A measurement error approach to assess the association between dietary diversity, nutrient intake, and mean probability of adequacy

Collection of dietary intake information requires time-consuming and expensive methods, making it inaccessible to many resource-poor countries. Quantifying the association between simple measures of usual dietary diversity and usual nutrient intake/adequacy would allow inferences to be made about the adequacy of micronutrient intake at the population level for a fraction of the cost. In this study, we used secondary data from a dietary intake study carried out in Bangladesh to assess the association between 3 food group diversity indicators (FGI) and calcium intake; and the association between these same 3 FGI and a composite measure of nutrient adequacy, mean probability of adequacy (MPA). By implementing Fuller's error-in-the-equation measurement error model (EEM) and simple linear regression (SLR) models, we assessed these associations while accounting for the error in the observed quantities. Significant associations were detected between usual FGI and usual calcium intakes, when the more complex EEM was used. The SLR model detected significant associations between FGI and MPA as well as for variations of these measures, including the best linear unbiased predictor. Through simulation, we support the use of the EEM. In contrast to the EEM, the SLR model does not account for the possible correlation between the measurement errors in the response and predictor. The EEM performs best when the model variables are not complex functions of other variables observed with error (e.g. MPA). When observation days are limited and poor estimates of the within-person variances are obtained, the SLR model tends to be more appropriate.     

Adult myeloid leukaemia, geology, and domestic exposure to radon and gamma radiation: a case control study in central Italy

OBJECTIVES: To investigate whether indoor randon or gamma radiation might play a part in myeloid leukaemia as suggested by studies based on crude geographical or geological data for exposure assessment. METHODS: For six months randon and gamma radiation was measured with solid state nuclear track detectors and thermoluminescent dosimeters in dwellings of 44 adult male cases of acute myeloid leukaemia and 211 controls (all subjects deceased). Conditional logistic regression ORs (ORs) and 95% confidence intervals (95% CIs) were estimated for quartiles of radon and gamma radiation and for municipality and dwelling characteristics. RESULTS: The risk of leukaemia was associated with an increasing urbanisation index (p value for trend = 0.008). An increased OR was found among those living in more modern houses (OR 3.0, 95% CI 1.4 to 6.6). Confirming the findings of a previous study in the same area, geological features bore a positive association with myeloid leukemia, even by adjusting for level of urbanisation. Contrary to expectations from the previous study, however, no association appeared between myeloid leukaemia and radon and gamma radiation; for the highest quartiles of exposure, ORs were 0.56 (95% CI 0.2 to 1.4) and 0.52 (95% CI 0.2 to 1.4), respectively. Considering only subjects who had lived > or = 20 years in the monitored home and adjusting for urbanisation, there was still no effect of exposure to radiation. CONCLUSIONS: In view of the limited numbers, the results do not in general refute a possible risk of myeloid leukaemia from exposure to indoor radon or gamma radiation, but decrease the credibility of such a relation in the area studied and also of other studies suggesting an effect without monitoring indoor radiation. Some other fairly strong determinants have appeared--that is, level of urbanisation and living in modern houses-- that might need further consideration.

 

     

Combining data from primary and ancillary surveys to assess the association between neighborhood-level characteristics and health outcomes: the Multi-Ethnic Study of Artherosclerosis

There is increasing interest in understanding the role of neighborhood-level factors on the health of individuals. Many large-scale epidemiological studies that accurately measure health status of individuals and individual risk factors exist. Sometimes these studies are linked to area-level databases (e.g. census) to assess the association between crude area-level characteristics and health. However, information from such databases may not measure the neighborhood-level constructs of interest. More recently, large-scale epidemiological studies have begun collecting data to measure specific features of neighborhoods using ancillary surveys. The ancillary surveys are composed of a separate, typically larger, set of individuals. The challenge is then to combine information from these two surveys to assess the role of neighborhood-level factors. We propose a method for combining information from the two data sources using a likelihood-based framework. We compare it with currently used ad hoc approaches via a simulation study. The simulation study shows that the proposed approach yields estimates with better sampling properties (less bias and better coverage probabilities) compared with the other approaches. However, there are cases where some ad hoc approaches may provide adequate estimates. We also compare the methods by applying them to the Multi-Ethnic Study of Atherosclerosis and its Neighborhood Ancillary Survey.     

Microbiological indoor air quality in an office building in Gliwice,Poland: analysis of the case study

Bioaerosols play a significant role in indoor air quality (IAQ) as they can be the cause of several health problems, including acute allergies and infectious diseases. This study aimed to characterize and compare the microbial air quality of air-conditioned (AC) and naturally ventilated (NV) office rooms in the Upper Silesia region of Poland. The bacterial samples were collected during the late spring season. Culturable bacteria were deposited on the nutrient media on Petri dishes to investigate the viable-culturable count (VCC) of bacteria and bacterial community structure using a Biolog GEN III system. In total, 12 species of bacteria were identified, with the most isolated Macrococcus equipercicus, Micrococcus luteus D, Staphylococcus xylosus (indoor), and Bacillus species (outdoor). The indoor mean concentrations of bacterial aerosol ranged from 10² to 10³ CFU m^?3, below Polish proposals for threshold limit standards in office buildings. The indoor-to-outdoor (I/O) ratios indicated that studied air pollutants in the office rooms originated from the indoor air. These results, together with community composition of bacteria, indicate that most of the bacteria present in the studied office building were relatively fresh and of human origin. Multi-antibiotic resistance (MAR) tests showed that the most antibiotic-resistant features were present in Macrococcus species. The office building exposure dose (OBED) and mass median aerodynamic diameter (MMAD) of bacteria aerosol were estimated. The highest value of OBED over the study period was obtained for staff working in offices with natural ventilation (141 CFU kg^?1), in contrast to the value for staff working in offices equipped with air conditioning (about 100 CFU kg^?1). The MMAD of viable airborne bacteria was higher in AC offices (2.4 μm) than in NV offices (2.2 μm).     

A green and healthy future: the settings approach to building health,equity and sustainability

As we move further into the twenty-first century, there is growing realization that the relationship between humans and the wider environment is crucially important, and a recognition that unfettered globalization linked to an increasingly dominant consumer culture has wrought devastating impacts. Within this context, and catalyzed particularly by concerns about climate change, there has also been increased appreciation that public health and the health of the planet are closely interrelated. This article focuses on the opportunities and potential value of encouraging joined-up thinking and integrated action in the settings where people live their lives. Having set the broad context regarding health, equity and sustainability, we scope current activity in relation to ‘greening’ settings before honing in on two concerns: that few such initiatives reflect the holistic and ecological perspective that underpins a settings approach to health promotion, and that work on sustainability and work on health have largely been developed in parallel rather than in an integrated manner. Having discussed these concerns, we propose six principles for progressive practice as a means of grounding a healthy and sustainable settings approach, before concluding by looking to the future and highlighting the likely need and benefits of daring to make more radical changes to our individual, community and working lives.     

Lung cancer attributable to indoor radon exposure in france: impact of the risk models and uncertainty analysis

OBJECTIVE: The inhalation of radon, a well-established human carcinogen, is the principal-and omnipresent-source of radioactivity exposure for the general population of most countries. Scientists have thus sought to assess the lung cancer risk associated with indoor radon. Our aim here is to assess this risk in France, using all available epidemiologic results and performing an uncertainty analysis. METHODS: We examined the exposure-response relations derived from cohorts of miners and from joint analyses of residential case-control studies and considered the interaction between radon and tobacco. The exposure data come from measurement campaigns conducted since the beginning of the 1980s by the Institute for Radiation Protection and Nuclear Safety and the Directorate-General of Health in France. We quantified the uncertainties associated with risk coefficients and exposures and calculated their impact on risk estimates. RESULTS: The estimated number of lung cancer deaths attributable to indoor radon exposure ranges from 543 [90% uncertainty interval (UI) , 75-1,097] to 3,108 (90% UI, 2,996-3,221) , depending on the model considered. This calculation suggests that from 2.2% (90% UI, 0.3-4.4) to 12.4% (90% UI, 11.9-12.8) of these deaths in France may be attributable to indoor radon. DISCUSSION: In this original work we used different exposure-response relations from several epidemiologic studies and found that regardless of the relation chosen, the number of lung cancer deaths attributable to indoor radon appears relatively stable. Smokers can reduce their risk not only by reducing their indoor radon concentration but also by giving up smoking.     

Accounting for regional background and population size in the detection of spatial clusters and outliers using geostatistical filtering and spatial neutral models: the case of lung cancer in Long Island,New York

Background  

Complete Spatial Randomness (CSR) is the null hypothesis employed by many statistical tests for spatial pattern, such as local cluster or boundary analysis. CSR is however not a relevant null hypothesis for highly complex and organized systems such as those encountered in the environmental and health sciences in which underlying spatial pattern is present. This paper presents a geostatistical approach to filter the noise caused by spatially varying population size and to generate spatially correlated neutral models that account for regional background obtained by geostatistical smoothing of observed mortality rates. These neutral models were used in conjunction with the local Moran statistics to identify spatial clusters and outliers in the geographical distribution of male and female lung cancer in Nassau, Queens, and Suffolk counties, New York, USA.     

A spatial analysis of the association between restaurant density and body mass index in Canadian adults

Objective

To investigate the association between fast-food restaurant density and adult body mass index (BMI) in Canada.

Methods

Individual-level BMI and confounding variables were obtained from the 2007–2008 Canadian Community Health Survey master file. Locations of the fast-food and full-service chain restaurants and other non-chain restaurants were obtained from the 2008 Infogroup Canada business database. Food outlet density (fast-food, full-service and other) per 10,000 population was calculated for each Forward Sortation Area (FSA). Global (Moran's I) and local indicators of spatial autocorrelation of BMI were assessed. Ordinary least squares (OLS) and spatial auto-regressive error (SARE) methods were used to assess the association between local food environment and adult BMI in Canada.

Results

Global and local spatial autocorrelation of BMI were found in our univariate analysis. We found that OLS and SARE estimates were very similar in our multivariate models. An additional fast-food restaurant per 10,000 people at the FSA-level is associated with a 0.022 kg/m² increase in BMI. On the other hand, other restaurant density is negatively related to BMI.

Conclusions

Fast-food restaurant density is positively associated with BMI in Canada. Results suggest that restricting availability of fast-food in local neighborhoods may play a role in obesity prevention.     

Socioeconomic status, overweight and obesity in prepuberal children: A study in an area of Northern Italy

The aim of this study was to determine whether socio-economical status (SES) is associated with overweight and obesity in prepuberal children. In an area of North-Western Italy a sample of 1420 children, aged 10–11 years, had his/her height and weight recorded, (overweight and obesity were defined, respectively, as relative body weight 120% and 140%), and parents were requested to compile a questionnaire exploring some demographic and social conditions. 23% of the sample resulted overweight or obese. Prevalence rate ratios (PRR) of overweight and obesity (together) were calculated, adjusting for parents' age, parents' area of birth, and school district. PRR for mother's lowest educational level compared to the highest was 1.59 (95% CI: 1.19–2.13), while for father's education was 1.21 (0.90–1.63). PRRs for unemployed or manual mother compared to upper non manual were respectively 1.83 (1.20–2.79) and 2.20 (1.31–3.68), while for unemployed or manual father were 2.63 (1.97–2.63), and 1.63 (1.27–2.09). The cultural resources of the mother, and the economical resources of the family seem to influence the prevalence of weight gain in prepuberal children. This should be taken into account when planning programs for the prevention or reduction of obesity in children.     

Temporal and geographic heterogeneity of the association between socioeconomic position and hospitalisation in Italy: an income based indicator

Background  

The inverse association between socioeconomic position (SEP) and health has been extensively explored in Italy; however few studies have been carried out on the relationship between income inequalities and health status or health services utilisation, particularly at a local level.     

血清淀粉样蛋白A与宫颈癌病理特征关系的Logistic回归分析

目的 探讨HPV感染的宫颈癌患者血清淀粉样蛋白A(SAA)的表达水平及其与宫颈癌病理特征的关系.方法 检测239例首次治疗的HPV感染宫颈癌患者(研究组)、187例宫颈上皮内瘤变患者(良性对照组),154例正常体检对照组的SAA水平,并利用Logistic回归分析探讨SAA与宫颈癌患者病理特征的关系.宫颈癌分期采用国际妇产科联盟的分期标准.结果 研究组SAA水平为25.47 (9.74,36.42) mg/L,均高于良性对照组和正常对照组(Z=-6.146、-9.782,P均＜0.05).宫颈癌患者SAA水平在癌症分期Ⅲ-Ⅳ者及有淋巴转移者中较低分期水平和无淋巴结转移者明显升高(Z=-4.138、-3,842,P＜0.05).研究组SAA水平ROC曲线下面积为0.812,Cut-off值为16.38mg/L,灵敏度为89.15％,特异性为90.55％.结论 SAA测定在诊断宫颈癌,判断是否淋巴结转移,以及评估其分期具有重要临床价值.     

Using the Perceive, Recall, Plan and Perform System to assess cognitive deficits in adults with traumatic brain injury: A case study

One role of occupational therapy in the rehabilitation of people with traumatic brain injury is to determine the impact of cognitive and perceptual deficits on client performance of occupational tasks. Existing methods that can be used to assess cognitive deficits include standardised instruments and observations of everyday task performance. Few of these assessment methods are able to adequately link problems of cognition with problems with self-maintenance, productivity and leisure tasks relative to a client's expected occupational roles. The Perceive, Recall, Plan and Perform (PRPP) System of Task Analysis enables observation of performance of any functional task and allows therapists to identify the cognitive basis of disordered performance. The results of this assessment are then used to establish and evaluate client-centred goals and guide subsequent intervention. This article describes the PRPP System of Task Analysis and outlines how it can be used by occupational therapists involved in the management of adults with traumatic brain injury. Specifically, an in-depth case study illustrates how this innovative model of assessment has effectively been used to promote client learning of self-maintenance skills.     

Investigating the association between the socioeconomic environment of the service area and fast food visitation: A context-based crystal growth approach

Fast food consumption is one of the major causes of rising obesity rates. Fast food consumers are mostly residents located in the service area—the fast food outlet's surrounding area. Conventional buffer approaches may exhibit bias in measuring service areas by ignoring the local community's detailed spatial configuration and transportation preferences.This study uses fast food outlets and their visits provided by a mobile phone-based dataset named SafeGraph and applies a novel context-based crystal growth algorithm (CG) to delineate improved service areas of fast food outlets in Chicago. We also explore how socioeconomic variables in service areas by CG and buffer-based approaches are related to visits to fast food outlets.Results show that compared to conventional buffers, CG produces improved service areas as it excludes inaccessible barriers and adjusts the accessible areas by transportation preferences. Further, the model using service areas of public transport users by CG yields the best performance. Additionally, the rate of single-mother households and the number of other fast food outlets nearby are positively related to fast food visits in all models. Findings acknowledge the advantages of CG and help make policy interventions to reduce fast food consumption.     

Short-term monitoring of benzene air concentration in an urban area: a preliminary study of application of Kruskal-Wallis non-parametric test to assess pollutant impact on global environment and indoor

In step with the need to develop statistical procedures to manage small-size environmental samples, in this work we have used concentration values of benzene (C6H6), concurrently detected by seven outdoor and indoor monitoring stations over 12 000 minutes, in order to assess the representativeness of collected data and the impact of the pollutant on indoor environment. Clearly, the former issue is strictly connected to sampling-site geometry, which proves critical to correctly retrieving information from analysis of pollutants of sanitary interest. Therefore, according to current criteria for network-planning, single stations have been interpreted as nodes of a set of adjoining triangles; then, a) node pairs have been taken into account in order to estimate pollutant stationarity on triangle sides, as well as b) node triplets, to statistically associate data from air-monitoring with the corresponding territory area, and c) node sextuplets, to assess the impact probability of the outdoor pollutant on indoor environment for each area. Distributions from the various node combinations are all non-Gaussian, in the consequently, Kruskal-Wallis (KW) non-parametric statistics has been exploited to test variability on continuous density function from each pair, triplet and sextuplet. Results from the above-mentioned statistical analysis have shown randomness of site selection, which has not allowed a reliable generalization of monitoring data to the entire selected territory, except for a single "forced" case (70%); most important, they suggest a possible procedure to optimize network design.     

Analyzing differences between spatial exposure estimation methods: A case study of outdoor food and beverage advertising in London,Canada

Exposure assessment in the context of mobility-oriented health research often is challenged by the type of spatial measurement technique used to estimate exposures to environmental features. The purpose of this study is to compare smartphone global positioning system (GPS), shortest network path mobility, and buffer-based approaches in estimating exposure to outdoor food and beverage advertising among a sample of 154 teenagers involved in the SmartAPPetite study during 2018 in London, Ontario, Canada. Participants were asked to report their home postal code, age, gender identity, ethnicity, and number of purchases they had made at a retail food outlet in the past month. During the same time period, a mobile phone application was used to log their mobility and specifically record when a participant was in close proximity to outdoor advertising. The results of negative binomial regression modelling reveal significant differences in estimates of advertising exposure, and the relationship to self-reported purchasing. Spatial exposure estimation methods showed differences across regression models, with the buffer and observed GPS approaches delivering the best fitting models, depending on the type of retail food outlet. There is a clear need for more robust research of spatial exposure measurement techniques in the context of mobility and food (information) environment research.     

On the association analysis of genome‐sequencing data: A spatial clustering approach for partitioning the entire genome into nonoverlapping windows

For the association analysis of whole‐genome sequencing (WGS) studies, we propose an efficient and fast spatial‐clustering algorithm. Compared to existing analysis approaches for WGS data, that define the tested regions either by sliding or consecutive windows of fixed sizes along variants, a meaningful grouping of nearby variants into consecutive regions has the advantage that, compared to sliding window approaches, the number of tested regions is likely to be smaller. In comparison to consecutive, fixed‐window approaches, our approach is likely to group nearby variants together. Given existing biological evidence that disease‐associated mutations tend to physically cluster in specific regions along the chromosome, the identification of meaningful groups of nearby located variants could thus lead to a potential power gain for association analysis. Our algorithm defines consecutive genomic regions based on the physical positions of the variants, assuming an inhomogeneous Poisson process and groups together nearby variants. As parameters are estimated locally, the algorithm takes the differing variant density along the chromosome into account and provides locally optimal partitioning of variants into consecutive regions. An R‐implementation of the algorithm is provided. We discuss the theoretical advances of our algorithm compared to existing, window‐based approaches and show the performance and advantage of our introduced algorithm in a simulation study and by an application to Alzheimer's disease WGS data. Our analysis identifies a region in the ITGB3 gene that potentially harbors disease susceptibility loci for Alzheimer's disease. The region‐based association signal of ITGB3 replicates in an independent data set and achieves formally genome‐wide significance. Software Implementation : An implementation of the algorithm in R is available at: https://github.com/heidefier/cluster_wgs_data .     

Multicollinearity in associations between multiple environmental features and body weight and abdominal fat: using matching techniques to assess whether the associations are separable

Because of the strong correlations among neighborhoods' characteristics, it is not clear whether the associations of specific environmental exposures (e.g., densities of physical features and services) with obesity can be disentangled. Using data from the RECORD (Residential Environment and Coronary Heart Disease) Cohort Study (Paris, France, 2007-2008), the authors investigated whether neighborhood characteristics related to the sociodemographic, physical, service-related, and social-interactional environments were associated with body mass index and waist circumference. The authors developed an original neighborhood characteristic-matching technique (analyses within pairs of participants similarly exposed to an environmental variable) to assess whether or not these associations could be disentangled. After adjustment for individual/neighborhood socioeconomic variables, body mass index/waist circumference was negatively associated with characteristics of the physical/service environments reflecting higher densities (e.g., proportion of built surface, densities of shops selling fruits/vegetables, and restaurants). Multiple adjustment models and the neighborhood characteristic-matching technique were unable to identify which of these neighborhood variables were driving the associations because of high correlations between the environmental variables. Overall, beyond the socioeconomic environment, the physical and service environments may be associated with weight status, but it is difficult to disentangle the effects of strongly correlated environmental dimensions, even if they imply different causal mechanisms and interventions.     

孟德尔随机化探究类风湿性关节炎与冠状动脉疾病因果关系以及步行速度的介导作用

目的类风湿性关节炎(rheumatoid arthritis, RA)患者的冠状动脉疾病(coronary artery disease, CAD)发生风险会升高。由于关节疼痛/僵硬或其他关节问题, RA患者的身体素质通常会有所降低,比如步行速度下降。但是,RA、步行速度和CAD这3者之间的因果关联目前尚不清楚。本研究旨在采用网络孟德尔随机化方法研究RA与CAD因果关系及步行速度在该因果关系中的介导作用。方法公共数据库下载RA、CAD和步行速度的全基因组关联研究(genomewide association study, GWAS)统计结果数据,进行两样本的孟德尔随机化分析。RA数据共有103 688例样本,CAD数据有547 261例样本,步行速度有452 264例样本。选取与RA和步行速度相关的独立SNP作为工具变量。使用逆方差加权法与加权中值法进行因果关系分析,并采用MR-Egger和留一法进行模型评价。结果分析结果显示,RA与CAD的总体因果效应是正相关(OR=1.03, 95%CI:1.01～1.04, P=3.90×10-5),RA与正常步行速度负相关(β=-0.02, 9...     

VEGF基因多态性与子宫内膜异位症遗传易感性的Meta分析

目的 探讨血管内皮生长因子(VEGF)基因-460C/T、+936C/T单核苷酸多态性(SNPs)与子宫内膜异位症遗传易感性的关系.方法 检索PubMed、Embase、中国知网和万方数字化期刊等中英文数据库,检索时间为1990年1月至2012年2月.应用Meta分析的方法分别合并这两个SNPs与子宫内膜异位症遗传易感性关系的OR值,并进行亚组分析和文献的发表偏倚检验.结果 纳入的8篇研究文献中,对于+936C/T多态,病例组共计1 784例,对照组共计1 865例,Meta分析显示:比较C等位基因携带者,携带T等位基因的妇女明显增加子宫内膜异位症的患病风险(OR=1.15,95%CI:1.01~1.30,P=0.03);对于-460C/T多态,病例组共计2 158例,对照组共计2 191例,Meta分析显示:-460C/T多态与子宫内膜异位症的发病风险无关,按照种族进行亚组分析差异也无统计学意义(P>0.05).结论 VEGF基因+936C/T SNP可能是妇女子宫内膜异位症发病风险的一个低外显率分子标志物.