Critical windows of exposure to air pollution and gestational diabetes: assessing effect modification by maternal pre-existing conditions and environmental factors.

BACKGROUND: Ambient air pollution has been associated with gestational diabetes (GD), but critical windows of exposure and whether maternal pre-existing conditions and other environmental factors modify the associations remains inconclusive. METHODS: We conducted a retrospective cohort study of all singleton live birth that occurred between April 1st 2006 and March 31st 2018 in Ontario, Canada. Ambient air pollution data (i.e., fine particulate matter with a diameter ≤ 2.5 µm (PM2.5), nitrogen dioxide (NO2) and ozone (O3)) were assigned to the study population in spatial resolution of approximately 1 km × 1 km. The Normalized Difference Vegetation Index (NDVI) and the Green View Index (GVI) were also used to characterize residential exposure to green space as well as the Active Living Environments (ALE) index to represent the active living friendliness. Multivariable Cox proportional hazards regression models were used to evaluate the associations. RESULTS: Among 1,310,807 pregnant individuals, 68,860 incident cases of GD were identified. We found the strongest associations between PM2.5 and GD in gestational weeks 7 to 18 (HR = 1.07 per IQR (2.7 µg/m3); 95% CI: 1.02 - 1.11)). For O3, we found two sensitive windows of exposure, with increased risk in the preconception period (HR = 1.03 per IQR increase (7.0 ppb) (95% CI: 1.01 - 1.06)) as well as gestational weeks 9 to 28 (HR 1.08 per IQR (95% CI: 1.04 -1.12)). We found that women with asthma were more at risk of GD when exposed to increasing levels of O3 (p- value for effect modification = 0.04). Exposure to air pollutants explained 20.1%, 1.4% and 4.6% of the associations between GVI, NDVI and ALE, respectively. CONCLUSION: An increase of PM2.5 exposure in early pregnancy and of O3 exposure during late first trimester and over the second trimester of pregnancy were associated with gestational diabetes whereas exposure to green space may confer a protective effect.

Association between mood disorders and frequent emergency department use: a cross-sectional study.

OBJECTIVES: Frequent emergency department (ED) use is a growing problem that is associated with poor patient outcomes and increased health care costs. Our objective was to analyze the association between mood disorders and the incidence of frequent ED use. METHODS: We used the Canadian Community Health Survey conducted by Statistics Canada, 2015-2016. Mood disorder was defined as depression, bipolar disorder, mania, or dysthymia. Frequent ED use was defined as 4 or more visits in the year preceding the interview. Multivariable log-binomial regression models were used to determine the associations between mood disorders and frequent ED use. RESULTS: Among the 99,009 participants, 8.4% had mood disorders, 80.3% were younger than 65, and 2.2% were frequent ED users. Mood disorders were significantly associated with the 1-year cumulative incidence of frequent ED use (RR = 2.5, 95% CI 2.2-2.7), after adjusting for several potential confounders. CONCLUSIONS: This national survey showed that people with a mood disorder had a three-fold risk of frequent ED use, compared to people without mood disorder. These results can inform the development of policies and targeted interventions aimed at identifying and supporting ED patients with mood disorder.

RéSUMé: OBJECTIFS: L'utilisation fréquente des services d'urgence est un problème croissant qui est associé à de mauvais résultats pour les patients et à une augmentation des coûts des soins de santé. Notre objectif était d'analyser l'association entre les troubles de l'humeur et l'incidence de l'utilisation fréquente des urgences. MéTHODES: Nous avons utilisé l'Enquête sur la santé dans les collectivités canadiennes menée par Statistique Canada en 2015-2016. Le trouble de l'humeur est défini comme une dépression, un trouble bipolaire, une manie ou une dysthymie. L'utilisation fréquente des urgences est définie comme 4 visites ou plus dans l'année précédant l'entretien. Des modèles de régression log-binomiale multivariés ont été utilisés pour déterminer les associations entre les troubles de l'humeur et l'utilisation fréquente des services d'urgence. RéSULTATS: Parmi les 99 009 participants, 8,4 % souffraient de troubles de l'humeur, 80,3 % avaient moins de 65 ans et 2,2 % utilisaient fréquemment les services d'urgence. Les troubles de l'humeur étaient significativement associés à l'incidence cumulative sur un an d'utilisation fréquente des urgences (RR = 2,5, IC à 95 % 2,2-2,7), après ajustement pour plusieurs facteurs de confusion potentiels. CONCLUSIONS: Cette enquête nationale montre que les personnes souffrant d'un trouble de l'humeur ont un risque trois fois plus élevé de recourir fréquemment aux services d'urgence, par rapport aux personnes sans trouble de l'humeur. Ces résultats peuvent contribuer au développement de politiques et d'interventions ciblées visant à identifier et à soutenir les patients souffrant de troubles de l'humeur aux urgences.

Content Reporting in Post-Stroke Therapeutic Circuit-Class Exercise Programs in randomized control trials.

BACKGROUND: Therapeutic exercise in the form of group circuit-class training can improve mobility and gait while being cost-effective among patients who survived a stroke. Accurate clinical replication of interventions, especially when they are effective, is needed to advance research and treatment. However, replication is difficult when reporting is not detailed. OBJECTIVE: The objective of this study was to assess the quality of reporting of interventions within the selected studies using three different scales and to assess the criterion validity between the scales. METHODS: Two independent assessors used the CERT, the CONTENT scale, and TIDieR checklist to review the quality of reporting of 16 randomized controlled trials (RCTs) from a recent Cochrane Review. Assessments were done independently before a consensus was reached with an experienced third reviewer mediating any disagreements. Criterion validity between the three quality reporting tools was measured using weighted Cohen's kappa coefficients. RESULTS: The mean (±SD) for the CERT was 9.31 (±1.66) out of 19 points; the TIDieR checklist was 8.81 (±1.33) out of 12 points; and the CONTENT was 4.82 (±1.22) out of 9 points for the 16 included RCTs. The CERT and CONTENT scale had a fair agreement (k = 0.455, p = 0.064), while both CERT and CONTENT had only slight agreement with TIDieR (k = 0.143, p = 0.267; k = 0.200, p = 0.182, respectively). CONCLUSIONS: The results of this study indicate a lack of reporting from the 16 RCTs on post-stroke therapeutic circuit-class exercise programs. This presents a major barrier to knowledge translation and clinical implementation of effective exercise programs for stroke rehabilitation.