Pub Date : 2024-04-09DOI: 10.1016/j.gloepi.2024.100143
Daniel J. Lauer , Anthony J. Russell , Heather N. Lynch , William J. Thompson , Kenneth A. Mundt , Harvey Checkoway
Evidence triangulation may help identify the impact of study design elements on study findings and to tease out biased results when evaluating potential causal relationships; however, methods for triangulating epidemiologic evidence are evolving and have not been standardized. Building upon key principles of epidemiologic evidence triangulation and risk of bias assessment, and responding to the National Academies of Sciences, Engineering, and Medicine (NASEM) call for applied triangulation examples, the objective of this manuscript is to propose a triangulation framework and to apply it as an illustrative example to epidemiologic studies examining the possible relationship between occupational formaldehyde exposure and risk of myeloid leukemias (ML) including acute (AML) and chronic (CML) types.
A nine-component triangulation framework for epidemiological evidence was developed incorporating study quality and ROB guidance from various federal health agencies (i.e., US EPA TSCA and NTP OHAT). Several components of the triangulation framework also drew from widely used epidemiological analytic tools such as stratified meta-analysis and sensitivity analysis. Regarding the applied example, fourteen studies were identified and assessed using the following primary study quality domains to explore potential key sources of bias: 1) study design and analysis; 2) study participation; 3) exposure assessment; 4) outcome assessment; and 5) potential confounding. Across studies, methodological limitations possibly contributing to biased results were observed within most domains. Interestingly, results from one study – often providing the largest and least-precise relative risk estimates, likely reflecting study biases, deviated from most primary study findings indicating no such associations. Triangulation of epidemiological evidence appears to be helpful in exploring inconsistent results for the identification of study results possibly reflecting various biases. Nonetheless, triangulation methodologies require additional development and application to real-world examples to enhance objectivity and reproducibility.
{"title":"Triangulation of epidemiological evidence and risk of bias evaluation: A proposed framework and applied example using formaldehyde exposure and risk of myeloid leukemias","authors":"Daniel J. Lauer , Anthony J. Russell , Heather N. Lynch , William J. Thompson , Kenneth A. Mundt , Harvey Checkoway","doi":"10.1016/j.gloepi.2024.100143","DOIUrl":"https://doi.org/10.1016/j.gloepi.2024.100143","url":null,"abstract":"<div><p>Evidence triangulation may help identify the impact of study design elements on study findings and to tease out biased results when evaluating potential causal relationships; however, methods for triangulating epidemiologic evidence are evolving and have not been standardized. Building upon key principles of epidemiologic evidence triangulation and risk of bias assessment, and responding to the National Academies of Sciences, Engineering, and Medicine (NASEM) call for applied triangulation examples, the objective of this manuscript is to propose a triangulation framework and to apply it as an illustrative example to epidemiologic studies examining the possible relationship between occupational formaldehyde exposure and risk of myeloid leukemias (ML) including acute (AML) and chronic (CML) types.</p><p>A nine-component triangulation framework for epidemiological evidence was developed incorporating study quality and ROB guidance from various federal health agencies (i.e., US EPA TSCA and NTP OHAT). Several components of the triangulation framework also drew from widely used epidemiological analytic tools such as stratified meta-analysis and sensitivity analysis. Regarding the applied example, fourteen studies were identified and assessed using the following primary study quality domains to explore potential key sources of bias: 1) study design and analysis; 2) study participation; 3) exposure assessment; 4) outcome assessment; and 5) potential confounding. Across studies, methodological limitations possibly contributing to biased results were observed within most domains. Interestingly, results from one study – often providing the largest and least-precise relative risk estimates, likely reflecting study biases, deviated from most primary study findings indicating no such associations. Triangulation of epidemiological evidence appears to be helpful in exploring inconsistent results for the identification of study results possibly reflecting various biases. Nonetheless, triangulation methodologies require additional development and application to real-world examples to enhance objectivity and reproducibility.</p></div>","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590113324000099/pdfft?md5=1a7ead941966ce9014523a5ba67690c0&pid=1-s2.0-S2590113324000099-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140604784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-30DOI: 10.1016/j.gloepi.2024.100142
Sky Qiu , Alan E. Hubbard , Juan Pablo Gutiérrez , Ganesh Pimpale , Arturo Juárez-Flores , Rakesh Ghosh , Iván de Jesús Ascencio-Montiel , Stefano M. Bertozzi
Background
Type 2 diabetes elevates the risk of severe outcomes in COVID-19 patients, with multiple studies reporting higher case fatality rates. Metformin is a widely used medication for glycemic management. We hypothesize that improved adherence to metformin may lower COVID-19 post-infection mortality risk in this group. Utilizing data from the Mexican Social Security Institute (IMSS), we investigate the relationship between metformin adherence and mortality following COVID-19 infection in patients with chronic metformin prescriptions.
Methods
This is a retrospective cohort study consisting of 61,180 IMSS beneficiaries who received a positive polymerase chain reaction (PCR) or rapid test for SARS-CoV-2 and had at least two consecutive months of metformin prescriptions prior to the positive test. The hypothetical intervention is improved adherence to metformin, measured by proportion of days covered (PDC), with the comparison being the observed metformin adherence values. The primary outcome is all-cause mortality following COVID-19 infection. We defined the causal parameter using shift intervention, an example of modified treatment policies. We used the targeted learning framework for estimation of the target estimand.
Findings
Among COVID-19 positive patients with chronic metformin prescriptions, we found that a 5% and 10% absolute increase in metformin adherence is associated with a respective 0.26% (95% CI: −0.28%, 0.79%) and 1.26% (95% CI: 0.72%, 1.80%) absolute decrease in mortality risk.
Interpretation
Subject to the limitations of a real-world data study, our results indicate a causal association between improved metformin adherence and reduced COVID-19 post-infection mortality risk.
{"title":"Estimating the effect of realistic improvements of metformin adherence on COVID-19 mortality using targeted machine learning","authors":"Sky Qiu , Alan E. Hubbard , Juan Pablo Gutiérrez , Ganesh Pimpale , Arturo Juárez-Flores , Rakesh Ghosh , Iván de Jesús Ascencio-Montiel , Stefano M. Bertozzi","doi":"10.1016/j.gloepi.2024.100142","DOIUrl":"https://doi.org/10.1016/j.gloepi.2024.100142","url":null,"abstract":"<div><h3>Background</h3><p>Type 2 diabetes elevates the risk of severe outcomes in COVID-19 patients, with multiple studies reporting higher case fatality rates. Metformin is a widely used medication for glycemic management. We hypothesize that improved adherence to metformin may lower COVID-19 post-infection mortality risk in this group. Utilizing data from the Mexican Social Security Institute (IMSS), we investigate the relationship between metformin adherence and mortality following COVID-19 infection in patients with chronic metformin prescriptions.</p></div><div><h3>Methods</h3><p>This is a retrospective cohort study consisting of 61,180 IMSS beneficiaries who received a positive polymerase chain reaction (PCR) or rapid test for SARS-CoV-2 and had at least two consecutive months of metformin prescriptions prior to the positive test. The hypothetical intervention is improved adherence to metformin, measured by proportion of days covered (PDC), with the comparison being the observed metformin adherence values. The primary outcome is all-cause mortality following COVID-19 infection. We defined the causal parameter using shift intervention, an example of modified treatment policies. We used the targeted learning framework for estimation of the target estimand.</p></div><div><h3>Findings</h3><p>Among COVID-19 positive patients with chronic metformin prescriptions, we found that a 5% and 10% absolute increase in metformin adherence is associated with a respective 0.26% (95% CI: −0.28%, 0.79%) and 1.26% (95% CI: 0.72%, 1.80%) absolute decrease in mortality risk.</p></div><div><h3>Interpretation</h3><p>Subject to the limitations of a real-world data study, our results indicate a causal association between improved metformin adherence and reduced COVID-19 post-infection mortality risk.</p></div>","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590113324000087/pdfft?md5=a6ec9ca0bb8638bd123b2d043132b7e9&pid=1-s2.0-S2590113324000087-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140339685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-11DOI: 10.1016/j.gloepi.2024.100140
Julie E. Goodman, Leon M. Espira, Ke Zu , Denali Boon
{"title":"Quantitative recall bias analysis of the talc and ovarian cancer association","authors":"Julie E. Goodman, Leon M. Espira, Ke Zu , Denali Boon","doi":"10.1016/j.gloepi.2024.100140","DOIUrl":"https://doi.org/10.1016/j.gloepi.2024.100140","url":null,"abstract":"","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590113324000063/pdfft?md5=64e99086dc1b3d0a104e4bd42a503427&pid=1-s2.0-S2590113324000063-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140134651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-11DOI: 10.1016/j.gloepi.2024.100141
Wenchao Li, Julie E. Goodman, Christopher Long
{"title":"Population attributable fraction of gas cooking and childhood asthma: What was missed?","authors":"Wenchao Li, Julie E. Goodman, Christopher Long","doi":"10.1016/j.gloepi.2024.100141","DOIUrl":"https://doi.org/10.1016/j.gloepi.2024.100141","url":null,"abstract":"","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590113324000075/pdfft?md5=5fa3deb72e12e1602f6c1ca53740219f&pid=1-s2.0-S2590113324000075-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140134640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-12DOI: 10.1016/j.gloepi.2024.100139
Almaza A. Salim , Mona Elsayed , Mohamed Hafez Mohamed , Heba Yousef , Mohamed S. Hemeda , Alaa Ramadan , Nathan Ezie Kengo , Noha M. Abu Bakr Elsaid
Background
Domestic abuse is a widespread health issue that negatively impacts both mental health and quality of life.
Objectives
To determine the prevalence of domestic violence and anxiety among women visiting primary healthcare facilities in the rural Ismailia governorate.
Methods
Between October 2021 and December 2021, a cross-sectional study was conducted. Simple random methods were used to choose the participants from those who attended a clinic. 350 married women were included in the estimated sample size. By using an interview questionnaire, data were gathered including the following parts: The socio-demographic data, designed scale for assessment of violence and anxiety symptoms were assessed by the Hamilton anxiety scale.
Results
The prevalence of domestic violence was 41% and both physical and sexual abuse was 43%. The most predominant sexual abuse was practice without consent (63%). The prevalence of anxiety was 76%, the predominance was mild degree 46% followed by mild to moderate 18%. The significant predictors for anxiety in the total sample were the increase in age of women, rural residence, and exposure to abuse (OR = 11.2 (4.9–25.4). The use of the husband's stimulant drugs was the most predictor factor for women's abuse (OR = 2.3 (1.4–3.9).
Conclusion
forty-one of the women exposed to every form of violence, anxiety was present in more than three-quarters of the studied women. It is essential to screen any wife attending primary health care for the manifestation of domestic violence especially in rural areas and increase the awareness of family physicians towards screening of mental health problems.
{"title":"Prevalence and factors associated with anxiety disorder among married women exposed to violence in rural area, Ismailia, Egypt: A cross-sectional study","authors":"Almaza A. Salim , Mona Elsayed , Mohamed Hafez Mohamed , Heba Yousef , Mohamed S. Hemeda , Alaa Ramadan , Nathan Ezie Kengo , Noha M. Abu Bakr Elsaid","doi":"10.1016/j.gloepi.2024.100139","DOIUrl":"10.1016/j.gloepi.2024.100139","url":null,"abstract":"<div><h3>Background</h3><p>Domestic abuse is a widespread health issue that negatively impacts both mental health and quality of life.</p></div><div><h3>Objectives</h3><p>To determine the prevalence of domestic violence and anxiety among women visiting primary healthcare facilities in the rural Ismailia governorate.</p></div><div><h3>Methods</h3><p>Between October 2021 and December 2021, a cross-sectional study was conducted. Simple random methods were used to choose the participants from those who attended a clinic. 350 married women were included in the estimated sample size. By using an interview questionnaire, data were gathered including the following parts: The socio-demographic data, designed scale for assessment of violence and anxiety symptoms were assessed by the Hamilton anxiety scale.</p></div><div><h3>Results</h3><p>The prevalence of domestic violence was 41% and both physical and sexual abuse was 43%. The most predominant sexual abuse was practice without consent (63%). The prevalence of anxiety was 76%, the predominance was mild degree 46% followed by mild to moderate 18%. The significant predictors for anxiety in the total sample were the increase in age of women, rural residence, and exposure to abuse (OR = 11.2 (4.9–25.4). The use of the husband's stimulant drugs was the most predictor factor for women's abuse (OR = 2.3 (1.4–3.9).</p></div><div><h3>Conclusion</h3><p>forty-one of the women exposed to every form of violence, anxiety was present in more than three-quarters of the studied women. It is essential to screen any wife attending primary health care for the manifestation of domestic violence especially in rural areas and increase the awareness of family physicians towards screening of mental health problems.</p></div>","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590113324000051/pdfft?md5=e89ce5f6223f4f0afce6ed1f277aa822&pid=1-s2.0-S2590113324000051-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139874970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
It has been postulated that the lipid effects of coconut could be mediated by its fatty acids, fiber and lysine/arginine ratio. Hence, the lipid effects of coconut oil could be different from the effects of the kernel flakes or milk extract because the constituents could be different in each coconut preparation. The present research investigated the lipid effects of different modes of coconut used in food preparation.
Methods
This study involved a total of 190 participants, randomized into four groups, which received coconut oil supplement (30 ml) (n = 53), kernel flakes (30 g) (n = 52) or coconut milk powder (30 g) (n = 44) for a period of 8 weeks. The control group (n = 41) received no supplement. Lipid assays were performed at baseline and at the end of the 4th and 8th weeks. The generalized estimating equations (GEE), ANOVA, and paired and independent t-tests were used in the analysis.
Result
The age range of the participants was 25–60 years, and 52.6% of them (n = 100) were men. Coconut milk supplementation induced beneficial changes in the lipid profile in that the LDL and non-HDL levels decreased while the HDL levels increased. The subgroup whose baseline LDL level was elevated appeared to benefit most from coconut milk supplementation. Coconut oil and kernel flakes failed to induce favorable lipid changes comparable to coconut milk supplementation.
Conclusion
Differing concentrations of protein, fat and fiber in coconut preparations could possibly explain the dissimilar effects on the lipid profile caused by the different coconut preparations. The benefits of coconut milk seen in the high basal LDL subgroup warrant a detailed study.
{"title":"Effect of different forms of coconut on the lipid profile in normal free-living healthy subjects: A randomized controlled trial (Phase II)","authors":"Ruvan A.I. Ekanayaka , P.G.S.M. de Silva , Medhani K.I. Ekanayaka , W.M.M. Jayathilake , R.P.M.M.R. Pathirana , Y.N. Amaratunga , Prasadhini J.D. De Silva , Bilesha Perera","doi":"10.1016/j.gloepi.2024.100138","DOIUrl":"https://doi.org/10.1016/j.gloepi.2024.100138","url":null,"abstract":"<div><h3>Background</h3><p>It has been postulated that the lipid effects of coconut could be mediated by its fatty acids, fiber and lysine/arginine ratio. Hence, the lipid effects of coconut oil could be different from the effects of the kernel flakes or milk extract because the constituents could be different in each coconut preparation. The present research investigated the lipid effects of different modes of coconut used in food preparation.</p></div><div><h3>Methods</h3><p>This study involved a total of 190 participants, randomized into four groups, which received coconut oil supplement (30 ml) (<em>n</em> = 53), kernel flakes (30 g) (<em>n</em> = 52) or coconut milk powder (30 g) (<em>n</em> = 44) for a period of 8 weeks. The control group (<em>n</em> = 41) received no supplement. Lipid assays were performed at baseline and at the end of the 4th and 8th weeks. The generalized estimating equations (GEE), ANOVA, and paired and independent <em>t-</em>tests were used in the analysis.</p></div><div><h3>Result</h3><p>The age range of the participants was 25–60 years, and 52.6% of them (<em>n</em> = 100) were men. Coconut milk supplementation induced beneficial changes in the lipid profile in that the LDL and non-HDL levels decreased while the HDL levels increased. The subgroup whose baseline LDL level was elevated appeared to benefit most from coconut milk supplementation. Coconut oil and kernel flakes failed to induce favorable lipid changes comparable to coconut milk supplementation.</p></div><div><h3>Conclusion</h3><p>Differing concentrations of protein, fat and fiber in coconut preparations could possibly explain the dissimilar effects on the lipid profile caused by the different coconut preparations. The benefits of coconut milk seen in the high basal LDL subgroup warrant a detailed study.</p></div>","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S259011332400004X/pdfft?md5=4d92d8d64db8471c0414ee103b4cfbe3&pid=1-s2.0-S259011332400004X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139710145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-07DOI: 10.1016/j.gloepi.2024.100137
Anna K. Porter , Sarah E. Kleinschmidt , Kara L. Andres , Courtney N. Reusch , Ryan M. Krisko , Oyebode A. Taiwo , Geary W. Olsen , Matthew P. Longnecker
Per- and polyfluoroalkyl substances (PFAS) are a broad class of synthetic chemicals; some are present in most humans in developed countries. Some studies suggest that certain PFAS may have immunotoxic effects in humans, which could put individuals with high levels of exposure at increased risk for infectious diseases such as COVID-19. We conducted a case-control study to examine the association between COVID-19 diagnosis and PFAS serum concentrations among employees and retirees from two 3 M facilities, one of which historically generated perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), and perfluorohexane sulfonic acid (PFHxS). Participants completed enrollment and follow-up study visits in the Spring of 2021. Participants were categorized as cases if they reported a COVID-19 diagnosis or became sick with at least one symptom of COVID-19 when someone else in their household was diagnosed, otherwise they were categorized as a control. COVID-19 diagnosis was modeled in relation to concentration of serum PFAS measured at enrollment after adjusting for covariates. The analytic sample comprised 573 individuals, 111 cases (19.4%) and 462 controls (80.6%). In adjusted models, the odds ratio of COVID-19 was 0.94 per interquartile range (14.3 ng/mL) increase in PFOS (95% confidence interval 0.85, 1.04). Results for PFOA, PFHxS, and perfluorononanoic acid (PFNA) were similar. Other PFAS present at lower concentrations were examined as categorical variables (above the limit of quantification [LOQ], yes vs. no [referent category]), and also showed no positive associations. In our study, which used individual-level data and included people with high occupational exposure, the serum concentrations of all PFAS examined were not associated with an increased odds ratio for COVID-19. At this point, the epidemiologic data supporting no association of COVID-19 occurrence with PFAS exposure are stronger than those suggesting a positive association.
{"title":"Occurrence of COVID-19 and serum per- and polyfluoroalkyl substances: A case-control study among workers with a wide range of exposures","authors":"Anna K. Porter , Sarah E. Kleinschmidt , Kara L. Andres , Courtney N. Reusch , Ryan M. Krisko , Oyebode A. Taiwo , Geary W. Olsen , Matthew P. Longnecker","doi":"10.1016/j.gloepi.2024.100137","DOIUrl":"https://doi.org/10.1016/j.gloepi.2024.100137","url":null,"abstract":"<div><p><em>Per</em>- and polyfluoroalkyl substances (PFAS) are a broad class of synthetic chemicals; some are present in most humans in developed countries. Some studies suggest that certain PFAS may have immunotoxic effects in humans, which could put individuals with high levels of exposure at increased risk for infectious diseases such as COVID-19. We conducted a case-control study to examine the association between COVID-19 diagnosis and PFAS serum concentrations among employees and retirees from two 3 M facilities, one of which historically generated perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), and perfluorohexane sulfonic acid (PFHxS). Participants completed enrollment and follow-up study visits in the Spring of 2021. Participants were categorized as cases if they reported a COVID-19 diagnosis or became sick with at least one symptom of COVID-19 when someone else in their household was diagnosed, otherwise they were categorized as a control. COVID-19 diagnosis was modeled in relation to concentration of serum PFAS measured at enrollment after adjusting for covariates. The analytic sample comprised 573 individuals, 111 cases (19.4%) and 462 controls (80.6%). In adjusted models, the odds ratio of COVID-19 was 0.94 per interquartile range (14.3 ng/mL) increase in PFOS (95% confidence interval 0.85, 1.04). Results for PFOA, PFHxS, and perfluorononanoic acid (PFNA) were similar. Other PFAS present at lower concentrations were examined as categorical variables (above the limit of quantification [LOQ], yes vs. no [referent category]), and also showed no positive associations. In our study, which used individual-level data and included people with high occupational exposure, the serum concentrations of all PFAS examined were not associated with an increased odds ratio for COVID-19. At this point, the epidemiologic data supporting no association of COVID-19 occurrence with PFAS exposure are stronger than those suggesting a positive association.</p></div>","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590113324000038/pdfft?md5=0b41e758ae31284c9f51cb049c716f3f&pid=1-s2.0-S2590113324000038-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139436464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Today, vasovagal syncope is a common problem that has become a significant health and social challenge. The present study investigated the global prevalence of vasovagal syncope using a systematic review and meta-analysis.
Methods: In this systematic review and meta-analysis study, the global prevalence of vasovagal syncope using the keywords Prevalence, Epidemiology, Vasovagal syncope, and Reflex syncope in PubMed, WoS, Scopus, ScienceDirect databases, and Google scholar search engine without time limit until July 20, 2022, was extracted and transferred to the information management software (EndNote). Then the repeated studies were excluded, and researchers evaluated the remaining studies during three stages (i.e., screening, eligibility, and qualitative assessment). The heterogeneity of studies was investigated using the I2 index, and the analysis of eligible studies was performed using the random effects model.
Results
In the review of 12 studies with a sample size of 36,156 people, the global prevalence of vasovagal syncope was reported as 16.4 (95%CI: 6–37.5), and the study of publication bias in the studies through the Egger test shows the absence of publication bias in the studies.
Conclusion
The prevalence reported in the studies shows a high prevalence of vasovagal syncope, which requires serious intervention and preventive, diagnostic, and therapeutic measures. It is necessary for health policymakers to take effective measures in this field.
{"title":"Global prevalence of vasovagal syncope: A systematic review and meta-analysis","authors":"Nader Salari , Zohre Karimi , Mahvan Hemmati , Ali Mohammadi , Shamarina Shohaimi , Masoud Mohammadi","doi":"10.1016/j.gloepi.2024.100136","DOIUrl":"10.1016/j.gloepi.2024.100136","url":null,"abstract":"<div><h3>Background</h3><p>Today, vasovagal syncope is a common problem that has become a significant health and social challenge. The present study investigated the global prevalence of vasovagal syncope using a systematic review and meta-analysis.</p><p>Methods: In this systematic review and meta-analysis study, the global prevalence of vasovagal syncope using the keywords Prevalence, Epidemiology, Vasovagal syncope, and Reflex syncope in PubMed, WoS, Scopus, ScienceDirect databases, and Google scholar search engine without time limit until July 20, 2022, was extracted and transferred to the information management software (EndNote). Then the repeated studies were excluded, and researchers evaluated the remaining studies during three stages (i.e., screening, eligibility, and qualitative assessment). The heterogeneity of studies was investigated using the I<sup>2</sup> index, and the analysis of eligible studies was performed using the random effects model.</p></div><div><h3>Results</h3><p>In the review of 12 studies with a sample size of 36,156 people, the global prevalence of vasovagal syncope was reported as 16.4 (95%CI: 6–37.5), and the study of publication bias in the studies through the Egger test shows the absence of publication bias in the studies.</p></div><div><h3>Conclusion</h3><p>The prevalence reported in the studies shows a high prevalence of vasovagal syncope, which requires serious intervention and preventive, diagnostic, and therapeutic measures. It is necessary for health policymakers to take effective measures in this field.</p></div>","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590113324000026/pdfft?md5=b0863b1ef4032b11730b61751dc55dcb&pid=1-s2.0-S2590113324000026-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139395968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Around 2% of newborns are at risk of hepatitis B virus (HBV) infection from their mothers. To prevent this, infants born to HBsAg-positive mothers are given hepatitis B immune globulin (HBIG) and hepatitis B (HB) vaccine as immunoprophylaxis. This study aims to investigate the efficacy of immunoprophylaxis in infants born to HBsAg-positive mothers and the contributing factors.
Methods
The study was conducted on a group of 87 children, ranging from nine months to under 36 months, born to HBsAg-positive mothers and received immunoprophylaxis within 24 h after birth followed by a national immunization schedule at the Community Health Center (CHC) in three administrative cities of DKI Jakarta. We measured the levels of HBsAg and anti-HBs, and utilized ordinal logistic regression models to identify factors that influence the anti-HBs titers after vaccination.
Results
Out of 87 children, only one child had positive HBsAg results. The data showed that 88.5% of the children had seroprotection with anti-HBs levels ≥10 mIU/mL. Additionally, 48.3% of the children had a high protective response with anti-HBs levels ≥100 mIU/mL, while 11.5% had a non-protective response. Children under one year of age, with a family history of HBV carriers, and who received five doses of the HB vaccine exhibited higher levels of anti-HBs titer category with adjusted OR 3.9 (95%CI: 1.3–11.6), 5.3 (95%CI: 1.1–27.4), and 8.3 (95%CI: 2–34.8), respectively.
Conclusion
The administration of HBIG and HB vaccine successfully prevented vertical transmission, resulting in a high seroprotection rate.
{"title":"Seroconversion among children with HBsAg-positive mothers in Indonesia and factors affecting the anti-HBs titers","authors":"Angga Wirahmadi, Hartono Gunardi, Bernie Endyarni Medise, Hanifah Oswari, Teny Tjitra Sari, Nastiti Kaswandani, Mulya Rahma Karyanti","doi":"10.1016/j.gloepi.2024.100135","DOIUrl":"10.1016/j.gloepi.2024.100135","url":null,"abstract":"<div><h3>Background and aim</h3><p>Around 2% of newborns are at risk of hepatitis B virus (HBV) infection from their mothers. To prevent this, infants born to HBsAg-positive mothers are given hepatitis B immune globulin (HBIG) and hepatitis B (HB) vaccine as immunoprophylaxis. This study aims to investigate the efficacy of immunoprophylaxis in infants born to HBsAg-positive mothers and the contributing factors.</p></div><div><h3>Methods</h3><p>The study was conducted on a group of 87 children, ranging from nine months to under 36 months, born to HBsAg-positive mothers and received immunoprophylaxis within 24 h after birth followed by a national immunization schedule at the Community Health Center (CHC) in three administrative cities of DKI Jakarta. We measured the levels of HBsAg and anti-HBs, and utilized ordinal logistic regression models to identify factors that influence the anti-HBs titers after vaccination.</p></div><div><h3>Results</h3><p>Out of 87 children, only one child had positive HBsAg results. The data showed that 88.5% of the children had seroprotection with anti-HBs levels ≥10 mIU/mL. Additionally, 48.3% of the children had a high protective response with anti-HBs levels ≥100 mIU/mL, while 11.5% had a non-protective response. Children under one year of age, with a family history of HBV carriers, and who received five doses of the HB vaccine exhibited higher levels of anti-HBs titer category with adjusted OR 3.9 (95%CI: 1.3–11.6), 5.3 (95%CI: 1.1–27.4), and 8.3 (95%CI: 2–34.8), respectively.</p></div><div><h3>Conclusion</h3><p>The administration of HBIG and HB vaccine successfully prevented vertical transmission, resulting in a high seroprotection rate.</p></div>","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590113324000014/pdfft?md5=e7ff2f7fcae161d0e32ff0000d0679f6&pid=1-s2.0-S2590113324000014-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139395507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-23DOI: 10.1016/j.gloepi.2023.100134
Elli Gourna Paleoudis , Zhiyong Han , Simon Gelman , Hernan Arias-Ruiz , Destiney Carter , Jovan Bertrand , Nicole Mastrogiovanni , Stanley R. Terlecky
Background
Diverse representation in clinical trials is an important goal in the testing of a medical, diagnostic, or therapeutic intervention. To date, the desired level of trial equity and inclusivity has been unevenly achieved.
Methods
Employing the US National Library of Medicine's Clinicaltrials.gov registry, we examined 481 clinical trials conducted - at least in part - in the state of New Jersey. These trials were initiated after the FDA-mandated Common Rule changes, i.e., between January 2017 and October 2022, were enacted, and had their results posted. We analyzed sex/race/ethnicity reporting as well as applicable enrollment. Using meta-analysis, we estimated group participation proportions of a subset of the 481 identified trials; specifically, the 229 studies that were conducted solely within the US (i.e., without international sites) and compared them to US census data.
Findings
Within the 481 clinical trials analyzed, over 97% reported on the race and/or ethnicity of their enrollees; all included information on sex. Reporting was not affected by funding source or therapeutic area. Based on the 229 solely US-based studies, the participants overall were 76.7% White; 14.1% Black; 2.7% Asian; and 15% Hispanic. Inclusion of Black participants did not differ from the 2020 US census data; in contrast, the levels of Asian and Hispanic participation were below the corresponding census percentages.
Interpretation
The past five years have seen an overall uptick in the equity of race/ethnicity reporting and inclusivity of clinical trials, as compared to previously reported data, presaging the potential acquisition of ever more powerful and meaningful results of such interventional studies going forward.
Funding
Support for this study comes from the Hackensack Meridian Health Research Institute and the Hackensack Meridian School of Medicine.
Research in context
Evidence before this study
Clinical trials are a critical part of determining whether or not a medical (drug/device/biologic) or socio-behavioral intervention is safe and truly effective. Through their use, scientific understanding is advanced and, ideally, human health is improved. To gain the most impactful information from a clinical trial, it should be sufficiently representative, that is, should enroll an adequate number of participants, and include a diverse population. Without such inclusion, the study is of only limited generalizability. Efforts are underway by funders, sites, and other stakeholders, to enhance reporting and promote inclusive enrollment. The extent to which such attempts are yielding results - at least for clinical trials in the state of New Jersey - is the focus of this data-driven analysis. The ClinicalTrials.gov registry databa
{"title":"Improved clinical trial race/ethnicity reporting and updated inclusion profile, 2017–2022: A New Jersey snapshot","authors":"Elli Gourna Paleoudis , Zhiyong Han , Simon Gelman , Hernan Arias-Ruiz , Destiney Carter , Jovan Bertrand , Nicole Mastrogiovanni , Stanley R. Terlecky","doi":"10.1016/j.gloepi.2023.100134","DOIUrl":"https://doi.org/10.1016/j.gloepi.2023.100134","url":null,"abstract":"<div><h3>Background</h3><p>Diverse representation in clinical trials is an important goal in the testing of a medical, diagnostic, or therapeutic intervention. To date, the desired level of trial equity and inclusivity has been unevenly achieved.</p></div><div><h3>Methods</h3><p>Employing the US National Library of Medicine's <span>Clinicaltrials.gov</span><svg><path></path></svg> registry, we examined 481 clinical trials conducted - at least in part - in the state of New Jersey. These trials were initiated after the FDA-mandated Common Rule changes, i.e., between January 2017 and October 2022, were enacted, and had their results posted. We analyzed sex/race/ethnicity reporting as well as applicable enrollment. Using meta-analysis, we estimated group participation proportions of a subset of the 481 identified trials; specifically, the 229 studies that were conducted solely within the US (i.e., without international sites) and compared them to US census data.</p></div><div><h3>Findings</h3><p>Within the 481 clinical trials analyzed, over 97% reported on the race and/or ethnicity of their enrollees; all included information on sex. Reporting was not affected by funding source or therapeutic area. Based on the 229 solely US-based studies, the participants overall were 76.7% White; 14.1% Black; 2.7% Asian; and 15% Hispanic. Inclusion of Black participants did not differ from the 2020 US census data; in contrast, the levels of Asian and Hispanic participation were below the corresponding census percentages.</p></div><div><h3>Interpretation</h3><p>The past five years have seen an overall uptick in the equity of race/ethnicity reporting and inclusivity of clinical trials, as compared to previously reported data, presaging the potential acquisition of ever more powerful and meaningful results of such interventional studies going forward.</p></div><div><h3>Funding</h3><p>Support for this study comes from the Hackensack Meridian <em>Health</em> Research Institute and the Hackensack Meridian School of Medicine.</p></div><div><h3>Research in context</h3><p><em>Evidence before this study</em></p><p>Clinical trials are a critical part of determining whether or not a medical (drug/device/biologic) or socio-behavioral intervention is safe and truly effective. Through their use, scientific understanding is advanced and, ideally, human health is improved. To gain the most impactful information from a clinical trial, it should be sufficiently representative, that is, should enroll an adequate number of participants, and include a diverse population. Without such inclusion, the study is of only limited generalizability. Efforts are underway by funders, sites, and other stakeholders, to enhance reporting and promote inclusive enrollment. The extent to which such attempts are yielding results - at least for clinical trials in the state of New Jersey - is the focus of this data-driven analysis. The <span>ClinicalTrials.gov</span><svg><path></path></svg> registry databa","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590113323000378/pdfft?md5=619535c207850b8ebbb21fa9e4b0c77e&pid=1-s2.0-S2590113323000378-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139099831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}