How Generalizable Are Findings from a Community-Based Prospective Cohort Study? Extending Estimates from the Adult Changes in Thought Study to Its Source Population.

Background: The Adult Changes in Thought (ACT) study is a cohort of Kaiser Permanente Washington members ages 65+ that began in 1994. Objective: We wanted to know how well ACT participants represented all older adults in the region, and how well ACT findings on eye disease and its relationship with Alzheimer's disease generalized to all older adults in the Seattle Metropolitan Region. Methods: We used participation weights derived from pooling ACT and Behavioral Risk Factor Surveillance System (BRFSS) data to estimate prevalences of common eye diseases and their associations with Alzheimer's disease incidence. Cox proportional hazards models accounted for age, education, smoking, sex, and APOE genotype. Confidence intervals for weighted analyses were bootstrapped to account for error in estimating the weights. Results: ACT participants were fairly similar to older adults in the region. The largest differences were more self-reported current cholesterol medication use in BRFSS and higher proportions with low education in ACT. Incorporating the weights had little impact on prevalence estimates for age-related macular degeneration or glaucoma. Weighted estimates were slightly higher for diabetic retinopathy (weighted 5.7% (95% Confidence Interval 4.3, 7.1); unweighted 4.1% (3.6, 4.6)) and cataract history (weighted 51.8% (49.6, 54.3); unweighted 48.6% (47.3, 49.9)). The weighted hazard ratio for recent diabetic retinopathy diagnosis and Alzheimer's disease was 1.84 (0.34, 4.29), versus 1.32 (0.87, 2.00) in unweighted ACT. Conclusions: Most, but not all, associations were similar after participation weighting. Even in community-based cohorts, extending inferences to broader populations may benefit from evaluation with participation weights.

Relationship between metabolic syndrome and depression: A study based on Rafsanjan Youth Cohort Study.

BACKGROUND: Depressed people are susceptible to metabolic syndrome ression and metabolic syndrome in the Rafsanjan Youth Cohort Study in 2021. METHODS: In this cross-sectional study, the data of 3005 young people aged 15-35 under the coverage of urban and rural health centers was investigated in the enrollment stage of the Rafsanjan Youth Cohort Study as a part of the prospective epidemiological research studies in IrAN (PERSIAN). Data was collected using face-to-face interview and electronic questionnaires of the Rafsanjan Youth Cohort Study. RESULTS: Age of the youth was 25.78 ± 6.06 years, 56 % (n = 1682) were female. The prevalence of metabolic syndrome (MetS) was 7.7 % (95 % CI: 6.8 %-8.8 %) and the prevalence of depression was 11.1 % (95 % CI: 10.0 %-12.3 %). Depression did not have a significant impact on the odds ratio of developing MetS in young people (P = 0.604). The odds ratio (OR) of MetS increases by 1.057 times with increasing age (95 % CI for OR: 1.020-1.094). This OR is also 1.715 times higher in married young people than in unmarried Youth (95 % CI for OR: 1.715-2.692) and 0.196 times lower in young people with medium and high MET index than in young people with low MET index (95 % CI for OR: 0.048-0.811). LIMITATIONS: Inability to determine a causal relationship between MetS and depression. CONCLUSION: Due to the growing trend of components of MetS among the young population, this issue needs to be addressed in future policies and planning for prevention and control as a health priority.

Dietary antioxidants and hypertension among menopausal women in Rafsanjan Cohort Study.

Studies on the beneficial role of dietary antioxidants in preventing or managing hypertension in postmenopausal women are infrequent. The present cross-sectional study aimed to assess the association between dietary antioxidants and hypertension among menopausal women in Rafsanjan, a city located in the southeast of Iran. This study was based on data from the Rafsanjan Cohort Study (RCS), as part of the Prospective Epidemiological Research Studies in IrAN (PERSIAN). Among 2359 postmenopausal women, finally, 1936 women were included in this study. Participants were grouped as having normal blood pressure (BP), elevated BP, stage 1 hypertension, or stage 2 hypertension as defined by the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) BP guideline. A food frequency questionnaire (FFQ), was utilized to ascertain the levels of various nutrients and dietary antioxidants in the diet. The association between dietary intakes of antioxidants and blood pressure groups was evaluated by crude and adjusted models in the multinominal logistics regression analysis. Normal BP, elevated BP, stage 1 hypertension, and stage 2 hypertension were observed in 35.69%, 3.62%, 10.59%, and 50.10% of postmenopausal women respectively. In the adjusted model, in subjects with higher consumption of ß-carotene, the odds ratios of elevated BP in the 3rd quartile was about 2 times (OR: 2.04 (1.06-3.93) higher than 1st quartile. Also, in subjects with medium quality of DAQS, the odds ratios of elevated BP and stage 1 blood pressure were about 2 times (OR: 2.09 (1.05-4.17) and 1.69 times (OR: 1.69 (1.09-2.63) higher than subjects with low quality respectively. Furthermore, we did not find any statistically significant association between increased intake of dietary antioxidants and decreased odds of hypertension. After controlling the effects of confounding variables, increased dietary intake of selenium, carotenoids, vitamin A, vitamin C, and vitamin E did not decrease the odds of hypertension in postmenopausal women. Accordingly, it is suggested that this association be further investigated in the follow-up phase of this prospective study.

The association between dietary patterns and metabolic syndrome among Iranian adults, a cross-sectional population-based study (findings from Bandare-Kong non-communicable disease cohort study).

BACKGROUND: Metabolic syndrome is a cluster of metabolic disorders increasing the risk of cardiovascular disease and diabetes. Dietary patterns are supposed to be important and controllable factors in developing metabolic syndrome. The purpose of this study was to investigate the association of dietary patterns with metabolic syndrome and its components. SUBJECTS/METHODS: Cross-sectional data were extracted from the Bandare-Kong cohort study conducted on 4063 people aged 35 to 70. Dietary patterns were extracted using principal component analysis based on thirty-eight pre-defined food groups. Multivariable logistic regression was conducted to investigate the association between metabolic syndrome and its components with quintiles of dietary patterns in crude and adjusted models. RESULTS: Three major dietary patterns were identified (healthy, western, and traditional) in the final analysis of 2823 eligible individuals. After adjusting for covariates, the odds of metabolic syndrome were significantly decreased by 46% in subjects with the highest adherence to the healthy dietary pattern compared to those with the lowest adherence quintile. Results from fully adjusted models on individual metabolic syndrome components showed an inverse association between higher adherence to the healthy dietary pattern and the odds of increased blood glucose, high waist circumference, and elevated blood pressure. However, in fully adjusted models, no significant association was observed between the western and traditional dietary patterns with odds of metabolic syndrome and its components. CONCLUSIONS: Adherence to a healthy dietary pattern containing high amounts of fruits, vegetables, nuts, low-fat dairy products, and legumes, could be recommended to prevent and control metabolic syndrome.

Occupational status and chronic respiratory diseases: a cross-sectional study based on the data of the Rafsanjan Cohort Study.

BACKGROUND: The aim of the present study was to investigate the possible connection between occupational status and chronic respiratory diseases (CRDs) among the Iranian population. METHODS: The present cross-sectional study was conducted on 9934 individuals aged 35-70 years enrolled in the Rafsanjan Cohort Study (RCS), a component of the Prospective Epidemiological Research Studies in Iran (PERSIAN). Detailed questionnaires were used to collect information on various factors, such as occupation, sociodemographic characteristics, medical history, anthropometric measurements, physical activity, cigarette and hookah smoking, opium use, and alcohol consumption. The association between occupational class and CRD was evaluated using logistic regression models for rare events. RESULTS: In the present study, 4624 (46.55%) participants were male, and 5310 (53.45%) were female. The prevalence of CRD among all participants was 2.61%. Occupational activities were classified into two categories: In class I, the largest group was the homemaker and unemployment category (41.73%), followed by self-employment (34.39%), employment (13.03%), and retired individuals (10.84%). In class II, there were pistachio farmers (12.61%), copper miners (3.62%), and others in various occupations (83.76%). Subjects with CRD were significantly more likely to be homemakers, unemployed, elderly, female, less educated, and obese. There was no significant relationship between CRD and job type/occupational status after adjusting for some potential confounding variables. CONCLUSIONS: There was no significant relationship between CRD and job type/occupational status. However, longitudinal studies are needed to assess the impact of job type/occupational status on the risk of CRD.

Metabolic syndrome: a population-based study of prevalence and risk factors.

The association between personal habits and metabolic syndrome (MetS) remains controversial. This study aimed to assess the prevalence of MetS among youths and its association with cigarette, tobacco, opium, and alcohol consumption in the Rafsanjan Youth Cohort Study (RYCS). The current cross-sectional study was based on data from RYCS, as part of the Rafsanjan Cohort Study (RCS). RCS is a branch of the prospective epidemiological research studies in Iran (PERSIAN). In the present study, 2843 youths aged 15-35 were included. MetS was diagnosed using the international diabetes federation (International IDF), National Cholesterol Education Panel- Adult Treatment Panel III (NCEP-ATPIII), and Iranian criteria (IDF Iranian). Binary logistic regression models were performed to estimate odds ratios (ORs) and confidence intervals (CIs). The prevalence of MetS was 7.67%, 7.14%, and 10.13% based on NCEP-ATPIII, IDF Iranian, and International IDF criteria respectively. The odds of MetS according to international IDF and Iranian IDF in the alcohol-drinking group in the last 12 months (OR: 1.51, 95%CI 1.02-2.21, OR: 1.66, 95%CI 1.11-2.48 respectively) were greater compared with the non-drinking group. The odds of having high TG in the alcohol-drinking group in the last 12 months was 1.53 times higher than the control group (OR = 1.53, 95% CI: 1.20-1.94). Furthermore, the odds of having high waist circumference (WC) according to IDF International was significantly higher in the tobacco-smoking group in the last 12 months and in the tobacco-smoking group in the last 12 months daily (OR: 1.23, 95%CI 1.01-1.49 and OR: 1.41, 95%CI 1.01-1.98 respectively) compared to the control groups. The prevalence of MetS was 7.67%, 7.14%, and 10.13% based on NCEP-ATPIII, IDF Iranian, and International IDF criteria respectively. The odds of MetS and high TG were greater in the alcohol-drinking group in the last 12 months compared with the non-drinking group. The odds of high WC in the last 12 months, were greater in the tobacco-smoking group compared with the non-smoking group. However, more longitudinal studies are needed to verify the associations observed in the current study.

The relationship between pesticide exposures and primary headaches in adults: A cross-sectional study based on Rafsanjan cohort study.

Objectives: Toxic substances can trigger headaches. The prevalence of pesticide use and headaches was high among the population of Rafsanjan. Methods: A cross-sectional study was used to collect data from 9991 adults who participated via sampling people aged 35-70 years old of both genders from the Rafsanjan Cohort Study (RCS) in Iran. Demographic characteristics, habits, chronic primary headache (CPH), and episodic primary headache (EPH) were measured. Results: The prevalence of CPH and EPH were 7.4 % and 29.9 % respectively. The multivariable model showed the odds of EPH increased significantly by the pesticide exposure on farm OR: 1.16 (1.02-1.34), in yard OR: 1.18 (1.01-1.39), duration of pesticide exposure in yard > median OR: 1.35 (1.06-1.73), at home OR: 1.31 (1.17-1.46), duration of pesticide exposure at home ≤ median OR: 1.24 (1.10-1.40) and > median OR: 1.38 (1.22-1.57). Also, pesticide preparation OR: 1.20 (1.03-1.39), duration of exposure in pesticide preparation ≤ median OR: 1.31 (1.09-1.57), and duration of exposure in managed spraying pesticide > median OR: 1.28 (1.04-1.57) increased odds of EPH. These results showed that the odds of CPH increased in participants using pesticides at home OR: 1.22 (1.02-1.48), duration of pesticide exposure at home > median OR: 1.37 (1.11-1.70), and duration of pesticide exposure in pesticide preparation > median OR: 0.47 (0.27-0.82). The odds of EPH increased with more pesticide exposures (18 %) and duration of pesticide exposure (25 %). Conclusions: As evidenced by the obtained results, there is a relationship between pesticide exposure and headaches.

Association between DMFT and primary headaches: a study based on the Rafsanjan cohort study.

BACKGROUND: Although primary headaches are common disorders, there is little research on the possible relationship between primary headaches and oral health (decayed, missing, and filled teeth: DMFT). The present study aims to investigate the relationship between the DMFT index and primary headaches. METHOD: This descriptive study was performed on 8682 cases from the Rafsanjani cohort population based on the Rafsanjani cohort study (RCS) and Oral Health Branch of the Rafsanjan Cohort Study (OHBRCS). Episodic primary headache (EPH) and chronic primary headache (CPH) of RCS patients who participated in OHBRCS were studied according to their DMFT score in comparison to nonprimary headache patients. Demographic characteristics and risk factors were compared in different groups. We used crude and multiple logistic regression analyses in this study. RESULTS: The missing teeth were significantly higher in the CPH group than in the no CPH group (P < 0.001), and filled teeth were significantly higher in the EPH group than in the no EPH group (P < 0.001). In the crude model, there was a direct significant association between the prevalence of EPH and filled teeth total and > 5 filled teeth, and after adjusting for confounders, this relationship remained significant. The odds ratios of CPH were not associated with DMFT or its components in the adjusted models. CONCLUSION: Our study found a correlation between filled teeth and EPH cases, but no correlation between CPH and DMFT or its components.

Incidence Trends of Melanoma of the Lower Limbs and Hips in the United States: A Surveillance, Epidemiology, and End Results Analysis 2000-2019.

BACKGROUND/AIM: No specific studies on the changes in the incidence of melanoma in the lower limbs and hips have been performed. This article aimed to examine trends in incidence rates of melanoma of the lower extremities in the U.S. PATIENTS AND METHODS: Data from the SEER program provided by the National Cancer Institute were used to examine trends in melanoma incidence from 2000 to 2019. Data analysis was performed from October to December 2022. RESULTS: A total of 192,327 cases of melanoma of the lower limbs and hips were diagnosed from 2000 to 2019 and included in our study. The incidence rate increased from 9.78 to 13.65 cases per 100,000 person-year and by an average annual percent change (AAPC) of 2% (95%CI=1.4-2.9%). The incidence increased by an AAPC of 2.1% in men and 1.7% in women. The incidence among people under 50 remained stable but increased among those over 50 years. Localized stage disease was the only stage where a continuously increasing incidence was observed, with an AAPC of 1.7% (95%CI=0.9-2.5%). Lentiginous melanoma showed the highest incidence trend rate with an AAPC of 2.3% (95%CI=1.0-3.5%). CONCLUSION: The incidence rate of melanoma in the lower limbs and hips increased between 2000 and 2019, with a higher incidence in men, reversing the previously described trend of higher incidence among women. However, incidence among people under 50 remained stable, suggesting the efficacy of prevention campaigns in this population.

The profile of Oral Health Branch of Rafsanjan Cohort Study (OHBRCS) in Rafsanjan City, southeast of Iran.

Oral health status can be affected by some factors including drug abuse, systemic conditions and environmental pollutants. The present study was designed to investigate the most important and prevalent dental and oral conditions in adult population of Rafsanjan with the age of 35-70 years. Dental and oral health cohort center as part of the Rafsanjan Cohort Study (RCS) included in the prospective epidemiological research studies in IrAN was established in 2015. Of 9991 subjects enrolled in the RCS, 8682 people participated in the Oral Health Branch of Rafsanjan Cohort Study (OHBRCS). The OHBRCS included 4021 men and 4661 women with the mean age of 49.94 ± 9.51. The most prevalent of oral lesion in total population was candidiasis and the least was aphthous lesion. The prevalence of candidiasis, white and red lesions, periodontal pocket, dental calculus, CAL and the mean of DMFT were higher in the male group than that of female group (p < 0.05). Candidiasis, herpes, oral cancer, white and red lesions were more prevalent in the older age groups (p < 0.05). The mean of DMFT index in total population was 21.30 and was higher among opium users, men and older age (p < 0.05). Also, the opium users had a higher rate of CAL, periodontal pocket, red and white lesions, and candidiasis but a lower rate of BOP (p < 0.05). Younger people had more decayed and filling teeth compared to other age groups, whereas older people had more missing teeth and a higher DMFT index (p < 0.001).

Epidemiological research on rare diseases using large-scale online search queries and reported case data.

BACKGROUND: Rare diseases have become a major public health concern worldwide. However, detailed epidemiological data are lacking. With the development of the Internet, search queries have played an important role in disease surveillance. In this study, we explored a new method for the epidemiological research on rare diseases, using large-scale online search queries and reported case data. We distilled search logs related to rare diseases nationwide from 2016 to 2019. The case data were obtained from China's national database of rare diseases during the same period. RESULTS: A total of 120 rare diseases were included in this study. From 2016 to 2019, the number of patients with rare diseases estimated using search data and those obtained from the case database showed an increasing trend. Rare diseases can be ranked by the number of search estimated patients and reported patients, and the rankings of each disease in both search and reported case data were generally stable. Furthermore, the disease rankings in the search data were relatively consistent with the reported case data in each year, with more than 50% of rare diseases having a ranking difference of -20 to 20 between the two systems. In addition, the relationship between the disease rankings in the two systems was generally stable over time. Based on the relationship between the disease rankings in the search and reported case data, rare diseases can be classified into two categories. CONCLUSION: Online search queries may provide an important new resource for detecting rare diseases. Rare diseases can be classified into two categories to guide different epidemiological research strategies.

Dyslipidemia, diabetes and periodontal disease, a cross-sectional study in Rafsanjan, a region in southeast Iran.

THE OBJECTIVES: The association between dyslipidemia, diabetes and alterations in periodontal health are inconsistent. The aim of this study was to determine the association between dyslipidemia, diabetes and periodontal disease in the Oral Health Branch of Rafsanjan Cohort Study (OHBRCS). METHODS: Rafsanjan Cohort Study (RCS) was launched in 2015 in Rafsanjan City a region in the southeast of Iran. A total of 8682 participants aged 35-70 years of both gender were recruited into the OHBRCS as a part of RCS. Bleeding on probing (BOP), probing pocket depth (PPD) and Clinical attachment loss (CAL) were used to assess periodontal health status. When CAL progression was ≥ 1 mm and PPD was > 3 mm, it was defined as periodontitis. RESULTS: The final sample consisted of 6751 individuals with mean age of 47.67 ± 8.79 years. Among this population, 73.32% (n = 4949), 13.75% (n = 928), 59.67% (n = 4028) and 11.76% (n = 794) had BOP, PPD > 3 mm, CAL ≥ 1 mm and periodontitis respectively. The odds of CAL ≥ 1 mm increased 14% in subjects with high LDL cholesterol (OR: 1.14; 95% CI: 1.01-1.30), 17% in subjects with diabetes (OR: 1.17; 95% CI: 1.01-1.36) and 23% in subjects with both dyslipidemia and diabetes (OR: 1.23; 95% CI: 1.05-1.44). Also, the odds of PPD > 3 mm in the group with high total cholesterol (TC) was 16% higher compared to those with normal TC (OR: 1.16; 95% CI: 1.01-1.34). CONCLUSIONS: There was an increased odds in periodontal disease in association with high TC, high LDL cholesterol, diabetes and having both dyslipidemia and diabetes. This suggests that high TC, high LDL cholesterol, diabetes and having both dyslipidemia and diabetes might be potential indicators for the presence of periodontal disease.

Association between metabolic syndrome and stroke: a population based cohort study.

Both metabolic syndrome (MetS) and stroke are associated with increased risk of mortality. Here, we aimed to assess the prevalence of MetS among adults using three definitions (Adult Treatment Panel III (ATP-III), International Diabetes Federation (IDF) and IDF ethnic specific cut-off for Iranian criteria) and its association with stroke. We performed a cross-sectional study of a total of 9991 adult participants of Rafsanjan Cohort Study (RCS), as part of the Prospective epidemiological research studies in Iran (PERSIAN cohort study). The MetS prevalence was evaluated in participants according to the different criteria. Multivariate logistic regression analyses were conducted to assess the association between three definitions of MetS with stroke. We found that MetS was significantly associated with higher odds of stroke according to NCEP-ATP III (odds ratio (OR): 1.89, 95% confidence interval (CI) 1.30-2.74), international IDF (OR:1.66, 95% CI: 1.15-2.40) and Iranian IDF (OR:1.48, 95% CI: 1.04-2.09) after adjusted for variables confounders. Furthermore, after adjustment, in receiver operating characteristic (ROC) curve, the AUROC was 0.79 (95% CI = 0.75-0.82), 0.78(95% CI = 0.74-0.82) and 0.78(95% CI = 0.74-0.81) for presence of MetS according to NCEP-ATP III, international IDF and Iranian IDF, respectively. ROC analyses revealed that all of these three criteria for MetS are "moderately accurate" for the identification of increased stroke risk.In conclusion, our results showed that MetS was associated with increased odds of stroke. Our findings implicate the importance of early identification, treatment, and ultimately prevention of the metabolic syndrome.

The prevalence and associated factors of overweight/obesity and abdominal obesity in South-eastern of Iran: a cross-sectional study based on Rafsanjan cohort study.

BACKGROUND: Obesity has become a major health issue in both high and middle-income countries, increasing the risk of cardiovascular diseases and all-cause mortality. Risk of obesity is related to both unchangeable factors such as genetics and gender, and modifiable lifestyle factors. Most importantly, finding the major modifiable lifestyle factors which contribute to obesity may provide valuable benefits to every society. This study aimed to determine the association of demographic and lifestyle parameters with overweight/obesity and abdominal obesity in a population of Iranian adults. METHODS: In this cross-sectional study, adult participants of Rafsanjan Cohort Study (RCS) (as one of the district areas of the PERSIAN cohort (Prospective Epidemiological Research Studies in IrAN) included the study population. RCS is a population-based prospective cohort of men and women aged 35-70 years, launched in August 2015. Individuals were recruited from four urban and suburban areas of Rafsanjan, south-eastern of Iran. Trained experts interviewed each participant and completed the related questionnaires about his/her socioeconomic status, demography, anthropometric features, personal habits, physical activity and medical history. Multinomial logistic regression models were used to examine the relationships between overweight/obesity/abdominal obesity and associated factors. RESULTS: From 9980 participants, 1974 (42.42%) males and 2115 (39.70%) females were overweight, 784 (16.85%) males, 2223 (41.73%) females were obese and 1895 (40.73%) males and 989 (18.57%) females were normal weight. Also, 832 (17.9%) males and 4548 (85.4%) females had abdominal obesity and 3819 (82.1%) males and 778 (14.6%) females didn't have abdominal obesity. Based on the adjusted multiple logistic regression, overweight/obesity (BMI > 25) was associated with age > 45, female gender, education ≥ 13 years, heavy physical activity, wealth status index (WSI), alcohol consumption, current cigarette smoking and opium consumption compared to reference group. Also, odds of abdominal obesity displayed a significant association with age > 45, female gender, education > 5 years, physical activity, WSI, current cigarette smoking, alcohol and opium consumption compared to reference group. CONCLUSIONS: Our results recommend local public health strategies that promote training the society on the health benefits of avoiding alcohol, getting more physical exercise and gaining more personal education on the health-threatening lifestyle.

Oral candidiasis and cigarette, tobacco, alcohol, and opium consumption in Rafsanjan, a region in the southeast of Iran.

BACKGROUND: We investigated the association between oral candidiasis prevalence and cigarette, tobacco, alcohol, and opium consumption in Rafsanjan, a region in the southeast of Iran. METHODS: This cross-sectional study was conducted using the data of Oral Health Branch of Rafsanjan Cohort Study (OHBRCS) as a part of the Rafsanjan Cohort Study (RCS). RCS included in Prospective Epidemiological Research Studies in IrAN (PERSIAN) was begun in 2015 in the Rafsanjan. A full-mouth examination was done by trained dental specialists. Oral candidiasis was diagnosed based on clinical examination. Information about cigarette, tobacco, and opium smoking and alcohol consumption were collected based on data from self-reported questionaries. Univariate and multivariate dichotomous logistics regression were used to assess the association between oral candidiasis and cigarette, tobacco, alcohol, and opium consumption. RESULTS: Among 8682 participants with mean age of 49.94 years, the prevalence of oral candidiasis was 7.94%. There was a direct association between cigarette smoking in current and former cigarette smokers with an increased odds of oral candidiasis (OR: 3.26, 95% CI: 2.46-4.33 and OR: 1.63, 95% CI: 1.18-2.25 respectively) in fully adjusted models. There was a dose-response relationship between the odds of oral candidiasis and dose (OR: 3.31, 95% CI: 2.38-4.60), duration (OR: 2.48, 95% CI: 2.04-3.95) and number (OR: 3.01, 95% CI: 2.02-4.50) of cigarette smoking in the 4th quartile compared to reference group. CONCLUSIONS: A dose-response relationship was shown between cigarette smoking and increased odds of oral candidiasis.

Investigation of the relationship between sleep-related parameters and metabolic syndrome (MetS) among youths in the Southeast of Iran.

BACKGROUND AND AIM: There are few studies and inconsistent findings on the role of sleep-related parameters in the development of metabolic syndrome (MetS) among youths. In this study, we aim to investigate the relationship between sleep-related parameters and MetS among youths in a large sample size in Rafsanjan, a region in the southeast of Iran. METHODS: The current cross-sectional study was performed on 3,006 young adults aged 15-35, who registered for Rafsanjan Youth Cohort Study (RYCS), as part of Rafsanjan Cohort Study (RCS)). In fact, RCS is a branch of the prospective epidemiological research studies in Iran (PERSIAN). In the present study, we included 2,867 youths after excluding some subjects with missing information on MetS components. MetS was diagnosed based on Adult Treatment Panel III (ATP III) criteria. Besides, data on sleep-related parameters were collected by self-report questionnaires. RESULTS: The overall prevalence of MetS was 7.74% among the participants. In addition, bedtime, wake time, napping, night shift work, and sleep duration per night and day had no association with the higher odds of having MetS. In contrast, long sleep duration at night was associated with the lower odds of high waist circumference (WC) (OR: 0.82,95% CI :0.67-0.99). CONCLUSION: In the present study, long sleep duration at night was associated with lower odds of central obesity. However, more longitudinal studies with the objective measurement of sleep-related parameters are needed to verify the associations reported in the current study.

Examination of Risk Factors and Expression Patterns of Atypical Femoral Fractures Using the Japanese Adverse Drug Event Report Database: A Retrospective Pharmacovigilance Study.

Atypical femoral fracture (AFF) is a rare complication related to the use of bisphosphonates (BPs). Herein, we analyzed the risk factors and onset patterns of AFF using the Japanese Adverse Drug Event Report database and reported the findings. First, the independent risk factors for AFF were gender (female), high body mass index, and medical history of osteoporosis, arthritis, and systemic lupus erythematosus (SLE). Drug-related risk factors for AFF included BPs (i.e., alendronic acid, ibandronic acid, etidronic acid, zoledronic acid, minodronic acid, risedronic acid), denosumab, prednisolone, lansoprazole, rabeprazole, exemestane, letrozole, eldecalcitol, and menatetrenone. Therefore, it appears that AFF is influenced by a combination of patient backgrounds and drugs, and that the risk of developing AFF is particularly high in patients with fragile bones (e.g., osteoporosis, arthritis, and SLE). Second, in the analysis of AFF onset patterns, the onset of AFF from BPs and denosumab took a long time (>1 year) to develop. Analysis using a Weibull distribution showed wear-out failure-type AFF onset for BPs and denosumab, and both osteoporosis and cancer patients with long-term administration of these drugs showed a tendency to have an increased risk of onset. AFF developed earlier in osteoporosis patients with long-term administration of BPs and denosumab than in cancer patients.

Serum liver enzymes and metabolic syndrome from the Rafsanjan Cohort Study.

Our investigation aimed at evaluating the relationship between metabolic syndrome, alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma glutamyl transferase (GGT), and alkaline phosphatase (ALP) in the Rafsanjan cohort study (RCS). We used data obtained from the RCS, as a part of the prospective epidemiological research studies in Iran. In this cross-sectional research, 9895 participants from the baseline phase of RCS who completed medical questionnaire were included. Metabolic syndrome (MetS) defined using NCEP-ATP III criteria. The relationship between elevated serum liver enzymes levels even within the normal range and metabolic syndrome was evaluated by logistic regressions. The prevalence of MetS was 34.42% in the participants of study. The mean concentrations of AST, ALT, ALP, and GGT increased with increasing MetS components. After adjusting for all potential confounders, elevated serum concentrations of ALT, AST, GGT, and ALP even within the normal range were related with an increased odds of MetS. MetS was associated with increased levels of liver enzymes even within the normal range. These results indicated the potential for elevated liver enzymes as biomarkers for the possible presence of MetS.

Knowledge, Perceptions and Reporting Practices of Theoretical Design in Causal Observational Epidemiological Studies on the Role of Antibiotic Use in the Occurrence of Asthma in Children.

Good research is driven by study design encompassing theoretical design, design of data collection and design of data processing. In epidemiological research, theoretical design is based on a functional relationship between the occurrence and determinants studied (occurrence function) and should also define that part of the theoretical population and the context to which the results pertain (domain). Both are essential for the design of data collection, the design of data processing and the interpretation of the study results and should be explicitly reported. In order to gain insight into the role of theoretical design in the entire research process before publication, it was decided to informally question the corresponding authors of a selection of 30 articles (20 most recent and 10 less recent) reporting on causal observational epidemiological studies on asthma and early life exposure to antibiotics. The objective was to appraise the perceived knowledgeability of theoretical design among the authors of the selected articles. Fifteen authors responded. Authors were asked to indicate their knowledgeability with the concepts of theoretical design, causal theory, confounding and effect modification on a 5-level Likert scale. Other questions were related to the theoretical design of their study. The vast majority of the authors perceived themselves to be moderately to extremely knowledgeable with confounding and effect modification. Perceived knowledgeability of theoretical design and causal theory was more diverse. When provided with options for an occurrence function, almost all authors indicated "current occurrence as a function of past exposure" for their study. Nevertheless, half of these authors conducted their study based on "future occurrence as a function of current exposure". Even though the authors perceive themselves to be knowledgeable with theoretical design, this is not reflected in their articles. Theoretical design should be well known, implemented and explicitly reported.

Structural competency in epidemiological research: What's feasible, what's tricky, and the benefits of a 'structural turn'.

Structural competency is an emerging paradigm for both the training of health professionals and the creation of a common language addressing structural processes that determine health disparities. However, its application to the field of epidemiological design and research is absent. Based on our previous proposal of a tool for Structural and Intercultural Competency in Epidemiological Studies, the SICES guidelines, in this article we analyse the possibilities and challenges of a 'structural turn' in epidemiology. In terms of possibilities, we recognise the value of paradigms from multiple parts of the world, such as social and sociocultural epidemiology, critical epidemiology and collective health, in facilitating a structural turn in epidemiological studies. In this framework, structural competency would provide a new angle by focusing not only on what to research (e.g. inequalities), but with what skills and attitudes (e.g. cultural and epistemic humility). The challenges lie in the inclusion of reflexivity and a comprehensive view in the context of a positivist epidemiology oriented towards obtaining evidence from a biomedical, but not social, perspective.