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American Journal of Epidemiology
Journal Prestige (SJR): 2.713
Citation Impact (citeScore): 3
Number of Followers: 178  
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0002-9262 - ISSN (Online) 1476-6256
Published by Oxford University Press Homepage  [396 journals]
  • Physical Exertion Immediately Prior to Placental Abruption: A
           Case-Crossover Study
    • Authors: Chahal H; Gelaye B, Mostofsky E, et al.
      Pages: 2073 - 2079
      Abstract: While there is consistent evidence that episodes of physical exertion are associated with an immediately higher risk of acute ischemic vascular events, the risk of placental abruption immediately following episodes of physical exertion has not been studied. In a multicenter case-crossover study, we interviewed 663 women with placental abruption at 7 Peruvian hospitals between January 2013 and August 2015. We asked women about physical exertion in the hour before symptom onset and compared this with their frequency of physical exertion over the prior week. Compared with times with light or no exertion, the risk of placental abruption was 7.8 (95% confidence interval (CI): 5.5, 11.0) times greater in the hour following moderate or heavy physical exertion. The instantaneous incidence rate ratio of placental abruption within an hour of moderate or heavy physical exertion was lower for women who habitually engaged in moderate or heavy physical activity more than 3 times per week in the year before pregnancy (rate ratio (RR) = 3.0, 95% CI: 1.6, 5.9) compared with more sedentary women (RR = 17.3, 95% CI: 11.3, 26.7; P for homogeneity < 0.001), and the rate ratio was higher among women with preeclampsia/eclampsia (RR = 13.6, 95% CI: 7.0, 26.2) than among women without (RR = 6.7, 95% CI: 4.4, 10.0; P for homogeneity = 0.07).
      PubDate: Mon, 09 Jul 2018 00:00:00 GMT
      DOI: 10.1093/aje/kwy138
      Issue No: Vol. 187, No. 10 (2018)
  • Invited Commentary: Physical Exertion and Placental Abruption—Public
           Health Implications and Future Directions
    • Authors: Baylin A; Guyer H.
      Pages: 2080 - 2082
      Abstract: Chahal et al. (Am J Epidemiol. 2018;187(10):2073–2079) assessed the risk of placental abruption due to physical exertion using a case-crossover design. The authors found an increased risk of placental abruption following increased physical exertion in the hour prior to the abruption. The risk was greater among women who were primarily sedentary during pregnancy or prior to becoming pregnant compared with those who were more physically active. The authors used a case-crossover design to assess the association of an intermittent exposure on an acute event. Chahal et al. address the limitations of the study, including the inability to control for time-varying confounders as well as the potential for recall bias. The public health implications of the study must be carefully evaluated given that physical activity prior to and during pregnancy can lead to healthy outcomes and is likely recommended. While the current study is unable to determine the type of physical exertion associated with placental abruption, future studies are recommended to determine the type of activity that presents increased risk. Additionally, studies among larger samples and in other countries will help determine the generalizability of the results.
      PubDate: Mon, 09 Jul 2018 00:00:00 GMT
      DOI: 10.1093/aje/kwy136
      Issue No: Vol. 187, No. 10 (2018)
  • Chahal et al. Respond to “Physical Exertion and Placental
    • Authors: Chahal H; Gelaye B, Williams M.
      Pages: 2083 - 2084
      PubDate: Fri, 29 Jun 2018 00:00:00 GMT
      DOI: 10.1093/aje/kwy137
      Issue No: Vol. 187, No. 10 (2018)
  • Ramadan Exposure In Utero and Child Mortality in Burkina Faso: Analysis of
           a Population-Based Cohort Including 41,025 Children
    • Authors: Schoeps A; van Ewijk R, Kynast-Wolf G, et al.
      Pages: 2085 - 2092
      Abstract: Ramadan exposure in utero can be regarded as a natural experiment with which to study how nutritional conditions in utero influence susceptibility to disease later in life. We analyzed data from rural Burkina Faso on 41,025 children born between 1993 and 2012, of whom 25,093 were born to Muslim mothers. Ramadan exposure was assigned on the basis of overlap between Ramadan dates and gestation, creating 7 exclusive categories. We used proportional hazards regression with difference-in-differences analysis to estimate the association between Ramadan exposure at different gestational ages and mortality among children under 5 years of age. Under-5 mortality was 32 deaths per 1,000 child-years. Under-5 mortality among Muslims was 15% higher than that among non-Muslims (P < 0.001). In the difference-in-differences analysis, the occurrence of Ramadan during conception or the first or second trimester was associated with higher under-5 mortality rates among Muslims only. The mortality rates of children born to Muslim mothers were 33%, 29%, and 22% higher when Ramadan occurred during conception, the first trimester, and the second trimester, respectively, compared with children of non-Muslim mothers born at the same time (P = 0.01, P < 0.001, and P = 0.007). Having a Muslim mother was not associated with mortality when the child was not exposed to Ramadan, born during Ramadan, or exposed during the third trimester. Observance of Ramadan during early pregnancy can have detrimental consequences for the future health of the unborn child.
      PubDate: Sat, 05 May 2018 00:00:00 GMT
      DOI: 10.1093/aje/kwy091
      Issue No: Vol. 187, No. 10 (2018)
  • Invited Commentary: A Matter of Survival—The Detrimental Consequences of
           Adverse Early-Life Conditions
    • Authors: de Rooij S.
      Pages: 2093 - 2094
      Abstract: Studies across different species have shown that moderate dietary restriction is associated with a longer life span. Surprisingly, however, when diet is restricted in prenatal life, the effect is completely the opposite. Animal studies and human epidemiologic data have shown that undernutrition in utero negatively affects health in later life and reduces life span considerably. In this issue of the Journal, Schoeps et al. (Am J Epidemiol. 2018;187(10):2085–2092) provide new evidence that variations in nutritional conditions during pregnancy relate to the future health of the unborn child. In a detailed analysis of data from Muslim and non-Muslim pregnant women in Burkina Faso, they showed that the occurrence of Ramadan in early life was strongly associated with mortality rates among children under 5 years of age. Mortality rates were highest when Ramadan had occurred in the preconception period or during the first trimester. That nutritional conditions in early life can have such profound consequences for child mortality is both astonishing and extremely relevant from a public health perspective.
      PubDate: Sat, 05 May 2018 00:00:00 GMT
      DOI: 10.1093/aje/kwy088
      Issue No: Vol. 187, No. 10 (2018)
  • Invited Commentary: Ramadan, Pregnancy, Nutrition, and Epidemiology
    • Authors: Stein A.
      Pages: 2095 - 2097
      Abstract: Ramadan is observed by 1.6 billion Muslims. In an accompanying article that uses data from the Nouna Health and Demographic Surveillance System in Burkina Faso, Schoeps et al. (Am J Epidemiol. 2018;187(10):2085–2092) find that exposure to Ramadan in early pregnancy is associated with an increased risk of mortality among children under age 5 years. Ramadan exposes observant individuals to a specific pattern of nutrition and other behaviors, including changes in sleep patterns. How these behaviors might result in child mortality is not yet understood, and the findings reported in this paper should be replicated in other settings.
      PubDate: Sat, 05 May 2018 00:00:00 GMT
      DOI: 10.1093/aje/kwy089
      Issue No: Vol. 187, No. 10 (2018)
  • Gabrysch and van Ewijk Respond to “Detrimental Consequences of Adverse
           Early-Life Conditions” and “Ramadan, Pregnancy, Nutrition, and
    • Authors: Gabrysch S; van Ewijk R.
      Pages: 2098 - 2099
      PubDate: Sat, 05 May 2018 00:00:00 GMT
      DOI: 10.1093/aje/kwy090
      Issue No: Vol. 187, No. 10 (2018)
  • As Long as the Breath Lasts: In Utero Exposure to Ramadan and the
           Occurrence of Wheezing in Adulthood
    • Authors: Pradella F; van Ewijk R.
      Pages: 2100 - 2108
      Abstract: While prenatal exposure to Ramadan has been shown to be negatively associated with general physical and mental health, studies on specific organs remain scarce. In this study, we explored whether Ramadan exposure during pregnancy affects the occurrence of wheezing, a main symptom of obstructive airway disease. Using data from the Indonesian Family Life Survey collected between 1997 and 2008 (waves 2–4), we compared wheezing occurrence among adult Muslims who had been in utero during Ramadan with that in adult Muslims who had not been in utero during Ramadan. Wheezing prevalence was higher among adult Muslims who had been in utero during Ramadan, independent of the pregnancy phase in which the exposure to Ramadan occurred. Moreover, this association tended to increase with age, being strongest among those aged about 45 years or older. This is in line with fetal programming theory, suggesting that impacts of in utero exposures often manifest only after reproductive age. Particularly strong associations were detected for smokers. The respiratory system of prenatally exposed Muslims thus seems to perform worse in mitigating later ex utero harmful influences such as smoking. This study suggests that exposure to Ramadan during pregnancy may have lasting consequences for adult lung functionality.
      PubDate: Tue, 29 May 2018 00:00:00 GMT
      DOI: 10.1093/aje/kwy132
      Issue No: Vol. 187, No. 10 (2018)
  • Identification of Chronic Obstructive Pulmonary Disease Axes That Predict
           All-Cause MortalityThe COPDGene Study
    • Authors: Kinney G; Santorico S, Young K, et al.
      Pages: 2109 - 2116
      Abstract: Chronic obstructive pulmonary disease (COPD) is a syndrome caused by damage to the lungs that results in decreased pulmonary function and reduced structural integrity. Pulmonary function testing (PFT) is used to diagnose and stratify COPD into severity groups, and computed tomography (CT) imaging of the chest is often used to assess structural changes in the lungs. We hypothesized that the combination of PFT and CT phenotypes would provide a more powerful tool for assessing underlying morphologic differences associated with pulmonary function in COPD than does PFT alone. We used factor analysis of 26 variables to classify 8,157 participants recruited into the COPDGene cohort between January 2008 and June 2011 from 21 clinical centers across the United States. These factors were used as predictors of all-cause mortality using Cox proportional hazards modeling. Five factors explained 80% of the covariance and represented the following domains: factor 1, increased emphysema and decreased pulmonary function; factor 2, airway disease and decreased pulmonary function; factor 3, gas trapping; factor 4, CT variability; and factor 5, hyperinflation. After more than 46,079 person-years of follow-up, factors 1 through 4 were associated with mortality and there was a significant synergistic interaction between factors 1 and 2 on death. Considering CT measures along with PFT in the assessment of COPD can identify patients at particularly high risk for death.
      PubDate: Wed, 16 May 2018 00:00:00 GMT
      DOI: 10.1093/aje/kwy087
      Issue No: Vol. 187, No. 10 (2018)
  • Medical History, Medication Use, and Risk of Nasopharyngeal Carcinoma
    • Authors: Xiao X; Zhang Z, Chang E, et al.
      Pages: 2117 - 2125
      Abstract: Because persistent inflammation may render the nasopharyngeal mucosa susceptible to carcinogenesis, chronic ear-nose-throat (ENT) disease and its treatment might influence the risk of nasopharyngeal carcinoma (NPC). Existing evidence is, however, inconclusive and often based on methodologically suboptimal epidemiologic studies. In a population-based case-control study in southern China, we enrolled 2,532 persons with NPC and 2,597 controls, aged 20–74 years, from 2010 to 2014. Odds ratios were estimated for associations between NPC risk and history of ENT and related medications. Any history of chronic ENT disease was associated with a 34% increased risk of NPC. Similarly, use of nasal drops or aspirin was associated with approximately doubled risk of NPC. However, in secondary analyses restricted to chronic ENT diseases and related medication use at least 5 years prior to diagnosis/interview, most results were statistically nonsignificant, except a history of uncured ENT diseases, untreated nasal polyps, and earlier age at first diagnosis of ENT disease and first or most recent aspirin use. Overall, these findings suggest that ENT disease and related medication use are most likely early indications rather than causes of NPC, although the possibility of a modestly increased NPC risk associated with these diseases and related medications cannot be excluded.
      PubDate: Thu, 26 Apr 2018 00:00:00 GMT
      DOI: 10.1093/aje/kwy095
      Issue No: Vol. 187, No. 10 (2018)
  • Associations of Biomarker-Calibrated Intake of Total Sugars With the Risk
           of Type 2 Diabetes and Cardiovascular Disease in the Women’s Health
           Initiative Observational Study
    • Authors: Tasevska N; Pettinger M, Kipnis V, et al.
      Pages: 2126 - 2135
      Abstract: The inconsistent findings from epidemiologic studies relating total sugars (TS) consumption to cardiovascular disease (CVD) or type 2 diabetes (T2D) risk may be partly due to measurement error in self-reported intake. Using regression calibration equations developed based on the predictive biomarker for TS and recovery biomarker for energy, we examined the association of TS with T2D and CVD risk, before and after dietary calibration, in 82,254 postmenopausal women participating in the Women’s Health Initiative Observational Study. After up to 16 years of follow-up (1993–2010), 6,621 T2D and 5,802 CVD incident cases were identified. The hazard ratio for T2D per 20% increase in calibrated TS was 0.94 (95% confidence interval (CI): 0.77, 1.15) in multivariable energy substitution, and 1.00 (95% CI: 0.85, 1.18) in energy partition models. Multivariable hazard ratios for total CVD were 0.97 (95% CI: 0.87, 1.09) from energy substitution, and 0.91 (95% CI: 0.80, 1.04) from energy partition models. Uncalibrated TS generated a statistically significant inverse association with T2D and total CVD risk in multivariable energy substitution and energy partition models. The lack of conclusive findings from our calibrated analyses may be due to the low explanatory power of the calibration equations for TS, which could have led to incomplete deattenuation of the risk estimates.
      PubDate: Mon, 04 Jun 2018 00:00:00 GMT
      DOI: 10.1093/aje/kwy115
      Issue No: Vol. 187, No. 10 (2018)
  • New-Onset Asthma and Combat Deployment: Findings From the Millennium
           Cohort Study
    • Authors: Rivera A; Powell T, Boyko E, et al.
      Pages: 2136 - 2144
      Abstract: Recent reports suggest US military service members who deployed in support of the recent conflicts in Iraq and Afghanistan have higher rates of new-onset asthma than those who did not deploy. However, it is unknown whether combat experiences, in addition to deployment, contribute to new-onset asthma risk. This study aimed to longitudinally determine the risk factors for developing asthma, including combat deployment (categorized as deployed with combat experience, deployed without combat experience, or nondeployed), among participants in the Millennium Cohort Study from 2001 to 2013. A total of 75,770 participants completed a baseline survey and at least 1 triennial follow-up survey on deployment experiences, lifestyle characteristics, and health outcomes. Complementary log-log models stratified by sex were used to estimate the relative risk of developing asthma among participants who reported no history of asthma at baseline. In models with adjustments, those who deployed with combat experience were 24%–30% more likely to develop asthma than those who did not deploy. Deployed personnel without combat experience were not at a higher risk for new-onset asthma compared with nondeployers. Further research is needed to identify specific features of combat that are associated with greater asthma risk to inform prevention strategies.
      PubDate: Mon, 11 Jun 2018 00:00:00 GMT
      DOI: 10.1093/aje/kwy112
      Issue No: Vol. 187, No. 10 (2018)
  • Ten-Year Changes in Accelerometer-Based Physical Activity and Sedentary
           Time During MidlifeThe CARDIA Study
    • Authors: Pettee Gabriel K, Sidney S, Jacobs D, Jr; et al.
      Pages: 2145 - 2150
      Abstract: We describe 10-year changes in accelerometer-determined physical activity (PA) and sedentary time in a midlife cohort of the Coronary Artery Risk Development in Young Adults Study, within and by race and sex groups. Participants (n = 962) wore the accelerometer with valid wear (≥4 of 7 days, ≥10 hours per day) at baseline (2005–2006; ages 38–50 years) and 10-year follow-up (2015–2016; ages 48–60 years). Data were calibrated to account for accelerometer model differences. Participants (mean age = 45.0 (standard deviation, 3.5) years at baseline) had reduced accelerometer counts overall (mean = −65.5 (standard error (SE), 10.2) counts per minute/day), and within race and sex groups (all P < 0.001). Sedentary time increased overall (mean = 37.9 (SE, 3.7) minutes/day) and within race and sex groups, whereas light-intensity PA (mean = −30.6 (SE, 2.7) minutes/day) and moderate- to vigorous-intensity PA (mean = −7.5 (SE, 0.8) minutes/day) declined overall and within race and sex groups (all P < 0.001). Significant differences in 10-year change estimates were noted by race and sex groups for accelerometer counts, sedentary time, and moderate- to vigorous-intensity PA bouts; black men had the greatest reductions in PA compared with other groups. PA declines during midlife were characterized by reductions in light-intensity PA with increases in sedentary time, which may have important health consequences. Targeted efforts are needed to preserve PA, regardless of intensity level, across midlife.
      PubDate: Mon, 11 Jun 2018 00:00:00 GMT
      DOI: 10.1093/aje/kwy117
      Issue No: Vol. 187, No. 10 (2018)
  • Prolonged Leisure Time Spent Sitting in Relation to Cause-Specific
           Mortality in a Large US Cohort
    • Authors: Patel A; Maliniak M, Rees-Punia E, et al.
      Pages: 2151 - 2158
      Abstract: The majority of leisure time is spent in sedentary behaviors such as television viewing. Studies have documented that prolonged leisure-time sitting is associated with higher risk of mortality—total, cardiovascular disease, cancer, and “all other causes”—but few have examined the “other” causes of death in detail. To examine associations of leisure-time sitting with risk of specific causes of death, we analyzed data from the Cancer Prevention Study II (CPS-II) Nutrition Cohort, a prospective US cohort including 127,554 men and women who were free of major chronic disease at study entry, and among whom 48,784 died during 21 years of follow-up (1993–2014; median follow-up, 20.3 years, interquartile range, 4.6 years). After multivariable adjustment, prolonged leisure-time sitting (≥6 vs. <3 hours per day) was associated with higher risk of mortality from all causes, cardiovascular disease (including coronary heart disease and stroke-specific mortality), cancer, diabetes, kidney disease, suicide, chronic obstructive pulmonary disease, pneumonitis due to solids and liquids, liver, peptic ulcer and other digestive disease, Parkinson disease, Alzheimer disease, nervous disorders, and musculoskeletal disorders. These findings provide additional evidence for associations between a broad range of mortality outcomes and prolonged sitting time. Given the pervasive nature of sitting in the contemporary lifestyle, this study further supports the recommendation that encouraging individuals to reduce sedentary time may provide health benefits.
      PubDate: Tue, 26 Jun 2018 00:00:00 GMT
      DOI: 10.1093/aje/kwy125
      Issue No: Vol. 187, No. 10 (2018)
  • Prenatal Exposure to Antibiotics and Risk of Childhood Obesity in a
           Multicenter Cohort Study
    • Authors: Wang B; Liu J, Zhang Y, et al.
      Pages: 2159 - 2167
      Abstract: Mounting evidence has linked postnatal antibiotic use with body mass index (BMI) in children, but the influence of prenatal antibiotic use on offspring obesity risk remains unclear. We aimed to assess the association between fetal exposure to antibiotics and obesity at ages 4 and 7 years among 43,332 children using a multicenter prospective cohort of the US Collaborative Perinatal Project (1959–1976). Antibiotic use was ascertained for mothers during pregnancy. Modified Poisson regression models were used to estimate risk ratios for obesity (BMI >95th percentile), and linear mixed models were applied to assess the association with BMI z score. Repeated prenatal exposure to antibiotics was associated with childhood obesity at age 7 years, and risk of obesity tended to increase with an increasing number of antibiotic exposures (for 2–3 exposures, risk ratio (RR) = 1.22, 95% confidence interval (CI): 1.04, 1.44; for ≥4 exposures, RR = 1.34, 95% CI: 1.03, 1.73). The magnitude of association was strongest for repeated exposures in the second trimester (RR = 1.40, 95% CI: 1.16, 1.71). Prenatal antibiotic use was not associated with obesity or BMI z score at age 4 years. These findings support an increased risk of mid-childhood obesity with repeated use of antibiotics during pregnancy.
      PubDate: Mon, 11 Jun 2018 00:00:00 GMT
      DOI: 10.1093/aje/kwy122
      Issue No: Vol. 187, No. 10 (2018)
  • Temporal Trends in the Level and Decline of Cognition and Disability in an
           Elderly PopulationThe PAQUID Study
    • Authors: Grasset L; Jacqmin-Gadda H, Proust-Lima C, et al.
      Pages: 2168 - 2176
      Abstract: In line with declining trends in dementia incidence, we compared the cognitive and functional evolution of 2 “generations” of elderly individuals aged 78–88 years, who were included 10 years apart in the French Personnes Agées Quid cohort (n = 612 in 1991–1992 and n = 628 in 2001–2002) and followed-up for 12 years with assessments of cognition and disability. The impact of specific risk factors on this evolution was evaluated. Differences between the generations in baseline levels and decline over time were estimated using a joint model to account for differential attrition. Compared with the first generation, the second generation had higher performances at baseline on 4 cognitive tests (from P < 0.005). Differences in global cognition, verbal fluency, and processing speed, but not in working memory, were mostly explained by improvement in educational level. The second generation also exhibited less cognitive decline in verbal fluency and working memory. Progression of disability was less over the follow-up period for the second generation than for the first. The cognitive state of this elderly population improved, partially due to improvements in educational level.
      PubDate: Mon, 11 Jun 2018 00:00:00 GMT
      DOI: 10.1093/aje/kwy118
      Issue No: Vol. 187, No. 10 (2018)
  • Associations of Tipped and Untipped Service Work With Poor Mental Health
           in a Nationally Representative Cohort of Adolescents Followed Into
    • Authors: Andrea S; Messer L, Marino M, et al.
      Pages: 2177 - 2185
      Abstract: Precarious work is concentrated in the service industry in the United States and is a risk factor for poor mental health. Service occupations in which workers receive tips are potentially more precarious due to unstable schedule and income, and lack of benefits. We tested hypotheses that individuals working in tipped service occupations have greater odds of experiencing poor mental health (as indicated by self-reported depression, sleep problems, and/or greater perceived stress) relative to individuals in untipped service and nonservice occupations, using cross-sectional data from wave IV of the National Longitudinal Study of Adolescent to Adult Health data set (2007–2008; age range, 24–33 years). To improve comparability of occupation types, propensity scores were computed as a function of childhood factors, then used to construct a sample of 2,815 women and 2,586 men. In gender-stratified multivariable regression, women in tipped service had greater odds of reporting a depression diagnosis or symptoms relative to women in nonservice work (odds ratio = 1.61; 95% confidence interval: 1.11, 2.34). Associations of similar magnitude for sleep problems and perceived stress were observed among women but were not statistically significant; all associations were close to the null among men. Additional research is necessary to understand the factors that underlie differences in poor mental health in tipped and untipped service versus nonservice workers.
      PubDate: Mon, 11 Jun 2018 00:00:00 GMT
      DOI: 10.1093/aje/kwy123
      Issue No: Vol. 187, No. 10 (2018)
  • Leukocyte Telomere Length and All-Cause Mortality: A Between-Within Twin
           Study With Time-Dependent Effects Using Generalized Survival Models
    • Authors: Zhan Y; Liu X, Reynolds C, et al.
      Pages: 2186 - 2191
      Abstract: Although previous studies examining leukocyte telomere length (LTL) and all-cause mortality controlled for several confounders, the observed association could be biased due to unmeasured confounders, including familial factors. We aimed to examine the association of LTL with all-cause mortality in a Swedish twin sample while adjusting for familial factors and allowing for time-dependent effects. A total of 366 participants (174 twin pairs and 18 individuals) were recruited from the Swedish Twin Registry. LTL was assessed using the Southern blot method. All-cause mortality data were obtained through linkage with the Swedish Population Registry, updated through November 15, 2017. To control for familial factors within twin pairs, we applied a between-within shared frailty model based on generalized survival models. Overall, 115 (31.4%) participants were men and 251 (68.6%) were women. The average age of the study participants when blood was drawn was 79.1 years, and follow-up duration ranged from 10 days to 25.7 years (mean = 10.2 years). During the follow-up period, 341 (93.2%) participants died. Shorter LTL was associated with higher mortality rates when controlling for familial factors in the between-within shared frailty model. We found significant time-dependent effects of LTL on all-cause mortality, where the mortality rate ratios were attenuated with increasing age.
      PubDate: Fri, 29 Jun 2018 00:00:00 GMT
      DOI: 10.1093/aje/kwy128
      Issue No: Vol. 187, No. 10 (2018)
  • Diet Quality Indices and Leukocyte Telomere Length Among Healthy US
           Adults: Data From the National Health and Nutrition Examination Survey,
    • Authors: Leung C; Fung T, McEvoy C, et al.
      Pages: 2192 - 2201
      Abstract: Aging is the biggest risk factor for the development of chronic diseases. Telomere length may represent one important mechanism by which dietary intake influences risk of age-related diseases; however, it is unknown which diet pattern is most strongly related to telomere length. We compared the relationships between 4 evidence-based diet quality indices and leukocyte telomere length in a nationally representative sample of healthy adults, and the extent to which these associations differed between men and women. Data on 4,758 adults aged 20–65 years with no prior diagnosis of major chronic disease were obtained from the 1999–2002 cycles of the National Health and Nutrition Examination Survey. Diet was assessed using one 24-hour dietary recall. After adjustment for sociodemographic and health characteristics, comparison of the top and bottom quintiles showed that higher Healthy Eating Index 2010 scores (β = 0.065, 95% confidence interval (CI): 0.018, 0.112; P-trend = 0.007), Alternate Healthy Eating Index 2010 scores (β = 0.054, 95% CI: 0.010, 0.097; P-trend = 0.007), Mediterranean Diet scores (β = 0.058, 95% CI: 0.017, 0.098; P-trend = 0.008), and Dietary Approaches to Stop Hypertension (DASH) scores (β = 0.052, 95% CI: 0.014, 0.090; P-trend = 0.007) were each associated with longer telomere length in women. These results may provide insight into the complex associations between optimal nutrition and longevity. Further investigation is needed to understand why associations were not observed in men.
      PubDate: Fri, 15 Jun 2018 00:00:00 GMT
      DOI: 10.1093/aje/kwy124
      Issue No: Vol. 187, No. 10 (2018)
  • Incidence of Lyme Disease Diagnosis in a Maryland Medicaid Population,
    • Authors: Rebman A; Wang L, Yang T, et al.
      Pages: 2202 - 2209
      Abstract: The epidemiology of Lyme disease has been examined utilizing insurance claims from privately insured individuals; however, it is unknown whether reported patterns vary among the publicly insured. We examined trends in incidence rates of first Lyme disease diagnosis among 384,652 Maryland Medicaid recipients enrolled from July 2004 to June 2011. Age-, sex-, county-, season-, and year-specific incidence rates were calculated, and mixed-effects multiple logistic regression models were used to study the relationship between Lyme disease diagnosis and these variables. The incidence rate in our sample was 97.65 cases per 100,000 person-years (95% confidence interval (CI): 91.53, 104.06), and there was a 13% average annual increase in the odds of a Lyme disease diagnosis (odds ratio = 1.13, 95% CI: 1.09, 1.17; P < 0.001). Incidence rates for males and females were not significantly different, though males were significantly more likely to be diagnosed during high-season months (relative risk (RR) = 1.24, 95% CI: 1.06, 1.44) and less likely to be diagnosed during low-season months (RR = 0.63, 95% CI: 0.46, 0.87) than females. Additionally, adults were significantly more likely than children to be diagnosed during low-season months (RR = 1.59, 95% CI: 1.19, 2.12). While relatively rare in this study sample, Lyme disease diagnoses do occur in a Medicaid population in a Lyme-endemic state.
      PubDate: Wed, 27 Jun 2018 00:00:00 GMT
      DOI: 10.1093/aje/kwy133
      Issue No: Vol. 187, No. 10 (2018)
  • Identification of Etiology-Specific Diarrhea Associated With Linear Growth
           Faltering in Bangladeshi Infants
    • Authors: Schnee A; Haque R, Taniuchi M, et al.
      Pages: 2210 - 2218
      Abstract: Childhood diarrhea in low-resource settings has been variably linked to linear growth shortfalls. However, the association between etiology-specific diarrhea and growth has not been comprehensively evaluated. We tested diarrheal stools collected from the Performance of Rotavirus and Oral Polio Vaccines in Developing Countries study from 2011 to 2013 in Dhaka, Bangladesh, by quantitative polymerase chain reaction for a broad range of enteropathogens to characterize diarrhea etiology and examine the association between etiology-specific diarrhea and linear growth and systemic inflammation. Pathogen-specific burdens of diarrhea were determined using attributable fractions. Linear regression was used to examine associations of pathogen-specific diarrhea with length-for-age z scores (LAZ) and serum C-reactive protein. There was no relationship between all-cause diarrhea and length at 12 months (change in 12-month LAZ per episode, −0.01, 95% confidence interval (CI): −0.06, 0.03). However, Cryptosporidium (change in 12-month LAZ per attributable episode, −0.23, 95% CI: −0.50, 0.03), Campylobacter jejuni/coli (change of −0.16, 95% CI: −0.32, −0.01), and Shigella/enteroinvasive Escherichia coli diarrhea (change of −0.12, 95% CI: −0.26, 0.03) were associated with linear growth deficits. Diarrhea attributable to C. jejuni/coli and Shigella/enteroinvasive E. coli were associated with elevated C-reactive protein. The association between diarrhea and linear growth appears to be pathogen-specific, reinforcing the need for pathogen-specific interventions.
      PubDate: Tue, 15 May 2018 00:00:00 GMT
      DOI: 10.1093/aje/kwy106
      Issue No: Vol. 187, No. 10 (2018)
  • Revealing Measles Outbreak Risk With a Nested Immunoglobulin G Serosurvey
           in Madagascar
    • Authors: Winter A; Wesolowski A, Mensah K, et al.
      Pages: 2219 - 2226
      Abstract: Madagascar reports few measles cases annually and high vaccination campaign coverage. However, the underlying age profile of immunity and risk of a measles outbreak is unknown. We conducted a nested serological survey, testing 1,005 serum samples (collected between November 2013 and December 2015 via Madagascar’s febrile rash surveillance system) for measles immunoglobulin G antibody titers. We directly estimated the age profile of immunity and compared these estimates with indirect estimates based on a birth cohort model of vaccination coverage and natural infection. Combining these estimates of the age profile of immunity in the population with an age-structured model of transmission, we further predicted the risk of a measles outbreak and the impact of mitigation strategies designed around supplementary immunization activities. The direct and indirect estimates of age-specific seroprevalence show that current measles susceptibility is over 10%, and modeling suggests that Madagascar may be at risk of a major measles epidemic.
      PubDate: Wed, 06 Jun 2018 00:00:00 GMT
      DOI: 10.1093/aje/kwy114
      Issue No: Vol. 187, No. 10 (2018)
  • Combining a Food Frequency Questionnaire With 24-Hour Recalls to Increase
           the Precision of Estimation of Usual Dietary Intakes—Evidence From the
           Validation Studies Pooling Project
    • Authors: Freedman L; Midthune D, Arab L, et al.
      Pages: 2227 - 2232
      Abstract: Improving estimates of individuals’ dietary intakes is key to obtaining more reliable evidence for diet-health relationships from nutritional cohort studies. One approach to improvement is combining information from different self-report instruments. Previous work evaluated the gains obtained from combining information from a food frequency questionnaire (FFQ) and multiple 24-hour recalls (24HRs), based on assuming that 24HRs provide unbiased measures of individual intakes. Here we evaluate the same approach of combining instruments but base it on the better assumption that recovery biomarkers provide unbiased measures of individual intakes. Our analysis uses data from the 5 large validation studies included in the Validation Studies Pooling Project: the Observing Protein and Energy Nutrition Study (1999–2000), the Automated Multiple-Pass Method validation study (2002–2004), the Energetics Study (2006–2009), the Nutrition Biomarker Study (2004–2005), and the Nutrition and Physical Activity Assessment Study (2007–2009). The data included intakes of energy, protein, potassium, and sodium. Under a time-varying usual-intake model analysis, the combination of an FFQ with 4 24HRs improved correlations with true intake for predicted protein density, potassium density, and sodium density (range, 0.39–0.61) in comparison with use of a single FFQ (range, 0.34–0.50). Absolute increases in correlation ranged from 0.02 to 0.26, depending on nutrient and sex, with an average increase of 0.14. Based on unbiased recovery biomarker evaluation for these nutrients, we confirm that combining an FFQ with multiple 24HRs modestly improves the accuracy of estimates of individual intakes.
      PubDate: Mon, 18 Jun 2018 00:00:00 GMT
      DOI: 10.1093/aje/kwy126
      Issue No: Vol. 187, No. 10 (2018)
  • Understanding Tuberculosis Transmission in the United Kingdom: Findings
           From 6 Years of Mycobacterial Interspersed Repetitive Unit–Variable
           Number Tandem Repeats Strain Typing, 2010–2015
    • Authors: Davidson J; Thomas H, Maguire H, et al.
      Pages: 2233 - 2242
      Abstract: Genotyping provides the opportunity to better understand tuberculosis (TB) transmission. We utilized strain typing data to assess trends in the proportion of clustering and identify the characteristics of individuals and clusters associated with recent United Kingdom (UK) transmission. In this retrospective cohort analysis, we included all culture-confirmed strain-typed TB notifications from the UK between 2010 and 2015 to estimate the proportion of patients that clustered over time. We explored the characteristics of patients in a cluster using multivariable logistic regression. Overall, 58.5% of TB patients were concentrated in 2,701 clusters. The proportion of patients in a cluster decreased between 2010 (58.7%) and 2015 (55.3%) (P = 0.001). Being a clustered patient was associated with being male and UK-born, having pulmonary disease, having a previous TB diagnosis, and having a history of drug misuse or imprisonment. Our results suggest that TB transmission in the UK decreased between 2010 and 2015, during which time TB incidence also decreased. Targeted cluster investigation and extended contact tracing should be aimed at persons at risk of being in a transmission chain, including UK-born individuals with social risk factors in clusters with a high proportion of patients having pulmonary disease.
      PubDate: Thu, 07 Jun 2018 00:00:00 GMT
      DOI: 10.1093/aje/kwy119
      Issue No: Vol. 187, No. 10 (2018)
  • Which Method of Fall Ascertainment Captures the Most Falls in Prefrail and
           Frail Seniors'
    • Authors: Teister C; Chocano-Bedoya P, Orav E, et al.
      Pages: 2243 - 2251
      Abstract: There is no consensus on the most reliable method of ascertaining falls among the elderly. Therefore, we investigated which method captured the most falls among prefrail and frail seniors from 2 randomized controlled trials conducted in Zurich, Switzerland: an 18-month trial (2009–2010) including 200 community-dwelling prefrail seniors with a prior fall and a 12-month trial (2005–2008) including 173 frail seniors with acute hip fracture. Both trials included the same methods of fall ascertainment: monthly active asking, daily self-report diary entries, and a call-in hotline. We compared numbers of falls reported and estimated overall and positive percent agreement between methods. Prefrail seniors reported 499 falls (fall rate = 2.5/year) and frail seniors reported 205 falls (fall rate = 1.4/year). Most falls (81% of falls in prefrail seniors and 78% in frail seniors) were reported via active asking. Among prefrail seniors, diaries captured an additional 19% of falls, while the hotline added none. Among frail seniors, the hotline added 16% of falls, while diaries added 6%. The positive percent agreement between active asking and diary entries was 100% among prefrail seniors and 88% among frail seniors. While monthly active asking captures most falls in both groups, this method alone missed 19% of falls in prefrail seniors and 22% in frail seniors. Thus, a combination of active asking and diaries for prefrail seniors and a combination of active asking and a hotline for frail seniors is warranted.
      PubDate: Fri, 15 Jun 2018 00:00:00 GMT
      DOI: 10.1093/aje/kwy113
      Issue No: Vol. 187, No. 10 (2018)
  • Estimating an Individual’s Probability of Revision Surgery After Knee
           Replacement: A Comparison of Modeling Approaches Using a National Data Set
    • Authors: Aram P; Trela-Larsen L, Sayers A, et al.
      Pages: 2252 - 2262
      Abstract: Tools that provide personalized risk prediction of outcomes after surgical procedures help patients make preference-based decisions among the available treatment options. However, it is unclear which modeling approach provides the most accurate risk estimation. We constructed and compared several parametric and nonparametric models for predicting prosthesis survivorship after knee replacement surgery for osteoarthritis. We used 430,455 patient-procedure episodes between April 2003 and September 2015 from the National Joint Registry for England, Wales, Northern Ireland, and the Isle of Man. The flexible parametric survival and random survival forest models most accurately captured the observed probability of remaining event-free. The concordance index for the flexible parametric model was the highest (0.705, 95% confidence interval (CI): 0.702, 0.707) for total knee replacement and was 0.639 (95% CI: 0.634, 0.643) for unicondylar knee replacement and 0.589 (95% CI: 0.586, 0.592) for patellofemoral replacement. The observed-to-predicted ratios for both the flexible parametric and the random survival forest approaches indicated that models tended to underestimate the risks for most risk groups. Our results show that the flexible parametric model has a better overall performance compared with other tested parametric methods and has better discrimination compared with the random survival forest approach.
      PubDate: Mon, 11 Jun 2018 00:00:00 GMT
      DOI: 10.1093/aje/kwy121
      Issue No: Vol. 187, No. 10 (2018)
    • Authors: Coughlin S.
      Pages: 2263 - 2263
      PubDate: Mon, 11 Jun 2018 00:00:00 GMT
      DOI: 10.1093/aje/kwy120
      Issue No: Vol. 187, No. 10 (2018)
    • Pages: 2264 - 2264
      PubDate: Tue, 28 Aug 2018 00:00:00 GMT
      DOI: 10.1093/aje/kwy140
      Issue No: Vol. 187, No. 10 (2018)
School of Mathematical and Computer Sciences
Heriot-Watt University
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