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Wang C, Zhao J, Zhou Q, Li J. Serum vitamin C levels and their correlation with chronic kidney disease in adults: a nationwide study. Ren Fail 2024; 46:2298079. [PMID: 38186336 PMCID: PMC10776057 DOI: 10.1080/0886022x.2023.2298079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/18/2023] [Indexed: 01/09/2024] Open
Abstract
INTRODUCTION Inflammation and oxidative stress play significant roles in the development of chronic kidney disease (CKD). Given the recognized antioxidant properties of vitamin C, our study aimed to explore the correlation between CKD and serum vitamin C levels. METHODS Data were gathered from the 2017-2018 National Health and Nutrition Examination Survey. Participants below 18 years of age, pregnant individuals, those lacking essential data for CKD diagnosis, or individuals with incomplete serum vitamin C data were excluded. Subgroup and weighted multivariable logistic regression analyses were performed to assess the potential correlation between serum vitamin C and CKD. RESULTS Our study comprised 4969 participants, revealing an overall CKD prevalence of 15.0%. The results indicated that individuals with reduced serum vitamin C levels were more likely to be male, possess lower educational attainment, have a diminished poverty-income ratio, engage in heavy drinking, and be current smokers. Additionally, they exhibited a higher prevalence of obesity and diabetes. Significantly, participants in the third quartile group experienced a 37.0%, 47.0%, and 46.6% decrease in the risk of developing albuminuria, low estimated glomerular filtration rate (eGFR), and CKD, respectively. Subgroup analysis demonstrated that individuals between 65 and 80 years of age showed a statistically reduced risk of developing CKD and low eGFR when their serum vitamin C levels fell in the third and fourth quartile groups. CONCLUSIONS Our findings reveal a correlation between elevated serum vitamin C levels and a decreased risk of developing albuminuria, low eGFR, and CKD. Appropriately increasing serum vitamin C levels may hold promise in protecting renal function, particularly among older individuals.
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Affiliation(s)
- Chunli Wang
- Department of General Internal Medicine, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Jili Zhao
- Department of General Internal Medicine, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Qiaoqiao Zhou
- Department of General Internal Medicine, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Jing Li
- Department of General Internal Medicine, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
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Chan GCK, Sun T, Stjepanović D, Vu G, Hall WD, Connor JP, Leung J. Designing observational studies for credible causal inference in addiction research-Directed acyclic graphs, modified disjunctive cause criterion and target trial emulation. Addiction 2024; 119:1125-1134. [PMID: 38343103 DOI: 10.1111/add.16442] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 01/14/2024] [Indexed: 05/08/2024]
Abstract
Randomized controlled trials (RCTs) are considered the gold standard for causal inference. With a sufficient sample size, randomization removes confounding up to the time of randomization and allows the treatment effect to be isolated. However, RCTs may have limited generalizability and transportability and are often not feasible in addiction research due to ethical or logistical constraints. The importance of observational studies from real-world settings has been increasingly recognized in research on health. This paper provides an overview of modern approaches to designing observational studies that enable causal inference. It illustrates three key techniques, Directed Acyclic Graphs (DAGs), modified Disjunctive Cause Criterion and Target Trial Emulation, and discusses the strengths and limitations of their applications.
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Affiliation(s)
- Gary C K Chan
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
| | - Tianze Sun
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
| | - Daniel Stjepanović
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
| | - Giang Vu
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
| | - Wayne D Hall
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
- Queensland Alliance for Environmental Health Science, The University of Queensland, Woolloongabba, Australia
| | - Jason P Connor
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
- Discipline of Psychiatry, The University of Queensland, Brisbane, Australia
| | - Janni Leung
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
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Mick P, Kabir R, Karunatilake M, Kathleen Pichora-Fuller M, Young TL, Sosero Y, Gan-Or Z, Wittich W, Phillips NA. APOE-ε4 is not associated with pure-tone hearing thresholds, visual acuity or cognition, cross-sectionally or over 3 years of follow up in the Canadian Longitudinal Study on Aging. Neurobiol Aging 2024; 138:72-82. [PMID: 38547662 DOI: 10.1016/j.neurobiolaging.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 04/09/2024]
Abstract
INTRODUCTION Hearing loss and diminished visual acuity are associated with poorer cognition, but the underlying mechanisms are not understood. The apolipoprotein (APOE) ε4 allelic variant may drive the associations. We tested whether APOE-ε4 allele count (0, 1, or 2) was associated with declines in memory, executive function, pure-tone hearing threshold averages, and pinhole-corrected visual acuity among participants in the Canadian Longitudinal Study on Aging (CLSA). METHODS Multivariable linear mixed regression models were utilized to assess associations between APOE-ε4 allele count and each of the outcome variables. For each main effects model, interactions between APOE-ε4 and sex and age group (45-54-, 55-64-, 65-74-, and 75-85 years) respectively, were analyzed. RESULTS Significant associations were not observed in main effects models. Models including APOE-ε4 * age (but not APOE-ε4 * sex) interaction terms better fit the data compared to main effects models. In age group-stratified models, however, there were minimal differences in effect estimates according to allele count. CONCLUSION APOE-ε4 allele count does not appear to be a common cause of sensory-cognitive associations in this large cohort.
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Affiliation(s)
- Paul Mick
- University of Saskatchewan, College of Medicine, Department of Surgery, Canada.
| | | | - Malshi Karunatilake
- University of Alberta, College of Health Sciences, Department of Ophthalmology and Visual Sciences, Canada
| | - M Kathleen Pichora-Fuller
- Professor emeritus, University of Toronto, Faculty of Arts and Sciencies, Department of Psychology, Canada
| | - Terry-Lyn Young
- Memorial University of Newfoundland, Faculty of Medicine, Canada
| | - Yuri Sosero
- McGill University, Faculty of Medicine and Health Sciences, Department of Human Genetics, Canada
| | - Ziv Gan-Or
- McGill University, Faculty of Medicine and Health Sciences, Department of Human Genetics, Canada
| | | | - Natalie A Phillips
- Concordia University, Faculty of Arts and Sciences, Department of Psychology, Canada
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Kondo K, Inoue N, Honda K, Fushimi K. Effectiveness of antibiotic therapy for early recurrence of peritonsillar cellulitis and abscesses: A retrospective cohort study. Auris Nasus Larynx 2024; 51:450-455. [PMID: 38520976 DOI: 10.1016/j.anl.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/27/2023] [Accepted: 12/15/2023] [Indexed: 03/25/2024]
Abstract
OBJECTIVE Short-term recurrence is common in patients with peritonsillar cellulitis and abscesses, leading to socioeconomic problems. Early switching from intravenous to oral antibiotics is feasible for treating certain diseases. However, reports on early switching and total antibiotic administration duration in peritonsillar cellulitis and abscesses are limited. This study aimed to determine the appropriate antibiotic therapy duration and examine the impact of early oral switch therapy on peritonsillar cellulitis and abscesses. METHODS We retrospectively identified 98,394 patients who received antibiotic therapy during hospitalization for peritonsillar cellulitis and abscesses between July 1, 2010, and December 31, 2019, using the Japanese Diagnosis Procedure Combination database. RESULTS Propensity score matching analysis revealed no significant between-group difference in the rehospitalization rate (early oral switch therapy and long intravenous therapy: 1.7 % [198 of 11,621] vs. 2.0 % [234 of 11,621], odds ratio [OR] 0.84, 95 % confidence interval [CI] 0.70-1.02). A long total duration of antibiotic therapy (reference: 1-9 days) was associated with a low risk of rehospitalization (10-14 days: OR 0.86, 95 % CI 0.78-0.95; 15+ days: OR 0.51, 95 % CI 0.38-0.66). CONCLUSION Early oral switch therapy may be a viable option for treating patients with peritonsillar cellulitis and abscesses in good condition who can tolerate oral intake. No less than 10 days of antibiotic therapy is desirable.
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Affiliation(s)
- Keisuke Kondo
- Department of Health Policy and Informatics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan; Department of Otorhinolaryngology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Norihiko Inoue
- Department of Health Policy and Informatics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan; Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization Headquarters, Tokyo, Japan
| | - Keiji Honda
- Department of Otorhinolaryngology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
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Fadini GP, Bonora BM, Ghiani M, Anichini R, Melchionda E, Fattor B, Fazion S, Meregalli G, Giaccari A, Avogaro A, Consoli A. Oral or injectable semaglutide for the management of type 2 diabetes in routine care: A multicentre observational study comparing matched cohorts. Diabetes Obes Metab 2024; 26:2390-2400. [PMID: 38477183 DOI: 10.1111/dom.15554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 02/24/2024] [Accepted: 02/28/2024] [Indexed: 03/14/2024]
Abstract
AIM To investigate the real-world utilization and comparative clinical outcomes of injectable and oral semaglutide in individuals with type 2 diabetes (T2D) with the aim of enhancing understanding of the practical implications associated with choosing between these formulations. METHODS New users of oral or injectable semaglutide were selected from a cohort of 14 079 initiators of glucagon-like peptide-1 receptor agonists. Propensity-score matching (PSM) was employed to create balanced groups, ensuring comparability. The analysis encompassed dose exposure, drug persistence, and clinical outcomes, including changes in glycated haemoglobin (HbA1c) and body weight, with up to 18 months' follow-up. RESULTS We analysed two matched groups of 107 participants each, who comprised on average 63.6% men, aged 64 years, with diabetes duration of approximately 10 years, body mass index of 29 kg/m2 and HbA1c level of 7.7-7.8% (61-62 mmol/mol). The proportion of low, intermediate and high doses were similar with the oral and the injectable formulation. The change in HbA1c was similar between groups (-0.9% / -10 mmol/mol at 18 months) as was the proportion of individuals reaching HbA1c <6.5% (48 mmol/mol). The average change in body weight was similar in the two groups (-3.7 kg with injectable and -3.3 kg with oral at 18 months) but more new users of injectable semaglutide lost ≥5% body weight. Persistence on drug was longer with injectable than with oral semaglutide. CONCLUSION In a real-world setting, improvements in HbA1c and body weight were similar after initiation of oral or injectable semaglutide. These results may be specific to the features of the matched cohorts under investigation, with limited generalizability to populations with different characteristics.
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Affiliation(s)
- Gian Paolo Fadini
- Department of Medicine, University of Padova, Padua, Italy
- Veneto Institute of Molecular Medicine (VIMM), Padua, Italy
| | - Benedetta Maria Bonora
- Department of Medicine, University of Padova, Padua, Italy
- Veneto Institute of Molecular Medicine (VIMM), Padua, Italy
| | - Mariangela Ghiani
- Diabetology Unit, Azienda Sanitaria Locale 8 Cagliari Quartu S. Elena, Cagliari, Italy
| | - Roberto Anichini
- Diabetes Unit Area Pistoiese, USL Centro Toscana, Pistoia, Italy
| | - Elena Melchionda
- Diabetology and Metabolic Diseases, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Bruno Fattor
- Diabetology Service, Azienda Sanitaria dell'Alto Adige, Bolzano, Italy
| | - Stefano Fazion
- Diabetology and Metabolic Diseases, Ospedale C. Poma, Mantova, Italy
| | - Giancarla Meregalli
- Endocrine Disease Center and Regional Diabetes Center, ASST, Bergamo Ovest, Italy
| | - Andrea Giaccari
- Endocrine and Metabolic Center, Fondazione Policlinico Universitario A. Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy
| | - Angelo Avogaro
- Department of Medicine, University of Padova, Padua, Italy
| | - Agostino Consoli
- Endocrinology and Metabolism Unit, ASL, Pescara, Italy; Department of Medicine and Aging Sciences DMSI and Center for Advanced Studies and Technology CAST, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy
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Silva S, Hayden JA, Mendes G, Verhagen AP, Pinto RZ, Silva A. Sleep as a prognostic factor in low back pain: a systematic review of prospective cohort studies and secondary analyses of randomized controlled trials. Sleep 2024; 47:zsae023. [PMID: 38300526 DOI: 10.1093/sleep/zsae023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/12/2023] [Indexed: 02/02/2024] Open
Abstract
Sleep problems are common in individuals with low back pain (LBP) and sleep restriction seems to be associated with impaired pain processing. Our objective was to investigate whether sleep is associated with future LBP outcomes (i.e. pain intensity, disability, and recovery) in adults. We conducted a systematic review of prospective cohort studies and secondary analyses of randomized controlled trials (registration-PROSPERO CRD42022370781). In December 2022, we searched the MEDLINE, Embase, CINAHL, and PsycINFO databases. Fourteen studies, totaling 19 170 participants were included. Thirteen studies were rated as having high risk of bias (QUIPS tool). We used vote-counting and meta-analysis approaches to synthesize the data. We found associations between baseline sleep with future pain intensity, recovery, and between changes in sleep with changes in pain intensity, changes in disability, and recovery. We further synthesized outcomes as "overall LBP improvement" outcomes. Baseline poor sleep was moderately associated with non-improvement in LBP in the long-very long term (OR 1.55, 95% CI: 1.39 to 1.73; three studies providing unadjusted effect sizes), and non-improvement in sleep was largely associated with non-improvement in LBP in the short-moderate term (OR 3.45, 95% CI: 2.54 to 4.69; four studies providing unadjusted effect sizes). We found no association between baseline sleep with future disability and overall LBP improvement in the short-moderate term. Therefore, sleep may be a prognostic factor for pain intensity and recovery from LBP. All findings were supported by low to very low-quality evidence. Better-conducted studies are needed to strengthen our certainty about the evidence.
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Affiliation(s)
- Samuel Silva
- School of Physical Education, Physical Therapy, and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Jill A Hayden
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Gabriel Mendes
- School of Physical Education, Physical Therapy, and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Arianne P Verhagen
- Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Rafael Z Pinto
- School of Physical Education, Physical Therapy, and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- School of Health Sciences, University of New South Wales, Sydney, NSW, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
| | - Andressa Silva
- School of Physical Education, Physical Therapy, and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Vousden N, Bunch K, Kenyon S, Kurinczuk JJ, Knight M. Impact of maternal risk factors on ethnic disparities in maternal mortality: a national population-based cohort study. Lancet Reg Health Eur 2024; 40:100893. [PMID: 38585675 PMCID: PMC10998184 DOI: 10.1016/j.lanepe.2024.100893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/15/2024] [Accepted: 03/15/2024] [Indexed: 04/09/2024]
Abstract
Background Ethnic disparities in maternal mortality are consistently reported. This study aimed to investigate the contribution of known risk factors including age, socioeconomic status, and medical comorbidities to observed ethnic disparities in the United Kingdom (UK). Methods A cohort of all women who died during or up to six weeks after pregnancy in the UK 2009-2019 were identified through national surveillance. No single denominator population included data on all risk factors, therefore we used logistic regression modelling to compare to 1) routine population birth and demographic data (2015-19) (routine data comparator) and 2) combined control groups of four UK Obstetric Surveillance System studies (UKOSS) control comparator)). Findings There were 801 maternal deaths in the UK between 2009 and 2019 (White: 70%, Asian: 13%, Black: 12%, Chinese/Other: 3%, Mixed: 2%). Using the routine data comparator (n = 3,519,931 maternities) to adjust for demographics, including social deprivation, women of Black ethnicity remained at significantly increased risk of maternal death compared with women of white ethnicity (adjusted OR 2.43 (95% Confidence Interval 1.92-3.08)). The risk was greatest in women of Caribbean ethnicity (aOR 3.55 (2.30-5.48)). Among women of White ethnicity, risk of mortality increased as deprivation increased, but women of Black ethnicity had greater risk irrespective of deprivation. Using the UKOSS control comparator (n = 2210), after multiple adjustments including smoking, body mass index, and comorbidities, women of Black and Asian ethnicity remained at increased risk (aOR 3.13 (2.21-4.43) and 1.57 (1.16-2.12) respectively). Interpretation Known risk factors do not fully explain ethnic disparities in maternal mortality. The impact of socioeconomic deprivation appears to differ between ethnic groups. Funding This research is funded by the National Institute for Health and Care Research (NIHR) Policy Research Programme, conducted through the Policy Research Unit in Maternal and Neonatal Health and Care, PR-PRU-127-21202.
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Affiliation(s)
- Nicola Vousden
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK
| | - Kathryn Bunch
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK
| | - Sara Kenyon
- Institute of Applied Health Research, University of Birmingham, UK
| | - Jennifer J. Kurinczuk
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK
| | - Marian Knight
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK
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Miller V, Jenkins DA, Dehghan M, Srichaikul K, Rangarajan S, Mente A, Mohan V, Swaminathan S, Ismail R, Luz Diaz M, Ravindran RM, Zatonska K, Bahonar A, Altuntas Y, Khatib R, Lopez-Jaramillo P, Yusufali A, Yeates K, Chifamba J, Iqbal R, Yusuf R, Catherina Swart E, Bo H, Han G, Li X, Alhabib KF, Rosengren A, Avezum A, Lanas F, Yusuf S. Associations of the glycaemic index and the glycaemic load with risk of type 2 diabetes in 127 594 people from 20 countries (PURE): a prospective cohort study. Lancet Diabetes Endocrinol 2024; 12:330-338. [PMID: 38588684 DOI: 10.1016/s2213-8587(24)00069-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 02/25/2024] [Accepted: 02/26/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND The association between the glycaemic index and the glycaemic load with type 2 diabetes incidence is controversial. We aimed to evaluate this association in an international cohort with diverse glycaemic index and glycaemic load diets. METHODS The PURE study is a prospective cohort study of 127 594 adults aged 35-70 years from 20 high-income, middle-income, and low-income countries. Diet was assessed at baseline using country-specific validated food frequency questionnaires. The glycaemic index and the glycaemic load were estimated on the basis of the intake of seven categories of carbohydrate-containing foods. Participants were categorised into quintiles of glycaemic index and glycaemic load. The primary outcome was incident type 2 diabetes. Multivariable Cox Frailty models with random intercepts for study centre were used to calculate hazard ratios (HRs). FINDINGS During a median follow-up of 11·8 years (IQR 9·0-13·0), 7326 (5·7%) incident cases of type 2 diabetes occurred. In multivariable adjusted analyses, a diet with a higher glycaemic index was significantly associated with a higher risk of diabetes (quintile 5 vs quintile 1; HR 1·15 [95% CI 1·03-1·29]). Participants in the highest quintile of the glycaemic load had a higher risk of incident type 2 diabetes compared with those in the lowest quintile (HR 1·21, 95% CI 1·06-1·37). The glycaemic index was more strongly associated with diabetes among individuals with a higher BMI (quintile 5 vs quintile 1; HR 1·23 [95% CI 1·08-1·41]) than those with a lower BMI (quintile 5 vs quintile 1; 1·10 [0·87-1·39]; p interaction=0·030). INTERPRETATION Diets with a high glycaemic index and a high glycaemic load were associated with a higher risk of incident type 2 diabetes in a multinational cohort spanning five continents. Our findings suggest that consuming low glycaemic index and low glycaemic load diets might prevent the development of type 2 diabetes. FUNDING Full funding sources are listed at the end of the Article.
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Affiliation(s)
- Victoria Miller
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada.
| | - David A Jenkins
- Department of Nutritional Sciences and Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Toronto, ON, Canada; Clinical Nutrition Risk Factor Modification Centre, St Michael's Hospital, Toronto, ON, Canada; Division of Endocrinology and Metabolism, St Michael's Hospital, Toronto, ON, Canada
| | - Mahshid Dehghan
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Kristie Srichaikul
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Andrew Mente
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Viswanathan Mohan
- Department of Diabetology, Madras Diabetes Research Foundation & Dr Mohan's Diabetes Specialties Centre, Chennai, India
| | - Sumathi Swaminathan
- St John's Research Institute, St John's National Academy of Health Sciences, Bangalore, India
| | - Rosnah Ismail
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan, Kuala Lumpur, Malaysia
| | | | - Rekha M Ravindran
- Department of Health Sciences, Government of Kerala, Kerala, India; Health Action by People, Trivandrum, Kerala, India
| | | | - Ahmad Bahonar
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Yuksel Altuntas
- University of Health Sciences Turkey, Faculty of Medicine, Istanbul Sisli Hamidiye Etfal Health Training Research Hospital, Clinic of Endocrinology and Metabolism, Sisli/Istabul, Türkiye
| | - Rasha Khatib
- Advocate Aurora Research Institute, Milwaukee, WI, USA; Institute of Community and Public Health, Birzeit University, Birzeit, Palestine
| | | | | | - Karen Yeates
- Division of Nephrology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Jephat Chifamba
- Department of Biomedical Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Romaina Iqbal
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Rita Yusuf
- Center for Health, Population and Development, Independent University, Dhaka, Bangladesh
| | | | - Hu Bo
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Guoliang Han
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaocong Li
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Khalid F Alhabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University Medical City, King Saud University, Riyaadh, Saudi Arabia
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Alvaro Avezum
- International Research Center, Hospital Alemão-Oswaldo Cruz & UNISA, São Paulo, SP Brazil
| | | | - Salim Yusuf
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada
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Angriman F, Saoraya J, Lawler PR, Shah BR, Martin CM, Scales DC. Preexisting Diabetes Mellitus and All-Cause Mortality in Adult Patients With Sepsis: A Population-Based Cohort Study. Crit Care Explor 2024; 6:e1085. [PMID: 38709081 DOI: 10.1097/cce.0000000000001085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Abstract
OBJECTIVES We assessed the association of preexisting diabetes mellitus with all-cause mortality and organ support receipt in adult patients with sepsis. DESIGN Population-based cohort study. SETTING Ontario, Canada (2008-2019). POPULATION Adult patients (18 yr old or older) with a first sepsis-related hospitalization episode. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The main exposure of interest was preexisting diabetes (either type 1 or 2). The primary outcome was all-cause mortality by 90 days; secondary outcomes included receipt of invasive mechanical ventilation and new renal replacement therapy. We report adjusted (for baseline characteristics using standardization) risk ratios (RRs) alongside 95% CIs. A main secondary analysis evaluated the potential mediation by prior metformin use of the association between preexisting diabetes and all-cause mortality following sepsis. Overall, 503,455 adults with a first sepsis-related hospitalization episode were included; 36% had preexisting diabetes. Mean age was 73 years, and 54% of the cohort were females. Preexisting diabetes was associated with a lower adjusted risk of all-cause mortality at 90 days (RR, 0.81; 95% CI, 0.80-0.82). Preexisting diabetes was associated with an increased risk of new renal replacement therapy (RR, 1.53; 95% CI, 1.46-1.60) but not invasive mechanical ventilation (RR, 1.03; 95% CI, 1.00-1.05). Overall, 21% (95% CI, 19-28) of the association between preexisting diabetes and reduced risk of all-cause mortality was mediated by prior metformin use. CONCLUSIONS Preexisting diabetes is associated with a lower risk of all-cause mortality and higher risk of new renal replacement therapy among adult patients with sepsis. Future studies should evaluate the underlying mechanisms of these associations.
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Affiliation(s)
- Federico Angriman
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Jutamas Saoraya
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Faculty of Medicine, Chulalongkorn University, Pathum Wan, Bangkok, Thailand
- McGill University Health Centre, Montreal, QC, Canada
- ICES, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Critical Care, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
| | - Patrick R Lawler
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- McGill University Health Centre, Montreal, QC, Canada
| | - Baiju R Shah
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Faculty of Medicine, Chulalongkorn University, Pathum Wan, Bangkok, Thailand
- McGill University Health Centre, Montreal, QC, Canada
- ICES, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Critical Care, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
| | - Claudio M Martin
- Division of Critical Care, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
| | - Damon C Scales
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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10
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Bookwalter DB, Reese SE, Bougie DW. Reply: ABO nonidentical platelet transfusions and mortality. Transfusion 2024; 64:956-957. [PMID: 38733608 DOI: 10.1111/trf.17841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 03/31/2024] [Indexed: 05/13/2024]
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11
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Hone T, Gonçalves J, Seferidi P, Moreno-Serra R, Rocha R, Gupta I, Bhardwaj V, Hidayat T, Cai C, Suhrcke M, Millett C. Progress towards universal health coverage and inequalities in infant mortality: an analysis of 4·1 million births from 60 low-income and middle-income countries between 2000 and 2019. Lancet Glob Health 2024; 12:e744-e755. [PMID: 38614628 DOI: 10.1016/s2214-109x(24)00040-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/14/2024] [Accepted: 01/19/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Expanding universal health coverage (UHC) might not be inherently beneficial to poorer populations without the explicit targeting and prioritising of low-income populations. This study examines whether the expansion of UHC between 2000 and 2019 is associated with reduced socioeconomic inequalities in infant mortality in low-income and middle-income countries (LMICs). METHODS We did a retrospective analysis of birth data compiled from Demographic and Health Surveys (DHSs). We analysed all births between 2000 and 2019 from all DHSs available for this period. The primary outcome was infant mortality, defined as death within 1 year of birth. Logistic regression models with country and year fixed effects assessed associations between country-level progress to UHC (using WHO's UHC service coverage index) and infant mortality (overall and by wealth quintile), adjusting for infant-level, mother-level, and country-level variables. FINDINGS A total of 4 065 868 births to 1 833 011 mothers were analysed from 177 DHSs covering 60 LMICs between 2000 and 2019. A one unit increase in the UHC index was associated with a 1·2% reduction in the risk of infant death (AOR 0·988, 95% CI 0·981-0·995; absolute measure of association, 0·57 deaths per 1000 livebirths). An estimated 15·5 million infant deaths were averted between 2000 and 2019 because of increases in UHC. However, richer wealth quintiles had larger associated reductions in infant mortality from UHC (quintile 5 AOR 0·983, 95% CI 0·973-0·993) than poorer quintiles (quintile 1 0·991, 0·985-0·998). In the early stages of UHC, UHC expansion was generally beneficial to poorer populations (ie, larger reductions in infant mortality for poorer households [infant deaths per 1000 per one unit increase in UHC coverage: quintile 1 0·84 vs quintile 5 0·59]), but became less so as overall coverage increased (quintile 1 0·64 vs quintile 5 0·57). INTERPRETATION Since UHC expansion in LMICs appears to become less beneficial to poorer populations as coverage increases, UHC policies should be explicitly designed to ensure lower income groups continue to benefit as coverage expands. FUNDING UK National Institute for Health and Care Research.
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Affiliation(s)
- Thomas Hone
- Public Health Policy Evaluation Unit, Imperial College London, London, UK; Instituto de Estudos para Políticas de Saúde, São Paulo, Brazil.
| | - Judite Gonçalves
- Public Health Policy Evaluation Unit, Imperial College London, London, UK; NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, NOVA University Lisbon, Lisbon, Portugal
| | - Paraskevi Seferidi
- Public Health Policy Evaluation Unit, Imperial College London, London, UK
| | | | - Rudi Rocha
- Instituto de Estudos para Políticas de Saúde, São Paulo, Brazil; São Paulo School of Business Administration, Fundação Getulio Vargas, São Paulo, Brazil
| | - Indrani Gupta
- Institute of Economic Growth, University of Delhi, Delhi, India
| | - Vinayak Bhardwaj
- South African Medical Research Council and Wits Centre for Health Economics and Decision Science, PRICELESS South Africa, Faculty of Health Sciences, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Taufik Hidayat
- Center for Health Economics and Policy Studies, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia; Department of Economics, University of Sussex, Brighton, UK
| | - Chang Cai
- Public Health Policy Evaluation Unit, Imperial College London, London, UK
| | - Marc Suhrcke
- Centre for Health Economics, University of York, Heslington, York, UK; Luxembourg Institute of Socio-economic Research, Esch-sur-Alzette, Luxembourg
| | - Christopher Millett
- Public Health Policy Evaluation Unit, Imperial College London, London, UK; NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, NOVA University Lisbon, Lisbon, Portugal
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12
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Yan R, Kurz M, Guerra-Alejos BC, Min JE, Bach P, Greenland S, Gustafson P, Karim E, Korthuis PT, Loughin T, McCandless L, Platt RW, Schnepel K, Seaman S, Socías ME, Wood E, Xie H, Nosyk B. What is the ideal time to begin tapering opioid agonist treatment? A protocol for a retrospective population-based comparative effectiveness study in British Columbia, Canada. BMJ Open 2024; 14:e083453. [PMID: 38684262 PMCID: PMC11086281 DOI: 10.1136/bmjopen-2023-083453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/26/2024] [Indexed: 05/02/2024] Open
Abstract
INTRODUCTION Opioid agonist treatment (OAT) tapering involves a gradual reduction in daily medication dose to ultimately reach a state of opioid abstinence. Due to the high risk of relapse and overdose after tapering, this practice is not recommended by clinical guidelines, however, clients may still request to taper off medication. The ideal time to initiate an OAT taper is not known. However, ethically, taper plans should acknowledge clients' preferences and autonomy but apply principles of shared informed decision-making regarding safety and efficacy. Linked population-level data capturing real-world tapering practices provide a valuable opportunity to improve existing evidence on when to contemplate starting an OAT taper. Our objective is to determine the comparative effectiveness of alternative times from OAT initiation at which a taper can be initiated, with a primary outcome of taper completion, as observed in clinical practice in British Columbia (BC), Canada. METHODS AND ANALYSIS We propose a population-level retrospective observational study with a linkage of eight provincial health administrative databases in BC, Canada (01 January 2010 to 17 March 2020). Our primary outcomes include taper completion and all-cause mortality during treatment. We propose a 'per-protocol' target trial to compare different durations to taper initiation on the likelihood of taper completion. A range of sensitivity analyses will be used to assess the heterogeneity and robustness of the results including assessment of effectiveness and safety. ETHICS AND DISSEMINATION The protocol, cohort creation and analysis plan have been classified and approved as a quality improvement initiative by Providence Health Care Research Ethics Board and the Simon Fraser University Office of Research Ethics. Results will be disseminated to local advocacy groups and decision-makers, national and international clinical guideline developers, presented at international conferences and published in peer-reviewed journals electronically and in print.
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Affiliation(s)
- Ruyu Yan
- Centre for Advancing Health Outcomes, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Megan Kurz
- Centre for Advancing Health Outcomes, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | | | - Jeong Eun Min
- Centre for Advancing Health Outcomes, Vancouver, British Columbia, Canada
| | - Paxton Bach
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
| | - Sander Greenland
- Department of Epidemiology and Department of Statistics, UCLA, Los Angeles, California, USA
| | - Paul Gustafson
- Department of Statistics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ehsan Karim
- Centre for Advancing Health Outcomes, Vancouver, British Columbia, Canada
- School of Population and Public Health, UBC, Vancouver, British Columbia, Canada
| | - P Todd Korthuis
- School of Public Health, OHSU, Portland, Oregon, USA
- Section of Addiction Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Tom Loughin
- Department of Statistics and Actuarial Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Lawrence McCandless
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Department of Statistics and Actuarial Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Robert W Platt
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Kevin Schnepel
- Department of Economics, Simon Fraser University, Burnaby, British Columbia, Canada
| | | | - M Eugenia Socías
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
| | - Evan Wood
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Clinical Research, BC Centre on Substance Use, Vancouver, British Columbia, Canada
| | - Hui Xie
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Bohdan Nosyk
- Centre for Advancing Health Outcomes, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
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13
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Winter L, Moriarty H, Robinson KM, Leiby BE, Schmidt K, Whitehouse CR, Swanson RL. Age Suppresses the Association Between Traumatic Brain Injury Severity and Functional Outcomes: A Study Using the NIDILRR TBIMS Dataset. J Head Trauma Rehabil 2024:00001199-990000000-00145. [PMID: 38652669 DOI: 10.1097/htr.0000000000000955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
OBJECTIVES Recovery from traumatic brain injury (TBI) is extremely difficult to predict, with TBI severity usually demonstrating weak predictive validity for functional or other outcomes. A possible explanation may lie in the statistical phenomenon called suppression, according to which a third variable masks the true association between predictor and outcome, making it appear weaker than it actually is. Age at injury is a strong candidate as a suppressor because of its well-established main and moderating effects on TBI outcomes. We tested age at injury as a possible suppressor in the predictive chain of effects between TBI severity and functional disability, up to 10 years post-TBI. SETTING Follow-up interviews were conducted during telephone interviews. PARTICIPANTS We used data from the 2020 NDILRR Model Systems National Dataset for 4 successive follow-up interviews: year 1 (n = 10,734), year 2 (n = 9174), year 5 (n = 6,201), and year 10 (n = 3027). DESIGN Successive cross-sectional multiple regression analyses. MAIN MEASURES Injury severity was operationalized using a categorical variable representing duration of posttrauma amnesia. The Glasgow Outcomes Scale-Extended (GOS-E) operationally defined functioning. Sociodemographic characteristics having significant bivariate correlations with GOS-E were included. RESULTS Entry of age at injury into the regression models significantly increases the association between TBI severity and functioning up to 10 years post-TBI. CONCLUSIONS Age at injury is a suppressor variable, masking the true effect of injury severity on functional outcomes. Identifying the mediators of this suppression effect is an important direction for TBI rehabilitation research.
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Affiliation(s)
- Laraine Winter
- Author Affiliations: M. Louise Fitzpatrick College of Nursing (Drs Winter and Whitehouse), Villanova University, Villanova, Pennsylvania; Research Service (Dr Winter, Dr Moriarty, and Ms Schmidt), Nursing Service (Dr Moriarty), Physical Medicine and Rehabilitation/Rehabilitation Medicine Service (Dr Robinson and Dr Swanson), Center for Neurotrauma, Neurodegeneration and Restoration (Dr Swanson), Corporal Michael J. Crescenz Veterans Affairs Medical Center, Department of Physical Medicine and Rehabilitation (Dr Robinson and Dr Swanson), Perelman School of Medicine, University of Pennsylvania, and Division of Biostatistics, Department of Pharmacology, Physiology, and Cancer Biology (Dr Leiby), Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
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14
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Narita Z, Hidese S, Kanehara R, Tachimori H, Hori H, Kim Y, Kunugi H, Arima K, Mizukami S, Tanno K, Takanashi N, Yamagishi K, Muraki I, Yasuda N, Saito I, Maruyama K, Yamaji T, Iwasaki M, Inoue M, Tsugane S, Sawada N. Association of sugary drinks, carbonated beverages, vegetable and fruit juices, sweetened and black coffee, and green tea with subsequent depression: A five-year cohort study. Clin Nutr 2024; 43:1395-1404. [PMID: 38691982 DOI: 10.1016/j.clnu.2024.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 04/10/2024] [Accepted: 04/12/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND & AIMS Evidence on the impact of beverage consumption on depression is limited in the Asian population. Specifically, there is little information available on vegetable and fruit juices, while whole vegetables and fruits are reportedly protective against depression. Furthermore, evidence is scarce in differentiating the impacts of sweetened and black coffee. We aimed to examine the association of the consumption of total sugary drinks, carbonated beverages, vegetable and fruit juices, sweetened and black coffee, and green tea with subsequent depression in a general population sample. METHODS We studied individuals without a history of cancer, myocardial infarction, stroke, diabetes, or depression at baseline in 2011-2016, with a five-year follow-up. We used Poisson regression models and the g-formula, thereby calculating the risk difference (RD) for depression. Multiple sensitivity analyses were conducted. Missing data were handled using random forest imputation. We also examined effect heterogeneity based on sex, age, and body mass index by analyzing the relative excess risk due to interaction and the ratio of risk ratios. RESULTS In total, 94,873 individuals were evaluated, and 80,497 completed the five-year follow-up survey for depression. Of these, 18,172 showed depression. When comparing the high consumption group with the no consumption group, the fully adjusted RD (95% CI) was 3.6% (2.8% to 4.3%) for total sugary drinks, 3.5% (2.1% to 4.7%) for carbonated beverages, 2.3% (1.3% to 3.4%) for vegetable juice, 2.4% (1.1% to 3.6%) for 100% fruit juice, and 2.6% (1.9% to 3.5%) for sweetened coffee. In contrast, the fully adjusted RD (95% CI) was -1.7% (-2.6% to -0.7%) for black coffee. The fully adjusted RD for green tea did not reach statistical significance. The results were robust in multiple sensitivity analyses. We did not find substantial effect heterogeneity based on sex, age, and body mass index. CONCLUSIONS Total sugary drinks, carbonated beverages, vegetable and fruit juices, and sweetened coffee may increase the risk of depression, whereas black coffee may decrease it.
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Affiliation(s)
- Zui Narita
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
| | | | - Rieko Kanehara
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Hisateru Tachimori
- Department of Information Medicine, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan; Endowed Course for Health System Innovation, Keio University School of Medicine, Tokyo, Japan
| | - Hiroaki Hori
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Yoshiharu Kim
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Hiroshi Kunugi
- Department of Psychiatry, Teikyo University, Tokyo, Japan
| | - Kazuhiko Arima
- Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Satoshi Mizukami
- Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kozo Tanno
- Department of Hygiene and Preventive Medicine, Iwate Medical University, Yahaba-cho, Japan
| | - Nobuyuki Takanashi
- Department of Hygiene and Preventive Medicine, Iwate Medical University, Yahaba-cho, Japan
| | - Kazumasa Yamagishi
- Department of Public Health Medicine, Institute of Medicine, and Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan; Ibaraki Western Medical Center, Chikusei, Japan
| | - Isao Muraki
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Japan
| | - Nobufumi Yasuda
- Department of Public Health, Kochi University Medical School, Kochi, Japan
| | - Isao Saito
- Department of Public Health and Epidemiology, Faculty of Medicine, Oita University, Yufu, Japan
| | - Koutatsu Maruyama
- Department of Bioscience, Graduate School of Agriculture, Ehime University, Matsuyama, Japan
| | - Taiki Yamaji
- Division of Epidemiology, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Motoki Iwasaki
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan; Division of Epidemiology, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Manami Inoue
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan; Division of Prevention, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Shoichiro Tsugane
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan; International University of Health and Welfare Graduate School of Public Health, Tokyo, Japan
| | - Norie Sawada
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan.
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15
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Zhang Y, Munshi S, Burrows K, Kuplicki R, Figueroa-Hall LK, Aupperle RL, Khalsa SS, Teague TK, Yasuyuki T, Paulus MP, Savitz J, Zheng H. Leptin's Inverse Association with Brain Morphology and Depressive Symptoms - A Discovery and Confirmatory Study Across Two Independent Samples. Biol Psychiatry Cogn Neurosci Neuroimaging 2024:S2451-9022(24)00105-8. [PMID: 38631553 DOI: 10.1016/j.bpsc.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 04/04/2024] [Accepted: 04/05/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Major Depressive Disorder (MDD) has a complex, bi-directional relationship with metabolic dysfunction, yet the neural correlates of this association are not well understood. METHOD In this cross-sectional investigation, we employed a two-step 'discovery and confirmatory' strategy, utilizing two independent samples (Sample 1: 288 participants, Sample 2: 196 participants) to examine the association between circulating indicators of metabolic health (leptin and adiponectin) and brain structures in individuals with MDD. RESULTS We found a replicable inverse correlation between leptin levels and cortical surface area within essential brain areas responsible for emotion regulation, such as the left posterior cingulate cortex, right pars orbitalis, right superior temporal gyrus, and right insula (standardized beta coefficient (SBC) ranged: -0.27 to -0.49, puncorrected <0.05). Notably, this relationship was independent of C-Reactive Protein levels. We also identified a significant interaction effect of leptin levels and diagnosis on the cortical surface area of the right superior temporal gyrus (SBC = 0.26 in sample 1, SBC = 0.30 in sample 2, puncorrected < 0.05). We also observed a positive correlation between leptin levels and atypical depressive symptoms in both MDD groups (r = 0.14 in sample 1, r = 0.29 in sample 2, puncorrected < 0.05). CONCLUSION The inverse association between leptin and cortical surface area in brain regions that are important for emotion processing and leptin's association with sleep disturbances supports the hypothesis that metabolic processes may be related to emotion regulation. However, the molecular mechanisms through which leptin might exert these effects should be explored further.
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Affiliation(s)
- Ye Zhang
- Department of Aging Research and Geriatric Medicine, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan.
| | | | | | | | - Leandra K Figueroa-Hall
- Laureate Institute for Brain Research, Tulsa, OK, USA; Oxley College of Health Sciences, The University of Tulsa, Tulsa, OK, USA
| | - Robin L Aupperle
- Laureate Institute for Brain Research, Tulsa, OK, USA; Oxley College of Health Sciences, The University of Tulsa, Tulsa, OK, USA
| | - Sahib S Khalsa
- Laureate Institute for Brain Research, Tulsa, OK, USA; Oxley College of Health Sciences, The University of Tulsa, Tulsa, OK, USA
| | - T Kent Teague
- Department of Surgery, University of Oklahoma School of Community Medicine, Tulsa, OK, USA; Department of Psychiatry, University of Oklahoma School of Community Medicine, Tulsa, OK, USA; Department of Pharmaceutical Sciences, University of Oklahoma College of Pharmacy, Tulsa, OK, USA
| | - Taki Yasuyuki
- Department of Aging Research and Geriatric Medicine, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan; Department of Geriatric Medicine and Neuroimaging, Tohoku University Hospital, Sendai, Japan; Smart-Aging Research Center, Tohoku University, Sendai, Japan
| | - Martin P Paulus
- Laureate Institute for Brain Research, Tulsa, OK, USA; Oxley College of Health Sciences, The University of Tulsa, Tulsa, OK, USA
| | - Jonathan Savitz
- Laureate Institute for Brain Research, Tulsa, OK, USA; Oxley College of Health Sciences, The University of Tulsa, Tulsa, OK, USA
| | - Haixia Zheng
- Laureate Institute for Brain Research, Tulsa, OK, USA; Oxley College of Health Sciences, The University of Tulsa, Tulsa, OK, USA
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Danka MN, Steptoe A, Iob E. Physical activity, low-grade inflammation, and psychological responses to the COVID-19 pandemic among older adults in England. medRxiv 2024:2024.04.14.24305797. [PMID: 38699297 PMCID: PMC11065037 DOI: 10.1101/2024.04.14.24305797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Mental health responses to the COVID-19 pandemic have been widely studied, but less is known about the potentially protective role of physical activity (PA) and the impact of low-grade inflammation. Using a sample of older adults from England, this study tested (1) if pre-pandemic PA and its changes during the pandemic were associated with mental health responses; (2) if older adults with low-grade inflammation experienced greater increases in depression and anxiety, compared to pre-pandemic levels; (3) if PA attenuated the association between inflammation and depression/anxiety. The study used data from the English Longitudinal Study of Ageing, a cohort study following a national sample aged 50+. Information on mental health and PA were collected before the pandemic (2016/17 and 2018/19) and during November and December 2020. Inflammation was ascertained using pre-pandemic C-reactive protein (CRP). Analyses were adjusted for sociodemographic and health-related factors and pre-pandemic mental health. Increasing PA from before to during the pandemic was linked to reduced odds of depression (OR = 0.955, 95%CI [0.937, 0.974]) and anxiety (OR = 0.954, 95%CI [0.927; 0.982]). Higher pre-pandemic PA was associated with reduced odds of depression (OR = 0.964, 95%CI [0.948, 0.981]) and anxiety (OR = 0.976, 95%CI [0.953, 1.000]), whereas elevated CRP was associated with 1.343 times higher odds of depression (95%CI [1.100, 1.641]). PA did not attenuate the inflammation-depression association. The findings suggest that PA may contribute to psychological resilience among older adults, independently of inflammation. Further research is needed to explore the psychobiological pathways underlying this protective mechanism.
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Affiliation(s)
- Martin N. Danka
- Centre for Longitudinal Studies, University College London, UK
- Department of Behavioural Science and Health, University College London, UK
| | - Andrew Steptoe
- Department of Behavioural Science and Health, University College London, UK
| | - Eleonora Iob
- Department of Behavioural Science and Health, University College London, UK
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17
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Chong MY, Eussen SJPM, van Roekel EH, Pot GK, Koster A, Breukink SO, Janssen-Heijnen MLG, Keulen ETP, Stehouwer CDA, Weijenberg MP, Bours MJL. Longitudinal associations of circadian eating patterns with sleep quality, fatigue and inflammation in colorectal cancer survivors up to 24 months post-treatment. Br J Nutr 2024; 131:1166-1180. [PMID: 38012842 PMCID: PMC10918519 DOI: 10.1017/s0007114523002714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 09/29/2023] [Accepted: 11/21/2023] [Indexed: 11/29/2023]
Abstract
Fatigue and insomnia, potentially induced by inflammation, are distressing symptoms experienced by colorectal cancer (CRC) survivors. Emerging evidence suggests that besides the nutritional quality and quantity, also the timing, frequency and regularity of dietary intake (chrono-nutrition) could be important for alleviating these symptoms. We investigated longitudinal associations of circadian eating patterns with sleep quality, fatigue and inflammation in CRC survivors. In a prospective cohort of 459 stage I-III CRC survivors, four repeated measurements were performed between 6 weeks and 24 months post-treatment. Chrono-nutrition variables included meal energy contribution, frequency (a maximum of six meals could be reported each day), irregularity and time window (TW) of energetic intake, operationalised based on 7-d dietary records. Outcomes included sleep quality, fatigue and plasma concentrations of inflammatory markers. Longitudinal associations of chrono-nutrition variables with outcomes from 6 weeks until 24 months post-treatment were analysed by confounder-adjusted linear mixed models, including hybrid models to disentangle intra-individual changes from inter-individual differences over time. An hour longer TW of energetic intake between individuals was associated with less fatigue (β: -6·1; 95 % CI (-8·8, -3·3)) and insomnia (β: -4·8; 95 % CI (-7·4, -2·1)). A higher meal frequency of on average 0·6 meals/d between individuals was associated with less fatigue (β: -3·7; 95 % CI (-6·6, -0·8)). An hour increase in TW of energetic intake within individuals was associated with less insomnia (β: -3·0; 95 % CI (-5·2, -0·8)) and inflammation (β: -0·1; 95 % CI (-0·1, 0·0)). Our results suggest that longer TWs of energetic intake and higher meal frequencies may be associated with less fatigue, insomnia and inflammation among CRC survivors. Future studies with larger contrasts in chrono-nutrition variables are needed to confirm these findings.
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Affiliation(s)
- Marvin Y. Chong
- Department of Epidemiology, GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
- Department of Epidemiology, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
- Department of Epidemiology, CAPHRI School for Care and Public Health Research, Maastricht University, Maastricht, The Netherlands
| | - Simone J. P. M. Eussen
- Department of Epidemiology, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
- Department of Epidemiology, CAPHRI School for Care and Public Health Research, Maastricht University, Maastricht, The Netherlands
| | - Eline H. van Roekel
- Department of Epidemiology, GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Gerda K. Pot
- Nutrition and Healthcare Alliance Hospital Gelderse Vallei, Ede, The Netherlands
| | - Annemarie Koster
- Department of Social Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Stéphanie O. Breukink
- Department of Surgery, GROW School for Oncology and Reproduction, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Maryska L. G. Janssen-Heijnen
- Department of Epidemiology, GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
- Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, The Netherlands
| | - Eric T. P. Keulen
- Department of Internal Medicine and Gastroenterology, Zuyderland Medical Centre Sittard-Geleen, Geleen, The Netherlands
| | - Coen D. A. Stehouwer
- Department of Internal Medicine, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Matty P. Weijenberg
- Department of Epidemiology, GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Martijn J. L. Bours
- Department of Epidemiology, GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
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Bäck M, Topouchian J, Labat C, Gautier S, Blacher J, Cwynar M, de la Sierra A, Pall D, Duarte K, Fantin F, Farkas K, Garcia-Ortiz L, Hakobyan Z, Jankowski P, Jelakovic A, Kotsani M, Konradi A, Mikhailova O, Mintale I, Plunde O, Ramos R, Rogoza A, Sirenko Y, Tasic N, Rudyk I, Urazalina S, Wohlfahrt P, Zelveian P, Asmar R, Benetos A. Cardio-ankle vascular index for predicting cardiovascular morbimortality and determinants for its progression in the prospective advanced approach to arterial stiffness (TRIPLE-A-Stiffness) study. EBioMedicine 2024:105107. [PMID: 38632024 DOI: 10.1016/j.ebiom.2024.105107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 03/22/2024] [Accepted: 03/23/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND The cardio-ankle vascular index (CAVI) measure of arterial stiffness is associated with prevalent cardiovascular risk factors, while its predictive value for cardiovascular events remains to be established. The aim was to determine associations of CAVI with cardiovascular morbimortality (primary outcome) and all-cause mortality (secondary outcome), and to establish the determinants of CAVI progression. METHODS TRIPLE-A-Stiffness, an international multicentre prospective longitudinal study, enrolled >2000 subjects ≥40 years old at 32 centres from 18 European countries. Of these, 1250 subjects (55% women) were followed for a median of 3.82 (2.81-4.69) years. FINDINGS Unadjusted cumulative incidence rates of outcomes according to CAVI stratification were higher in highest stratum (CAVI > 9). Cox regression with adjustment for age, sex, and cardiovascular risk factors revealed that CAVI was associated with increased cardiovascular morbimortality (HR 1.25 per 1 increase; 95% confidence interval, CI: 1.03-1.51) and all-cause mortality (HR 1.37 per 1 increase; 95% CI: 1.10-1.70) risk in subjects ≥60 years. In ROC analyses, CAVI optimal threshold was 9.25 (c-index 0.598; 0.542-0.654) and 8.30 (c-index 0.565; 0.512-0.618) in subjects ≥ or <60 years, respectively, to predict increased CV morbimortality. Finally, age, mean arterial blood pressure, anti-diabetic and lipid-lowering treatment were independent predictors of yearly CAVI progression adjusted for baseline CAVI. INTERPRETATION The present study identified additional value for CAVI to predict outcomes after adjustment for CV risk factors, in particular for subjects ≥60 years. CAVI progression may represent a modifiable risk factor by treatments. FUNDING International Society of Vascular Health (ISVH) and Fukuda Denshi, Japan.
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Affiliation(s)
- Magnus Bäck
- Department of Medicine Solna, Karolinska Institutet and Department of Cardiology Karolinska University Hospital, Stockholm, Sweden; Inserm U1116, Nancy, France; Université de Lorraine, CHRU Nancy, University Hospital of Nancy, France.
| | - Jirar Topouchian
- Paris-Descartes University, AP-HP, Diagnosis and Therapeutic Center, Hôtel Dieu, Paris, France
| | | | - Sylvie Gautier
- Université de Lorraine, CHRU Nancy, University Hospital of Nancy, France
| | - Jacques Blacher
- Paris-Descartes University, AP-HP, Diagnosis and Therapeutic Center, Hôtel Dieu, Paris, France
| | - Marcin Cwynar
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland
| | - Alejandro de la Sierra
- Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Terrassa, Spain
| | - Denes Pall
- Department of Medical Clinical Pharmacology, University of Debrecen, Hungary
| | - Kevin Duarte
- Université de Lorraine, CHRU Nancy, University Hospital of Nancy, France
| | - Francesco Fantin
- Department of Medicine, Section of Geriatric Medicine, University of Verona, Italy
| | - Katalin Farkas
- Cardiometabolic Centre, Dept. of Angiology, Szent Imre University Teaching Hospital, Budapest, Hungary
| | - Luis Garcia-Ortiz
- Primary Care Research Unit of Salamanca (APISAL), Biomedical Research Institute of Salamanca (IBSAL), Department of Biomedical and Diagnostic Sciences, University of Salamanca, Salamanca, Spain
| | - Zoya Hakobyan
- Institute of Cardiology, Centre of Preventive Cardiology, Yerevan, Armenia
| | - Piotr Jankowski
- Department of Internal Medicine and Geriatric Cardiology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Ana Jelakovic
- Department of Nephrology, Hypertension, Dialysis and Transplantation, University Hospital Centre, Zagreb, Croatia
| | - Marina Kotsani
- Université de Lorraine, CHRU Nancy, University Hospital of Nancy, France
| | | | - Oksana Mikhailova
- FSBI "Chazov National Medical Research Centre of Cardiology" of the Ministery of Health of the Russian Federation, Moscow, Russia
| | - Iveta Mintale
- P. Stradins University Hospital, Cardiology Centre, Riga, Latvia
| | - Oscar Plunde
- Department of Medicine Solna, Karolinska Institutet and Department of Cardiology Karolinska University Hospital, Stockholm, Sweden
| | - Rafael Ramos
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Department of Medical Sciences, University of Girona, Primary Care Services, Biomedical Research Institute, Institut Català de la Salut, Girona, Spain
| | - Anatoly Rogoza
- FSBI "Chazov National Medical Research Centre of Cardiology" of the Ministery of Health of the Russian Federation, Moscow, Russia
| | | | - Nebojsa Tasic
- Medical Faculty, University of Belgrade and Cardiovascular Institute, Dedinje, Belgrade, Serbia
| | - Iurii Rudyk
- Government Institution, L.T. Malaya Therapy Institute of the National Academy of Medical Sciences of Ukraine, Kharkov, Ukraine
| | - Saule Urazalina
- Scientific and Research Institute of Cardiology and Internal Diseases, Almaty, Kazakhstan
| | - Peter Wohlfahrt
- Department of Preventive Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Parounak Zelveian
- Institute of Cardiology, Centre of Preventive Cardiology, Yerevan, Armenia
| | - Roland Asmar
- Foundation-Medical Research Institutes, Paris, France
| | - Athanase Benetos
- Inserm U1116, Nancy, France; Université de Lorraine, CHRU Nancy, University Hospital of Nancy, France
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Kato K, Nakashima A, Morishita M, Ohkido I, Yokoo T. Calcium-based phosphate binders and bone mineral density in patients undergoing hemodialysis: a retrospective cohort study. Clin Exp Nephrol 2024:10.1007/s10157-024-02493-8. [PMID: 38594468 DOI: 10.1007/s10157-024-02493-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 03/19/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Calcium supplements are commonly prescribed to prevent fractures in patients with osteoporosis. Nonetheless, they are generally eschewed in hemodialysis patients because they increase vascular calcification and induce cardiovascular disease. This retrospective cohort study aimed to investigate the effect of calcium-based phosphate binders (CBPB) on bone mineral density (BMD) in hemodialysis patients. METHODS Outpatients on dialysis who underwent BMD measurement from January to December 2017, whose data on BMD trends and CBPB administration were recorded over the next 4 years, were enrolled. Patients receiving anti-osteoporotic medications were excluded. The association between the presence and duration of CBPB administration and changes in BMD was evaluated. RESULTS The femoral neck's BMD decreased from 0.836 g/cm2 (0.702-0.952) to 0.764 g/cm2 (0.636-0.896) (P < 0.001) in the non-CBPB group (patients who never received CBPB over 4 years, n = 32). The CBPB group (n = 56) exhibited only a minute decrease from 0.833 g/cm2 (0.736-0.965) to 0.824 g/cm2 (0.706-0.939) (P = 0.004). Multivariate linear regression analysis revealed better BMD maintenance in the CBPB group [β-coefficient (95% CI): 0.033 (0.001-0.065); P = 0.046] than in the non-CBPB group. Additionally, the prolonged-CBPB administration group showed superior BMD preservation [β-coefficient (95% CI): 0.038 (0.001-0.076); P = 0.042]. CONCLUSION CBPB administration may be associated with BMD maintenance.
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Affiliation(s)
- Kazuhiko Kato
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi Minato-Ku, Tokyo, 105-8461, Japan
- Division of Molecular Epidemiology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Nephrology, Morishita Memorial Hospital, Kanagawa, Japan
| | - Akio Nakashima
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi Minato-Ku, Tokyo, 105-8461, Japan.
| | | | - Ichiro Ohkido
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi Minato-Ku, Tokyo, 105-8461, Japan
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi Minato-Ku, Tokyo, 105-8461, Japan
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20
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Aarsman SR, Greenwood CJ, Linardon J, Rodgers RF, Messer M, Jarman HK, Fuller-Tyszkiewicz M. Enhancing inferences and conclusions in body image focused non-experimental research via a causal modelling approach: A tutorial. Body Image 2024; 49:101704. [PMID: 38579514 DOI: 10.1016/j.bodyim.2024.101704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 02/29/2024] [Accepted: 03/06/2024] [Indexed: 04/07/2024]
Abstract
Causal inference is often the goal of psychological research. However, most researchers refrain from drawing causal conclusions based on non-experimental evidence. Despite the challenges associated with producing causal evidence from non-experimental data, it is crucial to address causal questions directly rather than avoiding them. Here we provide a clear, non-technical overview of the fundamental concepts (including the counterfactual framework and related assumptions) and tools that permit causal inference in non-experimental data, intended as a starting point for readers unfamiliar with the literature. Certain tools, such as the target trial framework and causal diagrams, have been developed to assist with the identification and reduction of potential biases in study design and analysis and the interpretation of findings. We apply these concepts and tools to a motivating example from the body image field. We assert that more precise and detailed elucidation of the barriers to causal inference within one's study is arguably a key first step in the enhancement of non-experimental research and future intervention development and evaluation.
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Affiliation(s)
- Stephanie R Aarsman
- Deakin University, School of Psychology, Faculty of Health, SEED Lifespan Strategic Research Centre for the Developmental Origins of Health and Wellbeing, Geelong, Australia; Centre for Adolescent Health, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia.
| | - Christopher J Greenwood
- Deakin University, School of Psychology, Faculty of Health, SEED Lifespan Strategic Research Centre for the Developmental Origins of Health and Wellbeing, Geelong, Australia; Centre for Adolescent Health, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia; University of Melbourne, Department of Paediatrics, Royal Children's Hospital, Melbourne, Australia
| | - Jake Linardon
- Deakin University, School of Psychology, Faculty of Health, SEED Lifespan Strategic Research Centre for the Developmental Origins of Health and Wellbeing, Geelong, Australia
| | - Rachel F Rodgers
- APPEAR, Department of Applied Psychology, Northeastern University, Boston, USA; Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, CHRU Montpellier, France
| | - Mariel Messer
- Deakin University, School of Psychology, Faculty of Health, SEED Lifespan Strategic Research Centre for the Developmental Origins of Health and Wellbeing, Geelong, Australia
| | - Hannah K Jarman
- Deakin University, School of Psychology, Faculty of Health, SEED Lifespan Strategic Research Centre for the Developmental Origins of Health and Wellbeing, Geelong, Australia
| | - Matthew Fuller-Tyszkiewicz
- Deakin University, School of Psychology, Faculty of Health, SEED Lifespan Strategic Research Centre for the Developmental Origins of Health and Wellbeing, Geelong, Australia
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21
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Ling RR, Ueno R, Alamgeer M, Sundararajan K, Sundar R, Bailey M, Pilcher D, Subramaniam A. FRailty in Australian patients admitted to Intensive care unit after eLective CANCER-related SURGery: a retrospective multicentre cohort study (FRAIL-CANCER-SURG study). Br J Anaesth 2024; 132:695-706. [PMID: 38378383 DOI: 10.1016/j.bja.2024.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND The association between frailty and short-term and long-term outcomes in patients receiving elective surgery for cancer remains unclear, particularly in those admitted to the ICU. METHODS In this multicentre retrospective cohort study, we included adults ≥16 yr old admitted to 158 ICUs in Australia from January 1, 2018 to March 31, 2022 after elective surgery for cancer. We investigated the association between frailty and survival time up to 4 yr (primary outcome), adjusting for a prespecified set of covariates. We analysed how this association changed in specific subgroups (age categories [<65, 65-80, ≥80 yr], and those who survived hospitalisation), and over time by splitting the survival information at monthly intervals. RESULTS We included 35,848 patients (median follow-up: 18.1 months [inter-quartile range: 8.3-31.1 months], 19,979 [56.1%] male, median age 69.0 yr [inter-quartile range: 58.8-76.0 yr]). Some 3502 (9.8%) patients were frail (defined as clinical frailty scale ≥5). Frailty was associated with lower survival (hazard ratio: 1.72, 95% confidence interval [CI]: 1.59-1.86 compared with clinical frailty scale ≤4); this was concordant across several sensitivity analyses. Frailty was most strongly associated with mortality early on in follow-up, up to 10 months (hazard ratio: 1.39, 95% CI: 1.03-1.86), but this association plateaued, and its predictive capacity subsequently diminished with time up until 4 yr (1.96, 95% CI: 0.73-5.28). Frailty was associated with similar effects when stratified based on age, and in those who survived hospitalisation. CONCLUSIONS Frailty was associated with poorer outcomes after an ICU admission after elective surgery for cancer, particularly in the short term. However, its predictive capacity with time diminished, suggesting a potential need for longitudinal reassessment to ensure appropriate prognostication in this population.
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Affiliation(s)
- Ryan R Ling
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore; Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Ryo Ueno
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Intensive Care, Box Hill Hospital, Eastern Health, Box Hill, VIC, Australia
| | - Muhammad Alamgeer
- Department of Medicine/School of Clinical Sciences, Monash University, Clayton, VIC, Australia; Department of Medical Oncology, Monash Health, Clayton, VIC, Australia; Centre for Cancer Research, Hudson Institute of Medical Research, Monash University, Clayton, VIC, Australia
| | - Krishnaswamy Sundararajan
- Department of Intensive Care, Royal Adelaide Hospital, Adelaide, SA, Australia; Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Raghav Sundar
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore; Department of Haematology-Oncology, National University Cancer Institute, National University Hospital, Singapore; Cancer and Stem Cell Biology Program, Duke-NUS Medical School, Singapore; The N.1 Institute for Health, National University of Singapore, Singapore; Singapore Gastric Cancer Consortium, Singapore
| | - Michael Bailey
- Department of Intensive Care, Box Hill Hospital, Eastern Health, Box Hill, VIC, Australia
| | - David Pilcher
- Department of Intensive Care, Box Hill Hospital, Eastern Health, Box Hill, VIC, Australia; Centre for Outcome and Resource Evaluation, Australian and New Zealand Intensive Care Society, Melbourne, VIC, Australia; Department of Intensive Care, Alfred Hospital, Melbourne, VIC, Australia
| | - Ashwin Subramaniam
- Department of Intensive Care, Box Hill Hospital, Eastern Health, Box Hill, VIC, Australia; Department of Intensive Care, Peninsula Health, Frankston, VIC, Australia; Department of Intensive Care, Dandenong Hospital, Dandenong, VIC, Australia; Peninsula Clinical School, Monash University, Frankston, VIC, Australia.
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22
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LoMartire R, Frumento P, Johansson P. Misconceptions Hinder the Progress of Evidence-based Interdisciplinary Treatment. J Pain 2024; 25:1108-1109. [PMID: 38276918 DOI: 10.1016/j.jpain.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/02/2024] [Accepted: 01/02/2024] [Indexed: 01/27/2024]
Affiliation(s)
- Riccardo LoMartire
- Center for Clinical Research Dalarna, Uppsala University, Falun, Region Dalarna, Sweden; School of Health and Welfare, Dalarna University, Falun, Region Dalarna, Sweden
| | - Paolo Frumento
- Department of Political Sciences, University of Pisa, Pisa, Administrative Region of Tuscany, Italy
| | - Per Johansson
- Department of Statistics, Uppsala University, Uppsala, Region Uppsala, Sweden; Yau Mathematical Science Center, Tsinghua University, Beijing, China
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Sheredy SA, Stone AC, Mostafavifar AM, Mostafavifar LG, Smith RM, Doepker BA. Risk Stratification for Supratherapeutic Peak Anti-Xa Levels in Adult Patients on Therapeutic Enoxaparin. Ann Pharmacother 2024; 58:366-374. [PMID: 37515524 DOI: 10.1177/10600280231189488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2023] Open
Abstract
BACKGROUND The American Society of Hematology Guidelines for the management of venous thromboembolism recommend against the use of anti-Xa monitoring for assessing enoxaparin dosing based on a low level of evidence associating supratherapeutic levels with an increased risk of bleeding. However, institutions still utilize anti-Xa levels in select patient populations with altered volume of distribution and/or excretion to monitor and adjust therapy. OBJECTIVE The primary objective of this study was to identify risk factors associated with supratherapeutic peak anti-Xa levels (≥1.10 IU/mL) for patients receiving therapeutic enoxaparin. METHODS This was a retrospective single-center study performed at an academic tertiary care hospital. Patients who received enoxaparin at 1 mg/kg twice daily and peak anti-Xa monitoring were separated into supratherapeutic and therapeutic/subtherapeutic cohorts. RESULTS A total of 436 patients were screened, and 215 were included, with a mean age of 62 years. There were 108 in the therapeutic/subtherapeutic cohort and 107 in the supratherapeutic cohort. Acute kidney injury (AKI), body mass index (BMI), weight, female sex, intensive care unit (ICU) service, Sequential Organ Failure Assessment (SOFA) score ≥4, and creatinine clearance at the time of peak anti-Xa level collection were associated with supratherapeutic anti-Xa levels in univariate models. Adjusted logistic regression models were created and identified BMI in the 30 to 34.9 kg/m2 (odds ratio [OR] 4.35; 95% confidence interval [CI] 1.70-11.13, P < 0.005) and ≥35 kg/m2 (OR 6.75; 95% CI 3.05-14.94, P < 0.005) and AKI (OR 2.62; 95% CI 1.04-6.62, P = 0.042) as significant risk factors for supratherapeutic anti-Xa levels. CONCLUSION AND RELEVANCE Our study identified BMI ≥ 30 kg/m2, AKI, female sex, ICU service, SOFA score ≥4, and creatinine clearance as risk factors for supratherapeutic anti-Xa levels in patients receiving 1 mg/kg twice daily dosing of enoxaparin. Further research should be done to provide evidence for the association between anti-Xa levels and bleeding risk.
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Affiliation(s)
- Shane A Sheredy
- Department of Pharmacy, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Andrew C Stone
- Department of Pharmacy, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Ahmad M Mostafavifar
- Department of Pharmacy, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | | | - Rachel M Smith
- Center for Biostatistics and Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
| | - Bruce A Doepker
- Department of Pharmacy, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
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24
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Aoki T, Sadashima E, Kobayashi K, Yamauchi A, Yamada A, Omori J, Ikeya T, Aoyama T, Tominaga N, Sato Y, Kishino T, Ishii N, Sawada T, Murata M, Takao A, Mizukami K, Kinjo K, Fujimori S, Uotani T, Fujita M, Sato H, Hayakawa Y, Fujishiro M, Kaise M, Nagata N. High risk stigmata and treatment strategy for acute lower gastrointestinal bleeding: a nationwide study in Japan. Endoscopy 2024; 56:291-301. [PMID: 38354743 DOI: 10.1055/a-2232-9630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
BACKGROUND The rebleeding risks and outcomes of endoscopic treatment for acute lower gastrointestinal bleeding (ALGIB) may differ depending on the bleeding location, type, and etiology of stigmata of recent hemorrhage (SRH) but have yet to be fully investigated. We aimed to identify high risk endoscopic SRH and to propose an optimal endoscopic treatment strategy. METHODS We retrospectively analyzed 2699 ALGIB patients with SRH at 49 hospitals (CODE BLUE-J Study), of whom 88.6 % received endoscopic treatment. RESULTS 30-day rebleeding rates of untreated SRH significantly differed among locations (left colon 15.5 % vs. right colon 28.6 %) and etiologies (diverticular bleeding 27.5 % vs. others [e. g. ulcerative lesions or angioectasia] 8.9 %), but not among bleeding types. Endoscopic treatment reduced the overall rebleeding rate (adjusted odds ratio [AOR] 0.69; 95 %CI 0.49-0.98), and the treatment effect was significant in right-colon SRH (AOR 0.46; 95 %CI 0.29-0.72) but not in left-colon SRH. The effect was observed in both active and nonactive types, but was not statistically significant. Moreover, the effect was significant for diverticular bleeding (AOR 0.60; 95 %CI 0.41-0.88) but not for other diseases. When focusing on treatment type, the effectiveness was not significantly different between clipping and other modalities for most SRH, whereas ligation was significantly more effective than clipping in right-colon diverticular bleeding. CONCLUSIONS A population-level endoscopy dataset allowed us to identify high risk endoscopic SRH and propose a simple endoscopic treatment strategy for ALGIB. Unlike upper gastrointestinal bleeding, the rebleeding risks for ALGIB depend on colonic location, bleeding etiology, and treatment modality.
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Affiliation(s)
- Tomonori Aoki
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Eiji Sadashima
- Department of Medical Research Institute, Saga-Ken Medical Centre Koseikan, Saga, Japan
| | - Katsumasa Kobayashi
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Atsushi Yamauchi
- Department of Gastroenterology and Hepatology, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Atsuo Yamada
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Jun Omori
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
| | - Takashi Ikeya
- Department of Gastroenterology, St. Luke's International University, Tokyo, Japan
| | - Taiki Aoyama
- Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Naoyuki Tominaga
- Department of Gastroenterology, Saga-Ken Medical Centre Koseikan, Saga, Japan
| | - Yoshinori Sato
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St Marianna University School of Medicine, Kanagawa, Japan
| | - Takaaki Kishino
- Department of Gastroenterology and Hepatology, Center for Digestive and Liver Diseases, Nara City Hospital, Nara, Japan
| | - Naoki Ishii
- Department of Gastroenterology, Tokyo Shinagawa Hospital, Tokyo, Japan
| | - Tsunaki Sawada
- Department of Endoscopy, Nagoya University Hospital, Aichi, Japan
| | - Masaki Murata
- Department of Gastroenterology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Akinari Takao
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | | | - Ken Kinjo
- Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Shunji Fujimori
- Department of Gastroenterology, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan
| | - Takahiro Uotani
- Department of Gastroenterology, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan
| | - Minoru Fujita
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Hiroki Sato
- Division of Gastroenterology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Yoku Hayakawa
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mitsuru Kaise
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
| | - Naoyoshi Nagata
- Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
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Wang Z, Albers FE, Wang SE, English DR, Lynch BM. Biased effects of pre-diagnostic physical activity on breast cancer survival: Systematic review and meta-analysis. Cancer Epidemiol 2024; 89:102544. [PMID: 38359727 DOI: 10.1016/j.canep.2024.102544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 02/01/2024] [Accepted: 02/05/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Pre-diagnostic physical activity is reported to improve survival for women with breast cancer. However, studies of pre-diagnostic exposures and cancer survival are susceptible to bias, made clear when applying a target trial framework. We investigated the impact of selection bias, immortal time bias, confounding and bias due to inappropriate adjustment for post-exposure variables in a systematic review and meta-analysis of pre-diagnostic physical activity and survival after breast cancer. METHODS Medline, Embase and Emcare were searched from inception to November 2021 for studies examining pre-diagnostic physical activity and overall or breast cancer-specific survival for women with breast cancer. Random-effects meta-analysis was used to estimate pooled hazard ratios (HRs) and 95% confidence intervals (CIs) comparing highest versus lowest pre-diagnostic physical activity. Subgroup meta-analyses were used to compare HRs of studies with and without different biases. ROBINS-E was used to assess risk of bias. RESULTS We included 22 studies. Women with highest versus lowest pre-diagnostic physical activity had higher overall and breast cancer-specific survival across most analyses. The overall risk of bias was high. We observed marked differences in estimated HRs between studies that did and did not adjust for post-exposure variables or have immortal time bias. All studies were at risk of selection bias due to participants becoming eligible for study when they have survived to post-exposure events (e.g., breast cancer diagnosis). Insufficient studies were available to investigate confounding. CONCLUSION Biases can substantially change effect estimates. Due to misalignment of treatment assignment (before diagnosis), eligibility (survival to post-exposure events) and start of follow-up, bias is difficult to avoid. It is difficult to lend a causal interpretation to effect estimates from studies of pre-diagnostic physical activity and survival after cancer. Biased effect estimates that are difficult to interpret may be less useful for clinical or public health policy applications.
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Affiliation(s)
- Ziyu Wang
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
| | - Frances Em Albers
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
| | - Sabrina E Wang
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
| | - Dallas R English
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
| | - Brigid M Lynch
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia; Physical Activity Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia.
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Long KNG, Wilkinson R, Cowden RG, Chen Y, VanderWeele TJ. Hope in adolescence and subsequent health and well-being in adulthood: An outcome-wide longitudinal study. Soc Sci Med 2024; 347:116704. [PMID: 38493683 DOI: 10.1016/j.socscimed.2024.116704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 02/16/2024] [Accepted: 02/16/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND A sense of hopelessness is rising at alarming levels among adolescents in the United States. There is urgent need to understand the potential implications of being hopeful on adolescents' future health and wellbeing. METHODS This study utilized data from the National Longitudinal Study of Adolescent to Adult Health (N = 11,038, mean age at baseline = 15 years) to prospectively examine the relationship between baseline hope and a wide range of outcomes 12 years later. Thirty-eight outcomes were examined in the domains of physical health, health behavior, mental health, psychological well-being, social factors, and civic and prosocial behavior. Regression models were used to regress each outcome on baseline hope separately. Models controlled for a wide range of factors as well as prior values of the exposure (hope) and outcomes. RESULTS Having hope for the future in adolescence was associated with improvements in 11 subsequent outcomes after Bonferonni correction, including higher cognition and self-rated health, less physical inactivity, fewer depressive symptoms, lower perceived stress, and improvement on a number of psychological and social factors including greater happiness, more satisfaction with parenting, and increased voting and volunteering in adulthood. There were also a number of associations that were close to the null, which are equally important to explore and understand. IMPLICATIONS The results of the study may have important implications for hope-based efforts and programs aimed at improving the lives of young people and promoting their current and future well-being.
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Affiliation(s)
- Katelyn N G Long
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Renae Wilkinson
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA
| | - Richard G Cowden
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA
| | - Ying Chen
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Tyler J VanderWeele
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Narita Z, DeVylder J, Yamasaki S, Ando S, Endo K, Miyashita M, Yamaguchi S, Usami S, Stanyon D, Knowles G, Hiraiwa-Hasegawa M, Furukawa TA, Kasai K, Nishida A. Uncovering associations between gender nonconformity, psychosocial factors, and mental health in adolescents: a birth cohort study. Psychol Med 2024; 54:921-930. [PMID: 37721216 DOI: 10.1017/s0033291723002623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
BACKGROUND Little information is available on the association between gender nonconformity during adolescence and subsequent mental health. While the distress related to gender nonconformity may be socially produced rather than attributed to individual-level factors, further research is needed to better understand the role of psychosocial factors in this context. METHOD We analyzed data from the Tokyo Teen Cohort, obtained through random sampling of adolescents born between 2002 and 2004. We used inverse probability weighting to examine the association of gender nonconformity at ages 12 and 14 as a time-varying variable with subsequent mental health at age 16, while accounting for time-fixed and time-varying confounders. Furthermore, we used a weighting approach to investigate the mediating role of modifiable psychosocial factors in this association, addressing exposure-mediator and mediator-mediator interactions. RESULTS A total of 3171 participants were analyzed. Persistent gender nonconforming behavior at ages 12 and 14 was associated with subsequent depression (β = 2.02, 95% confidence interval [CI] 0.85 to 3.19) and psychotic experiences (β = 0.33, 95% CI 0.14 to 0.52) at age 16. The results remained robust in sensitivity analyses. Approximately 30% of the association between gender nonconformity and depression was consistently mediated by a set of psychosocial factors, namely loneliness, bullying victimization, and relationships with mother, father, and friends. CONCLUSIONS Persistent gender nonconformity during adolescence is associated with subsequent mental health. Psychosocial factors play a vital mediating role in this association, highlighting the essential need for social intervention and change to reduce stigmatization and ameliorate mental health challenges.
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Grants
- JP16H06395, 16H06398, 16H06399, 16K21720, 16K15566, 16H03745, 17H05931, 20H03951, 20H01777, JP20H03596, JP21H05171 and JP21H05173 Japan Society for the Promotion of Science
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Affiliation(s)
- Zui Narita
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Jordan DeVylder
- Graduate School of Social Service, Fordham University, New York, USA
- Unit for Mental Health Promotion, Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Syudo Yamasaki
- Unit for Mental Health Promotion, Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Shuntaro Ando
- Unit for Mental Health Promotion, Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kaori Endo
- Unit for Mental Health Promotion, Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Mitsuhiro Miyashita
- Unit for Mental Health Promotion, Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Satoshi Yamaguchi
- Unit for Mental Health Promotion, Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Satoshi Usami
- Graduate School of Education, The University of Tokyo, Tokyo, Japan
- Center for Research and Development on Transition from Secondary to Higher Education, The University of Tokyo, Tokyo, Japan
| | - Daniel Stanyon
- Unit for Mental Health Promotion, Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Gemma Knowles
- Unit for Mental Health Promotion, Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
- Economic and Social Research Council (ESRC) Center for Society and Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Mariko Hiraiwa-Hasegawa
- School of Advanced Science, SOKENDAI (Graduate University for Advanced Studies), Kanagawa, Japan
| | - Toshiaki A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan
| | - Kiyoto Kasai
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- The International Research Center for Neurointelligence (WPI-IRCN), University of Tokyo Institutes of Advanced Study (UTIAS), Tokyo, Japan
| | - Atsushi Nishida
- Unit for Mental Health Promotion, Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
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Geng M, Ding P, Wang S, Wang B, Tong J, Gao H, Yan S, Liu K, Wu X, Zhu P, Cao Y, Huang K, Tao F. Prenatal antibiotics exposure and preschoolers' internalizing and externalizing problems: A biomonitoring-based prospective birth cohort study. Sci Total Environ 2024; 919:170891. [PMID: 38346651 DOI: 10.1016/j.scitotenv.2024.170891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/24/2024] [Accepted: 02/08/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Biomonitoring-based epidemiological studies on prenatal antibiotic exposure and behavioral problems in preschoolers are lacking. The present study aimed to investigate the relationship between prenatal antibiotic exposure and internalizing and externalizing problems in preschoolers. METHODS Data from 2449 mother-child pairs were analyzed. Urine samples were repeatedly collected across three trimesters, and 43 antibiotics and 2 metabolites were measured, including preferred as veterinary antibiotics (PVAs), VAs, preferred as human antibiotics and human antibiotics. Preschoolers' internalizing and externalizing problems were evaluated by the Achenbach Child Behavior Checklist. Poisson regression models with generalized estimating equations were used to estimate risk ratios (RRs) and 95 % confidence intervals (CIs) for preschoolers' internalizing, externalizing and total problems across tertiles of antibiotic concentrations during three periods of pregnancy, and performed several subgroup analyses. RESULTS First-trimester urinary oxytetracycline (RR = 1.69, 95%CI: 1.20, 2.39, P-FDR = 0.011), tetracycline (RR = 1.91, 95%CI: 1.36, 2.68, P-FDR < 0.001), doxycycline (RR = 1.66, 95%CI: 1.28, 2.17, P-FDR < 0.001) and PVAs (RR = 1.79, 95%CI: 1.29, 2.48, P-FDR < 0.001) concentrations in the highest tertile were related to an elevated risk of internalizing problems compared with concentrations in the lowest tertile. First-trimester urinary doxycycline concentrations in the third tertile were also associated with an increased risk of externalizing problems compared with the first tertile (RR = 2.00, 95%CI: 1.28, 3.15, P-FDR = 0.042). Compared with concentrations in the lowest tertile, first-trimester urinary doxycycline (RR = 1.63, 95%CI: 1.19, 2.22, P-FDR = 0.028) and PVAs (RR = 1.67, 95%CI: 1.14, 2.43, P-FDR = 0.047) concentrations in the middle tertile were related to an increased risk of total problems. Furthermore, the type of main caregiver and children's outdoor activities time modified the relationships between specific prenatal antibiotic exposure and preschoolers' behavioral problems. CONCLUSIONS Exposure to specific antibiotics during the first trimester may be related to an increased risk of internalizing and externalizing problems in preschoolers.
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Affiliation(s)
- Menglong Geng
- School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No. 81 Meishan Road, Hefei 230032, Anhui, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract (Anhui Medical University), No. 81 Meishan Road, Hefei 230032, Anhui, China; Anhui Provincial Key Laboratory of Environment and Population Health across the Life Course, Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, China; Scientific Research Center in Preventive Medicine, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, China
| | - Peng Ding
- School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No. 81 Meishan Road, Hefei 230032, Anhui, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract (Anhui Medical University), No. 81 Meishan Road, Hefei 230032, Anhui, China; Anhui Provincial Key Laboratory of Environment and Population Health across the Life Course, Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, China; Scientific Research Center in Preventive Medicine, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, China
| | - Sheng Wang
- The Center for Scientific Research of Anhui Medical University, Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, China
| | - Baolin Wang
- School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, China
| | - Juan Tong
- School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No. 81 Meishan Road, Hefei 230032, Anhui, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract (Anhui Medical University), No. 81 Meishan Road, Hefei 230032, Anhui, China; Anhui Provincial Key Laboratory of Environment and Population Health across the Life Course, Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, China; Scientific Research Center in Preventive Medicine, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, China
| | - Hui Gao
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No. 81 Meishan Road, Hefei 230032, Anhui, China; Anhui Provincial Key Laboratory of Environment and Population Health across the Life Course, Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, China; Department of Pediatric, the First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei 230022, Anhui, China
| | - Shuangqin Yan
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No. 81 Meishan Road, Hefei 230032, Anhui, China; Ma'anshan Maternal and Child Healthcare (MCH) Center, Ma'anshan 243011, China
| | - Kaiyong Liu
- School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No. 81 Meishan Road, Hefei 230032, Anhui, China; Anhui Provincial Key Laboratory of Environment and Population Health across the Life Course, Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, China
| | - Xiaoyan Wu
- School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No. 81 Meishan Road, Hefei 230032, Anhui, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract (Anhui Medical University), No. 81 Meishan Road, Hefei 230032, Anhui, China; Anhui Provincial Key Laboratory of Environment and Population Health across the Life Course, Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, China
| | - Peng Zhu
- School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No. 81 Meishan Road, Hefei 230032, Anhui, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract (Anhui Medical University), No. 81 Meishan Road, Hefei 230032, Anhui, China; Anhui Provincial Key Laboratory of Environment and Population Health across the Life Course, Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, China
| | - Yunxia Cao
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No. 81 Meishan Road, Hefei 230032, Anhui, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract (Anhui Medical University), No. 81 Meishan Road, Hefei 230032, Anhui, China
| | - Kun Huang
- School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No. 81 Meishan Road, Hefei 230032, Anhui, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract (Anhui Medical University), No. 81 Meishan Road, Hefei 230032, Anhui, China; Anhui Provincial Key Laboratory of Environment and Population Health across the Life Course, Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, China; Scientific Research Center in Preventive Medicine, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, China
| | - Fangbiao Tao
- School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No. 81 Meishan Road, Hefei 230032, Anhui, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract (Anhui Medical University), No. 81 Meishan Road, Hefei 230032, Anhui, China; Anhui Provincial Key Laboratory of Environment and Population Health across the Life Course, Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, China.
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Narita Z, Hazumi M, Kataoka M, Usuda K, Nishi D. Association between discrimination and subsequent psychotic experiences in patients with COVID-19: A cohort study. Schizophr Res 2024; 267:107-112. [PMID: 38531157 DOI: 10.1016/j.schres.2024.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 01/20/2024] [Accepted: 03/17/2024] [Indexed: 03/28/2024]
Abstract
Although cross-sectional studies have suggested that discrimination has a negative impact on the mental health of patients with COVID-19, no cohort studies with longitudinal data have established a causal relationship. Therefore, this study aimed to investigate the association between COVID-19-related discrimination and subsequent psychotic experiences in individuals who had contracted the disease. Secondary outcomes were PTSD symptoms, psychological distress, and suicidal ideation. We utilized inverse probability weighting and marginal structural models with robust standard errors to analyze the association, accounting for confounders and loss to follow-up. In a sensitivity analysis, we evaluated the robustness of the estimates to potential unmeasured confounding by analyzing E-values. Of 7760 participants who had contracted COVID-19, 5971 were included after excluding those with missing sociodemographic data. Of these, 1736 (29.1 %) reported experiencing COVID-19-related discrimination. Of the 2559 participants who completed the study, 253 (9.9 %) reported having at least one psychotic experience. Participants who reported experiencing any COVID-19-related discrimination showed a higher risk of subsequent psychotic experiences compared with participants without such discrimination (risk difference 6.6 %, 95 % CI 4.0 %-9.9 %; risk ratio 1.82, 95 % CI 1.42-2.47). A negative impact was also found in suicidal ideation, PTSD symptoms, and psychological distress. E-values demonstrated the robustness of some of the observed associations to unmeasured confounding. The study found that COVID-19-related discrimination was associated with subsequent psychotic experiences and other mental health outcomes in individuals who had contracted the disease. A study focusing on prevention strategies, such as an anti-discrimination campaign, is warranted.
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Affiliation(s)
- Zui Narita
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Megumi Hazumi
- Department of Public Mental Health Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Mayumi Kataoka
- Department of Public Mental Health Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Kentaro Usuda
- Department of Public Mental Health Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Daisuke Nishi
- Department of Public Mental Health Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan; Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Bunkyo, Tokyo, Japan.
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Wang Y, Su B, Xie J, Garcia-Rizo C, Prieto-Alhambra D. Long-term risk of psychiatric disorder and psychotropic prescription after SARS-CoV-2 infection among UK general population. Nat Hum Behav 2024:10.1038/s41562-024-01853-4. [PMID: 38514769 DOI: 10.1038/s41562-024-01853-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/28/2024] [Indexed: 03/23/2024]
Abstract
Despite evidence indicating increased risk of psychiatric issues among COVID-19 survivors, questions persist about long-term mental health outcomes and the protective effect of vaccination. Using UK Biobank data, three cohorts were constructed: SARS-CoV-2 infection (n = 26,101), contemporary control with no evidence of infection (n = 380,337) and historical control predating the pandemic (n = 390,621). Compared with contemporary controls, infected participants had higher subsequent risks of incident mental health at 1 year (hazard ratio (HR): 1.54, 95% CI 1.42-1.67; P = 1.70 × 10-24; difference in incidence rate: 27.36, 95% CI 21.16-34.10 per 1,000 person-years), including psychotic, mood, anxiety, alcohol use and sleep disorders, and prescriptions for antipsychotics, antidepressants, benzodiazepines, mood stabilizers and opioids. Risks were higher for hospitalized individuals (2.17, 1.70-2.78; P = 5.80 × 10-10) than those not hospitalized (1.41, 1.30-1.53; P = 1.46 × 10-16), and were reduced in fully vaccinated people (0.97, 0.80-1.19; P = 0.799) compared with non-vaccinated or partially vaccinated individuals (1.64, 1.49-1.79; P = 4.95 × 10-26). Breakthrough infections showed similar risk of psychiatric diagnosis (0.91, 0.78-1.07; P = 0.278) but increased prescription risk (1.42, 1.00-2.02; P = 0.053) compared with uninfected controls. Early identification and treatment of psychiatric disorders in COVID-19 survivors, especially those severely affected or unvaccinated, should be a priority in the management of long COVID. With the accumulation of breakthrough infections in the post-pandemic era, the findings highlight the need for continued optimization of strategies to foster resilience and prevent escalation of subclinical mental health symptoms to severe disorders.
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Affiliation(s)
- Yunhe Wang
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Binbin Su
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Junqing Xie
- Centre for Statistics in Medicine and NIHR Biomedical Research Centre Oxford, NDORMS, University of Oxford, Oxford, UK.
- Key Laboratory of Aging-related Bone and Joint Diseases Prevention and Treatment, Ministry of Education, Xiangya Hospital, Central South University, Changsha, China.
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China.
| | - Clemente Garcia-Rizo
- Barcelona Clinic Schizophrenia Unit, Hospital Clínic de Barcelona, Departament de Medicina, Institut de Neurociències (UBNeuro), Universitat de Barcelona (UB), Barcelona, Spain
- CIBERSAM, ISCIII, Madrid, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Daniel Prieto-Alhambra
- Centre for Statistics in Medicine and NIHR Biomedical Research Centre Oxford, NDORMS, University of Oxford, Oxford, UK
- Medical Informatics, Erasmus Medical Center University, Rotterdam, the Netherlands
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Salehi Z, Malmir H, Ghosn B, Onvani S, Ardestani ME, Feizi A, Esmaillzadeh A, Azadbakht L. Exploring the association between ultra-processed foods and COPD: a case-control study. BMC Pulm Med 2024; 24:124. [PMID: 38459450 PMCID: PMC10924350 DOI: 10.1186/s12890-024-02903-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 02/08/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND While it is known that the overconsumption of ultra-processed foods (UPFs) is associated with a heightened risk of respiratory ailments, the specific effects of UPF intake on COPD remain unclear. This study was designed to explore the potential link between COPD and the consumption of UPFs among adult individuals in Iran. METHODS In this hospital-based case-control study conducted at Alzahra University Hospital in Isfahan, Iran, we enrolled 84 patients newly diagnosed with COPD, along with 252 healthy controls matched for age and sex. COPD was defined based on the results of spirometry tests, specifically when the forced expiratory volume per second (FEV1) was less than 80% or the ratio of FEV1 to forced vital capacity (FVC) was less than 70%. To evaluate the dietary intake of the participants, we utilized a validated food frequency questionnaire (FFQ) consisting of 168 items. Additionally, we gathered data on potential confounding factors using a pre-tested questionnaire. RESULTS The mean ages for the case and control groups were 57.07 and 55.05 years, respectively. Our study found no significant association between the intake of ultra-processed foods (UPFs) and the likelihood of COPD, with an odds ratio (OR: 0.78, 95% CI: 0.34-1.77). This lack of association persisted even after adjusting for factors such as energy intake, sex, and age (OR: 0.48; 95% CI: 0.19-1.21). Further controlling for potential confounders like body mass index (BMI), physical activity, and smoking status did not alter this finding (OR: 0.367; 95% CI: 0.123-1.1008, P = 0.074). CONCLUSIONS In our study, we observed no significant association between the intake of Ultra-Processed Foods (UPFs) and the odds of Chronic Obstructive Pulmonary Disease (COPD). This finding remained consistent even after adjusting for factors such as energy intake, sex, age, Body Mass Index (BMI), physical activity, and smoking status. Therefore, within the scope of our study, it appears that the consumption of UPFs does not significantly impact the likelihood of developing COPD. However, we recommend further research to deepen our understanding of the intricate relationship between dietary habits and respiratory health.
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Affiliation(s)
- Zahra Salehi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, P.O. Box 14155-6117, Iran
| | - Hanieh Malmir
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Batoul Ghosn
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, P.O. Box 14155-6117, Iran
| | - Shokouh Onvani
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Emami Ardestani
- Division of Pulmonology, Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Awat Feizi
- Department of Epidemiology and Biostatistics, Endocrinology and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ahmad Esmaillzadeh
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Community Nutrition, School of Nutritional Science and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Azadbakht
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, P.O. Box 14155-6117, Iran.
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Zheutlin AR, Sharareh N, Guadamuz JS, Berchie RO, Derington CG, Jacobs JA, Mondesir FL, Alexander GC, Levitan EB, Safford M, Vos RO, Qato DM, Bress AP. Association Between Pharmacy Proximity With Cardiovascular Medication Use and Risk Factor Control in the United States. J Am Heart Assoc 2024; 13:e031717. [PMID: 38390820 PMCID: PMC10944071 DOI: 10.1161/jaha.123.031717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 01/16/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Poor neighborhood-level access to health care, including community pharmacies, contributes to cardiovascular disparities in the United States. The authors quantified the association between pharmacy proximity, antihypertensive and statin use, and blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) among a large, diverse US cohort. METHODS AND RESULTS A cross-sectional analysis of Black and White participants in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study during 2013 to 2016 was conducted. The authors designated pharmacy proximity by census tract using road network analysis with population-weighted centroids within a 10-minute drive time, with 5- and 20-minute sensitivity analyses. Pill bottle review measured medication use, and BP and LDL-C were assessed using standard methods. Poisson regression was used to quantify the association between pharmacy proximity with medication use and BP control, and linear regression for LDL-C. Among 16 150 REGARDS participants between 2013 and 2016, 8319 (51.5%) and 8569 (53.1%) had an indication for antihypertensive and statin medication, respectively, and pharmacy proximity data. The authors did not find a consistent association between living in a census tract with higher pharmacy proximity and antihypertensive medication use, BP control, or statin medication use and LDL-C levels, regardless of whether the area was rural, suburban, or urban. Results were similar among the 5- and 20-minute drive-time analyses. CONCLUSIONS Living in a low pharmacy proximity census tract may be associated with antihypertensive and statin medication use, or with BP control and LDL-C levels. Although, in this US cohort, outcomes were similar for adults living in high or low pharmacy proximity census tracts.
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Affiliation(s)
- Alexander R. Zheutlin
- Division of Cardiology, Feinberg School of MedicineNorthwestern UniversityChicagoILUSA
| | - Nasser Sharareh
- Department of Population Health Sciences, Spencer Fox Eccles School of MedicineUniversity of UtahSalt Lake CityUTUSA
| | - Jenny S. Guadamuz
- Division of Health Policy and ManagementUniversity of California, Berkeley, School of Public HealthBerkeleyCAUSA
| | - Ransmond O. Berchie
- Department of Population Health Sciences, Spencer Fox Eccles School of MedicineUniversity of UtahSalt Lake CityUTUSA
| | - Catherine G. Derington
- Department of Population Health Sciences, Spencer Fox Eccles School of MedicineUniversity of UtahSalt Lake CityUTUSA
| | - Joshua A. Jacobs
- Department of Population Health Sciences, Spencer Fox Eccles School of MedicineUniversity of UtahSalt Lake CityUTUSA
| | - Favel L. Mondesir
- Department of EpidemiologyUniversity of Alabama at Birmingham School of Public HealthBirminghamALUSA
| | - G. Caleb Alexander
- Department of EpidemiologyCenter for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
- Department of MedicineJohns Hopkins MedicineBaltimoreMDUSA
| | - Emily B. Levitan
- Department of EpidemiologyUniversity of Alabama at Birmingham School of Public HealthBirminghamALUSA
| | - Monika Safford
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical CollegeCornell UniversityNew YorkNYUSA
| | - Robert O. Vos
- Spatial Sciences Institute, Dornsife College of Letters, Arts, and SciencesUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Dima M. Qato
- Spatial Sciences Institute, Dornsife College of Letters, Arts, and SciencesUniversity of Southern CaliforniaLos AngelesCAUSA
- Program on Medicines and Public Health, Titus Family Department of Clinical Pharmacy, School of Pharmacy, University of Southern CaliforniaLos AngelesCAUSA
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern CaliforniaLos AngelesCAUSA
- Program on Medicines and Public Health, Alfred Mann School of Pharmacy and Pharmaceutical SciencesUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Adam P. Bress
- Department of Population Health Sciences, Spencer Fox Eccles School of MedicineUniversity of UtahSalt Lake CityUTUSA
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Guo Y, Li K, Zhao Y, Wang C, Mo H, Li Y. Association between long-term sedentary behavior and depressive symptoms in U.S. adults. Sci Rep 2024; 14:5247. [PMID: 38438459 PMCID: PMC10912732 DOI: 10.1038/s41598-024-55898-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/28/2024] [Indexed: 03/06/2024] Open
Abstract
The study aimed to investigate the association between long-term sedentary behavior (LTSB) and depressive symptoms within a representative sample of the U.S. adult population. Data from NHANES 2017-2018 were used, encompassing information on demographics, depressive symptoms, physical activity (PA), and LTSB. Depressive symptoms were identified using the Patient Health Questionnaire (PHQ-9), with "depressive symptoms" defined as a PHQ-9 score of ≥ 5, and "moderate to severe depressive symptoms (MSDS)" defined as a PHQ-9 score of ≥ 10. PA and LTSB were assessed through the Global Physical Activity Questionnaire, where LTSB was interpreted as sedentary time ≥ 600 min. Restricted Cubic Spline (RCS) curves were utilized to observe potential nonlinear relationships. Binary Logistic regressions were conducted to analyze the associations. A total of 4728 participants (mean age 51.00 ± 17.49 years, 2310 males and 2418 females) were included in the study. Among these individuals, 1194 (25.25%) displayed depressive symptoms, with 417 (8.82%) exhibiting MSDS. RCS curves displayed increased risk of depressive symptoms with prolonged sedentary duration. Logistic regression models indicated significant associations between LTSB and depressive symptoms (OR 1.398, 95% CI 1.098-1.780), and LTSB and MSDS (OR 1.567, 95% CI 1.125-2.183), after adjusting for covariates. These findings suggest that LTSB may act as a potential risk factor for both depressive symptoms and MSDS in the studied population.
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Affiliation(s)
- Yuyang Guo
- Department of Physical Education, Zhengzhou Railway Vocational and Technical College, Zhengzhou, Henan, People's Republic of China
| | - Kaixin Li
- Zhengzhou University, Zhengzhou, Henan, People's Republic of China
- Synergetic Innovation Center of Kinesis and Health, School of Physical Education (Main Campus), Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Yue Zhao
- Zhengzhou University, Zhengzhou, Henan, People's Republic of China
- Synergetic Innovation Center of Kinesis and Health, School of Physical Education (Main Campus), Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Changhong Wang
- The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, People's Republic of China
| | - Hongfei Mo
- Zhengzhou University, Zhengzhou, Henan, People's Republic of China.
- Synergetic Innovation Center of Kinesis and Health, School of Physical Education (Main Campus), Zhengzhou University, Zhengzhou, Henan, People's Republic of China.
- The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China.
| | - Yan Li
- Zhengzhou University, Zhengzhou, Henan, People's Republic of China.
- The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China.
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Teixeira LA, Vidal EIDO, Blake H, Barros GAMD, Fukushima FB. Evaluating the Interaction Between Pain Intensity and Resilience on the Impact of Pain in the Lives of People With Fibromyalgia. Clin J Pain 2024; 40:150-156. [PMID: 37994738 DOI: 10.1097/ajp.0000000000001178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/12/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVE Recent theoretical models posit that resilience acts as a resource/mechanism opposing pain catastrophizing and other vulnerability sources against pain adaptation. The aim of this study was to investigate the relationship between resilience, pain, and functionality in people living with fibromyalgia (FM). MATERIALS AND METHODS We conducted a cross-sectional online survey of people participating in Brazilian fibromyalgia virtual support groups on Facebook in May 2018. Resilience was evaluated by the Connor-Davidson Resilience Scale. Average pain and the degree of interference of pain in the lives of participants (DIPLP) were assessed using the Brief Pain Inventory. The association between these 3 variables was evaluated through multivariable robust linear regression with adjustment for 21 potential confounders. RESULTS We included 2176 participants with FM. Resilience was associated with a decreased DIPLP (β: -0.38, 95% CI: -0.54 to -0.22, P <0.001) but not with average pain scores (β: -0.01, 95% CI: -0.18 to 0.16, P =0.93). A significant interaction between resilience and average levels of pain on the DIPLP was observed so that resilience showed a much stronger protective association among participants with average null-to-mild pain than among those with moderate and severe pain levels. DISCUSSION Our results provide evidence against beliefs that the pain of people with FM is related to low psychological resilience and shed light on the complex interrelationships between resilience, pain, and functionality. This research signals both the relevance and limits of resilience in the management of FM. Future studies evaluating behavioral interventions for FM should consider how those interventions interact with baseline pain levels and resilience.
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Affiliation(s)
| | | | - Holly Blake
- School of Health Sciences, University of Nottingham
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
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Harewood R, Rothwell JA, Bešević J, Viallon V, Achaintre D, Gicquiau A, Rinaldi S, Wedekind R, Prehn C, Adamski J, Schmidt JA, Jacobs I, Tjønneland A, Olsen A, Severi G, Kaaks R, Katzke V, Schulze MB, Prada M, Masala G, Agnoli C, Panico S, Sacerdote C, Jakszyn PG, Sánchez MJ, Castilla J, Chirlaque MD, Atxega AA, van Guelpen B, Heath AK, Papier K, Tong TYN, Summers SA, Playdon M, Cross AJ, Keski-Rahkonen P, Chajès V, Murphy N, Gunter MJ. Association between pre-diagnostic circulating lipid metabolites and colorectal cancer risk: a nested case-control study in the European Prospective Investigation into Cancer and Nutrition (EPIC). EBioMedicine 2024; 101:105024. [PMID: 38412638 PMCID: PMC10907191 DOI: 10.1016/j.ebiom.2024.105024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/26/2024] [Accepted: 02/05/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Altered lipid metabolism is a hallmark of cancer development. However, the role of specific lipid metabolites in colorectal cancer development is uncertain. METHODS In a case-control study nested within the European Prospective Investigation into Cancer and Nutrition (EPIC), we examined associations between pre-diagnostic circulating concentrations of 97 lipid metabolites (acylcarnitines, glycerophospholipids and sphingolipids) and colorectal cancer risk. Circulating lipids were measured using targeted mass spectrometry in 1591 incident colorectal cancer cases (55% women) and 1591 matched controls. Multivariable conditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations between concentrations of individual lipid metabolites and metabolite patterns with colorectal cancer risk. FINDINGS Of the 97 assayed lipids, 24 were inversely associated (nominally p < 0.05) with colorectal cancer risk. Hydroxysphingomyelin (SM (OH)) C22:2 (ORper doubling 0.60, 95% CI 0.47-0.77) and acylakyl-phosphatidylcholine (PC ae) C34:3 (ORper doubling 0.71, 95% CI 0.59-0.87) remained associated after multiple comparisons correction. These associations were unaltered after excluding the first 5 years of follow-up after blood collection and were consistent according to sex, age at diagnosis, BMI, and colorectal subsite. Two lipid patterns, one including 26 phosphatidylcholines and all sphingolipids, and another 30 phosphatidylcholines, were weakly inversely associated with colorectal cancer. INTERPRETATION Elevated pre-diagnostic circulating levels of SM (OH) C22:2 and PC ae C34:3 and lipid patterns including phosphatidylcholines and sphingolipids were associated with lower colorectal cancer risk. This study may provide insight into potential links between specific lipids and colorectal cancer development. Additional prospective studies are needed to validate the observed associations. FUNDING World Cancer Research Fund (reference: 2013/1002); European Commission (FP7: BBMRI-LPC; reference: 313010).
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Affiliation(s)
- Rhea Harewood
- International Agency for Research on Cancer (IARC), 25 Av. Tony Garnier, 69007, Lyon, France.
| | - Joseph A Rothwell
- Centre for Epidemiology and Population Health (U1018), Exposome and Heredity Team, Faculté de Médecine, Université Paris-Saclay, UVSQ, INSERM, Gustave Roussy, F-94805, Villejuif, France
| | - Jelena Bešević
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Vivian Viallon
- International Agency for Research on Cancer (IARC), 25 Av. Tony Garnier, 69007, Lyon, France
| | - David Achaintre
- International Agency for Research on Cancer (IARC), 25 Av. Tony Garnier, 69007, Lyon, France; School of Plant Sciences and Food Security, Faculty of Biology, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Audrey Gicquiau
- International Agency for Research on Cancer (IARC), 25 Av. Tony Garnier, 69007, Lyon, France
| | - Sabina Rinaldi
- International Agency for Research on Cancer (IARC), 25 Av. Tony Garnier, 69007, Lyon, France
| | - Roland Wedekind
- International Agency for Research on Cancer (IARC), 25 Av. Tony Garnier, 69007, Lyon, France
| | - Cornelia Prehn
- Metabolomics and Proteomics Core, Helmholtz Zentrum München, 85764, Neuherberg, Germany
| | - Jerzy Adamski
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, 8 Medical Drive, Singapore, 117597; Institute of Experimental Genetics, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany; Institute of Biochemistry, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia
| | - Julie A Schmidt
- Department of Clinical Medicine, Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark
| | - Inarie Jacobs
- International Agency for Research on Cancer (IARC), 25 Av. Tony Garnier, 69007, Lyon, France
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Diet, Cancer and Health, Strandboulevarden 49, DK-2100, Copenhagen, Denmark; Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anja Olsen
- Danish Cancer Society Research Center, Diet, Cancer and Health, Strandboulevarden 49, DK-2100, Copenhagen, Denmark; The Department of Public Health, University of Aarhus, Aarhus, Denmark
| | - Gianluca Severi
- Centre for Epidemiology and Population Health (U1018), Exposome and Heredity Team, Faculté de Médecine, Université Paris-Saclay, UVSQ, INSERM, Gustave Roussy, F-94805, Villejuif, France; Department of Statistics, Computer Science, Applications "G. Parenti", University of Florence, Florence, Italy
| | - Rudolf Kaaks
- German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg, Germany
| | - Verena Katzke
- German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg, Germany
| | - Matthias B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany; Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany
| | - Marcela Prada
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany
| | - Giovanna Masala
- Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Claudia Agnoli
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian, 1, 20133, Milan, Italy
| | - Salvatore Panico
- Dipartimento Di Medicina Clinica E Chirurgia Federico Ii University, Naples, Italy
| | - Carlotta Sacerdote
- Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital and Center for Cancer Prevention (CPO), Via Santena 7, 10126, Turin, Italy
| | - Paula Gabriela Jakszyn
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain; Blanquerna School of Health Sciences, Ramon Llull University, Barcelona, Spain
| | - Maria-Jose Sánchez
- Escuela Andaluza de Salud Pública (EASP), 18011, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, 18012, Granada, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029, Madrid, Spain; Department of Preventive Medicine and Public Health, University of Granada, 18071, Granada, Spain
| | - Jesús Castilla
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029, Madrid, Spain; Instituto de Salud Pública de Navarra - IdiSNA, Pamplona, Spain
| | - María-Dolores Chirlaque
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029, Madrid, Spain; Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia University, Murcia, Spain
| | - Amaia Aizpurua Atxega
- Ministry of Health of the Basque Government, Sub Directorate for Public Health and Addictions of Gipuzkoa, San Sebastian, Spain; Biodonostia Health Research Institute, Epidemiology of Chronic and Communicable Diseases Group, San Sebastián, Spain
| | - Bethany van Guelpen
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden; Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden
| | - Alicia K Heath
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Keren Papier
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Tammy Y N Tong
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Scott A Summers
- Department of Nutrition and Integrative Physiology and the Diabetes and Metabolism Research Center, University of Utah, Salt Lake City, Utah, USA
| | - Mary Playdon
- Department of Nutrition and Integrative Physiology and the Diabetes and Metabolism Research Center, University of Utah, Salt Lake City, Utah, USA; Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Amanda J Cross
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Pekka Keski-Rahkonen
- International Agency for Research on Cancer (IARC), 25 Av. Tony Garnier, 69007, Lyon, France
| | - Véronique Chajès
- International Agency for Research on Cancer (IARC), 25 Av. Tony Garnier, 69007, Lyon, France
| | - Neil Murphy
- International Agency for Research on Cancer (IARC), 25 Av. Tony Garnier, 69007, Lyon, France
| | - Marc J Gunter
- International Agency for Research on Cancer (IARC), 25 Av. Tony Garnier, 69007, Lyon, France; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
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Smith TAD, West CML, Joseph N, Lane B, Irlam-Jones J, More E, Mistry H, Reeves KJ, Song YP, Reardon M, Hoskin PJ, Hussain SA, Denley H, Hall E, Porta N, Huddart RA, James ND, Choudhury A. A hypoxia biomarker does not predict benefit from giving chemotherapy with radiotherapy in the BC2001 randomised controlled trial. EBioMedicine 2024; 101:105032. [PMID: 38387404 PMCID: PMC10897900 DOI: 10.1016/j.ebiom.2024.105032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 02/01/2024] [Accepted: 02/08/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND BC2001 showed combining chemotherapy (5-FU + mitomycin-C) with radiotherapy improves loco-regional disease-free survival in patients with muscle-invasive bladder cancer (MIBC). We previously showed a 24-gene hypoxia-associated signature predicted benefit from hypoxia-modifying radiosensitisation in BCON and hypothesised that only patients with low hypoxia scores (HSs) would benefit from chemotherapy in BC2001. BC2001 allowed conventional (64Gy/32 fractions) or hypofractionated (55Gy/20 fractions) radiotherapy. An exploratory analysis tested an additional hypothesis that hypofractionation reduces reoxygenation and would be detrimental for patients with hypoxic tumours. METHODS RNA was extracted from pre-treatment biopsies (298 BC2001 patients), transcriptomic data generated (Affymetrix Clariom-S arrays), HSs calculated (median expression of 24-signature genes) and patients stratified as hypoxia-high or -low (cut-off: cohort median). PRIMARY ENDPOINT invasive loco-regional control (ILRC); secondary overall survival. FINDINGS Hypoxia affected overall survival (HR = 1.30; 95% CI 0.99-1.70; p = 0.062): more uncertainty for ILRC (HR = 1.29; 95% CI 0.82-2.03; p = 0.264). Benefit from chemotherapy was similar for patients with high or low HSs, with no interaction between HS and treatment arm. High HS associated with poor ILRC following hypofractionated (n = 90, HR 1.69; 95% CI 0.99-2.89 p = 0.057) but not conventional (n = 207, HR 0.70; 95% CI 0.28-1.80, p = 0.461) radiotherapy. The finding was confirmed in an independent cohort (BCON) where hypoxia associated with a poor prognosis for patients receiving hypofractionated (n = 51; HR 14.2; 95% CI 1.7-119; p = 0.015) but not conventional (n = 24, HR 1.04; 95% CI 0.07-15.5, p = 0.978) radiotherapy. INTERPRETATION Tumour hypoxia status does not affect benefit from BC2001 chemotherapy. Hypoxia appears to affect fractionation sensitivity. Use of HSs to personalise treatment needs testing in a biomarker-stratified trial. FUNDING Cancer Research UK, NIHR, MRC.
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Affiliation(s)
- Tim A D Smith
- Translational Radiobiology Group, Division of Cancer Sciences, University of Manchester, Manchester Cancer Research Centre, Christie NHS Foundation Trust, Manchester, UK; Nuclear Futures Institute, School of Computer Science and Electronic Engineering, Bangor University, Bangor, UK
| | - Catharine M L West
- Translational Radiobiology Group, Division of Cancer Sciences, University of Manchester, Manchester Cancer Research Centre, Christie NHS Foundation Trust, Manchester, UK.
| | - Nuradh Joseph
- Sri Lanka Cancer Research Group, Maharagama, Sri Lanka
| | - Brian Lane
- Translational Radiobiology Group, Division of Cancer Sciences, University of Manchester, Manchester Cancer Research Centre, Christie NHS Foundation Trust, Manchester, UK
| | - Joely Irlam-Jones
- Translational Radiobiology Group, Division of Cancer Sciences, University of Manchester, Manchester Cancer Research Centre, Christie NHS Foundation Trust, Manchester, UK
| | - Elisabet More
- Translational Radiobiology Group, Division of Cancer Sciences, University of Manchester, Manchester Cancer Research Centre, Christie NHS Foundation Trust, Manchester, UK
| | - Hitesh Mistry
- Translational Radiobiology Group, Division of Cancer Sciences, University of Manchester, Manchester Cancer Research Centre, Christie NHS Foundation Trust, Manchester, UK
| | - Kimberley J Reeves
- Translational Radiobiology Group, Division of Cancer Sciences, University of Manchester, Manchester Cancer Research Centre, Christie NHS Foundation Trust, Manchester, UK
| | - Yee Pei Song
- Translational Radiobiology Group, Division of Cancer Sciences, University of Manchester, Manchester Cancer Research Centre, Christie NHS Foundation Trust, Manchester, UK
| | - Mark Reardon
- Translational Radiobiology Group, Division of Cancer Sciences, University of Manchester, Manchester Cancer Research Centre, Christie NHS Foundation Trust, Manchester, UK
| | - Peter J Hoskin
- Translational Radiobiology Group, Division of Cancer Sciences, University of Manchester, Manchester Cancer Research Centre, Christie NHS Foundation Trust, Manchester, UK; Mount Vernon Cancer Centre, Northwood, London, UK
| | - Syed A Hussain
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Helen Denley
- Pathology Centre, Shrewsbury and Telford NHS Trust, Royal Shrewsbury Hospital, Shrewsbury, UK
| | - Emma Hall
- Institute of Cancer Research, Clinical Trials & Statistics Unit, London, UK
| | - Nuria Porta
- Institute of Cancer Research, Clinical Trials & Statistics Unit, London, UK
| | - Robert A Huddart
- Royal Marsden NHS Trust, Department of Oncology, Downs Road, Sutton, Surrey, England, UK
| | - Nick D James
- Royal Marsden NHS Trust, Department of Oncology, Downs Road, Sutton, Surrey, England, UK
| | - Ananya Choudhury
- Translational Radiobiology Group, Division of Cancer Sciences, University of Manchester, Manchester Cancer Research Centre, Christie NHS Foundation Trust, Manchester, UK
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Steenhuis D, Li X, Feenstra T, Hak E, de Vos S. The Association between Deductibles and Cardiovascular Medication Adherence: A Retrospective Inception Cohort Study. Drugs Real World Outcomes 2024; 11:99-108. [PMID: 37925375 DOI: 10.1007/s40801-023-00397-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 11/06/2023] Open
Abstract
OBJECTIVE Drug non-adherence in primary preventive cardiovascular therapy is one of the most important modifiable drivers of cardiovascular events. The effect of deductibles in healthcare cost-sharing plans (the amount that has to be paid for healthcare services before the insurance company starts to pay) on such non-adherence in a European setting is unknown. Therefore, we estimated the association between deductibles and the adherence to primary preventive antihypertensive and antihyperlipidemic medication. METHODS Using the claims database of Menzis Health Insurer in the Netherlands, we applied ordered beta regression mixed modelling to estimate the association between deductibles and adherence taking several demographic and social-economic factors, repeated measurements and within-patient variation into account. RESULTS All in all, 106,316 patients starting primary preventive antihypertensive or antihyperlipidemic monotherapy were eligible for analysis. At index date, mean age of the study population was 58 years and 52% were male. Reaching the deductible limit and no need to pay for medication anymore increased the adherence [relative adherence ratio (RAR) 1.03, 95% confidence interval (95% CI): 1.00-1.05] for antihyperlipidemic therapy and 1.02 (95% CI: 1.00-1.04) for antihypertensive therapy. A larger deductible amount decreases the adherence of antihyperlipidemic and antihypertensive therapy (RAR 0.83; 95% CI: 0.69-1.00 and RAR 0.85, 95% CI: 0.74-0.98, respectively). CONCLUSION Independent of other risk factors for non-adherence, presence of deductibles in health insurance is associated with a small negative effect on the adherence to both primary preventive antihypertensive as well as antihyperlipidemic therapy. Further study is needed on the potential health-economic consequences.
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Affiliation(s)
- Dennis Steenhuis
- Unit of PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, A. Deusinglaan 1, 9713 AV, Groningen, The Netherlands.
| | - Xuechun Li
- Unit of PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, A. Deusinglaan 1, 9713 AV, Groningen, The Netherlands
| | - Talitha Feenstra
- Unit of PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, A. Deusinglaan 1, 9713 AV, Groningen, The Netherlands
| | - Eelko Hak
- Unit of PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, A. Deusinglaan 1, 9713 AV, Groningen, The Netherlands
| | - Stijn de Vos
- Unit of PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, A. Deusinglaan 1, 9713 AV, Groningen, The Netherlands
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Kılınç A, Çam C, Aydoğan Gedik S, Oktar D, Taşcıoğlu U, Öznur Muz FN, Önsüz MF, Metintaş S. Public health literacy in primary users in western Turkey. Glob Health Promot 2024; 31:45-54. [PMID: 37724844 DOI: 10.1177/17579759231191507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
BACKGROUND Public health literacy (PHL) is a novel perspective on health literacy (HL). Differing from HL's individualist approach, PHL is concerned with public health events and promoting health in the whole society. OBJECTIVES To evaluate PHL, a newly developed concept, and related factors. METHODS In this cross-sectional study, people who visited primary healthcare centers in urban and rural settings were recruited using a questionnaire that includes Public Health Literacy Knowledge Scale (PHLKS) and Adult Health Literacy Scale (AHLS). Out of four Primary Healthcare Centers (PMCs) in western Turkey selected randomly, one PMC was located in a rural setting, while three PMCs were located in an urban setting. Multiple linear regression was used to determine the predictors for PHL. RESULTS The study group consisted of 1672 people, of which 55.3% were male. The mean age was 40.94 ± 15.22. The median score (min-max) from PHLKS was 13.0 (0-17). Multiple linear regression showed that income level had a negative impact on PHL. Higher education, fondness for reading, hospital admission and HL, however, increased PHL levels. Additionally, living in an urban area and not having auditory problems were positively associated with PHL. CONCLUSIONS Participants had a moderate level of PHL. Improving PHL should be a priority to tackle global and local problems that have an adverse effect on community health. To increase community engagement in public health events, people with low education and HL levels should be targeted in future training programs.
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Affiliation(s)
- Ali Kılınç
- Department of Public Health, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Cüneyt Çam
- Department of Public Health, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Sevil Aydoğan Gedik
- Department of Public Health, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Didem Oktar
- Department of Public Health, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Umur Taşcıoğlu
- Department of Public Health, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Feyza Nehir Öznur Muz
- Department of Public Health, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Muhammed Fatih Önsüz
- Department of Public Health, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Selma Metintaş
- Department of Public Health, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
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Mitro SD, Sundaram R, Qiao Y, Gleason JL, Yeung E, Hinkle SN, Mendola P, Mills JL, Grandi SM, Mumford SL, Schisterman EF, Zhang C, Grantz KL. History of multifetal gestation and long-term maternal mortality. Paediatr Perinat Epidemiol 2024; 38:219-226. [PMID: 37969031 PMCID: PMC10978292 DOI: 10.1111/ppe.13020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND Multifetal gestation could be associated with higher long-term maternal mortality because it increases the risk of pregnancy complications such as preeclampsia and preterm birth, which are in turn linked to postpartum cardiovascular risk. OBJECTIVES We examined whether spontaneously conceived multifetal versus singleton gestation was associated with long-term maternal mortality in a racially diverse U.S. COHORT METHODS We ascertained vital status as of 2016 via linkage to the National Death Index and Social Security Death Master File of 44,174 mothers from the Collaborative Perinatal Project (CPP; 1959-1966). Cox proportional hazards models with maternal age as the time scale assessed associations between history of spontaneous multifetal gestation (in the last CPP observed pregnancy or prior pregnancy) and all-cause and cardiovascular mortality, adjusted for demographics, smoking status, and preexisting medical conditions. We calculated hazard ratios (HR) for all-cause and cause-specific mortality over the study period and until age 50, 60, and 70 years (premature mortality). RESULTS Of eligible participants, 1672 (3.8%) had a history of multifetal gestation. Participants with versus without a history of multifetal gestation were older, more likely to have a preexisting condition, and more likely to smoke. By 2016, 51% of participants with and 38% of participants without a history of multifetal gestation had died (unadjusted all-cause HR 1.14, 95% confidence interval [CI] 1.07, 1.23). After adjustment for smoking and preexisting conditions, a history of multifetal gestation was not associated with all-cause (adjusted HR 1.00, 95% CI 0.93, 1.08) or cardiovascular mortality (adjusted HR 0.99, 95% CI 0.87, 1.11) over the study period. However, history of multifetal gestation was associated with an 11% lower risk of premature all-cause mortality (adjusted HR 0.89, 95% CI 0.82, 0.96). CONCLUSIONS In a cohort with over 50 years of follow-up, history of multifetal gestation was not associated with all-cause mortality, but may be associated with a lower risk of premature mortality.
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Affiliation(s)
- Susanna D Mitro
- Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Rajeshwari Sundaram
- Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Yan Qiao
- Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Jessica L Gleason
- Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Edwina Yeung
- Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Stefanie N Hinkle
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Pauline Mendola
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
| | - James L Mills
- Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Sonia M Grandi
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sunni L Mumford
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Enrique F Schisterman
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Cuilin Zhang
- Bia-Echo Asia Centre for Reproductive Longevity & Equality, Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Katherine L Grantz
- Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
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Homayra F, Enns B, Min JE, Kurz M, Bach P, Bruneau J, Greenland S, Gustafson P, Karim ME, Korthuis PT, Loughin T, MacLure M, McCandless L, Platt RW, Schnepel K, Shigeoka H, Siebert U, Socias E, Wood E, Nosyk B. Comparative Analysis of Instrumental Variables on the Assignment of Buprenorphine/Naloxone or Methadone for the Treatment of Opioid Use Disorder. Epidemiology 2024; 35:218-231. [PMID: 38290142 PMCID: PMC10833049 DOI: 10.1097/ede.0000000000001697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
BACKGROUND Instrumental variable (IV) analysis provides an alternative set of identification assumptions in the presence of uncontrolled confounding when attempting to estimate causal effects. Our objective was to evaluate the suitability of measures of prescriber preference and calendar time as potential IVs to evaluate the comparative effectiveness of buprenorphine/naloxone versus methadone for treatment of opioid use disorder (OUD). METHODS Using linked population-level health administrative data, we constructed five IVs: prescribing preference at the individual, facility, and region levels (continuous and categorical variables), calendar time, and a binary prescriber's preference IV in analyzing the treatment assignment-treatment discontinuation association using both incident-user and prevalent-new-user designs. Using published guidelines, we assessed and compared each IV according to the four assumptions for IVs, employing both empirical assessment and content expertise. We evaluated the robustness of results using sensitivity analyses. RESULTS The study sample included 35,904 incident users (43.3% on buprenorphine/naloxone) initiated on opioid agonist treatment by 1585 prescribers during the study period. While all candidate IVs were strong (A1) according to conventional criteria, by expert opinion, we found no evidence against assumptions of exclusion (A2), independence (A3), monotonicity (A4a), and homogeneity (A4b) for prescribing preference-based IV. Some criteria were violated for the calendar time-based IV. We determined that preference in provider-level prescribing, measured on a continuous scale, was the most suitable IV for comparative effectiveness of buprenorphine/naloxone and methadone for the treatment of OUD. CONCLUSIONS Our results suggest that prescriber's preference measures are suitable IVs in comparative effectiveness studies of treatment for OUD.
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Affiliation(s)
- Fahmida Homayra
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
| | - Benjamin Enns
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
| | - Jeong Eun Min
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
| | - Megan Kurz
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
| | - Paxton Bach
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Julie Bruneau
- Department of Family Medicine and Emergency Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Sander Greenland
- Department of Epidemiology, University of California, Los Angeles, California, USA
| | - Paul Gustafson
- Department of Statistics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mohammad Ehsanul Karim
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - P Todd Korthuis
- Addiction Medicine Section, Department of Medicine, School of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Thomas Loughin
- Department of Statistics and Actuarial Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Malcolm MacLure
- Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lawrence McCandless
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Robert William Platt
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Kevin Schnepel
- Department of Economics, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Hitoshi Shigeoka
- Department of Economics, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Uwe Siebert
- Department of Public Health, Health Services Research, and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics, and Technology, Hall in Tirol, Austria
- Center for Health Decision Science, Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Program on Cardiovascular Research, Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Eugenia Socias
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Evan Wood
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bohdan Nosyk
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
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Fadini GP, Longato E, Morieri ML, Del Prato S, Avogaro A, Solini A. Long-term benefits of dapagliflozin on renal outcomes of type 2 diabetes under routine care: a comparative effectiveness study on propensity score matched cohorts at low renal risk. Lancet Reg Health Eur 2024; 38:100847. [PMID: 38328413 PMCID: PMC10847023 DOI: 10.1016/j.lanepe.2024.100847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 12/29/2023] [Accepted: 01/11/2024] [Indexed: 02/09/2024]
Abstract
Background Despite the overall improvement in care, people with type 2 diabetes (T2D) experience an excess risk of end-stage kidney disease. We evaluated the long-term effectiveness of dapagliflozin on kidney function and albuminuria in patients with T2D. Methods We included patients with T2D who initiated dapagliflozin or comparators from 2015 to 2020. Propensity score matching (PSM) was performed to balance the two groups. The primary endpoint was the change in estimated glomerular filtration rate (eGFR) from baseline to the end of observation. Secondary endpoints included changes in albuminuria and loss of kidney function. Findings We analysed two matched groups of 6197 patients each. The comparator group included DPP-4 inhibitors (40%), GLP-1RA (22.3%), sulphonylureas (16.1%), pioglitazone (8%), metformin (5.8%), or acarbose (4%). Only 6.4% had baseline eGFR <60 ml/min/1.73 m2 and 15% had UACR >30 mg/g. During a mean follow-up of 2.5 year, eGFR declined significantly less in the dapagliflozin vs comparator group by 1.81 ml/min/1.73 m2 (95% C.I. from 1.13 to 2.48; p < 0.0001). The mean eGFR slope was significantly less negative in the dapagliflozin group by 0.67 ml/min/1.73 m2/year (95% C.I. from 0.47 to 0.88; p < 0.0001). Albuminuria declined significantly in new-users of dapagliflozin within 6 months and remained on average 44.3 mg/g lower (95% C.I. from -66.9 to -21.7; p < 0.0001) than in new-users of comparators. New-users of dapagliflozin had significantly lower rates of new-onset CKD, loss of kidney function, and a composite renal outcome. Results were confirmed for all SGLT2 inhibitors, in patients without baseline CKD, and when GLP-1RA were excluded from comparators. Interpretation Initiating dapagliflozin improved kidney function outcomes and albuminuria in patients with T2D and a low renal risk. Funding Funded by the Italian Diabetes Society and partly supported by a grant from AstraZeneca.
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Affiliation(s)
- Gian Paolo Fadini
- Division of Metabolic Diseases, Department of Medicine, University of Padova, 35128 Padova, Italy
- Laboratory of Experimental Diabetology, Veneto Institute of Molecular Medicine, 35128 Padova, Italy
| | - Enrico Longato
- Department of Information Engineering, University of Padova, 35100 Padua, Italy
| | - Mario Luca Morieri
- Division of Metabolic Diseases, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Stefano Del Prato
- Department of Clinical & Experimental Medicine, University of Pisa and Sant’Anna School of Advanced Studies, 56126 Pisa, Italy
| | - Angelo Avogaro
- Division of Metabolic Diseases, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Anna Solini
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Italy
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Holtfreter B, Conrad E, Kocher T, Baumeister SE, Völzke H, Welk A. Interdental cleaning aids are beneficial for oral health at 7-year follow-up: Results from the Study of Health in Pomerania (SHIP-TREND). J Clin Periodontol 2024; 51:252-264. [PMID: 38116705 DOI: 10.1111/jcpe.13936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 11/14/2023] [Accepted: 12/02/2023] [Indexed: 12/21/2023]
Abstract
AIM To estimate association between the use of interdental cleaning aids (IDAs) and type on 7-year follow-up levels of interdental plaque, interdental gingival inflammation, interdental periodontitis severity, the number of interdental sound surfaces and the number of missing teeth in a population-based cohort study. MATERIALS AND METHODS We used 7-year follow-up data of 2224 participants from the Study of Health in Pomerania (SHIP-TREND). We applied generalized linear and ordinal logistic models, adjusting for confounding and selection bias using inverse probability treatment weighting and multiple imputation. RESULTS Flossers were 32% less likely to have higher interdental plaque (iPlaque) levels than non-users of IDAs (odds ratio [OR] = 0.68; 95% confidence interval [CI]: 0.50-0.94); flossing resulted in 5% lower means of iPlaque. Effects on interdental bleeding on probing (iBOP), mean interdental probing depths and mean interdental clinical attachment levels were direction-consistent but statistically non-significant. Interdental brushing was associated with lower follow-up levels for interdental plaque (OR = 0.73; 95% CI: 0.57-0.93) and iBOP (OR = 0.69; 95% CI: 0.53-0.89). IDAs were more effective in reducing iPlaque in participants with periodontitis, whereas iBOP reduction was more pronounced in participants with no or mild periodontitis. The analyses did not suggest that the use of IDAs affected caries. Finally, applying change score analyses, flossing reduced tooth loss incidence (incidence rate ratio [IRR] = 0.71) compared with non-users of IDAs. CONCLUSIONS Recommending flossing and interdental brushing in dental practices represents an approach to the prevention of gingivitis and consequently periodontitis.
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Affiliation(s)
- Birte Holtfreter
- Department of Restorative Dentistry, Periodontology, Endodontology and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany
| | - Elena Conrad
- Department of Restorative Dentistry, Periodontology, Endodontology and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany
| | - Thomas Kocher
- Department of Restorative Dentistry, Periodontology, Endodontology and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany
| | | | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany
| | - Alexander Welk
- Department of Restorative Dentistry, Periodontology, Endodontology and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany
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Johnston A, Smith GN, Tanuseputro P, Coutinho T, Edwards JD. Assessing cardiovascular disease risk in women with a history of hypertensive disorders of pregnancy: A guidance paper for studies using administrative data. Paediatr Perinat Epidemiol 2024; 38:254-267. [PMID: 38220144 DOI: 10.1111/ppe.13043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 12/29/2023] [Accepted: 01/03/2024] [Indexed: 01/16/2024]
Abstract
BACKGROUND Hypertensive disorders of pregnancy (HDP) are a major cause of maternal morbidity and mortality, and their association with increased cardiovascular disease (CVD) risk represents a major public health concern. However, assessing CVD risk in women with a history of these conditions presents unique challenges, especially when studies are carried out using routinely collected data. OBJECTIVES To summarise and describe key challenges related to the design and conduct of administrative studies assessing CVD risk in women with a history of HDP and provide concrete recommendations for addressing them in future research. METHODS This is a methodological guidance paper. RESULTS Several conceptual and methodological factors related to the data-generating mechanism and study conceptualisation, design/data management and analysis, as well as the interpretation and reporting of study findings should be considered and addressed when designing and carrying out administrative studies on this topic. Researchers should develop an a priori conceptual framework within which the research question is articulated, important study variables are identified and their interrelationships are carefully considered. CONCLUSIONS To advance our understanding of CVD risk in women with a history of HDP, future studies should carefully consider and address the conceptual and methodological considerations outlined in this guidance paper. In highlighting these challenges, and providing specific recommendations for how to address them, our goal is to improve the quality of research carried out on this topic.
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Affiliation(s)
- Amy Johnston
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Brain and Heart Nexus Research Program, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Graeme N Smith
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Kingston Health Sciences Centre, Queens University, Kingston, Ontario, Canada
| | - Peter Tanuseputro
- ICES, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Thais Coutinho
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jodi D Edwards
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Brain and Heart Nexus Research Program, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- ICES, Ottawa, Ontario, Canada
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Peker Y, Celik Y, Behboudi A, Redline S, Lyu J, Wei Y, Gottlieb DJ, Jelic S. CPAP may promote an endothelial inflammatory milieu in sleep apnoea after coronary revascularization. EBioMedicine 2024; 101:105015. [PMID: 38403558 PMCID: PMC10944158 DOI: 10.1016/j.ebiom.2024.105015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/22/2024] [Accepted: 02/03/2024] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND Continuous positive airway pressure (CPAP) has failed to reduce cardiovascular risk in obstructive sleep apnoea (OSA) in randomized trials. CPAP increases angiopoietin-2, a lung distension-responsive endothelial proinflammatory marker associated with increased cardiovascular risk. We investigated whether CPAP has unanticipated proinflammatory effects in patients with OSA and cardiovascular disease. METHODS Patients with OSA (apnoea-hypopnea index [AHI] ≥15 events/h without excessive sleepiness) in the Randomized Intervention with CPAP in Coronary Artery Disease and OSA study were randomized to CPAP or usual care following coronary revascularization. Changes in plasma levels of biomarkers of endothelial (angiopoietin-2, Tie-2, E-selectin, vascular endothelial growth factor [VEGF-A]) and lung epithelial (soluble receptor of advanced glycation end-products [sRAGE]) function from baseline to 12-month follow-up were compared across groups and associations with cardiovascular morbidity and mortality assessed. FINDINGS Patients with OSA (n = 189; 84% men; age 66 ± 8 years, BMI 28 ± 3.5 kg/m2, AHI 41 ± 23 events/h) and 91 patients without OSA participated. Angiopoietin-2 remained elevated whereas VEGF-A declined significantly over 12 months in the CPAP group (n = 91). In contrast, angiopoietin-2 significantly declined whereas VEGF-A remained elevated in the usual care (n = 98) and OSA-free groups. The changes in angiopoietin-2 and VEGF-A were significantly different between CPAP and usual care, whereas Tie-2, sRAGE and E-selectin were similar. Greater 12-month levels of angiopoietin-2 were associated with greater mortality. Greater CPAP levels were associated with worse cardiovascular outcomes. INTERPRETATION Greater CPAP levels increase proinflammatory, lung distension-responsive angiopoietin-2 and reduce cardioprotective angiogenic factor VEGF-A compared to usual care, which may counteract the expected cardiovascular benefits of treating OSA. FUNDING National Institutes of Health/National Heart, Lung, and Blood Institute; Swedish Research Council; Swedish Heart-Lung Foundation; ResMed Foundation.
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Affiliation(s)
- Yuksel Peker
- Koç University School of Medicine, Istanbul, Turkey; University of Gothenburg, Gothenburg, Sweden; Brigham & Women's Hospital, Boston, MA, USA; University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Lund University, Lund, Sweden
| | - Yeliz Celik
- Koç University School of Medicine, Istanbul, Turkey; Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | | | | | - Jing Lyu
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Ying Wei
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Daniel J Gottlieb
- Brigham & Women's Hospital, Boston, MA, USA; VA Boston Healthcare System, Boston, MA, USA.
| | - Sanja Jelic
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.
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Kusama T, Takeuchi K, Kiuchi S, Aida J, Osaka K. Poor oral health and dementia risk under time-varying confounding: A cohort study based on marginal structural models. J Am Geriatr Soc 2024; 72:729-741. [PMID: 38064294 DOI: 10.1111/jgs.18707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/09/2023] [Accepted: 11/09/2023] [Indexed: 03/19/2024]
Abstract
BACKGROUND Bidirectional association between oral health, including tooth loss and oral hypofunction, and cognitive impairment can induce time-varying confounding in association with dementia. This study aimed to investigate the association between oral health and the development of dementia among older adults, considering cognitive impairment as a time-varying confounder. METHODS This nine-year follow-up cohort study targeted independent older adults aged ≥65 years who participated in the Japan Gerontological Evaluation Study. The exposure variables were self-reported poor oral health (≤19 remaining teeth, edentulousness, chewing difficulty, swallowing problems, and xerostomia), which were assessed in 2010 and 2013. The outcome variable was the incidence of dementia between 2013 and 2019, which was obtained from the municipalities' administrative database. Furthermore, in 2010 and 2013, we considered cognitive impairment as a time-varying confounder and treated it based on a marginal structural model (MSM), including possible baseline confounders. Oral health and cognitive impairment were assessed using the items of Kihon checklist. We employed a Cox proportional hazards model with a stabilized inverse probability weight and estimated hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS Among 37,556 participants (mean age: 72.8 years [1 SD = 5.5], males: 46.8%), the dementia incidence rate was 2.2/100 person-year. The proportions of those with ≤19 remaining teeth, edentulousness, chewing difficulty, swallowing problems, and xerostomia were 61.3%, 11.0%, 24.4%, 14.7%, and 19.2%, respectively. From the regression analysis based on MSM, ≤19 remaining teeth (HR = 1.12, 95% CI = 1.03-1.23), edentulousness (HR = 1.20, 95% CI = 1.09-1.32), chewing difficulty (HR = 1.11, 95% CI = 1.02-1.21), and xerostomia (HR = 1.10, 95% CI = 1.01-1.20) were significantly associated with an increased risk of dementia; however, swallowing problems were not significantly associated with dementia onset (p > 0.05). CONCLUSIONS Even after considering time-varying confounding by cognitive function at baseline and follow-up, we observed significant associations between poor oral health and increased risk of dementia among older adults.
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Affiliation(s)
- Taro Kusama
- Division of Statistics and Data Science, Liaison Center for Innovative Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
| | - Kenji Takeuchi
- Division of Statistics and Data Science, Liaison Center for Innovative Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Sakura Kiuchi
- Division of Statistics and Data Science, Liaison Center for Innovative Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
- Frontier Research Institute for Interdisciplinary Sciences, Tohoku University, Sendai, Miyagi, Japan
| | - Jun Aida
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan
| | - Ken Osaka
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
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Brunton RJ, Dryer R. Intimate Partner Violence Risk Factors: A Vulnerability-Adaptation Stress Model Approach. J Interpers Violence 2024:8862605241234352. [PMID: 38409776 DOI: 10.1177/08862605241234352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
Intimate partner violence (IPV) disproportionally affects women. Using the vulnerability-adaptation stress model, we examined adverse childhood experiences (ACEs), self-esteem, and hope as vulnerability indicators and relationship status and length, positive and negative affect, and socioeconomic status (SES) as stressors to ascertain the risk for IPV. Women (N = 491, M = 37.15, standard deviation = 12.51) completed an online survey comprised of the Positive and Negative Affect Scale, Rosenberg's Self-esteem Scale, Snyder's Hope Scale, ACE questionnaire, Composite Abuse Scale Revised-Short Form, and demographic questions. Factor analysis identified four ACE factors of sexual abuse, physical or psychological abuse, witnessing domestic violence, and household dysfunction. A five-step hierarchical multiple regression identified that greater exposure to physical or psychological child abuse was associated with an increased risk of IPV (Step 2), B = 0.73 [0.16, 1.34]. Lower self-esteem, B = -0.30 [-0.47, -0.14] predicted IPV (Step 3). Age B = 0.07 [0.01, 0.13], negative affect, B = 0.39 [0.19, 0.59], and relationship length, B = -1.24 [-2.16, 0.41] were associated with a higher risk of IPV (Step 4). In Step 5, previous variables attenuated to non-significance while age, B = 0.07 [0.01, 0.13], negative affect, B = 0.39 [0.19, 0.59], and relationship length B = -1.25 [-2.16, 0.41] remained significant. While the key findings of this study were inconsistent with some commonly reported findings (e.g., ACEs, self-esteem, hope, relationship status, SES, age), these inconsistencies are important to highlight given the factorial approach to examining ACEs, the comprehensive analyses conducted, and our examination of these variables' direct relationship to IPV. The study was limited by its cross-sectional nature, higher prevalence of IPV victims, and not examining IPV sub-types. Similar studies need to be conducted for other relationship types and victimized individuals (e.g., same-sex relationships and male victims) to provide a complete picture of risk factors for IPV.
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Affiliation(s)
| | - Rachel Dryer
- Australian Catholic University, Strathfield, NSW, Australia
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Nikiforuk AM, Kuchinski KS, Short K, Roman S, Irvine MA, Prystajecky N, Jassem AN, Patrick DM, Sekirov I. Nasopharyngeal angiotensin converting enzyme 2 (ACE2) expression as a risk-factor for SARS-CoV-2 transmission in concurrent hospital associated outbreaks. BMC Infect Dis 2024; 24:262. [PMID: 38408924 PMCID: PMC10898082 DOI: 10.1186/s12879-024-09067-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 01/28/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Widespread human-to-human transmission of the severe acute respiratory syndrome coronavirus two (SARS-CoV-2) stems from a strong affinity for the cellular receptor angiotensin converting enzyme two (ACE2). We investigate the relationship between a patient's nasopharyngeal ACE2 transcription and secondary transmission within a series of concurrent hospital associated SARS-CoV-2 outbreaks in British Columbia, Canada. METHODS Epidemiological case data from the outbreak investigations was merged with public health laboratory records and viral lineage calls, from whole genome sequencing, to reconstruct the concurrent outbreaks using infection tracing transmission network analysis. ACE2 transcription and RNA viral load were measured by quantitative real-time polymerase chain reaction. The transmission network was resolved to calculate the number of potential secondary cases. Bivariate and multivariable analyses using Poisson and Negative Binomial regression models was performed to estimate the association between ACE2 transcription the number of SARS-CoV-2 secondary cases. RESULTS The infection tracing transmission network provided n = 76 potential transmission events across n = 103 cases. Bivariate comparisons found that on average ACE2 transcription did not differ between patients and healthcare workers (P = 0.86). High ACE2 transcription was observed in 98.6% of transmission events, either the primary or secondary case had above average ACE2. Multivariable analysis found that the association between ACE2 transcription (log2 fold-change) and the number of secondary transmission events differs between patients and healthcare workers. In health care workers Negative Binomial regression estimated that a one-unit change in ACE2 transcription decreases the number of secondary cases (β = -0.132 (95%CI: -0.255 to -0.0181) adjusting for RNA viral load. Conversely, in patients a one-unit change in ACE2 transcription increases the number of secondary cases (β = 0.187 (95% CI: 0.0101 to 0.370) adjusting for RNA viral load. Sensitivity analysis found no significant relationship between ACE2 and secondary transmission in health care workers and confirmed the positive association among patients. CONCLUSION Our study suggests that ACE2 transcription has a positive association with SARS-CoV-2 secondary transmission in admitted inpatients, but not health care workers in concurrent hospital associated outbreaks, and it should be further investigated as a risk-factor for viral transmission.
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Affiliation(s)
- Aidan M Nikiforuk
- British Columbia Centre for Disease Control, V5Z 4R4, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, V6T 1Z4, Vancouver, BC, Canada
| | - Kevin S Kuchinski
- British Columbia Centre for Disease Control, V5Z 4R4, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, V6T 1Z4, Vancouver, BC, Canada
| | - Katy Short
- Fraser Health Authority, V3L 3C2, New Westminster, BC, Canada
| | - Susan Roman
- Fraser Health Authority, V3L 3C2, New Westminster, BC, Canada
| | - Mike A Irvine
- British Columbia Centre for Disease Control, V5Z 4R4, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, V5A 1S6, Burnaby, BC, Canada
| | - Natalie Prystajecky
- British Columbia Centre for Disease Control, V5Z 4R4, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, V6T 1Z4, Vancouver, BC, Canada
| | - Agatha N Jassem
- British Columbia Centre for Disease Control, V5Z 4R4, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, V6T 1Z4, Vancouver, BC, Canada
| | - David M Patrick
- British Columbia Centre for Disease Control, V5Z 4R4, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, V6T 1Z4, Vancouver, BC, Canada
| | - Inna Sekirov
- British Columbia Centre for Disease Control, V5Z 4R4, Vancouver, BC, Canada.
- Department of Pathology and Laboratory Medicine, University of British Columbia, V6T 1Z4, Vancouver, BC, Canada.
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Kasugai Y, Oze I, Koyanagi YN, Taniyama Y, Ito H, Imoto I, Matsuo K. Confounding in epidemiological studies on assessment of the impact of genetic factors on disease risk: the problem of redundant adjustment. J Epidemiol 2024:JE20230277. [PMID: 38403691 DOI: 10.2188/jea.je20230277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024] Open
Affiliation(s)
- Yumiko Kasugai
- Division of Cancer Epidemiology and Prevention, Aichi Cancer Center Research Institute
| | - Isao Oze
- Division of Cancer Epidemiology and Prevention, Aichi Cancer Center Research Institute
| | - Yuriko N Koyanagi
- Division of Cancer Epidemiology and Prevention, Aichi Cancer Center Research Institute
| | - Yukari Taniyama
- Division of Cancer Information and Control, Aichi Cancer Center Research Institute
| | - Hidemi Ito
- Division of Cancer Information and Control, Aichi Cancer Center Research Institute
- Department of Cancer Epidemiology, Nagoya University Graduate School of Medicine
| | | | - Keitaro Matsuo
- Division of Cancer Epidemiology and Prevention, Aichi Cancer Center Research Institute
- Department of Cancer Epidemiology, Nagoya University Graduate School of Medicine
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Kinter S, Delaney JA, Susarla S, McKinney C. Retrospective Cohort Studies in Craniofacial Outcomes Research: An Epidemiologist's Approach to Mitigating Bias. Cleft Palate Craniofac J 2024:10556656241233234. [PMID: 38389276 DOI: 10.1177/10556656241233234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024] Open
Abstract
Retrospective cohort studies, defined as a follow-up study in which outcome occurred prior to study onset, are common in craniofacial outcomes research and will continue to be prevalent given the increasing availability of secondary datasets and inherent prospective study limitations. However, if available data are not adequately measured, or necessary variables are absent, retrospective cohort studies can be particularly prone to bias. This brief communication aims to highlight the primary sources of bias, including measurement error, selection bias, and confounding. Each source is clearly defined, examples pertinent to craniofacial outcomes are provided, and mitigation strategies are discussed.
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Affiliation(s)
- Sara Kinter
- Department of Pediatrics, Division of Craniofacial Medicine, University of Washington, Seattle, WA, USA
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Joseph A Delaney
- General Internal Medicine, University of Washington, Seattle, WA, USA
| | - Srinivas Susarla
- Department of Oral & Maxillofacial Surgery, University of Washington, Seattle, WA, USA
- Department of Surgery, Division of Plastic Surgery, University of Washington, Seattle, WA, USA
| | - Christy McKinney
- Department of Pediatrics, Division of Craniofacial Medicine, University of Washington, Seattle, WA, USA
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, USA
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Bonde JPE, Begtrup LM, Jensen JH, Flachs EM, Jakobsson K, Nielsen C, Nilsson K, Rylander L, Vilhelmsson A, Petersen KU, Tøttenborg SS. Occupational risk of COVID-19 in foreign-born employees in Denmark. Occup Med (Lond) 2024; 74:63-70. [PMID: 37133767 DOI: 10.1093/occmed/kqad044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Foreign-born workers in high-income countries experience higher rates of COVID-19 but the causes are only partially known. AIMS To examine if the occupational risk of COVID-19 in foreign-born workers deviates from the risk in native-born employees in Denmark. METHODS Within a registry-based cohort of all residents employed in Denmark (n = 2 451 542), we identified four-digit DISCO-08 occupations associated with an increased incidence of COVID-19-related hospital admission during 2020-21 (at-risk occupations). The sex-specific prevalence of at-risk employment in foreign born was compared with the prevalence in native born. Moreover, we examined if the country of birth modified the risk of a positive SARS-CoV-2 polymerase chain reaction (PCR) test and COVID-19-related hospital admission in at-risk occupations. RESULTS Workers born in low-income countries and male workers from Eastern Europe more often worked in at-risk occupations (relative risks between 1.16 [95% confidence interval {CI} 1.14-1.17] and 1.87 [95% CI 1.82-1.90]). Being foreign-born modified the adjusted risk of PCR test positivity (test for interaction P < 0.0001), primarily because of higher risk in at-risk occupations among men born in Eastern European countries (incidence rate ratio [IRR] 2.39 [95% CI 2.09-2.72] versus IRR 1.19 [95% CI 1.14-1.23] in native-born men). For COVID-19-related hospital admission, no overall interaction was seen, and in women, country of birth did not consistently modify the occupational risk. CONCLUSIONS Workplace viral transmission may contribute to an excess risk of COVID-19 in male workers born in Eastern Europe, but most foreign-born employees in at-risk occupations seem not to be at higher occupational risk than native born.
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Affiliation(s)
- J P E Bonde
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen 2400, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen 1500, Denmark
| | - L M Begtrup
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen 2400, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen 1500, Denmark
| | - J H Jensen
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen 2400, Denmark
| | - E M Flachs
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen 2400, Denmark
| | - K Jakobsson
- School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg 405 30, Sweden
| | - C Nielsen
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund 22363, Sweden
- Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, Odense 5000, Denmark
| | - K Nilsson
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund 22363, Sweden
- Division of Public Health, Kristianstad University, Kristianstad 29188, Sweden
| | - L Rylander
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund 22363, Sweden
| | - A Vilhelmsson
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund 22363, Sweden
| | - K U Petersen
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen 2400, Denmark
| | - S S Tøttenborg
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen 2400, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen 1500, Denmark
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