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Amer F, Lan FY, Gil-Conesa M, Sidossis A, Bruque D, Iliaki E, Buley J, Nathan N, Bruno-Murtha LA, Carlos S, Kales SN, Fernandez-Montero A. Evolving SARS-CoV-2 severity among hospital and university affiliates in Spain and Greater Boston. Enferm Infecc Microbiol Clin (Engl Ed) 2024:S2529-993X(24)00112-6. [PMID: 38705747 DOI: 10.1016/j.eimce.2023.12.004] [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: 09/03/2023] [Accepted: 12/29/2023] [Indexed: 05/07/2024]
Abstract
INTRODUCTION The COVID-19 pandemic caused by the SARS-CoV-2 virus greatly affected healthcare workers and healthcare systems. It also challenged schools and universities worldwide negatively affecting in-person education. We conducted this study is to assess the evolution of SARs-CoV-2 virulence over the course of the pandemic. METHODS A combined cohort of University students in Spain and HCWs from the two hospitals in Spain, and one healthcare system in the Greater Boston area was followed prospectively from March 8th, 2020, to January 31st, 2022 for diagnosis with COVID-19 by PCR testing and related sequelae. Follow-up time was divided into four periods according to distinct waves of infection during the pandemic. Severity of COVID-19 was measured by case-hospitalization rate. Descriptive statistics and multivariable-adjusted statistics using the Poisson mixed-effects regression model were applied. As a sensitivity analysis, information on SARS-CoV-2 RNA in wastewater and COVID-19 deaths through May 30, 2023 from the Boston area was collected. RESULTS For the last two periods of the study (January 1st to December 15th, 2021 and December 16th, 2021 to January 31st, 2022) and relative to the first period (March 8th to May 31st, 2020), the incidence rate ratios (IRRs) of hospitalization were 0.08 (95% CI, 0.03-0.17) and 0.03 (95% CI, 0.01-0.15), respectively. In addition, a relative risk 0.012 CI95% (0.012-0.012) was observed when comparing COVID-19 mortality versus SARS-CoV-2 RNA copies/mL in Boston-area wastewater over the period (16th December 2021 to 30th May 2023) and relative to the first period. CONCLUSIONS The severity of COVID-19 and immunity of our populations evolved over time, resulting in a decrease in case severity. We found the case-hospitalization rate decreased more than 90% in our cohort despite an increase in incidence.
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Affiliation(s)
- Fares Amer
- Department of Preventive Medicine and Public Health, University of Navarra, Spain; PhD Programme in Applied Medicine and Biomedicine, University of Navarra, Spain
| | - Fan-Yun Lan
- Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA; Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, MA, USA; Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Mario Gil-Conesa
- Department of Preventive Medicine and Public Health, University of Navarra, Spain
| | - Amalia Sidossis
- Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA; Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, MA, USA
| | - Daniel Bruque
- Department of Preventive Medicine and Public Health, University of Navarra, Spain
| | - Eirini Iliaki
- Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA; Infection Prevention and Infectious Diseases, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
| | - Jane Buley
- Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
| | - Neetha Nathan
- Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
| | - Lou Ann Bruno-Murtha
- Infection Prevention and Infectious Diseases, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
| | - Silvia Carlos
- Department of Preventive Medicine and Public Health, University of Navarra, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Stefanos N Kales
- Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA; Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, MA, USA
| | - Alejandro Fernandez-Montero
- Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, MA, USA; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain; Department of Occupational Medicine, University of Navarra, Navarra, Spain.
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López-Gil JF, Fernandez-Montero A, Bes-Rastrollo M, Moreno-Galarraga L, Kales SN, Martínez-González MÁ, Moreno-Montañés J. Is Ultra-Processed Food Intake Associated with a Higher Risk of Glaucoma? A Prospective Cohort Study including 19,255 Participants from the SUN Project. Nutrients 2024; 16:1053. [PMID: 38613086 PMCID: PMC11013077 DOI: 10.3390/nu16071053] [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: 02/18/2024] [Revised: 03/16/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
OBJECTIVE The aim of this study was to examine the relationship of ultra-processed food (UPF) intake with the incidence of glaucoma in a large sample of Spanish university graduates followed prospectively. METHODS Prospective cohort study using data from the SUN Project. A final sample of 19,225 participants (60.1% women) was included in this study, with a mean age of 38.2 years (standard deviation (SD) = 12.4). Participants were followed-up for a mean time of 12.9 years (SD = 5.4). Dietary intake was measured using a 136-item semiquantitative food-frequency questionnaire. UPFs were defined based on the NOVA classification system. Glaucoma diagnosis was determined by asking the participants if they had ever been diagnosed with glaucoma by an ophthalmologist. This self-reported diagnosis of glaucoma has been previously validated. RESULTS After adjusting for several covariates, participants with the highest UPF consumption were at higher risk of glaucoma (hazard ratio (HR) = 1.83; 95% confidence interval (CI) 1.06 to 3.17) when compared to participants in the lowest category of UPF consumption. Regarding subgroup analyses, a significant multiplicative interaction was found for age (p = 0.004) and omega 3:6 ratio (p = 0.040). However, an association between UPF consumption and glaucoma was only found in older participants (aged ≥ 55 years), in men, in the most physically active group, in the group of non- or former smokers, in those with a lower omega 3:6 ratio, and in those with a lower energy intake. Regarding the contribution of each type of UPF group, UPF coming from sweets showed a significant risky effect (HR = 1.51; CI 95% 1.07 to 2.12). CONCLUSIONS This prospective cohort study shows that participants with a greater UPF consumption have a higher risk of developing glaucoma when compared to participants with a lower consumption. Our findings emphasize the relevance of monitoring and limiting the consumption of UPFs as a means of preventing glaucoma incidence.
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Grants
- (RD 06/0045, CIBER-OBN, Grants PI10/02658, PI10/02293, PI13/00615, PI14/01668, PI14/01798, PI14/01764, PI17/01795, and G03/140) Instituto de Salud Carlos III
- (27/2011, 45/2011, 122/2014) Gobierno de Navarra
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Affiliation(s)
| | - Alejandro Fernandez-Montero
- Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, MA 02138, USA;
- Department of Occupational Medicine, University of Navarra, 31008 Pamplona, Spain
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, 31008 Pamplona, Spain; (M.B.-R.); (M.Á.M.-G.)
| | - Maira Bes-Rastrollo
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, 31008 Pamplona, Spain; (M.B.-R.); (M.Á.M.-G.)
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain; (L.M.-G.); (J.M.-M.)
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBER Obn), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Laura Moreno-Galarraga
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain; (L.M.-G.); (J.M.-M.)
- Department of Pediatrics, Complejo Hospitalario de Navarra, Servicio Navarro de Salud, 31008 Pamplona, Spain
| | - Stefanos N. Kales
- Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, MA 02138, USA;
| | - Miguel Ángel Martínez-González
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, 31008 Pamplona, Spain; (M.B.-R.); (M.Á.M.-G.)
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain; (L.M.-G.); (J.M.-M.)
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBER Obn), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Department of Nutrition, T.H. Chan School of Public Health, Harvard University, Boston, MA 02138, USA
| | - Javier Moreno-Montañés
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain; (L.M.-G.); (J.M.-M.)
- Department of Ophthalmology, Clínica Universidad de Navarra, 31008 Pamplona, Spain
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Lutchman K, Wan M, Lan FY, Kales SN, Frates EP. Integrating the Lifestyle Medicine Residency Curriculum into an Occupational Medicine Training Program. J Occup Environ Med 2024; 66:e143-e144. [PMID: 38275180 DOI: 10.1097/jom.0000000000003056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
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Maroto-Rodriguez J, Delgado-Velandia M, Ortolá R, Perez-Cornago A, Kales SN, Rodríguez-Artalejo F, Sotos-Prieto M. Association of a Mediterranean Lifestyle With All-Cause and Cause-Specific Mortality: A Prospective Study from the UK Biobank. Mayo Clin Proc 2024; 99:551-563. [PMID: 37589638 DOI: 10.1016/j.mayocp.2023.05.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/12/2023] [Accepted: 05/31/2023] [Indexed: 08/18/2023]
Abstract
OBJECTIVE To examine the association between the Mediterranean lifestyle and all-cause, cancer, and cardiovascular disease (CVD) mortality in a British population. PATIENTS AND METHODS We studied 110,799 individuals 40 to 75 years of age from the UK Biobank cohort, free of CVD or cancer between 2009 and 2012 who were followed-up to 2021. The Mediterranean lifestyle was assessed at baseline through the Mediterranean Lifestyle (MEDLIFE) index, derived from the lifestyle questionnaire and diet assessments and comprising three blocks: (1) "Mediterranean food consumption," (2) "Mediterranean dietary habits," and (3) "physical activity, rest, social habits, and conviviality." Death information was retrieved from death register records. Cox regression models were used to analyze the study associations. RESULTS During a median 9.4-year follow-up, 4247 total deaths, 2401 cancer deaths, and 731 CVD deaths were identified. Compared with the first quartile of the MEDLIFE index, increasing quartiles had HRs of 0.89 (95% CI, 0.81 to 0.97), 0.81 (95% CI, 0.74 to 0.89), and 0.71 (95% CI, 0.65 to 0.78) (P-trend<.001 for all-cause mortality). For cancer mortality, the quartiles had HRs of 0.90 (95% CI, 0.80 to 1.01), 0.83 (95% CI, 0.74 to 0.93), and 0.72 (95% CI, 0.64 to 0.82) (P-trend<.001). All MEDLIFE index blocks were independently associated with lower risk of all-cause and cancer death, and block 3 was associated with lower CVD mortality. CONCLUSION Higher adherence to the Mediterranean lifestyle was associated with lower all-cause and cancer mortality in British middle-aged and older adults in a dose-response manner. Adopting a Mediterranean lifestyle adapted to the local characteristics of non-Mediterranean populations may be possible and part of a healthy lifestyle.
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Affiliation(s)
- Javier Maroto-Rodriguez
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Mario Delgado-Velandia
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain; CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - Rosario Ortolá
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain; CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - Aurora Perez-Cornago
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Stefanos N Kales
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain; CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain; IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
| | - Mercedes Sotos-Prieto
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain; CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA; IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain.
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Ojeda-Rodriguez A, Rangel-Zuñiga OA, Arenas-de Larriva AP, Gutierrez-Mariscal FM, Torres-Peña JD, Romero-Cabrera JL, Podadera-Herreros A, García-Fernandez H, Porras-Pérez E, Luque RM, Kales SN, Perez-Martinez P, Delgado-Lista J, Yubero-Serrano EM, Lopez-Miranda J. Telomere length as biomarker of nutritional therapy for prevention of type 2 diabetes mellitus development in patients with coronary heart disease: CORDIOPREV randomised controlled trial. Cardiovasc Diabetol 2024; 23:98. [PMID: 38493287 PMCID: PMC10944592 DOI: 10.1186/s12933-024-02175-5] [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: 12/19/2023] [Accepted: 02/20/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Telomere Length (TL), a marker of cellular aging, holds promise as a biomarker to elucidate the molecular mechanism of diabetes. This study aimed to investigate whether shorter telomeres are associated with a higher risk of type 2 diabetes mellitus (T2DM) incidence in patients with coronary heart disease; and to determine whether the most suitable dietary patterns, particularly a Mediterranean diet or a low-fat diet, can mitigate the development of diabetes in these patients after a follow-up period of five years. METHODS The CORonary Diet Intervention with Olive oil and cardiovascular PREVention study (CORDIOPREV study) was a single-centre, randomised clinical trial done at the Reina Sofia University Hospital in Córdoba, Spain. Patients with established coronary heart disease (aged 20-75 years) were randomly assigned in a 1:1 ratio by the Andalusian School of Public Health to receive two healthy diets. Clinical investigators were masked to treatment assignment; participants were not. Quantitative-PCR was used to assess TL measurements. FINDINGS 1002 patients (59.5 ± 8.7 years and 82.5% men) were enrolled into Mediterranean diet (n = 502) or a low-fat diet (n = 500) groups. In this analysis, we included all 462 patients who did not have T2DM at baseline. Among them, 107 patients developed T2DM after a median of 60 months. Cox regression analyses showed that patients at risk of short telomeres (TL < percentile 20th) are more likely to experience T2DM than those at no risk of short telomeres (HR 1.65, p-value 0.023). In terms of diet, patients at high risk of short telomeres had a higher risk of T2DM incidence after consuming a low-fat diet compared to patients at no risk of short telomeres (HR 2.43, 95CI% 1.26 to 4.69, p-value 0.008), while no differences were observed in the Mediterranean diet group. CONCLUSION Patients with shorter TL presented a higher risk of developing T2DM. This association could be mitigated with a specific dietary pattern, in our case a Mediterranean diet, to prevent T2DM in patients with coronary heart disease. TRIAL REGISTRATION Clinicaltrials.gov number NCT00924937.
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Affiliation(s)
- Ana Ojeda-Rodriguez
- Lipids and Atherosclerosis Unit, Internal Medicine Unit, Reina Sofia University Hospital, Cordoba, 14004, Spain
- Department of Medical and Surgical Science, University of Cordoba, Cordoba, 14004, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Av. Menendez Pidal, s/n, Cordoba, 14004, Spain
- CIBER Fisiopatologia de la Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, 28029, Spain
| | - Oriol A Rangel-Zuñiga
- Lipids and Atherosclerosis Unit, Internal Medicine Unit, Reina Sofia University Hospital, Cordoba, 14004, Spain
- Department of Medical and Surgical Science, University of Cordoba, Cordoba, 14004, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Av. Menendez Pidal, s/n, Cordoba, 14004, Spain
- CIBER Fisiopatologia de la Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, 28029, Spain
| | - Antonio P Arenas-de Larriva
- Lipids and Atherosclerosis Unit, Internal Medicine Unit, Reina Sofia University Hospital, Cordoba, 14004, Spain
- Department of Medical and Surgical Science, University of Cordoba, Cordoba, 14004, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Av. Menendez Pidal, s/n, Cordoba, 14004, Spain
- CIBER Fisiopatologia de la Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, 28029, Spain
| | - Francisco M Gutierrez-Mariscal
- Lipids and Atherosclerosis Unit, Internal Medicine Unit, Reina Sofia University Hospital, Cordoba, 14004, Spain
- Department of Medical and Surgical Science, University of Cordoba, Cordoba, 14004, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Av. Menendez Pidal, s/n, Cordoba, 14004, Spain
- CIBER Fisiopatologia de la Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, 28029, Spain
| | - Jose D Torres-Peña
- Lipids and Atherosclerosis Unit, Internal Medicine Unit, Reina Sofia University Hospital, Cordoba, 14004, Spain
- Department of Medical and Surgical Science, University of Cordoba, Cordoba, 14004, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Av. Menendez Pidal, s/n, Cordoba, 14004, Spain
- CIBER Fisiopatologia de la Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, 28029, Spain
| | - Juan L Romero-Cabrera
- Lipids and Atherosclerosis Unit, Internal Medicine Unit, Reina Sofia University Hospital, Cordoba, 14004, Spain
- Department of Medical and Surgical Science, University of Cordoba, Cordoba, 14004, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Av. Menendez Pidal, s/n, Cordoba, 14004, Spain
- CIBER Fisiopatologia de la Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, 28029, Spain
| | - Alicia Podadera-Herreros
- Lipids and Atherosclerosis Unit, Internal Medicine Unit, Reina Sofia University Hospital, Cordoba, 14004, Spain
- Department of Medical and Surgical Science, University of Cordoba, Cordoba, 14004, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Av. Menendez Pidal, s/n, Cordoba, 14004, Spain
- CIBER Fisiopatologia de la Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, 28029, Spain
| | - Helena García-Fernandez
- Lipids and Atherosclerosis Unit, Internal Medicine Unit, Reina Sofia University Hospital, Cordoba, 14004, Spain
- Department of Medical and Surgical Science, University of Cordoba, Cordoba, 14004, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Av. Menendez Pidal, s/n, Cordoba, 14004, Spain
- CIBER Fisiopatologia de la Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, 28029, Spain
| | - Esther Porras-Pérez
- Lipids and Atherosclerosis Unit, Internal Medicine Unit, Reina Sofia University Hospital, Cordoba, 14004, Spain
- Department of Medical and Surgical Science, University of Cordoba, Cordoba, 14004, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Av. Menendez Pidal, s/n, Cordoba, 14004, Spain
- CIBER Fisiopatologia de la Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, 28029, Spain
| | - Raul M Luque
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Av. Menendez Pidal, s/n, Cordoba, 14004, Spain
- CIBER Fisiopatologia de la Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, 28029, Spain
- Department of Cell Biology, Physiology and Immunology, University of Cordoba, Cordoba, 14004, Spain
| | - Stefanos N Kales
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
| | - Pablo Perez-Martinez
- Lipids and Atherosclerosis Unit, Internal Medicine Unit, Reina Sofia University Hospital, Cordoba, 14004, Spain
- Department of Medical and Surgical Science, University of Cordoba, Cordoba, 14004, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Av. Menendez Pidal, s/n, Cordoba, 14004, Spain
- CIBER Fisiopatologia de la Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, 28029, Spain
| | - Javier Delgado-Lista
- Lipids and Atherosclerosis Unit, Internal Medicine Unit, Reina Sofia University Hospital, Cordoba, 14004, Spain
- Department of Medical and Surgical Science, University of Cordoba, Cordoba, 14004, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Av. Menendez Pidal, s/n, Cordoba, 14004, Spain
- CIBER Fisiopatologia de la Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, 28029, Spain
| | - Elena M Yubero-Serrano
- Lipids and Atherosclerosis Unit, Internal Medicine Unit, Reina Sofia University Hospital, Cordoba, 14004, Spain
- Department of Medical and Surgical Science, University of Cordoba, Cordoba, 14004, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Av. Menendez Pidal, s/n, Cordoba, 14004, Spain
- CIBER Fisiopatologia de la Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, 28029, Spain
| | - Jose Lopez-Miranda
- Lipids and Atherosclerosis Unit, Internal Medicine Unit, Reina Sofia University Hospital, Cordoba, 14004, Spain.
- Department of Medical and Surgical Science, University of Cordoba, Cordoba, 14004, Spain.
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Av. Menendez Pidal, s/n, Cordoba, 14004, Spain.
- CIBER Fisiopatologia de la Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, 28029, Spain.
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Hershey MS, Bouziani E, Chen XY(M, Lidoriki I, Hadkhale K, Huang YC, Filippou T, López-Gil JF, Gribble AK, Lan FY, Sotos-Prieto M, Kales SN. Surviving & Thriving; a healthy lifestyle app for new US firefighters: usability and pilot study protocol. Front Endocrinol (Lausanne) 2023; 14:1250041. [PMID: 37908746 PMCID: PMC10614295 DOI: 10.3389/fendo.2023.1250041] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/11/2023] [Indexed: 11/02/2023] Open
Abstract
In the United States (US), new firefighters' fitness and health behaviors deteriorate rapidly after fire academy graduation. Over the long-term, this increases their risks for chronic diseases. This study protocol describes the proposed usability testing and pilot study of a newly designed and developed healthy lifestyle smartphone app, "Surviving & Thriving", tailored towards young US firefighters. "Surviving & Thriving" will provide interactive educational content on four lifestyle factors; nutrition, sleep, physical activity, and resilience, and include a personalized journey, habit tracker, and elements of gamification to promote engagement and long-term healthy behavior change. The first phase of the app development entails alpha testing by the research team and pre-beta testing by a fire service expert panel which will help refine the app into a pre-consumer version. Upon completion of the full app prototype, beta 'usability' testing will be conducted among new fire academy graduates from two New England fire academies to collect qualitative and quantitative feedback via focus groups and satisfaction surveys, respectively. A last phase of piloting the app will evaluate the app's efficacy at maintaining/improving healthy lifestyle behaviors, mental health metrics, and physical fitness metrics. We will also evaluate whether firefighters' perceived "health cultures" scores (ratings of each fire station's/fire department's environments as to encouraging/discouraging healthy behaviors) modify the changes in health metrics after utilizing the app for three to six months. This novel user-friendly app seeks to help new firefighters maintain/improve their health and fitness more effectively, reducing their risk of lifestyle-related chronic disease. Firefighters who can establish healthy habits early in their careers are more likely to sustain them throughout their lives.
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Affiliation(s)
- Maria Soledad Hershey
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Eleni Bouziani
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Department of Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Xin Yu (Maggie) Chen
- Harvard Faculty of Arts and Sciences, William James Hall, Cambridge, MA, United States
- Department of Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States
| | - Irene Lidoriki
- Department of Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States
| | - Kishor Hadkhale
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Department of Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States
| | - Ya-Chin Huang
- Department of Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States
- Department of Preventive Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Occupational & Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | - José Francisco López-Gil
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- One Health Research Group, Universidad de Las Américas, Quito, Ecuador
| | - Anne Katherine Gribble
- Department of Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States
- Illawarra Shoalhaven Local Health District, NSW Health, Warrawong, NSW, Australia
| | - Fan-Yun Lan
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Institute of Health and Welfare Policy, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Mercedes Sotos-Prieto
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, and IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Madrid, Spain
- Center for Biomedical Research in Epidemiology and Public Health Network (CIBERESP) [Consorcio Centro de Investigación Biomédica en Red (CIBER) of Epidemiology and Public Health], Madrid, Spain
- Madrid Institute for Advanced Studies (IMDEA)-Food Institute, The Campus of International Excellence (CEI), The Spanish National Research Council (CSIC), The Autonomous University of Madrid (UAM), Madrid, Spain
| | - Stefanos N. Kales
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Department of Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States
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Hershey MS, Chang CR, Sotos-Prieto M, Fernandez-Montero A, Cash SB, Christophi CA, Folta SC, Muegge C, Kleinschmidt V, Moffatt S, Mozaffarian D, Kales SN. Effect of a Nutrition Intervention on Mediterranean Diet Adherence Among Firefighters: A Cluster Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2329147. [PMID: 37589978 PMCID: PMC10436136 DOI: 10.1001/jamanetworkopen.2023.29147] [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: 03/28/2023] [Accepted: 07/09/2023] [Indexed: 08/18/2023] Open
Abstract
Importance US firefighters are a working population at risk of chronic diseases, including obesity, cardiovascular disease, and cancer. This risk may be mitigated by a healthy diet. Objective To evaluate the effect of a Mediterranean nutrition intervention using a behavioral/environmental approach (firefighter/fire station/home) at the individual participant level. Design, Setting, and Participants This 12-month cluster randomized clinical trial included US career firefighters from fire stations and homes within 2 Indiana fire departments. Participants were randomized by fire station to either Mediterranean diet or control (usual care). The study was conducted from October 2016 to December 2019, and data were analyzed in November 2022. Intervention For the first 12 months of the study, firefighters located at fire stations randomized to the intervention group were provided with access to supermarket discounts and free samples of Mediterranean diet foods, online nutrition education platforms, email announcements and reminders, family and peer education and support, and chef demonstrations. Firefighters in fire stations allocated to the control group received no intervention and were instructed to follow their usual diet. Main Outcomes and Measures Change in dietary habits at 12 months as measured by a modified Mediterranean diet score (range, 0 to 51 points) at baseline and 6-month and 12-month follow-up. Cardiometabolic parameters were secondary outcomes. Results Of 485 included firefighters, 458 (94.4%) were male, and the mean (SD) age was 47 (7.5) years. A total of 241 firefighters (27 fire stations) were randomized to the Mediterranean nutrition intervention, and 244 (25 fire stations) were randomized to usual diet. Outcomes were analyzed using generalized linear mixed models for modified Mediterranean diet score at 6 months (n = 336) and 12 months (n = 260), adjusting for baseline age, sex, race and ethnicity, fire department, physical activity, and waist circumference. In the intervention group compared with the control group, the modified Mediterranean diet score significantly increased by 2.01 points (95% CI, 0.62-3.40; P = .005) at 6 months and by 2.67 points (95% CI, 1.14-4.20; P = .001) at 12 months. Among secondary outcomes, changes in cardiometabolic risk factors were not statistically significant at 1 year. Results from analyses with multilevel multiple imputation for missingness were similar. Conclusions and Relevance In this Mediterranean nutrition intervention of multicomponent behavioral/environmental changes, career firefighters had increased adherence to a Mediterranean diet. Trial Registration ClinicalTrials.gov Identifier: NCT02941757.
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Affiliation(s)
- Maria Soledad Hershey
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Chia-Rui Chang
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Mercedes Sotos-Prieto
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red of Epidemiology and Public Health, Madrid, Spain
- Campus of International Excellence (CEI) Universidad Autónoma de Madrid (UAM), Spanish National Research Council (CSIC), Madrid, Spain
| | - Alejandro Fernandez-Montero
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Department of Occupational Medicine, University of Navarra, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Sean B. Cash
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Costas A. Christophi
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Lemesos, Cyprus
| | - Sara C. Folta
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Carolyn Muegge
- National Institute for Public Safety Health, Indianapolis, Indiana
| | | | - Steven Moffatt
- National Institute for Public Safety Health, Indianapolis, Indiana
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Stefanos N. Kales
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Occupational Medicine, Cambridge Hospital, Harvard Medical School, Cambridge, Massachusetts
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López-Gil JF, García-Hermoso A, Sotos-Prieto M, Cavero-Redondo I, Martínez-Vizcaíno V, Kales SN. Mediterranean Diet-Based Interventions to Improve Anthropometric and Obesity Indicators in Children and Adolescents: A Systematic Review with Meta-Analysis of Randomized Controlled Trials. Adv Nutr 2023; 14:858-869. [PMID: 37127186 PMCID: PMC10334150 DOI: 10.1016/j.advnut.2023.04.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [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: 12/23/2022] [Revised: 04/24/2023] [Accepted: 04/27/2023] [Indexed: 05/03/2023] Open
Abstract
To our knowledge, no systematic review with meta-analysis has separately synthesized the effects of Mediterranean diet-based interventions in children and adolescents in relation to the effects on anthropometric measures. A better understanding of the effects of Mediterranean diet-based interventions on anthropometric variables could facilitate their implementation in efforts to prevent obesity in the young population. The aim of the present meta-analysis was to evaluate the effects of Mediterranean diet-based interventions on anthropometric and obesity indicators among children and adolescents. Four databases were systematically searched (PubMed, Scopus, Web of Science, and Cochrane Database of Systematic Reviews), including all studies up until 15 March, 2023. Eligible articles were randomized controlled trials measuring the effect of an intervention based on the promotion of the Mediterranean diet and obesity-associated parameters. The effect size of each study was estimated by Cohen's d for continuous variables or risk difference for categorical variables. Compared to the control group, the Mediterranean diet-based interventions showed small and significant reductions in body mass index (d = -0.14; 95% CI: -0.26, -0.01; I2 = 77.52%). Participants in the Mediterranean diet-based interventions had a significant reduction in the percentage of obesity (risk difference = 0.12; 95% CI: 0.01, 0.23; I2 = 84.56%) in comparison with the control group. Interventions had greater effects when aiming at participants with excess weight (that is, overweight or obesity), both for body mass index, waist circumference, waist-to-height ratio, percentage of obesity, and percentage of abdominal obesity. Mediterranean diet-based interventions have a significant effect on reducing the body mass index as well as reducing obesity in children and adolescents (aged 3-18 y). This trial was registered at PROSPERO as CRD42023386789.
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Affiliation(s)
- José Francisco López-Gil
- Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Navarra, Spain; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States; One Health Research Group, Universidad de Las Américas, Quito, Ecuador.
| | - Antonio García-Hermoso
- Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Navarra, Spain
| | - Mercedes Sotos-Prieto
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States; Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Madrid, Spain; CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain; IMDEA-Food Institute, CEI UAM + CSIC, Madrid, Spain
| | - Iván Cavero-Redondo
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
| | - Vicente Martínez-Vizcaíno
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain; Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
| | - Stefanos N Kales
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
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Sidossis A, Lan FY, Hershey MS, Hadkhale K, Kales SN. Cancer and Potential Prevention with Lifestyle among Career Firefighters: A Narrative Review. Cancers (Basel) 2023; 15:cancers15092442. [PMID: 37173909 PMCID: PMC10177420 DOI: 10.3390/cancers15092442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/13/2023] [Accepted: 04/19/2023] [Indexed: 05/15/2023] Open
Abstract
Career firefighters are at considerable risk for chronic diseases, including an increased risk of various cancers, compared to the general population. Over the last two decades, several systematic reviews and large cohort studies have demonstrated that firefighters have statistically significant increases in overall and site-specific cancer incidence and site-specific cancer mortality compared to the general population. Exposure assessment and other studies have documented exposures to a variety of carcinogens in fire smoke and within the fire station. Other occupational factors such as shift work, sedentary behavior, and the fire service food culture may also contribute to this working population's increased cancer risk. Furthermore, obesity and other lifestyle behaviors such as tobacco use, excessive alcohol consumption, poor diet, inadequate physical activity, and short sleep duration have also been associated with an increased risk of certain firefighting-associated cancers. Putative prevention strategies are proposed based on suspected occupational and lifestyle risk factors.
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Affiliation(s)
- Amalia Sidossis
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02138, USA
| | - Fan-Yun Lan
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02138, USA
- Division of Occupational Medicine, Cambridge Health Alliance/Harvard Medical School, Cambridge, MA 02139, USA
- Institute of Health and Welfare Policy, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Occupational Medicine, Department of Family Medicine, National Yang Ming Chiao Tung University Hospital, Yilan 260, Taiwan
| | - Maria S Hershey
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02138, USA
| | - Kishor Hadkhale
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02138, USA
- Division of Occupational Medicine, Cambridge Health Alliance/Harvard Medical School, Cambridge, MA 02139, USA
- Faculty of Social Sciences Health Sciences (Epidemiology), Tampere University, 33100 Tampere, Finland
| | - Stefanos N Kales
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02138, USA
- Division of Occupational Medicine, Cambridge Health Alliance/Harvard Medical School, Cambridge, MA 02139, USA
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López-Gil JF, García-Hermoso A, Smith L, Gallego A, Victoria-Montesinos D, Ezzatvar Y, Hershey MS, Gutiérrez-Espinoza H, Mesas AE, Jiménez-López E, Sánchez-Miguel PA, López-Benavente A, Moreno-Galarraga L, Chen S, Brazo-Sayavera J, Fernandez-Montero A, Alcaraz PE, Panisello Royo JM, Tárraga-López PJ, Kales SN. A Cluster Randomized Controlled Trial of the Archena Infancia Saludable Project on 24-h Movement Behaviors and Adherence to the Mediterranean Diet among Schoolchildren: A Pilot Study Protocol. Children (Basel) 2023; 10:children10040738. [PMID: 37189987 DOI: 10.3390/children10040738] [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: 01/14/2023] [Revised: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 05/17/2023]
Abstract
Objective: The aim of this paper is to describe the protocol of pilot cluster randomized controlled trial (RCT) that will evaluate the effects of a lifestyle-based intervention. The Archena Infancia Saludable project will have several objectives. The primary objective of this project is to determine the 6-month effects of a lifestyle-based intervention on adherence to 24-h movement behaviors and Mediterranean diet (MedDiet) in schoolchildren. The secondary objective of this project is to test the intervention effects of this lifestyle-based intervention on a relevant set of health-related outcomes (i.e., anthropometric measurements, blood pressure, perceived physical fitness, sleep habits, and academic performance). The tertiary objective is to investigate this intervention's "halo" effect on parents'/guardians' 24-h movement behaviors and adherence to the MedDiet. Methods: The Archena Infancia Saludable trial will be a cluster RCT submitted to the Clinical Trials Registry. The protocol will be developed according to SPIRIT guidelines for RCTs and CONSORT statement extension for cluster RCTs. A total of 153 eligible parents/guardians with schoolchildren aged 6-13 years will be randomized into an intervention group or a control group. This project focuses on two fundamental pillars: 24-h movement behaviors and MedDiet. It will mainly focus on the relationship between parents/guardians and their children. Behavior change strategies for dietary and 24-h movement behaviors in schoolchildren will be based on healthy lifestyle education for parents/guardians through infographics, video recipes, brief video clips, and videos. Conclusions: Most of the current knowledge on 24-h movement behaviors and adherence to the MedDiet is based on cross-sectional or longitudinal cohort studies, warranting a need to design and conduct RCTs to obtain more robust evidence on the effect of a healthy lifestyle program to increase 24-h movement behaviors and to improve adherence to the MedDiet in schoolchildren.
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Affiliation(s)
- José Francisco López-Gil
- Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, 31006 Pamplona, Spain
- Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, MA 02138, USA
- One Health Research Group, Universidad de Las Américas, Quito 170124, Ecuador
| | - Antonio García-Hermoso
- Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, 31006 Pamplona, Spain
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge CB1 1PT, UK
| | - Alejandra Gallego
- Department of Applied Economics, Faculty of Economics and Business, University of Murcia, 30100 Murcia, Spain
| | | | - Yasmin Ezzatvar
- Department of Nursing, Universitat de València, 46007 Valencia, Spain
| | - Maria S Hershey
- Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, MA 02138, USA
| | | | - Arthur Eumann Mesas
- Health and Social Research Center, Universidad de Castilla-La Mancha (UCLM), 16071 Cuenca, Spain
- Postgraduate Program in Public Health, Universidade Estadual de Londrina, Londrina 86057-970, Brazil
| | - Estela Jiménez-López
- Health and Social Research Center, Universidad de Castilla-La Mancha (UCLM), 16071 Cuenca, Spain
| | - Pedro Antonio Sánchez-Miguel
- Grupo Análisis Comportamental de la Actividad Física y el Deporte (ACAFYDE), Departamento de Didáctica de la Expresión Musical, Plástica y Corporal, Facultad de Formación del Profesorado, Universidad de Extremadura, 10003 Cáceres, Spain
| | - Alba López-Benavente
- Departamento de Expresión Plástica, Musical y Dinámica, Facultad de Educación, Universidad de Murcia, 30100 Espinardo, Spain
| | - Laura Moreno-Galarraga
- IdiSNA (Instituto de Investigación Sanitaria de Navarra), 31008 Pamplona, Spain
- Department of Pediatrics, Complejo Hospitalario de Navarra, Servicio Navarro de Salud, 31008 Pamplona, Spain
| | - Sitong Chen
- Institute for Health and Sport, Victoria University, Melbourne 8001, Australia
| | - Javier Brazo-Sayavera
- PDU EFISAL, Centro Universitario Regional Noreste, Universidad de la República (UdelaR), Rivera 40000, Uruguay
- Department of Sports and Computer Science, Universidad Pablo de Olavide (UPO), 41013 Seville, Spain
| | - Alejandro Fernandez-Montero
- Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, MA 02138, USA
- IdiSNA (Instituto de Investigación Sanitaria de Navarra), 31008 Pamplona, Spain
- Department of Occupational Medicine, University of Navarra, 31008 Pamplona, Spain
| | - Pedro Emilio Alcaraz
- Research Center for High Performance Sport, San Antonio Catholic University of Murcia, 30830 Murcia, Spain
- Faculty of Sport Sciences, San Antonio Catholic University of Murcia, 30107 Murcia, Spain
| | | | - Pedro J Tárraga-López
- Departamento de Ciencias Médicas, Facultad de Medicina, Universidad Castilla-La Mancha (UCLM), 02008 Albacete, Spain
| | - Stefanos N Kales
- Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, MA 02138, USA
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11
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Lan FY, Kasteler SD, Sidossis A, Iliaki E, Buley J, Nathan N, Osgood R, Bruno-Murtha LA, Kales SN. Immunity Acquired From the First Wave of COVID-19 Against Reinfections Up to Omicron Predominance. Mayo Clin Proc 2023; 98:202-203. [PMID: 36603950 PMCID: PMC9640383 DOI: 10.1016/j.mayocp.2022.11.002] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 10/02/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Fan-Yun Lan
- Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA; Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, MA; Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Health and Welfare Policy, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Stephen D Kasteler
- Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, MA; Air Force Institute of Technology, Wright-Patterson AFB, OH
| | - Amalia Sidossis
- Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA; Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, MA
| | - Eirini Iliaki
- Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA; Infection Prevention and Infectious Diseases, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA
| | - Jane Buley
- Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA
| | - Neetha Nathan
- Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA
| | - Rebecca Osgood
- Pathology, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA; Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Lou Ann Bruno-Murtha
- Infection Prevention and Infectious Diseases, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA
| | - Stefanos N Kales
- Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA; Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, MA
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12
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Romero-Cabrera JL, García-Ríos A, Sotos-Prieto M, Quintana-Navarro G, Alcalá-Díaz JF, Martín-Piedra L, Torres-Peña JD, Luque RM, Yubero-Serrano EM, Delgado-Lista J, Katsiki N, Kales SN, López-Miranda J, Pérez-Martínez P. Adherence to a Mediterranean lifestyle improves metabolic status in coronary heart disease patients: A prospective analysis from the CORDIOPREV study. J Intern Med 2022; 293:574-588. [PMID: 36585892 DOI: 10.1111/joim.13602] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND OBJECTIVES A Mediterranean lifestyle may prevent and mitigate cardiometabolic disorders. We explored whether adherence to a Mediterranean lifestyle was prospectively associated with the risk of metabolic syndrome (MetS) among coronary heart disease (CHD) patients. METHODS The Coronary Diet Intervention with Olive Oil and Cardiovascular Prevention (CORDIOPREV) study was an interventional diet study to compare a Mediterranean diet with a low-fat diet, in 1002 CHD patients. The Mediterranean lifestyle (MEDLIFE) index was used to assess adherence to a MEDLIFE at baseline, and after 5 years, in 851 participants from the CORDIOPREV study. Subjects were classified as having high (>13 points), moderate (12-13 points), and low (<12 points) adherence to the MEDLIFE. Multivariable logistic regression models were used to determine the association between MEDLIFE adherence and the risk of MetS development or reversal. RESULTS During the 5-year follow-up, CORDIOPREV participants with high adherence to MEDLIFE had a lower risk of MetS development (odds ratio [OR] 0.37, 95% confidence interval [CI] 0.19-0.75, p < 0.01) and a higher likelihood of reversing preexisting MetS (OR 2.08 CI 95% 1.11-3.91, p = 0.02) compared with participants in the low MEDLIFE adherence group. Each additional one-point increment in the MEDLIFE index was associated with a 24% lower risk of MetS development (OR 0.76, 95% CI 0.64-0.90, p < 0.01) and a 21% higher likelihood of reversing preexisting MetS (OR 1.21 CI 95% 1.04-1.41, p = 0.01). CONCLUSIONS Our results showed that greater adherence to a MEDLIFE reduced the risk of subsequent MetS development and increased the likelihood of reversing preexisting MetS among patients with CHD at baseline.
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Affiliation(s)
- Juan Luis Romero-Cabrera
- Lipids and Atherosclerosis Unit, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain.,CIBEROBN (CIBER in Physiopathology of Obesity and Nutrition), Instituto de Salud Carlos III, Madrid, Spain.,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Antonio García-Ríos
- Lipids and Atherosclerosis Unit, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain.,CIBEROBN (CIBER in Physiopathology of Obesity and Nutrition), Instituto de Salud Carlos III, Madrid, Spain
| | - Mercedes Sotos-Prieto
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Department of Preventive Medicine and Public Health, School of Medicine, Autonomous University of Madrid, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.,CIBERESP (CIBER of Epidemiology and Public Health), Instituto de Salud Carlos III, Madrid, Spain
| | - Gracia Quintana-Navarro
- Lipids and Atherosclerosis Unit, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain.,CIBEROBN (CIBER in Physiopathology of Obesity and Nutrition), Instituto de Salud Carlos III, Madrid, Spain
| | - Juan Francisco Alcalá-Díaz
- Lipids and Atherosclerosis Unit, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain.,CIBEROBN (CIBER in Physiopathology of Obesity and Nutrition), Instituto de Salud Carlos III, Madrid, Spain
| | - Laura Martín-Piedra
- Lipids and Atherosclerosis Unit, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain.,CIBEROBN (CIBER in Physiopathology of Obesity and Nutrition), Instituto de Salud Carlos III, Madrid, Spain
| | - José David Torres-Peña
- Lipids and Atherosclerosis Unit, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain.,CIBEROBN (CIBER in Physiopathology of Obesity and Nutrition), Instituto de Salud Carlos III, Madrid, Spain
| | - Raúl M Luque
- CIBEROBN (CIBER in Physiopathology of Obesity and Nutrition), Instituto de Salud Carlos III, Madrid, Spain.,Department of Cell Biology, Phisiology and Immunology, University of Cordoba, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, Cordoba, Spain
| | - Elena María Yubero-Serrano
- Lipids and Atherosclerosis Unit, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain.,CIBEROBN (CIBER in Physiopathology of Obesity and Nutrition), Instituto de Salud Carlos III, Madrid, Spain
| | - Javier Delgado-Lista
- Lipids and Atherosclerosis Unit, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain.,CIBEROBN (CIBER in Physiopathology of Obesity and Nutrition), Instituto de Salud Carlos III, Madrid, Spain
| | - Niki Katsiki
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki, Greece.,School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Stefanos N Kales
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Occupational Medicine, Cambridge Health Alliance/Harvard Medical School, Cambridge, Massachusetts, USA
| | - José López-Miranda
- Lipids and Atherosclerosis Unit, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain.,CIBEROBN (CIBER in Physiopathology of Obesity and Nutrition), Instituto de Salud Carlos III, Madrid, Spain
| | - Pablo Pérez-Martínez
- Lipids and Atherosclerosis Unit, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain.,CIBEROBN (CIBER in Physiopathology of Obesity and Nutrition), Instituto de Salud Carlos III, Madrid, Spain
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13
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Barbosa WG, Saint Martin DR, Soares EDMKVKS, Fontana KE, Lan FY, Kales SN, Molina GE, Porto LGG. The effects of a 6-month mandatory military police academy training on recruits’ physical fitness. Work 2022; 73:1297-1306. [DOI: 10.3233/wor-210031] [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] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: Physical fitness for health and professional performance play important roles in police workforce considering that policing is a dangerous job, associated with high physical demands. OBJECTIVES: (1) To evaluate the effects of a 6-month course of police academy training on health-related physical fitness (HRPF) of military police recruits. (2) To investigate whether recruits’ HRPF still met the academy entry standards after an unsupervised 7-month period prior to academy. METHODS: We conducted an observational and longitudinal study with 219 male police recruits (aged 25.5±3.6 years; BMI of 24.4±2.5 kg/m2). HRPF parameters included the Cooper 12-min running test for cardiorespiratory fitness (CRF), curl-ups, pull-ups and push-ups for muscle strength/endurance which were evaluated 3 times: 7 months prior to academy course and pre- and post- the academy training period. RESULTS: Participants maintained optimal age-related HRPF during the unsupervised period prior to academy. After academy training upon graduation, all HRPF parameters further increased an average of 7.7 to 69.0% (p < 0.001; calculated Cohen’s d effect size ≥0.95). CRF was the only HRPF that improved less than 10% after the academy course. CONCLUSIONS: Police recruits that had passed the application fitness standards maintained their HRPF prior to academy, and all their HRPF parameters increased after a 6-month academy training period which was not primarily focused on exercise training. Among all components of HRPF, CRF appears to be the most challenging one to improve among police recruits. Our findings suggest that regular training with minimum physical standards could be potentially beneficial to police officers’ health and career longevity.
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Affiliation(s)
- Wélere G. Barbosa
- Faculty of Physical Education, University of Brasilia, Brasilia, Brazil
- Police Tocantins State Military, Palmas, Brazil
| | | | | | | | - Fan-Yun Lan
- Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
| | - Stefanos N. Kales
- Department of Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | - Luiz Guilherme G. Porto
- Faculty of Physical Education, University of Brasilia, Brasilia, Brazil
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA, USA
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14
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Lan FY, Scheibler C, Hershey MS, Romero-Cabrera JL, Gaviola GC, Yiannakou I, Fernandez-Montero A, Christophi CA, Christiani DC, Sotos-Prieto M, Kales SN. Effects of a healthy lifestyle intervention and COVID-19-adjusted training curriculum on firefighter recruits. Sci Rep 2022; 12:10607. [PMID: 35739126 PMCID: PMC9226180 DOI: 10.1038/s41598-022-10979-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 04/15/2022] [Indexed: 12/04/2022] Open
Abstract
There are knowledge gaps regarding healthy lifestyle (HLS) interventions in fire academy settings and also concerning the impacts of the pandemic on training. We enrolled fire recruits from two fire academies (A and B) in New England in early 2019 as the historical control group, and recruits from academies in New England (B) and Florida (C), respectively, during the pandemic as the intervention group. The three academies have similar training environments and curricula. The exposures of interest were a combination of (1) an HLS intervention and (2) impacts of the pandemic on training curricula and environs (i.e. social distancing, masking, reduced class size, etc.). We examined the health/fitness changes throughout training. The follow-up rate was 78%, leaving 92 recruits in the historical control group and 55 in the intervention group. The results show an HLS intervention improved the effects of fire academy training on recruits healthy behaviors (MEDI-lifestyle score, 0.5 ± 1.4 vs. − 0.3 ± 1.7), systolic blood pressure (− 7.2 ± 10.0 vs. 2.9 ± 12.9 mmHg), and mental health (Beck Depression score, − 0.45 ± 1.14 vs. − 0.01 ± 1.05) (all P < 0.05). The associations remained significant after multivariable adjustments. Moreover, a 1-point MEDI-lifestyle increment during academy training is associated with about 2% decrement in blood pressures over time, after multivariable adjustments (P < 0.05). Nonetheless, the impacts of pandemic restrictions on academy procedures compromised physical fitness training, namely in percent body fat, push-ups, and pull-ups.
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Affiliation(s)
- Fan-Yun Lan
- Department of Environmental Health, Harvard University T.H Chan School of Public Health, Boston, MA, USA.,Department of Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Macht Building 427, 1493 Cambridge Street, Cambridge, MA, 02139, USA.,Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Christopher Scheibler
- Department of Environmental Health, Harvard University T.H Chan School of Public Health, Boston, MA, USA
| | - Maria Soledad Hershey
- Department of Environmental Health, Harvard University T.H Chan School of Public Health, Boston, MA, USA
| | - Juan Luis Romero-Cabrera
- Department of Environmental Health, Harvard University T.H Chan School of Public Health, Boston, MA, USA.,Department of Internal Medicine, Hospital Universitario Reina Sofia, Córdoba, Spain
| | - Gabriel C Gaviola
- Department of Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Macht Building 427, 1493 Cambridge Street, Cambridge, MA, 02139, USA
| | - Ioanna Yiannakou
- Program in Biomedical Sciences, Boston University School of Medicine, Boston, MA, USA
| | - Alejandro Fernandez-Montero
- Department of Environmental Health, Harvard University T.H Chan School of Public Health, Boston, MA, USA.,Department of Occupational Medicine, Clínica Universidad de Navarra, Pamplona, Navarra, Spain.,Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, Spain
| | - Costas A Christophi
- Department of Environmental Health, Harvard University T.H Chan School of Public Health, Boston, MA, USA.,Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - David C Christiani
- Department of Environmental Health, Harvard University T.H Chan School of Public Health, Boston, MA, USA
| | - Mercedes Sotos-Prieto
- Department of Environmental Health, Harvard University T.H Chan School of Public Health, Boston, MA, USA.,Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid and CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain.,IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
| | - Stefanos N Kales
- Department of Environmental Health, Harvard University T.H Chan School of Public Health, Boston, MA, USA. .,Department of Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Macht Building 427, 1493 Cambridge Street, Cambridge, MA, 02139, USA.
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15
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Wei CF, Lan FY, Hsu YT, Lowery N, Dibona L, Akkeh R, Kales SN, Yang J. Risk of SARS-CoV-2 Infection Among Essential Workers in a Community-Based Cohort in the United States. Front Public Health 2022; 10:878208. [PMID: 35677773 PMCID: PMC9169416 DOI: 10.3389/fpubh.2022.878208] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives The objective of this paper is to identify the risk factors for SARS-CoV-2 infection that are related to occupation type as well as workplace conditions. Identifying such risk factors could have noteworthy implications in workplace safety enhancement and emergency preparedness planning for essential workers. Methods We conducted a retrospective analysis of visits at a community-based SARS-CoV-2 testing site in the greater Boston area between March 18th and June 19th, 2020, for individuals between 14 and 65 years of age. Nasopharyngeal swab specimen, medical review, and self-administered questionnaire were obtained, and SARS-CoV-2 infection was determined with real-time, reverse transcriptase-polymerase chain reaction (RT-PCR). Medical record-verified job classification, customer-facing, and work patterns were extracted from each individual's response through chart review and validated by licensed clinicians. The occupational patterns were coded by occupational medicine physicians with pre-specified criteria and were analyzed with logistic regression and inverse probability weighting. Results Among the 780 individuals included in the final analysis, working in healthcare-related jobs was associated with a four-fold increase in risk of SARS-CoV-2 infection (Adjusted OR: 4.00, 95% CI: 1.45–11.02). Individuals with customer-facing jobs had a two times risk increase (Adjusted OR: 1.97, 95% CI: 1.12–3.45) in having a positive SARS-CoV-2 RT-PCR assay result compared to participants with non-customer facing positions. Conclusions In this U.S. community-based population during the initial wave of the pandemic, a significant increase in risk of SARS-CoV-2 infection was observed in those employed in the healthcare sector or with customer-facing positions. Further research is warranted to determine if these correlations continued with the buildup of population immunity together with the attenuation of SARS-CoV-2 virulence.
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Affiliation(s)
- Chih-Fu Wei
- Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, MA, United States
| | - Fan-Yun Lan
- Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, MA, United States.,Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States
| | - Yu-Tien Hsu
- Department of Social and Behavioral Science, Harvard University T.H. Chan School of Public Health, Boston, MA, United States
| | - Nina Lowery
- Manet Community Health Center, Quincy, MA, United States
| | - Lauren Dibona
- Manet Community Health Center, Quincy, MA, United States
| | - Ream Akkeh
- Manet Community Health Center, Quincy, MA, United States
| | - Stefanos N Kales
- Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, MA, United States.,Department of Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States
| | - Justin Yang
- Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, MA, United States.,Manet Community Health Center, Quincy, MA, United States.,Department of Employee and Occupational Health, Atrius Health, Boston, MA, United States.,Department of General Internal Medicine, Boston University School of Medicine, Boston, MA, United States
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16
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Lan FY, Sidossis A, Iliaki E, Buley J, Nathan N, Bruno-Murtha LA, Kales SN. Continued effectiveness of COVID-19 vaccination among urban healthcare workers during delta variant predominance. BMC Infect Dis 2022; 22:457. [PMID: 35549891 PMCID: PMC9097140 DOI: 10.1186/s12879-022-07434-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/26/2022] [Indexed: 11/18/2022] Open
Abstract
Background Data on COVID-19 vaccine effectiveness (VE) among healthcare workers (HCWs) during periods of delta variant predominance are limited. Methods We followed a population of urban Massachusetts HCWs (45% non-White) subject to epidemiologic surveillance. We accounted for covariates such as demographics and community background infection incidence, as well as information bias regarding COVID-19 diagnosis and vaccination status. Results During the study period (December 16, 2020 to September 30, 2021), 4615 HCWs contributed to a total of 1,152,486 person-days at risk (excluding 309 HCWs with prior infection) and had a COVID-19 incidence rate of 5.2/10,000 (114 infections out of 219,842 person-days) for unvaccinated person-days and 0.6/10,000 (49 infections out of 830,084 person-days) for fully vaccinated person-days, resulting in an adjusted VE of 82.3% (95% CI 75.1–87.4%). For the secondary analysis limited to the period of delta variant predominance in Massachusetts (i.e., July 1 to September 30, 2021), we observed an adjusted VE of 76.5% (95% CI 40.9–90.6%). Independently, we found no re-infection among those with prior COVID-19, contributing to 74,557 re-infection-free person-days, adding to the evidence base for the robustness of naturally acquired immunity. Conclusions We found a VE of 76.5% against the delta variant. Our work also provides further evidence of naturally acquired immunity.
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Affiliation(s)
- Fan-Yun Lan
- Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Macht Building 427, 1493 Cambridge Street, Cambridge, MA, 02139, USA.,Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, MA, USA.,Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Amalia Sidossis
- Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Macht Building 427, 1493 Cambridge Street, Cambridge, MA, 02139, USA.,Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, MA, USA
| | - Eirini Iliaki
- Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Macht Building 427, 1493 Cambridge Street, Cambridge, MA, 02139, USA.,Infection Prevention and Infectious Diseases, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
| | - Jane Buley
- Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Macht Building 427, 1493 Cambridge Street, Cambridge, MA, 02139, USA
| | - Neetha Nathan
- Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Macht Building 427, 1493 Cambridge Street, Cambridge, MA, 02139, USA
| | - Lou Ann Bruno-Murtha
- Infection Prevention and Infectious Diseases, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
| | - Stefanos N Kales
- Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Macht Building 427, 1493 Cambridge Street, Cambridge, MA, 02139, USA. .,Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, MA, USA.
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17
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Parenteau M, Chen CJ, Luna-García B, Del Pilar Asmat M, Rielly A, Kales SN. Fatigue in NTSB-investigations 2013-2019: evidence of accidents and injuries. Int J Occup Saf Ergon 2022; 29:717-722. [PMID: 35535523 DOI: 10.1080/10803548.2022.2075639] [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: 10/18/2022]
Abstract
ABSTRACTThis study updates the prevalence of operator fatigue as a causative factor in accidents investigated by the National Transportation Safety Board (NTSB) and the associated injury severity in fatigue-related accidents. 394 investigations were analyzed and 12% of them were identified fatigue. The prevalence of fatigue varied among the transportation modes, ranging from 28% of aviation to 7% of marine. Most fatigue-related accidents (48%) occurred during late night or morning. Compared to non-fatigued operators, fatigued operators were more involved in severe or fatal injuries (odds ratio (OR) = 2.30; 95% confidence interval (CI) [1.66, 2.95]) and to injure non-operators (OR = 3.32; 95% CI [2.70, 3.95]). Obstructive sleep apnea (OSA) was identified as a probable cause, contributing cause, or finding in 15% of fatigued-related accidents, and 85.7% of these accidents, the operator met OSA screening criteria. Thus, opportunities remain for preventing fatigue-related accidents, including through more systematic operator screening for OSA.
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Affiliation(s)
- Michael Parenteau
- Department of Environmental Health, Harvard T.H Chan School of Public Health, Boston, MA 02215, USA
| | - Chen Julian Chen
- Division of Cardiology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Berenice Luna-García
- Department of Environmental Health, Harvard T.H Chan School of Public Health, Boston, MA 02215, USA.,School of Medicine, Universidad Nacional Autónoma de México. Mexico City, Mexico Mexico
| | - Marita Del Pilar Asmat
- Department of Environmental Health, Harvard T.H Chan School of Public Health, Boston, MA 02215, USA.,Department of Occupational Health and Prevention, Leon Hospital, Leon, Spain
| | - Albert Rielly
- Department of Environmental Health, Harvard T.H Chan School of Public Health, Boston, MA 02215, USA.,Occupational Medicine, Cambridge Health Alliance/Harvard Medical School, Cambridge, MA 02319, USA
| | - Stefanos N Kales
- Department of Environmental Health, Harvard T.H Chan School of Public Health, Boston, MA 02215, USA.,Occupational Medicine, Cambridge Health Alliance/Harvard Medical School, Cambridge, MA 02319, USA
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18
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Kales SN. In this issue of Occupational Medicine. Occup Med (Lond) 2022. [DOI: 10.1093/occmed/kqab179] [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: 11/13/2022] Open
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19
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Iliaki E, Lan FY, Christophi CA, Guidotti G, Jobrack AD, Buley J, Osgood R, Bruno-Murtha LA, Kales SN. COVID-19 Vaccine Effectiveness in a Diverse Urban Health Care Worker Population. Mayo Clin Proc 2021; 96:3180-3182. [PMID: 34863402 PMCID: PMC8523483 DOI: 10.1016/j.mayocp.2021.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 10/11/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Eirini Iliaki
- Occupational Medicine, Infection Prevention and Infectious Diseases, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA
| | - Fan-Yun Lan
- Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA; Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, MA; Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Costas A Christophi
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus; Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, MA
| | - Guido Guidotti
- Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA; Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, MA
| | - Alexander D Jobrack
- Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA; Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, MA
| | - Jane Buley
- Neetha Nathan, Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA
| | - Rebecca Osgood
- Pathology, Cambridge Health Alliance, Harvard Medical School, Cambridge MA; Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Lou Ann Bruno-Murtha
- Infection Prevention and Infectious Diseases, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA
| | - Stefanos N Kales
- Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA; Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, MA
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20
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Gribble AK, Sayón-Orea C, Bes-Rastrollo M, Kales SN, Shirahama R, Martínez-González MÁ, Fernandez-Montero A. Risk of Developing Metabolic Syndrome Is Affected by Length of Daily Siesta: Results from a Prospective Cohort Study. Nutrients 2021; 13:nu13114182. [PMID: 34836438 PMCID: PMC8619148 DOI: 10.3390/nu13114182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/17/2021] [Accepted: 11/19/2021] [Indexed: 11/19/2022] Open
Abstract
Background: Siesta has been associated with increased incidence of cardiovascular disease but the mechanism remains unclear. New studies into the relationship between siesta and metabolic syndrome have identified siesta length as a crucial differential, suggesting that siesta less than 40 min is associated with decreased risk of metabolic syndrome, while longer siesta is associated with increased risk. We aimed to investigate the effect of siesta duration on development of metabolic syndrome in a Mediterranean population using a prospective cohort study design. Methods: Our sample consisted of 9161 participants of the SUN cohort without components of metabolic syndrome at baseline. Siesta exposure was assessed at baseline and the development of metabolic syndrome components was assessed after an average 6.8 years of follow-up. We estimated odds ratios and fitted logistic regression models to adjust for potential cofounders including night-time sleep duration and quality, as well as other diet, health, and lifestyle factors. Results: We observed a positive association between average daily siesta >30 min and development of metabolic syndrome (aOR = 1.39 CI: 1.03–1.88). We found no significant difference in risk of developing metabolic syndrome between the group averaging ≤30 min of daily siesta and the group not taking siesta (aOR = 1.07 CI: 0.83–1.37). Further analysis suggested that average daily siesta <15 min may reduce risk of metabolic syndrome. Conclusions: Our study supports the J-curve model of the association between siesta and risk of metabolic syndrome, but suggests the protective effect is limited to a shorter range of siesta length than previously proposed.
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Affiliation(s)
- Anne Katherine Gribble
- School of Medicine, University of Sydney, Camperdown 2050, Australia;
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, 31008 Pamplona, Spain; (C.S.-O.); (M.B.-R.); (M.Á.M.-G.)
- Illawarra and Shoalhaven Local Health District, NSW Health, Wollongong 2500, Australia
| | - Carmen Sayón-Orea
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, 31008 Pamplona, Spain; (C.S.-O.); (M.B.-R.); (M.Á.M.-G.)
- Navarra Institute for Health Research (IdiSNa), 31008 Pamplona, Spain
- Navarra Public Health Institute, 31003 Pamplona, Spain
- CIBERobn, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Maira Bes-Rastrollo
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, 31008 Pamplona, Spain; (C.S.-O.); (M.B.-R.); (M.Á.M.-G.)
- Navarra Institute for Health Research (IdiSNa), 31008 Pamplona, Spain
- CIBERobn, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Stefanos N. Kales
- Department of Environmental Health, Harvard T.H Chan School of Public Health, Boston, MA 02115, USA; (S.N.K.); (R.S.)
- Department of Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA 02139, USA
| | - Ryutaro Shirahama
- Department of Environmental Health, Harvard T.H Chan School of Public Health, Boston, MA 02115, USA; (S.N.K.); (R.S.)
- Department of Public Health, Graduate School of Medicine, Juntendo University, Tokyo 113-8421, Japan
- Faculty of Science and Technology, Keio University, Kanagawa 223-8522, Japan
| | - Miguel Ángel Martínez-González
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, 31008 Pamplona, Spain; (C.S.-O.); (M.B.-R.); (M.Á.M.-G.)
- Navarra Institute for Health Research (IdiSNa), 31008 Pamplona, Spain
- CIBERobn, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Department of Nutrition, Harvard T.H Chan School of Public Health, Boston, MA 02115, USA
| | - Alejandro Fernandez-Montero
- Navarra Institute for Health Research (IdiSNa), 31008 Pamplona, Spain
- Department of Environmental Health, Harvard T.H Chan School of Public Health, Boston, MA 02115, USA; (S.N.K.); (R.S.)
- Department of Occupational Medicine, University of Navarra Clinic, Av. Pio XII, 36, 31008 Pamplona, Spain
- Correspondence: ; Tel.: +34-948-255400; Fax: +34-948-296500
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21
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Navarro-Font X, Kales SN, Vicente-Herrero MT, Rueda-Garrido JC, Del Campo MT, Reinoso-Barbero L, Fernandez-Montero A. Association Between the "COVID-19 Occupational Vulnerability Index" and COVID-19 Severity and Sequelae Among Hospital Employees. J Occup Environ Med 2021; 63:895-900. [PMID: 33973932 PMCID: PMC8478090 DOI: 10.1097/jom.0000000000002253] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES In addition to personal and health related factors, healthcare workers have an increased risk due to their work. We assessed the association of the score of the Occupational Vulnerability Index with the risk of suffering a severe COVID-19 and sequelae. METHODS Retrospective observational study carried out in healthcare workers. Among 119 employees infected, the COVID-19 Occupational Vulnerability Index (composed of 29 items regarding personal health, working conditions, and ability to comply with preventive measures) was calculated and correlated with COVID-19 severity/sequelae. RESULTS Workers with higher scores (six to seven points) had a significantly increased risk of developing severe disease (OR = 9.73; 95% CI, 1.53 to 35.56) and clinical sequelae (OR = 5.22; 95% CI, 1.80 to 15.16) than those with lower scores (0 to 3). CONCLUSION The "COVID-19 Occupational Vulnerability Index" may predict the risk of severe COVID-19 disease and clinical sequelae among healthcare workers.
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Affiliation(s)
- Xavier Navarro-Font
- Department of Occupational Medicine, Universidad de Navarra, Navarra (Mr Navarro-Font, Dr Fernandez-Montero); Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston (Dr Kales, Dr Fernandez-Montero); Department of Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge (Dr Kales), Massachusetts; Asociación Española de Especialistas en Medicina del Trabajo (Dr Vicente-Herrero, Dr Rueda-Garrido, Dr Campo, Dr Reinoso-Barbero, Dr Fernandez-Montero); Occupational Health and safety Services of Correos, Valencia (Dr Vicente-Herrero); Saudi Basic Industries Corporation Medical Services, Cartagena (Dr Rueda-Garrido); Department of Occupational and Prevention at University Hospital Fundación Jiménez Díaz, Universidad Autónoma de Madrid (Dr Campo), Madrid; Faculty of Health Sciences, Universidad Internacional de la Rioja, La Rioja (Dr Reinoso-Barbero); Navarra Institute for Health Research (IdisNa), Navarra (Dr Fernandez-Montero), Spain
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22
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Shirahama R, Tanigawa T, Ida Y, Fukuhisa K, Tanaka R, Tomooka K, Lan FY, Ikeda A, Wada H, Kales SN. Long-term effect of continuous positive airway pressure therapy on blood pressure in patients with obstructive sleep apnea. Sci Rep 2021; 11:19101. [PMID: 34580352 PMCID: PMC8476592 DOI: 10.1038/s41598-021-98553-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 09/08/2021] [Indexed: 11/13/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a common cause of hypertension. Previous studies have demonstrated beneficial short-term effects of continuous positive airway pressure (CPAP) therapy on blood pressure. However, long-term antihypertensive effects of CPAP have not been properly verified. This study examined the longitudinal effect of CPAP therapy adherence on blood pressure among OSA patients. All patients diagnosed with OSA and undergoing subsequent CPAP therapy at a Kanagawa-area sleep clinic were clinically followed for 24 months to examine CPAP adherence, as well as longitudinal changes in blood pressure and body weight because it may become a confound factor for changes in blood pressure. The hours of CPAP usage were collected over the course of 30 nights prior to each follow-up visit (1st, 3rd, 6th, 12th, and 24th month). The relationship between CPAP adherence and blood pressure was analyzed using mixed-effect logistic regression models. A total of 918 OSA patients were enrolled in the study. We found a significant reduction in diastolic blood pressure among patients with good CPAP adherence during the 24-month follow-up period (β = − 0.13, p = 0.03), when compared to the group with poor CPAP adherence. No significant association was found between CPAP adherence and weight loss (β = − 0.02, p = 0.59). Long-term, good CPAP therapy adherence was associated with lower diastolic blood pressure without significant weight loss.
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Affiliation(s)
- Ryutaro Shirahama
- Department of Public Health, Graduate School of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.,Faculty of Science and Technology, Keio University, Kanagawa, Japan
| | - Takeshi Tanigawa
- Department of Public Health, Graduate School of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Yoshifumi Ida
- Department of Public Health, Graduate School of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Kento Fukuhisa
- Department of Public Health, Graduate School of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Rika Tanaka
- Department of Public Health, Graduate School of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Kiyohide Tomooka
- Department of Public Health, Graduate School of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Fan-Yun Lan
- Environmental and Occupational Medicine and Epidemiology, Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Ai Ikeda
- Department of Public Health, Graduate School of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Hiroo Wada
- Department of Public Health, Graduate School of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Stefanos N Kales
- Environmental and Occupational Medicine and Epidemiology, Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, USA.,Occupational Medicine, Cambridge Health Alliance/Harvard Medical School, Cambridge, MA, USA
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Sotos-Prieto M, Del Rio D, Drescher G, Estruch R, Hanson C, Harlan T, Hu FB, Loi M, McClung JP, Mojica A, Puglielli D, Toong K, Yangarber F, Kales SN. Mediterranean diet - promotion and dissemination of healthy eating: proceedings of an exploratory seminar at the Radcliffe institute for advanced study. Int J Food Sci Nutr 2021; 73:158-171. [PMID: 34225548 DOI: 10.1080/09637486.2021.1941804] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 01/08/2023]
Abstract
The traditional Mediterranean diet is considered the world's most evidence-based eating pattern for promoting health and longevity. However, institutional food environments and their busy consumers often sacrifice health benefits for the convenience of faster and cheaper foods that generally are of lower quality and are more processed, and thus, contribute to the current epidemics of obesity and diabetes. Expert consensus has even identified the Mediterranean diet as the easiest to follow among healthy eating patterns. Nonetheless, fewer American families cook at home and many food services have been slow to implement healthier food options compatible with the Mediterranean diet. In September 2019, we convened a group of thought leaders at an exploratory seminar entitled: "Mediterranean Diet: Promotion and Dissemination of Healthy Eating", hosted by the Radcliffe Institute for Advanced Studies at Harvard University. The multidisciplinary faculty discussed best practices for translating traditional Mediterranean lifestyle principles to modern society.
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Affiliation(s)
- Mercedes Sotos-Prieto
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.,IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Madrid, Spain.,CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain.,IMDEA-Food Institute, CEI UAM + CSIC, Madrid, Spain.,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Daniele Del Rio
- School of Advanced Studies on Food and Nutrition, University of Parma, Parma, Italy
| | - Greg Drescher
- The Culinary Institute of America, Hyde Park, NY, USA
| | - Ramon Estruch
- Internal Medicine Department, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, Barcelona, Spain.,Ciber Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Chavanne Hanson
- Global, Food Choice Architecture and Nutrition Manager, Google, Mountain View, CA, USA
| | - Timothy Harlan
- School of Medicine, Tulane University, New Orleans, MA, USA
| | - Frank B Hu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Maria Loi
- Loi Estiatorio and Loi Brand, New York, NY, USA
| | - James P McClung
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA, USA
| | | | | | - Ken Toong
- University of Massachusetts, Amherst, MA, USA
| | | | - Stefanos N Kales
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
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24
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Mata-Fernández A, Hershey MS, Pastrana-Delgado JC, Sotos-Prieto M, Ruiz-Canela M, Kales SN, Martínez-González MA, Fernandez-Montero A. A Mediterranean lifestyle reduces the risk of cardiovascular disease in the "Seguimiento Universidad de Navarra" (SUN) cohort. Nutr Metab Cardiovasc Dis 2021; 31:1728-1737. [PMID: 33895077 DOI: 10.1016/j.numecd.2021.02.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 01/20/2021] [Accepted: 02/16/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND AIMS A healthy lifestyle is essential to prevent cardiovascular disease (CVD). However, beyond dietary habits, there is a scarcity of studies comprehensively assessing the typical traditional Mediterranean lifestyle with a multi-dimensional index. We assessed the association between the Mediterranean lifestyle (measured with the MEDLIFE index including diet, physical activity, and other lifestyle factors) and the incidence of CVD. METHODS AND RESULTS The "Seguimiento Universidad de Navarra" (SUN) project is a prospective, dynamic and multipurpose cohort of Spanish university graduates. We calculated a MEDLIFE score, composed of 28 items on food consumption, dietary habits, physical activity, rest, social habits, and conviviality, for 18,631 participants by assigning 1 point for each typical Mediterranean lifestyle factor achieved, for a theoretically possible final score ranging from 0 to 28 points. During an average follow-up of 11.5 years, 172 CVD cases (myocardial infarction, stroke or cardiovascular death) were observed. An inverse association between the MEDLIFE score and the risk of primary cardiovascular events was observed, with multivariable-adjusted hazard ratio (HR) = 0.50; (95% confidence interval, 0.31-0.81) for the highest MEDLIFE scores (14-23 points) compared to the lowest scores (0-9 points), p (trend) = 0.004. CONCLUSION A higher level of adherence to the Mediterranean lifestyle was significantly associated with a lower risk of CVD in a Spanish cohort. Public health strategies should promote the Mediterranean lifestyle to preserve cardiovascular health.
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Affiliation(s)
- Arancha Mata-Fernández
- University of Navarra, Emergency Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Maria S Hershey
- University of Navarra, Department of Preventive Medicine and Public Health, Pamplona, Spain; Department of Environmental Health, Harvard T.H Chan School of Public Health, Boston, MA, USA
| | - Juan C Pastrana-Delgado
- University of Navarra, Department of Internal Medicine, Clínica Universidad de Navarra, Pamplona, Spain
| | - Mercedes Sotos-Prieto
- Department of Environmental Health, Harvard T.H Chan School of Public Health, Boston, MA, USA; Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), and CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain; IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
| | - Miguel Ruiz-Canela
- University of Navarra, Department of Preventive Medicine and Public Health, Pamplona, Spain; Biomedical Research Network Centre for Pathophysiology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, Madrid, Spain; Navarra Institute for Health Research (IdisNa), Pamplona, Spain
| | - Stefanos N Kales
- Department of Environmental Health, Harvard T.H Chan School of Public Health, Boston, MA, USA; Department of Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
| | - Miguel A Martínez-González
- University of Navarra, Department of Preventive Medicine and Public Health, Pamplona, Spain; Biomedical Research Network Centre for Pathophysiology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, Madrid, Spain; Navarra Institute for Health Research (IdisNa), Pamplona, Spain; Department of Nutrition, Harvard T.H Chan School, Boston, MA, USA
| | - Alejandro Fernandez-Montero
- Department of Environmental Health, Harvard T.H Chan School of Public Health, Boston, MA, USA; Navarra Institute for Health Research (IdisNa), Pamplona, Spain; University of Navarra, Department of Occupational Medicine, Pamplona, Spain.
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25
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Christophi CA, Sotos-Prieto M, Lan FY, Delgado-Velandia M, Efthymiou V, Gaviola GC, Hadjivasilis A, Hsu YT, Kyprianou A, Lidoriki I, Wei CF, Rodriguez-Artalejo F, Kales SN. Ambient temperature and subsequent COVID-19 mortality in the OECD countries and individual United States. Sci Rep 2021; 11:8710. [PMID: 33888744 PMCID: PMC8062561 DOI: 10.1038/s41598-021-87803-w] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 04/05/2021] [Indexed: 12/23/2022] Open
Abstract
Epidemiological studies have yielded conflicting results regarding climate and incident SARS-CoV-2 infection, and seasonality of infection rates is debated. Moreover, few studies have focused on COVD-19 deaths. We studied the association of average ambient temperature with subsequent COVID-19 mortality in the OECD countries and the individual United States (US), while accounting for other important meteorological and non-meteorological co-variates. The exposure of interest was average temperature and other weather conditions, measured at 25 days prior and 25 days after the first reported COVID-19 death was collected in the OECD countries and US states. The outcome of interest was cumulative COVID-19 mortality, assessed for each region at 25, 30, 35, and 40 days after the first reported death. Analyses were performed with negative binomial regression and adjusted for other weather conditions, particulate matter, sociodemographic factors, smoking, obesity, ICU beds, and social distancing. A 1 °C increase in ambient temperature was associated with 6% lower COVID-19 mortality at 30 days following the first reported death (multivariate-adjusted mortality rate ratio: 0.94, 95% CI 0.90, 0.99, p = 0.016). The results were robust for COVID-19 mortality at 25, 35 and 40 days after the first death, as well as other sensitivity analyses. The results provide consistent evidence across various models of an inverse association between higher average temperatures and subsequent COVID-19 mortality rates after accounting for other meteorological variables and predictors of SARS-CoV-2 infection or death. This suggests potentially decreased viral transmission in warmer regions and during the summer season.
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Affiliation(s)
- Costas A Christophi
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, 30 Archbishop Kyprianou Str., 3036, Lemesos, Cyprus.,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Mercedes Sotos-Prieto
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), and CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - Fan-Yun Lan
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Mario Delgado-Velandia
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), and CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - Vasilis Efthymiou
- Department of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Gabriel C Gaviola
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Alexandros Hadjivasilis
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, 30 Archbishop Kyprianou Str., 3036, Lemesos, Cyprus
| | - Yu-Tien Hsu
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Aikaterini Kyprianou
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, 30 Archbishop Kyprianou Str., 3036, Lemesos, Cyprus
| | - Irene Lidoriki
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Chih-Fu Wei
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Fernando Rodriguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), and CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain.,IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
| | - Stefanos N Kales
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA. .,Department of Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Macht Building 427, 1493 Cambridge Street, Cambridge, MA, 02139, USA.
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26
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Burks SV, Anderson JE, Panda B, Haider R, Ginader T, Sandback N, Pokutnaya D, Toso D, Hughes N, Haider HS, Brockman R, Toll A, Solberg N, Eklund J, Cagle M, Hickman JS, Mabry E, Berger M, Czeisler CA, Kales SN. Employer-mandated obstructive sleep apnea treatment and healthcare cost savings among truckers. Sleep 2021; 43:5606928. [PMID: 31648298 DOI: 10.1093/sleep/zsz262] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 06/20/2018] [Revised: 08/01/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate the effect of an employer-mandated obstructive sleep apnea (OSA) diagnosis and treatment program on non-OSA-program trucker medical insurance claim costs. METHODS Retrospective cohort analysis; cohorts constructed by matching (randomly, with replacement) Screen-positive Controls (drivers with insurance screened as likely to have OSA, but not yet diagnosed) with Diagnosed drivers (n = 1,516; cases = 1,224, OSA Negatives = 292), on two factors affecting exposure to medical claims: experience level at hire and weeks of job tenure at the Diagnosed driver's polysomnogram (PSG) date (the "matching date"). All cases received auto-adjusting positive airway pressure (APAP) treatment and were grouped by objective treatment adherence data: any "Positive Adherence" (n = 932) versus "No Adherence" (n = 292). Bootstrap resampling produced a difference-in-differences estimate of aggregate non-OSA-program medical insurance claim cost savings for 100 Diagnosed drivers as compared to 100 Screen-positive Controls before and after the PSG/matching date, over an 18-month period. A two-part multivariate statistical model was used to set exposures and demographics/anthropometrics equal across sub-groups, and to generate a difference-in-differences comparison across periods that identified the effect of OSA treatment on per-member per-month (PMPM) costs of an individual driver, separately from cost differences associated with adherence choice. RESULTS Eighteen-month non-OSA-program medical claim costs savings from diagnosing (and treating as required) 100 Screen-positive Controls: $153,042 (95% CI: -$5,352, $330,525). Model-estimated effect of treatment on those adhering to APAP: -$441 PMPM (95% CI: -$861, -$21). CONCLUSIONS Results suggest a carrier-based mandatory OSA program generates substantial savings in non-OSA-program medical insurance claim costs.
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Affiliation(s)
- Stephen V Burks
- Division of Social Science, University of Minnesota Morris (UMN Morris), Morris, MN.,Behavioral and Personnel Economics Program, Institute of Labor Economics (IZA), Bonn, Germany.,Roadway Safety Institute, Region 5 University Transportation Center, Minneapolis, MN
| | - Jon E Anderson
- Division of Science and Math, University of Minnesota Morris (UMN Morris), Morris, MN
| | - Bibhudutta Panda
- Division of Social Science, University of Minnesota Morris (UMN Morris), Morris, MN
| | - Rebecca Haider
- Division of Social Science, University of Minnesota Morris (UMN Morris), Morris, MN
| | - Tim Ginader
- Division of Social Science, University of Minnesota Morris (UMN Morris), Morris, MN
| | - Nicole Sandback
- Division of Social Science, University of Minnesota Morris (UMN Morris), Morris, MN
| | - Darya Pokutnaya
- Division of Science and Math, University of Minnesota Morris (UMN Morris), Morris, MN
| | - Derek Toso
- Division of Social Science, University of Minnesota Morris (UMN Morris), Morris, MN
| | - Natalie Hughes
- Division of Social Science, University of Minnesota Morris (UMN Morris), Morris, MN
| | - Humza S Haider
- Division of Science and Math, University of Minnesota Morris (UMN Morris), Morris, MN
| | - Resa Brockman
- Division of Science and Math, University of Minnesota Morris (UMN Morris), Morris, MN
| | - Alice Toll
- Division of Science and Math, University of Minnesota Morris (UMN Morris), Morris, MN
| | - Nicholas Solberg
- Division of Science and Math, University of Minnesota Morris (UMN Morris), Morris, MN
| | - Jesse Eklund
- Division of Social Science, University of Minnesota Morris (UMN Morris), Morris, MN
| | - Michael Cagle
- Division of Science and Math, University of Minnesota Morris (UMN Morris), Morris, MN
| | | | - Erin Mabry
- Virginia Tech Transportation Institute, Blacksburg, VA
| | - Mark Berger
- Precision Pulmonary Diagnostics, Houston, TX
| | - Charles A Czeisler
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Stefanos N Kales
- Division of Sleep Medicine, Harvard Medical School, Boston, MA.,Department of Environmental & Occupational Medicine & Epidemiology, Harvard TH Chan School of Public Health, Boston, MA.,Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA
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27
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Lan FY, Suharlim C, Kales SN, Yang J. Association between SARS-CoV-2 infection, exposure risk and mental health among a cohort of essential retail workers in the USA. Occup Environ Med 2021; 78:237-243. [PMID: 33127659 PMCID: PMC7597418 DOI: 10.1136/oemed-2020-106774] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/11/2020] [Accepted: 09/26/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To investigate SARS-CoV-2 (the virus causing COVID-19) infection and exposure risks among grocery retail workers, and to investigate their mental health state during the pandemic. METHODS This cross-sectional study was conducted in May 2020 in a single grocery retail store in Massachusetts, USA. We assessed workers' personal/occupational history and perception of COVID-19 by questionnaire. The health outcomes were measured by nasopharyngeal SARS-CoV-2 reverse transcriptase PCR (RT-PCR) results, General Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9). RESULTS Among 104 workers tested, 21 (20%) had positive viral assays. Seventy-six per cent positive cases were asymptomatic. Employees with direct customer exposure had an odds of 5.1 (95% CI 1.1 to 24.8) being tested positive for SARS-CoV-2 after adjustments. As to mental health, the prevalence of anxiety and depression (ie, GAD-7 score >4 or PHQ-9 score >4) was 24% and 8%, respectively. After adjusting for potential confounders, those able to practice social distancing consistently at work had odds of 0.3 (95% CI 0.1 to 0.9) and 0.2 (95% CI 0.03 to 0.99) screening positive for anxiety and depression, respectively. Workers commuting by foot, bike or private cars were less likely to screen positive for depression (OR 0.1, 95% CI 0.02 to 0.7). CONCLUSIONS In this single store sample, we found a considerable asymptomatic SARS-CoV-2 infection rate among grocery workers. Employees with direct customer exposure were five times more likely to test positive for SARS-CoV-2. Those able to practice social distancing consistently at work had significantly lower risk of anxiety or depression.
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Affiliation(s)
- Fan-Yun Lan
- Environmental & Occupational Medicine & Epidemiology Program, Department of Environmental Health, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
- Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | | | - Stefanos N Kales
- Environmental & Occupational Medicine & Epidemiology Program, Department of Environmental Health, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
- Department of Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, Massachusetts, USA
| | - Justin Yang
- Environmental & Occupational Medicine & Epidemiology Program, Department of Environmental Health, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
- Department of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
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28
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Lan FY, Yiannakou I, Scheibler C, Hershey MS, Cabrera JLR, Gaviola GC, Fernandez-Montero A, Christophi CA, Christiani DC, Sotos-Prieto M, Kales SN. The Effects of Fire Academy Training and Probationary Firefighter Status on Select Basic Health and Fitness Measurements. Med Sci Sports Exerc 2021; 53:740-748. [PMID: 33044439 DOI: 10.1249/mss.0000000000002533] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE This study aimed to investigate changes in firefighter recruits' select health and fitness measurements, from academy training to the early probationary firefighter period. METHODS Firefighter recruits from two New England fire academies were followed up prospectively from enrollment at the academy to graduation after 15- to 16-wk training programs, and then for an average of 8 months as probationary firefighters. The participants' demographic, lifestyle, and mental health information was collected using a questionnaire. Body mass index, percent body fat, blood pressure, and push-ups were also measured at each time point. Furthermore, the academies tested the recruits on selected fitness measures (push-ups, pull-ups, and 1.5-mile running time) at academy entry, midtraining, and at graduation. RESULTS Ninety-two recruits consented and were included in the analyses. The recruits' percent body fat significantly decreased (median, 21.0%-18.2%) from baseline to graduation, and push-up capacity significantly improved (median, 34-53 per minute) in the same period, along with pull-ups and 1.5-mile running time. However, the recruits' blood pressure, both systolic and diastolic, increased significantly by an average of 3 mm Hg during the training. Those completing probationary follow-up (45/92 recruits) showed that most health/fitness improvements declined after graduation. From academy graduation to probationary follow-up, recruits' physical activity decreased and TV screen time increased significantly, leading to a lower healthy lifestyle score (median, 4-3). After multivariate adjustments, the recruits' diastolic blood pressure increased by 2 mm Hg per measuring time throughout the study period. CONCLUSIONS Fire academy training improved recruits' select health and fitness measurements, but the benefits dissipated as probationary firefighters, and blood pressures increased throughout the study period. Further interventions regarding blood pressure and to maintain training benefits after joining fire departments are warranted.
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Affiliation(s)
| | - Ioanna Yiannakou
- Boston University School of Medicine, Program in Biomedical Sciences, Boston, MA
| | - Christopher Scheibler
- Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, MA
| | - Maria Soledad Hershey
- Department of Preventive Medicine and Public Health, University of Navarra School of Medicine, Pamplona, Navarra, SPAIN
| | | | - Gabriel C Gaviola
- Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, MA
| | | | | | - David C Christiani
- Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, MA
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29
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Bruno-Murtha LA, Osgood R, Lan FY, Buley J, Nathan N, Weiss M, MacDonald M, Kales SN, Sayah AJ. SARS-CoV-2 antibody seroprevalence after the first wave among workers at a community healthcare system in the Greater Boston area. Pathog Glob Health 2021; 115:331-334. [PMID: 33729103 PMCID: PMC8547825 DOI: 10.1080/20477724.2021.1901041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
SARS-CoV-2 antibody seroprevalence among health-care workers (HCW) can assess past exposure and possible immunity, which varies across different regions, populations and times. We investigated the seroprevalence among HCW in Massachusetts (a region suffering high COVID-19 mortality) at the end of first wave of the SARS-CoV-2 pandemic. All HCW at Cambridge Health Alliance were invited to participate in this cross-sectional survey in June 2020. Those who volunteered, consented and provided a blood sample were included. Dried blood specimens from finger-prick sampling collected either at home by each HCW or onsite by the study team were analyzed for anti-SARS-CoV-2 IgM and IgG to the virus’ receptor binding domain, using an enzyme-linked immunosorbent assay. IgM and IgG antibody abundance were categorized based on the number of standard deviations above the cross-reacting levels found in existing, pre-pandemic blood samples previously obtained by the Ragon Institute and analyzed by the Broad Institute (Cambridge, MA). Seroprevalence estimates were made based on ‘positive’ IgM or IgG using ‘low’ (>6 SD), ‘medium’ (>4.5 SD), and ‘high’ prevalence cutoffs (>3 SD). A total of 433 out of 5,204 eligible HCWs consented and provided samples. Participating HCWs had a lower cumulative incidence (from the start of the pandemic up to the bloodspot collections) of SARS-CoV-2 RT-PCR positivity (1.85%) compared to non-participants (3.29%). The low, medium, and high seroprevalence estimates were 8.1%, 11.3%, and 14.5%, respectively. The weighted estimates based on past PCR positivity were 13.9%, 19.4%, and 24.9%, respectively, for the entire healthcare system population after accounting for participation bias.
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Affiliation(s)
- Lou Ann Bruno-Murtha
- Department of Medicine and Quality, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
| | - Rebecca Osgood
- Department of Pathology, Cambridge Health Alliance Harvard Medical School, Cambridge, MA, USA
| | - Fan-Yun Lan
- Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, MA, USA.,Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
| | - Jane Buley
- Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
| | - Neetha Nathan
- Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
| | - Michelle Weiss
- Information Technology, Cambridge Health Alliance, Cambridge, MA, USA
| | - Mary MacDonald
- Information Technology, Cambridge Health Alliance, Cambridge, MA, USA
| | - Stefanos N Kales
- Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, MA, USA.,Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
| | - Assaad J Sayah
- Department of Emergency Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA.,Cambridge Department of Public Health, Cambridge, MA, USA
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Thiese MS, Moffitt G, Hanowski RJ, Kales SN, Porter RJ, Hartenbaum N, Hegmann KT. What Medical Conditions Limit or Medically Disqualify Truck Drivers: A Large Cross Sectional Study. J Occup Environ Med 2021; 63:139-146. [PMID: 33523617 DOI: 10.1097/jom.0000000000002101] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Commercial Motor Vehicle drivers must be medically certified to obtain/maintain a commercial driver license. 88,246 exams from 2005 to 2012 were analyzed for relationships between health and certification length. Relationships were quantified using adjusted odds ratios (ORs). Most conditions and/or examination findings had statically significantly limited medical certification. Obesity > 35 kg/m2, hypertension and diabetes mellitus requiring medication were most common. Significant and meaningful relationships were found for opioid or benzodiazepine use (OR = 7.30), heart disease (OR = 5.19), musculoskeletal conditions (OR = 5.13), seizures (10.18), stroke (OR = 6.73), neurological (OR = 18.51) and vascular (OR = 11.83). Drivers with 2 or more of 13 medical conditions were statistically significantly more likely to have limited medical certification (OR = 122.35) or disqualification (OR = 4.91). Drivers with any condition are more likely to have limited medical certification. There is variability in medical certification lengths related to medical conditions and differences between examiners.
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Affiliation(s)
- Matthew S Thiese
- Rocky Mountain Center for Occupational & Environment Health, Department of Family and Preventive Medicine, School of Medicine, University of Utah, Salt Lake City, Utah (Dr Thiese, Dr Hegmann); Arkansas Occupational Health Clinic, Springdale, Arkansas (Dr Moffitt); Center for Truck and Bus Safety, Virginia Tech Transportation Institute, Blacksburg, Virginia (Dr Hanowski); Department of Environmental Health, Harvard Chan School of Public Health, Boston, Massachusetts (Dr Kales); Occupational Medicine, Cambridge Health Alliance, Cambridge, Massachusetts (Dr Kales, Dr Porter); VHB - Vanasse Hangen Brustlin, Raleigh, North Carolina (Dr Kales, Dr Porter); Occumedix, Inc., Dresher, Pennsylvania (Dr Hartenbaum)
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Romero Cabrera JL, Sotos-Prieto M, García Ríos A, Moffatt S, Christophi CA, Pérez-Martínez P, Kales SN. Sleep and Association With Cardiovascular Risk Among Midwestern US Firefighters. Front Endocrinol (Lausanne) 2021; 12:772848. [PMID: 34858343 PMCID: PMC8632221 DOI: 10.3389/fendo.2021.772848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/26/2021] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION Cardiovascular disease is the leading cause of on-duty fatalities among U.S. firefighters. Research has demonstrated that many modifiable risk factors are contributors to the high prevalence of cardiometabolic risk factors. The current study aimed to assess whether sleep is associated with cardiometabolic risk factors among Indianapolis firefighters. The findings could support improving sleep hygiene in this population. MATERIAL AND METHODS This cross-sectional study was conducted from the baseline data of eligible firefighters enrolled in "Feeding America's Bravest", a Mediterranean diet lifestyle intervention within the Indiana Fire Departments. Participants' sleep quality was categorized as "good" (≤ 8 points) or "bad" (>8 points) by a sleep quality questionnaire based on some questions from Pittsburgh Sleep Quality Index. In addition, firefighters' sleep duration was stratified based on the number of hours slept per night (≤6 as "short sleep" or >6 hours as normal). Linear and logistic regression models were used to examine the association of sleep with cardiometabolic risk factors. RESULTS A total of 258 firefighters were included. Bad sleepers had higher weight, greater waist circumference, higher body mass index (BMI), and increased body fat (all p<0.01) compared to good sleepers. Similarly, participants with short sleep duration were heavier (p<0.02), had greater BMI (p<0.02) and increased body fat (p<0.04) compared with participants with normal sleep duration. Both bad and short sleepers had a higher prevalence of hypertension and obesity (p <0.05). CONCLUSIONS Our study supports that both sleep quality and quantity are associated with cardiometabolic risk among firefighters.
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Affiliation(s)
- Juan Luis Romero Cabrera
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Institute of Health, Madrid, Spain
- *Correspondence: Juan Luis Romero Cabrera,
| | - Mercedes Sotos-Prieto
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid; IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz); and CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - Antonio García Ríos
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Institute of Health, Madrid, Spain
| | - Steven Moffatt
- National Institute for Public Safety Health, Indianapolis, IN, United States
| | - Costas A. Christophi
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - Pablo Pérez-Martínez
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Institute of Health, Madrid, Spain
| | - Stefanos N. Kales
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Occupational Medicine, Cambridge Health Alliance/Harvard Medical School, Cambridge, MA, United States
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Lan FY, Christophi CA, Buley J, Iliaki E, Bruno-Murtha LA, Sayah AJ, Kales SN. Effects of universal masking on Massachusetts healthcare workers' COVID-19 incidence. Occup Med (Lond) 2020; 70:606-609. [PMID: 33225363 PMCID: PMC7665621 DOI: 10.1093/occmed/kqaa179] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background Healthcare workers (HCWs) and other essential workers are at risk of occupational infection during the COVID-19 pandemic. Several infection control strategies have been implemented. Evidence shows that universal masking can mitigate COVID-19 infection, though existing research is limited by secular trend bias. Aims To investigate the effect of hospital universal masking on COVID-19 incidence among HCWs compared to the general population. Methods We compared the 7-day average incidence rates between a Massachusetts (USA) healthcare system and Massachusetts residents statewide. The study period was from 17 March (the date of first incident case in the healthcare system) to 6 May (the date Massachusetts implemented public masking). The healthcare system implemented universal masking on 26 March, we allotted a 5-day lag for effect onset and peak COVID-19 incidence in Massachusetts was 20 April. Thus, we categorized 17–31 March as the pre-intervention phase, 1–20 April the intervention phase and 21 April to 6 May the epidemic decline phase. Temporal incidence trends (i.e. 7-day average slopes) were compared using standardized coefficients from linear regression models. Results The standardized coefficients were similar between the healthcare system and the state in both the pre-intervention and epidemic decline phases. During the intervention phase, the healthcare system’s epidemic slope became negative (standardized β: −0.68, 95% CI: −1.06 to −0.31), while Massachusetts’ slope remained positive (standardized β: 0.99, 95% CI: 0.94 to 1.05). Conclusions Universal masking was associated with a decreasing COVID-19 incidence trend among HCWs, while the infection rate continued to rise in the surrounding community.
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Affiliation(s)
- F-Y Lan
- Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, MA, USA.,Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - C A Christophi
- Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, MA, USA.,Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - J Buley
- Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
| | - E Iliaki
- Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA.,Infection Prevention, Infectious Diseases, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
| | - L A Bruno-Murtha
- Infection Prevention, Infectious Diseases, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
| | - A J Sayah
- Emergency Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA.,Cambridge Department of Public Health, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
| | - S N Kales
- Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, MA, USA.,Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
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Romanidou M, Tripsianis G, Hershey MS, Sotos-Prieto M, Christophi C, Moffatt S, Constantinidis TC, Kales SN. Association of the Modified Mediterranean Diet Score (mMDS) with Anthropometric and Biochemical Indices in US Career Firefighters. Nutrients 2020; 12:nu12123693. [PMID: 33265967 PMCID: PMC7759922 DOI: 10.3390/nu12123693] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 11/24/2020] [Accepted: 11/27/2020] [Indexed: 12/26/2022] Open
Abstract
The Mediterranean diet is associated with multiple health benefits, and the modified Mediterranean Diet Score (mMDS) has been previously validated as a measure of Mediterranean diet adherence. The aim of this study was to examine associations between the mMDS and anthropometric indices, blood pressure, and biochemical parameters in a sample of career firefighters. The participants were from Indiana Fire Departments, taking part in the "Feeding America's Bravest" study, a cluster-randomized controlled trial that aimed to assess the efficacy of a Mediterranean diet intervention. We measured Mediterranean diet adherence using the mMDS. Anthropometric, blood pressure, and biochemical measurements were also collected. Univariate and multivariate linear regression models were used. In unadjusted analyses, many expected favorable associations between the mMDS and cardiovascular disease risk factors were found among the 460 firefighters. After adjustment for age, gender, ethnicity, physical activity, and smoking, a unitary increase in the mMDS remained associated with a decrease of the total cholesterol/HDL ratio (β-coefficient -0.028, p = 0.002) and an increase of HDL-cholesterol (β-coefficient 0.254, p = 0.004). In conclusion, greater adherence to the Mediterranean diet was associated with markers of decreased cardiometabolic risk. The mMDS score is a valid instrument for measuring adherence to the Mediterranean diet and may have additional utility in research and clinical practice.
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Affiliation(s)
- Maria Romanidou
- Department of Medical Statistics, Medical Faculty, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
- Correspondence:
| | - Grigorios Tripsianis
- Department of Medical Statistics, Medical Faculty, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
| | - Maria Soledad Hershey
- Department of Preventive Medicine and Public Health, Navarra Institute for Health Research, University of Navarra, 31008 Pamplona, Spain;
| | - Mercedes Sotos-Prieto
- Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, MA 02215, USA or (M.S.-P.); (C.C.); (S.N.K.)
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Calle del Arzobispo Morcillo 4, 28029 Madrid, Spain
- Biomedical Research Network Centre of Epidemiology and Public Health (CIBERESP), Carlos III Health Institute, 28029 Madrid, Spain
| | - Costas Christophi
- Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, MA 02215, USA or (M.S.-P.); (C.C.); (S.N.K.)
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, 30 Archbishop Kyprianou Str., Lemesos 3036, Cyprus
| | - Steven Moffatt
- National Institute for Public Safety Health, IN 324 E New York Street, Indianapolis, IN 46204, USA;
| | - Theodoros C. Constantinidis
- Laboratory of Hygiene and Environmental Protection, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
| | - Stefanos N. Kales
- Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, MA 02215, USA or (M.S.-P.); (C.C.); (S.N.K.)
- Occupational Medicine, Cambridge Health Alliance/Harvard Medical School, Cambridge, MA 02319, USA
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Sotos-Prieto M, Ruiz-Canela M, Song Y, Christophi C, Mofatt S, Rodriguez-Artalejo F, Kales SN. The Effects of a Mediterranean Diet Intervention on Targeted Plasma Metabolic Biomarkers among US Firefighters: A Pilot Cluster-Randomized Trial. Nutrients 2020; 12:E3610. [PMID: 33255353 PMCID: PMC7761450 DOI: 10.3390/nu12123610] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/12/2020] [Accepted: 11/18/2020] [Indexed: 02/07/2023] Open
Abstract
Metabolomics is improving the understanding of the mechanisms of the health effects of diet. Previous research has identified several metabolites associated with the Mediterranean Diet (MedDiet), but knowledge about longitudinal changes in metabolic biomarkers after a MedDiet intervention is scarce. A subsample of 48 firefighters from a cluster-randomized trial at Indianapolis fire stations was randomly selected for the metabolomics study at 12 months of follow up (time point 1), where Group 1 (n = 24) continued for another 6 months in a self-sustained MedDiet intervention, and Group 2 (n = 24), the control group at that time, started with an active MedDiet intervention for 6 months (time point 2). A total of 225 metabolites were assessed at the two time points by using a targeted NMR platform. The MedDiet score improved slightly but changes were non-significant (intervention: 24.2 vs. 26.0 points and control group: 26.1 vs. 26.5 points). The MedDiet intervention led to favorable changes in biomarkers related to lipid metabolism, including lower LDL-C, ApoB/ApoA1 ratio, remnant cholesterol, M-VLDL-CE; and higher HDL-C, and better lipoprotein composition. This MedDiet intervention induces only modest changes in adherence to the MedDiet and consequently in metabolic biomarkers. Further research should confirm these results based on larger study samples in workplace interventions with powerful study designs.
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Affiliation(s)
- Mercedes Sotos-Prieto
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Calle del Arzobispo Morcillo 4, 28029 Madrid, Spain;
- Biomedical Research Network Centre of Epidemiology and Public Health (CIBERESP), Carlos III Health Institute, 28029 Madrid, Spain
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; (C.C.); (S.N.K.)
| | - Miguel Ruiz-Canela
- Department of Preventive Medicine and Public Health, IdiSNA, University of Navarra, 31009 Pamplona, Spain;
- Biomedical Research Network Centre for Pathophysiology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, 28029 Madrid, Spain
| | - Yiqing Song
- Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN 46202, USA;
| | - Costas Christophi
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; (C.C.); (S.N.K.)
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, 30 Archbishop Kyprianou Str., 3036 Lemesos, Cyprus
| | - Steven Mofatt
- National Institute for Public Safety Health, Indianapolis, IN 46204, USA;
| | - Fernando Rodriguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Calle del Arzobispo Morcillo 4, 28029 Madrid, Spain;
- Biomedical Research Network Centre of Epidemiology and Public Health (CIBERESP), Carlos III Health Institute, 28029 Madrid, Spain
- IMDEA-Food Institute, CEI UAM+CSIC, 28049 Madrid, Spain
| | - Stefanos N. Kales
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; (C.C.); (S.N.K.)
- Department of Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA 02145, USA
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35
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Lan FY, Filler R, Mathew S, Iliaki E, Osgood R, Bruno-Murtha LA, Kales SN. Evolving virulence? Decreasing COVID-19 complications among Massachusetts healthcare workers: a cohort study. Pathog Glob Health 2020; 115:4-6. [PMID: 33191880 DOI: 10.1080/20477724.2020.1847778] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Fan-Yun Lan
- Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University , Tainan, Taiwan.,Department of Environmental Health, Harvard University T.H. Chan School of Public Health , Boston, MA, USA
| | - Robert Filler
- Department of Environmental Health, Harvard University T.H. Chan School of Public Health , Boston, MA, USA
| | - Soni Mathew
- Cambridge Health Alliance, Harvard Medical School , Cambridge, MA, USA
| | - Eirini Iliaki
- Cambridge Health Alliance, Harvard Medical School , Cambridge, MA, USA
| | - Rebecca Osgood
- Cambridge Health Alliance, Harvard Medical School , Cambridge, MA, USA
| | | | - Stefanos N Kales
- Department of Environmental Health, Harvard University T.H. Chan School of Public Health , Boston, MA, USA.,Cambridge Health Alliance, Harvard Medical School , Cambridge, MA, USA
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Segedi LC, Saint-Martin DRF, da Cruz CJG, Von Koenig Soares EMK, do Nascimento NL, da Silva LL, Nogueira RM, Korre M, Smith DL, Kales SN, Molina GE, Porto LGG. Cardiorespiratory fitness assessment among firefighters: Is the non-exercise estimate accurate? Work 2020; 67:173-183. [PMID: 32955482 DOI: 10.3233/wor-203263] [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: 11/15/2022] Open
Abstract
BACKGROUND Minimum cardiorespiratory fitness (CRF) has been recommended for firefighters due to job requirements. Thus, it is important to identify accurate and readily available methods to assess CRF in this population. Non-exercise CRF estimates (NEx-CRF) have been proposed but this approach requires validation in this population. OBJECTIVE To evaluate the accuracy of a NEx-CRF, as compared to a field maximum exercise test, among career military firefighters of both genders using a comprehensive agreement analysis. METHODS We evaluated the accuracy of a NEx-CRF estimate compared to the Cooper 12 min running test among 702 males and 106 female firefighters. RESULTS Cooper and NEx-CRF tests yielded similar CRF in both genders (differences <1.8±4.7 ml/kg-1.min-1; effect size <0.34). However, NEx-CRF underestimated Cooper-derived CRF among the fittest firefighters. NEx-CRF showed moderate to high sensitivity/specificity to detect fit or unfit firefighters (71.9% among men and 100% among women). Among men, the NEx-CRF method correctly identified most firefighters with less than 11 METs or greater than 13 METs, but showed lower precision to discriminate those with CRF between 11-13 METs. CONCLUSIONS The NEx-CRF method to estimate firefighters' CRF may be considered as an alternative method when an exercise-based method is not available or may be used to identify those who require more traditional testing (CRF 11-13 METs).
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Affiliation(s)
- Leonardo Correa Segedi
- Faculty of Physical Education, The University of Brasilia FEF/UnB, Brazil.,Federal District (Brasilia) Military Firefighter Brigade, CBMDF, Brazil.,Grupo de Estudos em Fisiologia e Epidemiologia do Exercício e da Atividade Física (GEAFS), Brazil
| | - Daniel Rodrigues Ferreira Saint-Martin
- Faculty of Physical Education, The University of Brasilia FEF/UnB, Brazil.,Grupo de Estudos em Fisiologia e Epidemiologia do Exercício e da Atividade Física (GEAFS), Brazil
| | - Carlos Janssen Gomes da Cruz
- Faculty of Physical Education, The University of Brasilia FEF/UnB, Brazil.,Grupo de Estudos em Fisiologia e Epidemiologia do Exercício e da Atividade Física (GEAFS), Brazil
| | - Edgard M K Von Koenig Soares
- Faculty of Physical Education, The University of Brasilia FEF/UnB, Brazil.,Grupo de Estudos em Fisiologia e Epidemiologia do Exercício e da Atividade Física (GEAFS), Brazil
| | | | | | - Rosenkranz Maciel Nogueira
- Faculty of Physical Education, The University of Brasilia FEF/UnB, Brazil.,Federal District (Brasilia) Military Firefighter Brigade, CBMDF, Brazil.,Grupo de Estudos em Fisiologia e Epidemiologia do Exercício e da Atividade Física (GEAFS), Brazil
| | - Maria Korre
- Environmental and Occupational Medicine and Epidemiology Program, Department of Environmental Health, Harvard T. H. Chan School of Public Health, USA
| | - Denise L Smith
- Department of Health and Human Physiological Sciences, Skidmore College, First Responder Health and Safety Laboratory, Saratoga Springs, NY, USA
| | - Stefanos N Kales
- Environmental and Occupational Medicine and Epidemiology Program, Department of Environmental Health, Harvard T. H. Chan School of Public Health, USA.,Occupational Medicine, The Cambridge Health Alliance/Harvard Medical School, Cambridge, MA, USA
| | - Guilherme E Molina
- Faculty of Physical Education, The University of Brasilia FEF/UnB, Brazil.,Grupo de Estudos em Fisiologia e Epidemiologia do Exercício e da Atividade Física (GEAFS), Brazil
| | - Luiz Guilherme Grossi Porto
- Faculty of Physical Education, The University of Brasilia FEF/UnB, Brazil.,Grupo de Estudos em Fisiologia e Epidemiologia do Exercício e da Atividade Física (GEAFS), Brazil.,Environmental and Occupational Medicine and Epidemiology Program, Department of Environmental Health, Harvard T. H. Chan School of Public Health, USA
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Christodoulou A, Sotos-Prieto M, Kales SN, Christophi CA. Dietary patterns and their association with cardio-metabolic outcomes in US firefighters. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cardiovascular disease is prevalent among US firefighters. Obesity is known to be associated with an increased risk of CVD and it can be prevented by following a more Mediterranean style diet. The aim of this study was to identify the dietary patterns of US firefighters and assess how these patterns are associated with cardio-metabolic outcomes in the specific population.
Methods
Individuals were recruited from within a FEMA sponsored study from the Indiana Fire Department. IFD members with permanent station assigned were included. All participants underwent the Public Safety Medical examination, which includes occupational and medical history; a physical examination; routine laboratory tests; resting electrocardiograms; and maximal treadmill exercise testing. Participants self-reported their dietary habits.
Results
The mean BMI of the participants was 30.0 ± 4.5 kg/m2 and the percentage of body fat was 28.1 ± 6.1%. Using principal component analysis, two dietary patterns were identified, namely a Mediterranean style diet and an American Standard style diet. The Mediterranean style diet is positively associated with HDL cholesterol (β = 2.08, p = 0.001) even after adjusting for gender, BMI, VO2 max, max METS, age, and body fat percent. Triglycerides (β=-3.195, p = 0.585) and glucose (β=-0.079, p = 0.219) decreased with the Mediterranean style diet. The Standard American diet was also significantly associated with HDL cholesterol (β=-4.82, p = 0.002) and LDL cholesterol (β = 0.455, p = 0.014). In addition, body fat percentage increases significantly in the Standard American style diet (β = 1.778, p = 0.029), even after the adjustments.
Discussion
Two dietary patterns were identified in US firefighters - a Mediterranean style diet and an American Standard diet. Mediterranean diet was protective whereas the American Standard diet had the opposite effect. This could help provide suitable recommendations that could improve the lives of US firefighters.
Key messages
Two diet patterns have been identified in US firefighters. The Mediterranean style diet seems to have a protective effect. The American Standard diet has a negative impact on cardio-metabolic outcomes as expected.
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Affiliation(s)
- A Christodoulou
- Cyprus Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - M Sotos-Prieto
- Medical Faculty, Universidad Autonoma de Madrid, Madrid, Spain
| | - S N Kales
- Faculty of Environmental Health, Harvard T.H Chan School of Public Health, Cambridge, USA
| | - C A Christophi
- Cyprus Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus
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Rueda-Garrido JC, Vicente-Herrero MT, Del Campo MT, Reinoso-Barbero L, de la Hoz RE, Delclos GL, Kales SN, Fernandez-Montero A. Return to work guidelines for the COVID-19 pandemic. Occup Med (Lond) 2020; 70:300-305. [PMID: 32476022 PMCID: PMC7313801 DOI: 10.1093/occmed/kqaa099] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Juan Carlos Rueda-Garrido
- SABIC Medical Services, Cartagena, Spain.,Asociación Española de Especialistas en Medicina del Trabajo, Madrid, Spain
| | - Mª Teofila Vicente-Herrero
- Asociación Española de Especialistas en Medicina del Trabajo, Madrid, Spain.,Occupational Health and Safety Services of Correos, Valencia, Spain
| | - Mª Teresa Del Campo
- Asociación Española de Especialistas en Medicina del Trabajo, Madrid, Spain.,Department of Occupational and Prevention at University Hospital Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - Luis Reinoso-Barbero
- Asociación Española de Especialistas en Medicina del Trabajo, Madrid, Spain.,Occupational Medicine Service Grupo Banco Santander, Madrid, Spain.,Faculty of Health Sciences, Universidad Internacional de la Rioja, La Rioja, Spain
| | - Rafael E de la Hoz
- Division of Occupational and Environmental Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - George L Delclos
- Southwest Center for Occupational and Environmental Health, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Stefanos N Kales
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
| | - Alejandro Fernandez-Montero
- Asociación Española de Especialistas en Medicina del Trabajo, Madrid, Spain.,Department of Occupational Medicine, Universidad de Navarra, Navarra, Spain
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Porto LGG, Silveira WGB, Molina GE, Soares EMKVK, Saint Martin DR, Christophi CA, Kales SN. Predictors Of Physical Activity Level Among Brazilian Military Law Enforcement Personnel. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000678560.14512.db] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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40
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Lan FY, Filler R, Mathew S, Buley J, Iliaki E, Bruno-Murtha LA, Osgood R, Christophi CA, Fernandez-Montero A, Kales SN. COVID-19 symptoms predictive of healthcare workers' SARS-CoV-2 PCR results. PLoS One 2020; 15:e0235460. [PMID: 32589687 PMCID: PMC7319316 DOI: 10.1371/journal.pone.0235460] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 06/16/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Coronavirus 2019 disease (COVID-19) is caused by the virus SARS-CoV-2, transmissible both person-to-person and from contaminated surfaces. Early COVID-19 detection among healthcare workers (HCWs) is crucial for protecting patients and the healthcare workforce. Because of limited testing capacity, symptom-based screening may prioritize testing and increase diagnostic accuracy. METHODS AND FINDINGS We performed a retrospective study of HCWs undergoing both COVID-19 telephonic symptom screening and nasopharyngeal SARS-CoV-2 assays during the period, March 9-April 15, 2020. HCWs with negative assays but progressive symptoms were re-tested for SARS-CoV-2. Among 592 HCWs tested, 83 (14%) had an initial positive SARS-CoV-2 assay. Fifty-nine of 61 HCWs (97%) who were asymptomatic or reported only sore throat/nasal congestion had negative SARS-CoV-2 assays (P = 0.006). HCWs reporting three or more symptoms had an increased multivariate-adjusted odds of having positive assays, 1.95 (95% CI: 1.10-3.64), which increased to 2.61 (95% CI: 1.50-4.45) for six or more symptoms. The multivariate-adjusted odds of a positive assay were also increased for HCWs reporting fever and a measured temperature ≥ 37.5°C (3.49 (95% CI: 1.95-6.21)), and those with myalgias (1.83 (95% CI: 1.04-3.23)). Anosmia/ageusia (i.e. loss of smell/loss of taste) was reported less frequently (16%) than other symptoms by HCWs with positive assays, but was associated with more than a seven-fold multivariate-adjusted odds of a positive test: OR = 7.21 (95% CI: 2.95-17.67). Of 509 HCWs with initial negative SARS-CoV-2 assays, nine had symptom progression and positive re-tests, yielding an estimated negative predictive value of 98.2% (95% CI: 96.8-99.0%) for the exclusion of clinically relevant COVID-19. CONCLUSIONS Symptom and temperature reports are useful screening tools for predicting SARS-CoV-2 assay results in HCWs. Anosmia/ageusia, fever, and myalgia were the strongest independent predictors of positive assays. The absence of symptoms or symptoms limited to nasal congestion/sore throat were associated with negative assays.
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Affiliation(s)
- Fan-Yun Lan
- Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Robert Filler
- Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Cambridge Health Alliance, Occupational Medicine, Harvard Medical School, Cambridge, Massachusetts, United States of America
| | - Soni Mathew
- Cambridge Health Alliance, Occupational Medicine, Harvard Medical School, Cambridge, Massachusetts, United States of America
| | - Jane Buley
- Cambridge Health Alliance, Occupational Medicine, Harvard Medical School, Cambridge, Massachusetts, United States of America
| | - Eirini Iliaki
- Cambridge Health Alliance, Occupational Medicine, Harvard Medical School, Cambridge, Massachusetts, United States of America
- Cambridge Health Alliance, Infection Prevention, Infectious Diseases, Harvard Medical School, Cambridge, Massachusetts, United States of America
| | - Lou Ann Bruno-Murtha
- Cambridge Health Alliance, Infection Prevention, Infectious Diseases, Harvard Medical School, Cambridge, Massachusetts, United States of America
| | - Rebecca Osgood
- Cambridge Health Alliance, Pathology, Harvard Medical School, Cambridge, Massachusetts, United States of America
- Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Costas A. Christophi
- Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - Alejandro Fernandez-Montero
- Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Occupational Medicine, University of Navarra, Pamplona, Spain
| | - Stefanos N. Kales
- Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Cambridge Health Alliance, Occupational Medicine, Harvard Medical School, Cambridge, Massachusetts, United States of America
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Shirahama R, Tanigawa T, Tomooka K, Fan Yun L, Ikeda A, Wada H, Kales SN. 0653 Positive Effects of Long Term Continuous Positive Airway Pressure Therapy on Blood Pressure in Obstructive Sleep Apnea Patients. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.649] [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] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Obstructive sleep apnea (OSA) is one of the common causes of hypertension. Therefore, we examine the longitudinal effect of continuous positive airway pressure (CPAP) therapy and its adherence on blood pressure among OSA patients.
Methods
One thousand two hundred ninety-three (male 1,130, female 163) patients, who were diagnosed with OSA and underwent CPAP therapy were investigated for longitudinal changes (24 months observation period) in the levels of blood pressure and body weight. The longitudinal analyses were performed by mixed effect model. Multiple Imputation with Chained Equations was also used to impute missing data. Good CPAP adherence is defined as more than 70% of the time using CPAP more than 4hours at all the measuring. Poor CPAP adherence is defined as less than 70% of the time using CPAP more than 4hours at all the measuring time points.
Results
The patient group with good CPAP adherences), compared to poor CPAP adherence, showed significant diastolic blood pressure reduction in 24 months follow-up period (β=-0.13, p=0.03) despite a lack of significant weight loss (β=-0.02, p=0.59). However, no significant associations were found between systolic blood pressure and CPAP adherence (β=-0.14, p=0.11).
Conclusion
CPAP therapy was found to have a longitudinal effect on diastolic blood pressure despite a lack of significant weight loss.
Support
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Affiliation(s)
- R Shirahama
- Department of Public Hearth. Graduate School of Medicine, Juntendo university, Tokyo, JAPAN
| | - T Tanigawa
- Department of Public Hearth. Graduate School of Medicine, Juntendo university, Tokyo, JAPAN
| | - K Tomooka
- Department of Public Hearth. Graduate School of Medicine, Juntendo university, Tokyo, JAPAN
| | - L Fan Yun
- Occupational medicine Residency, Harverd TH Chan School of Public Health, BOSTON, MA
| | - A Ikeda
- Department of Public Hearth. Graduate School of Medicine, Juntendo university, Tokyo, JAPAN
| | - H Wada
- Department of Public Hearth. Graduate School of Medicine, Juntendo university, Tokyo, JAPAN
| | - S N Kales
- Occupational medicine Residency, Harverd TH Chan School of Public Health, BOSTON, MA
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Lan FY, Wei CF, Hsu YT, Christiani DC, Kales SN. Work-related COVID-19 transmission in six Asian countries/areas: A follow-up study. PLoS One 2020; 15:e0233588. [PMID: 32428031 PMCID: PMC7237000 DOI: 10.1371/journal.pone.0233588] [Citation(s) in RCA: 139] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 05/08/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE There is limited evidence of work-related transmission in the emerging coronaviral pandemic. We aimed to identify high-risk occupations for early coronavirus disease 2019 (COVID-19) local transmission. METHODS In this observational study, we extracted confirmed COVID-19 cases from governmental investigation reports in Hong Kong, Japan, Singapore, Taiwan, Thailand, and Vietnam. We followed each country/area for 40 days after its first locally transmitted case, and excluded all imported cases. We defined a possible work-related case as a worker with evidence of close contact with another confirmed case due to work, or an unknown contact history but likely to be infected in the working environment (e.g. an airport taxi driver). We calculated the case number for each occupation, and illustrated the temporal distribution of all possible work-related cases and healthcare worker (HCW) cases. The temporal distribution was further defined as early outbreak (the earliest 10 days of the following period) and late outbreak (11th to 40th days of the following period). RESULTS We identified 103 possible work-related cases (14.9%) among a total of 690 local transmissions. The five occupation groups with the most cases were healthcare workers (HCWs) (22%), drivers and transport workers (18%), services and sales workers (18%), cleaning and domestic workers (9%) and public safety workers (7%). Possible work-related transmission played a substantial role in early outbreak (47.7% of early cases). Occupations at risk varied from early outbreak (predominantly services and sales workers, drivers, construction laborers, and religious professionals) to late outbreak (predominantly HCWs, drivers, cleaning and domestic workers, police officers, and religious professionals). CONCLUSIONS Work-related transmission is considerable in early COVID-19 outbreaks, and the elevated risk of infection was not limited to HCW. Implementing preventive/surveillance strategies for high-risk working populations is warranted.
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Affiliation(s)
- Fan-Yun Lan
- Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Fu Wei
- Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Yu-Tien Hsu
- Department of Social and Behavioral Science, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - David C. Christiani
- Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Stefanos N. Kales
- Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, Massachusetts, United States of America
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Lidoriki I, Schizas D, Frountzas M, Machairas N, Prodromidou A, Kapelouzou A, Karavokyros I, Pikoulis E, Kales SN, Liakakos T. GNRI as a Prognostic Factor for Outcomes in Cancer Patients: A Systematic Review of the Literature. Nutr Cancer 2020; 73:391-403. [PMID: 32321298 DOI: 10.1080/01635581.2020.1756350] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Oncologic patients often suffer from malnutrition which in turn, might have negative impact on treatment outcomes. The Geriatric Nutritional Risk Index (GNRI), as an index of impaired nutritional status, has emerged as a significant prognostic factor for short-and long-term outcomes in cancer patients. The aim of the current systematic review is to determine whether the GNRI is an independent prognostic factor of postoperative complications and survival in cancer patients. A systematic search was conducted to identify studies, published from 2005 to 2019, which assessed associations between GNRI and short- and long-term outcomes in cancer patients. Eighteen studies fulfilled the eligibility criteria and were included in the analysis. Low scores of GNRI were associated with increased risk for developing postoperative complications and impaired survival of cancer patients in most studies. Our findings support the use of the GNRI in the clinical practice, since it is a simple and reliable tool for assessing nutritional status in oncologic patients. More prospective, multi-centered studies are warranted to confirm the current results, as well as the role of nutritional support in improving the prognosis of cancer patients.
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Affiliation(s)
- Irene Lidoriki
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Maximos Frountzas
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Machairas
- Third Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | | | - Alkistis Kapelouzou
- Center for Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - Ioannis Karavokyros
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Emmanouil Pikoulis
- Third Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Stefanos N Kales
- Harvard Medical School, Cambridge Health Alliance, Cambridge, Massachusetts, USA.,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Theodoros Liakakos
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
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Korre M, Loh K, Eshleman EJ, Lessa FS, Porto LG, Christophi CA, Kales SN. Recruit fitness and police academy performance: a prospective validation study. Occup Med (Lond) 2019; 69:541-548. [PMID: 31424077 DOI: 10.1093/occmed/kqz110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 01/25/2023] Open
Abstract
BACKGROUND Police academies need fit recruits to successfully engage in training activities. In a previous retrospective study, we documented that recruits with poor fitness at entry to the academy had significantly lower graduation rates, and we also suggested evidence-based entry-level fitness recommendations. AIMS To validate our findings in a prospective cohort of police recruits. METHODS Recruits entering Massachusetts municipal police academies during 2015-16 were followed prospectively until they dropped out, failed or successfully graduated their academy classes. Entry-level fitness was quantified at the start of each training class using: body composition, push-ups, sit-ups, sit-and-reach and 1.5-mile run time. The primary outcome of interest was the odds of failure (not successfully graduating from an academy). We used logistic regression to assess the probability of not graduating, based on entry-level fitness. RESULTS On average, successful graduates were leaner and possessed better overall entry-level fitness. After adjusting for age, gender and body mass index, several fitness measures were strongly associated with academy failure: fewer sit-ups completed (OR 9.6 (95% CI 3.5-26.3) (≤15 versus 41-60)); fewer push-ups completed (OR 6.7 (95% CI 2.5-17.5) (≤20 versus 41-60)); and slower run times (OR 18.4 (95% CI 6.8-50.2) (1.5 miles in > 15 min 20 s versus 10 min 37 s to 12 min 33 s)). The prospective study results supported previously suggested minimum entry-level fitness (95% graduation rate) and target (98% graduation rate) recommendations. CONCLUSIONS Push-ups completed and 1.5-mile run time at police academy entry were successfully validated as predictors of successful academy graduation, while sit-ups were also a strong independent predictor in the prospective study.
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Affiliation(s)
- M Korre
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,The Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA.,Department of Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY, USA
| | - K Loh
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Occupational Medicine, Northwest Permanente Physicians and Surgeons, PC, Portland, OR, USA
| | - E J Eshleman
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,The Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
| | - F S Lessa
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Workers' Health Coordination, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - L G Porto
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Faculty of Physical Education of the University of Brasilia, Campus Darcy Ribeiro, Brasilia, DF, Brazil
| | - C A Christophi
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - S N Kales
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,The Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
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Soteriades ES, Kim J, Christophi CA, Kales SN. Cancer Incidence and Mortality in Firefighters: A State-of-the-Art Review and Meta-َAnalysis. Asian Pac J Cancer Prev 2019; 20:3221-3231. [PMID: 31759344 PMCID: PMC7063017 DOI: 10.31557/apjcp.2019.20.11.3221] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Indexed: 11/30/2022] Open
Abstract
Objective: A systematic literature review and meta-analysis was conducted on the association between firefighting and cancer. Methods: A comprehensive literature search of databases including Medline, EMBASE, Biosis, NIOSHTIC2, Web of Science, Cancerlit, and HealthStar, for the period between 1966 to January 2007, was conducted. We also retrieved additional studies by manual searching. Results: A total of 49 studies were included in the meta-analysis. We found statistically significant associations between firefighting and cancers of bladder, brain and CNS, and colorectal cancers, consistent with several previous risk estimates. We also found statistically significant associations of firefighting with non-Hodgkin’s lymphoma, skin melanoma, prostate, and testicular cancer. For kidney, Hodgkin’s lymphoma, leukemia, lymphosarcoma and reticulosarcoma, multiple myeloma, and pancreatic cancer, we found some statistically significant but less consistent results. For all other cancers evaluated (esophageal, laryngeal, oral and pharyngeal, liver and gallbladder, lung, lymphatic and hematopoietic, non-melanoma skin cancer, stomach, and urinary cancer) we did not find any statistically significant associations. Conclusions: Although our meta-analysis showed statistically significant increased risks of either cancer incidence or mortality of certain cancers in association with firefighting, a number of important limitations of the underlying studies exist, which, precluded our ability to arrive at definitive conclusions regarding causation.
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Affiliation(s)
- Elpidoforos S Soteriades
- United Arab Emirates University, College of Medicine and Health Sciences, Institute of Public Health, Al Ain, United Arab Emirates.,Harvard T.H. Chan School of Public Health, Department of Environmental Health, Environmental and Occupational Medicine and Epidemiology (EOME), Boston, MA, USA
| | - Jaeyoung Kim
- Harvard T.H. Chan School of Public Health, Department of Environmental Health, Environmental and Occupational Medicine and Epidemiology (EOME), Boston, MA, USA.,Keimyung University, College of Medicine, Department of Preventive Medicine, Daegu, Korea
| | - Costas A Christophi
- Harvard T.H. Chan School of Public Health, Department of Environmental Health, Environmental and Occupational Medicine and Epidemiology (EOME), Boston, MA, USA.,Cyprus University of Technology, School of Health Sciences, Cyprus International Institute for Environmental and Public Health in association with Harvard School of Public Health, Limassol, Cyprus.,The Biostatistics Center, The George Washington University, Rockville, MD, USA
| | - Stefanos N Kales
- Harvard T.H. Chan School of Public Health, Department of Environmental Health, Environmental and Occupational Medicine and Epidemiology (EOME), Boston, MA, USA.,Cambridge Health Alliance, Employee & Industrial Medicine, Cambridge, MA, USA
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Chin MS, Kales SN. Understanding mind–body disciplines: A pilot study of paced
breathing and dynamic muscle contraction on autonomic nervous system
reactivity. Stress Health 2019; 35:542-548. [PMID: 31347763 PMCID: PMC8758201 DOI: 10.1002/smi.2887] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 01/12/2019] [Revised: 06/15/2019] [Accepted: 07/03/2019] [Indexed: 01/05/2023]
Abstract
Mind-body disciplines such as yoga, Tai Chi, and Qigong have been demonstrated to activate the parasympathetic nervous system, but it remains unclear how these practices achieve these results, whether by breathing, movement, or some combination. This pilot study establishes a model to examine the individual and combined effects of paced breathing and rhythmic skeletal muscle contraction on the activation of the parasympathetic system during a cognitive stressor. Male participants were randomly assigned to one of four preconditioning groups: (a) paced breathing alone, (b) alternating upper extremity muscle contractions, (c) paced breathing synchronized with alternating contractions, or (d) a neutral control task. Autonomic response was assessed by heart rate variability during a standardized cognitive stressor. The alternating contraction group had 71.7% higher activation of parasympathetic signal over respiration alone (p < .001). Alternating contractions synchronized with breathing demonstrated 150% higher parasympathetic activation than control (p < .0001). Comparing the contraction alone and synchronized groups, the synchronized group demonstrated 45.9% higher parasympathetic response during a cognitive stressor (p < .001). In conclusion, paced breathing synchronized with rhythmic muscle contraction leads to more resilient activation of the parasympathetic response than either alternating contractions or breathing alone, which may help explain the stress reducing benefits of mind-body disciplines.
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Affiliation(s)
- Michael S. Chin
- Division of General Internal Medicine and Public Health,
Vanderbilt University School of Medicine, Nashville, Tennessee,Vanderbilt Occupational Health, Vanderbilt University
Medical Center, Nashville, Tennessee
| | - Stefanos N. Kales
- Environmental and Occupational Medicine and Epidemiology,
Harvard T.H. Chan School of Public Health, Boston, Massachusetts,Occupational Medicine, Cambridge Health Alliance, Harvard
Medical School, Cambridge, Massachusetts
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Abstract
Human fatigue is an important factor in transportation safety and a major causal factor of accidents. Employers play a vital role in minimizing fatigue-related risk, and are legally liable for damages arising from failure to address the risk. By taking an active role as stakeholders in transportation safety, employers not only reduce their risk of adverse safety events and limit their legal liability but may also benefit from improvements in productivity, morale, and health care expenditures. Employers should focus on reducing fatigue-related risk, with ongoing support from sleep safety research.
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Affiliation(s)
- David Rainey
- Occupational Medicine Residency, Harvard Medical School, Harvard TH Chan School of Public Health, Boston, MA, USA; Cambridge Health Alliance Occupational Health, 5 Middlesex Avenue, Somerville, MA 02145, USA
| | - Michael A Parenteau
- Occupational and Environmental Medicine Residency, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Building 1, Room 1406, Boston, MA 02115, USA
| | - Stefanos N Kales
- Occupational Medicine Residency, Harvard Medical School, Harvard TH Chan School of Public Health, Boston, MA, USA; The Cambridge Health Alliance - Occupational Medicine, Macht Building Suite 427, 1493 Cambridge Street, Cambridge, MA 02139, USA.
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Abstract
Introduction Flow describes a state of optimal experience that can promote a positive adaptation to increasing stress. The aim of the current study is to identify the ideal autonomic state for peak cognitive performance by correlating sympathovagal balance during cognitive stress with (1) perceived flow immersion and (2) executive task performance. Materials and Methods Autonomic states were varied in healthy male participants (n = 48) using combinations of patterned breathing and skeletal muscle contraction that are known to induce differing levels of autonomic response. After autonomic variation, a Stroop test was performed on participants to induce a mild stress response, and autonomic arousal was assessed using heart rate variability. Subjective experience of flow was measured by standardized self-report, and executive task performance was measured by reaction time on the Stroop test. Results There were significant associations between autonomic state and flow engagement with an inverted U-shaped function for parasympathetic stimulation, sympathetic response, and overall sympathovagal balance. There were also significant associations between autonomic states and reaction times. Combining sympathetic and parasympathetic responses to evaluate overall sympathovagal balance, there was a significant U-shaped relationship with reaction time. Discussion Our results support the flow theory of human performance in which the ideal autonomic state lies at the peak of an inverted-U function, and extremes at either end lead to both suboptimal flow experience. Similarly, cognitive task performance was maximized at the bottom of the U-function. Our findings suggest that optimal performance may be associated with predominant, but not total, sympathetic response.
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Affiliation(s)
- Michael S Chin
- Division of General Internal Medicine and Public Health, Vanderbilt University School of Medicine, Nashville, TN, United States.,Vanderbilt Occupational Health, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Stefanos N Kales
- Environmental and Occupational Medicine and Epidemiology Program, Harvard T.H. Chan School of Public Health, Boston, MA, United States.,Department of Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Boston, MA, United States
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Porto LGG, Segedi LC, Martin DS, Soares E, Molina GE, da Cruz CJ, Nogueira RM, Smith DL, Kales SN. Firefighters' Quality of Life is Positively Associated With Cardiorespiratory Fitness Both on Mem and Women. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000561317.50219.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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