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Journal Cover International Journal of Epidemiology
  [SJR: 4.381]   [H-I: 145]   [183 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0300-5771 - ISSN (Online) 1464-3685
   Published by Oxford University Press Homepage  [372 journals]
  • Your contribution to a living journal
    • Authors: Leeder S.
      Pages: 1 - 8
      Abstract: As we move into 2018, we at IJE thank our readers, authors, editors and reviewers, all of whom help us to achieve our ambition to publish new, robust and useful epidemiological research to contribute to the improvement of health worldwide. We are fully aware of the IJE’s dependence on you all.
      PubDate: Thu, 25 Jan 2018 00:00:00 GMT
      DOI: 10.1093/ije/dyy002
      Issue No: Vol. 47, No. 1 (2018)
  • Commentary: Beyond child survival: public policy priorities for avoiding
           premature adult mortality
    • Authors: Lopez A.
      Pages: 106 - 108
      Abstract: Decades of focus by the global public health community on improving child survival have delivered one of the most impressive achievements in public health history, namely, a 70% reduction in the annual number of child deaths since 1970.1 The fact that five million children still die each year before their fifth birthday from largely preventable causes must continue to drive global health priorities, but there is legitimate and increasing concern about avoiding premature adult mortality. Indeed, since 1990 worldwide death rates for young men aged 20–39 years fell on average by only 15–20%, less than half the declines observed at older adult ages and substantially less than the gains recorded for children.2 A life course approach to avoiding premature mortality suggests that it is not enough to keep babies alive until adolescence; public policies and programmes must equally focus on keeping adolescents alive well into old age.
      PubDate: Mon, 19 Feb 2018 00:00:00 GMT
      DOI: 10.1093/ije/dyy008
      Issue No: Vol. 47, No. 1 (2018)
  • Growing Inequality: Bridging Complex Systems, Population Health and Health
    • Authors: Braithwaite J.
      Pages: 351 - 353
      Abstract: Growing Inequality: Bridging Complex Systems, Population Health and Health Disparities.KaplanGeorge A, Diez RouxAna V, SimonCarl P and GaleaSandro (eds). Washington DC: Westphalia Press, 2017, pp 316, US$25, ISBN: 978-1-63391-517-6
      PubDate: Mon, 22 Jan 2018 00:00:00 GMT
      DOI: 10.1093/ije/dyy001
      Issue No: Vol. 47, No. 1 (2018)
  • My Friend Tells Me
    • Authors: Lewis O.
      Pages: 354 - 355
      Abstract: My friend tells me
      PubDate: Mon, 22 Jan 2018 00:00:00 GMT
      DOI: 10.1093/ije/dyx285
      Issue No: Vol. 47, No. 1 (2018)
  • Data Resource Profile: The UK Cystic Fibrosis Registry
    • Authors: Taylor-Robinson D; Archangelidi O, Carr S, et al.
      Pages: 9 - 10e
      PubDate: Tue, 03 Oct 2017 00:00:00 GMT
      DOI: 10.1093/ije/dyx196
      Issue No: Vol. 47, No. 1 (2017)
  • Cohort Profile: The Early Language in Victoria Study (ELVS)
    • Authors: Reilly S; Cook F, Bavin E, et al.
      Pages: 11 - 20
      PubDate: Wed, 14 Jun 2017 00:00:00 GMT
      DOI: 10.1093/ije/dyx079
      Issue No: Vol. 47, No. 1 (2017)
  • Cohort Profile: Stratifying Resilience and Depression Longitudinally
           (STRADL): a questionnaire follow-up of Generation Scotland: Scottish
           Family Health Study (GS:SFHS)
    • Authors: Navrady L; Wolters M, MacIntyre D, et al.
      Pages: 13 - 14g
      PubDate: Tue, 18 Jul 2017 00:00:00 GMT
      DOI: 10.1093/ije/dyx115
      Issue No: Vol. 47, No. 1 (2017)
  • Cohort Profile: The FinnBrain Birth Cohort Study (FinnBrain)
    • Authors: Karlsson L; Tolvanen M, Scheinin N, et al.
      Pages: 15 - 16j
      PubDate: Thu, 14 Sep 2017 00:00:00 GMT
      DOI: 10.1093/ije/dyx173
      Issue No: Vol. 47, No. 1 (2017)
  • Cohort Profile: The NSPN 2400 Cohort: a developmental sample supporting
           the Wellcome Trust NeuroScience in Psychiatry Network
    • Authors: Kiddle B; Inkster B, Prabhu G, et al.
      Pages: 18 - 19g
      PubDate: Tue, 21 Nov 2017 00:00:00 GMT
      DOI: 10.1093/ije/dyx117
      Issue No: Vol. 47, No. 1 (2017)
  • Cohort Profile: Building a New Life in Australia (BNLA): the longitudinal
           study of humanitarian migrants
    • Authors: Edwards B; Smart D, De Maio J, et al.
      Pages: 20 - 20h
      PubDate: Mon, 30 Oct 2017 00:00:00 GMT
      DOI: 10.1093/ije/dyx218
      Issue No: Vol. 47, No. 1 (2017)
  • Cohort Profile: The Oxford Biobank
    • Authors: Karpe F; Vasan S, Humphreys S, et al.
      Pages: 21 - 21g
      Abstract: OBB in a nutshellThe Oxford Biobank is a population-based repository of biological material and health-related information on ∼8000 healthy participants, men and women aged 30–50 years, from Oxfordshire, UK.The bioresource includes a broad range of cardiovascular- and obesity-related phenotypes including biochemical and genetic biomarkers, anthropometric measurements and body composition assessed using dual energy X-ray absorptiometry.The cohort has the specific feature to allow for future dedicated recall studies based on baseline phenotype and genotype.With that capacity, the Oxford biobank is a resource for mechanistic research of genetic and phenotypic traits in a broad range of chronic disease such as cardiovascular disease, type 2 diabetes and obesity complications.Researchers interested in using the cohort should go through the online portal [].
      PubDate: Mon, 31 Jul 2017 00:00:00 GMT
      DOI: 10.1093/ije/dyx132
      Issue No: Vol. 47, No. 1 (2017)
  • Cohort Profile: Pregnancy And Childhood Epigenetics (PACE) Consortium
    • Authors: Felix J; Joubert B, Baccarelli A, et al.
      Pages: 22 - 23u
      PubDate: Wed, 13 Sep 2017 00:00:00 GMT
      DOI: 10.1093/ije/dyx190
      Issue No: Vol. 47, No. 1 (2017)
  • Corrigendum: Cohort Profile: Pregnancy And Childhood Epigenetics (PACE)
    • Pages: 24 - 24
      Abstract: First published online: 13 September 2017, Int J Epidemiol, doi:
      PubDate: Wed, 11 Oct 2017 00:00:00 GMT
      DOI: 10.1093/ije/dyx220
      Issue No: Vol. 47, No. 1 (2017)
  • Cohort Profile: NICHD Fetal Growth Studies–Singletons and Twins
    • Authors: Grewal J; Grantz K, Zhang C, et al.
      Pages: 25 - 25l
      Abstract: NICHD Fetal Growth Studies–Singletons and Twins–in a nutshellThe primary aims of the NICHD Fetal Growth Studies–Singletons and Twins were: in singletons, to establish a standard for normal fetal growth; and in dichorionic twins, to describe empirically their growth trajectory compared with singleton trajectories, based on the standard.Recruitment occurred between 8 and 13 weeks’ gestation at 12 clinical sites (eight for twins) with enrolment of: 2334 low-risk women with singleton pregnancies stratified by four self-identified racial/ethnic groups (Caucasian, African American, Hispanic, Asian); 468 obese women; and 171 women with dichorionic twins.Singleton pregnancies had five follow-up visits; twin pregnancies had an additional follow-up visit.Using a standard protocol and after intensive sonographer training and credentialling, serial ultrasounds for fetal biometry were performed. Maternal anthropometric measurements, including fundal height, were taken serially, and neonatal measurements were taken soon after birth. Women completed demographic, reproductive and pregnancy history questionnaires at enrolment, and dietary intake, changes in health status, health behaviour, depression and stress questionnaires serially at each study visit. Longitudinal blood specimens were collected in all women, as well as placenta and cord blood in a subset of singletons and all twins.Data will be made Accessible in documented repositories and electronic archives after completion of the studies’ analytical phases.
      PubDate: Fri, 08 Sep 2017 00:00:00 GMT
      DOI: 10.1093/ije/dyx161
      Issue No: Vol. 47, No. 1 (2017)
  • Cohort Profile: The Triple B Pregnancy Cohort Study: A longitudinal study
           of the relationship between alcohol, tobacco and other substance use
           during pregnancy and the health and well-being of Australian children and
    • Authors: Hutchinson D; Wilson J, Allsop S, et al.
      Pages: 26 - 27m
      PubDate: Thu, 26 Oct 2017 00:00:00 GMT
      DOI: 10.1093/ije/dyx126
      Issue No: Vol. 47, No. 1 (2017)
  • Cohort Profile: The Heinz C. Prechter Longitudinal Study of Bipolar
    • Authors: McInnis M; Assari S, Kamali M, et al.
      Pages: 28 - 28n
      PubDate: Sat, 02 Dec 2017 00:00:00 GMT
      DOI: 10.1093/ije/dyx229
      Issue No: Vol. 47, No. 1 (2017)
  • Software Application Profile: PHESANT: a tool for performing automated
           phenome scans in UK Biobank
    • Authors: Millard L; Davies N, Gaunt T, et al.
      Pages: 29 - 35
      Abstract: MotivationEpidemiological cohorts typically contain a diverse set of phenotypes such that automation of phenome scans is non-trivial, because they require highly heterogeneous models. For this reason, phenome scans have to date tended to use a smaller homogeneous set of phenotypes that can be analysed in a consistent fashion. We present PHESANT (PHEnome Scan ANalysis Tool), a software package for performing comprehensive phenome scans in UK Biobank.General featuresPHESANT tests the association of a specified trait with all continuous, integer and categorical variables in UK Biobank, or a specified subset. PHESANT uses a novel rule-based algorithm to determine how to appropriately test each trait, then performs the analyses and produces plots and summary tables.ImplementationThe PHESANT phenome scan is implemented in R. PHESANT includes a novel Javascript D3.js visualization and accompanying Java code that converts the phenome scan results to the required JavaScript Object Notation (JSON) format.AvailabilityPHESANT is available on GitHub at []. Git tag v0.5 corresponds to the version presented here.
      PubDate: Thu, 05 Oct 2017 00:00:00 GMT
      DOI: 10.1093/ije/dyx204
      Issue No: Vol. 47, No. 1 (2017)
  • Socio-economic trajectories and cardiovascular disease mortality in older
           people: the English Longitudinal Study of Ageing
    • Authors: Stringhini S; Zaninotto P, Kumari M, et al.
      Pages: 36 - 46
      Abstract: BackgroundSocio-economic status from early life has been linked to cardiovascular disease risk, but the impact of life-course socio-economic trajectories, as well as the mechanisms underlying social inequalities in cardiovascular disease risk, is uncertain.ObjectivesWe assessed the role of behavioural, psychosocial and physiological (including inflammatory) factors in the association between life-course socio-economic status and cardiovascular disease mortality in older adults.MethodsParticipants were 7846 individuals (44% women) from the English Longitudinal Study of Ageing, a representative study of individuals aged ≥ 50 years, established in 2002–03. Comprising four indicators of socio-economic status (father’s social class, own education, occupational position and wealth), we computed an index of socio-economic trajectory and a lifetime cumulative socio-economic score. Behavioural (smoking, physical activity, alcohol consumption, body mass index) and psychosocial (social relations, loneliness) factors, physiological (blood pressure, total cholesterol, triglycerides) and inflammatory markers (C-reactive protein, fibrinogen), measured repeatedly over time, were potential explanatory variables. Cardiovascular disease mortality was ascertained by linkage of study members to a national mortality register. Mediation was calculated using the traditional ‘change-in-estimate method’ and alternative approaches such as counterfactual mediation modelling could not be applied in this context.ResultsDuring the 8.4-year follow-up, 1301 study members died (438 from cardiovascular disease). A stable low-social-class trajectory was associated with around double the risk of cardiovascular disease mortality (hazard ratio; 95% confidence interval: 1.94, 1.37; 2.75) compared with a stable high social class across the life course. Individuals in the lowest relative to the highest life-course cumulative socio-economic status group were also more than twice as likely to die of cardiovascular disease (2.57, 1.81; 3.65). Behavioural factors and inflammatory markers contributed most to explaining this gradient, whereas the role of psychosocial and other physiological risk factors was modest.ConclusionsIn a population-based cohort of older individuals living in England, we provide evidence that disadvantage across the life course is linked to cardiovascular mortality. That behavioural factors and inflammatory markers partially explain this gradient may provide insights into the potential for intervention.
      PubDate: Fri, 28 Jul 2017 00:00:00 GMT
      DOI: 10.1093/ije/dyx106
      Issue No: Vol. 47, No. 1 (2017)
  • Re-employment, job quality, health and allostatic load biomarkers:
           prospective evidence from the UK Household Longitudinal Study
    • Authors: Chandola T; Zhang N.
      Pages: 47 - 57
      Abstract: BackgroundThere is little evidence on whether becoming re-employed in poor quality work is better for health and well-being than remaining unemployed. We examined associations of job transition with health and chronic stress-related biomarkers among a population-representative cohort of unemployed British adults.MethodsA prospective cohort of 1116 eligible participants aged 35 to 75 years, who were unemployed at wave 1 (2009/10) of the UK Household Longitudinal Study, were followed up at waves 2 (2010/11) and 3 (2011/12) for allostatic load biomarkers and self-reported health. Negative binomial and multiple regression models estimated the association between job adversity and these outcomes.ResultsCompared with adults who remained unemployed, formerly unemployed adults who transitioned into poor quality jobs had higher levels of overall allostatic load (0.51, 0.32–0.71), log HbA1c (0.06, <0.001–0.12), log triglycerides (0.39, 0.22–0.56), log C-reactive protein (0.45, 0.16–0.75), log fibrinogen (0.09, 0.01–0.17) and total cholesterol to high-density lipoprotein (HDL) ratio (1.38, 0.88–1.88). Moreover, physically healthier respondents at wave 1 were more likely to transition into good quality and poor quality jobs after 1 year than those who remained unemployed.ConclusionsFormerly unemployed adults who transitioned into poor quality work had greater adverse levels of biomarkers compared with their peers who remained unemployed. The selection of healthier unemployed adults into these poor quality or stressful jobs was unlikely to explain their elevated levels of chronic stress-related biomarkers. Job quality cannot be disregarded from the employment success of the unemployed, and may have important implications for their health and well-being.
      PubDate: Thu, 10 Aug 2017 00:00:00 GMT
      DOI: 10.1093/ije/dyx150
      Issue No: Vol. 47, No. 1 (2017)
  • The Great Recession and inequalities in access to health care: a study of
           unemployment and unmet medical need in Europe in the economic crisis
    • Authors: Madureira-Lima J; Reeves A, Clair A, et al.
      Pages: 58 - 68
      Abstract: BackgroundUnmet medical need (UMN) had been declining steadily across Europe until the 2008 Recession, a period characterized by rising unemployment. We examined whether becoming unemployed increased the risk of UMN during the Great Recession and whether the extent of out-of-pocket payments (OOP) for health care and income replacement for the unemployed (IRU) moderated this relationship.MethodsWe used the European Survey on Income and Living Conditions (EU-SILC) to construct a pseudo-panel (n = 135 529) across 25 countries to estimate the relationship between unemployment and UMN. We estimated linear probability models, using a baseline of employed people with no UMN, to test whether this relationship is mediated by financial hardship and moderated by levels of OOP and IRU.ResultsJob loss increased the risk of UMN [β = 0.027, 95% confidence interval (CI) 0.022–0.033] and financial hardship exacerbated this effect. Fewer people experiencing job loss lost access to health care in countries where OOPs were low or in countries where IRU is high. The results are robust to different model specifications.ConclusionsUnemployment does not necessarily compromise access to health care. Rather, access is jeopardized by diminishing financial resources that accompany job loss. Lower OOPs or higher IRU protect against loss of access, but they cannot guarantee it. Policy solutions should secure financial protection for the unemployed so that resources do not have to be diverted from health.
      PubDate: Mon, 18 Sep 2017 00:00:00 GMT
      DOI: 10.1093/ije/dyx193
      Issue No: Vol. 47, No. 1 (2017)
  • The importance of historical residential address information in
           longitudinal studies using administrative health data
    • Authors: Youens D; Preen D, Harris M, et al.
      Pages: 69 - 80
      Abstract: BackgroundWhen information on changes in address or migration of people to or from a study jurisdiction is unavailable in longitudinal studies, issues relating to loss-to-follow-up and misclassification bias may result. This study investigated how estimations of associations between general practitioner (GP) contact and hospital use were affected by incomplete address and migration data.MethodsThis was a retrospective population-based cohort study of Western Australians from 1990 to 2004. Linked administrative data including mortality records, hospital admissions, primary care and Electoral Roll records were used. Regularity of GP contact, based on the variance of the number of days between GP visits, was calculated for each person-year. Outcomes were the number and costs (A$2014) of diabetes-related hospital admissions in the following year. Models were estimated separately for cohorts where (i) postcode was ascertained at study commencement and held constant, and (ii) postcode and residency within Western Australia were updated with each change of address recorded on the Electoral Roll over the study period.ResultsUpdating address data reduced total person-years by 11% and changed the distribution of covariates. Estimations of associations between patterns of GP contact and number of hospitalizations changed; the incidence rate ratios measuring the relationship with the most regular GP contact (baseline of those with <2 GP visits) changed from 0.81 [95% confidence interval (CI) 0.66–1.00] to 0.42 (95% CI 0.33–0.53) after updating postcode information. Impacts on cost models were smaller, though still statistically significant.ConclusionsLongitudinal studies using administrative data may report biased results if they ignore address changes and migration. Researchers should attempt to link to these data wherever possible, or choose study designs which these issues are less likely to affect. Custodians should be aware that such data can be vital to high quality research.
      PubDate: Fri, 18 Aug 2017 00:00:00 GMT
      DOI: 10.1093/ije/dyx156
      Issue No: Vol. 47, No. 1 (2017)
  • Explaining recent mortality trends among younger and middle-aged White
    • Authors: Masters R; Tilstra A, Simon D.
      Pages: 81 - 88
      Abstract: BackgroundRecent research has suggested that increases in mortality among middle-aged US Whites are being driven by suicides and poisonings from alcohol and drug use. Increases in these ‘despair’ deaths have been argued to reflect a cohort-based epidemic of pain and distress among middle-aged US Whites.MethodsWe examine trends in all-cause and cause-specific mortality rates among younger and middle-aged US White men and women between 1980 and 2014, using official US mortality data. We estimate trends in cause-specific mortality from suicides, alcohol-related deaths, drug-related deaths, ‘metabolic diseases’ (i.e. deaths from heart diseases, diabetes, obesity and/or hypertension), and residual deaths from extrinsic causes (i.e. causes external to the body). We examine variation in mortality trends by gender, age and cause of death, and decompose trends into period- and cohort-based variation.ResultsTrends in middle-aged US White mortality vary considerably by cause and gender. The relative contribution to overall mortality rates from drug-related deaths has increased dramatically since the early 1990s, but the contributions from suicide and alcohol-related deaths have remained stable. Rising mortality from drug-related deaths exhibit strong period-based patterns. Declines in deaths from metabolic diseases have slowed for middle-aged White men and have stalled for middle-aged White women, and exhibit strong cohort-based patterns.ConclusionsWe find little empirical support for the pain- and distress-based explanations for rising mortality in the US White population. Instead, recent mortality increases among younger and middle-aged US White men and women have likely been shaped by the US opiate epidemic and an expanding obesogenic environment.
      PubDate: Wed, 19 Jul 2017 00:00:00 GMT
      DOI: 10.1093/ije/dyx127
      Issue No: Vol. 47, No. 1 (2017)
  • Intelligence and all-cause mortality in the 6-Day Sample of the Scottish
           Mental Survey 1947 and their siblings: testing the contribution of family
    • Authors: Iveson M; Čukić I, Der G, et al.
      Pages: 89 - 96
      Abstract: BackgroundHigher early-life intelligence is associated with a reduced risk of mortality in adulthood, though this association is apparently hardly attenuated when accounting for early-life socio-economic status (SES). However, the use of proxy measures of SES means that residual confounding may underestimate this attenuation. In the present study, the potential confounding effect of early-life SES was instead accounted for by examining the intelligence–mortality association within families.MethodsThe association between early-life intelligence and mortality in adulthood was assessed in 727 members of the 6-Day Sample of the Scottish Mental Survey 1947 and, for the first time, 1580 of their younger siblings. These individuals were born between 1936 and 1958, and were followed up into later life, with deaths recorded up to 2015. Cox regression was used to estimate the relative risk of mortality associated with higher IQ scores after adjusting for shared family factors.ResultsA standard-deviation advantage in IQ score was associated with a significantly reduced mortality risk [hazard ratio = 0.76, p < 0.001, 95% confidence interval (CI) (0.68–0.84)]. This reduction in hazard was only slightly attenuated by adjusting for sex and shared family factors [hazard ratio = 0.79, p = 0.002, 95% CI (0.68–0.92)].ConclusionsAlthough somewhat conservative, adjusting for all variance shared by a family avoids any potential residual confounding of the intelligence–mortality association arising from the use of proxy measures of early-life SES. The present study demonstrates that the longevity associated with higher early-life intelligence cannot be explained by early-life SES or within-family factors.
      PubDate: Mon, 21 Aug 2017 00:00:00 GMT
      DOI: 10.1093/ije/dyx168
      Issue No: Vol. 47, No. 1 (2017)
  • Divergence and convergence in cause-specific premature adult mortality in
           Mexico and US Mexican Hispanics from 1995 to 2015: analyses of 4.9 million
           individual deaths
    • Authors: Reynales-Shigematsu L; Guerrero-López C, Hernández Ávila M, et al.
      Pages: 97 - 106
      Abstract: BackgroundMexicans and US Mexican Hispanics share modifiable determinants of premature mortality. We compared trends in mortality at ages 30–69 in Mexico and among US Mexican Hispanics from 1995 to 2015.MethodsWe examined nationally representative statistics on 4.2 million Mexican and 0.7 million US deaths to examine cause-specific mortality. We used lung cancer indexed methods to estimate smoking-attributable deaths stratified by high and lower burden Mexican states.ResultsIn 1995–99, Mexican men had about 30% higher relative risk of death from all causes than US Mexican Hispanic men, and this difference nearly doubled to 58% by 2010–15. The divergence between Mexican and US Mexican Hispanic women over this time period was less marked. Among US Mexican Hispanics, declines in the risk of smoking-attributable death constituted about 25–30% of the declines in the overall risk of death. However, among Mexican men the declines in the risk of smoking-attributable deaths were offset by increases in causes of death not due to smoking. Homicide rates (mostly from guns) rose among men in Mexico from 2005 to 2010, but not among Mexican women or US Mexican Hispanic men or women. The probability at 30–69 years of death from cardiac disease diverged significantly between Mexicans and US Mexican Hispanics, reaching 10% and 5% for men, and 7% and 2% for women, respectively.ConclusionsLarge differences in premature mortality between otherwise genetically and culturally similar groups arise from a few modifiable factors, most notably smoking, untreated diabetes and homicide.
      PubDate: Sat, 23 Sep 2017 00:00:00 GMT
      DOI: 10.1093/ije/dyx185
      Issue No: Vol. 47, No. 1 (2017)
  • Early life exposure to China’s 1959–61 famine and midlife
    • Authors: Xu H; Zhang Z, Li L, et al.
      Pages: 109 - 120
      Abstract: BackgroundExisting studies of the 1944–45 Dutch famine found little evidence of the association between early life malnutrition and midlife cognition.MethodsAmong 2446 rural participants born between 1958 and 1963 in the China Health and Retirement Longitudinal Study, we examined effects of exposure to China’s 1959–61 Great Leap Forward famine during prenatal and early postnatal life, on four cognitive measures in 2011 (baseline) and changes in cognition between 2011 and 2013 (first follow-up). We obtained difference-in-differences (DID) estimates of the famine effects by exploiting temporal variation in the timing and duration of famine exposure across six birth cohorts born between 1958 and 1963, together with geographical variation in famine severity at the prefecture level.ResultsAfter adjusting for gender, marital status and provincial fixed effects, we found that the 1961 cohort who experienced full-term prenatal and partial-term postnatal exposures to famine had lower scores on the Telephone Interview of Cognitive Status (TICS), a test of drawing pentagons, and general cognition at age 50 years compared with the unexposed 1963 cohort. Adjusting for education, the famine effects on drawing pentagons and general cognition were fully attenuated, but the effect on TICS persisted. We also found a robust negative famine effect on the longitudinal change in general cognition during the 2-year follow-up in the 1959 cohort.ConclusionsSevere nutritional deprivation during prenatal and postnatal periods has a lasting impact on cognitive performance in Chinese adults in their early 50s.
      PubDate: Tue, 07 Nov 2017 00:00:00 GMT
      DOI: 10.1093/ije/dyx222
      Issue No: Vol. 47, No. 1 (2017)
  • Use of paracetamol, ibuprofen or aspirin in pregnancy and risk of cerebral
           palsy in the child
    • Authors: Petersen T; Liew Z, Andersen A, et al.
      Pages: 121 - 130
      Abstract: BackgroundIt has been debated whether mild analgesics, mainly paracetamol, adversely affect aspects of neurodevelopment. We examined whether mother’s use of paracetamol, aspirin or ibuprofen in pregnancy is associated with increased risk of cerebral palsy (CP) in the child.MethodWe included 185 617 mother-child pairs from the Danish National Birth Cohort and the Norwegian Mother and Child Cohort Study. We created harmonized definitions of analgesic use in pregnancy, as well as indications for analgesic use and other potential confounders. Children with CP were identified in nationwide registers. We estimated the average causal effect of analgesics on risk of CP using marginal structural models with stabilized inverse probability weights.ResultsParacetamol use was reported in 49% of all pregnancies, aspirin in 3% and ibuprofen in 4%. Prenatal exposure to paracetamol ever in pregnancy was associated with increased risk of overall CP [adjusted odds ratio (aOR) 1.3, 95% confidence interval (CI): 1.0–1.7] and unilateral spastic CP (aOR 1.5, 95% CI: 1.0–2.2). The association appeared to be driven by an increased risk of unilateral spastic CP in children exposed in second trimester (aOR 1.6, 95% CI: 1.0–2.5). Children ever prenatally exposed to aspirin in pregnancy had an elevated risk of bilateral spastic CP (aOR 2.4, 95% CI: 1.1–5.3) compared with unexposed.ConclusionWe observed an increased risk of spastic CP in children prenatally exposed to paracetamol and aspirin. Although we controlled for several important indications for analgesic use, we cannot exclude the possibility of confounding by underlying diseases.
      PubDate: Tue, 14 Nov 2017 00:00:00 GMT
      DOI: 10.1093/ije/dyx235
      Issue No: Vol. 47, No. 1 (2017)
  • Associations between maternal lifestyle factors and neonatal body
           composition in the Screening for Pregnancy Endpoints (Cork) cohort study
    • Authors: Dahly D; Li X, Smith H, et al.
      Pages: 131 - 145
      Abstract: BackgroundNeonatal body composition likely mediates fetal influences on life long chronic disease risk. A better understanding of how maternal lifestyle is related to newborn body composition could thus inform intervention efforts.MethodsUsing Cork participant data (n = 1754) from the Screening for Pregnancy Endpoints (SCOPE) cohort study [ECM5(10)05/02/08], we estimated how pre-pregnancy body size, gestational weight gain, exercise, alcohol, smoking and diet were related to neonatal fat and fat-free mass, as well as length and gestational age at birth, using quantile regression. Maternal factors were measured by a trained research midwife at 15 gestational weeks, in addition to a 3rd trimester weight measurement used to calculate weight gain. Infant body composition was measured using air-displacement plethysmography.ResultsHealthy (versus excess) gestational weight gain was associated with lower median fat-free mass [−112 g, 95% confidence interval (CI): −47 to −176) and fat mass (−33 g, 95% CI: −1 to −65) in the offspring; and a 103 g decrease in the 95th centile of fat mass (95% CI: −33 to −174). Maternal normal weight status (versus obesity) was associated with lower median fat mass (−48 g, 95% CI: −12 to −84). At the highest centiles, fat mass was lower among infants of women who engaged in frequent moderate-intensity exercise early in the pregnancy (−92 g at the 95th centile, 95% CI: −168 to −16). Lastly, women who never smoked tended to have longer babies with more fat mass and fat-free mass. No other lifestyle factors were strongly related to infant body composition.ConclusionsThese results suggest that supporting healthy maternal lifestyles could reduce the risk of excess fat accumulation in the offspring, without adversely affecting fat-free mass development, length or gestational age.
      PubDate: Fri, 10 Nov 2017 00:00:00 GMT
      DOI: 10.1093/ije/dyx221
      Issue No: Vol. 47, No. 1 (2017)
  • A sibling study of whether maternal exposure to different types of natural
           space is related to birthweight
    • Authors: Richardson E; Shortt N, Mitchell R, et al.
      Pages: 146 - 155
      Abstract: BackgroundBirthweight is an important determinant of health across the life course. Maternal exposure to natural space has been linked to higher birthweight, but stronger evidence of a causal link is needed. We use a quasi-experimental sibling study design to investigate if change in the mother’s exposure to natural space between births was related to birthweight, in urban Scotland.MethodsAmount (% area) of total natural space, total accessible (public) natural space, parks, woodlands and open water within 100 m of the mother’s postcode was calculated for eligible births (n = 40 194; 1991–2010) in the Scottish Longitudinal Study (a semi-random 5.3% sample of the Scottish population). Associations between natural space and birthweight were estimated, using ordinary least squares and fixed effects models.ResultsBirthweight was associated with the total amount of natural space around the mother’s home (+8.2 g for interquartile range increase), but was unrelated to specific types of natural space. This whole-sample relationship disappeared in the sibling analysis, indicating residual confounding. The sibling models showed effects for total natural space with births to women who already had children (+20.1 g), and to those with an intermediate level of education (+14.1 g).ConclusionsThe importance of total natural space for birthweight suggests that benefits can be experienced near to as well as within natural space. Ensuring expectant mothers have good access to high quality neighbourhood natural space has the potential to improve the infant’s start in life, and consequently their health trajectory over the life course.
      PubDate: Wed, 13 Dec 2017 00:00:00 GMT
      DOI: 10.1093/ije/dyx258
      Issue No: Vol. 47, No. 1 (2017)
  • Re-examining the link between prenatal maternal anxiety and child
           emotional difficulties, using a sibling design
    • Authors: Bekkhus M; Lee Y, Nordhagen R, et al.
      Pages: 156 - 165
      Abstract: BackgroundPrenatal exposure to maternal anxiety has been associated with child emotional difficulties in a number of epidemiological studies. One key concern, however, is that this link is vulnerable to confounding by pleiotropic genes or environmental family factors.MethodsData on 82 383 mothers and children from the population-based Mother and Child Cohort Study and data on 21 980 siblings were used in this study. Mothers filled out questionnaires for each unique pregnancy, for infant difficulties at 6 months and for emotional difficulties at 36 months. The link between prenatal maternal anxiety and child difficulties were examined using logistic regression analyses and multiple linear regression analyses for the full study sample and the sibling sample.ResultsIn the conventional full-cohort analyses, prenatal exposure to maternal anxiety was associated with child difficulties at both 6 months [odds ratio (OR) = 2.1 (1.94–2.27)] and 36 months [OR = 2.72 (2.47–2.99)]. The findings were essentially the same whether we examined difficulties at 6 months or at 36 months. However, these associations were no longer present once we controlled for potential social and genetic confounders in the sibling comparison analyses, either at 6 months [OR = 1.32 (0.91–1.90)] or at 36 months [OR = 1.28 (0.63–2.60)]. Findings from multiple regression analyses with continuous measures were essentially the same.ConclusionsOur finding lends little support for there being an independent prenatal effect on child emotional difficulties; rather, our findings suggest that the link between prenatal maternal anxiety and child difficulties could be confounded by pleiotropic genes or environmental family factors.
      PubDate: Fri, 08 Sep 2017 00:00:00 GMT
      DOI: 10.1093/ije/dyx186
      Issue No: Vol. 47, No. 1 (2017)
  • Longitudinal depression or anxiety in mothers and offspring asthma: a
           Swedish population-based study
    • Authors: Brew B; Lundholm C, Viktorin A, et al.
      Pages: 166 - 174
      Abstract: BackgroundPrevious research has found that maternal stress during pregnancy increases the risk of offspring asthma. However, whether this association is consistent with a causal interpretation has never been tested. The objective is to determine whether there is a critical exposure period for maternal depression or anxiety on offspring asthma or whether cumulative exposure is most important, and to investigate evidence of confounding.MethodsThe study population included all children born in Sweden from July 2006 to December 2009 (n = 360 526). Information about childhood asthma, maternal depression or anxiety (diagnosis or medication) and covariates was obtained from the Swedish national health registers. The associations between exposure periods (pre-conception, pregnancy, postnatal or current) and childhood asthma were estimated using structured life course approach hypothesis testing. Paternal and cousin analyses were used to test for evidence of confounding from shared genes and environment.ResultsFor childhood asthma, cumulative exposure best described the effect of exposure to maternal depression or anxiety up to a maximum of any two exposure periods [adjusted odds ratio 1.44, 95% confidence interval (CI) 1.38, 1.52]. The hypotheses of a critical period were not supported. The paternal and cousin analyses indicated minimal influence from familial confounding.ConclusionsThese findings support an association between cumulative exposure to maternal depression or anxiety and asthma development in offspring. This association is unique for maternal depression or anxiety and not due to familial confounding. The clinical implication is that effective psychological management of women with chronic distress may reduce offspring asthma risk.
      PubDate: Sat, 23 Sep 2017 00:00:00 GMT
      DOI: 10.1093/ije/dyx208
      Issue No: Vol. 47, No. 1 (2017)
  • Bans of WHO Class I Pesticides in Bangladesh—suicide prevention without
           hampering agricultural output
    • Authors: Chowdhury F; Dewan G, Verma V, et al.
      Pages: 175 - 184
      Abstract: BackgroundPesticide self-poisoning is a major problem in Bangladesh. Over the past 20-years, the Bangladesh government has introduced pesticide legislation and banned highly hazardous pesticides (HHPs) from agricultural use. We aimed to assess the impacts of pesticide bans on suicide and on agricultural production.MethodsWe obtained data on unnatural deaths from the Statistics Division of Bangladesh Police, and used negative binomial regression to quantify changes in pesticide suicides and unnatural deaths following removal of WHO Class I toxicity HHPs from agriculture in 2000. We assessed contemporaneous trends in other risk factors, pesticide usage and agricultural production in Bangladesh from 1996 to 2014.ResultsMortality in hospital from pesticide poisoning fell after the 2000 ban: 15.1% vs 9.5%, relative reduction 37.1% [95% confidence interval (CI) 35.4 to 38.8%]. The pesticide poisoning suicide rate fell from 6.3/100 000 in 1996 to 2.2/100 000 in 2014, a 65.1% (52.0 to 76.7%) decline. There was a modest simultaneous increase in hanging suicides [20.0% (8.4 to 36.9%) increase] but the overall incidence of unnatural deaths fell from 14.0/100 000 to 10.5/100 000 [25.0% (18.1 to 33.0%) decline]. There were 35 071 (95% CI 25 959 to 45 666) fewer pesticide suicides in 2001 to 2014 compared with the number predicted based on trends between 1996 to 2000. This reduction in rate of pesticide suicides occurred despite increased pesticide use and no change in admissions for pesticide poisoning, with no apparent influence on agricultural output.ConclusionsStrengthening pesticide regulation and banning WHO Class I toxicity HHPs in Bangladesh were associated with major reductions in deaths and hospital mortality, without any apparent effect on agricultural output. Our data indicate that removing HHPs from agriculture can rapidly reduce suicides without imposing substantial agricultural costs.
      PubDate: Fri, 18 Aug 2017 00:00:00 GMT
      DOI: 10.1093/ije/dyx157
      Issue No: Vol. 47, No. 1 (2017)
  • Protective effects of household-based TB interventions are robust to
           neighbourhood-level variation in exposure risk in Lima, Peru: a
           model-based analysis
    • Authors: Zelner J; Murray M, Becerra M, et al.
      Pages: 185 - 192
      Abstract: BackgroundUntargeted active screening and treatment programmes for tuberculosis (TB) have not been shown to be more effective than passive screening and isoniazid preventive therapy (IPT) for reducing TB incidence. In this manuscript, we compare the efficacy of targeting screening and IPT on high-risk household contacts of diagnosed TB cases, with less-targeted active screening approaches in Lima, Peru.MethodsWe conducted a population-based prospective cohort study within households of TB cases in Lima. We identified all adults diagnosed with incident pulmonary TB from 2009 through 2012 at 106 participating public health centres (HC) within our catchment area of ∼3.3 million inhabitants. We estimated combined effects of community and household exposure on the risk of latent TB infection (LTBI) and incident TB disease. We used simulation modelling to assess the efficacy of TB screening programmes for reducing the risk of incident TB in these contacts.ResultsIndividuals with household exposure to TB are more likely to present with LTBI and TB disease than those without this exposure, despite wide variation in community exposure. Simulations suggest that more cases are prevented by 1000 administrations of IPT to tuberculin skin test (TST)-positive household contacts of identified TB cases (30, 95% CI = 16,47) than from blanket screening and treatment in the community (7, 95% CI = 2,17).ConclusionsHousehold exposure remains a major driver of incident TB risk among household contacts of identified TB cases. Targeting interventions on these individuals is likely to prevent more cases of TB than blanket screening of individuals in the community.
      PubDate: Wed, 13 Sep 2017 00:00:00 GMT
      DOI: 10.1093/ije/dyx171
      Issue No: Vol. 47, No. 1 (2017)
  • The duration of protection of school-aged BCG vaccination in England: a
           population-based case–control study
    • Authors: Mangtani P; Nguipdop-Djomo P, Keogh R, et al.
      Pages: 193 - 201
      Abstract: BackgroundEvidence of protection from childhood Bacillus Calmette-Guerin (BCG) against tuberculosis (TB) in adulthood, when most transmission occurs, is important for TB control and resource allocation.MethodsWe conducted a population-based case–control study of protection by BCG given to children aged 12–13 years against tuberculosis occurring 10–29 years later. We recruited UK-born White subjects with tuberculosis and randomly sampled White community controls. Hazard ratios and 95% confidence intervals (CIs) were estimated using case–cohort Cox regression, adjusting for potential confounding factors, including socio-economic status, smoking, drug use, prison and homelessness. Vaccine effectiveness (VE = 1 – hazard ratio) was assessed at successive intervals more than 10 years following vaccination.ResultsWe obtained 677 cases and 1170 controls after a 65% response rate in both groups. Confounding by deprivation, education and lifestyle factors was slight 10–20 years after vaccination, and more evident after 20 years. VE 10–15 years after vaccination was 51% (95% CI 21, 69%) and 57% (CI 33, 72%) at 15–20 years. Subsequently, BCG protection appeared to wane; 20–25 years VE = 25% (CI –14%, 51%) and 25–29 years VE = 1% (CI –84%, 47%). Based on multiple imputation of missing data (in 17% subjects), VE estimated in the same intervals after vaccination were similar [56% (CI 33, 72%), 57% (CI 36, 71%), 25% (–10, 48%), 21% (–39, 55%)].ConclusionsSchool-aged BCG vaccination offered moderate protection against tuberculosis for at least 20 years, which is longer than previously thought. This has implications for assessing the cost-effectiveness of BCG vaccination and when evaluating new TB vaccines.
      PubDate: Thu, 31 Aug 2017 00:00:00 GMT
      DOI: 10.1093/ije/dyx141
      Issue No: Vol. 47, No. 1 (2017)
  • Spatio-temporal models to determine association between Campylobacter
           cases and environment
    • Authors: Sanderson R; Maas J, Blain A, et al.
      Pages: 202 - 216
      Abstract: BackgroundCampylobacteriosis is a major cause of gastroenteritis in the UK, and although 70% of cases are associated with food sources, the remainder are probably associated with wider environmental exposure.MethodsIn order to investigate wider environmental transmission, we conducted a spatio-temporal analysis of the association of human cases of Campylobacter in the Tyne catchment with weather, climate, hydrology and land use. A hydrological model was used to predict surface-water flow in the Tyne catchment over 5 years. We analysed associations between population-adjusted Campylobacter case rate and environmental factors hypothesized to be important in disease using a two-stage modelling framework. First, we investigated associations between temporal variation in case rate in relation to surface-water flow, temperature, evapotranspiration and rainfall, using linear mixed-effects models. Second, we used the random effects for the first model to quantify how spatial variation in static landscape features of soil and land use impacted on the likely differences between subcatchment associations of case rate with the temporal variables.ResultsPopulation-adjusted Campylobacter case rates were associated with periods of high predicted surface-water flow, and during above average temperatures. Subcatchments with cattle on stagnogley soils, and to a lesser extent sheep plus cattle grazing, had higher Campylobacter case rates.ConclusionsAreas of stagnogley soils with mixed livestock grazing may be more vulnerable to both Campylobacter spread and exposure during periods of high rainfall, with resultant increased risk of human cases of the disease.
      PubDate: Tue, 24 Oct 2017 00:00:00 GMT
      DOI: 10.1093/ije/dyx217
      Issue No: Vol. 47, No. 1 (2017)
  • Measuring the impact of differences in risk factor distributions on
           cross-population differences in disease occurrence: a causal approach
    • Authors: Moreno-Betancur M; Koplin J, Ponsonby A, et al.
      Pages: 217 - 225
      Abstract: BackgroundIn cross-population comparisons of disease occurrence (prevalence, incidence), a common public health question is the extent to which variations in the distribution of risk factors for the disease explain observed differences. Limited work has been done on formalizing this problem, which is conceptually tantamount to quantifying the degree of confounding for the ‘population effect’ induced by different factors. A common approach is to compare ‘unadjusted’ and ‘adjusted’ regression-based estimates of that parameter, but the interpretation of the resulting ‘contribution’ measures may be hindered by other confounding sources and non-collapsibility issues. Interactions also raise interpretational challenges.MethodsWe formalized this problem using directed acyclic graphs and the potential outcomes framework, on the basis of which we defined a series of estimands that address specific questions and are identifiable under certain causal assumptions. We subsequently determined possible estimators. A study of regional differences in egg allergy prevalence in 1-year-olds was used for illustration.ResultsThe main estimands defined were: the change in the prevalence or incidence difference induced by compositional variations in measured risk factors, all at once and individually, relative to a reference population; and the proportion of the crude difference that remains unexplained by measured factors. Standardization (g-computation), inverse probability weighted (IPW) and doubly robust IPW estimators of these estimands were considered.ConclusionsThis work provides a causal theoretical basis for studying disease occurrence differences between populations. The proposed measures can be used to answer the questions that arise in this context under a set of clearly stated assumptions.
      PubDate: Mon, 18 Sep 2017 00:00:00 GMT
      DOI: 10.1093/ije/dyx194
      Issue No: Vol. 47, No. 1 (2017)
  • Collider scope: when selection bias can substantially influence observed
    • Authors: Munafò M; Tilling K, Taylor A, et al.
      Pages: 226 - 235
      Abstract: Large-scale cross-sectional and cohort studies have transformed our understanding of the genetic and environmental determinants of health outcomes. However, the representativeness of these samples may be limited–either through selection into studies, or by attrition from studies over time. Here we explore the potential impact of this selection bias on results obtained from these studies, from the perspective that this amounts to conditioning on a collider (i.e. a form of collider bias). Whereas it is acknowledged that selection bias will have a strong effect on representativeness and prevalence estimates, it is often assumed that it should not have a strong impact on estimates of associations. We argue that because selection can induce collider bias (which occurs when two variables independently influence a third variable, and that third variable is conditioned upon), selection can lead to substantially biased estimates of associations. In particular, selection related to phenotypes can bias associations with genetic variants associated with those phenotypes. In simulations, we show that even modest influences on selection into, or attrition from, a study can generate biased and potentially misleading estimates of both phenotypic and genotypic associations. Our results highlight the value of knowing which population your study sample is representative of. If the factors influencing selection and attrition are known, they can be adjusted for. For example, having DNA available on most participants in a birth cohort study offers the possibility of investigating the extent to which polygenic scores predict subsequent participation, which in turn would enable sensitivity analyses of the extent to which bias might distort estimates.
      PubDate: Wed, 27 Sep 2017 00:00:00 GMT
      DOI: 10.1093/ije/dyx206
      Issue No: Vol. 47, No. 1 (2017)
  • Incidence rate estimation, periodic testing and the limitations of the
           mid-point imputation approach
    • Authors: Vandormael A; Dobra A, Bärnighausen T, et al.
      Pages: 236 - 245
      Abstract: BackgroundIt is common to use the mid-point between the latest-negative and earliest-positive test dates as the date of the infection event. However, the accuracy of the mid-point method has yet to be systematically quantified for incidence studies once participants start to miss their scheduled test dates.MethodsWe used a simulation-based approach to generate an infectious disease epidemic for an incidence cohort with a high (80–100%), moderate (60–79.9%), low (40–59.9%) and poor (30–39.9%) testing rate. Next, we imputed a mid-point and random-point value between the participant’s latest-negative and earliest-positive test dates. We then compared the incidence rate derived from these imputed values with the true incidence rate generated from the simulation model.ResultsThe mid-point incidence rate estimates erroneously declined towards the end of the observation period once the testing rate dropped below 80%. This decline was in error of approximately 9%, 27% and 41% for a moderate, low and poor testing rate, respectively. The random-point method did not introduce any systematic bias in the incidence rate estimate, even for testing rates as low as 30%.ConclusionsThe mid-point assumption of the infection date is unjustified and should not be used to calculate the incidence rate once participants start to miss the scheduled test dates. Under these conditions, we show an artefactual decline in the incidence rate towards the end of the observation period. Alternatively, the single random-point method is straightforward to implement and produces estimates very close to the true incidence rate.
      PubDate: Wed, 09 Aug 2017 00:00:00 GMT
      DOI: 10.1093/ije/dyx134
      Issue No: Vol. 47, No. 1 (2017)
  • Comparing methods to address bias in observational data: statin use and
           cardiovascular events in a US cohort
    • Authors: Kaiser P; Arnold A, Benkeser D, et al.
      Pages: 246 - 254
      Abstract: BackgroundThe theoretical conditions under which causal estimates can be derived from observational data are challenging to achieve in the real world. Applied examples can help elucidate the practical limitations of methods to estimate randomized–controlled trial effects from observational data.MethodsWe used six methods with varying design and analytic features to compare the 5-year risk of incident myocardial infarction among statin users and non-users, and used non-cardiovascular mortality as a negative control outcome. Design features included restriction to a statin-eligible population and new users only; analytic features included multivariable adjustment and propensity score matching.ResultsWe used data from 5294 participants in the Cardiovascular Health Study from 1989 to 2004. For non-cardiovascular mortality, most methods produced protective estimates with confidence intervals that crossed the null. The hazard ratio (HR) was 0.92, 95% confidence interval: 0.58, 1.46 using propensity score matching among eligible new users. For myocardial infarction, all estimates were strongly protective; the propensity score-matched analysis among eligible new users resulted in a HR of 0.55 (0.29, 1.05)—a much stronger association than observed in randomized controlled trials.ConclusionsIn designs that compare active treatment with non-treated participants to evaluate effectiveness, methods to address bias in observational data may be limited in real-world settings by residual bias.
      PubDate: Fri, 08 Sep 2017 00:00:00 GMT
      DOI: 10.1093/ije/dyx179
      Issue No: Vol. 47, No. 1 (2017)
  • Reporting of ethics in peer-reviewed verbal autopsy studies: a systematic
    • Authors: Joshi R; Faruqui N, Nagarajan S, et al.
      Pages: 255 - 279
      Abstract: IntroductionVerbal autopsy (VA) is a method that determines the cause of death by interviewing a relative of the deceased about the events occurring before the death, in regions where medical certification of cause of death is incomplete. This paper aims to review the ethical standards reported in peer-reviewed VA studies.MethodsA systematic review of Medline and Ovid was conducted by two independent researchers. Data were extracted and analysed for articles based on three key areas: Institutional Review Board (IRB) clearance and consenting process; data collection and management procedures, including: time between death and interview; training and education of interviewer, confidentiality of data and data security; and declarations of funding and conflict of interest.ResultsThe review identified 802 articles, of which 288 were included. The review found that 48% all the studies reported having IRB clearance or obtaining consent of participants. The interviewer training and education levels were reported in 62% and 21% of the articles, respectively. Confidentiality of data was reported for 14% of all studies, 18% did not report the type of respondent interviewed and 51% reported time between death and the interview for the VA. Data security was reported in 8% of all studies. Funding was declared in 63% of all studies and conflict of interest in 42%. Reporting of all these variables increased over time.ConclusionsThe results of this systematic review show that although there has been an increase in ethical reporting for VA studies, there still remains a large gap in reporting.
      PubDate: Mon, 30 Oct 2017 00:00:00 GMT
      DOI: 10.1093/ije/dyx216
      Issue No: Vol. 47, No. 1 (2017)
  • Early predictors of Guillain-Barré syndrome in the life course of
    • Authors: Auger N; Quach C, Healy-Profitós J, et al.
      Pages: 280 - 288
      Abstract: BackgroundWe sought to determine if immune disorders early in life were associated with the later risk of Guillain-Barré syndrome, a neurological disorder thought to be infection-related.MethodsWe conducted a longitudinal cohort study with 16 108 819 person-years of follow-up for a population of 1 108 541 parous women in Quebec, Canada (1989–2014). The outcome was Guillain-Barré syndrome. We identified women with potential risk factors for future Guillain-Barré syndrome, including immune-mediated and rheumatological diseases, cancer, transfusion, surgical procedures and pregnancy-specific disorders. We estimated hazard ratios (HR) and 95% confidence intervals (CI) for the association of risk factors with later onset of Guillain-Barré syndrome, adjusted for personal characteristics of women.ResultsThe overall incidence of Guillain-Barré syndrome was 1.42 per 100 000 person-years. Incidence was higher for women with immune-mediated (8.79 per 100 000 person-years) and rheumatological disorders (9.84 per 100 000 person-years), transfusion (4.41 per 100 000 person-years), and preeclampsia (2.62 per 100 000 person-years). Immune-mediated disorders were associated with six times the risk of Guillain-Barré syndrome (HR 6.57, 95% CI 3.58 to 12.04), rheumatological disorders with seven times the risk (HR 7.23, 95% CI 3.21 to 16.28), transfusion three times the risk (HR 3.58, 95% CI 1.83 to 6.98) and preeclampsia two times the risk (HR 2.01, 95% CI 1.29 to 3.12). Women with other potential risk factors did not have an increased risk of Guillain-Barré syndrome.ConclusionsImmune-related conditions that occur early in life are associated with an increased risk of Guillain-Barré syndrome. The pathophysiology of Guillain-Barré syndrome may extend beyond infectious triggers.
      PubDate: Sat, 02 Sep 2017 00:00:00 GMT
      DOI: 10.1093/ije/dyx181
      Issue No: Vol. 47, No. 1 (2017)
  • Association between adult height, myocardial infarction, heart failure,
           stroke and death: a Korean nationwide population-based study
    • Authors: Park C; Choi E, Han K, et al.
      Pages: 289 - 298
      Abstract: BackgroundThe association between adult height and cardiovascular (CV) events and mortality has been suggested, albeit inconsistently. We sought to discover the comprehensive relationship between height, CV-related morbidity and all-cause death according to age.MethodsWe investigated the association between adult height and myocardial infarction (MI), heart failure (HF), stroke incidence and mortality in 16 528 128 Korean patients who underwent regular health check-ups (2005–08). Height was stratified by decile according to age (20–39 years, 40–59 years and ≥60 years) and gender.ResultsDuring a 9-year follow-up period, 590 346 participants died and 232 093 were admitted to hospital for MI, 201 411 for HF and 267 566 for stroke. An inverse relationship between height and MI, HF, stroke and all-cause death was observed in the overall cohort analysis. The association was unchanged after adjusting for CV risk and behavioural and adulthood socioeconomic factors. Both male and female sex showed an inverse relationship with height in adulthood, CV events and mortality. Adult height showed an inverse association in all CV events and mortality, especially in the older groups (≥40 years). In a subgroup analysis of body mass index, there was an inverse relationship between height, CV events and mortality in each group.ConclusionsShorter height in adulthood was strongly related to an increased risk of MI, HF, stroke and all-cause death. A suitable environment and appropriate nutrition early in life could influence adult height and eventually reduce the risk of CV events and mortality.
      PubDate: Tue, 05 Sep 2017 00:00:00 GMT
      DOI: 10.1093/ije/dyx175
      Issue No: Vol. 47, No. 1 (2017)
  • Pesticide use in agriculture and Parkinson’s disease in the AGRICAN
           cohort study
    • Authors: Pouchieu C; Piel C, Carles C, et al.
      Pages: 299 - 310
      Abstract: Background and AimEpidemiological studies have reported an increased risk of Parkinson’s disease (PD) in farmers exposed to pesticides, but no clear conclusion can be drawn on the type of pesticide and duration of use associated with an effect. In the French agricultural cohort AGRICAN, we assessed associations between PD and pesticide use according to the types of livestock and crops grown, including exposure to some active ingredients with duration of use.MethodsSelf-reported PD and history of lifetime exposure to 13 crops and 5 types of animals and pesticide use were collected at enrolment (2005–07) among 181 842 participants. Exposure to selected active ingredients and duration of use lifelong were assessed with the crop-exposure matrix PESTIMAT. Associations between pesticide use and PD were estimated by logistic regression according to crops and livestock, adjusted for sex, age, educational level, smoking status and alcohol consumption.ResultsPD was reported by 1732 subjects (1.2%) at enrolment in the cohort. Pesticide use lifelong was associated with an increased risk of PD in all types of activities [odds ratio (OR) = 1.31 (cattle) to 1.79 (peas), P < 0.05]. Rotenone, diquat, paraquat and several dithiocarbamates were associated with an increased risk of PD [OR = 1.31 (cuprobam) to 1.57 (rotenone)], especially in farmers with the longest exposure.ConclusionsOur work suggests that the risk of PD is increased in farmers exposed to pesticides on several French crops and livestock, and supports additional evidence of an association of PD with dithiocarbamate fungicides, rotenone and the herbicides diquat and paraquat.
      PubDate: Thu, 09 Nov 2017 00:00:00 GMT
      DOI: 10.1093/ije/dyx225
      Issue No: Vol. 47, No. 1 (2017)
  • Dietary glutamine, glutamate and mortality: two large prospective studies
           in US men and women
    • Authors: Ma W; Heianza Y, Huang T, et al.
      Pages: 311 - 320
      Abstract: BackgroundEmerging studies have related circulating glutamine metabolites to various chronic diseases such as cardiovascular disease and cancer; diet is the major source of nutrients involved in glutamine metabolism. However, it remains unknown whether dietary intakes of glutamine, glutamate,and their ratio are related to total and cause-specific mortality.MethodsWe followed 74 082 women from the Nurses’ Health Study (1984–2012) and 42 303 men from the Health Professionals Follow-up Study (1986–2012), who were free of cardiovascular disease and cancer at baseline. Diet was updated every 2 to 4 years by using validated food frequency questionnaires. The content of glutamine and glutamate in foods was calculated based on protein fractions generated from gene sequencing methods and adjusted for total energy intake.ResultsWe documented 30 424 deaths during 2 878 344 person-years of follow-up. After adjustment for potential confounders including lifestyle and dietary factors, higher intakes of glutamine and glutamine-to-glutamate ratio were associated with significantly lower risk of total and cause-specific mortality. Compared with people in the lowest quintile of dietary glutamine-to-glutamate ratio, the pooled hazard ratio (HR) in the highest quintile was 0.87 [95% confidence interval (CI): 0.84, 0.91; P for trend < 0.001) for total mortality, 0.81 (95% CI: 0.75, 0.88; P for trend < 0.001) for cardiovascular mortality, and 0.93 (95% CI: 0.87, 0.99; P for trend = 0.01) for cancer mortality.ConclusionsWe found dietary glutamine and glutamine-to-glutamate ratio were inversely related to risk of mortality, particularly cardiovascular mortality, independent of other dietary and lifestyle factors, in US men and women.
      PubDate: Mon, 13 Nov 2017 00:00:00 GMT
      DOI: 10.1093/ije/dyx234
      Issue No: Vol. 47, No. 1 (2017)
  • Cluster randomized trials with a small number of clusters: which analyses
           should be used'
    • Authors: Leyrat C; Morgan K, Leurent B, et al.
      Pages: 321 - 331
      Abstract: BackgroundCluster randomized trials (CRTs) are increasingly used to assess the effectiveness of health interventions. Three main analysis approaches are: cluster-level analyses, mixed-models and generalized estimating equations (GEEs). Mixed models and GEEs can lead to inflated type I error rates with a small number of clusters, and numerous small-sample corrections have been proposed to circumvent this problem. However, the impact of these methods on power is still unclear.MethodsWe performed a simulation study to assess the performance of 12 analysis approaches for CRTs with a continuous outcome and 40 or fewer clusters. These included weighted and unweighted cluster-level analyses, mixed-effects models with different degree-of-freedom corrections, and GEEs with and without a small-sample correction. We assessed these approaches across different values of the intraclass correlation coefficient (ICC), numbers of clusters and variability in cluster sizes.ResultsUnweighted and variance-weighted cluster-level analysis, mixed models with degree-of-freedom corrections, and GEE with a small-sample correction all maintained the type I error rate at or below 5% across most scenarios, whereas uncorrected approaches lead to inflated type I error rates. However, these analyses had low power (below 50% in some scenarios) when fewer than 20 clusters were randomized, with none reaching the expected 80% power.ConclusionsSmall-sample corrections or variance-weighted cluster-level analyses are recommended for the analysis of continuous outcomes in CRTs with a small number of clusters. The use of these corrections should be incorporated into the sample size calculation to prevent studies from being underpowered.
      PubDate: Wed, 23 Aug 2017 00:00:00 GMT
      DOI: 10.1093/ije/dyx169
      Issue No: Vol. 47, No. 1 (2017)
  • Spillover effects in epidemiology: parameters, study designs and
           methodological considerations
    • Authors: Benjamin-Chung J; Arnold B, Berger D, et al.
      Pages: 332 - 347
      Abstract: Many public health interventions provide benefits that extend beyond their direct recipients and impact people in close physical or social proximity who did not directly receive the intervention themselves. A classic example of this phenomenon is the herd protection provided by many vaccines. If these ‘spillover effects’ (i.e. ‘herd effects’) are present in the same direction as the effects on the intended recipients, studies that only estimate direct effects on recipients will likely underestimate the full public health benefits of the intervention. Causal inference assumptions for spillover parameters have been articulated in the vaccine literature, but many studies measuring spillovers of other types of public health interventions have not drawn upon that literature. In conjunction with a systematic review we conducted of spillovers of public health interventions delivered in low- and middle-income countries, we classified the most widely used spillover parameters reported in the empirical literature into a standard notation. General classes of spillover parameters include: cluster-level spillovers; spillovers conditional on treatment or outcome density, distance or the number of treated social network links; and vaccine efficacy parameters related to spillovers. We draw on high quality empirical examples to illustrate each of these parameters. We describe study designs to estimate spillovers and assumptions required to make causal inferences about spillovers. We aim to advance and encourage methods for spillover estimation and reporting by standardizing spillover parameter nomenclature and articulating the causal inference assumptions required to estimate spillovers.
      PubDate: Thu, 02 Nov 2017 00:00:00 GMT
      DOI: 10.1093/ije/dyx201
      Issue No: Vol. 47, No. 1 (2017)
  • Bangladeshi neonates miss the potential benefits of early BCG vaccination
    • Authors: Hanifi S; Das S, Rahman M.
      Pages: 348 - 349
      PubDate: Mon, 23 Oct 2017 00:00:00 GMT
      DOI: 10.1093/ije/dyx223
      Issue No: Vol. 47, No. 1 (2017)
  • Making epidemiology matter even more!
    • Authors: Nasseri K.
      Pages: 349 - 350
      PubDate: Sat, 02 Dec 2017 00:00:00 GMT
      DOI: 10.1093/ije/dyx250
      Issue No: Vol. 47, No. 1 (2017)
  • The epigenetic clock and telomere length are independently associated with
           chronological age and mortality
    • Authors: Marioni R; Harris S, Shah S, et al.
      Pages: 356 - 356
      Abstract: First published online: 13 April 2016, 45(2), 424–432, Int J Epidemiol, 2016, doi:
      PubDate: Mon, 27 Nov 2017 00:00:00 GMT
      DOI: 10.1093/ije/dyx233
      Issue No: Vol. 47, No. 1 (2017)
  • Data Resource Profile: The Nordic Obesity Surgery Cohort (NordOSCo)
    • Authors: Tao W; Artama M, von Euler-Chelpin M, et al.
      Pages: 357 - 357
      Abstract: First published online: 10 October 2017, 46(5), 1367-1367g, Int J Epidemiol, 2017, doi:
      PubDate: Mon, 27 Nov 2017 00:00:00 GMT
      DOI: 10.1093/ije/dyx256
      Issue No: Vol. 47, No. 1 (2017)
  • An introduction to instrumental variables for epidemiologists
    • Authors: Greenland S.
      Pages: 358 - 358
      Abstract: Int J Epidemiol 2000; 29: 722-729.
      DOI :
      PubDate: Mon, 25 Dec 2017 00:00:00 GMT
      Issue No: Vol. 47, No. 1 (2017)
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