COVID-19 prevalence and mortality in longer-term care facilities

European Journal of Epidemiology - This essay considers the factors that have contributed to very high COVID-19 mortality in longer-term care facilities (LTCFs). We compare the demographic...     

The effects of maternal risk factors during pregnancy on the onset of sleep difficulties in infants at 3 months old

Sleep problems in young children are among the most common concerns reported to paediatricians. Sleep is thought to have important regulatory functions, and sleep difficulties in early childhood are linked to several psychosocial and physiological problems. Moreover, several prenatal factors have been found to influence infants’ sleep. Among them, most of the studies have been focused on maternal prenatal depression and/or anxiety as potential risk factors for sleep problems in childhood, whereas other relevant psychological factors during pregnancy have not received as much attention. Therefore, we aimed to examine the effect of several psychiatric maternal risk factors during pregnancy (i.e. symptoms of anxiety, depression, insomnia, alcohol use, seasonality, attention deficit and hyperactivity disorder and/or stressful life events) on the onset of some sleep problems related to sleep quality and sleep practices in 3‐month‐old infants. We examined 1,221 cases from a population‐based birth cohort, with subjective measures during pregnancy in mothers, and at 3 months after birth in the infants. The findings showed that all the maternal risk factors during pregnancy, except for symptoms of alcoholism and sleepiness, were related to sleep difficulties in infants. Interestingly, attention deficit and hyperactivity disorder symptomatology in mothers during pregnancy was the only variable that predicted more than two sleeping difficulties (i.e. long sleep‐onset latency, co‐sleeping with parents and irregular sleeping routines) at 3 months old. Our results highlight the relevance of maternal risk factors during pregnancy, and not only prenatal depression and/or anxiety, as variables to be considered when examining sleep difficulties in infants.     

Gene variants as determinants of longevity: focus on the inflammatory factors

Human longevity is an extremely complex trait with various genetic, epigenetic and environmental factors acting upon the longevity phenotype. It is now becoming evident that whilst the genetic differences contribute only modestly to life expectancy before the age of 60 years, their impact on survival becomes more prominent at the extreme ages. Several longevity gene candidates have emerged during the past decade; the majority of them are related either to inflammatory functions, stress response or to lipid and glucose metabolism. The variants of inflammatory and immune response genes are of special interest since advancing ages is accompanied by a decline in several immune functions—a phenomenon called immunosenescence. Paradoxically, ageing is also characterised by chronic low-grade inflammation termed “inflammaging”, which manifests as a two- to fourfold increase in the production of proinflammatory cytokines and acute phase proteins. These contrasting phenomena provide a functional rationale of how the genetic differences in inflammatory mediators may modify the life span of the elderly. Besides describing the pre-existing inflammatory and immune-related longevity gene variants, in this review, we also explain some of the theoretical and practical challenges that genetic longevity studies often encounter.     

Four-year follow-up study of sleep and psychiatric symptoms in preadolescents: relationship of persistent and temporary sleep problems to psychiatric symptoms

The course of sleep disturbances in preadolescents was assessed during a 4-year follow-up, and psychiatric problems associated with persistent and temporary sleep problems were investigated in an epidemiological setting. A representative random sample of 1,290 children, their parents, and school teachers filled out various questionnaires when the children were aged 8 and 12 years. Response rates to the relevant items varied between 66.8% and 81.2%. Parental reports of sleep problems decreased from 23.4% to 9.1% during the 4-year period, whereas children's reports remained steady at 18%. Persistent sleep disturbances were found in 12% of children, and 33.3% of sleep problems reported at age 8 were continued. Both current and persistent sleep disturbances were associated with the broad range of mental health problems reported by teachers. However, multivariate modeling suggested that especially current sleep problems were associated with an increased risk for psychiatric problems (odds ratio [OR] 2.45; 95% confidence interval [CI] 1.20-4.99), particularly emotional problems (OR 2.92; 95% CI 1.58-5.38).     

Aging is associated with quantitative and qualitative changes in circulating cell-free DNA: the Vitality 90+ study

As a marker of cellular death, cell-free DNA (cf-DNA) has a utility in diagnosis and prognosis of various disorders. Since aging accompanies increased cellular senescence and death, we aimed to characterize potential age-related alterations in cf-DNA. The study population consisted of 12 nonagenarian women (participants in the Vitality 90+ Study) and 11 healthy control women (aged 22-37 years). Some of the nonagenarians (n=8) were also recruited for follow-up after one year. cf-DNA was extracted using two different methods. Total cf-DNA was quantified directly in plasma and the amplifiable cf-DNA was assessed using quantitative PCR. Quality of cf-DNA was analysed with a DNA Chip assay. For all the quantification methods, the concentration of cf-DNA was significantly higher (p<0.05) in nonagenarians as compared to controls. The quality of the cf-DNA also displayed a marked difference between nonagenarians and controls; a fragmented pattern or appearance of low molecular weight cf-DNA was observed in the majority of the nonagenarians, whereas in controls, cf-DNA was intact and had a quasi-genomic, high molecular weight appearance. In nonagenarians, the quality of cf-DNA appeared similar in the original and follow-up samples. We propose that some, as yet uncharacterized, aspects of aging are reflected in the appearance of cf-DNA.     

Prenatal Origins of Poor Sleep in Children

Study Objectives:

We examined whether small body size at birth and prenatal tobacco or alcohol exposure predict poor sleep and more sleep disturbances in children.

Design:

An epidemiologic cohort study of 289 eight-year-old children born at term.

Measurements and results:

Sleep duration and efficiency were measured by actigraphy for 7 consecutive nights (mean = 7.1, SD = 1.2). We used both continuous measures of poor sleep and binary variables of short sleep and low sleep efficiency ( ≤ 10^th percentiles). Parents completed the Sleep Disturbance Scale for Children. Lower birth weight and shorter length at birth were associated with lower sleep efficiency. For every 1-SD decrease in weight and length at birth, the odds for low sleep efficiency increased by 1.7 fold (95% confidence interval [CI]: 1.1 to 2.7) and 2.2 fold (95% CI: 1.3 to 3.7), respectively. For every 1-SD decrease in ponderal index at birth, the risk of parent-reported sleep disorders increased by 1.4 fold (95% CI: 1.0 to 2.0). Moreover, children exposed prenatally to alcohol had a 2.9-fold (95% CI: 1.1 to 7.6) and 3.6-fold (95% CI: 1.3 to 10.0) increased risk for having short sleep and low sleep efficiency, respectively. The associations were not confounded by sex, gestational length, prenatal and perinatal complications, body mass index at 8 years, asthma, allergies, or parental socioeconomic status.

Conclusions:

Poor sleep in children may have prenatal origins. Possible mechanisms include alcohol consumption during pregnancy and other conditions associated with small body size at birth.

Citation:

Pesonen AK; Röaikköonen K; Matthews K; Heinonen K; Paavonen JE; Lahti J; Komsi N; Lemola S; Jöarvenpöaöa AL; Kajantie E; Strandberg T. Prenatal origins of poor sleep in children. SLEEP 2009;32(8):1086-1092.     

Comparison of Diagnostic Methods for Asperger Syndrome

Several different diagnostic sets of criteria exist for Asperger syndrome (AS), but there is no agreement on a gold standard. The aim of this study was to compare four diagnostic sets of criteria for AS: the ICD-10, the DSM-IV, the Gillberg & Gillberg, and the Szatmari criteria. The series consists of 36 children who had been referred to two centers with a tentative diagnosis of AS. The best agreement was between the ICD-10 and the DSM-IV criteria (Kappa coefficient 0.48), and the lowest between the Gillberg & Gillberg and Szatmari criteria (Kappa coefficient -0.21). The poor agreement between these sets of diagnostic criteria compromises the comparability of studies on AS.     

Complement factor H 402His variant confers an increased mortality risk in Finnish nonagenarians: The Vitality 90+ study

Ageing is characterized by chronic low-grade inflammation and the expected lifespan may be affected by several immunological and inflammatory mediators. In this study, we investigated whether the functional Tyr402His polymorphism (rs1061170) on complement factor H (CFH) gene, which is a key inflammatory downregulator, modulates the longevity of 491 nonagenarians in the Vitality 90+ study. Logistic regression analysis and Kaplan–Meier method with the log rank test were used to examine the effect of the CFH Tyr402His polymorphism on 4-year mortality. After follow-up, we observed that risk factor-adjusted mortality was significantly higher among the carriers of CFH 402His allele compared to non-carriers (OR 1.78, 95% CI 1.19–2.67, p = 0.005) and that the survival curves of CFH 402His carriers and non-carriers deviated significantly (p = 0.016). We propose that the increased mortality is inflammation-related and mediated by aberrant complement regulation by the CFH 402His variant.