Miracle-dz/UniFAR-FTUs huggingface dataset:
Low serum adiponectin levels in childhood and adolescence predict increased intima-media thickness in adulthood. The Cardiovascular Risk in Young Finns Study

Abstract Introduction: Low adiponectin levels may predict the development of atherosclerosis. We examined the association of childhood adiponectin with preclinical carotid atherosclerosis that is defined as plaque and/or high (≥95th percentile) intima-media thickness (IMT) at the carotid bifurcation in adulthood. Methods: The Cardiovascular Risk in Young Finns Study is a cohort study on cardiovascular risk factors. We used risk factor data from the baseline study (1980) and ultrasound findings from the follow-ups (2001 and 2007). The study population included 1708 participants, aged 3–18 years at baseline. Results: In multivariate analysis, childhood adiponectin was inversely associated with preclinical carotid atherosclerosis: odds ratio 0.68, 95% confidence interval (CI) 0.53–0.86, p = . 001, for 1-SD increase in childhood adiponectin after adjusting for childhood non-high-density lipoprotein cholesterol, body mass index, and blood pressure. When examining the incremental predictive ability, we observed that compared to an approach utilizing only conventional risk factors, the model additionally including adiponectin levels improved c-statistics area under curve from 0.733 (95% Cl 0.694–0.771) to 0.748 (95% Cl 0.710–0.786), p = . 02. Conclusions: Childhood adiponectin levels improve the prediction of carotid atherosclerosis in adulthood over conventional risk factors. This supports the idea that low adiponectin levels may have a role in the development of preclinical atherosclerosis. Key messages Childhood adiponectin levels improve the prediction of increased carotid intima-media thickness in adulthood over conventional cardiovascular risk factors. These results suggest that adiponectin levels measured in childhood may have a role in the atherosclerotic process.
Perceived Stress, Reproductive Hormones, and Ovulatory Function: A Prospective Cohort Study

Background: Stress has been shown to suppress ovulation in experimental models, but its effect on human reproduction at the population level is unclear. Methods: Healthy women (n = 259), aged 18–44 years from Western New York, were followed for 2 menstrual cycles (2005–2007). Women completed daily perceived stress assessments, a 4-item Perceived Stress Scale (PSS-4) up to 4 times each cycle, and a 14-item PSS at baseline. Mixed model analyses were used to assess effects of stress on log reproductive hormone concentrations and sporadic anovulation. Results: High versus low daily stress was associated with lower estradiol (−9.5% [95% confidence interval (CI) = −15.6% to −3.0%]), free estradiol (−10.4% [−16.5% to −3.9%]), and luteinizing hormone (−14.8% [−21.3% to −7.7%]) and higher follicle-stimulating hormone (6.2% [95% CI = 2.0% to 10.5%]) after adjusting for age, race, percent body fat, depression score, and time-varying hormones and vigorous exercise. High versus low daily stress was also associated with lower luteal progesterone (−10.4% [95% CI = −19.7% to −0.10%]) and higher odds of anovulation (adjusted odds ratio = 2.2 [95% CI = 1.0 to 4.7]). For each unit increase in daily stress level, women had a 70% higher odds of an anovulatory episode (odds ratio = 1.7 [1.1 to 2.4]). Similar but attenuated results were found for the association between the PSS-4 and reproductive hormones, while null findings were found for the baseline PSS. Conclusion: Daily perceived stress does appear to interfere with menstrual cycle function among women with no known reproductive disorders, warranting further research to explore potential population-level impacts and causal biologic mechanisms.
Save epidemiology's footprints!: the case of Harvard epidemiology.

This paper uses the case of Harvard’s Department of epidemiology to sketch what could be an enlightened policy aiming to preserve modern epidemiology’s footprints for future generations. the preparation of a keynote lecture for the centennial anniversary of the Harvard School of Public Health (http://webapps.sph.harvard.edu/accordentG1/cuttersymposium20131108/) gave me a chance to spend several months focusing on the history of its epidemiology department. I witnessed the impact of the change in funding sources and archiving procedures of the 1960s and, later, the transition to electronic documentation. the culture of systematic archiving of paper documents came to an end, eliminating convenient troves for historical exploration. as no alternative mode of saving epidemiologic footprints emerged, the footprints of the last 50 years of epidemiology history are imperiled. It is urgent to act. Why is it important to save our footprints? Because history tells us who we are, how we contributed, to whom, and when. It gives us a shared sense of identity, allows us to learn from successes and failures, and helps us become better at what we do. as long as the past still seems vivid in our minds, we do not realize that it has become insubstantial. Without archives, at some point, it will be gone forever. the material needs to be stored and documented methodically. archiving is more than a hobby, it is an expertise. It is not only commendable but also indispensable. Future scholars should be able to reconstruct our history just as they are still able to understand how people lived under the Song Dynasty in 10th century China. I chose the example of the Song Dynasty purposefully. the Chinese empire had a tradition of geographical diaries (called “gazetteers”) and of dynastic histories. Historians belonging to newly prevailing dynasties dug into gazetteers from the immense empire to write a history of the former dynasty. modern scholars warn that the prevailing dynasty tended to exaggerate the weaknesses of the defeated dynasty to justify dynastic change. nonetheless, we can still consult a 2000-year-long stream of information, made of dynastic histories and even of the original gazetteers—a growing fraction of which can be consulted electronically. this material has sustained enthralling historical books. modern epidemiology departments may find inspiration in the proactive attitude and model used by the Chinese imperial administration to preserve the empire’s history, except for the bias and partiality of the prevailing dynasties. the following 6 recommendations are an attempt to transform the threat associated with the volatility of electronic documents into an asset, allowing us to archive more
Multiple Imputation to Account for Measurement Error in Marginal Structural Models

Background: Marginal structural models are an important tool for observational studies. These models typically assume that variables are measured without error. We describe a method to account for differential and nondifferential measurement error in a marginal structural model. Methods: We illustrate the method estimating the joint effects of antiretroviral therapy initiation and current smoking on all-cause mortality in a United States cohort of 12,290 patients with HIV followed for up to 5 years between 1998 and 2011. Smoking status was likely measured with error, but a subset of 3,686 patients who reported smoking status on separate questionnaires composed an internal validation subgroup. We compared a standard joint marginal structural model fit using inverse probability weights to a model that also accounted for misclassification of smoking status using multiple imputation. Results: In the standard analysis, current smoking was not associated with increased risk of mortality. After accounting for misclassification, current smoking without therapy was associated with increased mortality (hazard ratio [HR]: 1.2 [95% confidence interval [CI] = 0.6, 2.3]). The HR for current smoking and therapy [0.4 (95% CI = 0.2, 0.7)] was similar to the HR for no smoking and therapy (0.4; 95% CI = 0.2, 0.6). Conclusions: Multiple imputation can be used to account for measurement error in concert with methods for causal inference to strengthen results from observational studies.
Application of a New Statistical Model for Measurement Error to the Evaluation of Dietary Self-report Instruments

Most statistical methods that adjust analyses for dietary measurement error treat an individual’s usual intake as a fixed quantity. However, usual intake, if defined as average intake over a few months, varies over time. We describe a model that accounts for such variation and for the proximity of biomarker measurements to self-reports within the framework of a meta-analysis, and apply it to the analysis of data on energy, protein, potassium, and sodium from a set of five large validation studies of dietary self-report instruments using recovery biomarkers as reference instruments. We show that this time-varying usual intake model fits the data better than the fixed usual intake assumption. Using this model, we estimated attenuation factors and correlations with true longer-term usual intake for single and multiple 24-hour dietary recalls (24HRs) and food frequency questionnaires (FFQs) and compared them with those obtained under the “fixed” method. Compared with the fixed method, the estimates using the time-varying model showed slightly larger values of the attenuation factor and correlation coefficient for FFQs and smaller values for 24HRs. In some cases, the difference between the fixed method estimate and the new estimate for multiple 24HRs was substantial. With the new method, while four 24HRs had higher estimated correlations with truth than a single FFQ for absolute intakes of protein, potassium, and sodium, for densities the correlations were approximately equal. Accounting for the time element in dietary validation is potentially important, and points toward the need for longer-term validation studies.
Smoking and low serum testosterone associates with high concentration of oxidized LDL

Background. The interplay between smoking, oxidized low-density lipoprotein cholesterol (ox-LDL) and gonadal hormones has been scarcely investigated. Aim. To investigate associations in ox-LDL and gonadal hormones in smokers and non-smokers Methods. Participants (n=164) were obtained from a population cohort of Finnish men aged 40–70 years. The subjects answered a detailed questionnaire on their health behaviour, medication, diseases, and different symptoms, and the hormonal and lipid profiles were measured. Results. Smokers (n=33) had higher levels of ox-LDL (21%) and more free testosterone (12%) (P<0.01 for all) than non-smokers (n=131). The difference between smokers and non-smokers in ox-LDL persisted after controlling for possible confounding factors. When the smokers were divided into two subgroups (n=16 and n=17) according to total testosterone (≤15 and >15 nmol/L), the ox-LDL in the low-testosterone subgroup was significantly higher (30%) than in the high-testosterone group (P=0.006). Similarly in the corresponding non-smoking subgroups (n=72 and n=59), ox-LDL was significantly higher (11%) in the low-testosterone subgroup than in the high-testosterone subgroup (P=0.012). Conclusions. Smoking men have significantly more ox-LDL than non-smoking men. Furthermore, if smoking is combined with a low serum testosterone, ox-LDL is even higher. This may suggest a higher risk for atherosclerosis.
New diagnostic and treatment approaches in non-alcoholic fatty liver disease (NAFLD)

Non-alcoholic fatty liver disease or NAFLD is a chronic liver condition characterized by hepatic steatosis and associated with insulin resistance and type 2 diabetes mellitus (T2DM). In many patients fat accumulation leads to steatohepatitis (NASH) with chronic necrosis, inflammation, and fibrosis, and eventually to the development of cirrhosis. Obese and T2DM patients are at the greatest risk for NASH and progressive disease. New diagnostic techniques, such as magnetic resonance imaging and spectroscopy (MRS), have enhanced our way to non-invasively quantify liver fat and suggest that the epidemic of NAFLD is much larger than previously believed. However, the diagnosis of NAFLD for clinicians remains difficult due to a number of factors: limited awareness, non-specific symptoms, few laboratory findings, and the need for a liver biopsy to confirm the diagnosis. Traditional treatment approaches have centered on weight loss, but data are limited on its long-term efficacy, and the overall compliance is poor. Recently, pioglitazone has been shown to be safe and effective in patients with NASH and may radically change our approach to the disease. Still, many aspects remain poorly understood. Taken together, wider use of new diagnostic methods and treatment approaches appears to signal the dawn of a new era in the management of NAFLD.
Local and systemic allergic contact dermatitis due to dental alloys

1 Euvrard S, Kanitakis J, Claudy A. Skin cancers after organ transplantation. N Eng J Med 2003; 348: 1681–1691. 2 McMenamin ME, Fletcher CDM. Reactive angioendotheliomatosis. Am J Surg Pathol 2002; 26: 685– 697. 3 Mentzel T, Beham A, Calonje E, Katenkamp D, Fletcher CD. Epithelioid hemangioendothelioma of skin and soft tissue: clinicopathologic and immunohistochemical study of 30 cases. Am J Surg Pathol 1997; 21: 363–374. 4 Kanik AB, Oh CH, Bhawan J. Disseminated cutaneous epithelioid hemangioma. J Am Acad Dermatol 1996; 35: 851– 853. 5 Brenn T, Fletcher CDM. Cutaneous epithelioid angiomatous nodules: a distinct lesion in the morphologic spectrum of epithelioid vascular tumors. Am J Dermatopathol 2004; 26: 14–21. 6 Soo JK, Mortimer PS. Eruptive angiomas associated with graft-versus-host-disease. Br J Dermatol 2006; 154: 376–378. 7 Chang S-E, Roh K-H, Lee M-W et al. Microvenular hemangioma in a boy with acute myelogenous leukaemia. Pediatr Dermatol 2003; 20: 266–267.
Socioeconomic Risk Factors for Bacterial Gastrointestinal Infections

Background: Bacterial gastrointestinal infections cause considerable morbidity in industrialized countries, but little is known about socioeconomic factors affecting the risk of infection. Methods: By linkage among 3 national registers, we followed the entire population of Denmark (5.3 million people) from 1993 to 2004 for the occurrence of laboratory-confirmed bacterial gastrointestinal infections. Using Poisson regression analyses, incidence rate ratios (IRRs) were estimated for the major groups of bacteria in different socioeconomic strata, focusing on income group, level of education, marital status, number of children in the household, and country of birth. Results: Associations with socioeconomic variables varied by type of bacterium. High-income groups had increased risks of infection with Campylobacter, Shigella, and Salmonella Enteritidis, and education was positively associated with increased risk of infection with Campylobacter and Shigella. Married persons were generally at higher risk than single persons, but adults with children had lower risks compared with adults without children. Foreign-born persons generally had lower risks, whereas Danish-born persons with foreign-born parents were at reduced risk of infection with the pork-associated bacterium Yersinia (IRR = 0.33; 95% confidence interval 0.25–0.42), but increased risk with Shigella (5.7; 4.8–6.1), Salmonella, and Shiga toxin-producing Escherichia coli. Conclusions: The findings suggest that risk of infection is not primarily associated with poverty, but rather with increasing socioeconomic status. Risk of infection also varies with cultural background. Observed differences may be explained by differences in diet and travel activity, although they may also in part reflect differential probabilities of diagnostic reporting.
Comparison of ambulatory blood pressure-lowering effects of higher doses of different calcium antagonists in uncontrolled hypertension: the Calcium Antagonist Controlled-Release High-Dose Therapy in Uncontrolled Refractory Hypertensive Patients (CARILLON) Study

Abstract Background: Data are sparse regarding ambulatory blood pressure (BP) reduction of up-titration from a standard dose to a high dose in both nifedipine controlled-release (CR) and amlodipine. This was a prospective, randomized, multicenter, open-label trial. Patients and methods: Fifty-one uncontrolled hypertensives medicated by two or more antihypertensive drugs including a renin-angiotensin system inhibitor and a calcium antagonist were randomly assigned to either the nifedipine CR (80 mg)/candesartan (8 mg) group or the amlodipine (10 mg)/candesartan (8 mg) group. Results: The changes in 24-hr BP were comparable between the groups. The nifedipine group demonstrated a significant decrease in their urinary albumin creatinine ratio, whereas the amlodipine group demonstrated a significant decrease in their NTproBNP level. However, there was no significant difference in any biomarkers between the two groups. Conclusion: Nifedipine showed an almost equal effect on ambulatory blood pressure as amlodipine. Their potentially differential effects on renal protection and NTproBNP should be tested in larger samples.
The rationale and design of reduction of uncontrolled hypertension by Remote Monitoring and Telemedicine (REMOTE) study

Abstract Purpose: Although self-measurement of home blood pressure (HBP) is common in Japan and HBP telemonitoring via the Internet is possible, whether telemonitoring improves HBP control better than conventional practice remains unclear. Furthermore, hypertension care with online communication using telemonitored HBP is feasible, whereas the efficacy and safety of such telemedicine have not been established. We aim to compare traditional care, care with office visits using HBP telemonitoring, and antihypertensive telemedicine based on HBP telemonitoring. Methods and design: In total, 444 patients with uncontrolled hypertension will be recruited and randomly assigned to three groups: (1) control: usual care with office visits and HBP self-report, (2) telemonitoring: weekly assessment of transmitted HBP by physicians and treatment adjustment upon office visits, or (3) telemedicine: online communication instead of office visits to adjust medication using telemonitored HBP. Primary outcome is the time to control of HBP, and secondary outcomes include achieved HBP levels, adherence, treatment intensity, adverse events, patient satisfaction and cost-effectiveness. Discussion: Hypertension care with telemonitoring and telemedicine are expected to require shorter time to achieve HBP control compared to usual care. Combining HBP telemonitoring with telemedicine may lower the hurdles for starting and persisting to hypertension treatment and eventually reduce cardiovascular events.
Marginal Structural Models for the Estimation of Direct and Indirect Effects

The estimation of controlled direct effects can be carried out by fitting a marginal structural model and using inverse probability of treatment weighting. To use marginal structural models to estimate natural direct and indirect effects, 2 marginal structural models can be used: 1 for the effects of the treatment and mediator on the outcome and 1 for the effect of the treatment on the mediator. Unlike marginal structural models typically used in epidemiologic research, the marginal structural models used to estimate natural direct and indirect effects are made conditional on the covariates.
Suicide in the Kurdistan Region of Iraq, state of the art

In recent years the, incidence of suicide in Kurdistan has been increasing, especially among females, to a degree it cannot be neglected. Consequently, attention was given to this phenomena and the aggressive method of suicide used by young peoples, especially females, in Kurdistan. In attempt to obtain an objective picture of the frequently media-reported suicide among youths and women in the Kurdistan Region of Iraq. The responsible authorities and medical service units in the region were visited to collect information, and the available data were explored to produce a state-of-the-art overview on the subject. Because of insufficient documentation and lack of systematic registration, the data on suicide were scattered and difficult to evaluate. However, the findings did confirm that suicide exists as a serious problem in the society in Kurdistan, particularly among females. Urgent attention is demanded from the responsible authorities and organizations concerned in the region. Further research is needed to investigate the exact extent of suicide and its correlates in the society in Kurdistan, in order to plan for effective preventive measures.
Risk Factors for Injury During Typhoon Saomei

Background: Little is known about risk factors for typhoon-related injury. Methods: On 10 August 2006, Typhoon Saomei (one of the strongest typhoons on record) struck Southern China. We conducted a census in Longhua Village, Fujian Province to assess typhoon-related injury, and carried out a matched case-control analysis to evaluate risk factors. Results: Of the 3002 residents interviewed, 136 (4.5%) were injured, and 7 were reported by family members to have died (2.3 per 1000). Injuries were highest with the first peak of wind speed. Living in houses directly facing the sea, compared with living in the last row of houses, was associated with an increased risk (relative risk = 18 [95% confidence interval (CI) = 5.7–55]). Important risk factors were failure to reinforce doors or windows (adjusted odds ratio = 13 [95% CI = 2.4–76]), staying in a damaged room (8.7 [2.5–31]), and staying near a window or door (12 [4.1–38]). Conclusions: Injuries with typhoon Saomei were related to both wind speed and failure to take specific preventive measures.
Plasma Organochlorine Levels and Risk of Non-Hodgkin Lymphoma in a Cohort of Men

Background: Environmental exposure to polychlorinated biphenyls (PCBs) and p,p′-dichlorodiphenyldichloroethylene (p, p′-DDE) has been associated with the risk of non-Hodgkin lymphoma. Methods: We conducted a case-control study nested within the Physicians' Health Study, a prospective cohort established in 1982. We measured concentrations of PCBs and p,p′-DDE in baseline blood samples from 205 men later diagnosed with non-Hodgkin lymphoma and 409 age- and race-matched controls. Lipid-adjusted organochlorine concentrations were categorized into quintiles based on the distribution among controls. We used conditional logistic regression to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for each quintile relative to the lowest quintile. We also evaluated these associations for major histologic subtypes of non-Hodgkin lymphoma. Results: The risk of non-Hodgkin lymphoma was positively associated with the sum of 51 PCB congeners assayed (&Sgr;PCB); the group of immunotoxic congeners; the individual congeners 118, 138, 153, and 180; and the sum of these 4 congeners. The simple OR for the highest quintile of lipid-adjusted &Sgr;PCB versus the lowest was 1.9 (95% CI = 1.1–3.2; test for trend, P = 0.001), with similar trends for individual congeners and groups defined as above. Adjustment for height, body mass index, alcohol intake, smoking, and fish intake did not substantially change the effect estimates. No association was observed for p,p′-DDE. There was no evidence of statistical heterogeneity in effects by histologic subtype of lymphoma; however, this analysis was underpowered. Conclusions: These results support the hypothesis of a positive association between PCB exposure and development of NHL in men.