ORCID Profile
0000-0001-8437-1906
Current Organisations
University of Sydney School of Public Health
,
University Hospital of Lausanne
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Publisher: Elsevier BV
Date: 12-2015
Publisher: Wiley
Date: 24-09-2013
DOI: 10.1111/J.1542-4758.2012.00754.X
Abstract: Inflammation and lipid abnormalities are two important risk factors for cardiovascular disease in hemodialysis (HD) patients. The present study was designed to investigate the effects of flaxseed consumption on systemic inflammation and serum lipid profile in HD patients with lipid abnormalities. This was an unblinded, randomized clinical trial. Thirty HD patients with dyslipidemia (triglyceride >200 mg/dL and/or high-density lipoprotein-cholesterol (HDL-C) <40 mg/dL) were randomly assigned to either a flaxseed or control group. Patients in the flaxseed group received 40 g/day ground flaxseed for 8 weeks, whereas patients in the control group received their usual diet, without any flaxseed. At baseline and at the end of week 8, 7 mL of blood was collected after a 12- to 14-hour fast and serum concentrations of triglyceride, total cholesterol, low-density lipoprotein-cholesterol (LDL-C), HDL-C, and C-reactive protein (CRP) were measured. Serum concentrations of triglyceride (P < 0.01), total cholesterol (P < 0.01), LDL-C (P < 0.01), and CRP (P < 0.05) decreased significantly in the flaxseed group at the end of week 8 compared with baseline, whereas serum HDL-C showed a significant increase (P < 0.01). These changes in the flaxseed group were significant in comparison with the control group. The study indicates that flaxseed consumption improves lipid abnormalities and reduces systemic inflammation in HD patients with lipid abnormalities.
Publisher: Elsevier BV
Date: 12-2016
DOI: 10.1016/J.CLNU.2016.02.012
Abstract: Hospitalized patients should be screened for nutritional risk and adequately managed. Being nutritionally 'at-risk' increases in-hospital mortality, length of stay (LOS) and costs, but the impact on actual costs has seldom been assessed. We aimed to determine nutritional risk screening and management in a Swiss university hospital. The impact of being nutritionally 'at-risk' on in-hospital mortality, LOS and costs was also assessed. Retrospective analysis of administrative data for years 2013 and 2014 from the department of internal medicine of the Lausanne university hospital (8541 hospitalizations, mean age 72.8 ± 16.5 years, 50.4% women). Being nutritionally 'at-risk' was defined as a Nutritional risk screening-2002 score ≥ 3 and nutritional managements were collected from medical records. Screening increased from 16.5% in 2013 to 41.9% in 2014 (p < 0.001), while prevalence of 'at-risk' patients remained stable (64.6% in 2013 and 62.7% in 2014, p = 0.37). Prevalence of 'at-risk' patients was highest in patients with cancer (85.3% in 2013 and 70.2% in 2014) and lowest in patients with disease of skin (42% in 2013 and 44.8% in 2014). Less than half of patients 'at-risk' received any nutritional management, and this value decreased between 2013 and 2014 (46.9% vs. 40.3%, p < 0.05). After multivariate adjustment, 'at-risk' patients had a 3.7-fold (95% confidence interval: 1.91 7.03) higher in-hospital mortality and higher costs (excess 5642.25 ± 1479.80 CHF in 2013 and 5529.52 ± 847.02 CHF in 2014, p < 0.001) than 'not at-risk' patients, while no difference was found for LOS. Despite an improvement in screening, management of nutritionally 'at-risk' patients is not totally covered yet. Being nutritionally 'at-risk' affects three in every five patients and is associated with increased mortality and hospitalization costs.
Publisher: Elsevier BV
Date: 08-2020
DOI: 10.1016/J.CLNU.2019.11.025
Abstract: People report many barriers that prevent them from achieving a healthy diet. Whether perceived barriers are associated with dietary behavior remains unclear. To assess the association between barriers to healthy eating and adherence to the Swiss dietary guidelines. Cross-sectional data from the Swiss Health Survey 2012 (N = 15,450 53% women). Barriers included price, daily habits, taste, gluttony, lack of time, lack of willpower, limited options in restaurants, in supermarkets, no social support, and social opposition. The associations between barriers and adherence to Swiss dietary guidelines were assessed using multivariable logistic regression. Daily habits (odds ratio 95% confidence interval: 0.91 0.85-0.98) and taste (0.85 0.79-0.91) were associated with lower adherence to the guidelines for fruits, while price (1.13 1.06-1.21) and limited options in restaurants (1.33 1.23-1.45) and in supermarkets (1.18 1.03-1.35) were associated with higher adherence. Taste was associated with lower adherence to the guidelines for vegetables (0.72 0.66-0.78), while price (1.20 1.11-1.30), gluttony (1.17 1.04-1.31), social group opposition (1.48 1.18-1.85) and limited options in restaurants (1.56 1.42-1.72) and in supermarkets (1.25 1.07-1.47) were associated with higher adherence. Daily habits (0.82 0.75-0.90), time (0.86 0.78-0.94), lack of willpower (0.78 0.70-0.87), and gluttony (0.86 0.76-0.98) were associated with lower adherence to the guidelines for fish, whereas price (1.09 1.01-1.19), and limited options in restaurants (1.26 1.14-1.39) and supermarkets (1.40 1.20-1.63) were associated with higher adherence. Daily habits (0.89 0.82-0.97), taste (0.66 0.61-0.72), lack of willpower (0.84 0.76-0.92) and gluttony (0.66 0.58-0.75) were associated with lower adherence to the guidelines for meat. Time (0.88 0.78-0.99) was associated with lower adherence to the guidelines for dairy, while gluttony (1.26 1.09-1.46) was associated with higher adherence. Daily habits was associated with lower adherence (0.91 0.85-0.97) to the guidelines for liquids, while limited options in restaurants was associated with higher adherence (1.12 1.03-1.22). In the Swiss adult population, several self-reported barriers to healthy eating appear to hinder adherence to the dietary guidelines, while other commonly reported barriers are linked to higher adherence.
Publisher: Oxford University Press (OUP)
Date: 04-02-2021
Abstract: Socioeconomic status (SES) has been suggested as a risk factor for falls but the few prospective studies to test this have had mixed results. We evaluated the prospective association between SES and falls in the Concord Health and Ageing in Men Project (CHAMP). CHAMP is a population-based prospective cohort study of men aged ≥70 years in Sydney, Australia. Incident falls were ascertained by triannual telephone calls for up to 4 years. SES was assessed with 4 indicators (education, occupation, source of income, home ownership) and cumulative SES score. We tested for interaction between SES indicators and country of birth and conducted stratified analyses. We evaluated 1624 men (mean age: 77.3 ± 5.4 years). During a mean ± SD follow-up of 42.6 ± 8.7 months, 766 (47%) participants reported ≥1 incident falls. In nonstratified analyses, there were no associations between SES indicators and falls. In stratified analyses, falls rates were higher among Australian-born men with less formal education (incidence rate ratio [IRR] 1.66, 95% confidence interval [CI] 1.16–2.37, compared with those with more education) and those with low occupational position (1.45 1.09–1.93). However, among men born in non-main English-speaking countries the rate of falls was lower among those with low educational level and no associations were evident for occupational position. Lower educational level and occupational position predicted a higher falls rate in Australian-born men the opposite relationship was evident for educational level among migrants born in non-main English-speaking countries. Further studies should test these relationships in different populations and settings and evaluate targeted interventions.
Publisher: BMJ
Date: 08-05-2020
Abstract: Disadvantaged socioeconomic position (SEP) is widely associated with disease and mortality, and there is no reason to think this will not be the case for the newly emerged coronavirus disease 2019 (COVID-19) that has reached a pandemic level. In iduals with a more disadvantaged SEP are more likely to be affected by most of the known risk factors of COVID-19. SEP has been previously established as a potential determinant of infectious diseases in general. We hypothesise that SEP plays an important role in the COVID-19 pandemic either directly or indirectly via occupation, living conditions, health-related behaviours, presence of comorbidities and immune functioning. However, the influence of socioeconomic factors on COVID-19 transmission, severity and outcomes is not yet known and is subject to scrutiny and investigation. Here we briefly review the extent to which SEP has been considered as one of the potential risk factors of COVID-19. From 29 eligible studies that reported the characteristics of patients with COVID-19 and their potential risk factors, only one study reported the occupational position of patients with mild or severe disease. This brief overview of the literature highlights that important socioeconomic characteristics are being overlooked when data are collected. As COVID-19 spreads worldwide, it is crucial to collect and report data on socioeconomic determinants as well as race/ethnicity to identify high-risk populations. A systematic recording of socioeconomic characteristics of patients with COVID-19 will be beneficial to identify most vulnerable groups, to identify how SEP relates to COVID-19 and to develop equitable public health prevention measures, guidelines and interventions.
Publisher: Elsevier BV
Date: 04-2018
DOI: 10.1016/J.CLNU.2017.02.012
Abstract: Undernutrition is associated with increased hospital costs. Whether these increased costs are totally compensated by third payer systems has not been assessed. We aimed to assess the differences between actual and reimbursed hospital costs according to presence/absence of nutritional risk, defined by a Nutritional risk screening-2002 (NRS-2002) score ≥3. Retrospective study. Administrative data for years 2013 and 2014 of the department of internal medicine of the Lausanne university hospital. The data included total and specific costs (i.e. clinical biology, treatments, pathology). Reimbursed costs were based on the Swiss Diagnosis Related Group (DRG) system. 2200 admissions with NRS-2002 data were included (mean age 76 years, 53.9% women), 1398 (63.6%) of which were considered nutritionally 'at-risk'. After multivariate adjustment, patients nutritionally 'at-risk' had higher costs (multivariate-adjusted difference ± standard error: 34,206 ± 1246 vs. 22,214 ± 1666 CHF, p < 0.001) and higher reimbursements (26,376 ± 1105 vs. 17,783 ± 1477 CHF, p < 0.001). Still, the latter failed to cover the costs, leading to a deficit between costs and reimbursements of 7831 ± 660 CHF in patients 'at-risk' vs. 4431 ± 881 in patients 'not at-risk' (p < 0.003). Being nutritionally 'at-risk' also led to a lower likelihood of complete coverage of costs: multivariate-adjusted odds ratio and 95% confidence interval 0.77 (0.62-0.97). Patients 'at-risk' had lower percentage of total costs in medical interventions, food, imaging and "other", but the absolute differences were less than 2%. Hospital costs of patients nutritionally 'at-risk' are less well reimbursed than of patients 'not at-risk'. Better reporting of undernutrition in medical records and better reimbursement of undernourished patients is needed.
Publisher: Elsevier BV
Date: 11-2018
DOI: 10.1016/J.NUT.2018.03.051
Abstract: Hospital administrative databases are widely used for disease monitoring. Undernutrition is highly prevalent among hospitalized patients but the diagnostic accuracy of undernutrition coding in administrative data is poorly known. This study examined the diagnostic accuracy of undernutrition coding in administrative hospital discharge databases. A retrospective cross-sectional study was conducted using 2013 and 2014 administrative data of the Internal Medicine Unit of the Lausanne University Hospital (n = 2509). Two reference diagnoses were defined: Confirmed undernutrition (2002 nutrition risk screening [NRS-2002] score ≥3 plus body mass index [BMI] < 18.5 kg/m Of the 2509 eligible patients, 262 (10.4%) were classified as confirmed and 631 (25.2%) as probable undernutrition. The sensitivity, specificity, and negative and positive predictive values (and corresponding 95% confidence intervals) for undernutrition codes using confirmed undernutrition were 43.0 (37.0-49.3), 87.2 (85.8-88.6), 92.9 (91.7-94.0), and 28.2 (23.8-32.8), respectively. The corresponding values using both confirmed and probable undernutrition were 30.0 (27.2-32.9), 93.4 (92.0-94.6), 66.7 (64.7-68.7), and 75.1 (70.6-79.3), respectively. Similar findings were obtained after stratifying for sex or age groups or restricting the analysis to patients with non-missing BMI data. The undernutrition codes in hospital discharge data have good specificity but the sensitivity and positive predictive values are low.
Publisher: S. Karger AG
Date: 20-05-2023
DOI: 10.1159/000524311
Abstract: b i Introduction: /i /b This study aimed to assess the extent to which a single item of self-reported hearing difficulties is associated with future risk of falling among community-dwelling older adults. b i Methods: /i /b We used data from two Australian population-based cohorts: three waves from the PATH Through Life study (PATH i n /i = 2,048, 51% men, age 66.5 ± 1.5 SD years) and three waves from the Concord Health and Ageing in Men Project (CHAMP i n /i = 1,448, 100% men with mean age 77.3 ± 5.3 SD years). Hearing difficulties were recorded on a four-point ordinal scale in PATH and on a dichotomous scale in CHAMP. The number of falls in the past 12 months was reported at each wave in both studies. In CHAMP, incident falls were also ascertained by triannual telephone call cycles for up to four years. Multivariable-adjusted random intercept negative binomial regression models were used to estimate the association between self-reported hearing difficulties and number of falls reported at the following wave or 4-monthly follow-ups. b i Results: /i /b In PATH, self-reported hearing difficulties were associated with a higher rate of falls at follow-up (incidence rate ratio = 1.15, 95% CI = 1.03–1.27 per a one-level increase in self-reported hearing difficulties), after adjusting for sociodemographic characteristics, health behaviours, physical functioning, balance, mental health, medical conditions, and medications. There were no significant associations between hearing difficulties and the rate of falls based on either repeated survey or 4-monthly follow-ups in CHAMP. b i Conclusion: /i /b Though we find mixed results, findings from PATH data indicate an ordinal measure of self-reported hearing loss may be predictive of falls incidence in young-old adults. However, the null findings in the male-only CHAMP preclude firm conclusions of a link between hearing loss and falls risk.
Publisher: Springer Science and Business Media LLC
Date: 02-12-2015
DOI: 10.1007/S10157-014-1061-3
Abstract: Inflammation is a common complication in hemodialysis (HD) patients with no valid treatment strategy. In addition, carnitine deficiency occurs frequently in HD patients because of intradialytic loss of carnitine, impaired de novo carnitine renal synthesis, and reduced dietary intake. It appears that carnitine deficiency is related to inflammation in HD patients. A few clinical trials have investigated the effect of L-carnitine supplement on inflammatory markers in HD patients. All studies in this field, except one, showed that L-carnitine could significantly reduce C-reactive protein and serum amyloid A, as two systemic inflammation markers, in HD patients. Therefore, considering high prevalence of inflammation and carnitine deficiency in HD patients, L-carnitine therapy is a reasonable approach for reducing systemic inflammation and its complications in these patients.
Publisher: Elsevier BV
Date: 03-2017
Publisher: Frontiers Media SA
Date: 28-10-2022
Publisher: Elsevier BV
Date: 06-2016
Publisher: American Medical Association (AMA)
Date: 07-04-2022
DOI: 10.1001/JAMANETWORKOPEN.2022.6398
Abstract: Among older adults, there is limited and inconsistent evidence on the association between socioeconomic position (SEP) and elective and nonelective hospitalization. To evaluate the association between SEP and all-cause and cause-specific elective and nonelective hospitalization and hospital length of stay among older men. This population-based, prospective cohort study used data from the Concord Health and Aging in Men Project (CHAMP). CHAMP recruited 1705 men aged 70 years or older between January 28, 2005, and June 4, 2007, in Sydney, Australia. Data were analyzed from February 1 to September 30, 2021. Indicators of SEP, including education (university degree certificate, diploma or no postschool qualifications), occupation (professionals and managers small employers and self-employed or lower clerical, service, sales workers, skilled, and unskilled workers), and source of income (other sources of income than government pension, reliance on government pensions and other sources of income, or reliant solely on a government pension), and a cumulative SEP score (tertiles) as SEP indicators 3-level variables present high, intermediate, and low SEP. All-cause and cause-specific elective and nonelective hospitalizations, number of hospitalizations, and length of stay were the study outcomes, ascertained through data linkage. Associations were quantified using competing-risks survival regression and negative binomial regression. A total of 1566 men (mean [SD] age, 76.8 [5.4] years) were included. During a mean (SD) 9.07 (3.53) years of follow-up, 1067 men had at least 1 elective hospitalization, and 1255 men had at least 1 nonelective hospitalization. No associations were found between SEP and elective hospitalizations. Being in the lowest tertile for educational level (subhazard ratio [SHR], 1.32 95% CI, 1.11-1.58), occupational position (SHR, 1.30 95% CI, 1.12-1.50), sources of income (SHR, 1.33 95% CI, 1.17-1.52), and cumulative SEP tertile groups (SHR, 1.45 95% CI, 1.24-1.68) were all associated with having at least 1 nonelective hospitalization compared with those in the highest tertiles. Significant associations were found between being in the lowest SEP groups and increased numbers and longer length of stay of nonelective hospitalizations. In this prospective cohort study, low SEP was inversely associated with nonelective hospitalizations but not elective hospitalization in older men in Australia. These findings point to the existence of socioeconomic inequalities in health care use, indicative of a need to take action to reduce these inequalities.
Publisher: Oxford University Press (OUP)
Date: 04-08-2022
DOI: 10.1093/AJE/KWAC137
Abstract: We estimated the degree to which language used in the high-profile medical ublic health/epidemiology literature implied causality using language linking exposures to outcomes and action recommendations examined disconnects between language and recommendations identified the most common linking phrases and estimated how strongly linking phrases imply causality. We searched for and screened 1,170 articles from 18 high-profile journals (65 per journal) published from 2010–2019. Based on written framing and systematic guidance, 3 reviewers rated the degree of causality implied in abstracts and full text for exposure/outcome linking language and action recommendations. Reviewers rated the causal implication of exposure/outcome linking language as none (no causal implication) in 13.8%, weak in 34.2%, moderate in 33.2%, and strong in 18.7% of abstracts. The implied causality of action recommendations was higher than the implied causality of linking sentences for 44.5% or commensurate for 40.3% of articles. The most common linking word in abstracts was “associate” (45.7%). Reviewers’ ratings of linking word roots were highly heterogeneous over half of reviewers rated “association” as having at least some causal implication. This research undercuts the assumption that avoiding “causal” words leads to clarity of interpretation in medical research.
Publisher: MDPI AG
Date: 25-10-2022
DOI: 10.3390/NU14214486
Abstract: Ultra-processed foods (UPFs) are associated with lower diet quality and several non-communicable diseases. Their consumption varies between countries/regions of the world. We aimed to describe the consumption of UPFs in adults aged 18–75 years living in Switzerland. We analysed data from the national food consumption survey conducted among 2085 participants aged 18 to 75 years. Foods and beverages resulting from two 24-h recalls were classified as UPFs or non-UPFs according to the NOVA classification, categorized into 18 food groups, and linked to the Swiss Food Composition Database. Overall, the median energy intake [P25–P75] from UPFs was 587 kcal/day [364–885] or 28.7% [19.9–38.9] of the total energy intake (TEI). The median intake of UPFs relative to TEI was higher among young participants ( years, p = 0.001) and those living in the German-speaking part of Switzerland (p = 0.002). The food groups providing the most ultra-processed calories were confectionary, cakes & biscuits (39.5% of total UPF kcal) meat, fish & eggs (14.9%) cereal products, legumes & potatoes (12.5%), and juices & soft drinks (8.0%). UPFs provided a large proportion of sugars (39.3% of total sugar intake), saturated fatty acids (32.8%), and total fats (31.8%) while providing less than 20% of dietary fibre. Consumption of UPFs accounted for nearly a third of the total calories consumed in Switzerland. Public health strategies to reduce UPF consumption should target sugary foods/beverages and processed meat.
Publisher: Human Kinetics
Date: 07-2023
Abstract: Background : Most reviews investigating physical activity interventions for older people consider evidence primarily from high-income countries. This review examined physical activity interventions for older people from low- and middle-income countries. Methods : We searched 9 electronic databases to identify randomized controlled trials or quasi-randomized trials studies investigating physical activity interventions for people aged 60+ in low- and middle-income countries. Following study selection, one reviewer extracted relevant data. A second reviewer double-checked the data extraction of a randomly selected s le of interventions (20%). Data were summarized using descriptive statistics. Results : We included 234 studies from 19 countries, investigating 259 distinct physical activity interventions. Studies were mostly conducted in upper middle-income countries (89%), often assessing physical activity interventions through randomized controlled trials (82%). Most studies investigated a mixed population in terms of sex (68%), with a mean age between 65 and 70 years (36%), not selected on the basis of having a specific health condition (55%). The intervention most commonly investigated was structured exercise (63%) and “no intervention” was the most frequent comparator (47%). The outcomes measured more often were intrinsic capacity (59%) and functional ability (51%), whereas physical activity, falls, and social outcomes were rare. Only 2 studies targeted underserved populations. Conclusion : Although we identified a substantial number of randomized controlled trials, most evidence for physical activity interventions for older people in low- and middle-income countries is limited to upper middle-income countries. Gaps identified included interventions targeting populations with underserved backgrounds, using sport as an intervention, and assessing the impact of physical activity interventions on physical activity, falls, and social outcomes.
Publisher: Wiley
Date: 09-2020
DOI: 10.1111/AJAG.12839
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 19-07-2021
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-09-2022
DOI: 10.1097/J.PAIN.0000000000002777
Abstract: Pain is a global public health problem given its high prevalence and incidence, long duration, and social and economic impact. There is growing interest in nutrition as potential modifiable risk factor related to pain however, the associations between healthy dietary patterns and pain have not yet been well established. Thus, we aimed to systematically review and synthesise current cross-sectional and longitudinal evidence on the relationship between a priori healthy dietary patterns and noncancer pain among adults aged ≥18 years. We identified relevant published cross-sectional and longitudinal studies by systematically searching several electronic databases from inception to September 2021. Risk of bias was assessed using the modified Newcastle–Ottawa scale for cohort studies. A total of 14 cross-sectional and 6 longitudinal studies were included in the review. These studies measured different dietary scores/indices, such as different measures of adherence to the Mediterranean diet and the dietary inflammatory index. Pain ascertainment methods and pain measurements used differed across studies. All 20 of the included studies had different study designs and statistical analysis. Of these studies, 10 reported an inverse association between adherence to a healthy dietary pattern and pain, 5 reported mixed results, and 5 reported no associations. Despite notable heterogeneity, 50% of included observational studies reported that adherence to a healthy diet, particularly the Mediterranean diet, is inversely associated with pain. Of note, the cross-sectional design of most studies precludes any causal interpretation. Moreover, limited and inconsistent evidence from longitudinal studies highlights the need for further studies.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 16-03-2022
Publisher: Springer Science and Business Media LLC
Date: 24-01-2019
Publisher: Elsevier BV
Date: 02-2019
DOI: 10.1016/J.CLNU.2018.01.021
Abstract: How undernutrition is reported in hospital discharge data is not understood. To assess trends in reported undernutrition and its management among hospitalized patients in Switzerland, and the association between reported undernutrition and in-hospital mortality, acquired infection, intensive care unit stay (ICU), and length of hospital stay (LOS). Data from the Swiss hospital discharge databases from 1998 to 2014 (n = 13,297,188 hospitalizations, 52.2% women, 48.4% aged 65+, and 85% Swiss national). Reported undernutrition was defined by the presence of any undernutrition-related International Classification of Diseases 10th revision code. Nutritional management was defined by the presence of any nutritional intervention code. Prevalence of reported undernutrition increased from 0.32% in 1998 to 3.97% in 2014 in Switzerland, and similar but varying trends were found for each of the seven Swiss administrative regions: ranging from 0.18% to 2.13% in Ticino and from 0.23% to 5.63% in Mittelland. Undernutrition management of hospitalizations with reported undernutrition increased from 0.6% in 1998 to 57.8% in 2014, with wide variations according to administrative region: from 0% to 32.9% in Ticino and from 0% to 68.9% in Central Switzerland. After multivariable adjustment, reported undernutrition was positively associated with in-hospital mortality: odds-ratio and (95% confidence interval): 2.30 (2.26-2.34) acquired infection: 3.57 (3.46-3.70) ICU stay: 1.65 (1.63-1.68) and longer LOS: 19.6 ± 0.2 vs. 13.0 ± 0.1 days. Undernutrition is increasingly reported in Switzerland still, over 40% of undernourished hospitalizations don't benefit from nutritional support. Reported undernutrition is associated with increased in-hospital mortality, acquired infection, ICU stay, and LOS.
Publisher: Elsevier BV
Date: 08-2021
Publisher: Environmental Health Perspectives
Date: 11-2022
DOI: 10.1289/EHP11015
Publisher: Cold Spring Harbor Laboratory
Date: 28-08-2021
DOI: 10.1101/2021.08.25.21262631
Abstract: We estimated the degree to which language used in the high profile medical ublic health/epidemiology literature implied causality using language linking exposures to outcomes and action recommendations examined disconnects between language and recommendations identified the most common linking phrases and estimated how strongly linking phrases imply causality. We searched and screened for 1,170 articles from 18 high-profile journals (65 per journal) published from 2010-2019. Based on written framing and systematic guidance, three reviewers rated the degree of causality implied in abstracts and full text for exposure/outcome linking language and action recommendations. Reviewers rated the causal implication of exposure/outcome linking language as None (no causal implication) in 13.8%, Weak 34.2%, Moderate 33.2%, and Strong 18.7% of abstracts. The implied causality of action recommendations was higher than the implied causality of linking sentences for 44.5% or commensurate for 40.3% of articles. The most common linking word in abstracts was “associate” (45.7%). Reviewer’s ratings of linking word roots were highly heterogeneous over half of reviewers rated “association” as having at least some causal implication. This research undercuts the assumption that avoiding “causal” words leads to clarity of interpretation in medical research.
Publisher: Oxford University Press (OUP)
Date: 06-2023
Abstract: To investigate associations between leisure-time physical activity (LPA) and injurious falls in older women and explore modification of associations by physical function and frailty. Women born during 1946–51 from the Australian Longitudinal Study on Women’s Health, injurious falls (self-reported fall with injury and/or medical attention) and self-reported weekly LPA (duration and type). We undertook cross-sectional and prospective analyses using data from 2016 [n = 8,171, mean (SD) age 68 (1)] and 2019 surveys (n = 7,057). Associations were quantified using directed acyclic graph-informed logistic regression and effect modification examined using product terms. Participation in LPA as recommended by World Health Organization (150–300 min/week) was associated with lower odds of injurious falls in cross-sectional (adjusted Odds Ratio (OR) 0.74, 95% CI 0.61–0.90) and prospective analyses (OR 0.75, 95% CI 0.60–0.94). Compared with those who reported no LPA, cross-sectionally, odds of injurious falls were lower in those who reported brisk walking (OR 0.77, 95% CI 0.67–0.89) and vigorous LPA (OR 0.86, 95% CI 0.75–1.00). No significant association was found between different types of LPA and injurious falls prospectively. Only cross-sectionally, physical function limitation and frailty modified the association between LPA and injurious falls, with tendencies for more injurious falls with more activity in those with physical limitation or frailty, and fewer injurious falls with more activity among those without physical function limitation or frailty. Participation in recommended levels of LPA was associated with lower odds of injurious falls. Caution is required when promoting general physical activity among people with physical limitation or frailty.
Publisher: Elsevier BV
Date: 09-2022
DOI: 10.1016/J.JCLINEPI.2022.05.021
Abstract: Obtaining accurate estimates of the causal effects of socioeconomic position (SEP) on health is important for public health interventions. To do this, researchers must identify and adjust for all potential confounding variables, while avoiding inappropriate adjustment for mediator variables on a causal pathway between the exposure and outcome. Unfortunately, 'overadjustment bias' remains a common and under-recognized problem in social epidemiology. This paper offers an introduction on selecting appropriate variables for adjustment when examining effects of SEP on health, with a focus on overadjustment bias. We discuss the challenges of estimating different causal effects including overadjustment bias, provide guidance on overcoming them, and consider specific issues including the timing of variables across the life-course, mutual adjustment for socioeconomic indicators, and conducting systematic reviews. We recommend three key steps to select the most appropriate variables for adjustment. First, researchers should be clear about their research question and causal effect of interest. Second, using expert knowledge and theory, researchers should draw causal diagrams representing their assumptions about the interrelationships between their variables of interest. Third, based on their causal diagram(s) and causal effect(s) of interest, researchers should select the most appropriate set of variables, which maximizes adjustment for confounding while minimizing adjustment for mediators.
Publisher: Springer Science and Business Media LLC
Date: 29-07-2020
DOI: 10.1186/S12877-020-01648-Y
Abstract: Conflicting evidence exists regarding the association of socioeconomic status (SES) with mortality among older people and little is known about the mechanisms underlying this association. We investigated the association of SES with mortality among older Australian men. We also investigated potential mediating effects of health-related behaviours in SES-mortality associations. We used data from a prospective population-based cohort (the Concord Health and Aging in Men Project), in Sydney, Australia. The main outcomes were all-cause and cause-specific mortality. Educational attainment, occupational position, source of income, housing tenure, and a cumulative SES score were assessed at baseline. Longitudinally assessed alcohol consumption, smoking, physical activity, and body mass index were investigated as potential mediators. Associations were quantified using Cox regression. We evaluated 1527 men (mean age: 77.4 ± 5.5 years). During a mean follow-up time of 9.0 years, 783 deaths occurred. For deaths from all causes, the adjusted hazard ratio (HR) for the lowest tertile of cumulative SES score versus the highest tertile was 1.44 (95% CI 1.21 to 1.70) the corresponding sub-HRs were 1.35 (0.96 to 1.89) for cardiovascular disease (CVD) mortality 1.58 (1.15 to 2.18) for cancer mortality, and 1.86 (1.36 to 2.56) for non-CVD, non-cancer mortality. SES-mortality associations were attenuated by 11–25% after adjustment for mediating health-related behaviours. Low SES is associated with increased mortality in older Australian men and health-related behaviours accounted for less than one-fourth of these associations. Further research is needed to fully understand the mechanisms underlying SES inequalities in mortality among older people.
Publisher: BMJ
Date: 06-2020
DOI: 10.1136/BMJOPEN-2019-034903
Abstract: Growing ethnic ersity in the UK has made it increasingly important to determine the presence of ethnic health inequalities. There has been no systematic review that has drawn together research on ethnic differences in mortality in the UK. All types of observational studies that compare all-cause mortality between major ethnic groups and the white majority population in the UK will be included. We will search Medline (OvidSP), Embase (OvidSP), Scopus and Web of Science and search the grey literature through conference proceedings and online thesis registries. Searches will be carried out from inception to 2 August 2019 with no language or other restrictions. Database searches will be repeated prior to publication to identify new articles published since the initial search. We will conduct forward and backward citation tracking of identified references and consult with experts in the field to identify further publications and ongoing or unpublished studies. Two reviewers will independently screen studies and extract data. Two reviewers will independently assess the quality of included studies using the Newcastle-Ottawa Scale. If at least two studies are located for each ethnic group and studies are sufficiently homogeneous, we will conduct a meta-analysis. If insufficient studies are located or if there is high heterogeneity we will produce a narrative summary of results. As no primary data will be collected, formal ethical approval is not required. The findings of this review will be disseminated through publication in peer reviewed journals and conference presentations. CRD42019146143.
Publisher: Wiley
Date: 25-01-2021
DOI: 10.1111/AJAG.12896
Abstract: To investigate the association between home ownership and health in older men. Cross‐sectional analysis of 909 community‐dwelling Australian men (mean age: 81.3 ± 4.6) from the Concord Health and Ageing in Men Project (CHAMP, 2012‐2013). We considered self‐rated health, frailty status, multimorbidity, and anxiety and depressive symptoms which identify different dimensions of health. Most participants were owner‐occupiers (89.7%). In age‐ and country of birth–adjusted analyses, not being an owner‐occupier was associated with an increased likelihood of depressive symptoms [prevalence ratio: 1.82, 95% confidence intervals 1.17 to 2.84]. There were no associations between home ownership and other health conditions. Lack of home ownership was associated with a higher prevalence of depressive symptoms, largely explained by poorer social support. Thus, targeting mental health programs at older orced or separated men who do not own their own home could be an appropriate community‐based intervention.
Publisher: Oxford University Press (OUP)
Date: 12-2022
Abstract: Falls and fall-related health service use among older adults continue to increase. The New South Wales Health Department, Australia, is delivering the Stepping On fall prevention programme at scale. We compared fall-related health service use in Stepping On participants and matched controls. A non-randomised observational trial was undertaken using 45 and Up Study data. 45 and Up Study participants who did and did not participate in Stepping On were extracted in a 1:4 ratio. Rates of fall-related health service use from linked routinely collected data were compared between participants and controls over time using multilevel Poisson regression models with adjustment for the minimally sufficient set of confounders identified from a directed acyclic graph. Data from 1,452 Stepping On participants and 5,799 controls were analysed. Health service use increased over time and was greater in Stepping On participants (rate ratios (RRs) 1.47–1.82) with a spike in use in the 6 months prior to programme participation. Significant interactions indicated differential patterns of health service use in participants and controls: stratified analyses revealed less fall-related health service use in participants post-programme compared to pre-programme (RRs 0.32–0.48), but no change in controls’ health service use (RRs 1.00–1.25). Gender was identified to be a significant effect modifier for health service use (P & 0.05 for interaction). Stepping On appeared to mitigate participants’ rising fall-related health service use. Best practice methods were used to maximise this study’s validity, but cautious interpretation of results is required given its non-randomised nature.
Publisher: Public Library of Science (PLoS)
Date: 21-09-2018
Publisher: Springer Science and Business Media LLC
Date: 12-03-2021
DOI: 10.1038/S41430-021-00893-7
Abstract: To compare the Australian Dietary Guideline Index (DGI-2013) and the Pyramid-based Mediterranean Diet Score (pyrMDS) as measures of diet quality in an ethnically erse group of older men. Seven hundred and ninety-four older men aged ≥75 participated in wave 3 (2012-2013) of the Concord Health and Ageing in Men Project. Dietary intake was assessed using a validated diet history questionnaire. Ethnicity was based on self-reported country of birth and categorised as Australian-born (418 men), Italian or Greek migrants (188), and other migrants (188). Incident cardiovascular outcomes until March 2018 were measured using the composite of major adverse cardiovascular events (MACE), which comprises all-cause mortality, acute myocardial infarction, congestive cardiac failure, coronary revascularisation and/or ischaemic stroke. Ability to predict incident cardiovascular outcomes and all-cause mortality were compared between standardised DGI-2013 pyrMDS scores by comparison of hazard ratios, discrimination (Harrell's C-statistic) and calibration (calibration plots). Italian and Greek migrant men had significantly lower DGI-2013 scores (91.7 vs. 93.9 p = 0.01) but significantly higher pyrMDS scores (8.8 vs. 8.2 p < 0.0001) than Australian-born men. In the whole s le (794 men), the pyrMDS was a better predictor of both MACE (age-adjusted HR = 0.84 95% CI = 0.75-0.94 vs. HR = 0.92 95% CI = 0.82-1.03 for DGI-2013) and all-cause mortality (age-adjusted HR = 0.69 95% CI = 0.60-0.80 vs. HR = 0.86 95% CI = 0.74-0.99). The pyrMDS also demonstrated superior discrimination for predicting all-cause mortality and superior calibration for MACE and all-cause mortality. The DGI-2013 appears to underestimate diet quality in older Italian and Greek migrant men. The pyrMDS appears superior to the DGI-2013 for prediction of incident cardiovascular disease and mortality regardless of ethnic background.
Publisher: Elsevier BV
Date: 06-2015
DOI: 10.1016/J.CLNESP.2015.04.003
Abstract: Malnutrition among hospitalized patients increases length of stay (LOS) and carries extra hospitalization costs. To review the impact of malnutrition on hospital LOS and costs in Europe. PubMed and Google Scholar search. All articles from January 2004 until November 2014 were identified. Reference lists of relevant articles were also manually searched. Ten studies on LOS and nine studies on costs were reviewed. The methods used to assess malnutrition and to calculate costs differed considerably between studies. Malnutrition led to an increased LOS ranging from 2.4 to 7.2 days. Among hospitalized patients, malnutrition led to an additional in idual cost ranging between 1640 € and 5829 €. At the national level, the costs of malnutrition ranged between 32.8 million € and 1.2 billion €. Expressed as percentage of national health expenditures, the values ranged between 2.1% and 10%. In Europe, malnutrition leads to an increase in LOS and in hospital costs, both at the in idual and the national level. Standardization of methods and results reported is needed to adequately compare results between countries.
Publisher: Springer Science and Business Media LLC
Date: 28-03-2018
DOI: 10.1038/S41430-018-0149-3
Abstract: Undernutrition is a frequent condition among hospitalized patients, with a significant impact on patient's outcome and hospital costs. Whether undernutrition is reported similarly at the national level has seldom been assessed. We aimed to (1) assess regional differences within Switzerland regarding undernutrition prevalence, management, and cost reimbursement and (2) identify the factors associated with reporting of undernutrition status and its management. Observational cross-sectional study including routine statistics from the Swiss hospital discharge databases for years 2013 and 2014 (seven administrative regions). All adults aged ≥20 with length of hospital stay of at least 1 day was included. Reported undernutrition was defined based on the International Classification of Diseases (ICD)-10 codes. Nutritional management and "reimbursable" undernutrition codes were also assessed. Of the initial 1,784,855 hospitalizations, 3.6% had reported undernutrition, the prevalence ranging between 1.8% (Ticino) and 4.6% (Mittelland). Use of different undernutrition-related ICD-10 codes also varied considerably across regions. Multivariable analysis showed a twofold variation in reported undernutrition: multivariable-adjusted odds ratio and 95% confidence interval relative to Eastern Switzerland: 2.31 (2.23, 2.38) for Mittelland and 0.74 (0.70, 0.79) for Ticino. Over half (59.6%) of hospitalizations with reported undernutrition also included information on undernutrition management, ranging between 28.6% (Ticino) and 67.2% (Zürich). Only one third (36.8%) of undernutrition-related codes were reimbursable, ranging between 8.3% (Ticino) and 50.7% (Zürich). In Switzerland, there is considerable regional variation regarding reporting of undernutrition prevalence, management, and cost reimbursement. Undernutrition appears to be insufficiently managed and valued.
Publisher: Springer Science and Business Media LLC
Date: 07-10-2020
DOI: 10.1186/S12939-020-01277-2
Abstract: Among older people, the extent to which psychosocial factors explain socioeconomic inequalities in mortality is debated. We aimed to investigate the potential mediating effect of psychosocial factors on socioeconomic inequalities in mortality. We used data from a prospective population-based cohort (the Concord Health and Ageing in Men Project baseline recruitment in 2005–2007), in Sydney, Australia. The main outcomes were all-cause and cause-specific mortality. Socioeconomic status (SES educational attainment, occupational position, source of income, housing tenure, and a cumulative SES score) was assessed at baseline. Measures of structural and functional social support, as well as depressive and anxiety symptoms were assessed three times during follow-ups. Associations were quantified using Cox regression. Mediation was calculated using “change-in-estimate method”. 1522 men (mean age at baseline: 77·4 ± 5·5 years) were included in the analyses with a mean (SD) follow-up time of 9·0 (3·6) years for all-cause and 8·0 (2·8) years for cause-specific mortality. At baseline, psychosocial measures displayed marked social patterning. Being unmarried, living alone, low social interactions, and elevated depressive symptoms were associated with higher risk of all-cause and cardiovascular disease (CVD) mortality. Psychosocial factors explained 35% of SES inequalities in all-cause mortality, 29% in CVD mortality, 12% in cancer mortality, and 39% in non-CVD, non-cancer mortality. Psychosocial factors may account for up to one-third of SES inequalities in deaths from all and specific causes (except cancer mortality). Our findings suggest that interventional studies targeting social relationships and/or psychological distress in older men aiming to reduce socioeconomic inequalities in mortality are warranted.
Publisher: BMJ
Date: 12-2020
DOI: 10.1136/BMJOPEN-2020-040959
Abstract: The Mediterranean diet has been promoted as a healthy dietary pattern, but whether the Mediterranean diet may help to prevent hepatic steatosis is not clear. This study aimed to evaluate the prospective association between adherence to the Mediterranean diet and risk of hepatic steatosis. Population-based prospective cohort study. The Swiss CoLaus Study. We evaluated 2288 adults (65.4% women, aged 55.8±10.0 years) without hepatic steatosis at first follow-up in 2009–2012. Adherence to the Mediterranean diet was scaled as the Mediterranean diet score (MDS) based on the Mediterranean diet pyramid ascertained with responses to Food Frequency Questionnaires. New onset of hepatic steatosis was ascertained by two indices separately: the Fatty Liver Index (FLI, ≥60 points) and the non-alcoholic fatty liver disease (NAFLD) score (≥−0.640 points). Prospective associations between adherence to the Mediterranean diet and risk of hepatic steatosis were quantified using Poisson regression. During a mean 5.3 years of follow-up, hepatic steatosis was ascertained in 153 (6.7%) participants by FLI criteria and in 208 (9.1%) by NAFLD score. After multivariable adjustment, higher adherence to MDS was associated with lower risk of hepatic steatosis based on FLI: risk ratio 0.84 (95% CI 0.73 to 0.96) per 1 SD of MDS 0.85 (0.73 to 0.99) adjusted for BMI and 0.85 (0.71 to 1.02) adjusted for both BMI and waist circumference. When using NAFLD score, no significant association was found between MDS and risk of hepatic steatosis (0.95 (0.83 to 1.09)). A potential role of the Mediterranean diet in the prevention of hepatic steatosis is suggested by the inverse association observed between adherence to the Mediterranean diet and incidence of hepatic steatosis based on the FLI. The inconsistency of this association when hepatic steatosis was assessed by NAFLD score points to the need for accurate population-level assessment of fatty liver and its physiological markers.
Location: Iran (Islamic Republic of)
Location: United Kingdom of Great Britain and Northern Ireland
Start Date: 2017
End Date: 2017
Funder: Swiss National Science Foundation (SNSF)
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