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Postural assessments of the lumbar spine lack valuable information about its properties. The purpose of this study was to assess neutral zone (NZ) characteristics via in vivo lumbar spine passive stiffness and relate NZ characteristics to standing lumbar lordosis. A comparison was made between those that develop low back pain during prolonged standing (pain developers) and those that do not (nonpain developers). Twenty-two participants with known pain status stood on level ground, and median lumbar lordosis angle was calculated. Participants were then placed in a near-frictionless jig to characterize their passive stiffness curve and location of their NZ. Overall, both pain developers and nonpain developers stood with a lumbar lordosis angle that was more extended than their NZ boundary. Pain developers stood slightly more extended (in comparison to nonpain developers) and had a lower moment corresponding to the location of their extension NZ boundary. Overall, in comparison to nonpain developers, pain developers displayed a lower moment corresponding to the location of their extension NZ boundary which could correspond to greater laxity in the lumbar spine. This may indicate why pain developers have a tendency to stand further beyond their NZ with greater muscle co-contraction. [ABSTRACT FROM AUTHOR]

To investigate the association between physical activity (PA) domains and chronic low back pain (LBP) in older adults. A cross-sectional study where sociodemographic, behavioral, and health variables; PA; and presence of chronic LBP were collected. Higher scores of PA defined the "more active" participants. Binary logistic regression was used to test the association between PA domains and chronic LBP. A total of 516 participants were included. The mean age was 71.8 (95% confidence interval, CI, [71.1, 72.5]) years, and 29%, 27%, 25%, and 31% were identified as "more active" in the household, sports, leisure-time, and total PA domains, respectively. "More active" participants in sports (odds ratio = 0.62, 95% CI [0.40, 0.97]), leisure-time (odds ratio = 0.54, 95% CI [0.35, 0.85]) and total (odds ratio = 0.60, 95% CI [0.39, 0.92]) PA domains were less likely to report chronic LBP. High levels of sports, leisure-time, and total PA were inversely associated with chronic LBP. [ABSTRACT FROM AUTHOR]

Objective: To describe sex differences in concussion characteristics in US Service Academy cadets. Design: Descriptive epidemiology study. Setting: Four US service academies. Participants: 2209 cadets (n = 867 females, n = 1342 males). Independent Variable: Sex. Outcome Measures: Injury proportion ratios (IPR) compared the proportion of injuries by sex (females referent) for injury situation, certainty of diagnosis, prolonged recovery, recurrent injuries, mental status alterations, loss of consciousness (LOC), posttraumatic amnesia (PTA), retrograde amnesia (RGA), motor impairments, delayed symptom presentation, and immediate reporting. Main Results: Concussions from varsity/intercollegiate sports [IPR of 1.73, 95% confidence interval (CI) 1.43–2.10] and intramurals (IPR of 1.53, 95% CI 1.02–2.32) accounted for a larger proportion in males, whereas concussions outside of sport and military activities accounted for a smaller proportion among males (IPR of 0.70, 95% CI 0.58–0.85). The proportion of concussions with prolonged recovery was lower among males (IPR of 0.69, 95% CI 0.60–0.78), while concussions with altered mental status (IPR of 1.23, 95% CI 1.09–1.38), LOC (IPR of 1.67, 95% CI 1.17–2.37), PTA (IPR of 1.94, 95% CI 1.43–2.62), and RGA (IPR of 2.14, 95% CI 1.38–3.31) accounted for a larger proportion among males. A larger proportion of concussions that were immediately reported was observed in males (IPR of 1.15, 95% CI 1.00–2.31). Proportions of other characteristics (e.g., recurrent injuries) were not different between sexes. Conclusions: A higher proportion of concussions occurred outside of sport and military training for female cadets, who also displayed proportionally longer recovery times than males, despite males demonstrating a higher proportion of LOC, PTA, and RGA. Possible factors may include different mechanisms of injury outside of sport and military training, different biopsychosocial states associated with sex or injury context, and delayed injury reporting when outside of an observed environment, possibly secondary to perceived stigma about reporting injuries. [ABSTRACT FROM AUTHOR]

Simple Summary: The purpose of this pediatric cancer research investigation was to assess how radiation therpay in the first primary malignannt neoplasm predispose to Second Primary Thyroid Maligancy (SPTM), as well as therapeutics and mortality associated with SPTM. This study applied a retrospective cohort design, as non-experiment translational epidemiologic investigation, utilizing the USA National Cancer Institute, Surveillance Epidemiology and End Results (SEER) data in the assessment of risk determinants and predisposing factors in SPTM, as well as racial differentials in SPTM cumulative incidence and mortality. Specifically, radiation utilization in first primary malignancy among children predisposed to SPTM, indicative of the need to assess exposure effect of other carcinogens prior to radiation therapy in first primary malignant neoplasm, hence SPTM marginilaization. Objective: To assess racial and sex variances in second primary thyroid malignancy (SPTM) cumulative incidence and temporal trends and the radiation exposure effect in pediatric SPTM. Materials and Methods: A retrospective cohort study, a non-experimental epidemiologic design, was used to assess the cumulative incidence (CmI) and temporal trends as well as the exposure effect of radiation in SPTM among children, 0–19 years, in the Surveillance, Epidemiology, and End Results (SEER) registry, National Cancer Institute (NCI), USA. Percent change (PC) and annual percent change (APC) were used to examine CmI rates and temporal trends, while chi-square statistics and binomial regression models were used to examine variable distribution by race and to determine the exposure effect of radiation on SPTM as well as mortality, respectively. Results: The frequency of pediatric thyroid cancer was (n = 3457) between 1973 and 2013/14, while the PC was 151.2 for all races but 99.8 among whites. Of all pediatric thyroid cancers diagnosed during this period, SPTM accounted for 3% (n = 99). Compared to whites, blacks/AA were 60% less likely to present with SPTM, adjusted risk ratio, aRR = 0.40, 99% CI 0.06–2.47, while other races were 18% more likely to develop SPTM, aRR = 1.18, 99% CI 0.48–2.87. Additionally, females relative to males were 63% less likely to be diagnosed with SPTM, aRR = 0.37, 99% CI 0.22–0.61. With respect to urbanicity, compared to children in rural areas, those in urban areas were 21% less likely to develop SPTM, aRR = 0.79, 99% CI, 0.12–5.35, while children in metropolitan areas were 40% less likely to develop SPTM, aRR = 0.60, 99% CI, 0.10–3.59. Although imprecise, there was a 5% increased risk of SPTM, with radiation as an exposure effect, aRR = 1.05, 99% CI 1.01–1.75. Conclusions: There are increasing temporal trends in pediatric SPTM with blacks relative to whites having observed lower incidence, despite an increasing percent change among blacks/AA, indicative of the disproportionate burden of this malignant neoplasm. SPTM risk was higher among males and in rural areas, while radiation as a risk for SPTM was clinically and biologically meaningful, albeit an observed statistically insignificant inference due to sampling variability, requiring intervention mapping in radiation exposure margination among children. [ABSTRACT FROM AUTHOR]

Background: Participation in recreational and competitive sports can predispose people to musculoskeletal injuries. Chronic overuse with insufficient recovery, overloading, and direct contact can result in acute primary tendon ruptures. There is scarce literature regarding the epidemiology of sports-related acute primary tendon ruptures in the United States (US). Purpose: To identify the incidence rate (IR) of sports-related acute primary tendon ruptures presenting to US emergency departments using the National Electronic Injury Surveillance System (NEISS) database and describe the trends in the IR from 2001 to 2020. Study Design: Descriptive epidemiology study. Methods: The NEISS database was queried using injury case narratives; cases with a clear diagnosis of an acute primary tendon rupture were included in the final analysis. National estimates, estimated IRs (reported as per 1,000,000 person-years at risk), and temporal trends in the annual IR (reported as average annual percent change) of acute primary tendon ruptures were calculated using NEISS sample estimates and US Census Bureau population estimates. Results: An estimated total of 141,382 patients (95% confidence interval [CI], 107,478-175,286) presented to US emergency departments with a sports-related tendon rupture over the study period (IR, 22.9 person-years at risk [95% CI, 17.4-28.3]). The mean age was 37.7 years (95% CI, 37.0-38.5). Of all cases of a tendon rupture identified from 2001 to 2020, 60.1% were secondary to exercise/sports-related injury mechanisms. An Achilles tendon rupture was the most common injury, representing 55.9% of cases. Basketball was the most common sports-related injury mechanism, accounting for 36.6% of cases. The overall injury rate in male patients was 7.7 times that of female patients (IR ratio, 7.7 [95% CI, 4.4-13.5]; P <.05). The annual incidence of all sports-related tendon ruptures in the US increased significantly from 2001 to 2020 (average annual percent change, 1.9 [95% CI, 1.0-2.8]; P <.01). Conclusion: Recreational/competitive sports participation accounted for a large proportion of acute primary tendon ruptures in the US during the study period. [ABSTRACT FROM AUTHOR]

Suicide remains a leading cause of death in the United States, and recent data suggest suicide deaths involving opioids are increasing. Given unprecedented increases in drug-poisoning deaths, suicidality, and suicide deaths in recent years, an updated examination of the trends in suicide deaths involving opioids is warranted. In this descriptive epidemiologic analysis, we leverage final and provisional mortality data from the US Centers for Disease Control and Prevention's WONDER database to examine trends in suicide deaths involving opioid poisoning from 1999 to 2021 by biological sex. Results reveal complex changes over time: the number and age-adjusted rate of suicide deaths involving opioid poisoning among male and female residents tended to track together, and both increased through 2010, but then diverged, with the number and rate of suicide deaths involving opioid poisoning among female residents outpacing that of male residents. However, the number and rate of suicide deaths involving opioid poisoning among male residents then began to stabilize, while that of female residents declined, closing the sex-based gap. Across all years of data, the proportion of suicide deaths that involved opioid poisoning was consistently higher among female decedents (5.8%-11.0%) compared with male decedents (1.4%-2.8%). Findings have implications for improved suicide prevention and harm reduction efforts. This article is part of a Special Collection on Mental Health. [ABSTRACT FROM AUTHOR]

A priority of nutrition science is to identify dietary determinants of health and disease to inform effective public health policies, guidelines, and clinical interventions. Yet, conflicting findings in synthesizing evidence from randomized trials and observational studies have contributed to confusion and uncertainty. Often, heterogeneity can be explained by the fact that seemingly similar bodies of evidence are asking very different questions. Improving the alignment within and between research domains begins with investigators clearly defining their diet and disease questions; however, nutritional exposures are complex and often require a greater degree of specificity. First, dietary data are compositional, meaning a change in a food may imply a compensatory change of other foods. Second, dietary data are multidimensional; that is, the primary components (ie, foods) comprise subcomponents (eg, nutrients), and subcomponents can be present in multiple primary components. Third, because diet is a lifelong exposure, the composition of a study population's background diet has implications for the interpretation of the exposure and the transportability of effect estimates. Collectively clarifying these key aspects of inherently complex dietary exposures when conducting research will facilitate appropriate evidence synthesis, improve certainty of evidence, and improve the ability of these efforts to inform policy and decision-making. [ABSTRACT FROM AUTHOR]

Clinicians, researchers, regulators, and other decision-makers increasingly rely on evidence from real-world data (RWD), including data routinely accumulating in health and administrative databases. RWD studies often rely on algorithms to operationalize variable definitions. An algorithm is a combination of codes or concepts used to identify persons with a specific health condition or characteristic. Establishing the validity of algorithms is a prerequisite for generating valid study findings that can ultimately inform evidence-based health care. In this paper, we aim to systematize terminology, methods, and practical considerations relevant to the conduct of validation studies of RWD-based algorithms. We discuss measures of algorithm accuracy, gold/reference standards, study size, prioritization of accuracy measures, algorithm portability, and implications for interpretation. Information bias is common in epidemiologic studies, underscoring the importance of transparency in decisions regarding choice and prioritizing measures of algorithm validity. The validity of an algorithm should be judged in the context of a data source, and one size does not fit all. Prioritizing validity measures within a given data source depends on the role of a given variable in the analysis (eligibility criterion, exposure, outcome, or covariate). Validation work should be part of routine maintenance of RWD sources. This article is part of a Special Collection on Pharmacoepidemiology. [ABSTRACT FROM AUTHOR]

This study retrospectively compared the effect of holding the 2022 FIFA World Cup™ (WC) mid-season (season 2022/23) on injury rates and patterns in French Ligue 1 soccer clubs. Epidemiological data in 17 clubs were prospectively recorded by their physicians. Time-loss injuries (injuries leading to a player being unable to fully participate in play over the following 72-hour period) were compared with those reported during a regular season (2021–22). In the WC season, an increase of approximately 23% (training + match-play) was observed for both the total number of injuries and knee, ankle and muscle injuries combined. Incidences for match-play injury overall and for the knee, ankle and muscle regions combined and the hamstrings and calf regions specifically also rose significantly (range: p < 0.05-p < 0.01). These results suggest that injury occurrence and patterns in French L1 soccer clubs were substantially affected during the 2022/23 season when a mid-season WC was held. [ABSTRACT FROM AUTHOR]

Background: The metabolic syndrome (MetS) comprises metabolic irregularities, including hypertension and central obesity, which are influenced by genetic, metabolic, environmental, and dietary factors. As diet and lifestyle are risk factors for MetS, it is important to know which diet quality index better predicts MetS. The aim of this study is to compare the ability of different diet quality indices in predicting MetS and to identify the most effective one. Methods: This cross-sectional study involved 5,206 participants aged 35 to 70 engaged in the Prospective Epidemiological Research Study in Iran (PERSIAN) cohort. Assessment of one year's food intake via a validated 134-item semi-quantitative food frequency questionnaire (FFQ) facilitated the calculation of adherence to five diet quality indices: Dietary Approaches to Stop Hypertension (DASH), Mediterranean, Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND), Dietary Inflammatory Index (DII), and Diet Quality Indices (DQI). While bivariate Pearson correlation and binary logistic regression aided in identifying the strongest correlation and predictor for MetS among the indices. Results: This study showed a significant association between adhering to the DASH diet score, Mediterranean diet score, MIND diet score, DII score, and DQI score, and the odds of developing MetS (OR: 0.94, (95% CI: 0.93–0.95), OR: 0.85, (95% CI: 0.81–0.89), OR: 0.84, (95% CI: 0.80–0.89), OR: 1.22, (95%CI: 1.11–1.34), OR: 0.95, (95%CI 0.94–0.96) respectively). Therefore, with each unit increase in DASH diet score, Mediterranean diet score, MIND diet score, DII score, and DQI score, the odds of MetS was reduced by 5.4%, 14.5%, 15.6%, 22%, 5%, respectively. All the indices were correlated with the intake of most of the micronutrients, with the strongest correlations being observed in the DII. DASH diet score aligned with the most favourable MetS biomarker risk, while DII score primarily associated with MetS and could be considered as a predictor for MetS. Conclusion: The present study's findings reveal that between all these five diet quality indices, the DASH diet score correlates strongly with a favourable biomarker risk profile, while the DII score is predominantly linked to MetS. [ABSTRACT FROM AUTHOR]

Background: Cannabis use has been causally linked to violent behaviors in experimental and case studies, but its association with homicide victimization has not been rigorously assessed through epidemiologic research. Methods: We performed a case-control analysis using two national data systems. Cases were homicide victims from the National Violent Death Reporting System (NVDRS), and controls were participants from the National Survey on Drug Use and Health (NSDUH). While the NVDRS contained toxicological testing data on cannabis use, the NSDUH only collected self-reported data, and thus the potential misclassification in the self-reported data needed to be corrected. We took a data fusion approach by concatenating the NSDUH with a third data system, the National Roadside Survey of Alcohol and Drug Use by Drivers (NRS), which collected toxicological testing and self-reported data on cannabis use for drivers. The data fusion approach provided multiple imputations (MIs) of toxicological testing results on cannabis use for the participants in the NSDUH, which were then used in the case-control analysis. Bootstrap was used to obtain valid statistical inference. Results: The analyses revealed that cannabis use was associated with 3.55-fold (95% CI: 2.75–4.35) increased odds of homicide victimization. Alcohol use, being Black, male, aged 21–34 years, and having less than a high school education were also significantly associated with increased odds of homicide victimization. Conclusions: Cannabis use is a major risk factor for homicide victimization. The data fusion with MI method is useful in integrative data analysis for harmonizing measures between different data sources. [ABSTRACT FROM AUTHOR]

Objective To construct a land use regression (LUR) model for particulate matter with an aerodynamic diameter ≤2.5 μm (PM2.5) in Zunyi. Methods Collect and organize hourly PM2.5 monitoring data from routine air quality monitoring stations from January 1, 2020 to December 31, 2020, as well as geographic information data such as land use, roads, population density, altitude, and meteorological factors in Zunyi. Conduct multiple stepwise linear regression with PM2.5 concentration as the dependent variable and geographic information variables and meteorological factors as independent variables to construct a model. Use leave-one-out cross validation (LOOCV) to verify the performance of the model. Results The model formula is Y=72.656-0.026×altitude-0.009×NDVI-0.62×average temperature-383.512×average precipitation. The model had R2=0.74, adjusted R2=0.72, cross validation R2=0.69, RMSE=3.51, and a high spatial resolution (250 m×250 m). Conclusion The model fits well and fully reflects the influencing factors of PM2.5 spatial distribution in Zunyi. It can be used to estimate individual exposure levels and provide strong support for environmental health epidemiological research. [ABSTRACT FROM AUTHOR]

Background: In Venezuela, the predominant vaccines administered are BBIBP-CorV and Gam-COVID-Vac. Despite robust evidence from randomized clinical trials validating the effectiveness of COVID-19 vaccines in mitigating hospitalization and mortality, there is still a lack of post-authorization safety studies conducted within this demographic population. Methods: A prospective observational study from October 5, 2021 to March 31, 2022 encompassed COVID-19 vaccinated and unvaccinated patients from four sentinel hospitals in Venezuela. Patient lethality was predicted using Charlson Comorbidity index. Clinical outcomes were assessed through WHO's COVID-19 Clinical Progression Scale. Results: Out of the 175 patients assessed, 85 (48.6%) were vaccinated. The median Charlson Comorbidity index was 3 points, with no statistically significant differences observed between the groups (p = 0.2). A total of 50 (28.6%) patients died during the study period, with higher proportion of deaths in unvaccinated patients (35.6% vs. 21.2%, p = 0.035). Advanced age (OR = 1.043, 95% CI = 1.015–1.071, p = 0.002) was associated with increased death risk, whereas vaccination against COVID-19 (OR = 0.428, 95% CI = 0.185–0.99, p = 0.047), high oxygen saturation (OR = 0.964, 95% CI = 0.934–0.995, p = 0.024), and enoxaparin administration (OR = 0.292, 95% CI = 0.093–0.917, p = 0.035) were associated with decreased death risk. Conclusion: During the third and fourth waves of the pandemic, COVID-19 vaccination was associated with a 57% reduction in lethality among patients in four public hospitals in Venezuela. Key summary points: Less than half (48.6%) of the patients were vaccinated against SARS-CoV-2. At least one out of four patients died during the study period, mainly in the unvaccinated group. Advanced age was associated with a higher risk of death. Vaccination against COVID-19, high oxygen, and enoxaparin administration were factors associated with a lower risk of death. [ABSTRACT FROM AUTHOR]

Background: Previous research introduced V-PFCRC as an effective spot urinary dilution adjustment method for various metal analytes, including the major environmental toxin arsenic. V-PFCRC normalizes analytes to 1 g/L creatinine (CRN) by adopting more advanced power-functional corrective equations accounting for variation in exposure level. This study expands on previous work by examining the impacts of age and sex on corrective functions. Methods: Literature review of the effects of sex and age on urinary dilution and the excretion of CRN and arsenic. Data analysis included a Data Set 1 of 5,752 urine samples and a partly overlapping Data Set 2 of 1,154 combined EDTA blood and urine samples. Both sets were classified into age bands, and the means, medians, and interquartile ranges for CRN and TWuAs in uncorrected (UC), conventionally CRN-corrected (CCRC), simple power-functional (S-PFCRC), sex-aggregated (V-PFCRC SA), and sex-differentiated V-PFCRC SD modes were compared. Correlation analyses assessed residual relationships between CRN, TWuAs, and age. V-PFCRC functions were compared across three numerically similar age groups and both sexes. The efficacy of systemic dilution adjustment error compensation was evaluated through power-functional regression analysis of residual CRN and the association between arsenic in blood and all tested urinary result modes. Results: Significant sex differences in UC and blood were neutralized by CCRC and reduced by V-PFCRC. Age showed a positive association with blood arsenic and TWuAs in all result modes, indicating factual increments in exposure. Sex-differentiated V-PFCRC best matched the sex-age kinetics of blood arsenic. V-PFCRC formulas varied by sex and age and appeared to reflect urinary osmolality sex-age-kinetics reported in previous research. V-PFCRC minimized residual biases of CRN on TWuAs across all age groups and sexes, demonstrating improved standardization efficacy compared to UC and CCRC arsenic. Interpretation: Sex differences in UC and CCRC arsenic are primarily attributable to urinary dilution and are effectively compensated by V-PFCRC. While the sex and age influence on V-PFCRC formulas align with sex- and age-specific urinary osmolality and assumed baseline vasopressor activities, their impact on correction validity for entire collectives is minimal. Conclusion: The V-PFCRC method offers a robust correction for urinary arsenic dilution, significantly reducing systemic dilution adjustment errors. Its application in various demographic contexts enhances the accuracy of urinary biomarker assessments, benefiting clinical and epidemiological research. V-PFCRC effectively compensates for sex differences in urinary arsenic. Age-related increases in TWuAs are exposure-related and should be additionally accounted for by algebraic normalization, covariate models, or standard range adjustments. [ABSTRACT FROM AUTHOR]

Background and Aim Methods Results Conclusions Epidemiological research is scarce in Asian countries including Japan. We aimed to clarify the epidemiological trend of nonampullary duodenal cancer (NADC) in Japan using a national database.All patients with NADC diagnosed between 2016 and 2020 were identified from the Japanese national cancer registry. The crude and age‐adjusted incidences were determined and temporal trends including diagnostic mode, tumor stage, and treatments were analyzed.A total of 14 484 patients were included. The crude and age‐adjusted incidences were 21.8–23.5 and 10.7–12.1 per 1 000 000 person‐years. Male‐to‐female ratio was 1.7:1, and the incidence increased with age. The number of patients was highest among 70–79 year age group in both sexes. In total, 55% of patients were diagnosed during screening or surveillance for other diseases. In 54% of patients, the tumor stage was localized. The major treatment was surgery (32%), followed by endoscopic resection (27%). The trends for detection mode, tumor stage, and treatment were consistent during 2016–2020.This study clarified and confirmed the high incidence of duodenal cancer in Japan. Characteristically, many NADC cases are diagnosed asymptomatically and treated by endoscopic or surgical treatment. [ABSTRACT FROM AUTHOR]

Purpose: Step count is an intuitive measure of physical activity frequently quantified in health-related studies; however, accurate step counting is difficult in the free-living environment, with error routinely above 20% in wrist-worn devices against camera-annotated ground truth. This study aimed to describe the development and validation of step count derived from a wrist-worn accelerometer and assess its association with cardiovascular and all-cause mortality in a large prospective cohort. Methods: We developed and externally validated a self-supervised machine learning step detection model, trained on an open-source and step-annotated free-living dataset. Thirty-nine individuals will free-living ground-truth annotated step counts were used for model development. An open-source dataset with 30 individuals was used for external validation. Epidemiological analysis was performed using 75,263 UK Biobank participants without prevalent cardiovascular disease (CVD) or cancer. Cox regression was used to test the association of daily step count with fatal CVD and all-cause mortality after adjustment for potential confounders. Results: The algorithm substantially outperformed reference models (free-living mean absolute percent error of 12.5% vs 65%–231%). Our data indicate an inverse dose–response association, where taking 6430–8277 daily steps was associated with 37% (25%–48%) and 28% (20%–35%) lower risk of fatal CVD and all-cause mortality up to 7 yr later, compared with those taking fewer steps each day. Conclusions: We have developed an open and transparent method that markedly improves the measurement of steps in large-scale wrist-worn accelerometer datasets. The application of this method demonstrated expected associations with CVD and all-cause mortality, indicating excellent face validity. This reinforces public health messaging for increasing physical activity and can help lay the groundwork for the inclusion of target step counts in future public health guidelines. [ABSTRACT FROM AUTHOR]

The health and well-being of transgender, non-binary, and gender-diverse people is receiving increasing attention from epidemiologists and public health researchers, including those utilizing longitudinal observational cohort studies. These longitudinal studies are advantageous over cross-sectional observational study designs given their scope over several timepoints rather than one, and when exposures and outcomes are prospectively measured this improves validity of causal claims. However, within these longitudinal studies, gender is often collected inconsistently (e.g. only asked at a single timepoint), or inadequately (e.g. questions that use limiting notions of gender). Due to the temporal nature of gender, this introduces potential including misclassification error and may provide an incomplete picture of gender diversity in a sample. This article considers these methodological issues and offers evidence-based recommendations to ensure longitudinal data on trans, non-binary, and gender-diverse people is treated with epidemiological rigor, while maintaining inclusivity. [ABSTRACT FROM AUTHOR]

Before examining the impact of training load on injury risk in runners, it is important to gain insight into the differences between methods that are used to measure change in training load. To investigate differences between 4 methods when calculating change in training load: (1) weekly training load; (2) acute : chronic workload ratio (ACWR), coupled rolling average (RA); (3) ACWR, uncoupled RA; (4) ACWR, exponentially weighted moving average (EWMA). Descriptive epidemiology study. This study is part of a randomized controlled trial on running injury prevention among recreational runners. Runners received a baseline questionnaire and a request to share global positioning system training data. Runners who registered for running events (distances 10–42.195 km) in the Netherlands. The primary outcome measure was the predefined significant increase in training load (weekly training loads ≥ 30% progression and ACWRs ≥ 1.5), based on training distance. Proportional Venn diagrams visualized the differences between the methods. A total of 430 participants (73.3% men; mean age = 44.3 ± 12.2 years) shared their global positioning system training data for a total of 22 839 training sessions. For the weekly training load, coupled RA, uncoupled RA, and EWMA method, respectively, 33.4% (95% CI = 32.8, 34.0), 16.2% (95% CI = 15.7, 16.6), 25.8% (95% CI = 25.3, 26.4), and 18.9% (95% CI = 18.4, 19.4) of the training sessions were classified as significant increases in training load. Of the training sessions with significant increases in training load, 43.0% from the weekly training load method were different than the coupled RA and EWMA methods. Training sessions with significant increases in training load based on the coupled RA method showed 100% overlap with the uncoupled RA and EWMA methods. The difference in the change in training load measured by weekly training load and ACWR methods was high. To validate an appropriate measure of change in training load in runners, future research on the association between training loads and running-related injury risk is needed. [ABSTRACT FROM AUTHOR]

Limited longitudinal data exist on patient-reported outcomes (PROs) after acute lateral ankle sprain (LAS). The impact of prospective hop testing on PROs at return to play (RTP) and 6 months post-RTP is unclear. To determine if high school athletes with an LAS who return to baseline physical function as measured by a single-leg hop for distance (SLHOP) have better PROs relative to individuals who return to symmetry. Cohort study. Ten high schools over 2 years. Two hundred six high school athletes who sustained an LAS were included. Baseline SLHOP testing was completed preinjury. Patient-reported outcomes were recorded at time of injury, RTP, and 6 months post-RTP. Participants were classified as symmetry (n = 134) or restorative (n = 72). Symmetry was defined as achieving an SLHOP performance within 10% of the uninjured limb at RTP. Restorative was defined as achieving an SLHOP performance within 10% of preinjury levels. The Foot and Ankle Ability Measure (FAAM)–Activities of Daily Living, FAAM-Sport, Patient-Reported Outcomes Measurement Information System (PROMIS) Anxiety, and PROMIS Depression were analyzed using a 2-way nonparametric analysis of variance. The interaction term of group by time was the main comparison of interest and was interpreted if significant. Post hoc multiple comparisons were performed using the Tukey-Kramer test. The restorative group reported better FAAM scores at RTP and 6 months post-RTP (P <.05) relative to the symmetry group. There were no differences in PROMIS Anxiety scores at time of injury, RTP, or 6 months post-RTP between groups (P >.05). There were no differences in PROMIS Depression scores at time of injury between groups (P =.34), but the restorative group had worse PROMIS Depression scores at RTP (P =.03). The restorative group reported better FAAM-ADL and FAAM-Sport scores at RTP and 6 months post-RTP relative to the symmetry group. Restoring individuals to baseline physical function rather than limb symmetry may ensure better PROs after an LAS. [ABSTRACT FROM AUTHOR]

The coronavirus disease 2019 (COVID-19) pandemic, and its associated mortality, morbidity, and deep social and economic impacts, was a global traumatic stressor that challenged population mental health and our de facto mental health care system in unprecedented ways. Yet, in many respects, this crisis is not new. Psychiatric epidemiologists have recognized for decades the need and unmet need of people in distress and the limits of the public mental health services in the United States. We argue that psychiatric epidemiologists have a critical role to play as we endeavor to address population mental health and draw attention to 3 areas of consideration: elevating population-based solutions; engaging equitably with lived experience; and interrogating recovery. Psychiatric epidemiology has a long history of both responding to and shaping our understanding of the relationships among psychiatric disorders and society through evolving methods and training, and the current sociohistorical moment again suggests that shifts in our practice can strengthen our field and its impact. This article is part of a Special Collection on Mental Health. [ABSTRACT FROM AUTHOR]

Multiple imputation (MI) is commonly implemented to mitigate potential selection bias due to missing data. The accompanying article by Nguyen and Stuart (Am J Epidemiol. 2024;193(10):1470-1476) examines the statistical consistency of several ways of integrating MI with propensity scores. As Nguyen and Stuart noted, variance estimation for these different approaches remains to be developed. One common option is the nonparametric bootstrap, which can provide valid inference when closed-form variance estimators are not available. However, there is no consensus on how to implement MI and nonparametric bootstrapping in analyses. To complement Nguyen and Stuart's article on MI and propensity score analyses, we review some currently available approaches on variance estimation with MI and nonparametric bootstrapping. [ABSTRACT FROM AUTHOR]

In recent years, a growing body of research in positive epidemiology has sought to expand the traditional focus of epidemiologic research beyond risk factors for disease and towards a more holistic understanding of health that includes the study of positive assets that shape well-being more broadly. While this paradigm shift holds great promise for transforming people's lives for the better, it is also critiqued for showcasing decontextualized perspectives that could cause great harm to the public's health if translated uncritically into population-based interventions. In this commentary, we argue for orienting positive epidemiology within a human rights and economic justice framework to mitigate this threat, and we discuss two examples of previously proposed health assets (religious involvement and marriage) that demonstrate the urgent need for positive epidemiologic research to center health equity. Finally, to advance the field, we provide recommendations for how future research can address shortcomings of the extant literature by moving from individual-level to societal-level applications. In doing so, we believe that positive epidemiology can be transformed into a powerful force for health equity. This article is part of a Special Collection on Mental Health. [ABSTRACT FROM AUTHOR]

In 1952, James Watt, a young US Public Health Service (PHS) infectious disease epidemiologist, was appointed—amid wide surprise—director of the US National Heart Institute (NHI) where he served until 1961. He skillfully advanced epidemiologic research methods and study conduct nationally while also establishing epidemiology in the administrative hierarchy of the institute. Watt soon turned to development of an effective program in international cardiovascular disease (CVD) epidemiology under auspices of the World Health Organization (WHO) at the United Nations in Geneva. That effort resulted in the 1959 appointment of Zdenek Fejfar, a young Czech clinical investigator, as director of the WHO CVD Unit. The coming together of Watt and Fejfar, with a joint focus on improved methods and population comparisons, helped establish a vigorous international community of CVD epidemiology. Their collaboration and friendship remained active and close throughout their career assignments and thereafter, as documented in this story. [ABSTRACT FROM AUTHOR]

• Dietary Inflammatory Index (DII) scores are positively associated with the risk of dyslipidemia. • Association between DII levels and dyslipidemia appears only in women. • Inflammation feature of diets is important for preventing dyslipidemia in middle-aged women. The dietary inflammatory index (DII) is a tool to evaluate the inflammatory potential of diets. Our research hypothesized that a higher DII score would be associated with an increased risk of dyslipidemia and that this outcome may differ by sex. Data from the Korean Genome and Epidemiology Study were used. The analysis included participants aged 40 to 69 years from the HEXA study (n = 40,500) and the Ansan-Ansung study (n = 4701). The mean follow-up was 5.03 years for the HEXA study and 8.14 years for the Ansan–Ansung study. The DII scores were calculated based on dietary data. Cox proportional hazards regression analysis was used to calculate hazard ratio (HR) and 95% confidence interval (CI). In pooled analyses, a high DII score was associated with a higher risk of dyslipidemia and its components. Sex-specific analyses revealed associations only in women. A pro-inflammatory diet, as indicated by a higher DII score, was associated with an increased risk of hypercholesterolemia, hyper-low-density lipoprotein cholesterolemia, hypertriglyceridemia, and dyslipidemia, with HR of 1.17 (95% CI: 1.06, 1.29), 1.16 (95% CI: 1.03, 1.29), 1.32 (95% CI: 1.12, 1.52), and 1.17 (95% CI: 1.08, 1.26), respectively. However, among men, there was no association between DII and dyslipidemia. These findings emphasize the inflammation feature of existing dietary patterns in influencing the development of dyslipidemia and related health issues. Further research will be needed to identify the mechanisms of how DII scores affect the risk of dyslipidemia. [Display omitted] This study aimed to investigate the association between DII and dyslipidemia among Korean adults, considering sex differences. Based on dietary data, the 38 food parameters were adopted to calculate DII. Sex-specific analyses revealed associations only in women. A pro-inflammatory diet, as indicated by a higher DII score, is associated with an increased risk of dyslipidemia, with HR of 1.17 [95% CI: 1.08, 1.26]. This result emphasizes the inflammation feature of diets is important for preventing dyslipidemia in middle-aged women. Abbreviations: DII, dietary inflammatory index; HR, hazard ratio; CI, confidence interval. [ABSTRACT FROM AUTHOR]

Objective: We aimed to demonstrate the use of quantitative bias analysis (QBA), which reveals the effects of systematic error, including confounding, misclassification and selection bias, on study results in epidemiological studies published in the period from 2010 to mid‐23. Method: The articles identified through a keyword search using Pubmed and Scopus were included in the study. The articles obtained from this search were eliminated according to the exclusion criteria, and the articles in which QBA analysis was applied were included in the detailed evaluation. Results: It can be said that the application of QBA analysis has gradually increased over the 13‐year period. Accordingly, the number of articles in which simple is used as a method in QBA analysis is 9 (9.89%), the number of articles in which the multidimensional approach is used is 10 (10.99%), the number of articles in which the probabilistic approach is used is 60 (65.93%) and the number of articles in which the method is not specified is 12 (13.19%). The number of articles with misclassification bias model is 44 (48.35%), the number of articles with uncontrolled confounder(s) bias model is 32 (35.16%), the number of articles with selection bias model is 7 (7.69%) and the number of articles using more than one bias model is 8 (8.79%). Of the 49 (53.85%) articles in which the bias parameter source was specified, 19 (38.78%) used internal validation, 26 (53.06%) used external validation and 4 (8.16%) used educated guess, data constraints and hypothetical data. Probabilistic approach was used as a bias method in 60 (65.93%) of the articles, and mostly beta (8 [13.33%)], normal (9 [15.00%]) and uniform (8 [13.33%]) distributions were selected. Conclusion: The application of QBA is rare in the literature but is increasing over time. Future researchers should include detailed analyzes such as QBA analysis to obtain inferences with higher evidence value, taking into account systematic errors. [ABSTRACT FROM AUTHOR]

Background: Older adults, an increasingly diverse segment of the United States population, are a priority population for prescription painkiller misuse. This study documents trends and correlates of prescription painkiller misuse among Hispanic and non-Hispanic adults ages 50 and older. Methods: A secondary analysis of adults 50 years and older across 5 cohorts using the 2015–2019 National Survey on Drug Use and Health (unweighted n = 16,181, 8.5% Hispanic, and 54% female). Logistic regression modeling with complex survey design was used to examine trends in prescription painkiller misuse. Results: Over time, the prevalence of past year painkiller misuse significantly decreased for Hispanic respondents (56.1% relative decrease, p = 0.02); elevated proportions were observed across strata of demographic characteristics. Conclusions: Variability in the prevalence of painkiller misuse may be explained by demographic characteristics. Further, these results emphasize the importance of addressing comorbid recreational marijuana use when designing interventions to address painkiller misuse for older adults. [ABSTRACT FROM AUTHOR]

The aim of this study was to analyse the attributable risk of mortality and DALYs (Disability Adjusted Life Years) due to occupational carcinogens for lung cancer between 1990 and 2019 in Brazil and federation units, as well as its relationship with the Socio-demographic Index (SDI). Epidemiological study. This is an epidemiological study that used GBD 2019 (Global Burden of Disease Study) estimates of lung cancer mortality rates and DALYs attributable to occupational carcinogens. The relationship between these rates and SDI was assessed using panel data analysis. In Brazil, occupational exposure to asbestos, silica and diesel vapours accounted for more than 85.00% of lung cancer deaths and DALYs attributable to occupational carcinogens in both sexes between 1990 and 2019. An increase in both rates was observed in women for almost all the occupational carcinogens assessed, especially in the North and Northeast regions of the country, with diesel vapours standing out the most. The present study highlighted the urge to characterise exposure to occupational risks for lung cancer, especially for the female population in the North and Northeast regions of Brazil. [ABSTRACT FROM AUTHOR]

Objective: Atrial fibrillation (AF) is one of the most common arrhythmic disorders worldwide. This study aims to describe the prevalence of AF in various cities in Indonesia using single‐lead hand held electrocardiography linked to a smartphone‐based application. Methods: This is a cross‐sectional epidemiological study conducted at tertiary hospital of major cities in Indonesia, between January 2018 and July 2019. The AliveCor Kardia™ Mobile system device was used as a screening tool for AF and confirmed its finding with clinical diagnoses made by cardiologists. Results: A total of 9773 subjects were enrolled in this study. The prevalence of AF reported by the device and cardiologist was 3.2% and 3.5%, respectively. AF prevalences are equal in men than women. The majority of subjects (56%) are having low risk for stroke or systemic thromboembolism. Prevalence of risk factors such as heart failure, hypertension, diabetes, and history of stroke among AF patients were 50%, 22.9%, 31.9%, 13.5%, and 5.8%, respectively. Conclusion: The prevalence of AF at referral hospitals visitors based on smartphone diagnosis in Indonesia is 3.2%. [ABSTRACT FROM AUTHOR]

This critical review considers the status of 21st-century epidemiological theories of disease distribution, updating to 2024 prior analyses published up through 2014, and discusses the implications of these theories for research, practice, and pedagogy. Three key trends stand out: (a) the continued dominance of individualistic biomedical and lifestyle theories; (b) growth and elaboration of social epidemiological alternatives; and (c) the ongoing inattention to epidemiologic theories of disease distribution in the training of epidemiologists and public health professionals and in current efforts to improve the rigor of epidemiological research and causal inference. In a context of growing global political polarization, climate crisis, broader environmental and ecological crises, and stubbornly persistent health inequities within and between nations, producing actionable knowledge relevant to improving the people's health and advancing health justice will require much greater engagement with social epidemiologic theories of disease distribution in research, pedagogy, and practice. At issue is critically engaging with the embodied truths manifested in the stories bodies tell in population patterns of health, disease, and well-being. [ABSTRACT FROM AUTHOR]

Objective: To investigate the factors associated with diabesity in older women. Methods: This epidemiological study used a cross‐sectional design and included 196 older women (72.70 ± 7.20 years) from Jequié, Bahia, Brazil. Diabesity was defined as having both an elevated abdominal circumference (≥88 cm) and diabetes mellitus. For the inferential analyses, we constructed crude models followed by a multiple hierarchical explanatory model, with the following levels: Level 1 (socioeconomic variables), Level 2 (behavioral aspects), and Level 3 (health conditions). Poisson regression with a robust estimator was employed, and we calculated Prevalence Ratios (PR) with 95% Confidence Intervals (CI). Results: The prevalence of abdominal obesity, diabetes mellitus, and diabesity were 79.60%, 27.80%, and 22.40%, respectively. Women who were insufficiently active had a higher likelihood of diabesity (PR: 2.04; 95% CI: 1.22–3.41), as did those who spent more time in sedentary behavior (PR: 1.81; 95% CI: 1.04–3.16), used three or more continuous medications (PR: 2.51; 95% CI: 1.29–4.89), or reported a negative self‐perception of health (PR: 2.57; 95% CI: 1.03–5.80). Conclusion: The study identified several factors associated with diabesity in older women: insufficient physical activity, prolonged sedentary behavior, polypharmacy, and negative self‐perception of health. [ABSTRACT FROM AUTHOR]

In modern medicine, studies devoted to the assessment of the parameters of residential infrastructure and the population's attitude towards them have become quite large-scale. Objectives: The aim of the study was to establish associations between individually perceived parameters of residential infrastructure and the main modifiable cardiovascular risk factors (hypertension, obesity, lipid and carbohydrate metabolism disorders) in one of the subjects of the Russian Federation. Methods: The epidemiological study "Study of the influence of social factors on chronic non-communicable diseases" started in 2015 and ended in 2023. The sample was formed by using the stratification method based on the assignment to a medical organization. The study included 1598 respondents aged 35 to 70 years (491 rural residents). The study of infrastructure parameters was conducted based on the subjective opinions of respondents using the neighborhood environment walkability scale (NEWS) questionnaire, divided into eight scales. Logistic regression analysis was used to identify associations between infrastructure parameters and cardiovascular risk factors; the odds ratio (OR) and 95% confidence interval were evaluated. Results: Individually perceived infrastructure parameters of the scale B, reflecting the accessibility of infrastructure facilities, were associated with hypertension [OR = 1.33], obesity [OR = 1.40], and abdominal obesity [OR = 1.59]. Elements of the social infrastructure of the scale C, describing the streets in the residential area, increased the likelihood of developing obesity [OR = 1.42] and visceral obesity [OR = 1.43]. The characteristics of the residential area, represented by the scale D that evaluates pedestrian infrastructure, were associated with all major cardiovascular risk factors (hypertension [OR = 1.65], obesity [OR = 1.62] and abdominal obesity [OR = 1.82], and disorders of lipid [OR = 1.41] and carbohydrate metabolism [OR = 1.44]). Conclusion: Social factors represented by various aspects of infrastructure have become important criteria for determining cardiovascular health. Environmental conditions affect cardiovascular risk factors through behavioral patterns that shape the respondent's lifestyle. Interventions in urban planning—increasing accessibility to infrastructure facilities for the population, developing a pedestrian-friendly urban environment, improving physical activity resources in areas, planning recreation areas, and landscaping—can become the most important concept for the prevention of cardiovascular diseases. [ABSTRACT FROM AUTHOR]

Background/Objectives: Intensive care unit (ICU) e-referrals are an important indicator for exploring potential deficiencies in critical care resources. This study aimed to examine the epidemiology and patterns of ICU e-referrals across all regions of Saudi Arabia during the COVID-19 pandemic using routinely collected data from April 2020 to December 2021. Methods: This descriptive epidemiological study analyzed data from the Saudi Medical Appointments and Referrals Centre (SMARC). This study reveals novel regional ICU e-referral patterns for critical cases using national unique digital health data, adding insights beyond the existing literature. Variables included age, sex, referral timing, reason, specialty, and region of origin. Descriptive statistics and mapping of administrative areas were performed based on e-referral request rates per 10,000 population. Results: During the study period, 36,619 patients had ICU e-referral requests. The mean age was 54.28 years, with males constituting 64.81% of requests. Out-of-scope e-referrals comprised 71.44% of requests. Referrals related to medical specialties, such as cardiology and pulmonology, were the most common (62.48%). Referral patterns showed peaks in July–August 2020 and May 2021. The Northern Border and Albaha areas had the highest request rates per population, potentially reflecting a higher proportion of severe cases requiring ICU-level care compared to other regions. Conclusions: The temporal pattern and geographic distribution of ICU e-referrals mirrored previously reported critical COVID-19 cases in Saudi Arabia. Preventive measures and vaccination programs contributed to a significant decline in ICU e-referral requests, suggesting a positive impact on controlling severe COVID-19 cases. Population-adjusted analysis revealed regional disparities, highlighting the importance of considering population size in healthcare resource management and policy. [ABSTRACT FROM AUTHOR]

Objective: We aimed to describe the clinical characteristics associated with severity in children hospitalized with COVID-19. Method: This was an epidemiological cohort study conducted in two hospitals, one of which was a reference center for the treatment of COVID-19 cases. Data were collected from the reports generated by the hospital epidemiology centers and the medical records of patients aged between 0 and 14 years with a diagnosis of COVID-19, hospitalized between March 2020 and June 2021. To analyze the association between the clinical profile and severity, the cases were classified as severe (severe and critical) and non-severe (asymptomatic, mild, and moderate). Results: Of the 191 children followed up in the cohort, 73.3% developed the severe form. The percentage of children with oxygen saturation below 95% was 46.6%. In the multivariate analysis, a higher risk of severity was estimated among children with uncontrolled asthma (RR = 13.2), who were overweight or obese (RR = 3.21), who had cough symptoms (RR = 2.72), and those aged under one year (RR = 3.23). Conclusions: This result underscores the need to improve healthcare at every level for children and for the management of asthma and nutrition when considering children with this clinical profile who are diagnosed with COVID-19. [ABSTRACT FROM AUTHOR]

Purpose/Objective: Frequent consumption of fermented carbohydrates and bottle feeding contribute to the development of early childhood caries (ECC). There are no substantial findings on the effects of breastfeeding patterns on oral health conditions in children in the United States. We aimed to assess the nexus between exclusive breastfeeding during the first 6 months and oral health disorders, namely toothache, decayed teeth, or unfilled cavities in early childhood. Materials and Methods: Design: Cross-sectional epidemiologic design of nationally representative data collected via telephone surveys in the United States was utilized. Setting: National Survey of Children's Health, 2012 Participants: Population-based random sample of parents/guardians of 24,655 children aged 6 months to 5 years. Main Outcome and Measure: The primary outcome was the presence of oral health disorders (OHD) in children, defined as the parent-reported occurrence of one or more of the following conditions in the past 12 months: toothache, decayed teeth, or an unfilled cavity. This was assessed through a single composite question in the survey, asking parents/guardians if their child had experienced any of these specific oral health issues within the previous year with a binary (yes/no) response option. Results: Among 24,655 children aged 6 months to 5 years, 2392 (9.7%) had experienced an oral health disorder (OHD) in the previous 12 months. In unadjusted analysis, children exclusively breastfed for 6 months were 28% less likely to present with OHD compared to never-breastfed children (OR = 0.72, 95% CI, 0.52–0.98). However, after adjusting for key factors, including maternal health and race/ethnicity, this association was no longer statistically significant (aOR = 1.11, 95% CI 0.79–1.57). Significant predictors of OHD included maternal health (aOR for fair/poor vs. excellent/very good maternal health = 1.79, 95% CI 1.08–2.69) and race/ethnicity, with a higher prevalence among non-Hispanic Black (12.9%) and multi-racial children (12.6%) compared to non-Hispanic White children (7.7%). Conclusions and Relevance: While exclusive breastfeeding for the first six months of life was not found to be a significant predictor of pediatric oral health outcomes after adjustment, maternal health and race/ethnicity were significant determinants of oral health disorders. These findings underscore the importance of comprehensive healthcare approaches that consider maternal well-being and socio-demographic factors. Future research should explore interventions targeting these factors to improve pediatric oral health outcomes. [ABSTRACT FROM AUTHOR]

Background: Numerous studies have explored the impact of pre- and post-migration factors on the overall health of migrant populations. The objective of this study is to enhance our understanding of additional determinants affecting migrants' health by examining the impact of the migration phase and related journeys in the European context. Methods: We conducted a systematic review of studies published in the MEDLINE, Embase, and Scopus databases from 2003 up to January 5, 2024. We included observational studies reporting information on the health status of migrant populations recorded upon arrival in a country situated in Europe, and on the transit phase, including specific risk factors experienced during the journey or its characteristics. Title and abstract screening were performed using active learning techniques provided by ASReview software. The results of the included studies were presented qualitatively, with a focus on publications that formally assessed the association between the journey and the investigated health outcomes. The systematic review was registered on PROSPERO, CRD42024513421. Results: Out of 11,370 records screened, we ultimately included 25 studies, all conducted since 2017. Most adopted a cross-sectional design and a quantitative approach, with relatively small sample sizes. The majority of the studies were conducted in Serbia and Italy. Only 14 of them formally assessed the association between different exposures in the transit phase and health outcomes, including mental health, well-being and quality of life, infectious and non-communicable diseases. Conclusion: Epidemiological research focusing on the transit phase in Europe remains limited, with few available studies facing challenges related to data collection, study design and analysis, thereby limiting the interpretability and generalisability of their results. These findings underscore the need for action, prompting the development of adequate and feasible strategies to conduct additional studies focusing on migrant populations during migration journeys. [ABSTRACT FROM AUTHOR]

Background: Epidemiological research links asthma progression to dietary nonallergic factors, particularly high-calorie intake. However, evidence supporting the relationship with total dietary calorie consumption remains scarce. Objective: This study aimed to explore the potential correlation between asthma occurrence and total dietary energy intake. Methods: A retrospective cross-sectional study of 21,354 US adults collected comprehensive participant data, including demographics, blood parameters, fatty acids, zinc, fiber intake, and asthma outcomes. Statistical analyses included interaction effects analysis, smooth curve fitting, and logistic regression. Results: Of 21,354 participants, 14.77% self-reported asthma diagnosis. After adjusting for confounders, odds ratios (OR) for asthma decreased with higher energy intake: Q2 (OR = 0.77, 95% CI: 0.69–0.86, p <.001), Q3 (OR = 0.66, 95% CI: 0.59–0.75, p <.001), and Q4 (OR = 0.61, 95% CI: 0.53–0.69, p <.001) compared to Q1 (< 17.73 kcal/kg/day). A non-linear (L-shaped) association between energy intake and asthma was observed (p <.001), with a critical threshold around 24 kcal/kg/day, supported by subgroup and sensitivity analyses. Conclusion: This study reveals an L-shaped trend between total energy intake and asthma in US adults, with a significant threshold at approximately 24 kcal/kg/day. [ABSTRACT FROM AUTHOR]

AbstractIntroductionMethodsResultsConclusionBlunt and hemp wraps, as a means of consuming cannabis, have emerged into the retail space where the prevalence has been increasing since 2017. There is limited epidemiological research on the prevalence of use of these products across the U.S. particularly among young adults who are at greater risk of tobacco and cannabis use.This study draws from a U.S. national representative sample of young adults (n = 1178) captured in May 2022. Respondents participated in an online survey about their use of blunt and hemp wraps. Multinomial regression was used to examine differences in sociodemographic characteristics (gender, race/ethnicity, sexual orientation, educational attainment, and region) in relation to use of each wrap type.One quarter (22.7%) of young adults reported ever having used a blunt wrap, 3.2% in the past 30-days. One in seven (14.3%) had ever used a hemp wrap, 2.3% in the past 30-days. Non-Hispanic Black young adults were 1.55 and 2.91 times as likely to have ever used blunt or hemp wraps, respectively, compared to non-Hispanic Whites. Similarly, participants who identified as gay or lesbian or bisexual similarly had greater odds of having ever used blunt or hemp wraps. Hispanic young adults were 2.49 times as likely to have used hempwraps compared to non-Hispanic Whites.Blunt and hemp wrap use is prevalent among young adults, particularly among minoritized populations. Continued research and surveillance of use of these products is needed to fully evaluate the impact their use may have on the broader population. [ABSTRACT FROM AUTHOR]

Background: Health care is not exempt from harboring social inequalities, including in those countries with a universal public system. The objective was to ascertain whether the population's assessment of primary care (PC) changed between 2006 and 2016, the decade that included the economic crisis of 2008, and also if it exhibited patterns of social inequality in Barcelona (Spain). Methods: This was a cross-sectional study using Barcelona Health Surveys 2006 and 2016. Samples (4027 and 3082 respectively) comprised residents in Barcelona, over 15 years old. Dependent variable: Primary Care (PC) index. Independent variables: age, social class, and birthplace. Analyses included means and percentiles of PC index, and Somers' D test to compare the distribution of the groups. Results: Comparing 2016 with 2006, the distribution of the PC index remained in women (median of 73.3) and improved in men (from 70 to 73.3). By social class, the pattern of inequality observed in 2006 in men with perceived poor health status disappeared in 2016. Inequalities according to birthplace persisted in women, regardless of perceived health status, but disappeared in men. Conclusions: In the 10 years between which the global economic crisis occurred, the assessment of PC did not worsen, and it did improve for men, but the study points to the need for more focus on people born abroad. [ABSTRACT FROM AUTHOR]

In pandemic mitigation, strategies such as social distancing and mask-wearing are vital to prevent disease resurgence. Yet, monitoring adherence is challenging, as individuals might be reluctant to share behavioral data with public health authorities. To address this challenge and demonstrate a framework for conducting observational research with sensitive data in a privacy-conscious manner, we employ a privacy-centric epidemiological study design: the federated cohort. This approach leverages recent computational advances to allow for distributed participants to contribute to a prospective, observational research study while maintaining full control of their data. We apply this strategy here to explore pandemic intervention adherence patterns. Participants (n = 3808) were enrolled in our federated cohort via the "Google Health Studies" mobile application. Participants completed weekly surveys and contributed empirically measured mobility data from their Android devices between November 2020 to August 2021. Using federated analytics, differential privacy, and secure aggregation, we analyzed data in five 6-week periods, encompassing the pre- and post-vaccination phases. Our results showed that participants largely utilized non-pharmaceutical intervention strategies until they were fully vaccinated against COVID-19, except for individuals without plans to become vaccinated. Furthermore, this project offers a blueprint for conducting a federated cohort study and engaging in privacy-preserving research during a public health emergency. [ABSTRACT FROM AUTHOR]

Participation in high school sports has physical, physiological, and social development benefits, while also increasing the risk of acute and overuse injuries. Risk of sport-related overuse injury differs between boys and girls. To investigate differences in overuse injuries among US high school athletes participating in the gender-comparable sports of soccer, basketball, and baseball/softball. Descriptive epidemiology study using a nationally representative sample from the High School Reporting Information Online (RIO) database. High schools. Athletes with overuse injuries during the 2006–2007 through 2018–2019 academic years. National estimates and rates of overuse injuries were extrapolated from weighted observed numbers with the following independent variables: sport, gender, academic year, class year, event type, body site, diagnosis, recurrence, activity, and position. Among an estimated 908 295 overuse injuries nationally, 43.9% (n = 398 419) occurred in boys' soccer, basketball, and baseball, whereas 56.1% (n = 509 876) occurred in girls' soccer, basketball, and softball. When comparing gender across sports, girls were more likely to sustain an overuse injury than boys (soccer, injury rate ratio [IRR]: 1.37, 95% CI = 1.20–1.57; basketball, IRR: 1.82, 95% CI = 1.56–2.14; baseball/softball, IRR: 1.21, 95% CI = 1.04–1.41). Most overuse injuries in soccer and basketball for both genders occurred to a lower extremity (soccer: 83.9% [175 369/209 071] for boys, 90.0% [243 879/271 092] for girls; basketball: 77.0% [59 239/76 884] for boys, 80.5% [81 826/101 709] for girls), whereas most overuse injuries in baseball and softball were to an upper extremity (72.5% [81 363/112 213] for boys, 53.7% [73 557/136 990] for girls). For boys' baseball, pitching (43.5% [47 007/107 984]) was the most common activity associated with an overuse injury, which differed from the most common activity of throwing (31.7% [39 921/126 104]) for girls' softball. Gender differences observed in this study can help guide future strategies that are more specific to gender and sport to reduce overuse injuries among high school athletes. [ABSTRACT FROM AUTHOR]

Objective: To describe the epidemiology of hamstring tears in National Collegiate Athletic Association (NCAA) sports. Design: Descriptive epidemiology study. Athletic trainers from NCAA schools reported injuries to the NCAA Injury Surveillance Program. Setting: A convenience sample of NCAA hamstring tear injuries during the 2014/2015 through 2018/2019 academic years. Patients (or Participants): NCAA student-athletes. Independent Variables: Sport, sex, event type, season segment, injury history, and activity at the time of injury. Main Outcome Measures: Injury counts, rates, and proportions were used. Results: Two thousand ninety-six hamstring tears from 8 474 400 athlete-exposures (AEs) were reported (2.47 per 10 000 AEs). Rates were highest in Men's Soccer (5.97 per 10 000 AEs) and Women's Soccer (3.13 per 10 000 AEs), among all Men's and Women's sports, respectively. Competition-related rates in Men's and Women's sports were highest in 2015 to 2016 then followed a decreasing pattern across the remainder of the study period. Among sex-comparable sports, rates were higher in men's (compared with women's) Baseball/Softball, Soccer, and Track and Field. The prevalence of recurrent injuries was comparable among men's (14.8%) and women's (11.5%) sports. Time loss hamstring tears were more prevalent in Men's sports than Women's sports [injury proportion ratio 5 1.33; 95% confidence interval, (1.21, 1.47)]. Conclusions: Overall, hamstring tear rates were higher across all Men's sports compared with Women's sports. Rates across event type were comparable in several sports; and so, adjustments to practice are needed considering that practice environments are more modifiable than competitions. Indeed, improving hamstring tear prevention programs to reduce the burden of this injury in NCAA athletes remains critical. [ABSTRACT FROM AUTHOR]

Purpose: Dyslipidemia is a major health issue worldwide. There is growing interest in understanding the potential role of kimchi consumption on serum lipid profiles. However, there are limited epidemiological studies available on this topic. Therefore, this study aims to investigate the association between kimchi intake and serum lipid profiles. Methods: We conducted an epidemiological study on participants (aged 40–69 years old) selected from the Health Examinees (HEXA) cohort study (n = 61,761). Four types of kimchi, including Baechu kimchi (cabbage kimchi), Kkakdugi (radish kimchi), Nabak kimchi/Dongchimi (a type of water kimchi made with fermented vegetables), and other kimchi, were assessed by a 106-food item semi-quantitative validated food frequency questionnaire (FFQ). Each kimchi intake is the average value calculated from the FFQ of the baseline and follow-up surveys. Fasting blood data were obtained at baseline and follow-up visits. Linear regression was used to examine the relationship between the intake of kimchi and the change in serum lipid profiles. Results: The mean years between the baseline survey and a follow-up survey was 4.97 years. In this study, compared to the lowest category (< 1 serving/day), Baechu kimchi intake (2− < 3 servings/day) had more negative correlations with the change in values of total cholesterol (β: −1.600, 95% confidence interval [CI, −2.744, −0.456]), triglycerides (β: −3.372, 95% CI [−5.414, −1.330]), and low-density lipoprotein cholesterol (β: −1.155, 95% CI [−2.214, −0.095]) in women. In men, Baechu kimchi intake (2− < 3 servings/day) had a more positive correlation associated with the changes in values of high-density lipoprotein cholesterol (β: 0.049, 95% CI [0.031, 0.907]) compared to the lowest intake category (< 1 serving/day). Conclusions: Among Korean adults, consumption of kimchi, particularly Baechu kimchi, was found to be associated with improvements in serum lipid profiles. Further studies are required to conduct additional interventions to confirm the association between kimchi and serum lipid profiles. [ABSTRACT FROM AUTHOR]

Person-generated health data (PGHD) are valuable for studying outcomes relevant to everyday living, for obtaining information not otherwise available, for long-term follow-up, and in situations where decisions cannot wait for traditional clinical research to be completed. While there is no dispute that these data are subject to bias, insights gained may be better than having an information void, provided the biases are understood and addressed. People will share information known uniquely to them about exposures that may affect drug tolerance, safety, and effectiveness (eg, nonprescription and complementary medications, alcohol, tobacco, illicit drugs, exercise, etc). Patients may be the best source of safety information when long-term follow-up is needed (eg, the 5- to 15-year follow-up required for some gene therapies). Validation studies must be performed to evaluate what people can accurately report and when supplementary confirmation information is needed. However, PGHD has already proven valuable in quantifying and contrasting COVID-19 vaccine benefits and risks and for evaluating disease transmission and the accuracy of COVID-19 testing. Going forward, PGHD will be used for patient-measured and patient-relevant outcomes, including for regulatory purposes, and will be linked to broader health data networks using tokenization, becoming a mainstay for signals about risks and benefits for diverse populations. This article is part of a Special Collection on Pharmacoepidemiology. [ABSTRACT FROM AUTHOR]

The World Health Organization specifies that sexual health requires the potential for pleasurable and safe sexual experiences. Yet epidemiologic research into sexual pleasure and other positive sexual outcomes has been scant. In this commentary, we aim to support the development and adoption of sex-positive epidemiology, which we define as epidemiology that incorporates the study of pleasure and other positive features alongside sexually transmitted infections and other familiar negative outcomes. We first call epidemiologists' attention to the potential role that stigma plays in the suppression of sex-positive research. We further describe existing measures of sex-positive constructs that may be useful in epidemiologic research. Finally, the study of sex-positive constructs is vulnerable to biases that are well-known to epidemiologists, especially selection bias, information bias, and confounding. We outline how these biases influence existing research and identify opportunities for future research. Epidemiologists have the potential to contribute a great deal to the study of sexuality by bringing their considerable methodological expertise to long-standing challenges in the field. We hope to encourage epidemiologists to broaden their sexual health research to encompass positive outcomes and pleasure. [ABSTRACT FROM AUTHOR]

The aim of this literature review was to identify and provide a summary update on the validity and applicability of the most promising dietary biomarkers reflecting the intake of important foods in the Western diet for application in epidemiological studies. Many dietary biomarker candidates, reflecting intake of common foods and their specific constituents, have been discovered from intervention and observational studies in humans, but few have been validated. The literature search was targeted for biomarker candidates previously reported to reflect intakes of specific food groups or components that are of major importance in health and disease. Their validity was evaluated according to 8 predefined validation criteria and adapted to epidemiological studies; we summarized the findings and listed the most promising food intake biomarkers based on the evaluation. Biomarker candidates for alcohol, cereals, coffee, dairy, fats and oils, fruits, legumes, meat, seafood, sugar, tea, and vegetables were identified. Top candidates for all categories are specific to certain foods, have defined parent compounds, and their concentrations are unaffected by nonfood determinants. The correlations of candidate dietary biomarkers with habitual food intake were moderate to strong and their reproducibility over time ranged from low to high. For many biomarker candidates, critical information regarding dose response, correlation with habitual food intake, and reproducibility over time is yet unknown. The nutritional epidemiology field will benefit from the development of novel methods to combine single biomarkers to generate biomarker panels in combination with self-reported data. The most promising dietary biomarker candidates that reflect commonly consumed foods and food components for application in epidemiological studies were identified, and research required for their full validation was summarized. [ABSTRACT FROM AUTHOR]

The present study aimed to examine the spatial characteristics of myopia and identify the socioeconomic and environmental factors influencing its prevalence. Myopia prevalence among children of school age of Han ethnicity in China was 56.6% in 2019, with the highest and lowest prevalence's in Shandong (66.8%) and Guizhou (47.3%), respectively. There was a spatial aggregation of myopia prevalence in China. Environmental factors (atmospheric PM2.5 concentration and forest coverage) and socioeconomic factors (gross domestic product per capita, per capita disposable income, hospital beds per thousand people, and Engel coefficient) have significant influences on myopia prevalence. The interaction of each factor on myopia showed nonlinear enhancement. Myopia prevalence among children of school age was spatially clustered, and environmental and socioeconomic conditions are associated with myopia prevalence. Our findings provide novel perspectives for the comprehensive prevention and control of myopia. [ABSTRACT FROM AUTHOR]

Background: Perinatal mental health disorders (PMHDs) are associated with a myriad of negative outcomes for women, infants, and the rest of the family unit. Understanding the prevalence of these conditions is important to guide prevention and treatment pathways. Indeed, the burden of PMHDs has been studied in many countries, but for Malta, an island with an annual birth rate of 4500 births, this burden is still to be determined. The main objective of this study was to address this gap, determine the prevalence of PMHDs among postpartum women in Malta, and study associated psychosocial determinants for this population. Methods: A cross‐sectional epidemiological study was conducted between March and April 2022 to determine the point prevalence of postpartum PMHDs in Malta. A representative, random sample of 243 postnatal mothers were recruited and screened for mental health issues using a two stage approach incorporating symptom scales and a diagnostic interview. Results: The point prevalence of postnatal PMHDs in Malta, according to a diagnostic interview, was found to be 21.4%. Anxiety disorders were the most prevalent conditions (16.8%), followed by obsessive‐compulsive disorder (6.1%) and borderline personality disorder (5.6%), respectively. A higher rate of 32.1% was identified with self‐report measures. Conclusions: PMHDs are highly prevalent, affecting approximately 20% of women in Malta across the first postnatal year. The value of this finding accentuates the need for service availability and the implementation of perinatal mental health screening programs. [ABSTRACT FROM AUTHOR]

The term long COVID (LC) effectively describes the broad long-term disease burden of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infections, encompassing individual suffering and significant socioeconomic impacts. However, its general use hampers precise epidemiological research, diagnostics and therapeutic strategies. Misinterpretations occur, for example, when population surveys are compared to studies using health record data, because both refer to these data as LC. This also emphasizes the need for different terminology. The National Institute for Health and Care Excellence (NICE) rapid guideline differentiates ongoing symptomatic COVID-19 from post-COVID conditions, yet real-world observations challenge these two subgroup definitions. We propose refining the term LC into three subgroups: ongoing symptomatic COVID-19, SARS-CoV-2 induced or exacerbated diseases and post-acute COVID condition. This stratification aids targeted diagnostics, treatment and epidemiological research. Subgroup-specific documentation using the International Classification of Diseases, Tenth Revision (ICD-10) codes ensures accurate tracking and understanding of long-term effects. The subgroup of post-acute COVID condition again includes various symptoms, syndromes and diseases like post-exertional malaise (PEM), dysautonomia or cognitive dysfunctions. In this regard, differentiation, especially considering PEM, is crucial for effective diagnostics and treatment. [ABSTRACT FROM AUTHOR]

Background: American football is the most popular sport in the United States, with over 5.6 million people >6 years old playing the sport. Fractures in American football athletes are significant, as they compromise an athlete's performance and can also lead to prolonged recovery periods, affecting team dynamics and player careers. Analyzing these injuries is critical to evaluate preventive measures and tailor rehabilitation strategies to ensure the well-being and sustained peak performance of football athletes on and off the field. Purpose: To analyze the trend of American football fractures by body site, sex, and age in amateur athletes over a 20-year period between 2002 and 2021. Study Design: Descriptive epidemiology study. Methods: The National Electronic Injury Surveillance System (NEISS) database was queried to characterize football-related fractures and injuries from 2002 to 2021 in patients aged 0-99 years old. National injury estimates were calculated using sample weights. Chi-square analysis and one-way ANOVA were performed to compare categorical variables. Results: Of 56,809 cases of American football-related fractures over 20 years, patients aged 10 to 14 years had the highest incidence of fractures, composing 41.2% of all fractures (n = 23,389), and patients aged <18 years represented 88.8% of all fractures (n = 50,457). The median age of players when fractures occurred was 13 years. Upper extremity fractures (n = 41,863 [73.7%]) were the most common fracture reported compared with lower extremity and head, neck, and trunk fractures. Among upper extremity fractures, finger fractures had the highest prevalence (35.6%), followed by lower arm fractures (19.9%) and wrist fractures (13%). While most cases resulted in release after treatment (93.1%), 5.9% resulted in treatment and hospitalization. When analyzing trends in American football-related fractures over time, we observed the largest number of fractures in 2006 (n = 3664), while the smallest number of fractures occurred in 2020 (n = 1313). Also, a downward trend was found in American football-related fractures since 2006, with a mean of 101 fewer fractures each year. Conclusion: Our analysis showed that American football-related fractures diagnosed in the emergency department in the United States were most likely to occur in pediatric patients (10-18 years old). In addition, patients experiencing American football-related fractures were most likely to have an upper extremity fracture and not require hospitalization. The trend in American football-related fractures has been decreasing since 2006. [ABSTRACT FROM AUTHOR]