Hyacinthe, QC, Canada
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26
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Dale AM, Ekenga CC, Buckner-Petty S, Merlino L, Thiese MS, Bao S, Meyers AR, Harris-Adamson C, Kapellusch J, Eisen EA, Gerr F, Hegmann KT, Silverstein B, Garg A, Rempel D, Zeringue A, Evanoff BA. Incident CTS in a large pooled cohort study: associations obtained by a Job Exposure Matrix versus associations obtained from observed exposures. Occup Environ Med 2018; 75:501-506. [PMID: 29599164 PMCID: PMC6035491 DOI: 10.1136/oemed-2017-104744] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 02/07/2018] [Accepted: 03/12/2018] [Indexed: 11/19/2022]
Abstract
Background There is growing use of a job exposure matrix (JEM) to provide exposure estimates in studies of work-related musculoskeletal disorders; few studies have examined the validity of such estimates, nor did compare associations obtained with a JEM with those obtained using other exposures. Objective This study estimated upper extremity exposures using a JEM derived from a publicly available data set (Occupational Network, O*NET), and compared exposure-disease associations for incident carpal tunnel syndrome (CTS) with those obtained using observed physical exposure measures in a large prospective study. Methods 2393 workers from several industries were followed for up to 2.8 years (5.5 person-years). Standard Occupational Classification (SOC) codes were assigned to the job at enrolment. SOC codes linked to physical exposures for forceful hand exertion and repetitive activities were extracted from O*NET. We used multivariable Cox proportional hazards regression models to describe exposure-disease associations for incident CTS for individually observed physical exposures and JEM exposures from O*NET. Results Both exposure methods found associations between incident CTS and exposures of force and repetition, with evidence of dose–response. Observed associations were similar across the two methods, with somewhat wider CIs for HRs calculated using the JEM method. Conclusion Exposures estimated using a JEM provided similar exposure-disease associations for CTS when compared with associations obtained using the ‘gold standard’ method of individual observation. While JEMs have a number of limitations, in some studies they can provide useful exposure estimates in the absence of individual-level observed exposures.
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Affiliation(s)
- Ann Marie Dale
- Division of General Medical Sciences, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Christine C Ekenga
- George Warren Brown School, Washington University in Saint Louis, St Louis, Missouri, USA
| | - Skye Buckner-Petty
- Division of General Medical Sciences, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Linda Merlino
- Department of Occupational and Environmental Health, University of Iowa, Iowa City, Iowa, USA
| | - Matthew S Thiese
- Rocky Mountain Center for Occupational and Environmental Health (RMCOEH), University of Utah, Salt Lake City, Utah, USA
| | - Stephen Bao
- Safety and Health Assessment and Research for Prevention (SHARP) Program, Washington State Department of Labor and Industries, Olympia, Washington, USA
| | - Alysha Rose Meyers
- Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - Carisa Harris-Adamson
- Department of Environmental Health Sciences, University of California Berkeley, Berkeley, California, USA
| | - Jay Kapellusch
- Department of Occupational Science and Technology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Ellen A Eisen
- Department of Environmental Health Sciences, University of California Berkeley, Berkeley, California, USA
| | - Fred Gerr
- Department of Occupational and Environmental Health, University of Iowa, Iowa City, Iowa, USA
| | - Kurt T Hegmann
- Rocky Mountain Center for Occupational and Environmental Health (RMCOEH), University of Utah, Salt Lake City, Utah, USA
| | - Barbara Silverstein
- Safety and Health Assessment and Research for Prevention (SHARP) Program, Washington State Department of Labor and Industries, Olympia, Washington, USA
| | - Arun Garg
- Department of Occupational Science and Technology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - David Rempel
- Division of Occupational and Environmental Medicine, University of California at San Francisco, San Francisco, California, USA.,Department of Bioengineering, University of California Berkeley, Berkeley, California, USA
| | | | - Bradley A Evanoff
- Division of General Medical Sciences, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
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27
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Flegal KM, Kit BK, Graubard BI. Bias in Hazard Ratios Arising From Misclassification According to Self-Reported Weight and Height in Observational Studies of Body Mass Index and Mortality. Am J Epidemiol 2018; 187:125-134. [PMID: 29309516 DOI: 10.1093/aje/kwx193] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 02/06/2017] [Indexed: 12/31/2022] Open
Abstract
Misclassification of body mass index (BMI) categories arising from self-reported weight and height can bias hazard ratios in studies of BMI and mortality. We examined the effects on hazard ratios of such misclassification using national US survey data for 1976 through 2010 that had both measured and self-reported weight and height along with mortality follow-up for 48,763 adults and a subset of 17,405 healthy never-smokers. BMI was categorized as <22.5 (low), 22.5-24.9 (referent), 25.0-29.9 (overweight), 30.0-34.9 (class I obesity), and ≥35.0 (class II-III obesity). Misreporting at higher BMI categories tended to bias hazard ratios upwards for those categories, but that effect was augmented, counterbalanced, or even reversed by misreporting in other BMI categories, in particular those that affected the reference category. For example, among healthy male never-smokers, misclassifications affecting the overweight and the reference categories changed the hazard ratio for overweight from 0.85 with measured data to 1.24 with self-reported data. Both the magnitude and direction of bias varied according to the underlying hazard ratios in measured data, showing that findings on bias from one study should not be extrapolated to a study with different underlying hazard ratios. Because of misclassification effects, self-reported weight and height cannot reliably indicate the lowest-risk BMI category.
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Affiliation(s)
- Katherine M Flegal
- Division of Health and Nutrition Examination Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland
- Prevention Research Center, School of Medicine, Stanford University, Palo Alto, California
| | - Brian K Kit
- Division of Health and Nutrition Examination Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland
| | - Barry I Graubard
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
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28
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Yao S, Kuja-Halkola R, Thornton LM, Norring C, Almqvist C, D'Onofrio BM, Lichtenstein P, Långström N, Bulik CM, Larsson H. Risk of being convicted of theft and other crimes in anorexia nervosa and bulimia nervosa: A prospective cohort study in a Swedish female population. Int J Eat Disord 2017; 50:1095-1103. [PMID: 28791709 DOI: 10.1002/eat.22743] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 07/04/2017] [Accepted: 07/09/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVE We examined epidemiological associations between anorexia nervosa (AN) and bulimia nervosa (BN) and risks of committing theft and other crimes in a nationwide female population. METHOD Females born in Sweden during 1979-1998 (N = 957,106) were followed from age 15 for up to 20 years using information on clinically diagnosed AN and BN (exposures), convictions of theft and other crimes (outcomes), psychiatric comorbidities, and familial relatedness from Swedish national registers. We estimated hazard ratios (HRs) of criminality in exposed versus unexposed females using Cox proportional hazards regressions and explored how comorbidities and unmeasured familial factors explained the associations. RESULTS The cumulative incidence of convictions of theft (primarily petty theft) and other crimes was higher in exposed females (AN: 11.60% theft, 7.39% other convictions; BN: 17.97% theft, 13.17% other convictions) than in unexposed females (∼5% theft, ∼6% other convictions). The significantly increased risk of being convicted of theft in exposed females (AN: HR = 2.51, 95% confidence interval = [2.29, 2.74], BN: 4.31 [3.68, 5.05]) was partially explained by comorbidities; unmeasured familial factors partially explained the association with convictions of theft in BN but not in AN. Females with BN had a doubled risk of convictions of other crimes, which was partially explained by comorbidities. DISCUSSION Individuals with eating disorders had increased risk for convictions of theft and potentially other crimes. Results underscore the importance of regular forensic screening and encourage research on mechanisms underlying the relation between crime and eating disorder psychopathology and efforts to determine how best to address such relation in treatment.
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Affiliation(s)
- Shuyang Yao
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Laura M Thornton
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Claes Norring
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Stockholm Center for Eating Disorders, Stockholm Health Care Services, Stockholm, Sweden
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Brian M D'Onofrio
- Department of Psychological and Brain Science, Indiana University, Bloomington, Indiana
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Niklas Långström
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Cynthia M Bulik
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,School of Medical Sciences, Örebro University, Örebro, Sweden
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29
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Abstract
Background Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease characterised by a rapid loss of lower and upper motor neurons. As a complex disease, the ageing process and complicated gene-environment interactions are involved in the majority of cases. Main body Significant advances have been made in unravelling the genetic susceptibility to ALS with massively parallel sequencing technologies, while environmental insults remain a suspected but largely unexplored source of risk. Several studies applying the strategy of Mendelian randomisation have strengthened the link between environmental insults and ALS, but none so far has proved conclusive. We propose a new ALS model which links the current knowledge of genetic factors, ageing and environmental insults. This model provides a mechanism as to how ALS is initiated, with environmental insults playing a critical role. Conclusion The available evidence has suggested that inherited defect(s) could cause mitochondrial dysfunction, which would establish the primary susceptibility to ALS. Further study of the underlying mechanism may shed light on ALS pathogenesis. Environmental insults are a critical trigger for ALS, particularly in the aged individuals with other toxicant susceptible genes. The identification of ALS triggers could lead to preventive strategies for those individuals at risk.
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Affiliation(s)
- Bing Yu
- Sydney Medical School (Central), The University of Sydney, Camperdown, NSW 2006 Australia.,Department of Medical Genomics, Royal Prince Alfred Hospital and NSW Health Pathology, Camperdown, NSW 2050 Australia
| | - Roger Pamphlett
- Discipline of Pathology, Brain and Mind Centre, The University of Sydney, 94 Mallett St, Camperdown, NSW 2050 Australia.,Department of Neuropathology, Royal Prince Alfred Hospital, Camperdown, NSW 2050 Australia
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30
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Brouwer M, Schinasi L, Beane Freeman LE, Baldi I, Lebailly P, Ferro G, Nordby KC, Schüz J, Leon ME, Kromhout H. Assessment of occupational exposure to pesticides in a pooled analysis of agricultural cohorts within the AGRICOH consortium: authors' response. Occup Environ Med 2017; 74:81. [PMID: 27852645 DOI: 10.1136/oemed-2016-104110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 10/30/2016] [Indexed: 11/03/2022]
Affiliation(s)
- Maartje Brouwer
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands
| | - Leah Schinasi
- Section of Environment and Radiation, International Agency for Research on Cancer (IARC), Lyon, France
| | - Laura E Beane Freeman
- Occupational and Environmental Epidemiology Branch, National Cancer Institute (NCI), Bethesda, USA
| | - Isabelle Baldi
- Laboratoire Santé Travail Environnement, ISPED, Université Bordeaux, Bordeaux, France
- Epidemiologie-Biostatistique, INSERM, Bordeaux, France
- Service de Médecine du Travail, CHU de Bordeaux, Bordeaux, France
| | - Pierre Lebailly
- Cancers et Préventions, INSERM, Caen, France
- Cancers et Préventions, Université Caen Basse-Normandie, Caen, France
- Centre de Lutte Contre le Cancer François Baclesse, Caen, France
| | - Gilles Ferro
- Section of Environment and Radiation, International Agency for Research on Cancer (IARC), Lyon, France
| | - Karl-Christian Nordby
- Department of Occupational Medicine and Epidemiology, National Institute of Occupational Health (STAMI), Oslo, Norway
| | - Joachim Schüz
- Section of Environment and Radiation, International Agency for Research on Cancer (IARC), Lyon, France
| | - Maria E Leon
- Section of Environment and Radiation, International Agency for Research on Cancer (IARC), Lyon, France
| | - Hans Kromhout
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands
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31
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Kim S. Overview of Cotinine Cutoff Values for Smoking Status Classification. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13121236. [PMID: 27983665 PMCID: PMC5201377 DOI: 10.3390/ijerph13121236] [Citation(s) in RCA: 192] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 11/10/2016] [Accepted: 11/14/2016] [Indexed: 11/26/2022]
Abstract
While cotinine is commonly used as a biomarker to validate self-reported smoking status, the selection of an optimal cotinine cutoff value for distinguishing true smokers from true nonsmokers shows a lack of standardization among studies. This review describes how the cutoff values have been derived, and explains the issues involved in the generalization of a cutoff value. In this study, we conducted an English-language literature search in PubMed using the keywords “cotinine” and “cutoff” or “self-reported” and “smoking status” and “validation” for the years 1985–2014. We obtained 104 articles, 32 of which provided (1) sensitivity and specificity of a cutoff value and (2) determination methods for the given cutoff value. We found that the saliva cotinine cutoff value range of 10–25 ng/mL, serum and urine cotinine cutoff of 10–20 ng/mL and 50–200 ng/mL, respectively, have been commonly used to validate self-reported smoking status using a 2 × 2 table or a receiver operating characteristics (ROC) curve. We also found that recent large population-based studies in the U.S. and UK reported lower cutoff values for cotinine in serum (3 ng/mL) and saliva (12 ng/mL), compared to the traditionally accepted ones (15 and 14 ng/mg, respectively).
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Affiliation(s)
- Sungroul Kim
- Department of Environmental Health Sciences, Soonchunhyang University, Asan 31538, Korea.
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Cantuaria ML, Suh H, Løfstrøm P, Blanes-Vidal V. Characterization of exposure in epidemiological studies on air pollution from biodegradable wastes: Misclassification and comparison of exposure assessment strategies. Int J Hyg Environ Health 2016; 219:770-779. [PMID: 27692572 DOI: 10.1016/j.ijheh.2016.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 08/16/2016] [Accepted: 08/25/2016] [Indexed: 11/30/2022]
Abstract
The assignment of exposure is one of the main challenges faced by environmental epidemiologists. However, misclassification of exposures has not been explored in population epidemiological studies on air pollution from biodegradable wastes. The objective of this study was to investigate the use of different approaches for assessing exposure to air pollution from biodegradable wastes by analyzing (1) the misclassification of exposure that is committed by using these surrogates, (2) the existence of differential misclassification (3) the effects that misclassification may have on health effect estimates and the interpretation of epidemiological results, and (4) the ability of the exposure measures to predict health outcomes using 10-fold cross validation. Four different exposure assessment approaches were studied: ammonia concentrations at the residence (Metric I), distance to the closest source (Metric II), number of sources within certain distances from the residence (Metric IIIa,b) and location in a specific region (Metric IV). Exposure-response models based on Metric I provided the highest predictive ability (72.3%) and goodness-of-fit, followed by IV, III and II. When compared to Metric I, Metric IV yielded the best results for exposure misclassification analysis and interpretation of health effect estimates, followed by Metric IIIb, IIIa and II. The study showed that modelled NH3 concentrations provide more accurate estimations of true exposure than distances-based surrogates, and that distance-based surrogates (especially those based on distance to the closest point source) are imprecise methods to identify exposed populations, although they may be useful for initial studies.
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Affiliation(s)
- Manuella Lech Cantuaria
- The Mærsk Mc-Kinney Møller Institute, Faculty of Engineering, University of Southern Denmark, Odense, Denmark
| | - Helen Suh
- Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Per Løfstrøm
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Victoria Blanes-Vidal
- The Mærsk Mc-Kinney Møller Institute, Faculty of Engineering, University of Southern Denmark, Odense, Denmark.
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Frei A, Siebeling L, Wolters C, Held L, Muggensturm P, Strassmann A, Zoller M, Ter Riet G, Puhan MA. The Inaccuracy of Patient Recall for COPD Exacerbation Rate Estimation and Its Implications: Results from Central Adjudication. Chest 2016; 150:860-868. [PMID: 27400907 DOI: 10.1016/j.chest.2016.06.031] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 06/01/2016] [Accepted: 06/27/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND COPD exacerbation incidence rates are often ascertained retrospectively through patient recall and self-reports. We compared exacerbation ascertainment through patient self-reports and single-physician chart review to central adjudication by a committee and explored determinants and consequences of misclassification. METHODS Self-reported exacerbations (event-based definition) in 409 primary care patients with COPD participating in the International Collaborative Effort on Chronic Obstructive Lung Disease: Exacerbation Risk Index Cohorts (ICE COLD ERIC) cohort were ascertained every 6 months over 3 years. Exacerbations were adjudicated by single experienced physicians and an adjudication committee who had information from patient charts. We assessed the accuracy (sensitivities and specificities) of self-reports and single-physician chart review against a central adjudication committee (AC) (reference standard). We used multinomial logistic regression and bootstrap stability analyses to explore determinants of misclassifications. RESULTS The AC identified 648 exacerbations, corresponding to an incidence rate of 0.60 ± 0.83 exacerbations/patient-year and a cumulative incidence proportion of 58.9%. Patients self-reported 841 exacerbations (incidence rate, 0.75 ± 1.01; incidence proportion, 59.7%). The sensitivity and specificity of self-reports were 84% and 76%, respectively, those of single-physician chart review were between 89% and 96% and 87% and 99%, respectively. The multinomial regression model and bootstrap selection showed that having experienced more exacerbations was the only factor consistently associated with underreporting and overreporting of exacerbations (underreporters: relative risk ratio [RRR], 2.16; 95% CI, 1.76-2.65 and overreporters: RRR, 1.67; 95% CI, 1.39-2.00). CONCLUSIONS Patient 6-month recall of exacerbation events are inaccurate. This may lead to inaccurate estimates of incidence measures and underestimation of treatment effects. The use of multiple data sources combined with event adjudication could substantially reduce sample size requirements and possibly cost of studies. CLINICAL TRIAL REGISTRATION www.ClinicalTrials.gov, NCT00706602.
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Affiliation(s)
- Anja Frei
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland.
| | - Lara Siebeling
- Department of General Practice, Academic Medical Center, University of Amsterdam, the Netherlands
| | - Callista Wolters
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland
| | - Leonhard Held
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland
| | - Patrick Muggensturm
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland; Department of Internal Medicine, Zollikerberg Hospital, Zollikon, Switzerland
| | - Alexandra Strassmann
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland
| | - Marco Zoller
- Institute of General Practice and Health Services Research, University of Zurich, Switzerland
| | - Gerben Ter Riet
- Department of General Practice, Academic Medical Center, University of Amsterdam, the Netherlands
| | - Milo A Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland
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Su FC, Goutman SA, Chernyak S, Mukherjee B, Callaghan BC, Batterman S, Feldman EL. Association of Environmental Toxins With Amyotrophic Lateral Sclerosis. JAMA Neurol 2016; 73:803-11. [PMID: 27159543 PMCID: PMC5032145 DOI: 10.1001/jamaneurol.2016.0594] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
IMPORTANCE Persistent environmental pollutants may represent a modifiable risk factor involved in the gene-time-environment hypothesis in amyotrophic lateral sclerosis (ALS). OBJECTIVE To evaluate the association of occupational exposures and environmental toxins on the odds of developing ALS in Michigan. DESIGN, SETTING, AND PARTICIPANTS Case-control study conducted between 2011 and 2014 at a tertiary referral center for ALS. Cases were patients diagnosed as having definitive, probable, probable with laboratory support, or possible ALS by revised El Escorial criteria; controls were excluded if they were diagnosed as having ALS or another neurodegenerative condition or if they had a family history of ALS in a first- or second-degree blood relative. Participants completed a survey assessing occupational and residential exposures. Blood concentrations of 122 persistent environmental pollutants, including organochlorine pesticides (OCPs), polychlorinated biphenyls (PCBs), and brominated flame retardants (BFRs), were measured using gas chromatography-mass spectrometry. Multivariable models with self-reported occupational exposures in various exposure time windows and environmental toxin blood concentrations were separately fit by logistic regression models. Concordance between the survey data and pollutant measurements was assessed using the nonparametric Kendall τ correlation coefficient. MAIN OUTCOMES AND MEASURES Occupational and residential exposures to environmental toxins, and blood concentrations of 122 persistent environmental pollutants, including OCPs, PCBs, and BFRs. RESULTS Participants included 156 cases (mean [SD] age, 60.5 [11.1] years; 61.5% male) and 128 controls (mean [SD] age, 60.4 [9.4] years; 57.8% male); among them, 101 cases and 110 controls had complete demographic and pollutant data. Survey data revealed that reported pesticide exposure in the cumulative exposure windows was significantly associated with ALS (odds ratio [OR] = 5.09; 95% CI, 1.85-13.99; P = .002). Military service was also associated with ALS in 2 time windows (exposure ever happened in entire occupational history: OR = 2.31; 95% CI, 1.02-5.25; P = .046; exposure ever happened 10-30 years ago: OR = 2.18; 95% CI, 1.01-4.73; P = .049). A multivariable model of measured persistent environmental pollutants in the blood, representing cumulative occupational and residential exposure, showed increased odds of ALS for 2 OCPs (pentachlorobenzene: OR = 2.21; 95% CI, 1.06-4.60; P = .04; and cis-chlordane: OR = 5.74; 95% CI, 1.80-18.20; P = .005), 2 PCBs (PCB 175: OR = 1.81; 95% CI, 1.20-2.72; P = .005; and PCB 202: OR = 2.11; 95% CI, 1.36-3.27; P = .001), and 1 BFR (polybrominated diphenyl ether 47: OR = 2.69; 95% CI, 1.49-4.85; P = .001). There was modest concordance between survey data and the measurements of persistent environmental pollutants in blood; significant Kendall τ correlation coefficients ranged from -0.18 (Dacthal and "use pesticides to treat home or yard") to 0.24 (trans-nonachlor and "store lawn care products in garage"). CONCLUSIONS AND RELEVANCE In this study, persistent environmental pollutants measured in blood were significantly associated with ALS and may represent modifiable ALS disease risk factors.
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Affiliation(s)
- Feng-Chiao Su
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor
| | | | - Sergey Chernyak
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor
| | | | | | - Stuart Batterman
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor
| | - Eva L Feldman
- Department of Neurology, University of Michigan, Ann Arbor4A. Alfred Taubman Medical Research Institute, University of Michigan, Ann Arbor
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Brouwer M, Schinasi L, Beane Freeman LE, Baldi I, Lebailly P, Ferro G, Nordby KC, Schüz J, Leon ME, Kromhout H. Assessment of occupational exposure to pesticides in a pooled analysis of agricultural cohorts within the AGRICOH consortium. Occup Environ Med 2016; 73:359-67. [PMID: 27009271 DOI: 10.1136/oemed-2015-103319] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 03/05/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND This paper describes methods developed to assess occupational exposure to pesticide active ingredients and chemical groups, harmonised across cohort studies included in the first AGRICOH pooling project, focused on the risk of lymph-haematological malignancies. METHODS Three prospective agricultural cohort studies were included: US Agricultural Health Study (AHS), French Agriculture and Cancer Study (AGRICAN) and Cancer in the Norwegian Agricultural Population (CNAP). Self-reported pesticide use was collected in AHS. Crop-exposure matrices (CEMs) were developed for AGRICAN and CNAP. We explored the potential impact of these differences in exposure assessment by comparing a CEM approach estimating exposure in AHS with self-reported pesticide use. RESULTS In AHS, 99% of participants were considered exposed to pesticides, 68% in AGRICAN and 63% in CNAP. For all cohorts combined (n=316 270), prevalence of exposure ranged from 19% to 59% for 14 chemical groups examined, and from 13% to 46% for 33 active ingredients. Exposures were highly correlated within AGRICAN and CNAP where CEMs were applied; they were less correlated in AHS. Poor agreement was found between self-reported pesticide use and assigned exposure in AHS using a CEM approach resembling the assessment for AGRICAN (κ -0.00 to 0.33) and CNAP (κ -0.01 to 0.14). CONCLUSIONS We developed country-specific CEMs to assign occupational exposure to pesticides in cohorts lacking self-reported data on the use of specific pesticides. The different exposure assessment methods applied may overestimate or underestimate actual exposure prevalence, and additional work is needed to better estimate how far the exposure estimates deviate from reality.
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Affiliation(s)
- Maartje Brouwer
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Leah Schinasi
- Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, France
| | - Laura E Beane Freeman
- Occupational and Environmental Epidemiology Branch, National Cancer Institute (NCI), Bethesda, Maryland, USA
| | - Isabelle Baldi
- Laboratoire Santé Travail Environnement, ISPED, Université Bordeaux, Bordeaux, France Centre INSERM U897-Epidemiologie-Biostatistique, ISPED, INSERM, Bordeaux, France Service de Médecine du Travail, CHU de Bordeaux, Bordeaux, France
| | - Pierre Lebailly
- UMR1086-Cancers et Préventions, INSERM, Caen, France Cancers et Préventions, IFR146 ICORE, Université Caen Basse-Normandie, Caen, France Centre de Lutte Contre le Cancer François Baclesse, Caen, France
| | - Gilles Ferro
- Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, France
| | - Karl-Christian Nordby
- Department of Occupational Medicine and Epidemiology, National Institute of Occupational Health, Oslo, Norway
| | - Joachim Schüz
- Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, France
| | - Maria E Leon
- Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, France
| | - Hans Kromhout
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
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Abstract
BACKGROUND Chronic opioid therapy for chronic pain treatment has increased. Hospital physicians, including hospitalists and medical/surgical resident physicians, care for many hospitalized patients, yet little is known about opioid prescribing at hospital discharge and future chronic opioid use. OBJECTIVE We aimed to characterize opioid prescribing at hospital discharge among 'opioid naïve' patients. Opioid naïve patients had not filled an opioid prescription at an affiliated pharmacy 1 year preceding their hospital discharge. We also set out to quantify the risk of chronic opioid use and opioid refills 1 year post discharge among opioid naïve patients with and without opioid receipt at discharge. DESIGN This was a retrospective cohort study. PARTICIPANTS From 1 January 2011 to 31 December 2011, 6,689 opioid naïve patients were discharged from a safety-net hospital. MAIN MEASURE Chronic opioid use 1 year post discharge. KEY RESULTS Twenty-five percent of opioid naïve patients (n = 1,688) had opioid receipt within 72 hours of discharge. Patients with opioid receipt were more likely to have diagnoses including neoplasm (6.3% versus 3.5%, p < 0.001), acute pain (2.7% versus 1.0 %, p < 0.001), chronic pain at admission (12.1% versus 3.3%, p < 0.001) or surgery during their hospitalization (65.1% versus 18.4%, p < 0.001) compared to patients without opioid receipt. Patients with opioid receipt were less likely to have alcohol use disorders (15.7% versus 20.7%, p < 0.001) and mental health disorders (23.9% versus 31.4%, p < 0.001) compared to patients without opioid receipt. Chronic opioid use 1 year post discharge was more common among patients with opioid receipt (4.1% versus 1.3%, p < 0.0001) compared to patients without opioid receipt. Opioid receipt was associated with increased odds of chronic opioid use (AOR = 4.90, 95% CI 3.22-7.45) and greater subsequent opioid refills (AOR = 2.67, 95% CI 2.29-3.13) 1 year post discharge compared to no opioid receipt. CONCLUSION Opioid receipt at hospital discharge among opioid naïve patients increased future chronic opioid use. Physicians should inform patients of this risk prior to prescribing opioids at discharge.
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Fan L, Yeatts SD, Wolf BJ, McClure LA, Selim M, Palesch YY. The impact of covariate misclassification using generalized linear regression under covariate-adaptive randomization. Stat Methods Med Res 2015; 27:20-34. [PMID: 26596352 DOI: 10.1177/0962280215616405] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Under covariate adaptive randomization, the covariate is tied to both randomization and analysis. Misclassification of such covariate will impact the intended treatment assignment; further, it is unclear what the appropriate analysis strategy should be. We explore the impact of such misclassification on the trial's statistical operating characteristics. Simulation scenarios were created based on the misclassification rate and the covariate effect on the outcome. Models including unadjusted, adjusted for the misclassified, or adjusted for the corrected covariate were compared using logistic regression for a binary outcome and Poisson regression for a count outcome. For the binary outcome using logistic regression, type I error can be maintained in the adjusted model, but the test is conservative using an unadjusted model. Power decreased with both increasing covariate effect on the outcome as well as the misclassification rate. Treatment effect estimates were biased towards the null for both the misclassified and unadjusted models. For the count outcome using a Poisson model, covariate misclassification led to inflated type I error probabilities and reduced power in the misclassified and the unadjusted model. The impact of covariate misclassification under covariate-adaptive randomization differs depending on the underlying distribution of the outcome.
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Affiliation(s)
- Liqiong Fan
- 1 Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Sharon D Yeatts
- 1 Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Bethany J Wolf
- 1 Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Leslie A McClure
- 2 Department of Epidemiology & Biostatistics, Drexel University, Philadelphia, PA, USA
| | - Magdy Selim
- 3 Beth Israel Deaconess Medical Center, Department of Neurology,Division of Cerebrovascular Diseases, Boston MA, USA
| | - Yuko Y Palesch
- 1 Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
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Yli-Tuomi T, Siponen T, Taimisto RP, Aurela M, Teinilä K, Hillamo R, Pekkanen J, Salonen RO, Lanki T. Impact of wood combustion for secondary heating and recreational purposes on particulate air pollution in a suburb in Finland. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2015; 49:4089-4096. [PMID: 25734752 DOI: 10.1021/es5053683] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Little information is available on the concentrations of ambient fine particles (PM2.5) in residential areas where wood combustion is common for recreational purposes and secondary heating. Further, the validity of central site measurements of PM2.5 as a measure of exposure is unclear. Therefore, outdoor PM2.5 samples were repeatedly collected at a central site and home outdoor locations from a panel of 29 residents in a suburb in Kuopio, Finland. Source apportionment results from the central site were used to estimate the contributions from local sources, including wood combustion, to PM2.5 and absorption coefficient (ABS) at home outdoor locations. Correlations between the central and home outdoor concentrations of PM2.5, ABS, and their local components were analyzed for each home. At the central site, the average PM2.5 was 6.0 μg m(-)(3) during the heating season, and the contribution from wood combustion (16%) was higher than the contribution from exhaust emissions (12%). Central site measurements predicted poorly daily variation in PM2.5 from local sources. In conclusion, wood combustion significantly affects air quality also in areas where it is not the primary heating source. In epidemiological panel studies, central site measurements may not sufficiently capture daily variation in exposure to PM2.5 from local wood combustion.
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Affiliation(s)
- Tarja Yli-Tuomi
- †Department of Environmental Health, National Institute for Health and Welfare (THL), FI-70701, Kuopio, Finland
| | - Taina Siponen
- †Department of Environmental Health, National Institute for Health and Welfare (THL), FI-70701, Kuopio, Finland
| | - R Pauliina Taimisto
- †Department of Environmental Health, National Institute for Health and Welfare (THL), FI-70701, Kuopio, Finland
| | - Minna Aurela
- ‡Finnish Meteorological Institute, Air Quality Research, FI-00101, Helsinki, Finland
| | - Kimmo Teinilä
- ‡Finnish Meteorological Institute, Air Quality Research, FI-00101, Helsinki, Finland
| | - Risto Hillamo
- ‡Finnish Meteorological Institute, Air Quality Research, FI-00101, Helsinki, Finland
| | - Juha Pekkanen
- †Department of Environmental Health, National Institute for Health and Welfare (THL), FI-70701, Kuopio, Finland
- §Institute of Public Health and Clinical Nutrition, University of Eastern Finland, FI-70211, Kuopio, Finland
| | - Raimo O Salonen
- †Department of Environmental Health, National Institute for Health and Welfare (THL), FI-70701, Kuopio, Finland
| | - Timo Lanki
- †Department of Environmental Health, National Institute for Health and Welfare (THL), FI-70701, Kuopio, Finland
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LeMasters GK, Khurana Hershey GK, Sivaprasad U, Martin LJ, Pilipenko V, Ericksen MB, Burkle JW, Lindsey MA, Bernstein DI, Lockey JE, Gareri J, Lubetsky A, Koren G, Biagini Myers JM. N-acetyltransferase 1 polymorphism increases cotinine levels in Caucasian children exposed to secondhand smoke: the CCAAPS birth cohort. THE PHARMACOGENOMICS JOURNAL 2015; 15:189-95. [PMID: 25156213 PMCID: PMC4342329 DOI: 10.1038/tpj.2014.44] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 06/13/2014] [Accepted: 06/25/2014] [Indexed: 01/21/2023]
Abstract
Cotinine is a proxy for secondhand smoke (SHS) exposure. Genetic variation along nicotine and cotinine metabolic pathways may alter the internal cotinine dose, leading to misinterpretations of exposure-health outcome associations. Caucasian children with available SHS exposure and hair cotinine data were genotyped for metabolism-related genes. SHS-exposed children had 2.4-fold higher hair cotinine (0.14±0.22 ng mg(-1)) than unexposed children (0.06±0.05 ng mg(-1), P<0.001). SHS-exposed children carrying the NAT1 minor allele had twofold higher hair cotinine (0.18 ng mg(-1) for heterozygotes and 0.17 ng mg(-1) for homozygotes) compared with major allele homozygotes (0.09 ng mg(-1), P=0.0009), even after adjustment for SHS dose. These findings support that NAT1 has a role in the metabolic pathway of nicotine/cotinine and/or their metabolites. The increased cotinine levels observed for those carrying the minor allele may lead to SHS exposure misclassification in studies utilizing cotinine as a biomarker. Additional studies are required to identify functional single-nucleotide polymorphism(s) (SNP(s)) in NAT1 and elucidate the biological consequences of the mutation(s).
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Affiliation(s)
- Grace K LeMasters
- Department of Environmental Health, University of Cincinnati, Cincinnati, OH, USA
| | - Gurjit K Khurana Hershey
- Division of Asthma Research Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - Umasundari Sivaprasad
- Division of Asthma Research Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - Lisa J Martin
- Division of Human Genetics Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Valentina Pilipenko
- Division of Human Genetics Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - Mark B Ericksen
- Division of Asthma Research Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - Jeffrey W Burkle
- Department of Environmental Health, University of Cincinnati, Cincinnati, OH, USA
| | - Mark A Lindsey
- Division of Asthma Research Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - David I Bernstein
- Department of Internal Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - James E Lockey
- Department of Environmental Health, University of Cincinnati, Cincinnati, OH, USA
| | - Joey Gareri
- Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Angelika Lubetsky
- Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Gideon Koren
- Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jocelyn M Biagini Myers
- Division of Asthma Research Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
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Solovieva S, Pensola T, Kausto J, Shiri R, Heliövaara M, Burdorf A, Husgafvel-Pursiainen K, Viikari-Juntura E. Evaluation of the validity of job exposure matrix for psychosocial factors at work. PLoS One 2014; 9:e108987. [PMID: 25268276 PMCID: PMC4182611 DOI: 10.1371/journal.pone.0108987] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 09/06/2014] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To study the performance of a developed job exposure matrix (JEM) for the assessment of psychosocial factors at work in terms of accuracy, possible misclassification bias and predictive ability to detect known associations with depression and low back pain (LBP). MATERIALS AND METHODS We utilized two large population surveys (the Health 2000 Study and the Finnish Work and Health Surveys), one to construct the JEM and another to test matrix performance. In the first study, information on job demands, job control, monotonous work and social support at work was collected via face-to-face interviews. Job strain was operationalized based on job demands and job control using quadrant approach. In the second study, the sensitivity and specificity were estimated applying a Bayesian approach. The magnitude of misclassification error was examined by calculating the biased odds ratios as a function of the sensitivity and specificity of the JEM and fixed true prevalence and odds ratios. Finally, we adjusted for misclassification error the observed associations between JEM measures and selected health outcomes. RESULTS The matrix showed a good accuracy for job control and job strain, while its performance for other exposures was relatively low. Without correction for exposure misclassification, the JEM was able to detect the association between job strain and depression in men and between monotonous work and LBP in both genders. CONCLUSIONS Our results suggest that JEM more accurately identifies occupations with low control and high strain than those with high demands or low social support. Overall, the present JEM is a useful source of job-level psychosocial exposures in epidemiological studies lacking individual-level exposure information. Furthermore, we showed the applicability of a Bayesian approach in the evaluation of the performance of the JEM in a situation where, in practice, no gold standard of exposure assessment exists.
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Affiliation(s)
- Svetlana Solovieva
- Centre of Expertise for Health and Work Ability, Finnish Institute of Occupational Health, Helsinki, Finland
- Disability Prevention Centre, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Tiina Pensola
- Centre of Expertise for Health and Work Ability, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Johanna Kausto
- Centre of Expertise for Health and Work Ability, Finnish Institute of Occupational Health, Helsinki, Finland
- Disability Prevention Centre, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Rahman Shiri
- Centre of Expertise for Health and Work Ability, Finnish Institute of Occupational Health, Helsinki, Finland
- Disability Prevention Centre, Finnish Institute of Occupational Health, Helsinki, Finland
| | | | - Alex Burdorf
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Kirsti Husgafvel-Pursiainen
- Centre of Expertise for Health and Work Ability, Finnish Institute of Occupational Health, Helsinki, Finland
- Disability Prevention Centre, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Eira Viikari-Juntura
- Disability Prevention Centre, Finnish Institute of Occupational Health, Helsinki, Finland
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Utility and cutoff value of hair nicotine as a biomarker of long-term tobacco smoke exposure, compared to salivary cotinine. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:8368-82. [PMID: 25153466 PMCID: PMC4143866 DOI: 10.3390/ijerph110808368] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 07/22/2014] [Accepted: 07/29/2014] [Indexed: 11/30/2022]
Abstract
While hair samples are easier to collect and less expensive to store and transport than biological fluids, and hair nicotine characterizes tobacco exposure over a longer time period than blood or urine cotinine, information on its utility, compared with salivary cotinine, is still limited. We conducted a cross-sectional study with 289 participants (107 active smokers, 105 passive smokers with self-reported secondhand smoke (SHS) exposure, and 77 non-smokers with no SHS exposure) in Baltimore (Maryland, USA). A subset of the study participants (n = 52) were followed longitudinally over a two-month interval. Median baseline hair nicotine concentrations for active, passive and non-smokers were 16.2, 0.36, and 0.23 ng/mg, respectively, while those for salivary cotinine were 181.0, 0.27, and 0.27 ng/mL, respectively. Hair nicotine concentrations for 10% of passive or non-smokers were higher than the 25th percentile value for active smokers while all corresponding salivary cotinine concentrations for them were lower than the value for active smokers. This study showed that hair nicotine concentration values could be used to distinguish active or heavy passive adult smokers from non-SHS exposed non-smokers. Our results indicate that hair nicotine is a useful biomarker for the assessment of long-term exposure to tobacco smoke.
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LaMonte MJ, Hovey KM, Millen AE, Genco RJ, Wactawski-Wende J. Accuracy of self-reported periodontal disease in the Women's Health Initiative Observational Study. J Periodontol 2014; 85:1006-18. [PMID: 24354649 PMCID: PMC6004791 DOI: 10.1902/jop.2013.130488] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND This study examines the accuracy of self-reported periodontal disease in a cohort of older females. METHODS The study comprised 972 postmenopausal females aged 53 to 83 years who completed baseline (1997 to 2001) and follow-up (2002 to 2006) whole-mouth oral examinations. Examinations included: 1) probing depth, 2) clinical attachment level, and 3) oral radiographs for alveolar crestal height in a study ancillary to the Women's Health Initiative Observational Study (WHI-OS) conducted in Buffalo, New York, called the OsteoPerio study. Participants also self-reported any history of diagnosis of periodontal/gum disease on a WHI-OS study-wide questionnaire administered during the time interval between the two OsteoPerio examinations. RESULTS Participants reporting diagnosis of periodontal/gum disease on the WHI-OS questionnaire (n = 259; 26.6%) had worse oral hygiene habits, periodontal disease risk factors, and clinical periodontal measures compared with those not reporting periodontal/gum disease. Frequency of reported periodontal/gum disease was 13.5%, 24.7%, and 56.2% across OsteoPerio baseline examination categories of none/mild, moderate, and severe periodontal disease, respectively (trend: P <0.001), defined by criteria of the Centers for Disease Control and Prevention/American Academy of Periodontology (CDC/AAP). Sensitivity, specificity, and positive and negative predictive values for reported periodontal disease status were 56.2%, 78.8%, 32.8%, and 90.7%, respectively, when CDC/AAP-defined severe periodontal disease at baseline was the criterion measure (prevalence of 15%) and were 76.0%, 77.4%, 22.0%, and 97.4%, respectively, when tooth loss to periodontitis (prevalence of 7%) was the criterion. CONCLUSION A simple question for self-reported periodontal disease characterizes periodontal disease prevalence with moderate accuracy in postmenopausal females who regularly visit their dentist, particularly in those with more severe disease.
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Affiliation(s)
- Michael J. LaMonte
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, NY
| | - Kathleen M. Hovey
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, NY
| | - Amy E. Millen
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, NY
| | - Robert J. Genco
- Department of Oral Biology, School of Dental Medicine, University at Buffalo, State University of New York
| | - Jean Wactawski-Wende
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, NY
- Department of Gynecology–Obstetrics, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York
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Redelmeier DA, Woodfine JD, Thiruchelvam D, Scales DC. Maternal organ donation and acute injuries in surviving children. J Crit Care 2014; 29:923-9. [PMID: 25115273 DOI: 10.1016/j.jcrc.2014.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 07/11/2014] [Accepted: 07/14/2014] [Indexed: 12/20/2022]
Abstract
PURPOSE The purpose of this study is to test whether maternal deceased organ donation is associated with rates of subsequent acute injuries among surviving children after their mother's death. METHODS This is a longitudinal cohort analysis of children linked to mothers who died of a catastrophic brain event in Ontario, Canada, between April 1988 and March 2012. Surviving children were distinguished by whether their mother was an organ donor after death. The primary outcome was an acute injury event in surviving children during the year after their mother's death. RESULTS Surviving children (n=454) had a total of 293 injury events during the year after their mother's death, equivalent to an average of 65 events per 100 children per year and a significant difference comparing children of mothers who were organ donors to children of mothers who were not organ donors (21 vs 82, P<.001). This difference in subsequent injury rates between groups was equal to a 76% relative reduction in risk (95% confidence interval, 62%-85%). CONCLUSIONS Deceased organ donation was associated with a reduction in excess acute injuries among surviving children after their mother's death. An awareness of this positive association provides some reassurance about deceased organ donation programs.
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Affiliation(s)
- Donald A Redelmeier
- Department of Medicine, University of Toronto, Ontario, Canada; Evaluative Clinical Sciences Program, Sunnybrook Research Institute, Ontario, Canada; Institute for Clinical Evaluative Sciences in Ontario, Ontario, Canada; Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Center for Leading Injury Prevention Practice Education & Research, Ontario, Canada.
| | - Jason D Woodfine
- Department of Medicine, University of Toronto, Ontario, Canada; Evaluative Clinical Sciences Program, Sunnybrook Research Institute, Ontario, Canada; Institute for Clinical Evaluative Sciences in Ontario, Ontario, Canada.
| | - Deva Thiruchelvam
- Evaluative Clinical Sciences Program, Sunnybrook Research Institute, Ontario, Canada; Institute for Clinical Evaluative Sciences in Ontario, Ontario, Canada.
| | - Damon C Scales
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Interdepartmental Division of Critical Care, University of Toronto, Ontario, Canada.
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Kauppinen T, Uuksulainen S, Saalo A, Mäkinen I, Pukkala E. Use of the Finnish Information System on Occupational Exposure (FINJEM) in epidemiologic, surveillance, and other applications. ACTA ACUST UNITED AC 2014; 58:380-96. [PMID: 24401793 DOI: 10.1093/annhyg/met074] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This paper reviews the use of the Finnish Information System on Occupational Exposure (Finnish job-exposure matrix, FINJEM) in different applications in Finland and other countries. We describe and discuss studies on FINJEM and studies utilizing FINJEM in regard to the validity of exposure estimates, occupational epidemiology, hazard surveillance and prevention, the assessment of health risks and the burden of disease, the assessment of exposure trends and future hazards, and the construction of job-exposure matrices (JEMs) in countries other than Finland. FINJEM can be used as an exposure assessment tool in occupational epidemiology, particularly in large register-based studies. It also provides information for hazard surveillance at the national level. It is able to identify occupations with high average exposures to chemical agents and can therefore serve the priority setting of prevention. However, it has only limited use at the workplace level due to the variability of exposure between workplaces. The national estimates of exposure and their temporal trends may contribute to the assessment of both the recent and future burden of work-related health outcomes. FINJEM has also proved to be useful in the construction of other national JEMs, for example in the Nordic Occupational Cancer study in the Nordic countries. FINJEM is a quantitative JEM, which can serve many purposes and its comprehensive documentation also makes it potentially useful in countries other than Finland.
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Affiliation(s)
- Timo Kauppinen
- 1. Surveillance and Reviews, Finnish Institute of Occupational Health (FIOH), Topeliuksenkatu 41aA, FI-00250 Helsinki, Finland
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Mortality Risk of Obesity and Underweight Is Overestimated with Self-Reported Body Mass Index. Epidemiology 2014; 25:156-8. [DOI: 10.1097/ede.0000000000000009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Andersson E, Murgia N, Nilsson T, Karlsson B, Torén K. Incidence of chronic bronchitis in a cohort of pulp mill workers with repeated gassings to sulphur dioxide and other irritant gases. Environ Health 2013; 12:113. [PMID: 24354705 PMCID: PMC3882105 DOI: 10.1186/1476-069x-12-113] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 12/06/2013] [Indexed: 06/03/2023]
Abstract
BACKGROUND Occupational exposure to irritants is associated with chronic bronchitis. The aim of this study was to elucidate whether repeated peak exposures with respiratory symptoms, gassings, to sulphur dioxide (SO2) and other irritant gases could increase the risk of chronic bronchitis. METHODS The study population comprised 3,060 Swedish pulp mill workers (84% males) from a cohort study, who completed a comprehensive questionnaire with items on chronic bronchitis symptoms, smoking habit, occupational history, and specific exposures, including gassings. 2,037 have worked in sulphite mills. Incidence rates and hazard ratios (HRs) for the observation period, 1970-2000, in relation to exposure and the frequency of repeated gassings to SO2 and other irritant gases were calculated. RESULTS The incidence rate for chronic bronchitis among workers with repeated gassings was 3.5/1,000 person-years compared with 1.5/1,000 person-years among unexposed workers (HR 2.1, 95% confidence interval (CI) 1.4-3.1). The risk was even higher in the subgroup with frequent gassings (HR 3.2, 95% CI 2.0-5.2), particularly among never-smokers (HR 8.7, 95% CI 3.5-22). CONCLUSIONS Repeated gassings to irritant gases increased the incidence of chronic bronchitis in our study population during and after work in pulp mills, supporting the hypothesis that occupational exposures to irritants negatively affect the airways. These results underscore the importance of preventive actions in this work environment.
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Affiliation(s)
- Eva Andersson
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Nicola Murgia
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
- Section of Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Perugia, Italy
| | - Tohr Nilsson
- Department of Occupational and Environmental Medicine, Sundsvall Hospital, Sundsvall, Sweden
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden
| | - Berndt Karlsson
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden
| | - Kjell Torén
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
- Section of Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Perugia, Italy
- Section of Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
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Meyer ACL, Boscardin WJ, Kwasa JK, Price RW. Is it time to rethink how neuropsychological tests are used to diagnose mild forms of HIV-associated neurocognitive disorders? Impact of false-positive rates on prevalence and power. Neuroepidemiology 2013; 41:208-16. [PMID: 24157541 DOI: 10.1159/000354629] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 07/22/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Between 0 and 48% of normal HIV-uninfected individuals score below threshold neuropsychological test scores for HIV-associated neurocognitive disorders (HAND) or are false positives. There has been little effort to understand the effect of varied interpretations of research criteria for HAND on false-positive frequencies, prevalence and analytic estimates. METHODS The proportion of normal individuals scoring below Z score thresholds drawn from research criteria for HAND, or false-positive frequencies, was estimated in a normal Kenyan population and a simulated normal population using varied interpretations of research criteria for HAND. We calculated the impact of false-positive frequencies on prevalence estimates and statistical power. RESULTS False-positive frequencies of 2-74% were observed for asymptomatic neurocognitive impairment/mild neurocognitive disorder and 0-8% for HIV-associated dementia. False-positive frequencies depended on the definition of an abnormal cognitive domain, Z score thresholds and neuropsychological battery size. Misclassification led to clinically important overestimation of prevalence and dramatic decreases in power. CONCLUSIONS Minimizing false-positive frequencies is critical to decrease bias in prevalence estimates and minimize reductions in power in studies of association, particularly for mild forms of HAND. We recommend changing the Z score threshold to ≤-1.5 for mild impairment, limiting analysis to 3-5 cognitive domains and using the average Z score to define an abnormal domain.
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Affiliation(s)
- Ana-Claire L Meyer
- Department of Neurology, San Francisco General Hospital, University of California, San Francisco, San Francisco, Calif., USA
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Chen Q, Galfalvy H, Duan N. Effects of disease misclassification on exposure-disease association. Am J Public Health 2013; 103:e67-73. [PMID: 23488509 DOI: 10.2105/ajph.2012.300995] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We explore how misclassification in disease status can distort the exposure-disease association in a study with dichotomous disease and exposure status. METHODS We define the difference in population odds ratios between populations with and without disease misclassification as population-level bias and derive the bias as a function of sensitivity and specificity for observed disease status. The magnitude and direction of bias can be elucidated through analytic derivations, as illustrated with numerical examples. RESULTS Patterns of bias exist not only for nondifferential misclassification but also for some differential misclassification scenarios. We have provided conditions defined in terms of sensitivity and specificity that correspond to each pattern of bias. CONCLUSIONS Caution is needed in interpreting results when misclassification is present. Our findings can be used to assess the effects of disease misclassification in a population when sensitivity and specificity are known or can be estimated.
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Affiliation(s)
- Qixuan Chen
- Department of Biostatistics, Columbia University, New York, NY, USA.
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van Tongeren M, Kincl L, Richardson L, Benke G, Figuerola J, Kauppinen T, Lakhani R, Lavoué J, McLean D, Plato N, Cardis E. Assessing occupational exposure to chemicals in an international epidemiological study of brain tumours. ACTA ACUST UNITED AC 2013; 57:610-26. [PMID: 23467593 DOI: 10.1093/annhyg/mes100] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The INTEROCC project is a multi-centre case-control study investigating the risk of developing brain cancer due to occupational chemical and electromagnetic field exposures. To estimate chemical exposures, the Finnish Job Exposure Matrix (FINJEM) was modified to improve its performance in the INTEROCC study and to address some of its limitations, resulting in the development of the INTEROCC JEM. An international team of occupational hygienists developed a crosswalk between the Finnish occupational codes used in FINJEM and the International Standard Classification of Occupations 1968 (ISCO68). For ISCO68 codes linked to multiple Finnish codes, weighted means of the exposure estimates were calculated. Similarly, multiple ISCO68 codes linked to a single Finnish code with evidence of heterogeneous exposure were refined. One of the key time periods in FINJEM (1960-1984) was split into two periods (1960-1974 and 1975-1984). Benzene exposure estimates in early periods were modified upwards. The internal consistency of hydrocarbon exposures and exposures to engine exhaust fumes was improved. Finally, exposure to polycyclic aromatic hydrocarbon and benzo(a)pyrene was modified to include the contribution from second-hand smoke. The crosswalk ensured that the FINJEM exposure estimates could be applied to the INTEROCC study subjects. The modifications generally resulted in an increased prevalence of exposure to chemical agents. This increased prevalence of exposure was not restricted to the lowest categories of cumulative exposure, but was seen across all levels for some agents. Although this work has produced a JEM with important improvements compared to FINJEM, further improvements are possible with the expansion of agents and additional external data.
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Affiliation(s)
- Martie van Tongeren
- Centre for Human Exposure Science, Institute of Occupational Medicine (IOM), Research Avenue North, Riccarton, Edinburgh EH14 4AP, UK
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Rosella LC, Corey P, Stukel TA, Mustard C, Hux J, Manuel DG. The influence of measurement error on calibration, discrimination, and overall estimation of a risk prediction model. Popul Health Metr 2012; 10:20. [PMID: 23113916 PMCID: PMC3545925 DOI: 10.1186/1478-7954-10-20] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Accepted: 10/18/2012] [Indexed: 11/10/2022] Open
Abstract
Background Self-reported height and weight are commonly collected at the population level; however, they can be subject to measurement error. The impact of this error on predicted risk, discrimination, and calibration of a model that uses body mass index (BMI) to predict risk of diabetes incidence is not known. The objective of this study is to use simulation to quantify and describe the effect of random and systematic error in self-reported height and weight on the performance of a model for predicting diabetes. Methods Two general categories of error were examined: random (nondirectional) error and systematic (directional) error on an algorithm relating BMI in kg/m2 to probability of developing diabetes. The cohort used to develop the risk algorithm was derived from 23,403 Ontario residents that responded to the 1996/1997 National Population Health Survey linked to a population-based diabetes registry. The data and algorithm were then simulated to allow for estimation of the impact of these errors on predicted risk using the Hosmer-Lemeshow goodness-of-fit χ2 and C-statistic. Simulations were done 500 times with sample sizes of 9,177 for males and 10,618 for females. Results Simulation data successfully reproduced discrimination and calibration generated from population data. Increasing levels of random error in height and weight reduced the calibration and discrimination of the model. Random error biased the predicted risk upwards whereas systematic error biased predicted risk in the direction of the bias and reduced calibration; however, it did not affect discrimination. Conclusion This study demonstrates that random and systematic errors in self-reported health data have the potential to influence the performance of risk algorithms. Further research that quantifies the amount and direction of error can improve model performance by allowing for adjustments in exposure measurements.
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