Significant Positive Dose-response Relationship Research Articles

Per- and polyfluoroalkyl substances, apolipoproteins and the risk of coronary heart disease in US men and women

BackgroundExisting evidence for associations of per- and polyfluoroalkyl substances (PFASs) with blood lipids, lipoproteins and apolipoproteins (apo), and coronary heart disease (CHD) risk is limited and inconsistent. This study aims to explore associations between plasma PFASs, blood lipoprotein subspecies defined by apolipoproteins, and CHD risk.MethodsA case–control study of CHD was conducted in the Health Professionals Follow-Up Study (HPFS) and Nurses' Health Study (NHS). Among participants initially free of cardiovascular disease at blood collection in 1994 (HPFS) or 1990 (NHS), 101 participants who developed non-fatal myocardial infarction or fatal CHD were identified and confirmed. A healthy control was matched to each case for age, smoking status, and date of blood draw. Plasma levels of perfluorohexane sulfonic acid (PFHxS), perfluorooctanoic acid (PFOA), total perfluorooctane sulfonic acid (PFOS), branched PFOS (brPFOS), linear PFOS (nPFOS), perfluorononanoic acid (PFNA), and perfluorodecanoic acid (PFDA) were measured. Conditional logistic regression and cubic spline regression models were used to examine associations between baseline PFASs and CHD risk. Linear regression models were applied to study PFAS associations with lipids and their subfractions.ResultsAfter multivariate adjustments, total PFOS, brPFOS and nPFOS were significantly associated with increased risk of developing CHD, and HRs (95% CIs) per log(ng/mL) increment of PFASs were 3.66 (1.36–9.89), 3.68 (1.55–8.76), and 3.01 (1.16–7.86), respectively. Significant positive dose–response relationships were identified for these PFASs (Plinearity = 0.01, 0.002, 0.02, respectively). Other PFASs were not associated with CHD risk. PFNA and PFDA were positively associated with total apoE levels among HDL particles with or without apoC-III. No associations were observed for other PFASs with blood lipid subspecies. Blood lipid subfractions did not explain the association between PFOS and CHD risk.ConclusionsPlasma PFOS and its isomers were positively associated with CHD risk. These findings suggest that PFOS exposure causes public health risks that are greater than hitherto believed.

Remnant cholesterol increases the risk of incident kidney stones: a nested case-control study in Chinese adults.

Kidney stones pose a significant healthcare burden worldwide. Dyslipidemia is a risk factor for kidney stones, but the relationship between remnant cholesterol (RC) and kidney stone risk is unknown. We aimed to investigate the association between RC and the risk of incident kidney stones. We conducted a nested case-control study based on data from Shanghai Kidney Stone Cohort conducted in Shanghai from December 2018 to February 2023. Propensity score matching was used to select 2550 incident kidney stone cases and 7650 controls from a total of 60,158 adults. Baseline fasting plasma samples were collected to measure RC, which was calculated as total cholesterol minus high-density lipoproteins cholesterol and low-density lipoproteins cholesterol. Multivariable conditional logistic regression and a restricted cubic spline were used to estimate the association between tertiles of RC and kidney stone risk. Subgroup and sensitivity analyses were also performed. The baseline RC of incident kidney stone cases and controls were 0.58 (0.57) and 0.54 (0.55), respectively. Incident kidney stones had much higher baseline RC levels than controls (P < 0.001). Higher baseline RC levels were significantly associated with increased kidney stone risk after adjustment for potential confounders (highest vs. lowest tertile: OR 1.16, 95% CI 1.04-1.30; per 1 mmol/L increase: OR 1.16, 95% CI 1.07-1.26). Restricted cubic spline showed a significant positive and linear dose-response relationship between RC and the risk of developing kidney stones (P-overall = 0.005, P-nonlinear = 0.482). Sensitivity analyses yielded consistent results. Elevated RC levels are associated with a greater risk of incident kidney stones in Chinese adults.

Fucoidan prevents diabetic cognitive dysfunction via promoting TET2-mediated active DNA demethylation in high-fat diet induced diabetic mice

Diabetic cognitive dysfunction (DCD) refers to cognitive impairment in individuals with diabetes, which is one of the most important comorbidities and complications. Preliminary evidence suggests that consuming sufficient dietary fiber could have benefits for both diabetes and cognitive function. However, the effect and underlying mechanism of dietary fiber on DCD remain unclear. We conducted a cross-sectional analysis using data from NHANES involving 2072 diabetics and indicated a significant positive dose-response relationship between the dietary fiber intake and cognitive performance in diabetics. Furthermore, we observed disrupted cognitive function and neuronal morphology in high-fat diet induced DCD mice, both of which were effectively restored by fucoidan supplementation through alleviating DNA epigenetic metabolic disorders. Moreover, fucoidan supplementation enhanced the levels of short-chain fatty acids (SCFAs) in the cecum of diabetic mice. These SCFAs enhanced TET2 protein stability by activating phosphorylated AMPK and improved TETs activity by reducing the ratio of (succinic acid + fumaric acid)/ α-ketoglutaric acid, subsequently enhancing TET2 function. The positive correlation between dietary fiber intake and cognitive function in diabetics was supported by human and animal studies alike. Importantly, fucoidan can prevent the occurrence of DCD by promoting TET2-mediated active DNA demethylation in the cerebral cortex of diabetic mice.

Association between urinary metals and prostate-specific antigen in aging population with depression: a cross-sectional study

ObjectiveThis study aims to investigate the impact of depression and urinary metals on Prostate-Specific Antigen (PSA).MethodsAnalysis was conducted on 1901 samples collected from the National Health and Nutrition Examination Survey (NHANES) database between 2001 and 2010. Analytical methods included stepwise multiple linear regression (MLR) analysis of the overall population’s urinary metals and PSA relationship, analysis of urinary metals and PSA relationship in older adults and BMI subgroups, analysis of urinary metals and PSA relationship in the depressed population, and restricted cubic spline (RCS) analysis. A significance level of p &amp;lt; 0.05 was considered statistically significant.ResultsIn the stepwise multiple linear regression, beryllium (Be) showed a dose–response association with PSA (third quartile: β = 0.05, 95%CI (0.02, 0.09); fourth quartile: β = 0.07, 95%CI (0.02, 0.12), p trend = 0.048). Subgroup analysis indicated that in individuals aged &amp;gt;60, Be at Q4 level [β = 0.09, 95%CI (0.05, 0.21)] exhibited a dose–response correlation with PSA. In the population with 25 ≤ BMI &amp;lt; 30, Be might more significantly elevate PSA, with Q4 level having a pronounced impact on PSA levels [β = 0.03, 95%CI (0.02, 1.27)]. In the depressed population, urinary cadmium (Cd) levels showed a significant positive dose–response relationship, with Q4 level of Cd having the maximum impact on PSA [β = 0.3, 95%CI (0.09, 0.49)].ConclusionIndividuals exposed to beryllium (Be), especially the older adults and overweight, should monitor their PSA levels. In depressed patients, cadmium (Cd) levels may further elevate PSA levels, necessitating increased monitoring of PSA levels among males.

Potential risk of proton pump inhibitors for Parkinson’s disease: A nationwide nested case-control study

Proton pump inhibitor (PPI) use is a potential risk factor for neurodegenerative disease development; however, its role in Parkinson’s disease (PD) remains unclear. This study aimed to investigate the association between PPI use and PD risk. A total of 31,326 patients with newly diagnosed PD were matches by age, sex, body mass index, diabetes, and hypertension with 125,304 controls at a ratio of 1:4. The data were collected from the Korean National Health Insurance Services Database from January 2010 to December 2019. Cumulative defined daily doses of PPIs were extracted from treatment claims. We examined the association between PPI use and PD risk using conditional logistic regression. To prevent protopathic bias, we excluded patients diagnosed with PD within a 1-year lag period after PPI exposure. We applied 2- and 3-year lag periods for sensitivity analysis. PPI use was associated with an increased risk of PD when a 1-year lag period was applied between PPI exposure and PD development (adjusted odds ratio, 1.10; 95% confidence interval, 1.07–1.13). A significant positive dose-response relationship existed between the cumulative defined daily doses of PPIs and PD development (P&lt;0.001). Similar results were obtained for the 2- or 3-year lag periods. The association did not vary based on gender. Older age, a higher Charlson Comorbidity Index score, no alcohol consumption, and a non-smoking status were associated with a significantly increased PD risk with PPI use. We observed an association between PPI use and PD risk, although long-term follow-up studies are necessary to verify this association.

Religion and survival among European older adults

There are several pathways through which religion can affect longevity. Previous research, predominately from North America, has shown decreased mortality risk for participants that attended religious services. This study aims to examine the association between religion and all-cause mortality in a large sample of older European adults, comparing religious affiliations, and using prayer frequency as well as frequency of participation in a religious organisation as measures of religiousness. To this end, a total of 16,062 participants from the Survey of Health Ageing and Retirement in Europe were employed for a survival analysis (median follow-up 11.3 years; 3790 recorded deaths). Following a religion was negatively associated with mortality regardless of demographic and socioeconomic factors (HR = 0.81; 95% CI 0.74–0.89). Large differences in the median survival of participants from different religious affiliations can be mostly attributed to demographic and socioeconomic factors. Both frequency of prayer and religious participation exhibited a significant positive dose–response relationship with survival despite adjustments, although the results for religious participation were more profound. Changes on the religiosity levels of the European population will require additional research on the subject in the future.

Consumption of Sugar-Sweetened Soft Drinks and Risk of Gastrointestinal Cancer: A Systematic Review and Meta-Analysis of Observational Studies

Introduction: Previous observational studies have reported inconsistent findings on the association between consumption of sugar-sweetened soft drinks (SSSDs) and the risk of gastrointestinal (GI) cancer. This study investigated the associations between SSSD consumption and the risk of GI cancer using a systematic review and meta-analysis. Methods: Observational epidemiological studies were searched from the PubMed and EMBASE databases until June 2021. We conducted a meta-analysis of all included studies and subgroup meta-analyses based on various factors. Results: In a meta-analysis of 27 studies with nine case-control studies and 18 cohort studies, the consumption of SSSDs was modestly associated with an increased risk of GI cancer (odds ratio [OR]/relative risk [RR]: 1.08; 95% confidence interval [CI]: 1.01–1.16), with a significant positive dose-response relationship. In the subgroup meta-analysis by study design, there was a significant positive association between the consumption of SSSDs and GI cancer in cohort studies (RR: 1.11; 95% CI: 1.03–1.20; n = 18), but not in case-control studies. In the subgroup meta-analysis by type of cancer, consumption of SSSDs was significantly associated with an increased risk of colorectal cancer (OR/RR: 1.13; 95% CI: 1.07–1.19). Conclusions: This meta-analysis suggests that SSSD consumption significantly increases the risk of GI cancer, specifically colorectal cancer.

Association of multi-metals with the risk of hypertension and the interaction with obesity: A cross-sectional study in China.

Environmental exposure to multiple metals have been inconsistently associated with hypertension. Obesity is an important independent risk factor for hypertension, and few studies have assessed the interaction between obesity and metals in this context. We aimed to clarify their association and interaction. This cross-sectional study included 3,063 adults from 11 districts or counties, Guangdong. We measured the whole blood levels of 13 metals and used multipollutant-based statistical methods to analyze the association of metals with hypertension. The interaction between metals and obesity on hypertension was assessed on additive and multiplicative scales. Four metals (manganese, arsenic, cadmium, and lead) were significantly associated with hypertension risk, five metals (manganese, zinc, arsenic, cadmium, and lead) were related to elevated SBP levels, five metals (manganese, zinc, selenium, cadmium, and lead) were associated with elevated DBP levels in single-metal model. Manganese remained significantly related to hypertension risk [odds ratio, 1.35 (1.02-1.78)] after adjusting for these four metals. Significant positive dose-response relationships between manganese, arsenic, cadmium, lead and hypertension risk were observed (P for overall < 0.001, P for non-linearity > 0.05). Compared with those in the lowest quartile, participants in the highest manganese quartile had a 2.83 mmHg (95% Cl: 0.71-4.96) (P FDR = 0.040) higher level of SBP. Individuals in the highest quartiles of zinc and lead had a 1.45 mmHg (0.10-2.81) (P FDR = 0.033) and 2.06 mmHg (0.59-3.53) (P FDR = 0.020) higher level of DBP, respectively. The negative interactions between cadmium, lead and obesity influences hypertension risk. BKMR analysis showed a significant joint effect of manganese, arsenic, cadmium and lead on hypertension when the concentrations of four metals were at or above their 55th percentile compared to their median values. The combined effect of four metals (manganese, arsenic, cadmium and lead) were associated with the prevalence of hypertension. Potential interaction effects of cadmium, lead and obesity on hypertension risk may exist. Further cohort studies in larger population are needed to clarify these findings.

Heavy metals and inflammatory, oxidative/antioxidant and DNA damage biomarkers among people living with HIV/AIDS (PLWHA) in Niger Delta, Nigeria

This study evaluated the association of heavy metals (HMs) and effect biomarkers (inflammation, oxidative stress/antioxidant capacity and DNA damage) among people living with HIV/AIDS (PHWHA) in Niger Delta area, Nigeria. Blood levels of lead (BPb), cadmium (BCd), copper (BCu), zinc (BZn), iron (BFe), C-reactive protein (CRP), Interleukin-6 (IL-6), Tumor necrosis factor-α (TNF-α), Interferon-γ (IFN-γ), Malondialdehyde (MDA), Glutathione (GSH) and 8-hydroxy-2-deoxyguanosine (8-OHdG) were determined in a total of 185 participants, 104 HIV-positive and 81 HIV-negative sampled in both Niger Delta and non-Niger Delta regions. BCd (p < 0.001) and BPb (p = 0.139) were higher in HIV-positive subjects compared to HIV-negative controls; on the contrary, BCu, BZn and BFe levels were lower (p < 0.001) in HIV-positive subjects compared to HIV-negative controls. The Niger Delta population had higher levels of heavy metals (p < 0.01) compared to non-Niger Delta residents. CRP and 8-OHdG were higher (p < 0.001) in HIV-positive than in HIV-negative subjects and in Niger-Delta than in non-Niger Delta residents. BCu had significant positive dose-response relationship with CRP (61.9%, p = 0.063) and GSH (1.64%, p = 0.035) levels in HIV-positive subjects, and negative response with MDA levels (26.6%, p < 0.001). Periodic assessment of HMs levels among PLWHA is recommended.

Sedentary Time And Prescription Medication Use In United States Adults: 2017-2018 NHANES

Prescription medication usage has been used as a predictor of disease prevalence and overall health status. Evidence suggests a deleterious relationship exists between increased medication usage and physical activity participation. However, there is limited evidence examining the relationship between sedentary time and increased prescription medication usage in adults. PURPOSE: Examine the associations between sedentary time and increased prescription medication usage in a large nationally representative sample of U.S. adults. METHODS: Study sample (n=3,063) included non-pregnant adult (≥ 20 years old) participants in the 2017-2018 National Health and Nutrition Examination Survey. Self-reported minutes per day of sedentary time were converted to hours per day of sedentary time. The dependent variable was increased medication usage (≥ 5 medications). Logistic regression analysis was adjusted for age, race, and education level. RESULTS: Analysis revealed that for every hour of sedentary time, there was a 5% greater odds of increased medication usage (Odds Ratio 1.05; 95% Confidence Interval 1.01-1.08, P-value=0.0144). A significant positive dose-response relationship was seen between sedentary time and prescription medication use (P for trend <0.0001). CONCLUSIONS: Our findings suggest increased sedentary time is associated with increased prescription medication usage among a large nationally representative sample of U.S. adults.

Finding the Relationship of Smoking and Survival Rate in Oral Submucous Cancer Patients

Introduction: Cancer is a global public health issue, causing approximately 8.8 million deaths per year. According to the World Health Organization (WHO), the countries that suffer most from the disease are low-income and middle-income countries. Objectives: The main objective of the study is to finding the relationship of smoking and survival rate in oral submucous cancer patients. Material and methods: This cross sectional study was conducted in Services Hospital, Lahore during 2021. The data was collected from 204 patients. From this sample socio-demographic data such as age, sex, education, marital status, smoking status, and method of hospital admission were analyzed. Results: The data was collected from 204 patients. Most patients were up to 65-year-old, with no difference in age distribution between the groups. Regarding the type of treatment, nonsmoking patients complied with no treatment, surgery or surgery plus radiotherapy (RT), with RT associated with chemotherapy (CT) being the most common treatment. Conclusion: It is concluded that we found the significant positive dose-response relationship among smokers on clinical outcome in OSCC patients and that non-smokers were worse prognosis than light smokers. In addition, this effect might differ by treatment method.

Urinary polycyclic aromatic hydrocarbon metabolites and depression: a cross-sectional study of the National Health and Nutrition Examination Survey 2005-2016.

The adverse effects of polycyclic aromatic hydrocarbon (PAHs), a group of common environmental pollutants, on mental health are unclear. This study is developed to evaluate the potential association of urinary PAH metabolites with depression in US adults. Measurement of 8 urinary PAH metabolites and assessment of depression were available for 9625 adults in the National Health and Nutritional Examination Survey 2005-2016. Multiple logistic regression models and weighted quantile sum (WQS) regression models were applied to evaluate the association between urinary PAH metabolites and depression. Among 9625 individuals with a weighted geometric mean age of 42.63years, 801 participants suffered from depression. Significant positive dose-response relationships were observed between specific urinary PAH metabolites and the risk of depression after adjusting for potential confounders. Urinary 1-hydroxynaphthalene was positively and dose-dependently associated with the risk of depression among total participants (odds ratio: 1.188; 95% confidence interval: 1.096-1.288). In addition, each 1-unit increase of ln-transformed urinary 1-hydroxynaphthalene, 2-hydroxynaphthalene, 3-hydroxyfluorene, 2-hydroxyfluorene, 1-hydroxyphenanthrene, 2&3-hydroxyphenanthrene, 1-hydroxypyrene, and total PAH metabolites was associated with a 23.3%, 32.6%, 23.3%, 29.4%, 30.8%, 22.8%, 29.4%, and 31.7% increment in the risk of depression in smokers, respectively (all P and P trend < 0.05). Of note, the positive WQS index was also significantly associated with the increased risk of depression in smokers (1.122, 1.059-1.188). Exposure to PAHs may elevate the risk of depression among US adults. More studies are warranted to investigate the underlying mechanism by which PAHs induce the development of depression.

Effects of Alcohol Consumption and Smoking on the Onset of Hypertension in a Long-Term Longitudinal Study in a Male Workers' Cohort.

Aim: To determine the effects of alcohol consumption and smoking on the onset of hypertension in a long-term longitudinal study. Methods: 7511 non-hypertensive male workers were enrolled. This cohort study was performed over an 8-year period using the results of the annual workers-health screening. The end-point was defined as systolic blood pressure ≥ 140 mmHg, diastolic blood pressure ≥ 90 mmHg, or use of antihypertensive drugs. For alcohol consumption, weekly alcohol intake (g ethanol/week) was estimated (1 “gou” = 22 g ethanol). Annual survey data were analyzed by pooled logistic regression that included alcohol consumption, smoking, age, body mass index, job schedule types, habitual exercise, and blood test measurements into the statistical model. Results: A significant positive dose–response relationship between alcohol consumption and onset of hypertension was observed, with synergistic health effects present. Compared with abstainers and nonsmokers, the adjusted odds ratios (95% confidence interval) for the onset of hypertension were: 1.51 (1.27–1.79) for 154 g ethanol/week and nonsmokers, and 1.81 (1.54–2.11) for 154 g ethanol/week and smokers. An interaction between alcohol and smoking was confirmed. Conclusions: This study provided information useful to the prevention of hypertension. By reducing alcohol consumption and smoking simultaneously, the risk of hypertension may be considerably lowered.

Positive Association between Endothelium-Platelet Microparticles and Urinary Concentration of Lead and Cadmium in Adolescents and Young Adults.

(1) Background: In previous research, higher levels of urine heavy metals, especially lead and cadmium, have been associated with increased cardiovascular risk. However, there is no information linking exposure to heavy metal to endothelial and platelet microparticles (EMPs and PMPs), particularly in the younger population, which are novel biomarkers of endothelial dysfunction. (2) Methods: From a nationwide database, which was incepted in 1992–2000, screening for renal health among Taiwanese school children, a total of 789 subjects were recruited. Cross-sectional analysis was performed to evaluate the association between serum EMPs/PMPs and urine iron, nickel, copper, cadmium, lead, chromium, manganese, and zinc levels in the adolescent and young adult population. (3) Results: After we adjusted the conventional cardiovascular risk factors, CD31+/CD42a− and CD31+/CD42a+ counts, in subjects’ serum, respective markers of EMP and PMP displayed a significant positive dose-response relationship with urinary lead and cadmium levels. Higher quartiles of urine lead and cadmium levels were associated with an increased risk of higher EMPs/PMPs (≥75th percentile) in a multivariate logistic regression model. (4) Conclusion: Higher urinary lead and cadmium concentrations are strongly associated with endothelium–platelet microparticles in this adolescent and young adult population, which could help explain, in part, the mechanism through which heavy metal exposure results in cardiotoxicity.

Association of hearing loss with total and cause-specific mortality in US adults.

We expected to explore the associations of hearing loss and hearing thresholds at different frequencies with total and cause-specific mortality. In this study, 11,732 individuals derived from the National Health and Nutrition Examination Survey (NHANES) 1999-2012 were included. Data of death was extracted from the NHANES Public-Use Linked Mortality File through December 31, 2015. Cox proportional hazards models were used to explore the associations between hearing loss, hearing thresholds at different frequencies, and total or cause-specific mortality. A total of 1,253 deaths occurred with a median follow-up of 12.15 years. A significant positive dose-response relationship between hearing loss in speech frequency and total mortality was observed, and the HRs and 95% CIs were 1.16 (0.91, 1.47), 1.54 (1.19, 2.00), and 1.85 (1.36, 2.50), respectively, for mild, moderate, and severe speech-frequency hearing loss (SFHL) with a P trend of 0.0003. In addition, moderate (HR: 1.90, 95% CI: 1.20-3.00) and greater (3.50, 1.38-8.86) SFHL significantly elevated risk of heart disease mortality. Moreover, hearing thresholds of >25 dB at 500, 1000, or 2000 Hz were significantly associated with elevated mortality from all causes (1.40, 1.17-1.68; 1.44, 1.20-1.73; and 1.33, 1.10-1.62, respectively) and heart disease (1.89, 1.08-3.34; 1.95, 1.21-3.16; and 1.89, 1.16-3.09, respectively). Hearing loss is associated with increased risks of total mortality and heart disease mortality, especially for hearing loss at speech frequency. Preventing or inhibiting the pathogenic factors of hearing loss is important for reducing the risk of death.

Blood volatile organic aromatic compounds concentrations across adulthood in relation to total and cause specific mortality: A prospective cohort study

ObjectiveWe aimed to evaluate the relationship between blood volatile organic aromatic compounds (VOACs) across adulthood and mortality. MethodsA total of 16,968 participants from the National health and Nutrition Examination Surveys (NHANES 1988–1994 and 1999–2014) were included in the present study. Cox proportional hazards models were used to explore the associations between VOACs and total or cause-specific mortality. ResultsA total of 1,282 deaths occurred among 16,968 participants with a median follow-up of 8.06 years. We observed significant positive dose-response relationship between VOACs including benzene, ethylbenzene, o-xylene, m-/p-xylene and BEX (the sum of benzene, ethylbenzene, m-/p-and o-xylene concentrations) and total mortality, the multiple adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were 1.24 (1.13, 1.36), 1.15 (1.04, 1.27), 1.10 (1.00, 1.23), 1.09 (1.01, 1.19) and 1.21 (1.08, 1.35), respectively. In addition, all VOACs significantly elevated risk of the mortality from cancer, and benzene was associated with risk of the mortality from heart disease and the HRs and 95% CIs was 1.39 (1.09–1.77). For non-smokers, benzene, ethylbenzene and BEX were associated with elevated risk of total mortality and the mortality from cancer, and benzene was associated with risk of the mortality from heart disease. ConclusionsBlood VOACs are associated with increased risks of total and specific-cause mortality, which are also observed among non-smokers.

Perception and Willingness to Maintain Continuity of Care by Parents of Children with Asthma in Taiwan.

To investigate caregivers’ attitudes toward continuity of care (COC) and their willingness to maintain continuity for their children with asthma under a national health insurance (NHI) system without strict referral management. We sampled 825 individuals from six pediatric outpatient departments in different parts of Taiwan from 2017 to 2018. We used a contingent valuation with a payment card method. Post-stratification weighting adjustment and coarsened exact matching were utilized. Multiple logistic regression was used to compare the willingness to pay and spend extra time maintaining continuity by parents. More than 80% of caregivers in the asthma group believed having a primary pediatrician was important for children’s health. Only 27.5% and 15.8% of caregivers in the asthma and control groups, respectively, believed changing pediatricians would negatively affect therapeutic outcomes. Regression analysis showed that the predicted willingness to pay for the asthma and non-asthma groups were NT$508 (SD = 196) and NT$402 (SD = 172), respectively, and there was a significant positive dose–response relationship between household income and willingness to pay for maintaining health care provider continuity. Caregivers’ free choices among health care providers may reduce willingness to spend extra effort to maintain high COC. Caregivers should be educated on the importance of COC.

Association of Hearing Loss With Total and Specific Cause Mortality Among US Adults: A Prospective Cohort Study

Background: Hearing loss has become an increasingly prevalent disability and has greatly increased the global burden of diseases. However, evidences on the associations between hearing loss and total and cause-specific mortality are limited. Thus, we aimed to investigate the associations of hearing loss with total and cause-specific mortality among US adults. Methods: 11,732 individuals derived from the National Health and Nutrition Examination Survey (NHANES) 1999-2012 were included in this study. Data of death was extracted from the NHANES Public-Use Linked Mortality File through December 31, 2015. Cox proportional hazards models were used to explore the associations between hearing loss and total or cause-specific mortality. A meta-analysis was conducted to summarize the epidemiological evidences on the association of hearing loss with total mortality. Findings: A total of 1,253 deaths occurred with a median follow-up of 12.15 years. Significant positive dose-response relationship between hearing loss in speech frequency and total mortality was observed, and the HRs and 95% CIs were 1.16 (0.91, 1.47), 1.54 (1.19, 2.00) and 1.85 (1.36, 2.50), respectively for mild, moderate and severe speech-frequency hearing loss (SFHL) with a Ptrend of 0.0003. In addition, moderate (HR: 1.90, 95%CI: 1.20-3.00) and greater (3.50, 1.38-8.86) SFHL significantly elevated risk of heart diseases mortality. With regard to the frequency, hearing thresholds of >25 dB at 500, 1000, or 2000 Hz were significantly associated with elevated mortality from all causes (1.40, 1.17-1.68; 1.44, 1.20-1.73; and 1.33, 1.10-1.62, respectively) and heart diseases (1.89, 1.08-3.34; 1.95, 1.21-3.16; and 1.89, 1.16-3.09, respectively). The meta-analysis further revealed the positive association between hearing loss and total mortality (pooled HR: 1.33, 95%CI: 1.11-1.60). Interpretation: Hearing loss is associated with increased risks of total mortality and heart diseases mortality, especially for hearing loss at speech frequency. Funding Statement: National Natural Science Foundation of China (81903291). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The NHANES protocol was approved by the NCHS Ethics Review Board and written informed consent was obtained from all participants.

Giardiasis notifications are associated with socioeconomic status in Sydney, Australia: a spatial analysis

ObjectiveIn developed countries prolonged symptoms due to, or following, Giardia intestinalis infection can have a significant impact on the quality of life. In this research, we investigate the presence of a socioeconomic status (SES) gradient in the reporting of giardiasis in South West Sydney Local Health District (SWSLHD), New South Wales (NSW), Australia, across geographic scales. MethodsWe used a large database, spatial‐cluster analysis and a linear model. ResultsFirstly, we found one spatial cluster of giardiasis in one of the most advantaged neighbourhoods of SWSLHD. Secondly, rates of giardiasis notifications were significantly and consistently lower in SWSLHD compared to an unnamed advantaged Local Health District and NSW over multiple years. Finally, we found an overall significant positive dose–response relationship between counts of giardiasis and area‐level SES. ConclusionsLower reporting in disadvantaged areas may represent true differences in incidence across SES groups or may result from differential use of health services and reporting. Implications for public healthIf the disparities result from differential use of health services, research should be directed toward identifying barriers and facilitators of use. If disparities result from a true difference in incidence, then the behavioural mediators between SES and giardiasis should be identified and addressed.

Mobile phone use and body weight: evidence from the UK COSMOS and UK Biobank cohort studies

Background/Aim: Television viewing and computer use has been associated with obesity due to the sedentary time associated with these activities. Mobile phone technology would not necessarily predict sedentary behaviour and thus obesity in the same way. However, literature on mobile phone use and weight is limited to a few studies in adolescents with inconsistent findings.Methods: This analysis included 81,113 and 330,285 adults from the UK COSMOS and UK Biobank cohorts respectively. Multiple linear and logistic regression were used to explore the association between weight outcomes (BMI, weight, obesity) and mobile phone use frequency (calls/day), duration (min/week) and lifetime mobile phone use (years), with adjustment for potential confounders. Analyses of UK Biobank were enhanced with the addition of genetic risk scores for BMI, sleep and personality traits, to investigate potential effect modification. Longitudinal analyses of UK COSMOS are ongoing.Results: Cross-sectional analyses revealed statistically significant positive dose-response relationships between increasing mobile phone use and increasing body weight, BMI, and odds of obesity in both populations independently. For example, after adjustment, spending ≥7 hrs per week on mobile phone calls was associated with mean difference in body weight of 2.1 kg (95% CI 1.7, 2.5) and 2.4 kg (95% CI 2.1, 2.6), for UK COSMOS and UK Biobank participants respectively, compared to those who spend 5-29 mins per week making calls. Longitudinal analyses from the UK COSMOS study will be presented.Conclusion: We found a novel association between mobile phone use and body weight. Further research with longitudinal data is essential to explore the direction of these relationships. However, given the widespread use of mobile phones by adults and children, and public health concerns regarding obesity, mobile phone use might be an important lifestyle factor that can be modified to help reduce obesity on a population level.