Periodontitis and osteoporosis: a two-sample Mendelian randomization analysis

Abstract The incidences of periodontitis and osteoporosis are rising worldwide. Observational studies have shown that periodontitis is associated with increased risk of osteoporosis. We performed a Mendelian randomization (MR) study to genetically investigate the causality of periodontitis on osteoporosis. We explored the causal effect of periodontitis on osteoporosis by MR analysis. A total of 9 single nucleotide polymorphisms (SNP) were related to periodontitis. The primary approach in this MR analysis was the inverse variance-weighted (IVW) method. Simple median, weighted median, and penalized weighted median were used to analyze sensitivity. The fixed-effect IVW model and random-effect IVW model showed no significant causal effect of genetically predicted periodontitis on the risk of osteoporosis (OR=1.032; 95%CI: 0.923-1.153; P=0.574; OR=1.032; 95%CI: 0.920-1.158; P=0.588, respectively). Similar results were observed in simple mode (OR=1.031; 95%CI: 0.780-1.361, P=0.835), weighted mode (OR=1.120; 95%CI: 0.944-1.328, P=0.229), simple median (OR=1.003; 95%CI: 0.839-1.197, P=0.977), weighted median (OR=1.078; 95%CI: 0.921-1.262, P=0.346), penalized weight median (OR 1.078; 95%CI: 0.919-1.264, P=0.351), and MR-Egger method (OR=1.360; 95%CI: 0.998-1.853, P=0.092). There was no heterogeneity in the IVW and MR-Egger analyses (Q=7.454, P=0.489 and Q=3.901, P=0.791, respectively). MR-Egger regression revealed no evidence of a pleiotropic influence through genetic variants (intercept: -0.004; P=0.101). The leave-one-out sensitivity analysis indicated no driven influence of any individual SNP on the association between periodontitis and osteoporosis. The Mendelian randomization analysis did not show a significant detrimental effect of periodontitis on the risk of osteoporosis.

Bidirectional casual effects between periodontitis and Sjögren's syndrome: a Mendelian randomization study / 口腔疾病防治

Objective@#To evaluate the bidirectional association between periodontitis and Sjögren's syndrome using the Mendelian randomization (MR) method.@*Methods@#Genome-wide association study (GWAS) data of periodontitis (N = 45 563) and Sjögren's syndrome (N = 214 435) were selected to meet the requirements of the same ethnicity and different regions. Inverse variance-weighted (IVW), MR-Egger, and weighted median (WM) tests were used to evaluate the causal effect. Cochran's Q statistics, MR-Egger intercept, MR-PRESSO and leave-one-out analysis were used as sensitivity analyses to assess the stability and reliability of the results.@*Results@#After screening, the GWAS data of Sjögren's syndrome were based on the Finnish region, and the periodontitis GWAS data were based on the UK region, both of which originated from European ancestry. Using IVW (OR = 1.017, 95% CI = 0.956-1.082), MR-Egger (OR = 0.985, 95% CI= 0.956-1.082), and WM (OR =1.021, 95% CI = 0.948-1.099), no causal effect of Sjögren's syndrome on periodontitis was found using any of the three methods. Conversely, no causal effect of periodontitis on Sjögren's syndrome was found (IVW, OR = 1.024, 95% CI = 0.852-1.230; MR-Egger, OR = 0.978, 95% CI = 0.789-1.212; WM, OR = 1.024, 95% CI = 0.846-1.260). The sensitivity analyses indicated that the results were stable and reliable. Cochran's Q test and MR-PRESSO revealed that there was no significant heterogeneity among the instrumental variables, which included single nucleotide polymorphisms (SNPs). The intercept of MR-Egger regression indicated no pleiotropy in the included SNPs. No individual SNP was found that significantly affected the results using the leave-one-out method.@*Conclusion@#This study does not support a bidirectional causal effect between periodontitis and Sjögren's syndrome.

Applications and advancements of instrumental variable approach in causal inference in environmental epidemiology / 环境与职业医学

In environmental epidemiological research, extensive non-random environmental exposures and complex confounding biases pose significant challenges when attempting causal inference. In recent years, the introduction of causal inference methods into observational studies has provided a broader range of statistical tools for causal inference research in environmental epidemiology. The instrumental variable (IV) approach, as a causal inference technique for effectively controlling unmeasured confounding factors, has gradually found application in the field of environmental epidemiological research. This article reviewed the basic principles of IV and summarized the current research progress and limitations of applying IV for causal inference in environmental epidemiology. IV application in the field of environmental epidemiology is still in the initial stage. Rational use of IV and effective integration with other causal inference methods will become the focus of the development of causal inference in environmental epidemiology. The aim of this paper is to provide a methodological reference and basis for future studies involving causal inference to target population health effects of environmental exposures in China.

Psychometric Properties of the Causal Attributions Scale for Reading Comprehension / Propiedades psicométricas de la Escala de Atribuciones Causales para la Comprensión Lectora / Propriedades psicométricas da Escala Atribuições de Causas para a Compreensão de Leitura

Causal attributions, achievement goals, and self-efficacy comprise the motivational dimension of self-regulated learning. Due to the absence of scales to assess the causal attributions of Brazilian middle school students, this study aimed to investigate the psychometric properties of the Causal Attributions Scale for Reading Com-prehension. The study involved three samples: one of the expert judges and two composed of students. Evidence of content validity was found through theo-retical and practical representativeness and the intel-ligibility of the scale items. The associations between the attributional causes and psychological dimensions proved validity based on the scale's internal structure. The effects identified in the comparisons between the scale and achievement goals, and the scale and self-efficacy indicated validity based on the relationship with other variables. This instrument can be recom-mended for use by professionals in psychology and education. We also suggest the performance of further studies with the scale.

Las atribuciones causales, los objetivos de logro y la autoeficacia constituyen la dimensión motivacional del aprendizaje autorregulado. Debido a la ausencia de escalas para evaluar las atribuciones causales de estudiantes brasileños de enseñanza fundamental, en este estudio investigamos las propiedades psicométricas de la Escala de Atribuciones Causales para la Comprensión Lectora. Este análisis involucró tres muestras: una de jueces expertos y dos formadas por estudiantes. Se encontró evidencia de validez de contenido a través de la representatividad teórica y práctica, y por medio de la inteligibilidad de los ítems de la escala. Los resultados de las asociaciones entre las causas atribucionales y las dimensiones psicológicas proporcionaron evidencia de validez basada en la estructura interna. Los efectos identificados en las comparaciones entre la escala y metas de logro, y la escala y autoeficacia, indicaron evidencia de validez basada en la relación con otras variables. Este instrumento puede ser recomendado para su uso por profesionales en psicología y educación. También se sugiere la realización de más estudios con la escala

Atribuições causais, metas de realização e autoeficácia constituem a dimensão motivacional da aprendizagem autorregulada. Devido à ausência de escalas para avaliar as atribuições causais de estudantes brasileiros do ensino fundamental, neste estudo investigamos as propriedades psicométricas da Escala Atribuições de Causas para a Compreensão de Leitura. Este estudo envolveu três amostras: uma amostra de juízes especialistas e duas amostras compostas por estudantes. Encontrouse evidência de validade de conteúdo através da represen-tatividade teórica e prática e por meio da inteligibilidade dos itens da escala. Os resultados das associações entre as causas atribuídas e as dimensões psicológicas forneceram evidências de validade com base na estru-tura interna. Os efeitos identificados nas comparações entre a escala e os objetivos de realização, e a escala e autoeficácia indicaram evidências de validade com base na relação com outras variáveis. Recomendamos que este instrumento seja utilizado por profissionais da psicologia e da educação. Outros estudos com a escala também são sugeridos.

Genetically predicted insomnia causally increases the risk of erectile dysfunction / 亚洲男科学杂志(英文版)

Sleep has attracted extensive attention due to its significance in health. However, its association with erectile dysfunction (ED) is insufficiently investigated. To investigate the potential causal links between sleep traits (insomnia, sleep duration, and chronotype) and ED, this study was performed. The single-nucleotide polymorphisms (SNPs) associated with insomnia, sleep duration, and chronotype were retrieved from previous genome-wide association studies (GWAS). A conventional two-sample Mendelian randomization (MR) was used to estimate the causal links between sleep traits and ED. The summary statistics of ED were from individuals of European ancestry (6175 cases vs 217 630 controls). As shown by the random effect inverse-variance-weighting (IVW) estimator, genetically predicted insomnia was causally associated with a 1.15-fold risk of ED (95% confidence interval: 1.07-1.23, P < 0.001). Sleep duration and morningness were not causally associated with ED, as indicated by the IVW (all P > 0.05). These findings were consistent with the results of sensitivity analyses. Based on genetic data, this study provides causal evidence that genetically predicted insomnia increases the risk of ED, whereas sleep duration and chronotype do not.

Association of ticagrelor with risk of infection：a two-sample Mendelian randomization study based on the GWAS database / 中国药房

OBJECTIVE To investigate the causal association between ticagrelor and risk of infection METHODS Two-sample Mendelian randomization was adopted. Genetic instrumental variables were selected based on the results of the largest genome-wide association analysis to in vivo exposure of ticagrelor and its major active metabolite AR-C124910XX. The causal associations of ticagrelor and its major active metabolite AR-C124910XX with drug indications （coronary artery disease， unstable angina pectoris， myocardial infarction， stroke and ischemic stroke）were analyzed by inverse variance weighted Mendelian randomization model as a positive control for genetic instrumental variables. The causal relationship between ticagrelor and bacterial infection， acute lower respiratory infection， bacterial pneumoniae， pneumoniae，acute upper respiratory infection and sepsis were furtheranalyzed by using this method， and the robustness of the results was assessed by using heterogeneity tests and horizontal 202002030415） pleiotropy tests. RESULTS The increase of area under the curve at steady state （AUCss） of the genetic surrogated ticagrelor significantly reduced the risk of coronary artery disease， myocardial infarction and unstable angina pectoris （P＜0.001）. AUCss genetic instrument variables of its main active metabolite AR-C124910XX failed to pass positive control. Further analysis showed that the increase of the genetic surrogated ticagrelor exposure suggestively reduced the risk of bacterial infection [OR（95%CI）＝0.80（0.65，0.99），P＝0.040] and sepsis [OR （95%CI）＝0.84（0.73， 0.98）， P＝0.023]. The results of the heterogeneity tests showed that there was no heterogeneity in the causal association of the genetic surrogated ticagrelor AUCss with bacterial infection and sepsis （P＞0.05）. The results of horizontal pleiotropy tests showed that the causal association of genetic surrogated ticagrelor AUCss with bacterial infection and sepsis had no effects on horizontal pleiotropy （P＞0.05）. CONCLUSIONS Ticagrelor has a potential role in reducing the risk of sepsis and bacterial infections.

Causal Relationship Between Acromegaly and Colon Cancer: A Two-sample Mendelian Randomization Study / 肿瘤防治研究

Objective To determine the causal relationship between acromegaly and colon cancer by using two-sample Mendelian randomization. Methods Genetic loci closely related to acromegaly in the whole genome-wide association study (GWAS) were selected as tool variables, and the genetic data of colon cancer from different GWASs were analyzed by two-sample Mendelian randomization (MR).The inverse variance weighting method (IVW) of the random effect model was used for analysis, and MR-weighted median and MR-Egger methods were used to supplement the analysis. Results were presented as OR values. Results Four SNPs closely related to acromegaly were obtained as tool variables, and the multiplicity test of tool variables showed that P=0.59.Three methods were used to estimate causal effects.The IVW analysis were OR=1.00(0.99-1.001) and P=0.42;the MR-Egger analysis results were OR=1.00(0.99-1.001) and P=0.42;and the Weighted median analysis results were OR=1.00(1.00-1.001) and P=0.03.The sensitivity test showed that the confidence interval of the tool variable SNP passed through 0, indicating the robustness of the MR results. Conclusion Acromegaly is not an independent risk factor for colon cancer.

A mendelian randomization study of the causal association between gastroesophageal reflux and atrial fibrillation / 公共卫生与预防医学

Objective In this study，we performed two sampie Mendelian Randomization to infer a causal association between Gastroesophageal reflux(GERD) and Atrial fibrillation(AF)，it can effectively avoid the problems such as reverse causation and confounds in traditional epidemiology. Methods We used the Summary data of GERD and AF from published Genome wide association study(GWAS) of European Individuals. Single Nucleotide Polymorphisms (SNPs) were extracted as Instrumental Variables (IVs).The main MR methods include Inverse Variance [] Weighted(IVW)，Weighted Median(WME)，MR-Egger，Simple Mode，and Weighted Mode.In addition，we used the sensitivity analysis such as MR-PRESSO，Cochran's Q test etc. Results The IVW shows a causal association between GERD and AF(P<0.0001，OR=1.16，95%CI:1.10-1.23).The WME shows P＜0.0001，OR=1.20，95%CI:1.11-1.30；Simple Mode shows P=0.01，OR=1.34，95%CI:1.07-1.69；Weighted Mode shows P=0.02，OR=1.33，95%CI:1.06-1.66. Conclusion This study based on genetic data supports the causal association between GERD and AF. The occurrence of GERD could increase the risk of AF.

Association between Crohn's disease and frailty: a bidirectional Mendelian randomization study / 预防医学

Objective @#o evaluate the association between Crohn's disease (CD) and frailty using a Mendelian randomization (MR) approach, so as to provide the evidence for prevention and control strategies.@*Methods@#Genetic association data for CD were collected through the International Inflammatory Bowel Disease Genetics Consortium, with 20 883 samples and 12 276 506 single nucleotide polymorphism (SNP), and genetic association data for frailty were collected through a meta-analysis including 175 226 samples and 7 589 717 SNPs. A forward MR analysis was performed using the inverse-variance weighted (IVW) method with 37 CD-associated SNPs as instrumental variables, and frailty as the study outcome, and a reverse MR analysis was performed with 13 frailty-associated SNPs as instrumental variables and CD as the study outcome. The heterogeneity was assessed using the Cochran's Q test, and the horizontal pleiotropy was assessed using the MR-PRESSO global test and MR-Egger regression. In addition, the robustness of the results was verified with the leave-one-out. @*Results@#Forward MR analysis results showed that patients with genetically predicted CD had an increased risk of frailty index relative to those without CD (β=0.018, 95%CI: 0.011-0.026, P<0.05). Cochran's Q test detected no heterogeneity (P>0.05), and neither the MR-PRESSO test nor the MR-Egger regression revealed horizontal pleiotropy of instrumental variables (both P>0.05). Leave-one-out analysis showed robustness of the MR analysis results. Reverse MR analysis showed no association between frailty index and the risk of CD (OR=0.740, 95%CI: 0.206-2.661, P>0.05). @*Conclusions@#Genetically predicted CD is associated with an increased risk of frailty. It is suggested that screening and prevention of frailty should be reinforced among CD patients.

Analysis of causes and prevention of ankle injuries in college basketball / Análise das causas e prevenção contra lesões no tornozelo no basquetebol universitário / Análisis de las causas y la prevención de las lesiones de tobillo en el baloncesto universitario

ABSTRACT Introduction: Basketball is a combative sport, very popular among college students. However, it requires many periods of running, interspersed with emergency breaks, tackling, and other actions prone to ankle injuries. Objective: Investigate the causes of ankle joint injuries in college basketball, raising countermeasures to prevent these sports injuries. Methods: 413 college students who regularly participate in basketball games at 10 colleges and universities were selected as research objects. The causes of ankle joint injuries in the process of this sport were investigated through questionnaires, and the main causes of injuries were analyzed using statistical methods. Results: The causes of ankle joint injuries in college basketball include subjective and objective factors. Subjective factors include inadequate psychological preparation, warm-up exercise, cushioning, and excessive exercise, among others listed; objective factors mainly contemplate local injury and accidental injury. Conclusion: The participation of college students in basketball is beneficial to improve their physical health, requiring effective measures to prevent possible ankle injuries, both related to subjective and objective aspects. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução: o basquetebol é uma modalidade esportiva combativa, muito popular entre os universitários. No entanto, necessita de muitos períodos de corrida, intercalados por pausas emergenciais, enfrentamentos e outras ações propensas a lesões no tornozelo. Objetivo: Investigar as causas de lesões nas articulações do tornozelo no basquetebol universitário, levantando contramedidas para prevenir essas lesões desportivas. Métodos: O total de 413 estudantes universitários que participam regularmente em jogos de basquetebol em 10 faculdades e universidades foram selecionados como objetos de pesquisa. As causas das lesões nas articulações do tornozelo no processo desse esporte foram investigadas através de questionários, sendo analisadas as principais causas das lesões através de métodos estatísticos. Resultados: as causas das lesões nas articulações do tornozelo dentro do basquetebol universitário incluem principalmente fatores subjetivos e objetivos. Os fatores subjetivos incluem a preparação psicológica inadequada, o exercício de aquecimento inadequado, o amortecimento inadequado, o exercício excessivo, entre outros listados; os fatores objetivos contemplam principalmente a lesão local e a lesão acidental. Conclusão: A participação dos estudantes universitários no basquetebol é benéfica para melhorar a sua saúde física, requerendo medidas eficazes para prevenir possíveis lesões no tornozelo, tanto as relacionadas aos aspectos subjetivos como objetivos. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción: El baloncesto es una modalidad deportiva combativa, muy popular entre los estudiantes universitarios. Sin embargo, requiere muchos periodos de carrera, intercalados con pausas de emergencia, enfrentamientos y otras acciones propensas a las lesiones de tobillo. Objetivo: Investigar las causas de las lesiones de la articulación del tobillo en el baloncesto universitario, planteando contramedidas para prevenir estas lesiones deportivas. Métodos: Se seleccionaron como objeto de investigación un total de 413 estudiantes universitarios que participaban regularmente en partidos de baloncesto en 10 colegios y universidades. Las causas de las lesiones de la articulación del tobillo en el proceso de este deporte se investigaron mediante cuestionarios, y las principales causas de las lesiones se analizaron mediante métodos estadísticos. Resultados: Las causas de las lesiones de la articulación del tobillo en el baloncesto universitario incluyen principalmente factores subjetivos y objetivos. Los factores subjetivos incluyen una preparación psicológica inadecuada, un ejercicio de calentamiento inadecuado, una amortiguación inadecuada, un ejercicio excesivo, entre otros enumerados; los factores objetivos contemplan principalmente la lesión local y la lesión accidental. Conclusión: La participación de los estudiantes universitarios en el baloncesto es beneficiosa para mejorar su salud física, requiriendo medidas eficaces para prevenir posibles lesiones de tobillo, tanto las relacionadas con aspectos subjetivos como objetivos. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Complicaciones quirúrgicas infecciosas en adultos mayores tras cirugía abdominal de urgencia

Introducción: En la actualidad el aumento de la población envejecida, asociado al desarrollo de la anestesiología, la cirugía y los cuidados intensivos ha generado un incremento del número de adultos mayores con abdomen agudo, que requieren tratamiento quirúrgico con urgencia, no exentos de complicaciones. Se realizó una revisión en bases de datos bibliográficas y se seleccionaron 25 documentos en idioma inglés y español. Objetivo: Analizar las características esenciales que identifican a los pacientes adultos mayores con complicaciones quirúrgicas infecciosas tras cirugía abdominal de urgencia. Desarrollo: En el plano biológico suceden cambios por reducción de la reserva fisiológica del adulto mayor: respiratorios, cardiovasculares, genitourinarios, digestivos, endocrino-metabólicos y del equilibrio ácido-base, que los hacen vulnerables al estrés quirúrgico. Las complicaciones posoperatorias constituyen un importante indicador de calidad: retardan la evolución de la enfermedad, prolongan la estadía hospitalaria e incrementan los índices de morbilidad y mortalidad de modo significativo en enfermos de este grupo etario. Conclusiones: A pesar del aumento del número de adultos mayores con abdomen agudo que requieren tratamiento quirúrgico con urgencia, la edad no debe considerarse como una limitante para efectuar la operación. Además del tratamiento específico y preventivo de las complicaciones tras cirugía abdominal de urgencia, las comorbilidades y la fragilidad presentes en estos pacientes requieren adecuada compensación preoperatoria, operatoria y posoperatoria, a fin de garantizar la evolución satisfactoria de estos enfermos.

Introduction: Currently, the increase in the aging population associated with the development of anesthesiology, surgery and intensive care has generated an increase in the number of older adults with acute abdomen requiring urgent surgical treatment. A review was carried out in bibliographic databases, and 25 documents were selected in English and Spanish. Objective: To analyze the clinical, epidemiological and therapeutic characteristics that identify older adult patients with infectious surgical complications after emergency abdominal surgery. Development: At the biological level, changes occur due to the reduction of the physiological reserve of the elderly: respiratory, cardiovascular, genitourinary, digestive, endocrine-metabolic and acid-base balance that makes them vulnerable to surgical stress. Postoperative complications are an important indicator of quality: they delay the evolution of the disease, prolong hospital stay and significantly increase morbidity and mortality rates in patients of this age group. Conclusions: Despite the increase in the number of older adults with acute abdomen who require urgent surgical treatment, age should not be considered as a limitation to perform the operation. In addition to the specific and preventive treatment of complications after emergency abdominal surgery, the comorbidities and frailty present in these patients require adequate preoperative, operative and postoperative compensation, in order to guarantee the satisfactory evolution of these patients.

Atribuciones sobre las causas de la pobreza general e infantil en Argentina / Attributions on the causes of general and child poverty in Argentina

Resumen El estudio acerca de las causas de la pobreza ha sido influenciado por la teoría de la atribución, lo que permitió identificar los juicios predominantes que las personas establecen sobre tales causas. Los estudios locales sobre las atribuciones causales de la pobreza son escasos y no se ha identificado ninguno referido a las causas de la pobreza infantil, a pesar de las altas tasas de su incidencia en el país. Así, el presente estudio propone evaluar las atribuciones causales de la pobreza general e infantil por parte de adultos de Argentina, empleando dos cuestionarios (uno sobre las causas de la pobreza en general y el otro sobre la pobreza infantil en particular) implementados de manera virtual. La muestra incluyó a 1 659 participantes (17 a 90 años), quienes debieron indicar la importancia de cada ítem como causa de la pobreza en una escala tipo Likert de cinco puntos. En cuanto al cuestionario sobre las causas de la pobreza general, el análisis exploratorio permitió identificar una estructura de tres factores -similar a la identificada en otros estudios: individualista, estructurales y fatalistas-, la cual no fue verificada en el análisis confirmatorio. Con respecto al cuestionario sobre las causas de la pobreza infantil, se identificó y se confirmó un modelo de dos factores (que podrían estar relacionados con atribuciones estructurales y familiares) que representa una nueva evidencia en el campo. Los resultados sugieren diferencias en las atribuciones de las causas de pobreza general e infantil, cuyos posibles mecanismos (e. g., modulación por parte de factores individuales, contextuales y culturales) deberían explorarse en estudios futuros.

Abstract In the last decades, different studies have addressed the perspectives of people regarding the causes of poverty, as they could play a fundamental role in the development of individual and social attitudes, beliefs and expectations towards people living in such a condition, and in the strategies implemented to solve related problems and issues. In addition, many of those studies have investigated the causes of poverty using the theoretical model proposed by Feagin (1972), which suggests three broad explanations: (1) individualistic (i. e., causal attribution is placed on the poor themselves); (2) structural (i. e., poverty is due to external social and economic factors); and (3) fatalistic (i. e., poverty is attributed to factors such as bad luck). Most of those studies have been carried out considering the causes of poverty in general, which means that there is very little research aimed at studying specifically the causes of child poverty. Given the high incidence of poverty in Argentina the knowledge about such perspectives is of interest for multiple basic and applied purposes. In this sense, the present study proposed to evaluate the attributions of the causes of poverty in general and child poverty in particular, by adults from Argentina, through two virtual questionnaires (one asking for the causes of poverty in general, and the other for the causes of child poverty). The sample included responses from 1 659 citizens of Argentina from 17 to 90 years old (M = 45.72, SD = 16.94). The questionnaires included 32 items aimed at evaluating the attribution of causes of general poverty, and 30 items related to child poverty. Participants were asked to indicate the importance of each item as a cause of poverty on a five-point Likert-type scale (1 = does not matter; 5 = extremely important). Exploratory and confirmatory factor analyses were implemented (separately from the general and child questionnaires) and retained items with factor loadings at .40 or above. In addition, for the general questionnaire, a second approach was implemented to analyze if the factorial structure supported by different studies in the literature was confirmed in this sample. For such a purpose, confirmatory factor analyses were implemented. Regarding the questionnaire for the causes of general poverty, the exploratory analysis allowed identifying a three-factor structure (as in the case of other studies) (RMSEA = .071; CFI = .94; TLI = .93), which was not verified in the confirmatory analysis (RMSEA = .103; CFI = .88; TLI = .86). On the other hand, the results of the second approach suggest the confirmation of the two-factor model proposed in the literature (RMSEA = .083; CFI = .96; TLI = .95). This pattern of results suggests sensitivity to the inclusion of new items. In this sense, in future studies it would be important to invest efforts in determining new items from consultations with experts and other social actors. Regarding the questionnaire for the causes of poverty in children, two-factor model was identified and confirmed (RMSEA = .074; CFI = .94; TLI = .93), which is a new piece of evidence in the field, suggesting variability in the attribution of causes of poverty according to the considered age group, and whose potential mechanisms in comparison with the studies on adult poverty should be explored in future research (e. g., individual, contextual and cultural factors). Finally, this study confirms that having valid and reliable instruments to explore the causal attributions of general and child poverty would be important to advance in the understanding of poverty as a complex and multidimensional phenomenon.

Psicopatología como red causal compleja de síntomas interactivos / Psychopathology as a complex network of causally interacting symptoms

Resumen El modelo de la psicopatología como red de síntomas propone centrarse en las interacciones dinámicas y causales entre los síntomas constitutivos del problema clínico. La idea principal es que la activación de un síntoma clínico lleva a la activación de otro síntoma vecino. Las conexiones entre ellos pueden ser biológicas, psicológicas o sociales. Los trastornos mentales son concebidos como estados estables alternativos de redes de síntomas fuertemente conectados. Esto permite un modelo explicativo común para todos los trastornos mentales, un modelo integral de psicopatología. A pesar del éxito de este nuevo camino metodológico, la mayoría de la información relevante se encuentra publicada en inglés. En este artículo, se presenta, en idioma español, la teoría de la psicopatología como red de síntomas y su modelo, su relevancia para la investigación, docencia y práctica clínica de la psicología y la psiquiatría, a los fines de incrementar su difusión y diseminación.

Abstract Over the past years, psychopathology has frequently been represented as a complex system, where psychiatric symptoms are causally interconnected in a network architecture. The network theory of psychopathology has led to more than 300 novel publications, academic courses, methodology for estimating novel models, and freely available software. However, despite the success of this novel research avenue, all relevant information has mostly been published in English. This paper translates the network theory of psychopathology and its model, together with its relevance for research and clinical practice of psychology and psychiatry, to the Spanish language. To serve the dissemination of this theory, this paper serves as an introductory paper for Spanish scholars, for example, as a starting point to learn more about the approach or for academic courses. The main idea of the network theory of psychopathology is that the activation of one clinical symptom in the network leads to the activation of a neighboring symptom. If symptoms are strongly connected with each other, for example, excessive worry and insomnia, they are more likely to be in the same state, meaning that if a person faces a stressful life event such as losing one's job, the activation of the symptom excessive worry will increase the probability they will also suffer from insomnia. In this way, a whole symptom activation pattern develops from which mental disorders emerge. Mental disorders are conceived as stable states of strongly connected symptom networks, allowing for a common explanatory model for multiple mental disorders, thereby providing a comprehensive model of psychopathology. Traditional representations of mental disorders conceptualize symptoms as merely passive indicators of latent, underlying mental disorders which act as common causes for patients' symptomatology. The network theory of psychopathology flips the explanatory and statistical model: instead of focusing on one underlying cause or underlying causes, it proposes to study the direct interactions between these symptoms. This imposes two important implications for the conceptualization of mental disorders. First, symptoms are no longer statistically exchangeable since every symptom can have a different role in the onset and development of psychopathology. Some symptoms can be more important than others in keeping the whole system "stuck" in a disordered state. Second, comorbidity is conceptualized as clustering symptoms which are connected to each other via certain "bridge symptoms". Bridge symptoms are symptoms which are attributed to two (or more) mental disorders, such as Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD). If a person suffers from symptoms of MDD, such as loss of motivation and depressed mood, this can lead to the activation of bridge symptoms such as fatigue and concentration problems, which by themselves lead to the activation of GAD symptoms such as irritability and excessive worry.

Association of C-reactive Protein with Cardiovascular Outcomes: A Mendelian Randomization Study in the Japanese Population / 生物医学与环境科学（英文）

OBJECTIVE@#Traditional epidemiological studies have shown that C-reactive protein (CRP) is associated with the risk of cardiovascular diseases (CVDs). However, whether this association is causal remains unclear. Therefore, Mendelian randomization (MR) was used to explore the causal relationship of CRP with cardiovascular outcomes including ischemic stroke, atrial fibrillation, arrhythmia and congestive heart failure.@*METHODS@#We performed two-sample MR by using summary-level data obtained from Japanese Encyclopedia of Genetic association by Riken (JENGER), and we selected four single-nucleotide polymorphisms associated with CRP level as instrumental variables. MR estimates were calculated with the inverse-variance weighted (IVW), penalized weighted median and weighted median. MR-Egger regression was used to explore pleiotropy.@*RESULTS@#No significant causal association of genetically determined CRP level with ischemic stroke, atrial fibrillation or arrhythmia was found with all four MR methods (all Ps > 0.05). The IVW method indicated suggestive evidence of a causal association between CRP and congestive heart failure ( OR: 1.337, 95% CI: 1.005-1.780, P = 0.046), whereas the other three methods did not. No clear pleiotropy or heterogeneity were observed.@*CONCLUSIONS@#Suggestive evidence was found only in analysis of congestive heart failure; therefore, further studies are necessary. Furthermore, no causal association was found between CRP and the other three cardiovascular outcomes.

Applying the adjustment set to estimate causal effect of data based on the causal graph model / 四川精神卫生

The purpose of this paper was to introduce the five limitations of the PROC CAUSALGRAPH procedure and estimate the causal effect of the data by using the adjustment set based on the causal graph model. The five limitations were as follows： ①the PROC CAUSALGRAPH procedure could not deal with the causal graph model of directed circles； ② the PROC CAUSALGRAPH procedure could not evaluate dynamic processing scheme； ③ causal effect identification was a population concept； ④ causal effect identification was a nonparametric concept； ⑤ the PROC CAUSALGRAPH procedure could not identify the causal effect in some causal graph models. The example was for a simulated data set， using the conventional multiple Logistic regression model analysis and the causal graph model analysis， respectively. By comparing the analysis results of the two， the following conclusions were drawn： ① causal graph theory was useful in identifying causal effects in confounding situations； ② by implementing hierarchical estimation of causal effects， a good statistical estimation of causal effects could be achieved based on the identification results of the PROC CAUSALGRAPH procedure.

Identifying causal effects based on instrumental variables and distinguishing different models with data / 四川精神卫生

The purpose of this paper was to introduce the methods of identifying causal effects based on instrumental variables， distinguishing different models with data， and using SAS software to realize calculation. Firstly， the four main contents of causal graph theory were introduced， including sources of association， statistical properties of causal models， identification and adjustment， and instrumental variables. Secondly， for two examples and with the help of the CAUSALGRAPH procedure in SAS/STAT， the following two tasks were completed： the first task was to identify causal effects using instrumental variables； the second task was to use data to distinguish different models.

Checking adjustment sets and finding common adjustment sets based on a causal graph model / 四川精神卫生

The purpose of this paper was to introduce the method of checking adjustment sets based on a causal graph model， finding common adjustment sets and implementing the statistical calculation with SAS software. Firstly， the basic concepts related to the causal graph model were introduced.Secondly， the primary contents of the causal graph theory were given， including the composition and terminology of the causality diagram. Finally， for the two instances and with the help of the CAUSALGRAPH procedure in SAS/STAT， the following two tasks were completed： the first task was to examine the adjustment set and enumerate paths； the second task was to find the adjustment set common to the multiple causal graph models.

Constructing and searching adjustment sets based on a causal graph model / 四川精神卫生

The purpose of this paper was to introduce the basic knowledge of the causal graph model， the contents of the CAUSALGRAPH procedure and the method of constructing and searching adjustment sets based on the CAUSALGRAPH procedure in SAS/STAT. The causal graph model was the product of the combination of graph theory and probability theory. It could find all possible adjustment sets including the minimum adjustment set based on the action relationship between the variables set by the user. The contents of the CAUSALGRAPH procedure mainly included three identification criteria， two operating modes and one verification checking method. This paper analyzed the causal effect of two instances based on the CAUSALGRAPH procedure in SAS， and explained the output results.

Analysis of causal mediation effect with odds ratio and excess relative risk as evaluation indexes / 四川精神卫生

The purpose of this paper was to introduce how to set the options of variable levels and multimodal covariates， and to demonstrate the causal mediation effect analysis method with odds ratio （OR） and excess relative risk （ERR） as evaluation indicators through examples. For treatment variables， mediator variables and covariates， the variable-level options of them could be set through the evaluate statement. For categorical variables and their interaction terms， they could be treated as multimodal covariates， and the variable levels could also be set for them by using the evaluate statement. Through an example， this paper used SAS to realize the causal mediation effect analysis and the decomposition of effect components with OR and ERR as the evaluation indicators.

Causal mediation effect analysis based on different variable stratification / 四川精神卫生

The purpose of this paper was to introduce the setting method of the three types of variable levels in the causal mediation effect analysis and the implementing calculation method under the condition of stratification by using SAS. The setting of the three types of variable levels referred to the setting of the levels of treatment variable， the mediator variable and the covariate. Besides， a specific level combination could also be set for two variables. Through an example， with the help of the enveluate statement in proc causualmed procedure， this paper used an example to conduct the causal mediation effect based on different variable stratification， and gave the output results and explanations.