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Purpose: The American College of Epidemiology (ACE) held its 2022 Annual Meeting, September 8-11, with a conference theme of 'Pandemic of Misinformation: Building Trust in Epidemiology'. The ACE Ethics Committee hosted a symposium session in recognition of the global spotlight placed on epidemiology and public health due to the COVID-19 crisis. The ACE Ethics Committee invited previous Chairs of the Ethics Committee and current President of the International Epidemiological Association to present at the symposium session. This paper aims to highlight the ethical challenges presented during the symposium session., Methods: Three speakers with diverse backgrounds representing expertize from the fields of ethics, epidemiology, public health, clinical trials, pharmacoepidemiology, statistics, law, and public policy, covering perspectives from the U.S., Europe, and Southeast Asia were selected to present on the ethical challenges in epidemiology and public health applying a global theme. Dr. D. Weed presented on 'Causation, Epidemiology and Ethics'; Dr. C.M. Pandey presented on the 'Ethical Challenges in the Practice of Digital Epidemiology'; and Dr. J. Acquavella presented on 'Departures from Scientific Objectivity: A Cause of Eroding Trust in Epidemiology.', Results: The collective goal to improve the public's health was a mutually shared theme across the three distinct areas. We highlight the common ethical guidance and principle-based approaches that have served epidemiology and public health in framing and critical analysis of novel challenges, including autonomy, beneficence, justice, scientific integrity, duties to the profession and community, and developing and maintaining public trust; however, gaps remain in how best to address health inequalities and the novel emergence and pervasiveness of misinformation and disinformation that have impacted the health of the global community. We introduce an ethical framework of translational bioethics that places considerations of the social determinants of health at the forefront., Conclusions: The COVID-19 pandemic required an expedited public health response and, at the same time, placed the profession of epidemiology and public health, its system, and structures, under the microscope like never before. This article illustrates that revisiting our foundations in research and practice and orienting contemporary challenges using an ethical lens can assist in identifying and furthering the health of populations globally., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Causal assessments in epidemiology are a complex process due to the many methods involved. The general scientific method lords over the process joined by study designs and statistical methods. Other methods include those that evaluate quality and bias along with the research synthesis methods such as the systematic narrative review, meta-analysis, and the criteria-based methods. When different investigators apply these methods to the same evidence and come up with different causal assessments, as described in the review by Goodman et al. in this issue, a key question becomes, how can the differences be explained? A prime candidate involves different methodologic choices. A deeper question emerges from this same situation: are the methods used for causal assessments reliable? Reliability is a hallmark of scientific practice. The methods used to make claims about causality should be reliable. Given the complexity of the causal assessment process, an objective evaluation of reliability is challenging but clearly worth the effort. Fortunately, Hill's criterion of analogy, much maligned in epidemiology, provides a clue. This commentary explores the issue of the reliability of causal claims using the Goodman et al. systematic review as its foil along with the claims by EPA, IARC, and ATSDR about the relationship between perchloroethylene and non-Hodgkin lymphoma, the claims Goodman et al. believe are wrong., (© 2022 The Author. Published by Elsevier Inc.)

Background: Bradford Hill (BH) viewpoints are widely used to assess causality in systematic reviews, but their application has often lacked reproducibility. We describe an approach for assessing causality within systematic reviews ('causal' reviews), illustrating its application to the topic of income inequality and health. Our approach draws on principles of process tracing, a method used for case study research, to harness BH viewpoints to judge evidence for causal claims., Methods: In process tracing, a hypothesis may be confirmed by observing highly unique evidence and disconfirmed by observing highly definitive evidence. We drew on these principles to consider the value of finding supportive or contradictory evidence for each BH viewpoint characterised by its uniqueness and definitiveness., Results: In our exemplar systematic review, we hypothesised that income inequality adversely affects self-rated health and all-cause mortality. BH viewpoints 'analogy' and 'coherence' were excluded from the causal assessment because of their low uniqueness and low definitiveness. The 'experiment' viewpoint was considered highly unique and highly definitive, and thus could be particularly valuable. We propose five steps for using BH viewpoints in a 'causal' review: (1) define the hypothesis; (2) characterise each viewpoint; (3) specify the evidence expected for each BH viewpoint for a true or untrue hypothesis; (4) gather evidence for each viewpoint (e.g., systematic review meta-analyses, critical appraisal, background knowledge); (5) consider if each viewpoint was met (supportive evidence) or unmet (contradictory evidence)., Conclusions: Incorporating process tracing has the potential to provide transparency and structure when using BH viewpoints in 'causal' reviews., (© 2024 The Author(s). Research Synthesis Methods published by John Wiley & Sons Ltd.)

This study addresses the critical need for effective groundwater (GW) management in Muzaffarabad, Pakistan, amidst challenges posed by rapid urbanization and population growth. By integrating Support Vector Machine (SVM) and Weight of Evidence (WOE) techniques, this study aimed to delineate GW potential zones and assess water quality. This study fills the gap in applying advanced machine learning and geostatistical methods for accurate GW potential mapping. Eight thematic layers based on topography, hydrology, geology, and ecology were utilized to compute the GW potential model. Additionally, water quality analysis was performed on collected samples. The findings indicate that flat and gently sloping terrains, areas with an elevation range of 611 –687 m, and concave slope geometries are associated with higher GW potential. Additionally, proximity to drainage and high-density lineament zones contribute to increased GW potential. The results showed that 31.1% of the area had excellent GW potential according to the WOE model, whereas the SVM model indicated that only 20.3% fell in the excellent potential zone. Results showed that both models performed well in the delineating GW potential zones. Nevertheless, the application of the SVM method is highly recommended which will be benefited in GW resources management related to urban planning. The study also evaluates the spatial distribution of GW quality, with a focus on physical and chemical parameters, including electrical conductivity, pH, turbidity, total dissolved solids, calcium, magnesium, chloride, nitrate, and sulphate. Bacterial contamination assessment reveals that 76% of spring water samples (30 out of 39 samples) are contaminated with E.coli, raising public health concerns. Based on the chemical analysis of GW samples the study identified exceedances of WHO guidelines for calcium in two samples, magnesium in seven samples, sulphate in ten samples, and nitrate levels were below the WHO guideline across all samples. These results highlight localized chemical contamination issues that require targeted remediation efforts to safeguard water quality for public health. [ABSTRACT FROM AUTHOR]

Background: Gastroparesis is a major complication following complete mesocolic excision (CME) and significantly impacts patient outcomes. This study aimed to create a machine learning model to pinpoint key risk factors before, during, and after surgery, effectively predicting the risk of gastroparesis after CME. Methods: The study involved 1146 patients with colon cancer, out of which 95 developed gastroparesis. Data were collected on 34 variables, including demographics, chronic conditions, pre-surgery test results, types of surgery, and intraoperative details. Four machine learning techniques were employed: extreme gradient boosting (XGBoost), random forest (RF), support vector machine (SVM), and k-nearest neighbor (KNN). The evaluation involved k-fold cross-validation, receiver operating characteristic (ROC) analysis, calibration curves, decision curve analysis (DCA), and external validation. Results: XGBoost excelled in its performance for predictive models. ROC analysis showed high accuracy for XGBoost, with area under the curve (AUC) scores of 0.976 for the training set and 0.906 for the validation set. K-fold cross-validation confirmed the model's stability, and calibration curves indicated high predictive accuracy. Additionally, DCA highlighted XGBoost's superior patient benefits for intervention treatments. An AUC of 0.77 in external validation demonstrated XGBoost's strong generalization ability. Conclusion: The XGBoost-fueled predictive model for post-surgery colon cancer patients proved highly effective. It underlined gastroparesis as a significant post-operative issue, associated with advanced age, prolonged surgeries, extensive intraoperative blood loss, surgical techniques, low serum protein levels, anemia, diabetes, and hypothyroidism. [ABSTRACT FROM AUTHOR]

Background: Although it is thought that prostatitis or benign prostatic hyperplasia (BPH) is related to prostate cancer (PCa), the underlying causal effects of these diseases are unclear. Methods: We assessed the causal relationship between prostatitis or BPH and PCa using a two-sample Mendelian randomization (MR) approach. The data utilized in this study were sourced from genome-wide association study. The association of genetic variants from cohorts of prostatitis or BPH and PCa patients was determined using inverse-variance weighted and MR Egger regression techniques. The direction of chance was determined using independent genetic variants with genome-wide significance (P < 5 × 10–6). The accuracy of the results was confirmed using sensitivity analyses. Results: MR analysis showed that BPH had a significant causal effect on PCa (Odds Ratio = 1.209, 95% Confidence Interval: 0.098–0.281, P = 5.079 × 10− 5) while prostatitis had no significant causal effect on PCa (P > 0.05). Additionally, the pleiotropic test and leave-one-out analysis showed the two-sample MR analyses were valid and reliable. Conclusions: This MR study supports that BPH has a positive causal effect on PCa, while genetically predicted prostatitis has no causal effect on PCa. Nonetheless, further studies should explore the underlying biochemical mechanism and potential therapeutic targets for the prevention of these diseases. [ABSTRACT FROM AUTHOR]

The high lethality caused by paraquat (PQ) poisoning has attracted much attention in public and human health due to its high toxicity and lethality. However, the understanding of the mechanism of PQ-induced apoptosis from the perspective of organelles, especially inter-organelle interactions, is still scarce. Exploring the linkage of multiple organelles during PQ poisoning and the molecular mechanisms of PQ poisoning under its mediation will help to gain insight into the mode of PQ poisoning at the organelle level. In this study, we observed that a certain dose of PQ gavage induced oxidative stress, mitochondrial dysfunction and endoplasmic reticulum stress in rat lung tissue cells. PQ toxicity led to the occurrence of Ca 2+ overload in the endoplasmic reticulum, and the activated BIP and CHOP pathways directly/indirectly led to the expression of apoptogenic factors Caspase family factors. In addition, PQ promoted Ca 2+ release from the endoplasmic reticulum and Ca 2+ uptake by mitochondria, which induced the disruption of Bax/Bcl-2 channel proteins in response to the IP 3 R/RyR/VDAC1&2/MCU Ca 2+ axis thereby leading to the release of CytoC, which ultimately induced endoplasmic reticulum stress and apoptotic cell death. In addition, 10 differential proteins were screened and validated by proteomics that may act as upstream and downstream active factors of mitochondria-endoplasmic reticulum interaction-mediated biotoxicity. Our findings provide new perspectives for researchers to explore the toxicity mechanisms of PQ to reduce their adverse effects., Competing Interests: Declarations Conflict of interest This manuscript has not been published in whole or in part and is not being considered for publication elsewhere. This manuscript does not violate or infringe upon any existing copyright/s or license/s from any third party. All authors contributed significantly to the work and are in agreement with the content of the manuscript. There are no conflicts of interests. Ethical Approval This manuscript contains any studies with animals performed by any of the authors. The experimental patients followed the regulations of the Experimental Ethics Committee of the Tianjin First Central Hospital. Consent for publication This manuscript has not been published in whole or in part and is not being considered for publication elsewhere. This manuscript does not violate or infringe upon any existing copyright/s or license/s from any third party. All authors contributed significantly to the work and are in agreement with the content of the manuscript. All the authors gave their consent to the publication of this manuscript., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Purpose: Several studies have investigated the association between anorexia nervosa and polymorphisms of genes regulating serotonin neurotransmission, with a focus on the rs6311 polymorphism of 5-HTR2A. However, inconsistent results of these studies and conflicting conclusions of existing meta-analyses complicate the understanding of a possible association. We have updated these results and evaluated the involvement of other serotonin receptor gene polymorphisms in anorexia nervosa. Methods: Adhering to PRISMA guidelines, we have searched studies on anorexia nervosa and serotonin-regulating genes published from 1997 to 2022, selected those concerning receptor genes and meta-analyzed the results from twenty candidate gene studies on the 5-HTR2A rs6311 polymorphism and the 5-HTR2C rs6318 polymorphism. Results: Present analyses reveal an association for the 5-HTR2A rs6311 polymorphism, with G and A alleles, across eighteen studies (2049 patients, 2877 controls; A vs. G allele, Odds Ratio = 1.24; 95% Confidence Interval = 1.06–1.47; p = 0.009). However, after geographic subgrouping, an association emerged only in a Southern European area, involving five studies (722 patients, 773 controls; A vs. G allele, Odds Ratio = 1.82; 95% Confidence Interval = 1.41–2.37; p < 0.00001). No association was observed for the 5-HTR2C rs6318 polymorphism across three studies. Conclusions: To date, the involvement in the pathophysiology of anorexia nervosa of the 5-HTR2A rs6311 polymorphism appears limited to a specific genetic and/or environmental context, while that of the 5-HTR2C rs6318 polymorphism seems excluded. Genome-wide association studies and epigenetic studies will likely offer deeper insights of genetic and environmental factors possibly contributing to the disorder. Level of evidence: III Evidence obtained from well-designed cohort or case–control analytic studies. Clinical trial registration PROSPERO registration number: CRD42021246122. [ABSTRACT FROM AUTHOR]

Purpose: We assessed the risk of death from prostate cancer (PCa) in relation to men's screening histories, i.e., screening attendance among men who were offered screening. Methods: Men in the Finnish Randomized Study of Screening for Prostate Cancer (FinRSPC) screening arm were invited to up to three screening rounds with the serum prostate-specific antigen (PSA) test at 4-year intervals during 1996–2007. Case subjects (n = 330) were men who died from PCa. Each case was matched to five controls (n = 1544) among the men who were free of PCa. Screening history was defined as (1) never/ever attended screening prior to the case diagnosis; (2) attended at the first screening round; and (3) recency of screening, calculated as the time from last screening attendance to the date of case diagnosis. The association between screening history and the risk of death from PCa was estimated by odds ratios (OR) with 95% confidence intervals (CI) using conditional logistic regression. Results: Having ever attended screening versus never attended was associated with a reduced risk of PCa death (OR 0.60, 95% CI 0.45–0.81) and a similar association was found for those attended (versus not attended) the first screening round (OR 0.67, 95% CI 0.51–0.87). The effect by time since last screen for the risk of PCa death was significantly lower 2–7 years since last screen. Conclusion: Among men invited to screening, subjects who attended any PSA screening during the previous 19 years had a 40% reduction in PCa mortality compared to non-screened men. [ABSTRACT FROM AUTHOR]

Background: The incidence of prostate cancer is increasing in older males globally. Age, ethnicity, and family history are identified as the well-known risk factors for prostate cancer, but few modifiable factors have been firmly established. The objective of this study was to identify and evaluate various factors modifying the risk of prostate cancer reported in meta-analyses of prospective observational studies and mendelian randomization (MR) analyses. Methods and findings: We searched PubMed, Embase, and Web of Science from the inception to January 10, 2022, updated on September 9, 2023, to identify meta-analyses and MR studies on prostate cancer. Eligibility criteria for meta-analyses were (1) meta-analyses including prospective observational studies or studies that declared outcome-free at baseline; (2) evaluating the factors of any category associated with prostate cancer incidence; and (3) providing effect estimates for further data synthesis. Similar criteria were applied to MR studies. Meta-analysis was repeated using the random-effects inverse-variance model with DerSimonian—Laird method. Quality assessment was then conducted for included meta-analyses using AMSTAR-2 tool and for MR studies using STROBE-MR and assumption evaluation. Subsequent evidence grading criteria for significant associations in meta-analyses contained sample size, P values and 95% confidence intervals, 95% prediction intervals, heterogeneity, and publication bias, assigning 4 evidence grades (convincing, highly suggestive, suggestive, or weak). Significant associations in MR studies were graded as robust, probable, suggestive, or insufficient considering P values and concordance of effect directions. Finally, 92 selected from 411 meta-analyses and 64 selected from 118 MR studies were included after excluding the overlapping and outdated studies which were published earlier and contained fewer participants or fewer instrument variables for the same exposure. In total, 123 observational associations (45 significant and 78 null) and 145 causal associations (55 significant and 90 null) were categorized into lifestyle; diet and nutrition; anthropometric indices; biomarkers; clinical variables, diseases, and treatments; and environmental factors. Concerning evidence grading on significant associations, there were 5 highly suggestive, 36 suggestive, and 4 weak associations in meta-analyses, and 10 robust, 24 probable, 4 suggestive, and 17 insufficient causal associations in MR studies. Twenty-six overlapping factors between meta-analyses and MR studies were identified, with consistent significant effects found for physical activity (PA) (occupational PA in meta: OR = 0.87, 95% CI: 0.80, 0.94; accelerator-measured PA in MR: OR = 0.49, 95% CI: 0.33, 0.72), height (meta: OR = 1.09, 95% CI: 1.06, 1.12; MR: OR = 1.07, 95% CI: 1.01, 1.15, for aggressive prostate cancer), and smoking (current smoking in meta: OR = 0.74, 95% CI: 0.68, 0.80; smoking initiation in MR: OR = 0.91, 95% CI: 0.86, 0.97). Methodological limitation is that the evidence grading criteria could be expanded by considering more indices. Conclusions: In this large-scale study, we summarized the associations of various factors with prostate cancer risk and provided comparisons between observational associations by meta-analysis and genetically estimated causality by MR analyses. In the absence of convincing overlapping evidence based on the existing literature, no robust associations were identified, but some effects were observed for height, physical activity, and smoking. Huijie Cui and team identify and evaluate various risk factors of prostate cancer reported in meta-analyses of prospective observational studies and Mendelian randomization analyses. Author summary: Why was this study done?: The incidence of prostate cancer is increasing with the growing trend of aging globally. Effective preventions and interventions for prostate cancer require better understandings of its etiology. The well-known risk factors for prostate cancer are age, ethnicity, and family history, but few modifiable factors have been firmly established. What did the researchers do and find?: Our study extensively collected, evaluated, and compared the current observational and genetic evidence for various factors modifying the risk of prostate cancer based on meta-analyses and Mendelian randomization (MR) studies. Totally 123 observational associations (45 significant and 78 null) from 92 meta-analyses and 145 causal associations (55 significant and 90 null) from 64 MR studies were identified and categorized into lifestyle; diet and nutrition; anthropometric indices; biomarkers; clinical variables, diseases, and treatments; and environmental factors. Concerning evidence grading on significant associations, there were 5 highly suggestive, 36 suggestive, and 4 weak associations in meta-analyses, and 10 robust, 24 probable, 4 suggestive, and 17 insufficient causal associations in MR studies. Consistent significant associations between meta-analysis and MR studies were found for physical activity, height, and smoking, which however were not robust. What do these findings mean?: Most included cohort studies were conducted in developed western countries, and hence the findings in this study are limited for mainly European descendants. The comparison between observational associations by meta-analysis and genetically estimated causality by MR analyses does not provide robust evidence due to the lack of overlapping associations and high-quality evidence, especially in MR studies. Evidence grading criteria for meta-analyses could be further improved by adding more indices such as magnitude of effect size and different levels of sample size. [ABSTRACT FROM AUTHOR]

Objective The study's objective was to explore Filipino physical therapists' views on social responsibility and the competencies it entails. Methods This study employed a constructivism-based qualitative design to inquire into the perspectives of physical therapist leaders and practitioners in the Philippines on Filipino physical therapists' social responsibility. Leaders were invited for their macro perspectives and influence on the profession; practitioners were invited to provide more practical viewpoints. Participants were interviewed one-on-one online. Interviews were transcribed, translated to English, and subjected to thematic analysis. Results Sixteen participants agreed to share their perspectives. Six themes were generated. Participants viewed the social responsibility of physical therapists in the Philippines as a professional duty that requires altruistic and social justice motivations. Socially responsible actions should address pressing issues affecting Filipino people's access to physical therapy and experience of health. Conclusion The social responsibility of physical therapists in the Philippines entails engaging in roles aside from clinical practice to contribute to Filipino people's attainment of health. This calls for the expansion of their ethical and practice frameworks to include addressing not only client issues, but also the wider societal barriers to equitable access to physical therapy and better experiences of health. Impact This study contributes to professional discourse on the increasing importance of social responsibility in the physical therapist profession amidst increasing rehabilitation needs and growing concerns on health inequity locally and globally, especially as worsened by the novel coronavirus disease (COVID-19) pandemic. It informs the development of a societal practice framework for physical therapists in the Philippines and the desired changes in physical therapist policies and education to facilitate fulfillment of their societal obligations. [ABSTRACT FROM AUTHOR]

Colorectal cancer (CRC) is one of themost lethal human malignancies, and with the growth of societies and lifestyle changes, the rate of people suffering from it increases yearly. Important factors such as genetics, family history, nutrition, lifestyle, smoking, and alcohol can play a significant role in increasing susceptibility to this cancer. On the other hand, themetabolism of several macromolecules is also involved in the fate of tumors and immune cells. The evidence discloses that cholesterol and its metabolism can play a role in the pathogenesis of several cancers because there appears to be an association between cholesterol levels and CRC, and cholesterol-lowering drugs may reduce the risk. Furthermore, changes or mutations of some involved genes in cholesterol metabolism, such as CYP7A1 as well as signaling pathways, such as mitogen-activated protein kinase (MAPK), can play a role in CRC pathogenesis. This review summarized and discussed the role of cholesterol in the pathogenesis of CRC as well as available cholesterolrelated therapeutic approaches in CRC. [ABSTRACT FROM AUTHOR]

Each year, floods are one of the most common natural disasters, wreaking havoc on ecosystems, human settlements, and individual lives all around the globe. Numerous factors, including flood intensity, amplitude, frequency, flow duration, changes in river course and geometry, etc., affect flooding's effectiveness. Shannon's entropy, frequency ratio, and weight of evidence have been used to identify flood susceptibility in the Kopai river basin. According to the results of these three models, the upper reach of the basin is comprised of non-flooded areas, while the lower part of the basin is home to extensive flooding. This makes the lower part of the basin more susceptible than the upper part. The final result of flood susceptibility zones is obtained using 11 thematic layers such as rainfall, soil moisture index, soil types, surface roughness,distance to the river, elevation, slope, drainage density, land use and land cover, normalised difference vegetation index, and normalized difference water index. Receiver operating characteristics curves have been produced using test data consisting of 370 data points to determine the validation of the models. The validation result demonstrates that the frequency ratio is 96.5% accurate. The weight of the evidence is 97.1% reliable, whereas Shannon entropy provides just 91.2% acuracy. Weight of evidence is therefore the best model for flood susceptibility zones identification for this Kopai river basin. [ABSTRACT FROM AUTHOR]

Determining whether repetitive head impacts (RHI) cause the development of chronic traumatic encephalopathy (CTE)-neuropathological change (NC) and whether pathological changes cause clinical syndromes are topics of considerable interest to the global sports medicine community. In 2022, an article was published that used the Bradford Hill criteria to evaluate the claim that RHI cause CTE. The publication garnered international media attention and has since been promoted as definitive proof that causality has been established. Our counterpoint presents an appraisal of the published article in terms of the claims made and the scientific literature used in developing those claims. We conclude that the evidence provided does not justify the causal claims. We discuss how causes are conceptualised in modern epidemiology and highlight shortcomings in the current definitions and measurement of exposures (RHI) and outcomes (CTE). We address the Bradford Hill arguments that are used as evidence in the original review and conclude that assertions of causality having been established are premature. Members of the scientific community must be cautious of making causal claims until the proposed exposures and outcomes are well defined and consistently measured, and findings from appropriately designed studies have been published. Evaluating and reflecting on the quality of research is a crucial step in providing accurate evidence-based information to the public., Competing Interests: Declarations. Funding: Open Access funding enabled and organized by CAUL and its Member Institutions. Conflicts of Interest: Lauren V Fortington, Ph.D, is supported through research grant funding at Edith Cowan University. She has received project funding from several sports, health and government agencies including: Australian Football League, Australian Institute of Health and Welfare, Australian Institute of Sport, Combat Sport Commission Western Australia, Cricket Australia, Defence Science WA, Exercise & Sports Science Australia, Injury Matters, International Olympic Committee, KidSafe WA, Rugby Australia, State Government of Victoria and VicSport. Lauren Fortington is an editorial board member of Sports Medicine. She was not involved in any of the editorial process or decisions for this manuscript. J. David Cassidy, PhD, Dr.Med.Sc., has received funds for expert testimony on long-term consequences of injuries, including TBI and sports concussions. He has received funding from various organizations in Canada, the USA, Sweden and Denmark to study traffic injuries and to undertake and publish systematic reviews on head and neck injuries. Rudolph J. Castellani, MD, is a collaborator on a grant funded by the National Football League to study the spectrum of concussion, including possible long-term effects. He has a consulting practice in forensic neuropathology, including expert testimony, which has involved former athletes at amateur and professional levels as well as sport organizations. He was reimbursed for hotel costs at the World Rugby Medical Commission Conference in 2022. Andrew J Gardner, PhD, has a clinical practice in neuropsychology involving individuals who have sustained sport-related concussion. He is a contracted concussion consultant to Rugby Australia. He has received travel funding or been reimbursed by professional sporting bodies, and commercial organisations for discussing or presenting sport-related concussion research at meetings, scientific conferences, workshops and symposiums. He is a member of the World Rugby Concussion Working Group, and a member of the Australian Football League Concussion Scientific Advisory Committee. He is currently supported by a National Health and Medical Research Council (NHMRC) investigator grant. He acknowledges unrestricted philanthropic support from the Tooth Foundation for concussion research and the National Rugby League for research in former professional rugby league players. Andrew McIntosh, PhD, is a self-employed consultant in biomechanics and ergonomics. His 1995 PhD was on the topic of head injury biomechanics. He commenced research on concussion in sport in the late 1990s. He has worked in the area of head injury biomechanics and prevention for 30 years. He holds two adjunct (honorary) academic appointments. As a university academic (employee and honorary), he has been awarded research grants paid to the university to fund research on sports injuries. Funding has been received from a range of national and international sporting organisations. As a consultant, he has been paid to assist a range of state, national and international organisations on injury biomechanics and safety, including concussion in sport and its prevention. His paid employment includes expert testimony on injury causation. Michael Austen has no conflicts of interest to declare. Zachary Yukio Kerr, PhD, acknowledges previous support from the Center for Disease Control and Prevention, National Institutes of Health, Department of Defense, National Football League, National Collegiate Athletic Association and National Operating Committee on Standards for Athletic Equipment. Kenneth L Quarrie, PhD, has been employed by New Zealand Rugby since 2000 and currently occupies the role of Chief Scientist, New Zealand Rugby. He also sits on World Rugby’s Scientific Committee and has contributed to various World Rugby working groups focussed on player welfare issues from 2011 to the time of publication. He has received funding for travel and accommodation from World Rugby to present at their medical conferences and meetings. He is the co-principal investigator on the Kumanu Tāngata project, a retrospective cohort study funded by World Rugby and the New Zealand Rugby Foundation. The purpose of the Kumanu Tāngata project is to investigate long-term health outcomes associated with participation in first-class rugby (provincial level and above) in New Zealand. Authors' Contributions: L.V.F. and K.L.Q. drafted the manuscript together with input from all authors on their specific areas of expertise. All authors have read and approved the final manuscript., (© 2024. The Author(s).)

Introduction: The Amyloid/Tau/Neurodegeneration (ATN) framework was proposed to identify the preclinical biological state of Alzheimer's disease (AD). We investigated whether ATN phenotype can be predicted using routinely collected research cohort data. Methods: 927 EPAD LCS cohort participants free of dementia or Mild Cognitive Impairment were separated into 5 ATN categories. We used machine learning (ML) methods to identify a set of significant features separating each neurodegeneration-related group from controls (A-T-(N)-). Random Forest and linear-kernel SVM with stratified 5-fold cross validations were used to optimize model whose performance was then tested in the ADNI database. Results: Our optimal results outperformed ATN cross-validated logistic regression models by between 2.2% and 8.3%. The optimal feature sets were not consistent across the 4 models with the AD pathologic change vs controls set differing the most from the rest. Because of that we have identified a subset of 10 features that yield results very close or identical to the optimal. Discussion: Our study demonstrates the gains offered by ML in generating ATN risk prediction over logistic regression models among pre-dementia individuals. [ABSTRACT FROM AUTHOR]

Drosophila melanogaster is a valuable model organism for a wide range of biological exploration. The well-known advantages of D. melanogaster include its relatively simple biology, the ease with which it is genetically modified, the relatively low financial and time costs associated with their short gestation and life cycles, and the large number of offspring they produce per generation. D. melanogaster has facilitated the discovery of many significant insights into the pathology of Parkinson's disease (PD) and has served as an excellent preclinical model of PD-related therapeutic discovery. In this review, we provide an overview of the major D. melanogaster models of PD, each of which provide unique insights into PD-relevant pathology and therapeutic targets. These models are discussed in the context of their past, current, and future potential use for studying the utility of secondary metabolites as therapeutic agents in PD. Over the last decade, senolytics have garnered an exponential interest in their ability to mitigate a broad spectrum of diseases, including PD. Therefore, an emphasis is placed on the senolytic and senomorphic properties of secondary metabolites. It is expected that D. melanogaster will continue to be critical in the effort to understand and improve treatment of PD, including their involvement in translational studies focused on secondary metabolites. [ABSTRACT FROM AUTHOR]

Background: Dietary intake has been shown to have a causal relationship with various lung diseases, such as lung cancer and asthma. However, the causal relationship between dietary intake and idiopathic pulmonary fibrosis (IPF) remains unclear. We conducted a two-sample Mendelian Randomization (MR) study to investigate the causal relationship between dietary intake and IPF. Methods: The exposure datasets included meat, fruit, vegetable, and beverage intake from the UK Biobank. IPF data came from the EBI database of 451,025 individuals. All data in this study were obtained from the IEU Open GWAS Project. The inverse variance weighted (IVW), MR-Egger, and weighted median methods were used as the primary methods. Sensitivity analyses were performed to ensure the validity of the results. Results: Oily fish intake [odds ratio (OR):0.995; 95% confidence interval (CI): 0.993–0.998; p = 6.458E-05] and Dried fruit intake (OR:0.995;95%CI:0.991–0.998; p = 0.001) were discovered as protective factors. There was also a suggestive correlation between Beef intake (OR:1.006;95%Cl:1.001–1.012; p = 0.023) and IPF. Sensitivity analysis did not reveal any contradictory results. No causal relationship was found between IPF and the rest of the dietary exposures. Conclusions: Our study found that Oily fish and Dried fruit intake were associated with the risk of IPF, while Beef intake was suggestively associated with the risk of IPF. Other studies are still needed to confirm the results in the future. [ABSTRACT FROM AUTHOR]

The study aimed to assess the prevalence of spin in the titles and abstracts of randomized controlled trials (RCTs) in dental caries with statistically nonsignificant primary outcomes and to assess the risk indicators which may be associated with spin. Any original publication reporting a two-arm RCT in dental caries with clearly identified statistically nonsignificant primary outcomes published from January 1, 2015, until October 28, 2022, were included. PubMed was searched electronically to identify the eligible publications. The prevalence of spin in titles and abstracts were assessed and categorized into spin patterns based on a predetermined classification scheme. The association between spin and the potential risk indicators at study, author, journal, institutional, and national levels was assessed. A total of 234 eligible RCT publications were included. The prevalence of spin in the titles and abstracts was 3% (95% confidence interval [CI]: 2–6%) and 79% (95% CI: 74–84%), respectively. The most common spin patterns in the results and conclusion sections, respectively, were results focusing on statistically significant within-group comparisons (23%), and conclusions focusing only on statistically significant results without acknowledgment of statistically nonsignificant results for the primary outcomes (26%). The spin was significantly associated with number of study centers (single-center vs. multicenter) (OR = 2.131; 95% CI: 1.092–4.158; p = 0.03), trial designs (nonparallel designs vs. parallel designs) (OR = 0.395; 95% CI: 0.193–0.810; p = 0.01), and overall H index of institutions for last authors (OR = 0.998; 95% CI: 0.996–0.999; p < 0.01), while it was not significantly associated with the other indicators. In the RCT publications with statistically nonsignificant results for primary outcomes in dental caries, the prevalence of spin may be low in the titles but high in the abstracts. Single-center studies with parallel designs and a lower overall H index of institutions for last authors may be more likely to have spin in the abstracts. [ABSTRACT FROM AUTHOR]

The bioethics literature has paid little attention to matters of informed reproductive decision-making among women of childbearing age who have chronic kidney disease (CKD), including women who are on dialysis or women who have had a kidney transplant. Women with CKD receive inconsistent and, sometimes, inadequate reproductive counseling, particularly with respect to information about pursuing pregnancy. We identify four factors that might contribute to inadequate and inconsistent reproductive counseling. We argue that women with CKD should receive comprehensive reproductive counseling, including information about the possibility of pursuing pregnancy, and that more rigorous research on pregnancy in women with CKD, including women on dialysis or who have received a kidney transplant, is warranted to improve informed reproductive decision making in this population. [ABSTRACT FROM AUTHOR]

Introduction: The bioethics literature reflects significant interest in and concern with the use of genetic and genomic information in various settings. Because psychiatric treatment and research raises unique ethical, legal, and social issues, we conducted a scoping review of the biomedical, bioethics, and psychology literature regarding the application of genetic and genomic tools to psychiatric disorders (as listed in the DSM-5) and two associated behaviors or symptoms to provide a more detailed overview of the state of the field. Objectives: The primary objective was to examine the available bioethics, biomedical, and psychology literature on applying genetic and genomic tools to psychiatric disorders (other than neurodevelopmental disorders) and two behaviors or symptoms sometimes associated with them (aggression or violence and suicidality) to identify the disorders to which these tools have been applied, the contexts in or purposes for which they have been applied, the ethical, legal, or social concerns associated with those uses, and proposed recommendations for mitigating those concerns. Methods: We used Arksey and O'Malley's scoping review framework: (1) identify the research question; (2) identify relevant studies; (3) select studies; (4) chart the data; and (5) collate, summarize, and report results (2005). We relied on Levac et al. to inform our application of the framework (2010). The PRISMA extension for scoping reviews checklist informed our reporting (2018). We searched three electronic databases MEDLINE (PubMed), Embase, and PsycInfo (EbscoHost) for peer-reviewed journal articles in English to identify relevant literature. One author screened the initial results and additional screening was done in consultation with other authors. A data extraction form using DSM-5 diagnostic categories (excluding neurodevelopmental disorders) was developed and two authors independently each reviewed approximately half of the articles. Inter-rater reliability was ensured by double-coding approximately 10% of the papers. An additional author independently coded 10% of the articles to audit the data. Results: In 365 coded publications, we identified 15 DSM-5 diagnostic categories in addition to the two pre-selected behaviors or symptoms (aggression or violence and suicidality) to which genetic or genomic tools have been applied. We identified 11 settings in or purposes for which these tools were applied. Twenty-two types of ethical, legal, or social concerns associated with the application of genetic or genomic tools to these disorders or behaviors/symptoms were identified along with 13 practices or policies that could mitigate these concerns. Conclusion: Genetic and genomic tools have been applied to a wide range of psychiatric disorders. These raise a range of ethical, legal, and social concerns. Additional research is warranted to better understand the concerns and effective ways to address them. Advancing the literature to identify relevant ethical, legal, or social concerns and solutions to those problems likely requires greater attention to specific applications of genetic or genomic tools to particular psychiatric disorders and associated behaviors/symptoms as well as broad stakeholder engagement. [ABSTRACT FROM AUTHOR]

Purpose of Review: This review summarizes recent evidence published since a previous review in 2018 on the association between egg consumption and risk of cardiovascular disease (CVD) mortality, CVD incidence, and CVD risk factors. Recent Findings: No recent randomized controlled trials were identified. Evidence from observational studies is mixed, with studies reporting either an increased risk or no association of highest egg consumption with CVD mortality, and a similar spread of increased risk, decreased risk, or no association between egg intake and total CVD incidence. Most studies reported a reduced risk or no association between egg consumption and CVD risk factors. Included studies reported low and high egg intake as between 0 and 1.9 eggs/week and 2 and ≥14 eggs/week, respectively. Ethnicity may influence the risk of CVD with egg consumption, likely due to differences in how eggs are consumed in the diet rather than eggs themselves. Summary: Recent findings are inconsistent regarding the possible relationship between egg consumption and CVD mortality and morbidity. Dietary guidance should focus on improving the overall quality of the diet to promote cardiovascular health. [ABSTRACT FROM AUTHOR]

Purpose: The 2020 Dietary Guidelines Advisory Committee specifically noted that meal frequency is associated with risks for cardiovascular disease, type 2 diabetes, and all-cause mortality, although the current evidence on meal frequency is conflicting. As meal frequency itself is affected by various factors, the aim of the study was not only to examine its relationships with cardiometabolic risk but also to identify the mediating effects of dietary quality. Methods: This study used a descriptive correlational design. In all 8,141 healthy adults participated in the study. Measurements included meal frequency, cardiometabolic risk, and diet quality. Data were analyzed using descriptive statistics, Pearson's correlation coefficient analysis, and process macro bootstrapping model 4. Results: The meal frequency was 3.52±0.61 times per day, the risk of cardiovascular metabolic diseases was 0.01±0.61 points, and the diet quality was 62.08±13.87 points. In mediation analysis, the effect of meal frequency on cardiometabolic risk score was completely mediated by diet quality. Conclusion: Improved diet quality in healthy adults should be considered when designing meal frequency interventions aimed at reducing their cardiometabolic risk, as the effect of meal frequency support on cardiometabolic risk was found to be mediated by diet quality. [ABSTRACT FROM AUTHOR]

Multiple myeloma (MM) is an incurable plasma cell malignancy, which is predominantly a disease of older adults (the median age at diagnosis is 70 years). The slow progression from asymptomatic stages and the late-onset of MM suggest fundamental differences compared to many other hematopoietic system-related malignancies. The concept discussed in this review is that age-related changes at the level of terminally differentiated plasma cells act as the main risk factors for the development of MM. Epigenetic and genetic changes that characterize both MM development and normal aging are highlighted. The relationships between cellular aging processes, genetic mosaicism in plasma cells, and risk for MM and the stochastic processes contributing to clonal selection and expansion of mutated plasma cells are investigated. In line with the DNA damage accumulation theory of aging, in this review, the evolution of monoclonal gammopathy to symptomatic MM is considered. Therapeutic consequences of age-dependent comorbidities that lead to frailty and have fundamental influence on treatment outcome are described. The importance of considering geriatric states when planning the life-long treatment course of an elderly MM patient in order to achieve maximal therapeutic benefit is emphasized. [ABSTRACT FROM AUTHOR]

Severe malaria is a potentially fatal condition that requires urgent treatment. In a clinical trial, a sub-group of children treated with rectal artesunate (RAS) before being referred to a health facility had an increased chance of survival. We recently published in BMC Medicine results of the CARAMAL Project that did not find the same protective effect of pre-referral RAS implemented at scale under real-world conditions in three African countries. Instead, CARAMAL identified serious health system shortfalls that impacted the entire continuum of care, constraining the effectiveness of RAS. Correspondence to the article criticized the observational study design and the alleged interpretation and consequences of our findings. Here, we clarify that we do not dispute the life-saving potential of RAS, and discuss the methodological criticism. We acknowledge the potential for confounding in observational studies. Nevertheless, the totality of CARAMAL evidence is in full support of our conclusion that the conditions under which RAS can be beneficial were not met in our settings, as children often failed to complete referral and post-referral treatment was inadequate. The criticism did not appear to acknowledge the realities of highly malarious settings documented in detail in the CARAMAL project. Suggesting that trial-demonstrated efficacy is sufficient to warrant large-scale deployment of pre-referral RAS ignores the paramount importance of functioning health systems for its delivery, for completing post-referral treatment, and for achieving complete cure. Presenting RAS as a "magic bullet" distracts from the most urgent priority: fixing health systems so they can provide a functioning continuum of care and save the lives of sick children. The data underlying our publication is freely accessible on Zenodo. [ABSTRACT FROM AUTHOR]

Importance: Statin use prior to hospitalization for Coronavirus Disease 2019 (COVID-19) is hypothesized to improve inpatient outcomes including mortality, but prior findings from large observational studies have been inconsistent, due in part to confounding. Recent advances in statistics, including incorporation of machine learning techniques into augmented inverse probability weighting with targeted maximum likelihood estimation, address baseline covariate imbalance while maximizing statistical efficiency. Objective: To estimate the association of antecedent statin use with progression to severe inpatient outcomes among patients admitted for COVD-19. Design, setting and participants: We retrospectively analyzed electronic health records (EHR) from individuals ≥ 40-years-old who were admitted between March 2020 and September 2022 for ≥ 24 h and tested positive for SARS-CoV-2 infection in the 30 days before to 7 days after admission. Exposure: Antecedent statin use—statin prescription ≥ 30 days prior to COVID-19 admission. Main outcome: Composite end point of in-hospital death, intubation, and intensive care unit (ICU) admission. Results: Of 15,524 eligible COVID-19 patients, 4412 (20%) were antecedent statin users. Compared with non-users, statin users were older (72.9 (SD: 12.6) versus 65.6 (SD: 14.5) years) and more likely to be male (54% vs. 51%), White (76% vs. 71%), and have ≥ 1 medical comorbidity (99% vs. 86%). Unadjusted analysis demonstrated that a lower proportion of antecedent users experienced the composite outcome (14.8% vs 19.3%), ICU admission (13.9% vs 18.3%), intubation (5.1% vs 8.3%) and inpatient deaths (4.4% vs 5.2%) compared with non-users. Risk differences adjusted for labs and demographics were estimated using augmented inverse probability weighting with targeted maximum likelihood estimation using Super Learner. Statin users still had lower rates of the composite outcome (adjusted risk difference: − 3.4%; 95% CI: − 4.6% to − 2.1%), ICU admissions (− 3.3%; − 4.5% to − 2.1%), and intubation (− 1.9%; − 2.8% to − 1.0%) but comparable inpatient deaths (0.6%; − 1.3% to 0.1%). Conclusions and relevance: After controlling for confounding using doubly robust methods, antecedent statin use was associated with minimally lower risk of severe COVID-19-related outcomes, ICU admission and intubation, however, we were not able to corroborate a statin-associated mortality benefit. Key points: Question: Is statin use prior to hospital admission for COVID-19 associated with reducing severe inpatient outcomes? Findings: In this observational study using electronic health records from a multi-hospital health system in Chicago, we used robust statistical methods to account for confounding and found that adults 40 years or older who were prescribed statins prior to admission for COVID-19 had minimally lower rates of intubation and admission to the intensive care unit. However, inpatient mortality was comparable between statins users and non-users. Meaning: Consistent with current COVID-19 treatment guidelines, we did not find evidence supporting the utilization of statins for clinically significant reduction in severe inpatient COVID-19 outcomes. [ABSTRACT FROM AUTHOR]

Importance: Malignant primary brain tumors cause more than 15 000 deaths per year in the United States. The annual incidence of primary malignant brain tumors is approximately 7 per 100 000 individuals and increases with age. Five-year survival is approximately 36%. Observations: Approximately 49% of malignant brain tumors are glioblastomas, and 30% are diffusely infiltrating lower-grade gliomas. Other malignant brain tumors include primary central nervous system (CNS) lymphoma (7%) and malignant forms of ependymomas (3%) and meningiomas (2%). Symptoms of malignant brain tumors include headache (50%), seizures (20%-50%), neurocognitive impairment (30%-40%), and focal neurologic deficits (10%-40%). Magnetic resonance imaging before and after a gadolinium-based contrast agent is the preferred imaging modality for evaluating brain tumors. Diagnosis requires tumor biopsy with consideration of histopathological and molecular characteristics. Treatment varies by tumor type and often includes a combination of surgery, chemotherapy, and radiation. For patients with glioblastoma, the combination of temozolomide with radiotherapy improved survival when compared with radiotherapy alone (2-year survival, 27.2% vs 10.9%; 5-year survival, 9.8% vs 1.9%; hazard ratio [HR], 0.6 [95% CI, 0.5-0.7]; P <.001). In patients with anaplastic oligodendroglial tumors with 1p/19q codeletion, probable 20-year overall survival following radiotherapy without vs with the combination of procarbazine, lomustine, and vincristine was 13.6% vs 37.1% (80 patients; HR, 0.60 [95% CI, 0.35-1.03]; P =.06) in the EORTC 26951 trial and 14.9% vs 37% in the RTOG 9402 trial (125 patients; HR, 0.61 [95% CI, 0.40-0.94]; P =.02). Treatment of primary CNS lymphoma includes high-dose methotrexate-containing regimens, followed by consolidation therapy with myeloablative chemotherapy and autologous stem cell rescue, nonmyeloablative chemotherapy regimens, or whole brain radiation. Conclusions and Relevance: The incidence of primary malignant brain tumors is approximately 7 per 100 000 individuals, and approximately 49% of primary malignant brain tumors are glioblastomas. Most patients die from progressive disease. First-line therapy for glioblastoma is surgery followed by radiation and the alkylating chemotherapeutic agent temozolomide. This review summarizes current evidence regarding diagnosis and treatment of primary malignant brain tumors in adults. [ABSTRACT FROM AUTHOR]

In this paper, we take a framing perspective to corporate environmental irresponsibility and focus it on the community of place as one among the most affected, yet rarely examined, stakeholders. In particular, we take a framing microprocess perspective, to study how interactions within a community of place affect a mobilization after corporate environmental irresponsibility. We elicit two framing microprocess, losses display and scale augmentation, and show how they significantly, though differently, affect a mobilization. In so doing, we enrich our understanding of how communities of place mobilize, the types of, and venues, where interactions take place in a community of place—and how these affect a mobilization. [ABSTRACT FROM AUTHOR]

Research fellowship programs help medical graduates acquire research skills for an academic career. While our institution employed a large number of research fellows, it did not offer them a formal training program. This study aimed to assess the views of fellows and their mentors regarding the current research fellowship program, and to seek their suggestions for a formal training program at our medical center. We conducted a qualitative descriptive study using both focus group discussions and individual interviews with research fellows, and individual interviews with their mentors. We recruited all eligible participants by email. We collected data in person and analyzed it thematically. We followed the consolidated criteria for reporting of qualitative research (COREQ) checklist. A total of 17 research fellows and 17 mentors participated in the study. Participants described the current non-formal program and proposed suggestions for a formal training program. The identification of available vacant positions and the recruitment process followed an unstructured approach, through networking with mentors and previous fellows. Although there is a formal contract, there is no job description, and no definition of roles, responsibilities and rights. Some fellows get the opportunity of being involved in all aspects of research and benefit from a favorable mentor-mentee relationship. Conversely, others struggle with authorship and with the projects allocated to them, some being "non-research" related. Not all fellows end up publishing their projects. Participants provided suggestions to shift into a formal training, including measures to improve on the recruitment process of fellows, defining roles and exposure to all aspects of research. Research fellows are eager to learn, but the currently available program is unstructured. They need a formal training program that meets their expectations, one that offers equitable learning opportunities and benefits to all. [ABSTRACT FROM AUTHOR]

The article highlights the health effect of smoking from the U.S. Surgeon General report in 1964. Topics mentioned include the method use in the creation of the advisory committee to the U.S. Surgeon General, the criteria used in the assessment of the epidemiology of the link of smoking and a disease, the definition of causality, the mortality ratios for smokers, and the impact on tobacco smokers' beliefs and behavior.

Risk-based genetic tests are often used to determine cancer risk, when to initiate screening, and frequency of screening, but rely on interest in genetic testing. We examined overall interest in genetic testing for cancer risk assessment and willingness to change behavior, and whether these are affected by demographic or socioeconomic factors. We conducted a community needs health survey in 2019 among primary care and cancer patients, family members and community members in New York City. We used univariable analysis and relative risk regression to examine interest in genetic cancer risk testing and willingness to modify lifestyle behaviors in response to an informative genetic test. Of the 1225 participants, 74.0% (n = 906) expressed interest in having a genetic test to assess cancer risk. Interest in genetic testing was high across all demographic and socioeconomic groups; reported interest in genetic testing by group ranged from 65.0 (participants aged 65 years and older) to 83.6% (participants below federal poverty level). Among the 906 participants that reported interest in genetic testing, 79.6% were willing to change eating habits, 66.5% to change exercise habits, and 49.5% to lose weight in response to an informative genetic test result. Our study reveals that interest in genetic testing for cancer risk is high among patients and community members and is high across demographic and socioeconomic groups, as is the reported willingness to change behavior. Based on these results, we recommend that population-based genetic testing may result in greater reduction cancer risk, particularly among minoritized groups. [ABSTRACT FROM AUTHOR]

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Background: Pre-eclampsia is a leading cause of maternal mortality and morbidity that involves pregnancy-related stressors on the maternal cardiovascular and metabolic systems. As nutrition is important to support optimal development of the placenta and for the developing fetus, maternal diets may play a role in preventing pre-eclampsia. The purpose of this scoping review is to map the maternal nutritional deficiencies and imbalances associated with pre-eclampsia incidence and discuss evidence consistency and linkages with current understandings of the etiology of pre-eclampsia. Methods: A narrative scoping review was conducted to provide a descriptive account of available research, summarize research findings and identify gaps in the evidence base. Relevant observational studies and reviews of observational studies were identified in an iterative two-stage process first involving electronic database searches then more sensitive searches as familiarity with the literature increased. Results were considered in terms of their consistency of evidence, effect sizes and biological plausibility. Results: The review found evidence for associations between nutritional inadequacies and a greater risk of pre-eclampsia. These associations were most likely mediated through oxidative stress, inflammation, maternal endothelial dysfunction and blood pressure in the pathophysiology of pre-eclampsia. Maternal nutritional risk factors for pre-eclampsia incidence with the strongest consistency, effect and biological plausibility include vitamin C and its potential relationship with iron status, vitamin D (both on its own and combined with calcium and magnesium), and healthy dietary patterns featuring high consumption of fruits, vegetables, whole grains, fish, seafood and monounsaturated vegetable oils. Foods high in added sugar, such as sugary drinks, were associated with increased risk of pre-eclampsia incidence. Conclusion: A growing body of literature highlights the involvement of maternal dietary factors in the development of pre-eclampsia. Our review findings support the need for further investigation into potential interactions between dietary factors and consideration of nutritional homeostasis and healthy dietary patterns. Further research is recommended to explore gestational age, potential non-linear relationships, dietary diversity and social, cultural contexts of food and meals. Plain language summary: Pre-eclampsia is a condition of high blood pressure during the second half of pregnancy with signs of damage to another organ system, often the liver and kidneys. It is a serious and potentially deadly disease and is the second top cause of deaths related to pregnancy and childbirth globally. Though the exact cause of pre-eclampsia is unclear, researchers have discovered that pre-eclampsia develops through abnormal development of the placenta, which is the interface between the growing baby and the mother in the womb. The placenta helps to transfer nutrients, oxygen and waste between the mother and fetus. Nutrition has important roles to play in the development of the placenta and certain vitamins and minerals have clinical properties that may help prevent pre-eclampsia. We conducted a review to summarize observational studies on maternal nutritional risk factors associated with the development of pre-eclampsia. Promising maternal dietary factors that fit with current understandings of how pre-eclampsia develops include vitamin C and its potential relationship with iron, calcium and vitamin D. Healthy dietary patterns with high consumption of fruits, vegetables, whole grains, fish and seafood and monounsaturated vegetable oils are likely beneficial. Foods high in added sugar, such as sugary drinks, may be linked to higher rates of developing pre-eclampsia. Instead of focusing on single nutrient deficiencies, our findings support a broader approach to explore interrelationships between dietary factors and balanced healthy dietary intake for the prevention of pre-eclampsia. [ABSTRACT FROM AUTHOR]

Meat consumption has represented an important evolutionary step for humans. However, modern patterns of consumption, including excess intake, type of meat and cooking method have been the focus of attention as a potential cause of rise in non-communicable diseases. The aim of this study was to investigate the association between total, red and processed meat with health outcomes and to assess the level of evidence by performing a systematic search of meta-analyses of prospective cohort studies. Convincing evidence of the association between increased risk of (i) colorectal adenoma, lung cancer, CHD and stroke, (ii) colorectal adenoma, ovarian, prostate, renal and stomach cancers, CHD and stroke and (iii) colon and bladder cancer was found for excess intake of total, red and processed meat, respectively. Possible negative associations with other health outcomes have been reported. Excess meat consumption may be detrimental to health, with a major impact on cardiometabolic and cancer risk. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the risk profile of preterm birth (PTB) in 2018 in China. Method: A prospective multicentre case–control study was conducted in 15 hospitals located in seven provinces throughout three geographical areas (the Eastern, South‐Central and North‐Western regions) in China. A total of 3147 preterm (<37+0 weeks) and 3147 term (37+0 to 41+6 weeks) live‐birth mothers were included. Designed questionnaires were used to investigate maternal and fetal information. We calculated multivariable logistic regression and population attributable risk (PAR). Results: Iatrogenic PTB accounted for 48.1% of preterm mothers. Multivariable analysis showed PTB was significantly associated with six categories of maternal and fetal factors, adverse life‐style and psychological conditions (adjusted odds ratio (aOR) 2.063, 95% confidence interval (CI) 1.601–2.657) had the highest PAR% (60.1%). High school and below education level (PAR% = 25.8%), living in town or village (PAR% = 24.4%), low pregnant weight gain (PAR% = 16.8%), hypertensive disorders in pregnancy (aOR: 5.010, 95% CI: 4.039–6.216, PAR% = 15.3%), placental abnormality (aOR: 4.242, 95% CI: 3.454–5.211, PAR% = 14.1%) and multiple pregnancy (aOR: 10.990, 95% CI: 7.743–15.599, PAR% = 11.8%) were significantly associated with PTB with high PAR% value. Conclusion: The main risk factors for PTB in China were placental abnormality, hypertensive disorders in pregnancy and multiple pregnancy. Adverse life‐style and psychological conditions and socio‐economic disadvantage had high public health significance. [ABSTRACT FROM AUTHOR]

Background: East Asia has high suicide rates but low prevalence of mental disorders. We examined the associations between prior lifetime mental disorders (mood disorders, anxiety disorders, substance use disorders, and impulse control disorders) and subsequent suicidal behaviors (suicidal ideation and attempts in the general population and suicide plans, planned attempts, and unplanned attempts in suicidal ideators) in Taiwan. Methods: This survey applied the World Mental Health Survey Composite International Diagnostic Interview to a population representative sample of noninstitutionalized adults between 2003 and 2005. Odds ratios (ORs) obtained using discrete-time survival analysis were used to estimate population attributable fractions (PAFs) of suicidal behaviors due to lifetime mental disorders. Results: Lifetime mental illness was a significant risk factor for subsequent suicidal behaviors (except unplanned attempts among ideators) despite the relatively low prevalence of mental disorders in people with suicidality (16.1%–35.0%). Each diagnosis increased the odds of suicidal ideation. In terms of acting on suicidal ideation, mood disorders were most strongly associated with having plans (OR = 10.0; 95% confidence interval, CI 4.3–21.1), whereas substance use disorders most strongly with either planned (OR = 27.3; 95% CI 6.3–118.5) or unplanned attempts (OR = 14.5; 95% CI 1.7–121.5). PAFs of all mental disorders on suicidality lay between 20 and 30% (except 11% of unplanned attempts among ideators). Mood, anxiety, and substance use disorders had higher PAFs than impulse control disorders. Conclusions: In addition to mood disorders, considering anxiety and substance use disorders is essential in devising population-based suicide prevention strategies. [ABSTRACT FROM AUTHOR]

Background: The objective of this study was to update the association between multivitamin supplementation and total or cause‐specific mortality in a population with a high prevalence of undernutrition in China. Methods: The Linxian Dysplasia Nutrition Intervention Trial was a randomized, double‐blind, placebo‐controlled trial in which 3318 persons aged 40–69 years with esophageal squamous dysplasia were assigned to receive daily multivitamin supplementation or a placebo for 6 years and were followed for 29 years. The primary outcome was esophageal/gastric cardia cancer mortality. The data were analyzed with Cox proportional hazards regression models. Subgroup analyses were performed by common characteristics such as age and gender. Results: The cumulative total mortality was 83.5%. Multivitamin supplementation did not affect total or cause‐specific mortality in the participants as a whole (hazard ratio [HR], 0.96; 95% confidence interval [CI], 0.89–1.03). Subgroup analyses showed that no association between multivitamin supplementation and all‐cause mortality was observed in men (HR, 0.90; 95% CI, 0.81–1.01), women (HR, 1.01; 95% CI, 0.91–1.12), younger participants (HR, 0.97; 95% CI, 0.87–1.08), or older participants (HR, 0.94; 95% CI, 0.85–1.04). Significant reductions in heart disease mortality (HR, 0.64; 95% CI, 0.47–0.87) and cerebrovascular disease mortality (HR, 0.74; 95% CI, 0.56–1.00) were seen in older men. In a subgroup of younger men and a subgroup of moderate or severe dysplasia, subjects receiving multivitamin supplementation had a lower risk of esophageal/cardia cancer mortality (HR for younger men, 0.76; 95% CI, 0.58–0.99; HR for moderate or severe dysplasia, 0.76; 95% CI, 0.58–1.00). No association between multivitamin supplementation and any cause‐specific mortality was observed in a mild dysplasia population. Conclusions: Multivitamin supplementation in a population with esophageal squamous dysplasia was not associated with the risk of total mortality in the 35‐year follow‐up of this randomized controlled trial. In light of this and previous trials, multivitamin supplements should be used thoughtfully to improve health status of populations with esophageal squamous dysplasia. Lay summary: Multivitamin supplementation is common, yet its effect on mortality is unclear.The aim of this study was to update the long‐term effects of multivitamin supplementation on total and cause‐specific mortality during nearly 35 years of follow‐up in the Linxian Dysplasia Nutrition Intervention Trial in China.Multivitamin supplementation in a population with esophageal squamous dysplasia was not associated with the risk of total mortality in the 35‐year follow‐up of this randomized controlled trial, and this indicates that multivitamin supplements should be used thoughtfully to improve health status. Cancer Hospital, Chinese Academy of Medical Sciences and the National Cancer Institute collaborated to conduct the Linxian Dysplasia Nutrition Intervention Trial. The purpose of this report is to update the results of this randomized, double‐blind, placebo‐controlled trial after nearly 35 years of follow‐up and provide evidence for the effect of multivitamin supplementation on health. [ABSTRACT FROM AUTHOR]

Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease associated with a history of repetitive head impacts (RHI). CTE was described in boxers as early as the 1920s and by the 1950s it was widely accepted that hits to the head caused some boxers to become "punch drunk." However, the recent discovery of CTE in American and Australian-rules football, soccer, rugby, ice hockey, and other sports has resulted in renewed debate on whether the relationship between RHI and CTE is causal. Identifying the strength of the evidential relationship between CTE and RHI has implications for public health and medico-legal issues. From a public health perspective, environmentally caused diseases can be mitigated or prevented. Medico-legally, millions of children are exposed to RHI through sports participation; this demographic is too young to legally consent to any potential long-term risks associated with this exposure. To better understand the strength of evidence underlying the possible causal relationship between RHI and CTE, we examined the medical literature through the Bradford Hill criteria for causation. The Bradford Hill criteria, first proposed in 1965 by Sir Austin Bradford Hill, provide a framework to determine if one can justifiably move from an observed association to a verdict of causation. The Bradford Hill criteria include nine viewpoints by which to evaluate human epidemiologic evidence to determine if causation can be deduced: strength, consistency, specificity, temporality, biological gradient, plausibility, coherence, experiment, and analogy. We explored the question of causation by evaluating studies on CTE as it relates to RHI exposure. Through this lens, we found convincing evidence of a causal relationship between RHI and CTE, as well as an absence of evidence-based alternative explanations. By organizing the CTE literature through this framework, we hope to advance the global conversation on CTE mitigation efforts. [ABSTRACT FROM AUTHOR]