scholarly journals Risk factors relate to the variability of health outcomes as well as the mean: a GAMLSS tutorial

eLife ◽  
2022 ◽  
Vol 11 ◽  
Author(s):  
David Bann ◽  
Liam Wright ◽  
Tim J Cole
Keyword(s):  
Risk Factors ◽  
Social Class ◽  
Health Outcomes ◽  
Physical Inactivity ◽  
Research Council ◽  
Additive Models ◽  
Mental Wellbeing ◽  
Lower Social Class ◽  
The Mean ◽  
Lower Variability

Background: Risk factors or interventions may affect the variability as well as the mean of health outcomes. Understanding this can aid aetiological understanding and public health translation, in that interventions which shift the outcome mean and reduce variability are typically preferable to those which affect only the mean. However, most commonly used statistical tools do not test for differences in variability. Tools that do have few epidemiological applications to date, and fewer applications still have attempted to explain their resulting findings. We thus provide a tutorial for investigating this using GAMLSS (Generalised Additive Models for Location, Scale and Shape). Methods: The 1970 British birth cohort study was used, with body mass index (BMI; N=6,007) and mental wellbeing (Warwick-Edinburgh Mental Wellbeing Scale; N=7,104) measured in midlife (42-46 years) as outcomes. We used GAMLSS to investigate how multiple risk factors (sex, childhood social class and midlife physical inactivity) related to differences in health outcome mean and variability. Results: Risk factors were related to sizable differences in outcome variability-for example males had marginally higher mean BMI yet 28% lower variability; lower social class and physical inactivity were each associated with higher mean and higher variability (6.1% and 13.5% higher variability, respectively). For mental wellbeing, gender was not associated with the mean while males had lower variability (-3.9%); lower social class and physical inactivity were each associated with lower mean yet higher variability (7.2% and 10.9% higher variability, respectively). Conclusions: The results highlight how GAMLSS can be used to investigate how risk factors or interventions may influence the variability in health outcomes. This underutilised approach to the analysis of continuously distributed outcomes may have broader utility in epidemiologic, medical, and psychological sciences. A tutorial and replication syntax is provided online to facilitate this (https://osf.io/5tvz6/). Funding: DB is supported by the Economic and Social Research Council (grant number ES/M001660/1), The Academy of Medical Sciences / Wellcome Trust ('Springboard Health of the Public in 2040' award: HOP001/1025); DB and LW are supported by the Medical Research Council (MR/V002147/1). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

scholarly journals What if risk factors influenced the variability of health outcomes as well as the mean? Evidence and implications

2021 ◽  
Author(s):  
David Bann ◽  
Tim J Cole
Keyword(s):  
Risk Factors ◽  
Social Class ◽  
Health Outcomes ◽  
Physical Inactivity ◽  
Causal Effect ◽  
Additive Models ◽  
Mental Wellbeing ◽  
Lower Social Class ◽  
The Mean ◽  
Lower Variability

Risk factors may affect the variability as well as the mean of health outcomes. Understanding this can aid aetiological understanding and public health translation, in that interventions which shift the outcome mean and reduce variability are preferable to those which affect only the mean. However, few statistical tools routinely test for differences in variability. We used GAMLSS (Generalised Additive Models for Location, Scale and Shape) to investigate how multiple risk factors (sex, childhood social class and midlife physical inactivity) related to differences in health outcome mean and variability. The 1970 British birth cohort study was used, with body mass index (BMI; N = 6,025) and mental wellbeing (Warwick-Edinburgh Mental Wellbeing Scale; N = 7,128) as outcomes. For BMI, males had a 2% higher mean than females yet 28% lower variability. Lower social class and physical inactivity were associated with higher mean and higher variability (6% and 13% respectively). For mental wellbeing, gender was not associated with the mean while males had 4% lower variability. Lower social class and physical inactivity were associated with lower mean yet higher variability (−7% and 11% respectively). This provides empirical support for the notion that risk factors can reduce or increase variability in health outcomes. Such findings may be explained by heterogeneity in the causal effect of each exposure, by the influence of other (typically unmeasured) variables, and/or by measurement error. This underutilised approach to the analysis of continuously distributed outcomes may have broader utility in epidemiological, medical, and psychological sciences.

scholarly journals Risk factors of coronary heart disease: attitude and behaviour in family practice in Saudi Arabia

1999 ◽  
Vol 5 (1) ◽  
pp. 35-45 ◽  
Author(s):  
M. S. Khattab ◽  
M. A. Abolfotouh ◽  
W. Alakija ◽  
M. A. Al Humaidi ◽  
S. Al Wahat
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Family Practice ◽  
Physical Inactivity ◽  
Fat Intake ◽  
Significant Difference ◽  
Lifestyle Questionnaire ◽  
Males And Females ◽  
The Mean

To study risk factors of attitudes and behaviour towards coronary heart disease [CHD], 280 Saudis > or = 20 years attending a family practice answered a structured health and lifestyle questionnaire and had their weight, height, blood pressure and random total cholesterol measured. Significant difference was found between males and females in the mean number of cardiovascular risk factors [t = -3.03, P < 0.01]. Few people with high dietary fat intake, obesity or physical inactivity perceived their behaviour as harmful. The number of people who perceived an associated risk to their health increased with incidence of smoking and obesity but not with high fat intake. Physically inactive people were least likely to perceive their behaviour as harmful

scholarly journals Childhood adversity and subsequent mental health status in adulthood: screening for associations using two linked surveys

2015 ◽  
Vol 25 (2) ◽  
pp. 160-170 ◽  
Author(s):  
S. B. Patten ◽  
T. C. R. Wilkes ◽  
J. V. A. Williams ◽  
D. H. Lavorato ◽  
N. el-Guebaly ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Longitudinal Study ◽  
Major Depression ◽  
Health Outcomes ◽  
Psychotropic Medication ◽  
Physical Inactivity ◽  
Medication Use ◽  
Childhood Adversity ◽  
Childhood Adversities

Aims.Accumulating evidence links childhood adversity to negative health outcomes in adulthood. However, most of the available evidence is retrospective and subject to recall bias. Published reports have sometimes focused on specific childhood exposures (e.g. abuse) and/or specific outcomes (e.g. major depression). Other studies have linked childhood adversity to a large and diverse number of adult risk factors and health outcomes such as cardiovascular disease. To advance this literature, we undertook a broad examination of data from two linked surveys. The goal was to avoid retrospective distortion and to provide a descriptive overview of patterns of association.Methods.A baseline interview for the Canadian National Longitudinal Study of Children and Youth collected information about childhood adversities affecting children aged 0–11 in 1994. The sampling procedures employed in a subsequent study called the National Population Health Survey (NPHS) made it possible to link n = 1977 of these respondents to follow-up data collected later when respondents were between the ages of 14 and 27. Outcomes included major depressive episodes (MDE), some risk factors and educational attainment. Cross-tabulations were used to examine these associations and adjusted estimates were made using the regression models. As the NPHS was a longitudinal study with multiple interviews, for most analyses generalized estimating equations (GEE) were used. As there were multiple exposures and outcomes, a statistical procedure to control the false discovery rate (Benjamini–Hochberg) was employed.Results.Childhood adversities were consistently associated with a cluster of potentially related outcomes: MDE, psychotropic medication use and smoking. These outcomes may be related to one another since psychotropic medications are used in the treatment of major depression, and smoking is strongly associated with major depression. However, no consistent associations were observed for other outcomes examined: physical inactivity, excessive alcohol consumption, binge drinking or educational attainment.Conclusions.The conditions found to be the most strongly associated with childhood adversities were a cluster of outcomes that potentially share pathophysiological connections. Although prior literature has suggested that a very large number of adult outcomes, including physical inactivity and alcohol-related outcomes follow childhood adversity, this analysis suggests a degree of specificity with outcomes potentially related to depression. Some of the other reported adverse outcomes (e.g. those related to alcohol use, physical inactivity or more distal outcomes such as obesity and cardiovascular disease) may emerge later in life and in some cases may be secondary to depression, psychotropic medication use and smoking.

Mental Health Among Adolescents from Returned Portuguese Immigrant Families

2010 ◽  
Vol 69 (3) ◽  
pp. 131-139 ◽  
Author(s):  
Félix Neto
Keyword(s):  
Mental Health ◽  
Health Outcomes ◽  
Mental Health Problems ◽  
Immigrant Families ◽  
Health Problems ◽  
Mental Health Outcomes ◽  
Control Group ◽  
Older Adolescents ◽  
The Mean ◽  
Portuguese Adolescents

This study investigated mental health problems and their predictors among adolescents from returned immigrant families. The sample consisted of 360 returned adolescents (mean age = 16.8 years; SD = 1.9). The mean duration of a sojourn in Portugal for the sample was 8.2 years (SD = 4.5). A control group of 217 Portuguese youths were also included in the study. Adolescents from immigrant families reported mental health levels similar to those of Portuguese adolescents who have never migrated. Girls showed more mental health problems than boys. Younger adolescents showed fewer mental health problems than older adolescents. Adaptation variables contributed to mental health outcomes even after acculturation variables were accounted for. Implications of the study for counselors are discussed.

‘Urfi marriage, an Egyptian Version of Cohabitation?

1970 ◽  
pp. 64-69
Author(s):  
Ikran Eum
Keyword(s):  
Social Class ◽  
Young People ◽  
The State ◽  
Sexual Desires ◽  
Lower Social Class ◽  
State Pension

In Egypt, the term ‘urfi2 in relation to marriage means literally “customary” marriage, something that has always existed in Egypt but nowadays tends mostly to be secretly practiced among young people. Traditionally, according to Abaza,3 ‘urfi marriage took place not only for practical purposes (such as enabling widows to remarry while keeping the state pension of their deceased husbands), but also as a way of matchmaking across classes (since men from the upper classes use ‘urfi marriage as a way of marrying a second wife from a lower social class). In this way a man could satisfy his sexual desires while retaining his honor by preserving his marriage to the first wife and his position in the community to which he belonged, and keeping his second marriage secret.

Quantifying empathy levels among UK undergraduate medical students: an online survey

2020 ◽  
Vol 70 (suppl 1) ◽  
pp. bjgp20X711293
Author(s):  
Sarah Garnett ◽  
Hajira Dambha-Miller ◽  
Beth Stuart
Keyword(s):  
Medical Students ◽  
Health Outcomes ◽  
Medical School ◽  
Curriculum Design ◽  
Online Survey ◽  
Mental Wellbeing ◽  
Reactivity Index ◽  
Free Text ◽  
Undergraduate Medical Students ◽  
Cross Sectional

BackgroundEmpathy is a key health care concept and refers to care that incorporates understanding of patient perspective’s, shared decision making, and consideration of the broader context in which illness is experience. Evidence suggests experiences of doctor empathy correlate with improved health outcomes and patient satisfaction. It has also been linked to job satisfaction, and mental wellbeing for doctors. To date, there is a paucity of evidence on empathy levels among medical students. This is critical to understand given that it is a key point at which perceptions and practices of empathy in the longer term might be formed.AimTo quantify the level of empathy among UK undergraduate medical studentsMethodAn anonymised cross-sectional online survey was distributed to medical students across three universities. The previously validated Davis’s Interpersonal Reactivity Index was used to quantify empathy. The survey also collected information on age, sex, ethnicity, year of medical school training and included a free-text box for ‘any other comments’.ResultsData analysis is currently underway with high response rates. Mean empathy scores by age, sex, year of study and ethnic group are presented. A correlation analysis will examine associations between age and year of study, and mean empathy sores.ConclusionThese data will help to provide a better understanding of empathy levels to inform the provision of future empathy training and medical school curriculum design. Given previous evidence linking experiences of empathy to better health outcomes, the findings may also be significant to future patient care

Investigation of the Association Between Carotid Artery Intima-Media Thickness (IMT) and Cardiac Risk Factors in Patients with Systemic Lupus Erythematosus

2020 ◽  
Vol 16 (2) ◽  
pp. 125-133
Author(s):  
Zahra Rezaieyazdi ◽  
Sima Sedighi ◽  
Masoumeh Salari ◽  
Mohammadreza H. Fard ◽  
Mahmoud R. Azarpazhooh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Insulin Resistance ◽  
Lupus Erythematosus ◽  
Serum Insulin ◽  
Venous Blood ◽  
Test Group ◽  
Control Groups ◽  
Significant Difference ◽  
The Mean ◽  
And Control

Background: The relationship between SLE and traditional risk factors for cardiovascular events was evaluated. Methods: The data regarding sixty patients with SLE and 30 healthy controls (age and sex matched) were gathered using SLEDAI forms. Venous blood (10mL) from all the participants was examined for hs-CRP, homocysteine, VCAM1, CBC, anti-DNA antibody, C3, C4, low-density lipoprotein (LDL), cholesterol, FBS and triglyceride. : The IMT of carotid arteries was determined bilaterally by ultrasound. Other measurements included insulin levels via Elisa (Linco/Millipore Corp) and the HOMA-IR index for insulin resistance. Results: The mean age (in years) in the test and control groups was 28.8±10.3 (18-52) and 33.8±9.13 (18-48), respectively. Results: The mean age (in years) in the test and control groups was 28.8±10.3 (18-52) and 33.8±9.13 (18-48), respectively. : The average IMT in the test group was directly related to serum levels of VCAM1 (p<0.001), homocysteine (p<0.001), cholesterol (p<0.009), LDL (p<0.001), TG (p<0.001), and FPG (p=0.004). The association between other risk factors, insulin resistance, carotid IMT and SLEDAI, was nonexistent. Mean insulin and insulin resistance levels in all the participants were 0.43±2.06 µU/mL and 0.09±0.44, respectively. There was no significant difference between the test and control groups regarding serum insulin and insulin resistance levels (p=0.42 and p=0.9, respectively). None of the risk factors, such as hsCRP, VCAM1, or homocysteine, were shown to be related to insulin resistance (p=0.6, p=0.6, p=0.09, respectively). Conclusion:: Our findings did not show an increase in the prevalence of atherosclerosis in patients with SLE. There was no association between IMT and insulin resistance. However, the former was associated with FPG, total cholesterol, LDL, TG, homocystein and VCAM1.

Social class and envy among Chinese undergraduates: Victim justice sensitivity as a mediator

2020 ◽  
Vol 48 (6) ◽  
pp. 1-9
Author(s):  
You-Juan Hong ◽  
Rong-Mao Lin ◽  
Rong Lian
Keyword(s):  
Social Class ◽  
Negative Emotion ◽  
Social Hierarchy ◽  
Scholarly Research ◽  
Justice Sensitivity ◽  
Lower Social Class ◽  
Subjective Social Class ◽  
The Relationship ◽  
Chinese Undergraduates

We examined the relationship between social class and envy, and the role of victim justice sensitivity in this relationship among a group of 1,405 Chinese undergraduates. The students completed measures of subjective social class, victim justice sensitivity, and dispositional envy. The results show that a lower social class was significantly and negatively related to envy and victim justice sensitivity, whereas victim justice sensitivity was significantly and positively related to envy. As predicted, a lower social class was very closely correlated with envy. In addition, individuals with a lower (vs. higher) social class had a greater tendency toward victim justice sensitivity, which, in turn, increased their envy. Overall, our results advance scholarly research on the psychology of social hierarchy by clarifying the relationship between social class and the negative emotion of envy.

scholarly journals Customization of Diet May Promote Exercise and Improve Mental Wellbeing in Mature Adults: The Role of Exercise as a Mediator

2021 ◽  
Vol 11 (5) ◽  
pp. 435
Author(s):  
Lina Begdache ◽  
Cara M. Patrissy
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
Mental Distress ◽  
Rank Order ◽  
Principal Component ◽  
Dietary Factors ◽  
Mental Wellbeing ◽  
Modifiable Risk Factors ◽  
Food Groups ◽  
Dietary Practices

Diet, dietary practices and exercise are modifiable risk factors for individuals living with mental distress. However, these relationships are intricate and multilayered in such a way that individual factors may influence mental health differently when combined within a pattern. Additionally, two important factors that need to be considered are gender and level of brain maturity. Therefore, it is essential to assess these modifiable risk factors based on gender and age group. The purpose of the study was to explore the combined and individual relationships between food groups, dietary practices and exercise to appreciate their association with mental distress in mature men and women. Adults 30 years and older were invited to complete the food–mood questionnaire. The anonymous questionnaire link was circulated on several social media platforms. A multi-analyses approach was used. A combination of data mining techniques, namely, a mediation regression analysis, the K-means clustering and principal component analysis as well as Spearman’s rank–order correlation were used to explore these research questions. The results suggest that women’s mental health has a higher association with dietary factors than men. Mental distress and exercise frequency were associated with different dietary and lifestyle patterns, which support the concept of customizing diet and lifestyle factors to improve mental wellbeing.

scholarly journals The prevalence of risk factors associated with non-communicable diseases in Afghan refugees in southern Iran: a cross-sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Erfan Taherifard ◽  
Mohammad Javad Moradian ◽  
Ehsan Taherifard ◽  
Abdolrasool Hemmati ◽  
Behnaz Rastegarfar ◽  
...  
Keyword(s):  
Risk Factors ◽  
Tobacco Smoking ◽  
Physical Inactivity ◽  
Vegetable Intake ◽  
Vegetable Consumption ◽  
Communicable Diseases ◽  
Cross Sectional ◽  
Non Communicable Diseases ◽  
Afghan Refugees ◽  
Southern Iran

Abstract Background Refugees are highly vulnerable to many health-related risks. Monitoring non-communicable diseases (NCDs) is of overriding importance in these populations. This study aimed to investigate the prevalence of risk factors for NCDs amongst Afghan refugees in a refugee camp located in southern Iran. Methods This cross-sectional sturdy was conducted in 2018. Risk factors such as inadequate nutrition, physical inactivity, tobacco smoking, obesity and overweight, hypertension (HTN), elevated fasting plasma glucose (FPG), and dyslipidaemia were assessed. Data were gathered with a modified WHO STEPS procedure. Prevalence and age-standardized prevalence and their 95% confidence intervals (CI) were estimated. Results The estimated prevalence were 94% for inadequate fruit/vegetable consumption, 18% for physical inactivity, 9% for tobacco smoking, 3% for FPG, 20% for HTN, 51% for central obesity, 24% for overweight, 19% for obesity, and 69% for dyslipidaemia. Conclusions Except for inadequate fruit and vegetable intake and dyslipidaemia, the prevalence of other NCD risk factors was low among Afghan refugees in Iran. Raising awareness about healthy diet and its importance and the provision of more affordable fruit and vegetables are two effective measures toward improving the health of refugees in Iran.

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