Relative Strength Of Association Research Articles

Systolic Blood Pressure, Diastolic Blood Pressure and Pulse Pressure and the Risk of Subclinical Myocardial Injury: The HUNT Study.

Subclinical myocardial injury expressed as higher cardiac troponin concentrations may represent an important intermediary between hypertension and the risk of cardiovascular disease. The study aimed to assess the relative strength of associations between systolic blood pressure (BP), diastolic BP, and pulse pressure, and subclinical myocardial injury, and how change in BP variables over time associates with subclinical myocardial injury. cTnl (cardiac troponin I) was measured in 32 968 participants of the fourth wave of the population-based cohort HUNT4 (Trøndelag Health Study) without a history of cardiovascular disease. An additional longitudinal analysis included participants from HUNT4 with BP measurements from HUNT3 (n=18 681). Associations between BP variables and cTnI concentrations were assessed by linear and logistic regression analyses. The median cTnI concentration was 1.6 ng/L (25th-75th percentiles, 0.6-3.1 ng/L), median age was 52 years (39.1-65.6 years), and 57% were female subjects. Cross-sectionally, only systolic BP categories ≥130 mm Hg associated with higher cTnI concentrations, compared with a reference systolic BP of <110 mm Hg. All categories of diastolic BP and pulse pressure were positively associated with higher cTnI concentrations when diastolic BP 70 to 79 mm Hg and pulse pressure <40 mm Hg were used as references, respectively. When comparing systolic BP, diastolic BP, and pulse pressure as continuous variables, cross-sectionally, pulse pressure most strongly associated with cTnI concentrations (P for all comparisons <0.001), whereas longitudinally, change in diastolic BP was most strongly associated with cTnI concentrations (P for all comparisons <0.05). Subjects with high pulse pressure and longitudinal increase in diastolic BP are at higher risk for subclinical myocardial injury.

Evaluating the Prognostic Variables for Overall Survival in Patients with Metastatic Renal Cell Carcinoma: A Meta-Analysis Of 29,366 Patients

Background: Scoring systems are a method of risk assessment used to stratify patients with metastatic renal cell carcinoma (mRCC) and guide systemic therapy. The variables are weighed equally when calculating total score. However, the difference of even 1 positive predictor can change one's risk category and therapy. Objective: To compare the relative strength of association between predictive variables and overall survival (OS) in mRCC. Methods: A search of Medical Literature Analysis and Retrieval System Online (MEDLINE) and Embase was conducted. Clinical studies, retrospective and prospective, were included if the association of at least 1 predictor and OS in patients with mRCC receiving first-line systemic therapy was evaluated. Meta-analysis was performed to generate pooled hazard ratios (HRs) and 95% CIs for OS for predictors with ≥ 5 included studies. Sensitivity analysis identified outlier heterogeneity and publication bias. Results: Sixty-six studies containing 29,366 patients were included. Meta-analysis indicated lung metastases, bone metastases, thrombocytosis, time to systemic therapy &lt; 1 year, liver metastases, hypercalcemia, anemia, elevated neutrophil-lymphocyte ratio, multiple metastatic sites, neutrophilia, poor Eastern Cooperative Oncology Group (ECOG) status, no previous nephrectomy, elevated lactate dehydrogenase, Fuhrman grade 3 or 4, central nervous system metastases, elevated C-reactive protein, and Karnofsky Performance Status &lt; 80% were associated with significantly worse OS. The HRs varied from 1.34 to 2.76, representing heterogeneity in predictive strength. The effects of study heterogeneity and publication bias were minimal to moderate across all predictors. Conclusions: Based on the differences in pooled HRs, prognostic strength between the variables is likely not equivalent. Restructuring scoring models, through inclusion of other variables and usage of relative weighting, should be considered to improve accuracy of risk stratification.

Association of Preoperative Lung Function with Complications after Lobectomy Using Race-Neutral and Race-Specific Normative Equations.

Rationale: Pulmonary function testing (PFT) is performed to aid patient selection before surgical resection for non-small cell lung cancer (NSCLC). The interpretation of PFT data relies on normative equations, which vary by race, but the relative strength of association of lung function using race-specific or race-neutral normative equations with postoperative pulmonary complications is unknown. Objectives: To compare the strength of association of lung function, using race-neutral or race-specific equations, with surgical complications after lobectomy for NSCLC. Methods: We studied 3,311 patients who underwent lobectomy for NSCLC and underwent preoperative PFT from 2001 to 2021. We used Global Lung Function Initiative equations to generate race-specific and race-neutral normative equations to calculate percentage predicted forced expiratory volume in 1 second (FEV1%). The primary outcome of interest was the occurrence of postoperative pulmonary complications within 30 days of surgery. We used unadjusted and race-adjusted logistic regression models and least absolute shrinkage and selection operator analyses adjusted for relevant comorbidities to measure the association of race-specific and race-neutral FEV1% with pulmonary complications. Results: Thirty-one percent of patients who underwent surgery experienced pulmonary complications. Higher FEV1, whether measured with race-neutral (odds ratio [OR], 0.98 per 1% change in FEV1% [95% confidence interval (CI), 0.98-0.99]; P < 0.001) or race-specific (OR, 0.98 per 1% change in FEV1% [95% CI, 0.98-0.98]; P < 0.001) normative equations, was associated with fewer postoperative pulmonary complications. The area under the receiver operator curve for pulmonary complications was similar for race-adjusted race-neutral (0.60) and race-specific (0.60) models. Using least absolute shrinkage and selection operator regression, higher FEV1% was similarly associated with a lower rate of pulmonary complications in race-neutral (OR, 0.99 per 1% [95% CI, 0.98-0.99]) and race-specific (OR, 0.99 per 1%; 95% CI, 0.98-0.99) models. The marginal effect of race on pulmonary complications was attenuated in all race-specific models compared with all race-neutral models. Conclusions: The choice of race-specific or race-neutral normative PFT equations does not meaningfully affect the association of lung function with pulmonary complications after lobectomy for NSCLC, but the use of race-neutral equations unmasks additional effects of self-identified race on pulmonary complications.

Differential Associations of A-/B-Type Natriuretic Peptides With Cardiac Structure, Function, and Prognosis in Heart Failure

BackgroundNatriuretic peptide (NP) elevations are prognostic in heart failure (HF), but relative atrial NP deficiency in acute HF has been suggested. ObjectivesThe authors compared plasma concentrations and relative strength of associations of A- and B-type NPs with cardiac structure/function and clinical outcomes in HF. MethodsMidregional pro–atrial natriuretic peptide (MR-proANP), B-type natriuretic peptide (BNP), and N-terminal pro–B-type natriuretic peptide (NT-proBNP) were measured in patients with compensated HF in a prospective, multicenter study. The primary outcome was a composite of HF-hospitalization or all-cause mortality. Secondary outcomes included individual primary outcome components and cardiovascular admission. ResultsAmong 1,278 patients (age 60.1 ± 12.1 years, 82% men, left ventricular ejection fraction [LVEF] 34% ± 14%), median concentrations of MR-proANP were 990 pg/mL (Q1-Q3: 557-1,563 pg/mL), NT-proBNP 1,648 pg/mL (Q1-Q3: 652-3,960 pg/mL), and BNP 291 pg/mL (Q1-Q3: 103-777 pg/mL). No subpopulation with inappropriately low MR-proANP (relative to BNP/NT-proBNP) was observed. Clinical event rates were similar for biomarker tertiles. Increments in MR-proANP exhibited steeper associations with concurrent shifts in left ventricular size, diastolic indexes and LVEF than BNP/NT-proBNP at baseline and serially (P < 0.05), and lower odds of beneficial left ventricular reverse remodeling: OR: 0.35 (95% CI: 0.18-0.70). In single-biomarker models, MR-proANP(log10) was associated with the highest hazard (4 to 6 times) for each outcome. In multimarker models, independent associations were observed for the primary outcome (MR-proANP and NT-proBNP), HF-hospitalization and cardiovascular admission (MR-proANP only), and all-cause mortality (NT-proBNP only) (P < 0.05). The discriminative value of MR-proANP was superior to BNP/NT-proBNP (HF-hospitalization) and BNP (primary outcome) (P < 0.05). ConclusionsMR-proANP was not inappropriately low relative to concurrent BNP/NT-proBNP values. Proportional increments in MR-proANP were more pronounced than for B-peptides for given decrements in cardiac structure/function. MR-proANP offered greater independent predictive power overall.

A lean method for selecting determinants when developing behavior change interventions

ABSTRACT When developing behavior change interventions in a systematic way, it is important to select determinants relevant to the target behavior. Data is needed to gain insight into the determinant structures (the relative strengths of associations between determinants and behavior) and their univariate distributions. This insight is crucial to select the most relevant determinants, but at the same time institutions tasked with behavior change (e.g. prevention organizations, municipal health services) often operate under prohibitive resource constraints, which also extend to how easily they can collect data from a sample. This paper introduces CIBERlite – an approach that furnishes the intervention developer with an idea of the relevance of a limited number of determinants using short measurements informed by theory. The first study (N = 401) in a series of three explores the convergent validity of short and full measurements of determinants derived from the Reasoned Action Approach. The short measurements are used in the main study (N = 415) that serves as a proof-of-concept for the CIBERlite plot, an efficient visualization combining data of determinant structures and their univariate distributions for eight behaviors. The unexpected patterns detected in the main study led to an expert estimation study (N = 45), which shows that individual experts have difficulty in predicting how people score on determinants. This stresses the importance of conducting determinant studies and CIBERlite is a valuable alternative to do so if resources are limited.

Does Local Failure Following Oligometastasis-Directed SBRT Predict for Widespread Progression and Overall Survival?

<h3>Purpose/Objective(s)</h3> The potential of oligometastasis (OM)-directed therapy to translate to survival benefit has been shown in randomized trials, but typically in small or histology-specific cohorts (i.e., prostate or NSCLC). We investigated the impact of local control (LC) on widespread progression (WSP) and overall survival (OS) in a large, multi-institutional cohort of patients across heterogeneous histologies treated with SBRT to OMs. <h3>Materials/Methods</h3> Patients treated at 6 international centers from 2007 – 2016 were retrospectively reviewed and included if they had 1) five or fewer lesions, 2) no history of brain metastases, 3) curative treatment for primary disease, and 4) SBRT to all known OMs at initial presentation. The relationship between LC at certain time points and OS and WSP (>5 active/untreated lesions) were explored using Cox and Fine-Gray regression models. The relative strength of association between LC and dosimetric predictors was analyzed with competing risk regression using death as a competing risk. <h3>Results</h3> In total, 1033 patients treated to 1700 OMs were analyzed. The median follow up was 24.1 mo (range: 0.3-104.7). Most patients (57.1%) had solitary OM, 24.0% had 2 OMs, 10.3% had 3 OMs, and 8.6% had 4-5 OMs. The most common histologies were NSCLC (25.2%), colorectal (22.8%), prostate (12.8%), and breast (8.1%). The median prescription dose was 48 Gy (range: 10-60) in a median of 5 fractions (range: 1-15). Median OS was 44.2 mo. Cumulative incidence of local failure at 6m, 1y, 2y and 3y was 3.3%, 10.0%, 19.6% and 23.9% respectively. As detailed below, patients who fail locally in any or all SBRT-targeted OMs have significantly increased risk of WSP and death compared to those with no failure. These risks may be greater with shorter duration of LC. Patients who failed in only a subset of treated OMs and those who failed in all OMs did not have significantly different WSP and OS outcomes. Minimum BED to the GTV or ITV was most predictive of LC when compared to prescription dose, PTV Dmin, and PTV Dmax, across a range of simulated a/b ratios. <h3>Conclusion</h3> This large multi-institutional series demonstrates that duration of LC in SBRT-targeted OMs translates strongly to WSP and OS outcomes in an all or nothing manner, where failure in a subset of treated OMs appears no different in risk compared to failing in all OMs. This highlights the importance of maximizing LC to each OM in this treatment paradigm, where GTV or ITV Dmin may be a key dosimetric parameter.

Association of vision impairment with suicide ideation, plans, and attempts among adults in the United States.

This study aims to investigate the relative strength of association between vision impairment (VI) and suicidal ideation, plans, and attempts among adults in the United States. The study sample consisted of 214,505 adults, aged 18 years and older. Researchers used data from the 2015-2019 National Survey on Drug Use and Health, in which respondents were asked whether they had any suicidal thoughts, plans, and attempts, in the past 12 months. Approximately, 4.4% of respondents reported experiencing VI, being blind, or having serious difficulty seeing. Compared to their sighted peers, a relatively high proportion of adults with VI had serious thoughts about suicide (9.0%), suicidal plans (3.0%), or suicidal attempts (1.6%) in the past year. The findings showed that individuals with VI may disproportionately experience suicidal ideation, plans, and attempts, after controlling potentially confounding variables (adjusted odds ratio[AOR] = 1.36; AOR = 1.27; AOR = 1.40, respectively). With findings demonstrating such a strong association between VI and suicide, this study suggests the importance of screening for suicidal ideation, plans, and attempts among adults with VI, and the strong need for developing behavioral health services which keep this correlation in mind.

Omics approaches to discover pathophysiological pathways contributing to human pain.

Omics approaches to discover pathophysiological pathways contributing to human pain.

Identifying relative strength of methadone versus health and social services in comprehensive substance use disorder treatment using a variance decomposition approach

BackgroundThe purpose of this study is to identify the relative strengths of association of medication and health and social services in comprehensive substance use disorder (SUD) treatment. Objectives: The study uses a novel variance decomposition method to assess the relative strength of association of six active ingredients of comprehensive SUD treatment: methadone medication, access services, SUD counseling, matched service ratio, client–provider relationship, and treatment duration. MethodsThe study uses data from the National Treatment Improvement Evaluation Study (1992–1997), a dataset with an unusual number of services and service strategies measured. The data include 3012 clients from 45 SUD treatment programs. Linear mixed models are used to assess the relation of service variables to the outcome of posttreatment substance use. Variance decomposition methods are used to assess the relative importance of the ingredients in the treatment model. ResultsAlong with a random intercept and background variables, receipt of methadone accounted for the greatest relative strength of association at 35.4%, compared with 23.8% for treatment duration, 15.4% for client–provider relationship, and 11.2% for matched service ratio. Access and SUD counseling accounted for modest strengths of association at 1% and 3% each. ConclusionFindings indicate somewhat greater strength of association of methadone compared with other services and service strategies and overall, reinforce the importance of both medication and services and service strategies in the design and development of effective models of service delivery. SignificanceThis study, among the first to evaluate the relative importance of specific services and service strategies of comprehensive SUD treatment, provides insights relevant to the development of effective models of service delivery.

Bullying and social goal‐setting in youth: A meta‐analysis

AbstractBullying is a serious concern worldwide and may compromise development for all involved. Growing evidence suggests that bullying may be viewed as a goal‐oriented strategy to achieve prestige and power or as a form of proactive aggression serving personal goals. The current paper reports a meta‐analysis of studies examining social goals‐bullying associations in youth. In addition to reporting an overall weighted‐average effect size, we compared the relative strength of associations of specific goals (status/dominance vs. antisocial/prosocial) with bullying, and examined goal type (situation‐specific vs. global), gender, and age as potential moderators. A thorough literature search identified 45 eligible effect sizes from 16 independent samples (14 sources). On average, bullying behavior was related significantly to social goal setting. Specifically, youth who displayed more bullying behavior were more likely to endorse status/power goals (r = .16, 95% CI [.11, .21]) and antisocial goals (r = .27, 95% CI [.04, .48]) and to disregard prosocial goals (r = −.10, 95% CI [−.19, −.02]) than their peers who displayed less bullying behavior. None of the included moderators related to differences in the weighted average effect size. The findings support conceptualization of bullying as instrumental behavior aimed at achieving personal goals. They also advance the understanding of motivations for bullying by indicating that, for example, goals for status/power among peers and goals of antisocial nature (e.g., revenge goals) are both related to the risk of bullying. Implications for basic research and bullying interventions are discussed.

Right ventricular dysfunction in acute heart failure from emergency department to discharge: Predictors and clinical implications.

Among acute heart failure (AHF) inpatients, right ventricular dysfunction (RVD) predicts clinical outcomes independent of left ventricular (LV) dysfunction. Prior studies have not accounted for congestion severity, show conflicting findings on echocardiography (echo) timing, and excluded emergency department (ED) patients. We describe for the first time the epidemiology, predictors, and outcomes of RVD in AHF starting with earliest ED treatment. Point-of-care echo and 10-point lung ultrasound (LUS) were obtained in 84 prospectively enrolled AHF patients at two EDs, ≤1h after first intravenous diuresis, vasodilator, and/or positive pressure ventilation (PPV). Echo and LUS were repeated at 24, 72, and 168h, unless discharged sooner (n=197 exams). RVD was defined as <17mm tricuspid annulus plane systolic excursion (TAPSE), our primary measure. To identify correlates of RVD, a multivariable linear mixed model (LMM) of TAPSE through time was fit. Possible predictors were specified a priori and/or with p≤0.1 difference between patients with/without RVD. Data were standardized and centered to facilitate comparison of relative strength of association between predictors of TAPSE. Survival curves for a 30-day death or AHF readmission primary outcome were assessed for RVD, LUS severity, and LVEF. A multivariable generalized linear mixed model (GLMM) for the outcome was used to adjust RVD for LVEF and LUS. 46% (n=39) of patients at ED arrival showed RVD by TAPSE (median 18mm, interquartile range 13-23). 18 variables with p≤0.1 unadjusted difference with/without RVD, and 12 a priori predictors of RVD were included in the multivariable LMM model of TAPSE through time (R2=0.76). Missed antihypertensive medication (within 7days), ED PPV, chronic obstructive pulmonary disease history, LVEF, LUS congestion severity, and right ventricular systolic pressure (RVSP) were the strongest multivariable predictors of RVD, respectively, and the only to reach statistical significance (p<0.05). 30-day death or AHF readmission was associated with RVD at ED arrival (hazard ratio {HR} 3.31 {95%CI: 1.28-8.53}, p=0.009), ED to discharge decrease in LUS (HR 0.11 {0.01-0.85}, p<0.0001 for top quartile Δ), but not LVEF (quartile 2 vs. 1 HR 0.78 {0.22-2.68}, 3 vs. 1 HR 0.55 {0.16-1.92}, 4 vs. 1 HR 0.32 {0.09-1.22}, p=0.30). The area under the receiver operating curve on GLMM for the primary outcome by TAPSE (p=0.0012), ΔLUS (p=0.0005), and LVEF (p=0.8347) was 0.807. In this observational study, RVD was common in AHF, and predicted by congestion on LUS, LVEF, RVSP, and comorbidities from ED arrival through discharge. 30-day death or AHF-rehospitalization was associated with RVD at ED arrival and ΔLUS severity, but not LVEF.

Of irrigation canals and multifunctional agroforestry: Traditional agriculture facilitates Woolly-necked Stork breeding in a north Indian agricultural landscape

Conservation of biodiversity alongside agriculture is now a global priority. Tree-nesting waterbirds have a tenuous relationship with farmlands because their survival requires farmers to retain trees and wetlands amid croplands. Research on such birds is rare on tropical and sub-tropical agricultural landscapes where high human densities and intensive farming ostensibly deteriorate breeding conditions. We explored breeding ecology and nest site selection by the single-nesting Woolly-necked Stork (Ciconia episcopus) in Haryana, north India using 298 nests from 166 locations discovered between 2016 and 2020. We determined the relative strengths of association of nest locations with natural features (trees, wetlands), human presence (habitation) and artificial water sources (irrigation canals) to understand cues used by breeding storks to situate nests. Woolly-necked Stork brood size from 42 successful nests was relatively high (3.1 ± 0.9 SD), with nests close to human habitation and wetlands having smaller broods. Storks showed high nest site fidelity (44.5% of sites used > 1 year), rarely nested on man-made structures (electricity pylons; 8.4%), and distributed nests in a clumped pattern. Woolly-necked Storks situated nests ambivalent to natural features but associated strongly with man-made features (positively with irrigation canals; negatively with human habitation). Contrary to expectations, most nests were not on the tallest trees but on the medium sized, native Dalbergia sissoo though storks situated nests on two tall trees (native Ficus religiosa and exotic Eucalyptus sp.) far more than the trees’ availability. All three tree species were favoured either for traditional agroforestry or local religious beliefs. Traditional agriculture in Haryana supported a substantial breeding population of Woolly-necked Storks facilitated by agriculture-related components rather than existing natural features. This novel scenario contradicts conventional narratives that suggest multi-season small holder tropical and sub-tropical agriculture degrades breeding conditions for waterbirds. Our findings in Haryana reiterate the need to assemble a diverse conservation toolkit of different locally relevant mechanisms supporting biodiversity amid cultivation.

Negative self-conscious emotions in women with borderline personality disorder as assessed by an Implicit Association Test.

Shame and guilt are vital in borderline personality disorder (BPD), and previous research using explicit measures has consistently found elevated levels of these self-conscious emotions (SCE) in those with BPD. However, these measures cannot elucidate implicit processes that are equally important, as they guide the perceptions of the self and influence behavioral responses. Thus, we aimed to extend the research on SCE in BPD utilizing an indirect latency-based measure. A total of 29 female inpatients with BPD and 21 healthy women were assessed with a shame and a guilt self-concept Implicit Association Test (IAT). These two tasks use reaction time measurements to determine the relative strengths of associations between the self versus others and shame versus pride and guilt versus innocence. In addition, participants completed questionnaires capturing shame, guilt, and BPD symptoms. Women with BPD displayed significantly more shame- and guilt-prone implicit self-concepts than the control group (d = 1.2 and d = 0.7, respectively). They also scored significantly higher on explicit measures of shame and guilt. Although explicitly and implicitly assessed shame and guilt were strongly associated with borderline pathology, multivariate models indicated that solely self-reported, but not implicitly measured, guilt was consistently related to all BPD outcomes. Shame was only associated with the number of BPD criteria. This study extends previous findings on SCE in BPD, in that women with BPD do not only explicitly conceive themselves as more shame- and guilt-prone but also exhibit implicitly more shame and guilt self-concepts than healthy controls. Our results may hold clinical and therapeutic implications. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Subscapularis management in stemmed and stemless total shoulder arthroplasty: a surgeon decision-making analysis study

Stemless total shoulder arthroplasty (TSA) continues to grow in popularity as an evolution of stemmed humeral implants. Proposed advantages include bone preservation and ease of potential revision. However, absence of a stem may necessitate a change in subscapularis takedown approach. Specifically, there is theoretical concern about violation of supportive bone with lesser tuberosity osteotomy when using a stemless device. Therefore, the goal of this study was to identify if surgeons change their subscapularis takedown preference when performing stemless vs. stemmed TSA. Data from a consecutive series of patients who underwent stemmed and stemless TSA at an academic institution were collected. The subscapularis management technique was documented. Subscapularis takedown techniques were divided into 2 groups: soft-tissue approach (subscapularis tenotomy or peel) and bony approach (lesser tuberosity osteotomy). Historical preference for each surgeon was determined by evaluating techniques employed using stemmed TSA. A Cramers V analysis was run to determine the strength of association between this historical preference and subscapularis management technique used for stemless TSA. One hundred and fifty-four patients were included in this analysis. There were 72 and 82 stemmed and stemless arthroplasty cases performed, respectively. Of the 154 patients, 50.6% were women. The average age of patients was 64.2 years. Four surgeons were included in this study. In all, there were 79 and 75 bony and soft-tissue subscapularis techniques, respectively. The historical preference for 3 of the surgeons was a subscapularis bony approach, and the historical preference for one of the surgeons was a soft-tissue approach. A Cramer's V analysis was used to measure the relative strength of association between patient factors, historical subscapularis management preference, and subscapularis takedown approach in stemless TSA. Our analysis yielded a value of 0.65 (P < .01), indicating a redundant association between subscapularis management approach used between stemmed and stemless implant per surgeon. In determining subscapularis tendon management strategy, in surgeons who performed stemmed TSA before stemless TSA, the subscapularis takedown approach used for stemless TSA is strongly associated with surgeon's historical preference for stemmed TSA. Future research will be needed to determine the clinical ramifications of this finding.

Third joint inter-agency report on integrated analysis of consumption of antimicrobial agents and occurrence of antimicrobial resistance in bacteria from humans and food-producing animals in the EU/EEA: JIACRA III 2016-2018.

The third joint inter‐agency report on integrated analysis of antimicrobial consumption (AMC) and the occurrence of antimicrobial resistance (AMR) in bacteria from humans and food‐producing animals (JIACRA) addressed data obtained by the Agencies' EU‐wide surveillance networks for 2016–2018. AMC in both sectors, expressed in mg/kg of estimated biomass, was compared at country and European level. Substantial variations in AMC between countries were observed in human and food animal sectors. In each year over the period 2016–2018, overall AMC was lower in food‐producing animals (for example in 2017, 108.3 mg/kg, range 3.1–423.1) than in humans (for example in 2017, 130.0 mg/kg; range 52.8–212.6). This is the first time this situation has been reported since JIACRA analyses were initiated on 2011 data. Univariate and multivariate analyses were applied to study associations between AMC and AMR for selected combinations of bacteria and antimicrobials. In both food‐producing animals and humans, associations were generally observed between the consumption of an antimicrobial class and bacterial resistance to the antimicrobials in this class in the same population. The multivariate analysis proved to be a useful approach for assessing the statistical significance and relative strength of associations between the occurrence of AMR in bacteria from humans, AMR in bacteria from food‐producing animals and AMC in both food‐producing animals and humans. For certain combinations of bacteria and antimicrobials, resistance in bacteria from humans was associated with resistance in bacteria from food‐producing animals which, in turn, was related to antimicrobial consumption in animals. The analyses showed that the relative strength of these associations differed markedly depending on antimicrobial class, microorganism and sector. Overall, the findings suggest that further interventions to reduce AMC will have a beneficial impact on AMR, which underlines the need to promote prudent use of antimicrobial agents in conjunction with infection control, prevention of infection and other relevant measures in both humans and foodproducing animals. The high levels of AMC and AMR still being reported in animals and humans from several countries show that these interventions should be reinforced.

Patterns of Growth in Childhood in Relation to Adult Schooling Attainment and Intelligence Quotient in 6 Birth Cohorts in Low- and Middle-Income Countries: Evidence from the Consortium of Health-Oriented Research in Transitioning Societies (COHORTS).

ABSTRACTBackgroundGrowth faltering has been associated with poor intellectual performance. The relative strengths of associations between growth in early and in later childhood remain underexplored.ObjectivesWe examined the association between growth in childhood and adult human capital in 5 low- and middle-income countries (LMICs).MethodsWe analyzed data from 9503 participants in 6 prospective birth cohorts from 5 LMICs (Brazil, Guatemala, India, the Philippines, and South Africa). We used linear and quasi-Poisson regression models to assess the associations between measures of height and relative weight at 4 age intervals [birth, age ∼2 y, midchildhood (MC), adulthood] and 2 dimensions of adult human capital [schooling attainment and Intelligence Quotient (IQ)].ResultsMeta-analysis of site- and sex-specific estimates showed statistically significant associations between size at birth and height at ∼2 y and the 2 outcomes (P < 0.001). Weight and length at birth and linear growth from birth to ∼2 y of age (1 z-score difference) were positively associated with schooling attainment (β: 0.13; 95% CI: 0.08, 0.19, β: 0.17; 95% CI: 0.07, 0.32, and β: 0.25, 95% CI: 0.10, 0.40, respectively) and adult IQ (β: 0.74, 95% CI: 0.35, 1.14, β: 0.73, 95% CI: 0.35, 1.10, and β: 1.52, 95% CI: 0.96, 2.08, respectively). Linear growth from age 2 y to MC and from MC to adulthood was not associated with higher school attainment or IQ. Change in relative weight in early childhood, MC, and adulthood was not associated with either outcome.ConclusionsLinear growth in the first 1000 d is a predictor of schooling attainment and IQ in adulthood in LMICs. Linear growth in later periods was not associated with either of these outcomes. Changes in relative weight across the life course were not associated with schooling and IQ in adulthood.

The association between natural environments and childhood mental health and development: A systematic review and assessment of different exposure measurements.

Several studies have assessed the relationship between exposure to natural environments (NEs) and childhood mental health and development. In most cases, a positive association has been found, but results are inconsistent, and the strength of association is unclear. This inconsistency may reflect the heterogeneity in measurements used to assess NE. This systematic review aims to identify the most common NE metrics used in childhood mental health and development research. Our second aim is to identify the metrics that are most consistently associated with health and assess the relative strength of association depending on type of NE exposure measurement, in terms of metric used (i.e., measurement technique, such as remote sensing), but also rate (i.e., spatial and temporal exposure). We used the PRISMA protocol to identify eligible studies, following a set of pre-defined inclusion criteria based on the PECOS strategy. A number of keywords were used for retrieving relevant articles from Medline, Embase, PsychINFO, and Web of Science databases between January 2000-November 2020. From these, we extracted data on type of NE measurement and relative association to a number of indicators of childhood mental health and development. We conducted a systematic assessment of quality and risk of bias in the included articles to evaluate the level of evidence. Case studies and qualitative studies were excluded. After screening of title (283 studies included), abstract, and full article, 45 studies were included in our review. A majority of which were conducted in North America and Europe (n=36; 80%). The majority of studies used land use or land covers (LULC, n=24; 35%) to determine exposures to NEs. Other metrics included the normalized difference vegetation index (NDVI), expert measures (e.g., surveys of data collection done by experts), surveys (e.g., self-reported assessments), and use of NE (e.g., measures of a participant's use of NE such as through GPS tracts or parent reports). Rate was most commonly determined by buffer zones around residential addresses or postal codes. The most consistent association to health outcomes was found for buffers of 100m, 250m, 500m, and within polygons boundaries (e.g., census tracts). Six health categories, academic achievement, prevalence of doctor diagnosed disorders, emotional and behavioral functioning, well-being, social functioning, and cognitive skills, were created post hoc. We found sufficient evidence between NDVI (Landsat) and emotional and behavioral well-being. Additionally, we found limited evidence between LULC datasets and academic achievement; use of NE, parent/guardian reported greenness, and expert measures of greenness and emotional and behavioral functioning; and use of NE and social functioning. This review demonstrates that several NE measurements must be evaluated further before sufficient evidence for a potential association between distinct NE exposure metrics and childhood mental health and development can be established. Further, we suggest increased coordination between research efforts, for example, by replication of studies and comparing different NE measurements systematically, so that effect sizes can be confirmed for various health outcomes. Finally, we recommend implementing research designs that assess underlying pathways of nature-health relations and utilize measurement techniques that adequately assess exposure, access, use, and perception of NEs in order to contribute to a better understanding of health impacts of surrounding natural environments.

Historical Wines of Portugal: The Classification, Consumer Associations and Marketing Implications.

Geographical origin, use of traditional varieties and ancestral viticulture/oenology practices characterize wines classified as Historical Wines of Portugal (HWP). This study identifies the authenticity attributes consumers associate with this classification and assesses the relative strength of associations. A review of brand authenticity research and interviews with Portuguese wine producers (n = 3) and consumers (n = 12) were conducted to identify HWP classification attributes. Strength of attribute association was subsequently evaluated in an online questionnaire with a convenience sample of Portuguese wine consumers (n = 641), which included a measure of general wine knowledge and questions about the adequacy of different contexts for HWP purchase and consumption. Wine knowledge markedly affected the nature and strength of consumer associations. Compared to Aspirational Explorers, wine connoisseurs emerged as Heritage Gatekeepers, associating origin, cultural heritage, quality, production and at-home consumption more strongly with HWP, and tradition, wine age and out-of-home consumption less strongly. Market recognition of HWP as a novel and distinctive table wine classification, with well-defined and unique attributes, is thus likely to depend on consumers’ general wine knowledge. Related promotional activities targeting wine novices should first focus on educating them on HWP classification, whereas those directed at savvier consumers should emphasize wine authenticity cues instead.

Association between hearing loss and suicidal ideation among middle-aged and older adults

Objectives Hearing loss (HL) is regarded as a major risk factor for late-life depression. This study aims to further examine the association between HL and suicidal ideation (SI) among middle-aged and older adults using a nationally representative sample. Method The study sample comprised 34,142 adults (aged 50+) drawn from the 2015 to 2018 National Survey on Drug Use and Health. SI was measured by response to the question, ‘At any time in the past year, did you seriously think about trying to kill yourself?’ HL was assessed by asking respondents whether they were deaf or had serious difficulty hearing. Multivariate logistic regression analyses were conducted to examine the association between HL and SI after adjusting for a comprehensive list of covariates. Results Compared to those without HL, middle-aged and older adults with HL experienced significant health disparities regarding history of hospitalization, poor perceived health, higher prevalence of chronic diseases, depression, substance use, and SI. HL was positively associated with SI in the past year in both middle-aged (aOR = 1.59, 95% CI [1.14, 2.21], p < .001) and older adult groups (aOR = 1.58, 95% CI [1.07, 2.33], p < .001), controlling for depression, substance use, health status, and sociodemographic variables. Conclusion Given the high prevalence of hearing loss (HL) in aging populations, this study aimed to expand our knowledge of the relative strength of association between HL and SI. Findings implied that healthcare providers should consider screening for SI in those with HL.

Predators, prey or temperature? Mechanisms driving niche use of a foundation plant species by specialist lizards.

Foundation species interact strongly with other species to profoundly influence communities, such as by providing food, refuge from predators or beneficial microclimates. We tested relative support for these mechanisms using spinifex grass (Triodia spp.), which is a foundation species of arid Australia that provides habitat for diverse lizard communities. We first compared the attributes of live and dead spinifex, bare ground and a structurally similar plant (Lomandra effusa), and then tested the relative strength of association of two spinifex specialist lizard species (Ctenophorus spinodomus and Ctenotus atlas) with spinifex using a mesocosm experiment. Temperatures were coolest within spinifex compared to bare ground and Lomandra. Invertebrate abundance and the threat of predation were indistinguishable between treatments, suggesting temperature attenuation may be a more important driver. Overall, the dragon C. spinodomus preferred live over dead spinifex, while the skink C. atlas preferred dead spinifex, particularly at warmer air temperatures. However, both species displayed individual variability in their use of available microhabitats, with some individuals rarely using spinifex. Our results provide an example of temperature attenuation by a foundation species driving niche use by ectothermic animals.