Religion as a Protective Factor Against Adolescent Smoking Habits: Evidence from Spain

Background: There are a wide number of assessments suggesting that being a member of a religious community inhibits adolescents’ risky behaviours and, consequently, can act as a protective factor against the consumption of smoking substances. Methods: We have analysed a structured questionnaire answered by 1935 adolescents from Tarragona (Spain). Results: We have found that variables linked to family were the principal explanatory factors of adolescents’ smoking habits. Living with two parents was a protective factor against tobacco and cannabis use since its Incidence Rate Ratio (IRR) was clearly below 1 (p<0.01). So, whereas living with one parent showed an IRR>1 (p<0.05), adolescents that live without parents presented an IRR close 2 (p<0.05 for tobacco and p<0.01 for cannabis). However, having a religious confession also influence smoking substance use in adolescents (IRR close 0.85 with p<0.01). Conclusion: We found a clear preventive effect in belonging to a religious community. Moreover, this protective effect was less intense, but not statistically significant, for Catholics than for members of other confessions.

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AB0180 A MULTICENTER SELF-CONTROLLED CASE SERIES STUDY INVESTIGATING THE PREVENTIVE EFFECT OF SULFASALAZINE AGAINST PNEUMOCYSTIS PNEUMONIA

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.3734 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 1115.2-1115

Author(s):

T. Nunokawa ◽

T. Kakutani ◽

N. Chinen ◽

K. Shimada ◽

M. Kimura ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Incidence Rate ◽

Rate Ratio ◽

Case Control Study ◽

Incidence Rate Ratio ◽

Case Series ◽

Pneumocystis Pneumonia ◽

Case Control ◽

Preventive Effect ◽

Control Study

Background:An animal study revealed that sulfasalazine (SSZ) enhances Pneumocystis clearance from the lung by accelerating macrophage activity.[1] Although the preventive effect of SSZ on Pneumocystis pneumonia (PCP) in patients with rheumatoid arthritis (RA) is reported in case-control studies, some important confounders might remain unmeasured and distort the results. [2-3]. The self-controlled case series (SCCS) method involves only cases and controls fixed confounders automatically.[4]Objectives:To evaluate the prophylactic effect of SSZ against PCP in patients with RA, controlling unmeasurable confounders by the SCCS method.Methods:A retrospective study was conducted at five hospitals. Patients with RA who developed PCP between 2003 and 2019 were included. PCP was defined by the following criteria: (1) detection of Pneumocystis jirovecii in respiratory specimens by polymerase chain reaction; (2) clinical manifestations (pyrexia, dry cough, dyspnea, or hypoxia); (3) diffuse interstitial infiltrate on chest imaging; (4) absence of prophylaxis for PCP. Incidence rate ratio (IRR) for Pneumocystis pneumonia associated with sulfasalazine use was calculated by conditional Poisson regression.Results:We identified 48 episodes of PCP in 47 cases. Of these, 15 (31.9%) died. Thirty received SSZ in certain periods of their observations (Table 1). While 46 episodes of PCP developed in the period of 168.9 person-years without SSZ use, only one episode of PCP developed in the period of 103.7 person-years with SSZ use. SSZ use had a decreased risk of PJP (adjusted IRR 0.007, 95% CI <0.001-0.067) after adjusted for age group, the use of glucocorticoid, methotrexate, and tacrolimus, and the use of biologic agent or janus kinase inhibitor (Table 2).Table 1.Characteristic of the 47 patients enrolled in the study.Male/female, n (%)14 (29.8)/33 (70.2)Observational period (years), median (IQR)72.0 (66.3-79.1)Lung disease, n (%)4.7 (1.4-9.5)Use of sulfasalazine, n (%)23 (48.9)Outcome of PCP, death, n (%)30 (63.8)Age at the onset of PCP (years), median (IQR)15 (31.9)PCP, Pneumocystis pneumonia; IQR, interquartile range.Table 2.Unadjusted and adjusted incidence rate ratio for Pneumocystis pneumonia associated with sulfasalazine use.Observation length (years)Episodes of PCP, n (%)Unadjusted IRR95% CI)Adjusted IRRa(% CI)Use of SSZ103.71 (2.1)0.010 (0.001-0.092)0.007 (<0.001-0.067)No use of SSZ168.947 (97.9)referencereferenceIRR, incidence rate ratio; PCP, Pneumocystis pneumonia; SSZ, sulfasalazine.Conclusion:Our study demonstrated the preventive effect of SSZ against PCP with confounders controlled by the SCCS.References:[1]Wang, J., et al. Immune modulation with sulfasalazine attenuates immunopathogenesis but enhances macrophage- mediated fungal clearance during pneumocystis pneumonia. PLoS Pathog. 2010;19;6(8):e1001058.[2]Nunokawa, T. et al. Prophylactic effect of sulfasalazine against Pneumocystis pneumonia in patients with rheumatoid arthritis: A nested case-control study. Semin. Arthritis Rheum. 2019;48(4):573-578.[3]Nunokawa, T., et al. Effect of Sulfasalazine Use on the Presence of Pneumocystis Organisms in the Lung among Patients with Rheumatoid Arthritis: A Test-Negative Design Case-Control Study with PCR Tests. Mod. Rheumatol. 2019;29(3):436-440.[4]Petersen, I., et al. Self controlled case series methods: an alternative to standard epidemiological study designs. BMJ. 2016;12;354:i4515.Disclosure of Interests:None declared

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Disability in instrumental activities of daily living among older adults: gender differences

Revista de Saúde Pública ◽

10.1590/s0034-8910.2014048004754 ◽

2014 ◽

Vol 48 (3) ◽

pp. 379-389 ◽

Cited By ~ 25

Author(s):

Tiago da Silva Alexandre ◽

Ligiana Pires Corona ◽

Daniella Pires Nunes ◽

Jair Lício Ferreira Santos ◽

Yeda Aparecida de Oliveira Duarte ◽

...

Keyword(s):

Older Adults ◽

Gender Differences ◽

Activities Of Daily Living ◽

Daily Living ◽

Rate Ratio ◽

Protective Factor ◽

Incidence Rate Ratio ◽

Incidence Density ◽

Instrumental Activities ◽

Clinical Conditions

OBJECTIVE To analyze gender differences in the incidence and determinants of disability regarding instrumental activities of daily living among older adults. METHODS The data were extracted from the Saúde, Bem-Estar e Envelhecimento (SABE – Health, Wellbeing and Ageing) study. In 2000, 1,034 older adults without difficulty in regarding instrumental activities of daily living were selected. The following characteristics were evaluated at the baseline: sociodemographic and behavioral variables, health status, falls, fractures, hospitalizations, depressive symptoms, cognition, strength, mobility, balance and perception of vision and hearing. Instrumental activities of daily living such as shopping and managing own money and medication, using transportation and using the telephone were reassessed in 2006, with incident cases of disability considered as the outcome. RESULTS The incidence density of disability in instrumental activities of daily living was 44.7/1,000 person/years for women and 25.2/1,000 person/years for men. The incidence rate ratio between women and men was 1.77 (95%CI 1.75;1.80). After controlling for socioeconomic status and clinical conditions, the incidence rate ratio was 1.81 (95%CI 1.77;1.84), demonstrating that women with chronic disease and greater social vulnerability have a greater incidence density of disability in instrumental activities of daily living. The following were determinants of the incidence of disability: age ≥ 80 and worse perception of hearing in both genders; stroke in men; and being aged 70 to 79 in women. Better cognitive performance was a protective factor in both genders and better balance was a protective factor in women. CONCLUSIONS The higher incidence density of disability in older women remained even after controlling for adverse social and clinical conditions. In addition to age, poorer cognitive performance and conditions that adversely affect communication disable both genders. Acute events, such as a stroke, disables elderly men more, whereas early deficits regarding balance disable women more.

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Inflammatory Bowel Disease and Risk of Major Bleeding During Anticoagulation for Venous Thromboembolism

Inflammatory Bowel Diseases ◽

10.1093/ibd/izaa337 ◽

2021 ◽

Author(s):

Susanna Scharrer ◽

Christian Primas ◽

Sabine Eichinger ◽

Sebastian Tonko ◽

Maximilian Kutschera ◽

...

Keyword(s):

Ulcerative Colitis ◽

Inflammatory Bowel Disease ◽

Venous Thromboembolism ◽

Incidence Rate ◽

Rate Ratio ◽

Incidence Rate Ratio ◽

Fatal Bleeding ◽

Adjusted Incidence Rate ◽

Inflammatory Bowel ◽

Adjusted Incidence

Abstract Background Little is known about the bleeding risk in patients with inflammatory bowel disease (IBD) and venous thromboembolism (VTE) treated with anticoagulation. Our aim was to elucidate the rate of major bleeding (MB) events in a well-defined cohort of patients with IBD during anticoagulation after VTE. Methods This study is a retrospective follow-up analysis of a multicenter cohort study investigating the incidence and recurrence rate of VTE in IBD. Data on MB and IBD- and VTE-related parameters were collected via telephone interview and chart review. The objective of the study was to evaluate the impact of anticoagulation for VTE on the risk of MB by comparing time periods with anticoagulation vs those without anticoagulation. A random-effects Poisson regression model was used. Results We included 107 patients (52 women, 40 with ulcerative colitis, 64 with Crohn disease, and 3 with unclassified IBD) in the study. The overall observation time was 388 patient-years with and 1445 patient-years without anticoagulation. In total, 23 MB events were registered in 21 patients, among whom 13 MB events occurred without anticoagulation and 10 occurred with anticoagulation. No fatal bleeding during anticoagulation was registered. The incidence rate for MB events was 2.6/100 patient-years during periods exposed to anticoagulation and 0.9/100 patient-years during the unexposed time. Exposure to anticoagulation (adjusted incidence rate ratio, 3.7; 95% confidence interval, 1.5-9.0; P = 0.003) and ulcerative colitis (adjusted incidence rate ratio, 3.5; 95% confidence interval, 1.5-8.1; P = 0.003) were independent risk factors for MB events. Conclusion The risk of major but not fatal bleeding is increased in patients with IBD during anticoagulation. Our findings indicate that this risk may be outweighed by the high VTE recurrence rate in patients with IBD.

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Cannulation technique and complications in arteriovenous fistulas: a Swedish Renal Registry-based cohort study

BMC Nephrology ◽

10.1186/s12882-021-02458-z ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Karin Staaf ◽

Anders Fernström ◽

Fredrik Uhlin

Keyword(s):

Cohort Study ◽

Lower Risk ◽

Rate Ratio ◽

Incidence Rate Ratio ◽

National Registry ◽

The Other ◽

Arteriovenous Fistulas ◽

Cannulation Technique ◽

Using Data ◽

The Relationship

Abstract Background The four cannulation techniques, rope ladder (RL), area puncture (AP), buttonhole with blunt needles (BHb), and buttonhole with sharp needles (BHs), affects the arteriovenous fistula (AVF) in different ways. The aim of this study was to describe the relationship between the different cannulation techniques and the occurrence of AVF complications. Methods The study was performed as a national registry-based cohort study using data from the Swedish Renal Registry (SRR). Data were collected from January 2014 to October 2019. Seventy of Sweden’s dialysis units participate in the registry. We analyzed a total of 1328 AVFs in this study. The risk of complications was compared between the four different cannulation techniques. The risk of AVF complications was measured by the incidence and incidence rate ratio (IRR). We compared the IRRs of complications between different cannulation techniques. Results BHs is the most common cannulation technique in Sweden. It has been used in 55% of the AVFs at some point during their functional patency. BHb (29%), RL (13%), and AP (3%) has been used less. BHb had the lowest risk of complications compared to the other techniques, and a significantly lower risk of stenosis, infiltration, cannulation difficulties, compared to RL and BHs. Cannulation difficulties were significantly more common using AP compared to BHs, and BHb. Infections were not significantly increased using the buttonhole technique. Conclusions BHb had the lowest risk of complications. Infections were not significantly increased using the buttonhole technique. Dialysis units with a low infection rate may continue to use the buttonhole technique, as the risk of complications is lower.

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Increases in social support co-occur with decreases in depressive symptoms and substance use problems among adults in permanent supportive housing: an 18-month longitudinal study

BMC Psychology ◽

10.1186/s40359-020-00507-0 ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Zhengqi Tan ◽

Eun-Young Mun ◽

Uyen-Sa D. T. Nguyen ◽

Scott T. Walters

Keyword(s):

Social Support ◽

Substance Use ◽

Depressive Symptoms ◽

Protective Factor ◽

Growth Models ◽

Parallel Process ◽

Supportive Housing ◽

Permanent Supportive Housing ◽

Substance Use Problems ◽

Over Time

Abstract Background Social support is a well-known protective factor against depressive symptoms and substance use problems, but very few studies have examined its protective effects among residents of permanent supportive housing (PSH), a housing program for people with a history of chronic homelessness. We utilized unconditional latent growth curve models (LGCMs) and parallel process growth models to describe univariate trajectories of social support, depressive symptoms, and substance use problems and to examine their longitudinal associations in a large sample of adults residing in PSH. Methods Participants were 653 adult PSH residents in North Texas (56% female; 57% Black; mean age: 51 years) who participated in a monthly health coaching program from 2014 to 2017. Their health behaviors were assessed at baseline and tracked every six months at three follow-up visits. Results Unconditional LGCMs indicated that over time, social support increased, whereas depressive symptoms and substance use problems decreased. However, their rates of change slowed over time. Further, in parallel process growth models, we found that at baseline, individuals with greater social support tended to have less severe depressive symptoms and substance use problems (coefficients: − 0.67, p < 0.01; − 0.52, p < 0.01, respectively). Individuals with a faster increase in social support tended to have steeper rates of reduction in both depressive symptoms (coefficient: − 0.99, p < 0.01) and substance use problems (coefficient: − 0.98, p < 0.01), respectively. Conclusions This study suggests that plausibly, increases in social support, though slowing over time, still positively impact depressive symptoms and substance use problems among PSH residents. Future PSH programs could emphasize social support as an early component as it may contribute to clients’ overall health.

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Perioperative management after elective cardiac surgery: the predictive value of procalcitonin for infective and noninfective complications

Future Cardiology ◽

10.2217/fca-2020-0245 ◽

2021 ◽

Author(s):

Alice Laudisio ◽

Antonio Nenna ◽

Marta Musarò ◽

Silvia Angeletti ◽

Francesco Nappi ◽

...

Keyword(s):

Cardiac Surgery ◽

Postoperative Complications ◽

Predictive Value ◽

Odds Ratio ◽

Rate Ratio ◽

Perioperative Management ◽

Incidence Rate Ratio ◽

Adverse Outcomes ◽

Elective Cardiac Surgery ◽

The Third

Objective: Procalcitonin (PCT) has been associated with adverse outcomes after cardiac surgery. Nevertheless, there is no consensus on thresholds and timing of PCT measurement to predict adverse outcomes. Materials & methods: A total of 960 patients undergoing elective cardiac surgery were retrospectively evaluated. PCT levels were measured from the first to the seventh postoperative day (POD). The onset of complications was recorded. Results: Complications occurred in 421 (44%) patients. PCT on the third POD was associated with the occurrence of any kind of complications (odds ratio: 1.06; p: 0.037), and noninfectious complications (odds ratio: 1.05; p: 0.035), after adjusting. PCT above the median value at the third POD (>0.33 μg/l) predicted postoperative complications (incidence rate ratio: 1.13; p = 0.035). Conclusion: PCT seems to predict postoperative complications in cardiac surgery. The determination at the third POD yields the greatest sensitivity and specificity.

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Secrets of the hospital underbelly: abundance of antimicrobial resistance genes in hospital wastewater reflects hospital antimicrobial use and inpatient length of stay

10.1101/19006858 ◽

2019 ◽

Author(s):

Meghan R. Perry ◽

Bram van Bunnik ◽

Luke McNally ◽

Bryan Wee ◽

Patrick Munk ◽

...

Keyword(s):

Antimicrobial Resistance ◽

Length Of Stay ◽

Incidence Rate ◽

Rate Ratio ◽

Incidence Rate Ratio ◽

Clinical Activity ◽

Hospital Wastewater ◽

Antimicrobial Consumption ◽

Gene Abundance ◽

Class Level

ABSTRACTIntroductionHospital wastewater is a potential major source of antimicrobial resistance (AMR). This study uses metagenomics to ask how abundances of AMR genes in hospital wastewater are related to clinical activity.MethodsSewage was collected over a 24-hour period from multiple wastewater collection points representing different specialties within a tertiary hospital site and simultaneously from community sewage works. High throughput shotgun sequencing was performed using Illumina HiSeq4000. AMR gene abundances were correlated to hospital antimicrobial usage (AMU), data on clinical activity and resistance prevalence in clinical isolates.FindingsMicrobiota and AMR gene composition varied between each collection point and overall AMR gene abundance was higher in hospital wastewater than in community influent. The composition of AMR genes correlated with microbiota composition (Procrustes analysis, p=0.002). Increased antimicrobial consumption at a class level was associated with higher AMR gene abundance within that class in wastewater (incidence rate ratio 2.80, C.I. 1.2-6.5, p=0.016). Prolonged average patient length of stay was associated with higher total AMR gene abundance in wastewater (incidence rate ratio 2.05, C.I. 1.39-3.01, p=0.0003). AMR gene abundance at a class level within hospital wastewater did not reflect resistance patterns in the 181 clinical isolates grown from hospital inpatients over the time of wastewater sampling.ConclusionsHospital antimicrobial consumption and patient length of stay are important drivers of AMR gene outflow into the environment. Using metagenomics to identify the full range of AMR genes in hospital wastewater could represent a useful surveillance tool to monitor hospital AMR gene outflow and guide environmental policy on AMR.

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What Can Help? Examining Levels of Substance (Non)use as a Protective Factor in the Effect of ACEs on Crime

Youth Violence and Juvenile Justice ◽

10.1177/1541204017728998 ◽

2017 ◽

Vol 17 (1) ◽

pp. 42-61 ◽

Cited By ~ 12

Author(s):

Jessica M. Craig ◽

Jonathan Intravia ◽

Kevin T. Wolff ◽

Michael T. Baglivio

Keyword(s):

Substance Use ◽

Protective Factor ◽

Policy Implications ◽

Future Research ◽

Southern State ◽

Childhood Experiences ◽

Adverse Childhood ◽

Race Ethnicity ◽

The Relationship

Although the deleterious impact of adverse childhood experiences (ACEs) on offending has been established, less is known about the possible protective factors that may buffer this relationship. Using a sample of over 28,000 adjudicated delinquents from a large southern state, the current study investigated the role of substance (non)use on the relationship between ACEs and recidivism and whether these results differed by race/ethnicity and sex. Results illustrate that ACEs increase the likelihood of recidivism among youth who engaged in moderate-to-high substance use. However, this effect was not found among youth who reported little-to-no substance use. Furthermore, these effects were largely consistent across race/ethnicity and sex. Policy implications of this buffering effect are discussed as well as limitations and directions for future research.

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Accelerometer-Measured Daily Steps, Physical Function, and Subsequent Fall Risk in Older Women: The Objective Physical Activity and Cardiovascular Disease in Older Women Study

Journal of Aging and Physical Activity ◽

10.1123/japa.2021-0159 ◽

2021 ◽

pp. 1-11

Author(s):

Benjamin T. Schumacher ◽

John Bellettiere ◽

Michael J. LaMonte ◽

Kelly R. Evenson ◽

Chongzhi Di ◽

...

Keyword(s):

Physical Function ◽

Older Women ◽

Incidence Rate ◽

Fall Risk ◽

Rate Ratio ◽

Incidence Rate Ratio ◽

Steps Per Day ◽

Falls In Older Adults ◽

Adjusted Incidence Rate ◽

Adjusted Incidence

Steps per day were measured by accelerometer for 7 days among 5,545 women aged 63–97 years between 2012 and 2014. Incident falls were ascertained from daily fall calendars for 13 months. Median steps per day were 3,216. There were 5,473 falls recorded over 61,564 fall calendar-months. The adjusted incidence rate ratio comparing women in the highest versus lowest step quartiles was 0.71 (95% confidence interval [0.54, 0.95]; ptrend across quartiles = .01). After further adjustment for physical function using the Short Physical Performance Battery, the incidence rate ratio was 0.86 ([0.64, 1.16]; ptrend = .27). Mediation analysis estimated that 63.7% of the association may be mediated by physical function (p = .03). In conclusion, higher steps per day were related to lower incident falls primarily through their beneficial association with physical functioning. Interventions that improve physical function, including those that involve stepping, could reduce falls in older adults.

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Incidence of chronic immune-mediated inflammatory diseases after diagnosis with Kawasaki disease: a population-based cohort study

Rheumatology ◽

10.1093/rheumatology/keab680 ◽

2021 ◽

Author(s):

Stephen G Fung ◽

Richard Webster ◽

M Ellen Kuenzig ◽

Braden D Knight ◽

Michelle Batthish ◽

...

Keyword(s):

Multiple Sclerosis ◽

Cohort Study ◽

Liver Disease ◽

Kawasaki Disease ◽

Sclerosing Cholangitis ◽

Rate Ratio ◽

Incidence Rate Ratio ◽

Population Based ◽

Immune Mediated ◽

Increased Risk

Abstract Objectives Kawasaki disease (KD) is an immune-mediated vasculitis of childhood with multi-organ inflammation. We determined the risk of subsequent immune-mediated inflammatory disease (IMID), including arthritis, type 1 diabetes, IBD, autoimmune liver disease, primary sclerosing cholangitis and multiple sclerosis. Methods We conducted a matched population-based cohort study using health administrative data from Ontario, Canada. Children aged <18 years born between 1991 and 2016 diagnosed with KD (n = 3753) were matched to 5 non-KD controls from the general population (n = 18 749). We determined the incidence of IMIDs after resolution of KD. Three- and 12-month washout periods were used to exclude KD-related symptoms. Results There was an elevated risk of arthritis in KD patients compared with non-KD controls, starting 3 months after index date [103.0 vs 12.7 per 100 000 person-years (PYs); incidence rate ratio 8.07 (95% CI 4.95, 13.2); hazard ratio 8.08 (95% CI 4.95, 13.2), resulting in the overall incidence of IMIDs being elevated in KD patients (175.1 vs 68.0 per 100 000 PYs; incidence rate ratio 2.58 (95% CI 1.93, 3.43); hazard ratio 2.58, 95% CI 1.94, 3.43]. However, there was no increased risk for diabetes, IBD, autoimmune liver disease, primary sclerosing cholangitis or multiple sclerosis in KD patients. Similar results were observed using a 12-month washout period. Conclusion Children diagnosed with KD were at increased risk of arthritis following the acute KD event, but not other IMIDs. Health-care providers should monitor for arthritis in children following a diagnosis of KD.

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