Inverse U-shaped Association Research Articles

Effect of timing of intubation on clinical outcomes of patients with septic shock: a retrospective cohort study.

Evidence-based data regarding the timing of the application of invasive mechanical ventilation among adults with septic shock is insufficient. The guidelines fail to provide clear advice about the optimal time to initiate this support. Consequently, we aimed to investigate whether early intubation could improve survival rates in septic shock patients. We conducted a retrospective analysis of the MIMIC-IV database to evaluate the effectiveness of early intubation on mortality in a cohort of septic shock patients. Adults diagnosed with septic shock, according to the Sepsis-3 definition, were included. They were categorized into an early intubation group (first 8h after vasopressor initiation) and a non-early intubation group (unexposed). A propensity score matching (PSM) analysis was used to balance the baseline characteristics between the two groups. The primary outcomes were 30-day and 90-day all-cause mortality rates. In addition, we employed the restricted cubic spline to analyze the potential non-linear relationship between the timing of intubation and 30-day or 90-day all-cause mortality. A total of 6864 adult patients, of whom 2048 were intubated in the first 8h, were evaluated in the final cohort. Following a 1:1 PSM procedure, 2786 patients were successfully paired. At 30days, 288 of 1393 patients (20.7%) in the early intubation group and 381 of 1393 patients (27.4%) in the non-early intubation group had died (hazard ratio [HR] 0.717; 95% confidence interval [CI] 0.616-0.836; p < 0.001). Similarly, the results also showed that early intubation was associated with a lower 90day all-cause mortality rate (HR 0.761; 95% CI 0.663-0.874; p < 0.001). Furthermore, ICU and hospital lengths of stay were significantly different between the groups (3.6 [1.9, 7.1] vs. 2.3 [1.3, 4.3]; p < 0.001 and 8.9 [5.4, 15.1] vs. 7.2 [4.5, 12.0]; p < 0.001). In the subgroup analysis, we further confirmed the robustness of our findings. Additionally, we found that the timing of intubation is inversely U-shaped correlated to the 30day all-cause mortality rate. Among adult patients with septic shock, the early initiation of invasive mechanical ventilation could improve clinical outcomes. The timing of intubation demonstrated an inverse U-shaped association with the 30day all-cause mortality rate, with the peak risk of death occurring at 50.5h after septic shock.

Normative Values and Anthropometric Prediction Models for Lean Mass and Fat Mass in the Northeastern Thai Population.

Background: Data on reference values for lean mass (LM) and fat mass (FM) in the Southeast Asian populations are currently lacking. Therefore, we aimed to estimate the normative values and generate anthropometric prediction models for LM and FM in the Thai population. Methods: Consecutive community-dwelling individuals aged 20-90 years were recruited from Srinagarind Hospital, Khon Kaen, Thailand, between 2010 and 2015. LM and FM were measured using dual energy X-ray absorptiometry. Age and sex stratified percentile of LM and FM were presented. Anthropometric prediction models for LM and FM were developed by using linear regression to generate competing models. Results: A total of 832 individuals (334 males and 498 females) were included in the study. The mean ± SD age, LM, and FM were 50.0 ± 16.2 years, 38.9 ± 8.0 kg, and 15.5 ± 7.7 kg, respectively. LM decreased with age from 49.4 kg in 20-29 years group to 42.3 kg in ≥70 years group in male and 34.6 kg in 30-39 years group to 30.8 kg in ≥70 years group in females. FM has an inverse U-shaped association with age, which peaked at 11.9 kg in 60-69 years group in males and 20.7 kg in 50-59 years group in females. Among the various anthropometric models, the models incorporating age, sex, weight, and height were considered the best fit for predicting both LM and FM. Conclusion: In the Thai population, peak LM was reached during early adulthood and decline with age, whereas FM showed an inverse U-shaped association with age. The prediction models incorporating age, sex, weight, and height were proposed as practical tools for assessing LM and FM in clinical practice.

Longitudinal associations between post-traumatic stress and post-traumatic growth among older adults 11 years after a disaster.

Previous studies have reported inconsistent findings regarding the association between post-traumatic stress (PTS) and post-traumatic growth (PTG). Three major issues could account for this inconsistency: (1) the lack of information about mental health problems before the disaster, (2) the concept of PTG is still under scrutiny for potentially being an illusionary perception of personal growth and (3) the overlooking of PTS comorbidities as time-dependent confounding factors. To address these issues, we explored the associations of PTS and PTG with trauma-related diseases and examined the association between PTS and PTG using marginal structural models to address time-dependent confounding, considering pre-disaster covariates, among older survivors of the 2011 Japan Earthquake and Tsunami. Seven months before the disaster, the baseline survey was implemented to ask older adults about their health in a city located 80km west of the epicentre. After the disaster, we implemented follow-up surveys approximately every 3 years to collect information about PTS and comorbidities (depressive symptoms, smoking and drinking). We asked respondents about their PTG in the 2022 survey (n=1,489 in the five-wave panel data). PTG was protectively associated with functional disability (coefficient -0.47, 95% confidence interval (CI) -0.82, -0.12, P<0.01) and cognitive decline assessed by trained investigators (coefficient -0.07, 95% CI -0.11, -0.03, P<0.01) and physicians (coefficient -0.06, 95% CI -0.11, -0.02, P<0.01), while PTS was not significantly associated with them. Severely affected PTS (binary variable) was associated with higher PTG scores, even after adjusting for depressive symptoms, smoking and drinking as time-dependent confounders (coefficient 0.35, 95% CI 0.24, 0.46, P<0.01). We also found that an ordinal variable of the PTS score had an inverse U-shaped association with PTG. PTG and PTS were differentially associated with functional and cognitive disabilities. Thus, PTG might not simply be a cognitive bias among survivors with severe PTS. The results also indicated that the number of symptoms in PTS had an inverse U-shaped association with PTG. Our findings provided robust support for the theory of PTG, suggesting that moderate levels of psychological struggles (i.e., PTS) are essential for achieving PTG, whereas intense PTS may hinder the attainment of PTG. From a clinical perspective, interventions that encourage social support could be beneficial in achieving PTG by facilitating deliberate rumination.

Sleep duration and biomarkers of fecundity in young men: a cross-sectional study from a population-based cohort.

Poor male fecundity is of concern and warrants the identification of potential modifiable risk factors. Short and long sleep duration might be risk factors for poor male fecundity although evidence in this research field is inconsistent. To investigate the association between sleep duration and biomarkers of male fecundity in young men. We conducted a cross-sectional study of 1,055 young men from the Fetal Programming of Semen Quality (FEPOS) cohort, Denmark, 2017-2019. Sleep duration was obtained from an online survey answered by the participants prior to the clinical visit, where semen and blood samples were obtained, and testis volume was self-assessed using an Orchidometer. Percentage differences in semen characteristics, testes volume, and reproductive hormone levels were analysed according to sleep duration using multivariable negative binomial regression models. Sleep duration was dichotomised (recommended (6-9h/night) versus deviant sleep) and visualised continuously as restricted cubic spline plots. Deviation from recommended sleep duration was associated with higher high DNA stainability (HDS) of 5% (95% CI: -1%; 13%), higher testosterone of 3% (95% CI: 0%; 7%) and higher free androgen index (FAI) of 6% (95% CI: 0%; 13%). The spline plots overall supported these results, suggesting u-shaped associations between sleep duration and HDS, testosterone and FAI, a linear association between sleep duration and semen volume and sex hormone binding globulin (SHBG) and an inverse u-shaped association with normal morphology. Information on sleep duration was obtained by self-report in broad categories with at least 3h intervals. We were not able to investigate short or long sleep duration separately, since only few participants reported this. Sleep duration was associated with some biomarkers of fecundity in young men. Maintaining a recommended sleep duration may thus be beneficial for young men with regard to reproductive health.

Number of siblings and social capital among parents rearing schoolchildren: Results from the A-CHILD study.

Having siblings may foster sociality; however, little is known about whether sibling number determines social capital, the resources obtained through social networks. We examined the association between sibling number and social capital among Japanese parents rearing schoolchildren. We used cross-sectional data from the 2018 and 2019 Adachi Child Health Impact of Living Difficulty (A-CHILD) study, targeting all primary and junior high school students and their parents in Adachi, Tokyo, Japan (n = 8,082). Individual-level social capital was evaluated by assessing caregivers' social cohesion, social support, and group affiliation. All analyses were adjusted for age and sex. An inverse U-shaped association was found between sibling number and social capital. Adults who grew up with 1 or 2, but not ≥3, siblings had greater social support (β = 0.23, 95% confidence interval [CI], 0.06-0.40; β = 0.46, 95% CI, 0.29-0.64, respectively) than those who grew up as an only child after covariate adjustment. Adults who grew up with 2 or 3, but not 1 or ≥4, siblings had greater group affiliation (β = 0.09, 95% CI, 0.03-0.16; β = 0.09, 95% CI, 0.01-0.18, respectively) than those who grew up as an only child after covariate adjustment. Sibling number was not associated with social cohesion. Growing up with 1 to 3 siblings was associated with higher social capital in adulthood than being an only child. Having siblings may provide an opportunity to foster social capital.

The associations of non-essential metal mixture with fasting plasma glucose among Chinese older adults without diabetes.

The evidence about the effect of non-essential metal mixture on fasting plasma glucose (FPG) levels among older adults without diabetes is limited. This study aims to estimate the individual and joint relationship between five non-essential metals and FPG levels in Chinese older adults without diabetes. This study included 2362 older adults without diabetes. Urinary concentrations of five non-essential metals, i.e., cesium (Cs), aluminum (Al), thallium (Tl), cadmium (Cd), and arsenic (As), were detected by inductively coupled plasma mass spectrometry (ICP-MS). The associations of single metals and the metal mixture with FPG levels were assessed using linear regression and Bayesian kernel machine regression (BKMR) models, respectively. Adjusted single-metal linear regression models showed positive associations of urinary Al (β = 0.016, 95%CI: 0.001-0.030) and Cs (β = 0.018, 95%CI: 0.006-0.031) with FPG levels. When comparing the 2th, 3th, and 4th quartiles of urine Cs to its 1th quartile, the significant associations between Cs and FPG levels were found and presented as an "inverted U" trend (βQ2 vs. Q1: 0.034; βQ3 vs. Q1:0.054; βQ4 vs. Q1: 0.040; all P<0.05). BKMR analyses showed urinary level of Cs exhibited an "inverted U" shape association with FPG levels. Moreover, the FPG levels increased linearly with the raised levels of the non-essential metal mixture, and the posterior inclusion probability (PIP) of Cs was the highest (0.92). Potential positive interaction of As and Cs on FPG levels was found in BKMR model. Stratified analysis displayed significant interactions of hyperlipidemia and urine Cs or Tl on FPG levels. An inverse U-shaped association between Cs and FPG was found, individually and as mixture. The FPG levels increased with the raised levels of the non-essential metal mixture, and Cs was the most contributor to FPG levels. Further research is required to confirm the correlation between non-essential metals and FPG levels and to clarify the underlying mechanisms.

ECONOMIC DEVELOPMENT AND RURAL ENERGY POVERTY: EVIDENCE FROM CHINA

Sustainable development places a premium on recognizing people at risk of energy poverty, defined as the incapability to get a sufficient level of residential energy services. Therefore, this study analyses the relationship between economic development and rural energy poverty in Chinese regions. Using statistics from the China Families Panel Studies, it is observed that the Great Chinese Drought increased the risk of living in poverty. We conclude that there is wide variation in China’s regions regarding economic liberalization and the country’s energy deprivation. In provinces with different degrees of poverty, there is an inverse U-shaped association between economic growth and the country’s energy poverty. The country’s energy poverty reduced or even eliminated by advancing economic development to a specific degree. Many socioeconomic indicators at the home level are connected with energy poverty in various ways depending on the dimension, implying that individualized criteria are required to classify vulnerable families in each size and country-level considerations.

Single and combined associations of blood lead and essential metals with serum lipid profiles in community-dwelling adults.

Although several studies have examined the relationships between lead (Pb) exposure and serum lipid profiles, the associations of the metal mixture, including lead (Pb) and essential metals with lipid profiles, remain unclear. To investigate the associations of the metal mixture including Pb and essential metals [magnesium (Mg), manganese (Mn), copper (Cu), iron (Fe), zinc (Zn), and calcium (Ca)] with serum lipid profiles [total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C)], as well as the potential interactions among the metals. Nine hundred and ninety-eight Chinese community-dwelling adults completed a questionnaire and underwent checkups of anthropometric parameters, serum lipid profile levels (TC, TG, LDL-C, and HDL-C), and blood metal concentrations (Pb, Mg, Mn, Cu, Fe, Zn, and Ca). The multivariable linear regression, weighted quantile sum (WQS) regression, and Bayesian kernel machine regression (BKMR) were applied to evaluate the single and combined associations of blood Pb and essential metals with serum lipid profiles. In the multivariable linear regression model, the blood Pb was positively associated with TC, LDL-C, and HDL-C (p < 0.05, all), and the blood Mg were positively associated with serum TC, LDL-C, and Ln TG (p < 0.05, all). In the WQS regression and BKMR models, the metal mixture of blood Pb and the essential metals was positively associated with all of the serum lipid profiles. In addition, an inverse U-shaped association of Pb with Ln TG and the positive interactive effect between blood Pb and Mg levels on TC and LDL-C were found. The levels of blood Pb, together with the essential metals, especially Mg levels, are suggested to be considered when assessing dyslipidemia risk. However, more evidence is still needed to validate the conclusions.

Governance matters: Urban expansion, environmental regulation, and PM2.5 pollution

Increasing PM2.5 pollution in urban expansion threatens citizens' health. Environmental regulation has proven to be an effective tool to directly combat PM2.5 pollution. However, whether it can moderate the impacts of urban expansion on PM2.5 pollution, in the context of rapid urbanization, is an interesting and unexplored topic. Therefore, this paper constructs a Drivers-Governance-Impacts framework and explores in depth the interactions among urban expansion, environmental regulation, and PM2.5 pollution. Based on 2005–2018 sample data from the Yangtze River Delta region, the estimation results of the Spatial Durbin model imply that (1) urban expansion has an inverse U-shaped association with PM2.5 pollution. The positive correlation may reverse when the ratio of urban built-up land area hits 0.21. (2) Of the three environmental regulations, investment in pollution control has little impact on PM2.5 pollution. Pollution charges and public attention exhibit a U-shaped and inverted U-shaped relationship with PM2.5 pollution, respectively. (3) In terms of moderating effects, pollution charges can exacerbate PM2.5 pollution from urban expansion, while public attention can inhibit it through its monitoring role. Therefore, we suggest that cities adopt differentiated strategies of urban expansion and environmental protection according to their urbanization levels. Meanwhile, appropriate formal regulation and strong informal regulation will help improve air quality.

Polybrominated diphenyl ethers in early pregnancy and preterm birth: Findings from the NICHD Fetal Growth Studies.

Studies suggest associations between exposure to individual polybrominated diphenyl ethers (PBDEs) with preterm birth (PTB) and shorter gestational age. Little is known about exposure to PBDE mixtures and these outcomes. We evaluated associations of multiple PBDEs in early pregnancy with gestational age at delivery and PTB. Data were collected from 2046 women without obesity and 396 women with obesity from the NICHD Fetal Growth Studies, who had early pregnancy plasma PBDEs concentrations and gestational age at delivery. PTB was defined as < 37 weeks of gestation at delivery and further categorized into subtypes (late or very early/moderate; spontaneous or medically indicated). We applied (1) generalized linear models (GLM); (2) principal component analysis (PCA); and (3) Bayesian Kernel Machine Regression (BKMR) to evaluate the individual and joint associations of log-transformed PBDE concentrations with gestational age at delivery and PTB, adjusting for potential confounders and evaluating effect modifiers. In GLM analyses, a 1-standard deviation (SD) increase in log-PBDE 153 was associated with shorter gestational age at delivery [adjusted β (95% CI)=-0.19 (-0.31, -0.06) weeks] among women without obesity. In PCA analyses, 1-SD increase in the principal component summarizing most of PBDE 153 variability was associated with shorter gestational age at delivery [adjusted β (95% CI)=-0.18 (-0.30, -0.06) weeks], very early/moderate PTB [adjusted OR (95% CI)=1.91 (1.19, 3.07)], and spontaneous PTB [adjusted OR (95% CI)=1.34 (1.00, 1.80)] among women without obesity. Associations were stronger among non-Hispanic Black women, women with BMI ranging between 25 and 30kg/m2, and women who were ≥35 years old among those without obesity. In BKMR analyses, a suggestive inverse association between PBDE 153 and gestational age at delivery, and an inverse U-shaped association between PBDE 154 and gestational age at delivery were observed in women without obesity. No statistically significant association of PBDEs and gestational age or PTB was observed among women with obesity. PBDEs, specifically PBDE 153, were associated with shorter gestation and higher risk of certain PTB subtypes among pregnant women without obesity.

The dose-response relationship of serum uric acid with Dyslipidaemia and its components: a cross-sectional study of a Chinese multi-ethnic cohort

BackgroundThe association between serum uric acid (SUA) and the components of dyslipidaemia and their dose-response relationships have not been thoroughly explored. This study assessed the relationship between SUA and each dyslipidaemia component in Dong, Miao, and Bouyei populations in Guizhou by sex and ethnicities and investigated the dose-response relationship.MethodsIn total, 16,092 participants aged 30–79 years from The China Multi-Ethnic Cohort (CMEC) Study were examined. Multivariable logistic regression models were applied to explore the relationship between SUA and each dyslipidaemia component by sex and three ethnicities. The dose-response associations between SUA and various dyslipidaemias were investigated using restricted cubic spline regression.ResultsAfter controlling for confounding factors, the SUA level in total participants positively correlated with each dyslipidaemia component, and women had higher odds ratios (ORs) for each dyslipidaemia component than men (P for trend < 0.001). At the SUA level > 6.37 mg/dL, ORs (95% CI) for dyslipidaemia in the Dong, Miao and Bouyei were 2.89 (2.00–4.19), 2.43 (1.70–3.48), and 3.26 (2.23–4.78), respectively. When the SUA concentration increased by 1 mg/dL, the ORs (95% CI) for total dyslipidaemia was 1.31 (1.24–1.37). A positive dose-response but nonlinear association was found between SUA and total dyslipidaemia, high total cholesterol, and low HDL, whereas an inverse U-shaped association was found between SUA and high LDL-C ( P-nonlinear< 0.0001).ConclusionThe SUA level was positively correlated with each dyslipidaemia component in Dong, Miao, and Bouyei adults, and sex and ethnic differences were also found. A nonlinear dose-response relationship was found between SUA levels and dyslipidaemia and its components. Further research is warranted to investigate the causal link between SUA levels and dyslipidaemia incidence.

Thyroid Status and Brain Circulation: The Rotterdam Study.

ContextWhether thyroid dysfunction is related to altered brain circulation in the general population remains unknown.ObjectiveWe determined the association of thyroid hormones with different markers of brain circulation within community-dwelling elderly people.MethodsThis was a population-based study of 3 subcohorts of the Rotterdam Study, starting in 1989, 2000, and 2006. A total of 5142 participants (mean age, 63.8 years; 55.4% women), underwent venipuncture to measure serum thyroid-stimulating hormone (TSH) and free thyroxine (FT4). Between 2005 and 2015, all participants underwent phase-contrast brain magnetic resonance imaging to assess global brain perfusion (mL of blood flow/100 mL of brain/minute). Arteriolar retinal calibers were assessed using digitized images of stereoscopic fundus color transparencies in 3105 participants as markers of microcirculation. We investigated associations of TSH, FT4 with brain circulation measures using (non)linear regression models.ResultsFT4 (in pmol/L) levels had an inverse U-shaped association with global brain perfusion, such that high and low levels of FT4 were associated with lower global brain perfusion than middle levels of FT4. The difference in global brain perfusion between high FT4 levels (25 pmol/L) and middle FT4 levels (FT4 = 15 pmol/L; P nonlinearity = .002) was up to –2.44 mL (95% CI –4.31; –0.56). Higher and lower levels of FT4, compared with middle FT4 levels, were associated with arteriolar retinal vessels (mean difference up to –2.46 µm, 95% CI –4.98; 0.05 for lower FT4).ConclusionThese results suggest that thyroid dysfunction could lead to brain diseases such as stroke or dementia through suboptimal brain circulation that is potentially modifiable.

Early pregnancy essential and non-essential metal mixtures and gestational glucose concentrations in the 2nd trimester: Results from project viva

Metals are involved in glucose metabolism, and some may alter glycemic regulation. However, joint effects of essential and non-essential metals on glucose concentrations during pregnancy are unclear. This study explored the joint associations of pregnancy exposures to essential (copper, magnesium, manganese, selenium, zinc) and non-essential (arsenic, barium, cadmium, cesium, lead, mercury) metals with gestational glucose concentrations using 1,311 women enrolled 1999–2002 in Project Viva, a Boston, MA-area pregnancy cohort. The study measured erythrocyte metal concentrations from 1st trimester blood samples and used glucose concentrations measured 1 h after non-fasting 50-gram glucose challenge tests (GCT) from clinical gestational diabetes screening at 26–28 weeks gestation. Bayesian Kernel Machine Regression (BKMR) and quantile-based g-computation were applied to model the associations of metal mixtures—including their interactions—with glucose concentrations post-GCT. We tested for reproducibility of BKMR results using generalized additive models. The BKMR model showed an inverse U-shaped association for barium and a linear inverse association for mercury. Specifically, estimated mean glucose concentrations were highest around 75th percentile of barium concentrations [2.1 (95% confidence interval: −0.2, 4.4) mg/dL higher comparing to the 25th percentile], and each interquartile range increase of erythrocyte mercury was associated with 1.9 mg/dL lower mean glucose concentrations (95% credible interval: −4.2, 0.4). Quantile g-computation showed joint associations of all metals, essential-metals, and non-essential metals on gestational glucose concentrations were all null, however, we observed evidences of interaction for barium and lead. Overall, we found early pregnancy barium and mercury erythrocytic concentrations were associated with altered post-load glucose concentrations in later pregnancy, with potential interactions between barium and lead.

Effect of non-optimum ambient temperature on cognitive function of elderly women in Germany

Non-optimum ambient temperature has been associated with a variety of health outcomes in the elderly population. However, few studies have examined its adverse effects on neurocognitive function. In this study, we explored the temperature-cognition association in elderly women. We investigated 777 elderly women from the German SALIA cohort during the 2007–2010 follow-up. Cognitive function was evaluated using the CERAD-Plus test battery. Modelled data on daily weather conditions were assigned to the residential addresses. The temperature-cognition association over lag 0–10 days was estimated using multivariable regression with distributed lag non-linear model. The daily mean temperature ranged between −6.7 and 26.0 °C during the study period for the 777 participants. We observed an inverse U-shaped association in elderly women, with the optimum temperature (15.3 °C) located at the 68th percentile of the temperature range. The average z-score of global cognitive function declined by −0.31 (95%CI: 0.73, 0.11) for extreme cold (the 2.5th percentile of temperature range) and −0.92 (95%CI: 1.50, −0.33) for extreme heat (the 97.5th percentile of temperature range), in comparison to the optimum temperature. Episodic memory was more sensitive to heat exposure, while semantic memory and executive function were the two cognitive domains sensitive to cold exposure. Individuals living in an urban area and those with a low educational level were particularly sensitive to extreme heat. In summary, non-optimum temperature was inversely associated with cognitive function in elderly women, with the effect size for heat exposure particularly substantial. The strength of association varied by cognitive domains and individual characteristics.

Workplace flexibility important for part-time sick leave selection\u2014an exploratory cross-sectional study of long-term sick listed in Norway

BackgroundPart-time sick leave (PTSL) where sick-listed individuals work a percentage corresponding to their remaining work capabilities is often used to promote return to work. The effects of PTSL are uncertain due to participant selection on personal and social factors, which are not easily captured by evaluations that primarily rely on register-data. More knowledge of health-related, workplace and personal characteristics that influence the propensity to utilize PTSL is needed.The objective of the present study was to explore whether individuals on PTSL and full-time sick leave (FTSL) differ in terms of self-reported health, workplace resources and psychological resilience while also considering known sociodemographic factors that influence PTSL selection.MethodsThe study utilized a cross-sectional sample of 661 workers sick listed for 8 weeks with a 50–100% sick-listing degree. Differences between those on PTSL and FTSL with regard to current self-reported health, previous long-term sick leave, workplace adjustment latitude, psychosocial work environment, work autonomy, coping with work demands, and psychological resilience were examined and adjusted for known selection factors (age, education, gender, sector, diagnosis, and physical work) using logistic regression.ResultsAn inverse U-shaped curvilinear association between self-reported health and PTSL was identified. Those on PTSL also reported greater workplace adjustment latitude and better psychosocial work environment than those on FTSL. These differences persisted after adjusting for previously known selection factors. Furthermore, the PTSL group reported more work autonomy and poorer coping with work demands, but these differences were more uncertain after adjustment. The groups did not differ in terms of previous long-term sick leave or psychological resilience.ConclusionThe present study found differences between those on PTSL and FTSL with regards to self-reported health, workplace adjustment latitude and psychosocial work environment that were independent of differences identified in previous research. These results are important for future evaluations of the effect of PTSL on RTW, suggesting more attention should be paid to self-reported health status and workplace characteristics that are not captured using register data.

Examining geographical disparities in the incubation period of the COVID-19 infected cases in Shenzhen and Hefei, China

BackgroundCurrent studies on the COVID-19 depicted a general incubation period distribution and did not examine whether the incubation period distribution varies across patients living in different geographical locations with varying environmental attributes. Profiling the incubation distributions geographically help to determine the appropriate quarantine duration for different regions.MethodsThis retrospective study mainly applied big data analytics and methodology, using the publicly accessible clinical report for patients (n = 543) confirmed as infected in Shenzhen and Hefei, China. Based on 217 patients on whom the incubation period could be identified by the epidemiological method. Statistical and econometric methods were employed to investigate how the incubation distributions varied between infected cases reported in Shenzhen and Hefei.ResultsThe median incubation period of the COVID-19 for all the 217 infected patients was 8 days (95% CI 7 to 9), while median values were 9 days in Shenzhen and 4 days in Hefei. The incubation period probably has an inverse U-shaped association with the meteorological temperature. The warmer condition in the winter of Shenzhen, average environmental temperature between 10 °C to 15 °C, may decrease viral virulence and result in more extended incubation periods.ConclusionCase studies of the COVID-19 outbreak in Shenzhen and Hefei indicated that the incubation period of COVID-19 had exhibited evident geographical disparities, although the pathological causality between meteorological conditions and incubation period deserves further investigation. Methodologies based on big data released by local public health authorities are applicable for identifying incubation period and relevant epidemiological research.

Intellectual Capital and Bank Risk in Vietnam—A Quantile Regression Approach

This study empirically presents evidence of nonlinearity and heterogeneity relation between intellectual capital and risk-taking for the Vietnamese banking system. We used quantile regression methods on a data set of 30 Vietnamese banks from 2007 to 2019. The results showed that bank insolvency was positively affected by its value-added intellectual coefficient (VAIC) at the upper quantiles (i.e., 80th and 90th), while the opposite was true for credit risk (i.e., 10th and 20th quantiles). When observing the VAIC’s components, risk-taking behaviors were also significantly affected by HCE (Human Capital Efficiency), CEE (Capital Employed Efficiency) and SCE (Structural Capital Efficiency) at the 90th quantile of instability distribution and the 10th quantile of credit risk distribution. Furthermore, the results also emphasized that there was an inverse U-shaped association between intellectual capital and bank risk-taking. Therefore, this study provides important implications for policymakers, regulators, bank managers and academics that encourage increasing investment in knowledge assets to minimize bank risks in the long run.

Vitamin A and its dervatives effect on bone mineral density, a systematic review.

Background:Even though vitamin A (Vit A) is one of the essential vitamins required for bone growth and development, it is still uncertain whether its effect on bone mineral density (BMD) is beneficial or harmful.Aim:To assess Vit A’s effect and its derivatives on BMD and the risk of developing osteoporosis.Data sources:PubMed, Cochrane Library, Science Direct, Embase, and Google Scholar were searched in February 2019 and updated in November 2020.Methods:Conducted following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines.Results:A total of 13 studies were included in this report out of 9,124 citations. Five of them were cross-sectional studies, and nine were cohort studies. Three out of five cross-sectional studies showed an increase in BMD, while two showed a decrease in BMD. Four out of eight cohort studies found an increase in BMD; two studies found no association between vitamin A level and BMD; one showed an inverse U-shape association of vitamin A with BMD, suggesting that both the increase or decrease levels of vitamin A affect BMD, while only one study showed a decrease in BMD.Conclusion:Although most of the included studies showed a favorable effect of Vit A on BMD, Vit A’s role or its derivatives on BMD change remains unclear.

The effects of an enabling approach to eco-control on firms’ environmental performance: A research note

This research note provides additional empirical evidence relating to the performance effects of diagnostic and interactive control, both in isolation and in combination with an enabling approach to control. Drawing on data from a survey of 221 Australian firms, the findings suggest that while diagnostic eco-control has no direct influence on environmental performance, its interaction with an enabling approach yields a positive complementary effect. However, while interactive eco-control and an enabling approach are independently associated with environmental performance, their interaction effect is not significant, which implies that their combination may not necessarily be value-adding. Finally, the results also indicate a non-linear (inverse U-shaped) association between an enabling approach to control and environmental performance, which implies that an increased emphasis on an enabling approach may lead to diminishing marginal returns.

Increasing trends in incidence of preterm birth among 2.5 million newborns in Guangzhou, China, 2001 to 2016: an age-period-cohort analysis

BackgroundThe incidence of preterm birth (PTB, < 37 weeks of gestation) has been increasing in China and many other countries in recent years. However, the causes of the increase were not well understood. The current study aims to examine the contribution of maternal age, period of delivery, and maternal birth cohorts to long-term trends in preterm birth in Guangzhou, China.MethodsIn a retrospective population-based study, data were obtained from 2,535,000 singleton live births with 20–43 gestational weeks from 2001 to 2016 and recorded in the Guangzhou Perinatal Health Care and Delivery Surveillance System, in China. The age-period-cohort models were applied to investigate the temporal changes in incidences of PTB, stratified by parity.ResultsThe incidence of preterm birth steadily increased from 5.1% in 2001 to 5.9% in 2016, with larger rise in primiparous mothers (from 5.0 to 5.9%) compared to multiparous mothers (from 5.6 to 5.9%). A J-shaped and a V-shaped relationship were found between maternal age and PTB among primiparous and multiparous mothers, respectively. A linear cohort effect was found among primiparous mothers with the lowest risk of PTB [risk ratio (RR) = 0.81, 95% confidence interval (CI): 0.74 to 0.89] in 1961 and the highest risk (RR = 1.06, 95% CI: 1.00 to 1.13) in 1997 compared to the mothers born in 1981. An inverse U-shaped association between maternal birth cohort and PTB was found in multiparous mothers. There were weak decreasing period effects on the trend of overall PTB among multiparous mothers and on the trend of extremely (< 27 weeks) or very (28–31 weeks) PTB among both parity groups during the period of 2001–2012.ConclusionsOur findings showed the PTB incidences had been increasing in the past 16 years in Guangzhou, China and both maternal age and cohort effects contributed to these trends. Further studies are recommended on the impact of altered maternal age and parity on premature births and corresponding public education and public health policies.