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We estimated the degree to which language used in the high-profile medical/public health/epidemiology literature implied causality using language linking exposures to outcomes and action recommendations; examined disconnects between language and recommendations; identified the most common linking phrases; and estimated how strongly linking phrases imply causality. We searched for and screened 1,170 articles from 18 high-profile journals (65 per journal) published from 2010-2019. Based on written framing and systematic guidance, 3 reviewers rated the degree of causality implied in abstracts and full text for exposure/outcome linking language and action recommendations. Reviewers rated the causal implication of exposure/outcome linking language as none (no causal implication) in 13.8%, weak in 34.2%, moderate in 33.2%, and strong in 18.7% of abstracts. The implied causality of action recommendations was higher than the implied causality of linking sentences for 44.5% or commensurate for 40.3% of articles. The most common linking word in abstracts was "associate" (45.7%). Reviewers' ratings of linking word roots were highly heterogeneous; over half of reviewers rated "association" as having at least some causal implication. This research undercuts the assumption that avoiding "causal" words leads to clarity of interpretation in medical research.

Background Overadjustment bias occurs when researchers adjust for an explanatory variable on the causal pathway from exposure to outcome, which leads to biased estimates of the causal effect of the exposure. This meta-research review aimed to examine how previous systematic reviews and meta-analyses of socio-economic inequalities in health have managed overadjustment bias. Methods We searched Medline and Embase until 16 April 2021 for systematic reviews and meta-analyses of observational studies on associations between individual-level socio-economic position and health outcomes in any population. A set of criteria were developed to examine methodological approaches to overadjustment bias adopted by included reviews (rated Yes/No/Somewhat/Unclear). Results Eighty-four reviews were eligible (47 systematic reviews, 37 meta-analyses). Regarding approaches to overadjustment, whereas 73% of the 84 reviews were rated as Yes for clearly defining exposures and outcomes, all other approaches were rated as Yes for <55% of reviews; for instance, 5% clearly defined confounders and mediators, 2% constructed causal diagrams and 35% reported adjusted variables for included studies. Whereas only 2% included overadjustment in risk of bias assessment, 54% included confounding. Of the 37 meta-analyses, 16% conducted sensitivity analyses related to overadjustment. Conclusions Our findings suggest that overadjustment bias has received insufficient consideration in systematic reviews and meta-analyses of socio-economic inequalities in health. This is a critical issue given that overadjustment bias is likely to result in biased estimates of health inequalities and accurate estimates are needed to inform public health interventions. There is a need to highlight overadjustment bias in review guidelines. [ABSTRACT FROM AUTHOR]

People report many barriers that prevent them from achieving a healthy diet. Whether perceived barriers are associated with dietary behavior remains unclear. To assess the association between barriers to healthy eating and adherence to the Swiss dietary guidelines. Cross-sectional data from the Swiss Health Survey 2012 (N = 15,450; 53% women). Barriers included price, daily habits, taste, gluttony, lack of time, lack of willpower, limited options in restaurants, in supermarkets, no social support, and social opposition. The associations between barriers and adherence to Swiss dietary guidelines were assessed using multivariable logistic regression. Daily habits (odds ratio; 95% confidence interval: 0.91; 0.85–0.98) and taste (0.85; 0.79–0.91) were associated with lower adherence to the guidelines for fruits, while price (1.13; 1.06–1.21) and limited options in restaurants (1.33; 1.23–1.45) and in supermarkets (1.18; 1.03–1.35) were associated with higher adherence. Taste was associated with lower adherence to the guidelines for vegetables (0.72; 0.66–0.78), while price (1.20; 1.11–1.30), gluttony (1.17; 1.04–1.31), social group opposition (1.48; 1.18–1.85) and limited options in restaurants (1.56; 1.42–1.72) and in supermarkets (1.25; 1.07–1.47) were associated with higher adherence. Daily habits (0.82; 0.75–0.90), time (0.86; 0.78–0.94), lack of willpower (0.78; 0.70–0.87), and gluttony (0.86; 0.76–0.98) were associated with lower adherence to the guidelines for fish, whereas price (1.09; 1.01–1.19), and limited options in restaurants (1.26; 1.14–1.39) and supermarkets (1.40; 1.20–1.63) were associated with higher adherence. Daily habits (0.89; 0.82–0.97), taste (0.66; 0.61–0.72), lack of willpower (0.84; 0.76–0.92) and gluttony (0.66; 0.58–0.75) were associated with lower adherence to the guidelines for meat. Time (0.88; 0.78–0.99) was associated with lower adherence to the guidelines for dairy, while gluttony (1.26; 1.09–1.46) was associated with higher adherence. Daily habits was associated with lower adherence (0.91; 0.85–0.97) to the guidelines for liquids, while limited options in restaurants was associated with higher adherence (1.12; 1.03–1.22). In the Swiss adult population, several self-reported barriers to healthy eating appear to hinder adherence to the dietary guidelines, while other commonly reported barriers are linked to higher adherence. [ABSTRACT FROM AUTHOR]

Summary Background & aims How undernutrition is reported in hospital discharge data is not understood. To assess trends in reported undernutrition and its management among hospitalized patients in Switzerland, and the association between reported undernutrition and in-hospital mortality, acquired infection, intensive care unit stay (ICU), and length of hospital stay (LOS). Methods Data from the Swiss hospital discharge databases from 1998 to 2014 (n = 13,297,188 hospitalizations, 52.2% women, 48.4% aged 65+, and 85% Swiss national). Reported undernutrition was defined by the presence of any undernutrition-related International Classification of Diseases 10th revision code. Nutritional management was defined by the presence of any nutritional intervention code. Results Prevalence of reported undernutrition increased from 0.32% in 1998 to 3.97% in 2014 in Switzerland, and similar but varying trends were found for each of the seven Swiss administrative regions: ranging from 0.18% to 2.13% in Ticino and from 0.23% to 5.63% in Mittelland. Undernutrition management of hospitalizations with reported undernutrition increased from 0.6% in 1998 to 57.8% in 2014, with wide variations according to administrative region: from 0% to 32.9% in Ticino and from 0% to 68.9% in Central Switzerland. After multivariable adjustment, reported undernutrition was positively associated with in-hospital mortality: odds-ratio and (95% confidence interval): 2.30 (2.26–2.34); acquired infection: 3.57 (3.46–3.70); ICU stay: 1.65 (1.63–1.68) and longer LOS: 19.6 ± 0.2 vs. 13.0 ± 0.1 days. Conclusion Undernutrition is increasingly reported in Switzerland; still, over 40% of undernourished hospitalizations don't benefit from nutritional support. Reported undernutrition is associated with increased in-hospital mortality, acquired infection, ICU stay, and LOS. Highlights • Undernutrition reporting in hospital data increased from 0.3% in 1998 to 4% in 2014. • 40% of hospitalizations with undernutrition had no nutritional management reported. • Reporting rates varied considerably between regions. • Undernutrition was positively associated with unfavourable outcomes. [ABSTRACT FROM AUTHOR]