Very short sleep duration reveals a proteomic fingerprint that is selectively associated with incident diabetes mellitus but not with incident coronary heart disease: a cohort study

BACKGROUND

The molecular pathways linking short and long sleep duration with incident diabetes mellitus (iDM) and incident coronary heart disease (iCHD) are not known. We aimed to identify circulating protein patterns associated with sleep duration and test their impact on incident cardiometabolic disease.

METHODS

We assessed sleep duration and measured 78 plasma proteins among 3336 participants aged 46-68 years, free from DM and CHD at baseline, and identified cases of iDM and iCHD using national registers. Incident events occurring in the first 3 years of follow-up were excluded from analyses. Tenfold cross-fit partialing-out lasso logistic regression adjusted for age and sex was used to identify proteins that significantly predicted sleep duration quintiles when compared with the referent quintile 3 (Q3). Predictive proteins were weighted and combined into proteomic scores (PS) for sleep duration Q1, Q2, Q4, and Q5. Combinations of PS were included in a linear regression model to identify the best predictors of habitual sleep duration. Cox proportional hazards regression models with sleep duration quintiles and sleep-predictive PS as the main exposures were related to iDM and iCHD after adjustment for known covariates.

RESULTS

Sixteen unique proteomic markers, predominantly reflecting inflammation and apoptosis, predicted sleep duration quintiles. The combination of PSQ1 and PSQ5 best predicted sleep duration. Mean follow-up times for iDM (n = 522) and iCHD (n = 411) were 21.8 and 22.4 years, respectively. Compared with sleep duration Q3, all sleep duration quintiles were positively and significantly associated with iDM. Only sleep duration Q1 was positively and significantly associated with iCHD. Inclusion of PSQ1 and PSQ5 abrogated the association between sleep duration Q1 and iDM. Moreover, PSQ1 was significantly associated with iDM (HR = 1.27, 95% CI: 1.06-1.53). PSQ1 and PSQ5 were not associated with iCHD and did not markedly attenuate the association between sleep duration Q1 with iCHD.

CONCLUSIONS

We here identify plasma proteomic fingerprints of sleep duration and suggest that PSQ1 could explain the association between very short sleep duration and incident DM.

Validity and reliability of the Oura Ring Generation 3 (Gen3) with Oura sleep staging algorithm 2.0 (OSSA 2.0) when compared to multi-night ambulatory polysomnography: A validation study of 96 participants and 421,045 epochs

PURPOSE

To evaluate the validity and the reliability of the Oura Ring Generation 3 (Gen3) with Oura Sleep Staging Algorithm 2.0 (OSSA 2.0) through multi-night polysomnography (PSG).

PARTICIPANTS AND METHODS

Participants were 96 generally healthy Japanese men and women aged between 20 and 70 years contributing with 421,045 30-s epochs. Sleep scoring was performed according to American Academy of Sleep Medicine criteria. Each participant could contribute with a maximum of three polysomnography (PSG) nights. Within-participant means were created for each sleep measure and paired t-tests were used to compare equivalent measures obtained from the PSG and Oura Rings (non-dominant and dominant hand). Agreement between sleep measures were assessed using Bland-Altman plots. Interrater reliability for epoch accuracy was determined by prevalence-adjusted and bias-adjusted kappa (PABAK).

RESULTS

The Oura Ring did not significantly differ from PSG for the measures time in bed, total sleep time, sleep onset latency, sleep period time, wake after sleep onset, time spent in light sleep, and time spent in deep sleep. Oura Rings worn on the non-dominant- and dominant-hand underestimated sleep efficiency by 1.1 %-1.5 % and time spent in REM sleep by 4.1-5.6 min. The Oura Ring had a sensitivity of 94.4 %-94.5 %, specificity of 73.0 %-74.6 %, a predictive value for sleep of 95.9 %-96.1 %, a predictive value for wake of 66.6 %-67.0 %, and accuracy of 91.7 %-91.8 %. PABAK was 0.83-0.84 and reliability was 94.8 %. Sleep staging accuracy ranged between 75.5 % (light sleep) and 90.6 % (REM sleep).

CONCLUSIONS

The Oura Ring Gen3 with OSSA 2.0 shows good agreement with PSG for global sleep measures and time spent in light and deep sleep.

A Disentangled VAE-BiLSTM Model for Heart Rate Anomaly Detection

Cardiovascular diseases (CVDs) remain a leading cause of death globally. According to the American Heart Association, approximately 19.1 million deaths were attributed to CVDs in 2020, in particular, ischemic heart disease and stroke. Several known risk factors for CVDs include smoking, alcohol consumption, lack of regular physical activity, and diabetes. The last decade has been characterized by widespread diffusion in the use of wristband-style wearable devices which can monitor and collect heart rate data, among other information. Wearable devices allow the analysis and interpretation of physiological and activity data obtained from the wearer and can therefore be used to monitor and prevent potential CVDs. However, these data are often provided in a manner that does not allow the general user to immediately comprehend possible health risks, and often require further analytics to draw meaningful conclusions. In this paper, we propose a disentangled variational autoencoder (β-VAE) with a bidirectional long short-term memory network (BiLSTM) backend to detect in an unsupervised manner anomalies in heart rate data collected during sleep time with a wearable device from eight heterogeneous participants. Testing was performed on the mean heart rate sampled both at 30 s and 1 min intervals. We compared the performance of our model with other well-known anomaly detection algorithms, and we found that our model outperformed them in almost all considered scenarios and for all considered participants. We also suggest that wearable devices may benefit from the integration of anomaly detection algorithms, in an effort to provide users more processed and straightforward information.

Association between Metabolic Syndrome Status and Daily Physical Activity Measured by a Wearable Device in Japanese Office Workers

(1) Background: This study examined the cross-sectional association between metabolic syndrome (MetS) status classified into three groups and daily physical activity (PA; step count and active minutes) using a wearable device in Japanese office workers. (2) Methods: This secondary analysis used data from 179 participants in the intervention group of a randomized controlled trial for 3 months. Individuals who had received an annual health check-up and had MetS or were at a high risk of MetS based on Japanese guidelines were asked to use a wearable device and answer questionnaires regarding their daily life for the entire study period. Multilevel mixed-effects logistic regression models adjusted for covariates associated with MetS and PA were used to estimate associations. A sensitivity analysis investigated the associations between MetS status and PA level according to the day of the week. (3) Results: Compared to those with no MetS, those with MetS were not significantly associated with PA, while those with pre-MetS were inversely associated with PA [step count Model 3: OR = 0.60; 95% CI: 0.36, 0.99; active minutes Model 3: OR = 0.62; 95% CI: 0.40, 0.96]. In the sensitivity analysis, day of the week was an effect modifier for both PA (p < 0.001). (4) Conclusions: Compared to those with no MetS, those with pre-MetS, but not MetS, showed significantly lower odds of reaching their daily recommended PA level. Our findings suggest that the day of the week could be a modifier for the association between MetS and PA. Further research with longer study periods and larger sample sizes are needed to confirm our results.

Coping in Mid- to Late Life and Risk of Mild Cognitive Impairment Subtypes and Dementia: A JPHC Saku Mental Health Study

BACKGROUND

The relationship between coping in mid- to late life and cognitive functions remains unclear.

OBJECTIVE

To investigate the relationship between habitual coping behaviors of a large Japanese population in their mid- to late-lives and their risk of cognitive decline 15 years later.

METHODS

Overall 1,299 participants were assessed for coping behaviors (in 2000) and cognition (2014-2015). We used the Stress and Coping Inventory to assess the frequency of six coping behaviors (i.e., consulting, planning, positive reappraisal, avoidance, fantasizing, and self-blame). Logistic regression analyses were conducted to examine odds ratios (ORs) for the diagnosis of mild cognitive impairment (MCI), MCI subtypes (single- and multiple-domain MCI), and dementia for coping behaviors.

RESULTS

Among the eligible 1,015 participants (72.6 [SD = 5.5] years old in 2014-2015), the numbers for cognitively normal, single-domain MCI, multiple-domain MCI, and dementia were 650 (64.0%), 116 (11.4%), 213 (21.0%), and 36 (3.5%), respectively. Among the six coping behaviors, avoidant coping was significantly associated with noticeable cognitive decline (multiple-domain MCI and dementia). This association remained significant after adjusting for sex, age, education, diagnosis of current major depressive disorder, past history of ischemic heart disease, diabetes, regular alcohol consumption, and smoking (OR = 2.52, 95% CI = 1.23 to 5.15). No significant association with other coping behaviors was found.

CONCLUSION

Avoidant coping in mid- and late life is associated with cognitive decline among older people.

Enhanced metabolism and negative regulation of ER stress support higher erythropoietin production in HEK293 cells

Recombinant protein production can cause severe stress on cellular metabolism, resulting in limited titer and product quality. To investigate cellular and metabolic characteristics associated with these limitations, we compare HEK293 clones producing either erythropoietin (EPO) (secretory) or GFP (non-secretory) protein at different rates. Transcriptomic and functional analyses indicate significantly higher metabolism and oxidative phosphorylation in EPO producers compared with parental and GFP cells. In addition, ribosomal genes exhibit specific expression patterns depending on the recombinant protein and the production rate. In a clone displaying a dramatically increased EPO secretion, we detect higher gene expression related to negative regulation of endoplasmic reticulum (ER) stress, including upregulation of ATF6B, which aids EPO production in a subset of clones by overexpression or small interfering RNA (siRNA) knockdown. Our results offer potential target pathways and genes for further development of the secretory power in mammalian cell factories.

Sleep duration and risk of cancer incidence and mortality: a pooled analysis of six population-based cohorts in Japan

Sleep duration is emerging as an important modifiable risk factor for morbidity and mortality. We assessed the association between sleep duration and cancer incidence and mortality among Japanese adults using data from six population-based cohorts with 271 694 participants. During a total follow-up period of about 5.9 million person-years, we identified 40 751 incident cancer cases and 18 323 cancer deaths. We computed study-specific hazard ratios (HRs) and 95% confidence intervals (CIs) using Cox proportional hazards regression models and pooled the estimates using random-effects meta-analysis. Sleep duration of ≥ 10 h (vs. 7 h) was associated with increased risk of cancer incidence among women (HR 1.19, 95% CI 1.02-1.38), but not men, and increased risk of cancer mortality among men (HR 1.18, 95% CI 1.00-1.39) and women (HR 1.44, 95% CI 1.20-1.73). Sleep duration of ≤ 5 h (vs. 7 h) was not associated with cancer incidence and mortality. However, among post-menopausal women, sleep durations of both ≤ 5 h and ≥ 10 h (vs. 7 h) were associated with an increased risk of cancer mortality. Among Japanese adults, sleep duration of ≥ 10 h is associated with increased risk of cancer incidence and mortality among women and cancer mortality among men. This article is protected by copyright. All rights reserved.

Statistical Methods for Item Reduction in a Representative Lifestyle Questionnaire: Pilot Questionnaire Study

Background

Reducing the number of items in a questionnaire while maintaining relevant information is important as it is associated with advantages such as higher respondent engagement and reduced response error. However, in health care, after the original design, an a posteriori check of the included items in a questionnaire is often overlooked or considered to be of minor importance. When conducted, this is often based on a single selected method. We argue that before finalizing any lifestyle questionnaire, a posteriori validation should always be conducted using multiple approaches to ensure the robustness of the results.

Objective

The objectives of this study are to compare the results of two statistical methods for item reduction (variance inflation factor [VIF] and factor analysis [FA]) in a lifestyle questionnaire constructed by combining items from different sources and analyze the different results obtained from the 2 methods and the conclusions that can be made about the original items.

Methods

Data were collected from 79 participants (heterogeneous in age and sex) with a high risk of metabolic syndrome working in a financial company based in Tokyo. The lifestyle questionnaire was constructed by combining items (asked with daily, weekly, and monthly frequency) from multiple validated questionnaires and other selected questions. Item reduction was conducted using VIF and exploratory FA. Adequacy tests were used to check the data distribution and sampling adequacy.

Results

Among the daily and weekly questions, both VIF and FA identified redundancies in sleep-related items. Among the monthly questions, both approaches identified redundancies in stress-related items. However, the number of items suggested for reduction often differed: VIF suggested larger reductions than FA for daily questions but fewer reductions for weekly questions. Adequacy tests always confirmed that the structural detection was adequate for the considered items.

Conclusions

As expected, our analyses showed that VIF and FA produced both similar and different findings, suggesting that questionnaire designers should consider using multiple methods for item reduction. Our findings using both methods indicate that many questions, especially those related to sleep, are redundant, indicating that the considered lifestyle questionnaire can be shortened.

Heart Rate Modeling and Prediction Using Autoregressive Models and Deep Learning

Physiological time series are affected by many factors, making them highly nonlinear and nonstationary. As a consequence, heart rate time series are often considered difficult to predict and handle. However, heart rate behavior can indicate underlying cardiovascular and respiratory diseases as well as mood disorders. Given the importance of accurate modeling and reliable predictions of heart rate fluctuations for the prevention and control of certain diseases, it is paramount to identify models with the best performance in such tasks. The objectives of this study were to compare the results of three different forecasting models (Autoregressive Model, Long Short-Term Memory Network, and Convolutional Long Short-Term Memory Network) trained and tested on heart rate beats per minute data obtained from twelve heterogeneous participants and to identify the architecture with the best performance in terms of modeling and forecasting heart rate behavior. Heart rate beats per minute data were collected using a wearable device over a period of 10 days from twelve different participants who were heterogeneous in age, sex, medical history, and lifestyle behaviors. The goodness of the results produced by the models was measured using both the mean absolute error and the root mean square error as error metrics. Despite the three models showing similar performance, the Autoregressive Model gave the best results in all settings examined. For example, considering one of the participants, the Autoregressive Model gave a mean absolute error of 2.069 (compared to 2.173 of the Long Short-Term Memory Network and 2.138 of the Convolutional Long Short-Term Memory Network), achieving an improvement of 5.027% and 3.335%, respectively. Similar results can be observed for the other participants. The findings of the study suggest that regardless of an individual's age, sex, and lifestyle behaviors, their heart rate largely depends on the pattern observed in the previous few minutes, suggesting that heart rate can be reasonably regarded as an autoregressive process. The findings also suggest that minute-by-minute heart rate prediction can be accurately performed using a linear model, at least in individuals without pathologies that cause heartbeat irregularities. The findings also suggest many possible applications for the Autoregressive Model, in principle in any context where minute-by-minute heart rate prediction is required (arrhythmia detection and analysis of the response to training, among others).

Midlife intake of the isoflavone genistein and soy, and the risk of late-life cognitive impairment: the JPHC Saku Mental Health Study

BACKGROUND

The number of people with cognitive impairment, including dementia, in the world is steadily increasing. Although the consumption of isoflavones and soy is associated with a reduced risk of cardiovascular disease, it might also be associated with cognitive impairment. The low number of studies investigating the association between soy/isoflavone intake and cognitive function warrant additional research.

METHODS

The Japan Public Health Center-based prospective (JPHC) Study is a large population-based cohort. Midlife dietary intake of soy and the isoflavone genistein was assessed on two occasions: in the years 1995 and 2000. In 2014-2015, 1299 participants from Nagano prefecture completed a mental health screening. Of these, a total of 1036 participants were included in analyses. Logistic regression was used to determine Odds Ratios (OR) and 95% Confidence Intervals (CI) for the association between midlife energy-adjusted genistein and soy food intake and cognitive impairment.

RESULTS

There were 392 cases of cognitive impairment (346 cases of MCI and 46 cases of dementia). Compared to the lowest dietary quartile of energy-adjusted genistein intake, the highest quartile was significantly associated with cognitive impairment (OR=1.51; 95% CI, 1.02-2.24; p for trend=0.03) in the final multivariable analysis.

CONCLUSIONS

High midlife intake of the isoflavone genistein is associated with late-life cognitive impairment.

Associations of work-related stress and total sleep time with cholesterol levels in an occupational cohort of Japanese office workers

OBJECTIVE

The aim of the study was to investigate the associations of total sleep time (TST) and occupational stress based on the Brief Job Stress Questionnaire (BJSQ) with cholesterol levels in an occupational cohort of Japanese office workers.

METHODS

The present study is a secondary analysis of a subset of participants from a randomized controlled trial. Participants were 179 employees from 5 companies in Tokyo who participated as the intervention group in a 3-month lifestyle intervention study among office workers with metabolic syndrome or at risk of metabolic syndrome. All intervention-group participants used a mobile app and a wearable device. The final population for analysis in the present study were 173 participants. Cholesterol measures were derived from participants' annual health check-up data in the fiscal year preceding their inclusion in the study. Multiple linear regression models were used to determine the association between exposures and outcome.

RESULTS

Overall, stress levels were significantly and inversely associated with LDL-C (-7.12 mg/dl; 95% CI: -11.78, -2.45) and LDL-C/HDL-C ratio (-0.16 mg/dl; 95% CI: -0.27, -0.04) per standard deviation increase. Compared to average TST 5.9-7.2 hours, average TST of 4.0-5.3 hours (-4.82 mg/dl; 95% CI: -9.22, -0.43) was inversely associated with HDL-C.

CONCLUSION

Incremental increases of stress were significantly and inversely associated with LDL-C and LDL-C/HDL-C ratio. The shortest average TST was inversely associated with HDL-C. The results should be interpreted with care given certain methodological limitations.

Claims-based algorithms for common chronic conditions were efficiently constructed using machine learning methods

Identification of medical conditions using claims data is generally conducted with algorithms based on subject-matter knowledge. However, these claims-based algorithms (CBAs) are highly dependent on the knowledge level and not necessarily optimized for target conditions. We investigated whether machine learning methods can supplement researchers' knowledge of target conditions in building CBAs. Retrospective cohort study using a claims database combined with annual health check-up results of employees' health insurance programs for fiscal year 2016-17 in Japan (study population for hypertension, N = 631,289; diabetes, N = 152,368; dyslipidemia, N = 614,434). We constructed CBAs with logistic regression, k-nearest neighbor, support vector machine, penalized logistic regression, tree-based model, and neural network for identifying patients with three common chronic conditions: hypertension, diabetes, and dyslipidemia. We then compared their association measures using a completely hold-out test set (25% of the study population). Among the test cohorts of 157,822, 38,092, and 153,608 enrollees for hypertension, diabetes, and dyslipidemia, 25.4%, 8.4%, and 38.7% of them had a diagnosis of the corresponding condition. The areas under the receiver operating characteristic curve (AUCs) of the logistic regression with/without subject-matter knowledge about the target condition were .923/.921 for hypertension, .957/.938 for diabetes, and .739/.747 for dyslipidemia. The logistic lasso, logistic elastic-net, and tree-based methods yielded AUCs comparable to those of the logistic regression with subject-matter knowledge: .923-.931 for hypertension; .958-.966 for diabetes; .747-.773 for dyslipidemia. We found that machine learning methods can attain AUCs comparable to the conventional knowledge-based method in building CBAs.

Association of Sleep Duration With All- and Major-Cause Mortality Among Adults in Japan, China, Singapore, and Korea

IMPORTANCE

The association between long sleep duration and mortality appears stronger in East Asian populations than in North American or European populations.

OBJECTIVES

To assess the sex-specific association between sleep duration and all-cause and major-cause mortality in a pooled longitudinal cohort and to stratify the association by age and body mass index.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study of individual-level data from 9 cohorts in the Asia Cohort Consortium was performed from January 1, 1984, to December 31, 2002. The final population included participants from Japan, China, Singapore, and Korea. Mean (SD) follow-up time was 14.0 (5.0) years for men and 13.4 (5.3) years for women. Data analysis was performed from August 1, 2018, to May 31, 2021.

EXPOSURES

Self-reported sleep duration, with 7 hours as the reference category.

MAIN OUTCOMES AND MEASURES

Mortality, including deaths from all causes, cardiovascular disease, cancer, and other causes. Sex-specific hazard ratios (HRs) and 95% CIs were estimated using Cox proportional hazards regression with shared frailty models adjusted for age and the key self-reported covariates of marital status, body mass index, smoking status, alcohol consumption, physical activity, history of diabetes and hypertension, and menopausal status (for women).

RESULTS

For 322 721 participants (mean [SD] age, 54.5 [9.2] years; 178 542 [55.3%] female), 19 419 deaths occurred among men (mean [SD] age of men, 53.6 [9.0] years) and 13 768 deaths among women (mean [SD] age of women, 55.3 [9.2] years). A sleep duration of 7 hours was the nadir for associations with all-cause, cardiovascular disease, and other-cause mortality in both men and women, whereas 8 hours was the mode sleep duration among men and the second most common sleep duration among women. The association between sleep duration and all-cause mortality was J-shaped for both men and women. The greatest association for all-cause mortality was with sleep durations of 10 hours or longer for both men (hazard ratio [HR], 1.34; 95% CI, 1.26-1.44) and women (HR, 1.48; 95% CI, 1.36-1.61). Sex was a significant modifier of the association between sleep duration and mortality from cardiovascular disease (χ25 = 13.47, P = .02), cancer (χ25 = 16.04, P = .007), and other causes (χ25 = 12.79, P = .03). Age was a significant modifier of the associations among men only (all-cause mortality: χ25 = 41.49, P < .001; cancer: χ25 = 27.94, P < .001; other-cause mortality: χ25 = 24.51, P < .001).

CONCLUSIONS AND RELEVANCE

The findings of this cohort study suggest that sleep duration is a behavioral risk factor for mortality in both men and women. Age was a modifier of the association between sleep duration in men but not in women. Sleep duration recommendations in these populations may need to be considered in the context of sex and age.

Genome-scale metabolic network reconstruction of model animals as a platform for translational research

Genome-scale metabolic models (GEMs) are used extensively for analysis of mechanisms underlying human diseases and metabolic malfunctions. However, the lack of comprehensive and high-quality GEMs for model organisms restricts translational utilization of omics data accumulating from the use of various disease models. Here we present a unified platform of GEMs that covers five major model animals, including Mouse1 (Mus musculus), Rat1 (Rattus norvegicus), Zebrafish1 (Danio rerio), Fruitfly1 (Drosophila melanogaster), and Worm1 (Caenorhabditis elegans). These GEMs represent the most comprehensive coverage of the metabolic network by considering both orthology-based pathways and species-specific reactions. All GEMs can be interactively queried via the accompanying web portal Metabolic Atlas. Specifically, through integrative analysis of Mouse1 with RNA-sequencing data from brain tissues of transgenic mice we identified a coordinated up-regulation of lysosomal GM2 ganglioside and peptide degradation pathways which appears to be a signature metabolic alteration in Alzheimer's disease (AD) mouse models with a phenotype of amyloid precursor protein overexpression. This metabolic shift was further validated with proteomics data from transgenic mice and cerebrospinal fluid samples from human patients. The elevated lysosomal enzymes thus hold potential to be used as a biomarker for early diagnosis of AD. Taken together, we foresee that this evolving open-source platform will serve as an important resource to facilitate the development of systems medicines and translational biomedical applications.

Association of managerial position with cardiovascular risk factors: A fixed-effects analysis for Japanese employees

Objectives:

Although higher occupational classes have been reported to be associated with better health, researchers do not fully understand whether such associations derive from the position or individual characteristics of the person in that position. We examined the association between being a manager and cardiovascular disease (CVD) risk factors using unique panel data in Japan that annually observed employees’ occupational class and health conditions.

Methods:

We analyzed data for 45 888 observations from a Japanese company from 2013 through 2017. The association between being a manager and CVD risk factors (metabolic risks and health-related behaviors) were evaluated using simple pooled cross-sectional analyses with adjustment for age, sex, marital status, and overtime-working hours. We further incorporated employee-level fixed-effects into the models to examine whether the associations were subject to individual time-invariant factors.

Results:

The pooled cross-sectional analyses showed that, compared to non-managers, managers had 2.0 mg/dl lower low density lipoprotein cholesterol (LDL-C) level, 1.4 mmHg-lower systolic blood pressure, and 0.2 kg/m² lower body mass index (BMI). After adjusting for employee-level fixed-effects, being a manager was associated with a significantly 2.2 mg/dl higher LDL-C level. However, the associations between an individual’s management status and blood pressure or BMI were not significant. Furthermore, managers were 5.5% less likely to exercise regularly and 6.1% less likely to report sufficient sleep in the fixed-effects models, although the pooled cross-sectional analyses did not demonstrate these significant associations.

Conclusions:

Our findings suggest the necessity of considering these unfavorable health risks associated with being promoted to a manager.

An Agent-Based Model of the Local Spread of SARS-CoV-2: Modeling Study

BACKGROUND

The spread of SARS-CoV-2, originating in Wuhan, China, was classified as a pandemic by the World Health Organization on March 11, 2020. The governments of affected countries have implemented various measures to limit the spread of the virus. The starting point of this paper is the different government approaches, in terms of promulgating new legislative regulations to limit the virus diffusion and to contain negative effects on the populations.

OBJECTIVE

This paper aims to study how the spread of SARS-CoV-2 is linked to government policies and to analyze how different policies have produced different results on public health.

METHODS

Considering the official data provided by 4 countries (Italy, Germany, Sweden, and Brazil) and from the measures implemented by each government, we built an agent-based model to study the effects that these measures will have over time on different variables such as the total number of COVID-19 cases, intensive care unit (ICU) bed occupancy rates, and recovery and case-fatality rates. The model we implemented provides the possibility of modifying some starting variables, and it was thus possible to study the effects that some policies (eg, keeping the national borders closed or increasing the ICU beds) would have had on the spread of the infection.

RESULTS

The 4 considered countries have adopted different containment measures for COVID-19, and the forecasts provided by the model for the considered variables have given different results. Italy and Germany seem to be able to limit the spread of the infection and any eventual second wave, while Sweden and Brazil do not seem to have the situation under control. This situation is also reflected in the forecasts of pressure on the National Health Services, which see Sweden and Brazil with a high occupancy rate of ICU beds in the coming months, with a consequent high number of deaths.

CONCLUSIONS

In line with what we expected, the obtained results showed that the countries that have taken restrictive measures in terms of limiting the population mobility have managed more successfully than others to contain the spread of COVID-19. Moreover, the model demonstrated that herd immunity cannot be reached even in countries that have relied on a strategy without strict containment measures.

Author Correction: Evolution from adherent to suspension: systems biology of HEK293 cell line development

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

eHealth Delivery of Educational Content Using Selected Visual Methods to Improve Health Literacy on Lifestyle-Related Diseases: Literature Review

BACKGROUND

Lifestyle-related diseases, such as stroke, heart disease, and diabetes, are examples of noncommunicable diseases. Noncommunicable diseases are now the leading cause of death in the world, and their major causes are lifestyle related. The number of eHealth interventions is increasing, which is expected to improve individuals' health literacy on lifestyle-related diseases.

OBJECTIVE

This literature review aims to identify existing literature published in the past decade on eHealth interventions aimed at improving health literacy on lifestyle-related diseases among the general population using selected visual methods, such as educational videos, films, and movies.

METHODS

A systematic literature search of the PubMed database was conducted in April 2019 for papers written in English and published from April 2, 2009, through April 2, 2019. A total of 538 papers were identified and screened in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram. Finally, 23 papers were included in this review.

RESULTS

The 23 papers were characterized according to study characteristics (author and year of publication, study design and region where the study was conducted, study objective, service platform, target disease and participant age, research period, outcomes, and research method); the playback time of the educational videos, films, and movies; and the evaluation of the study's impacts on health literacy. A total of 7 studies compared results using statistical methods. Of these, 5 studies reported significant positive effects of the intervention on health literacy and health-related measures (eg, physical activity, body weight). Although most of the studies included educational content aimed at improving health literacy, only 7 studies measured health literacy. In addition, only 5 studies assessed literacy using health literacy measurement tools.

CONCLUSIONS

This review found that the provision of educational content was satisfactory in most eHealth studies using selected visual methods, such as videos, films, and movies. These findings suggest that eHealth interventions influence people's health behaviors and that the need for this intervention is expected to increase. Despite the need to develop eHealth interventions, standardized measurement tools to evaluate health literacy are lacking. Further research is required to clarify acceptable health literacy measurements.

Using mHealth to Provide Mobile App Users With Visualization of Health Checkup Data and Educational Videos on Lifestyle-Related Diseases: Methodological Framework for Content Development

Background

The number of people with lifestyle-related diseases continues to increase worldwide. Improving lifestyle behavior with health literacy may be the key to address lifestyle-related diseases. The delivery of educational videos using mobile health (mHealth) services can replace the conventional way of educating individuals, and visualization can replace the provision of health checkup data.

Objective

This paper aimed to describe the development of educational content for MIRAMED, a mobile app aimed at improving users’ lifestyle behaviors and health literacy for lifestyle-related diseases.

Methods

All videos were based on a single unified framework to provide users with a consistent flow of information. The framework was later turned into a storyboard. The final video contents were created based on this storyboard and further discussions with leading experts and specialist physicians on effective communication with app users about lifestyle-related diseases.

Results

The app uses visualization of personal health checkup data and educational videos on lifestyle-related diseases based on the current health guidelines, scientific evidence, and expert opinions of leading specialist physicians in the respective fields. A total of 8 videos were created for specific lifestyle-related diseases affecting 8 organs: (1) brain–cerebrovascular disorder, (2) eyes–diabetic retinopathy, (3) lungs–chronic obstructive pulmonary disease, (4) heart–ischemic heart disease, (5) liver–fatty liver, (6) kidneys–chronic kidney disease (diabetic kidney disease), (7) blood vessels–peripheral arterial disease, and (8) nerves–diabetic neuropathy.

Conclusions

Providing enhanced mHealth education using novel digital technologies to visualize conventional health checkup data and lifestyle-related diseases is an innovative strategy. Future studies to evaluate the efficacy of the developed content are planned.

Association Between Electroencephalogram-Derived Sleep Measures and the Change of Emotional Status Analyzed Using Voice Patterns: Observational Pilot Study

Background

Measuring emotional status objectively is challenging, but voice pattern analysis has been reported to be useful in the study of emotion.

Objective

The purpose of this pilot study was to investigate the association between specific sleep measures and the change of emotional status based on voice patterns measured before and after nighttime sleep.

Methods

A total of 20 volunteers were recruited. Their objective sleep measures were obtained using a portable single-channel electroencephalogram system, and their emotional status was assessed using MIMOSYS, a smartphone app analyzing voice patterns. The study analyzed 73 sleep episodes from 18 participants for the association between the change of emotional status following nighttime sleep (Δvitality) and specific sleep measures.

Results

A significant association was identified between total sleep time and Δvitality (regression coefficient: 0.036, P=.008). A significant inverse association was also found between sleep onset latency and Δvitality (regression coefficient: –0.026, P=.001). There was no significant association between Δvitality and sleep efficiency or number of awakenings.

Conclusions

Total sleep time and sleep onset latency are significantly associated with Δvitality, which indicates a change of emotional status following nighttime sleep. This is the first study to report the association between the emotional status assessed using voice pattern and specific sleep measures.

The Association Between Habitual Sleep Duration and Mortality According to Sex and Age: The Japan Public Health Center-based Prospective Study

Background

Short and long sleep durations are associated with mortality outcomes. The association between sleep duration and mortality outcomes may differ according to sex and age.

Methods

Participants of the Japan Public Health Center-based prospective study (JPHC Study) were aged 40–69 years and had completed a detailed questionnaire on lifestyle factors. Sex- and age-stratified analyses on the association between habitual sleep duration and mortality from all-causes, cardiovascular diseases (CVD), cancer and other causes included 46,152 men and 53,708 women without a history of CVD or cancer. Cox proportional hazards regression models, adjusted for potential confounders, were used to determine hazard ratios and 95% confidence intervals.

Results

Mean follow-up time was 19.9 years for men and 21.0 years for women. In the multivariable sex-stratified models, some categories of sleep durations ≥8 hours were positively associated with mortality from all-causes, CVD, and other causes in men and women compared with 7 hours. The sex- and age-stratified analyses did not reveal any major differences in the association between sleep duration and mortality outcomes in groups younger and older than 50 years of age. The only exception was the significant interaction between sleep duration and age in women for mortality from other causes.

Conclusions

Sleep durations ≥8 hours are associated with mortality outcomes in men and women. Age may be an effect modifier for the association between sleep duration and mortality from other causes in women.

Exposure to risperidone versus other antipsychotics and risk of osteoporosis-related fractures: a population-based study

OBJECTIVE

Antipsychotics may increase serum prolactin, which has particularly been observed with risperidone. Further, hyperprolactinemia has been linked to osteoporosis-related fractures. Therefore, we investigated fracture risk in a nationwide cohort exposed to antipsychotics.

METHODS

Swedish registers were used to identify adults with two consecutive dispensations of risperidone (n = 38 211), other atypical antipsychotics not including paliperidone (n = 60 691), or typical antipsychotics (n = 17 445) within three months between 2006 and 2013. An osteoporosis-related fracture was defined as a non-open hip/femur fracture in primary analyses. Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).

RESULTS

Risperidone users were on average older (mean age of 68, 44, and 63 years for risperidone, other atypical antipsychotics, and typical antipsychotics respectively). Compared with other atypical antipsychotics, there was no association between risperidone and osteoporosis-related fractures in the overall (HR = 1.04, CI: 0.91-1.19) or age-stratified analyses. A significantly increased risk of typical antipsychotics (HR = 1.24, CI: 1.07-1.45) compared with other atypical antipsychotics remained for ages >45 years.

CONCLUSION

Risperidone does not appear to be associated with an increased risk of osteoporosis-related fracture compared with other atypical antipsychotic agents as a group. For typical antipsychotics, a moderately elevated risk of hip fractures was noted compared with other atypical antipsychotics, possibly because of residual confounding.

A validation study of a consumer wearable sleep tracker compared to a portable EEG system in naturalistic conditions

OBJECTIVE

To compare a wearable device, the Fitbit Versa (FV), to a validated portable single-channel EEG system across multiple nights in a naturalistic environment.

METHODS

Twenty participants (10 men and 10 women) aged 25-67 years were recruited for the present study. Study duration was 14 days during which participants were asked to wear the FV daily and nightly. The study intended to reproduce free-living conditions; thus, no guidelines for sleep or activity were imposed on the participants. A total of 138 person-nights, equivalent to 76,539 epochs, were used in the validation process. Sleep measures were compared between the FV and portable EEG using Bland-Altman plots, paired t-tests and epoch-by-epoch (EBE) analyses.

RESULTS

The FV showed no significant bias with the EEG for the global sleep measures time in bed (TIB) and total sleep time (TST), and for calculated sleep efficiency (cSE = [TST/TIB] x 100). The FV had 92.1% sensitivity, 54.1% specificity, and 88.5% accuracy with a Cohen's kappa of 0.41, but a prevalence- and bias adjusted kappa of 0.77. The predictive values for sleep (PVS; positive predictive value) and wakefulness (PVW; negative predictive value) were 95.0% and 42.0%, respectively. The FV showed significant bias compared to the portable EEG for time spent in specific sleep stages, for SE as provided by FV, for sleep onset latency, sleep period time, and wake after sleep onset.

CONCLUSIONS

The consumer sleep tracker could be a useful tool for measuring sleep duration in longitudinal epidemiologic naturalistic studies albeit with some limitations in specificity.

The association between midlife serum high-density lipoprotein and mild cognitive impairment and dementia after 19 years of follow-up

A third of dementia cases could be attributable to modifiable risk-factors. Midlife high-density lipoprotein cholesterol (HDL-C) is a measure which could help identify individuals at reduced risk of developing age-related cognitive decline. The Japan Public Health Centre-based prospective (JPHC) Study is a large population-based cohort which started in 1990. This study included 1299 participants from Saku area in Nagano prefecture. Participants had HDL-C measured in 1995-1996, and underwent a mental health screening in 2014-2015. Of these, 1114 participants were included in MCI analyses, and 781 participants were included in dementia analyses. Logistic regression models were used to determine odds ratios (OR) and 95% confidence intervals (CI) for the association between HDL-C quartiles and MCI and dementia, respectively. For dementia analysis, quartiles 2-4 were collapsed due to low number of cases. Missing data was addressed through multiple imputations. There were 386 cases of MCI and 53 cases of dementia. Compared to the lowest HDL-C quartile, the highest HDL-C quartile was significantly inversely associated with MCI (OR = 0.47, 95% CI, 0.28-0.79) in the multivariable analysis. High HDL-C (quartiles 2-4) was inversely associated with dementia compared to low HDL-C (quartile 1) (OR = 0.37, 95% CI, 0.16-0.88). This study has found that high midlife HDL-C levels are inversely associated with both late-life MCI and dementia in a Japanese population.

1,4-Benzenedimethanethiol (1,4-BDMT) as a scavenger for greener peptide resin cleavages

Aiming at elevating the environmental profile of the solid-phase peptide synthesis (SPPS) methodology by improving the quality of crude peptides that SPPS provides we assessed a series of benzylthiols (BTs) as scavengers for global deprotection/TFA cleavage of exenatide peptide resin accessed by Fmoc SPPS. In these studies we identified 1,4-BDMT as a scavenger that affords the peptide in higher quality than the standard aliphatic thiol reagents, not least in terms of the content of critical peptide impurities in the crude material. Further, 1,4-BDMT exhibited favorable UV detectability as well as stability and solubility in TFA. Finally, based on the MS assessment of the crude exenatide products herein we propose that thiol scavengers in the cleavage of Trp containing peptide resins do not minimize the content of Trp oxidants by means of inhibiting Trp oxidation but rather by forming a peptide–thiol adduct via a mechanism involving an attack of a thiol on an oxindolylalanine (Oia) impurity present in the crude material.

1,4-BDMT is a benign, non-odorous scavenger for peptide resin cleavages which provides crude peptides in higher quality than the aliphatic thiols used for this purpose.

Five-week yin yoga-based interventions decreased plasma adrenomedullin and increased psychological health in stressed adults: A randomized controlled trial

Background

Non-communicable diseases (NCDs, e.g. cardiovascular disease) are responsible for high rates of morbidity and the majority of premature deaths worldwide. It is necessary to develop preventative interventions that can reduce the associated risk factors of NCDs. Researchers have found that the biomarker adrenomedullin (ADM) becomes elevated years before the onset of NCDs and might play an important role in their development. ADM has also been linked to psychological problems such as stress, anxiety, and depression, which are known risk factors of NCDs. In this randomized controlled trial, we examined whether participating in a five-week yoga intervention reduces ADM and increases psychological health in middle-aged adults who self-report as moderately to highly stressed, but who otherwise exhibit no physical complaints.

Methods

One hundred and five adults (78% women; mean age = 53.5, SD = 6.7) were randomly assigned to (1) a five-week Yin yoga intervention, (2) a five-week intervention combining Yin yoga with psychoeducation and mindfulness practice (called the YOMI program), or (3) a control group who did not practice yoga or mindfulness for five weeks.

Results

Compared to the control group, we observed significantly greater pre-post reductions in plasma ADM levels (p < .001), anxiety (p ≤ .002), and sleep problems (p ≤ .003) in both intervention groups. Furthermore, the YOMI group exclusively showed significantly greater pre-post reductions in stress (p = .012) and depression (p = .021) compared to the control group. Significant correlations (p < .05) were found between pre-post reductions in ADM and anxiety symptoms (p = .02) and depression (p = .04) in the entire sample.

Conclusion

The five-week Yin yoga-based interventions appeared to reduce both the physiological and psychological risk factors known to be associated with NCDs. The study suggests that incorporating Yin yoga could be an easy and low-cost method of limiting the negative health effects associated with high stress.

Trial registration

ClinicalTrials.gov NCT03428542

Invasive Dental Treatment and Risk for a First Myocardial Infarction

Invasive dental treatment is suggested to be associated with an increased risk for the development of cardiovascular events. We tested the hypothesis that the incidence of a first myocardial infarction (MI) within 4 wk after invasive dental treatments is increased. A registry-based case-control study within nationwide health care and population registries in Sweden was performed. The case patients included 51,880 individuals with a first fatal or nonfatal MI between January 2011 and December 2013. For each case, 5 control subjects, free from prior MI and matched for age, sex, and geographic area of residence, were randomly selected from the national population registry through risk set sampling with replacement, resulting in 246,978 control subjects. Information on dental treatments was obtained from the Dental Health Register, and the procedures were categorized into invasive dental treatments or other dental treatments. Conditional logistic regression was used to estimate odds ratios (ORs) for MI with corresponding 95% confidence intervals (CIs). In addition to the matching variables, adjustments were made for the following confounders: diabetes, previous cardiovascular disease (CVD), CVD drug treatment, education, and income. The mean age for case patients and controls subjects was 72.6 ± 13.0 y and 72.3 ± 13.0 y, respectively. Case patients more often had previous CVD (49% vs. 23%; P < 0.001) and diabetes (19% vs. 11%; P < 0.001) and received more treatment with CVD drugs (68% vs. 56%; P < 0.001) than control subjects. There was no association between invasive dental treatments during the 4 wk preceding the MI index date (crude OR = 0.99; 95% CI, 0.92 to 1.06; adjusted for confounders OR = 0.98; 95% CI, 0.91 to 1.06). This study did not support the hypothesis of an increased incidence of MI after recent invasive dental treatment.

Plasma Concentration of Caspase-8 Is Associated With Short Sleep Duration and the Risk of Incident Diabetes Mellitus

CONTEXT

The biological mechanism for the association between sleep duration and incident diabetes mellitus (DM) is unclear. Sleep duration and caspase-8, a marker of apoptotic activity, have both been implicated in β-cell function.

OBJECTIVE

To investigate the associations between sleep duration and plasma caspase-8 and incident DM, respectively.

DESIGN

Prospective cohort study.

SETTING

The Malmö Diet and Cancer (MDC) Study is a population-based, prospective study run in the city of Malmö, Sweden.

PARTICIPANTS

A total of 4023 individuals from the MDC Study aged 45 to 68 years at baseline without a history of prevalent DM and with information on habitual sleep duration.

MAIN OUTCOMES

Incident DM.

RESULTS

Mean follow-up time was 17.8 years. Sleep duration was the only behavioral variable significantly associated with plasma caspase-8. Plasma caspase-8 was significantly associated with incident DM per standard deviation of its transformed continuous form [hazard ratio (HR) = 1.24; 95% confidence interval (CI), 1.13 to 1.36] and when dichotomized into high (quartile 4) (HR = 1.44; 95% CI, 1.19 to 1.74) compared with low (quartiles 1 to 3) concentrations. Caspase-8 interacted with sleep duration; compared with individuals who had 7 to 8 hours of sleep and low plasma caspase-8, those with high plasma caspase-8 and sleep duration <6 hours (HR = 3.54; 95% CI, 2.12 to 5.90), 6 to 7 hours (HR = 1.81; 95% CI, 1.24 to 2.65), and 8 to 9 hours (HR = 1.54; 95% CI, 1.09 to 2.18) were at significantly increased risks of incident DM.

CONCLUSIONS

Sleep duration is associated with plasma caspase-8. Caspase-8 independently predicts DM years before disease onset and modifies the effect of sleep duration on incident DM. Future studies should investigate if change of sleep duration modifies plasma concentrations of caspase-8.

Incident diabetes mellitus may explain the association between sleep duration and incident coronary heart disease

AIMS/HYPOTHESIS

Sleep duration is a risk factor for incident diabetes mellitus and CHD. The primary aim of the present study was to investigate, in sex-specific analyses, the role of incident diabetes as the possible biological mechanism for the reported association between short/long sleep duration and incident CHD. Considering that diabetes is a major risk factor for CHD, we hypothesised that any association with sleep duration would not hold for cases of incident CHD occurring before incident diabetes ('non-diabetes CHD') but would hold true for cases of incident CHD following incident diabetes ('diabetes-CHD').

METHODS

A total of 6966 men and 9378 women aged 45-73 years from the Malmö Diet Cancer Study, a population-based, prospective cohort, who had answered questions on habitual sleep duration and did not have a history of prevalent diabetes or CHD were included in the analyses. Incident cases of diabetes and CHD were identified using national registers. Sex-specific Cox proportional hazards regression models were stratified by BMI and adjusted for known covariates of diabetes and CHD.

RESULTS

Mean follow-up times for incident diabetes (n = 1137/1016 [men/women]), incident CHD (n = 1170/578), non-diabetes CHD (n = 1016/501) and diabetes-CHD (n = 154/77) were 14.2-15.2 years for men, and 15.8-16.5 years for women. In men, short sleep duration (< 6 h) was associated with incident diabetes (HR 1.35, 95% CI 1.01, 1.80), CHD (HR 1.41, 95% CI 1.06, 1.89) and diabetes-CHD (HR 2.34, 95% CI 1.20, 4.55). Short sleep duration was not associated with incident non-diabetes CHD (HR 1.35, 95% CI 0.98, 1.87). Long sleep duration (≥ 9 h) was associated with incident diabetes (HR 1.37, 95% CI 1.03, 1.83), CHD (HR 1.33, 95% CI 1.01, 1.75) and diabetes-CHD (HR 2.10, 95% CI 1.11, 4.00). Long sleep duration was not associated with incident non-diabetes CHD (HR 1.33, 95% CI 0.98, 1.80). In women, short sleep duration was associated with incident diabetes (HR 1.53, 95% CI 1.16, 2.01), CHD (HR 1.46, 95% CI 1.03, 2.07) and diabetes-CHD (HR 2.88, 95% CI 1.37, 6.08). Short sleep duration was not associated with incident non-diabetes CHD (HR 1.29, 95% CI 0.86, 1.93).

CONCLUSIONS/INTERPRETATION

The associations between sleep duration and incident CHD directly reflect the associations between sleep duration and incident diabetes. Incident diabetes may thus be the explanatory mechanism for the association between short and long sleep duration and incident CHD.

Temperature-controlled airflow ventilation in operating rooms compared with laminar airflow and turbulent mixed airflow

AIM

To evaluate three types of ventilation systems for operating rooms with respect to air cleanliness [in colony-forming units (cfu/m³)], energy consumption and comfort of working environment (noise and draught) as reported by surgical team members.

METHODS

Two commonly used ventilation systems, vertical laminar airflow (LAF) and turbulent mixed airflow (TMA), were compared with a newly developed ventilation technique, temperature-controlled airflow (T_cAF). The cfu concentrations were measured at three locations in an operating room during 45 orthopaedic procedures: close to the wound (<40cm), at the instrument table and peripherally in the room. The operating team evaluated the comfort of the working environment by answering a questionnaire.

FINDINGS

LAF and T_cAF, but not TMA, resulted in less than 10cfu/m³ at all measurement locations in the room during surgery. Median values of cfu/m³ close to the wound (250 samples) were 0 for LAF, 1 for T_cAF and 10 for TMA. Peripherally in the room, the cfu concentrations were lowest for T_cAF. The cfu concentrations did not scale proportionally with airflow rates. Compared with LAF, the power consumption of T_cAF was 28% lower and there was significantly less disturbance from noise and draught.

CONCLUSION

T_cAF and LAF remove bacteria more efficiently from the air than TMA, especially close to the wound and at the instrument table. Like LAF, the new T_cAF ventilation system maintained very low levels of cfu in the air, but T_cAF used substantially less energy and provided a more comfortable working environment than LAF. This enables energy savings with preserved air quality.

The continuous reaction time test for minimal hepatic encephalopathy validated by a randomized controlled multi-modal intervention-A pilot study

Background

Minimal hepatic encephalopathy (MHE) is clinically undetectable and the diagnosis requires psychometric tests. However, a lack of clarity exists as to whether the tests are in fact able to detect changes in cognition.

Aim

To examine if the continuous reaction time test (CRT) can detect changes in cognition with anti-HE intervention in patients with cirrhosis and without clinically manifest hepatic encephalopathy (HE).

Methods

Firstly, we conducted a reproducibility analysis and secondly measured change in CRT induced by anti-HE treatment in a randomized controlled pilot study: We stratified 44 patients with liver cirrhosis and without clinically manifest HE according to a normal (n = 22) or abnormal (n = 22) CRT. Each stratum was then block randomized to receive multimodal anti-HE intervention (lactulose+branched-chain amino acids+rifaximin) or triple placebos for 3 months in a double-blinded fashion. The CRT is a simple PC-based test and the test result, the CRT index (normal threshold > 1.9), describes the patient’s stability of alertness during the 10–minute test. Our study outcome was the change in CRT index in each group at study exit. The portosystemic encephalopathy (PSE) test, a paper-and-pencil test battery (normal threshold above -5), was used as a comparator test according to international guidelines.

Results

The patients with an abnormal CRT index who were randomized to receive the active intervention normalized or improved their CRT index (mean change 0.92 ± 0.29, p = 0.01). Additionally, their PSE improved (change 3.85 ± 1.83, p = 0.03). There was no such effect in any of the other study groups.

Conclusion

In this cohort of patients with liver cirrhosis and no manifest HE, the CRT identified a group in whom cognition improved with intensive anti-HE intervention. This finding infers that the CRT can detect a response to treatment and might help in selecting patients for treatment.

High serum total cholesterol is associated with suicide mortality in Japanese women

OBJECTIVE

To investigate the association between serum total cholesterol (TC) and suicide using a large general population cohort with long follow-up times.

METHOD

Analyses included 16 341 men and 28 905 women aged 40-69 from the Japan Public Health Center-based Prospective Study followed from 1990 to 2012. TC levels were defined per clinical guidelines: low (<4.66 mmol/l [180 mg/dl]), normal (4.66-5.70 mmol/l [180-220 mg/dl]), and high (≥5.70 mmol/l [220 mg/dl]). Cox proportional hazards regression models were used to determine hazard ratios (HR) and confidence intervals (CI) for suicide according to TC level. Mean follow-up time was 19 years for men and 20 years for women.

RESULTS

There were 185 suicides (men: 107; women: 78) during follow-up. Compared to women with normal TC, women with high TC had a significantly increased risk of suicide (HR = 1.90, 95% CI, 1.13-3.19). Incremental increases (0.26 mmol/l [10 mg/dl]) of low-density lipoprotein (HR = 1.11, 95% CI, 1.02-1.21) and non-high-density lipoprotein cholesterol (HR = 1.09, 95% CI, 1.01-1.18) were also associated with increased risk of suicide in women. There was no association between TC levels, or lipid fractions, and suicide in men.

CONCLUSION

High TC levels may be associated with an increased risk of suicide in women.

A genetic risk score for CAD, psychological stress, and their interaction as predictors of CAD, fatal MI, non-fatal MI and cardiovascular death

Background

Psychological stress is an independent risk factor for cardiovascular disease (CVD), but the mechanism by which stress is associated with CVD is not entirely understood. Although genetic factors are implied in both stress responsivity and cardiovascular reactivity, no studies to date have investigated their interactions with stress for cardiovascular end points. The objective was to elucidate the association and interactions between a genetic risk score (GRS), individual genetic variants and stress for three cardiovascular end points: coronary artery disease (CAD), fatal myocardial infarction (MI), non-fatal MI, and cardiovascular death.

Methods and findings

18,559 participants from the Malmö Diet Cancer Study, a population-based prospective study, were included in the analyses. Cox proportional hazards regression models were used and adjusted for a large number of known predictors of cardiovascular end points. Mean follow-up time in years was 14.6 (CAD; n = 1938), 14.8 (fatal MI; n = 436), 14.8 (non-fatal MI; n = 1108), and 15.1 (cardiovascular death; n = 1071) respectively. GRS was significantly associated with increased risks of CAD (top quartile hazard ratio [HR], 1.72; 95% confidence interval [CI], 1.51–1.96), fatal MI (top quartile HR, 1.62; 95%CI, 1.23–2.15), non-fatal MI (top quartile HR, 1.55; 95%CI, 1.31–1.84), and cardiovascular death (top quartile HR, 1.29; 95%CI, 1.08–1.53). Stress was not independently associated with any end point and did not interact with GRS. Four individual genetic variants interacted unfavorably with stress for end points with mortality outcomes.

Conclusion

A GRS composed of 50 SNPs and predictive of CAD was found for the first time to also strongly predict fatal MI, non-fatal MI and cardiovascular death. A stress-sensitive component of the GRS was isolated on the basis of individual genetic variants that interacted unfavorably with stress.

Psychological stress and risk of incident atrial fibrillation in men and women with known atrial fibrillation genetic risk scores

Psychological stress has been reported as a possible trigger of atrial fibrillation (AF). No studies have investigated whether any association between stress and AF could be modified by genetic susceptibility to AF (AF-genetic risk score (AF-GRS)). 8765 men and 13,543 women from the Malmö Diet Cancer Study, a population-based cohort, were included in the analyses. A variable representing stress was constructed from questions measuring job strain, and from one question assessing non-occupational stress. Cox proportional hazards regression models were adjusted for known covariates of AF. Mean follow-up times and number of recorded incident AF were 14.2 years and 1116 events for men, and 15.1 years and 932 events for women. Among women, high stress was associated with AF in the age adjusted model (hazard ratio [HR], 1.22; 95% confidence interval [CI], 1.01-1.47) but not following multivariable adjustment (HR, 1.15; 95% CI, 0.95-1.39). Stress was not associated with incident AF in men. AF-GRS was significantly associated with incident AF for both genders. Stress did not interact significantly with genetic susceptibility to AF in men or women. Chronic stress is not associated with long-term incident hospital diagnosed AF. This association does not appear to be modified by genetic susceptibility to AF.

Alcohol consumption, genetic variants in the alcohol- and folate metabolic pathways and colorectal cancer risk: the JPHC Study

The association between alcohol intake and colorectal cancer (CRC) may vary secondary to single nucleotide polymorphisms (SNPs) in two pathways related to alcohol intake. 375 cases of CRC were identified among 38 373 Japan Public Health Center-based prospective Study (JPHC Study) participants who had returned a baseline questionnaire, reported no diagnosis of any cancer and provided blood samples. For each case, two controls were selected on matching variables. Logistic regression models were used to determine matched Odds Ratios (OR) and 95% Confidence Intervals (CI) for the association between alcohol consumption, genetic polymorphisms of enzymes in the alcohol- and folate metabolic pathways (e.g. methylenetetrahydrofolate reductase (MTHFR) rs1801133) and CRC risk. Compared to never/occasional alcohol intake, moderate to heavy alcohol intake was associated with CRC (OR = 2.12, 95% CI, 1.34–3.36). When compared to the CC genotype, the MTHFR rs1801133 CT/TT genotype was inversely associated with CRC (OR = 0.72, 95% CI, 0.54–0.97). Never/occasional consumers of alcohol with the MTHFR rs1801133 CT/TT genotype were also at a reduced risk of CRC compared to never/occasional drinkers with the CC genotype (OR = 0.68, 95% CI, 0.47–0.98) (P for interaction = 0.27). The results indicate that the folate pathway is likely to be involved in alcohol-related CRC development.

Ionotropic Chemosensory Receptors Mediate the Taste and Smell of Polyamines

The ability to find and consume nutrient-rich diets for successful reproduction and survival is fundamental to animal life. Among the nutrients important for all animals are polyamines, a class of pungent smelling compounds required in numerous cellular and organismic processes. Polyamine deficiency or excess has detrimental effects on health, cognitive function, reproduction, and lifespan. Here, we show that a diet high in polyamine is beneficial and increases reproductive success of flies, and we unravel the sensory mechanisms that attract Drosophila to polyamine-rich food and egg-laying substrates. Using a combination of behavioral genetics and in vivo calcium imaging, we demonstrate that Drosophila uses multisensory detection to find and evaluate polyamines present in overripe and fermenting fruit, their favored feeding and egg-laying substrate. In the olfactory system, two coexpressed ionotropic receptors (IRs), IR76b and IR41a, mediate the long-range attraction to the odor. In the gustatory system, multimodal taste sensation by IR76b receptor and GR66a bitter receptor neurons is used to evaluate quality and valence of the polyamine providing a mechanism for the fly’s high attraction to polyamine-rich and sweet decaying fruit. Given their universal and highly conserved biological roles, we propose that the ability to evaluate food for polyamine content may impact health and reproductive success also of other animals including humans.

Polyamines are beneficial nutrients for reproduction, cognition, and lifespan. This study reveals that insects are highly attracted to them and identify their sources through an ancient class of ionotropic receptors on their smell and taste organs.

Animals, including humans, evaluate food by its smell and taste. Odors and tastes not only signal the presence of food, they also reveal details about the type and amount of nutrients contained in it. A preference for certain foods frequently reflects the specific metabolic needs of an animal. Among the important but less known compounds that animals consume with their diet are polyamines. These pungent smelling molecules are essential for reproduction, development, and cognition. Interestingly, they are also produced by the cell and body, but their levels decline with age. A diet high in polyamines can improve age-related memory deficits and loss of fertility. We have used the model fly Drosophila melanogaster to unravel if and how animals detect polyamines in their food and environment, and which role this detection plays in their food choice behavior. Polyamine levels are particularly high in the fly’s favorite food and egg-laying substrate, overripe and decaying fruit. We found that food supplemented with polyamines indeed improves the reproductive success of a fly couple. We show that Drosophila is highly attracted to polyamines and uses them to identify promising egg-laying and feeding sites. It detects them through an ancient clade of receptor proteins on its olfactory and taste organs. We speculate that other animals can also detect polyamines and use their smell and taste to identify sources of these beneficial nutrients.

Stable Peptide of the Endogenous Opioid Enkephalin Precursor and Breast Cancer Risk

Purpose

In experimental studies, enkephalins (ENKs) and related opioids have been implicated as negative regulators of breast cancer development by enhancing immune-mediated tumoral defense as well as directly inhibiting cancer cells. We hypothesized that plasma levels of ENKs are predictive of the long-term breast cancer risk. Therefore, our objective was to measure pro-ENK A, a surrogate for mature ENK, and evaluate its predictive value for the development of breast cancer in a large population of middle-aged women and an independent study population.

Patients and Methods

We related pro-ENK in fasting plasma samples from 1,929 healthy women (mean age, 57.6 ± 5.9 years) of the Malmö Diet and Cancer study to breast cancer incidence (n = 123) during a median follow-up of 14.7 years. For replication, pro-ENK was related to risk of breast cancer (n = 130) in an older independent sample from the Malmö Preventive Project consisting of 1,569 women (mean age, 70.0 ± 4.4 years).

Results

In the Malmö Diet and Cancer study, pro-ENK was inversely related to the risk of incident breast cancer, with a hazard ratio per each standard deviation increment of logarithm-transformed pro-ENK of 0.72 (95% CI, 0.62 to 0.85; P < .001). The linear elevation of risk over pro-ENK quartiles 3, 2, and 1, with the fourth quartile as a reference, was 1.38 (95% CI, 0.73 to 2.64), 2.29 (95% CI, 1.26 to 4.15), and 3.16 (95% CI, 1.78 to 5.60; for the trend, P < .001), respectively. These results were replicated in the Malmö Preventive Project, where the continuous odds ratio for incident breast cancer was 0.63 (95% CI, 0.52 to 0.76; P < .001) and the risk over pro-ENK quartiles 3, 2, and 1, where the fourth quartile was the reference, was 2.48 (95% CI, 1.25 to 4.94), 2.94 (95% CI, 1.50 to 5.77), and 4.81 (95% CI, 2.52 to 9.18; for the trend, P < .001), respecitvely.

Conclusion

Low fasting plasma concentration of the opioid precursor peptide pro-ENK is associated with an increased risk of future breast cancer in middle-aged and postmenopausal women.

The Chironomus tentans genome sequence and the organization of the Balbiani ring genes

BACKGROUND

The polytene nuclei of the dipteran Chironomus tentans (Ch. tentans) with their Balbiani ring (BR) genes constitute an exceptional model system for studies of the expression of endogenous eukaryotic genes. Here, we report the first draft genome of Ch. tentans and characterize its gene expression machineries and genomic architecture of the BR genes.

RESULTS

The genome of Ch. tentans is approximately 200 Mb in size, and has a low GC content (31%) and a low repeat fraction (15%) compared to other Dipteran species. Phylogenetic inference revealed that Ch. tentans is a sister clade to mosquitoes, with a split 150-250 million years ago. To characterize the Ch. tentans gene expression machineries, we identified potential orthologus sequences to more than 600 Drosophila melanogaster (D. melanogaster) proteins involved in the expression of protein-coding genes. We report novel data on the organization of the BR gene loci, including a novel putative BR gene, and we present a model for the organization of chromatin bundles in the BR2 puff based on genic and intergenic in situ hybridizations.

CONCLUSIONS

We show that the molecular machineries operating in gene expression are largely conserved between Ch. tentans and D. melanogaster, and we provide enhanced insight into the organization and expression of the BR genes. Our data strengthen the generality of the BR genes as a unique model system and provide essential background for in-depth studies of the biogenesis of messenger ribonucleoprotein complexes.

Loss of a close family member the year before or during pregnancy and the risk of placental abruption: a cohort study from Denmark and Sweden

BACKGROUND

Maternal stress during pregnancy is associated with a modestly increased risk of fetal growth restriction and pre-eclampsia. Since placental abruption shares similar pathophysiological mechanisms and risk factors with fetal growth restriction and pre-eclampsia, we hypothesized that maternal stress may be implicated in abruption risk. We investigated the association between maternal bereavement during pregnancy and placental abruption.

METHOD

We studied singleton births in Denmark (1978-2008) and Sweden (1973-2006) (n = 5,103,272). In nationwide registries, we obtained data on death of women's close family members (older children, siblings, parents, and partners), abruption and potential confounders.

RESULTS

A total of 30,312 (6/1000) pregnancies in the cohort were diagnosed with placental abruption. Among normotensive women, death of a child the year before or during pregnancy was associated with a 54% increased odds of abruption [95% confidence interval (CI) 1.30-1.82]; the increased odds were restricted to women who lost a child the year before or during the first trimester in pregnancy. In the group with chronic hypertension, death of a child the year before or in the first trimester of pregnancy was associated with eight-fold increased odds of abruption (odds ratio 8.17, 95% CI 3.17-21.10). Death of other relatives was not associated with abruption risk.

CONCLUSIONS

Loss of a child the year before or in the first trimester of pregnancy was associated with an increased risk of abruption, especially among women with chronic hypertension. Studies are needed to investigate the effect of less severe, but more frequent, sources of stress on placental abruption risk.