Migration and child health inequities in Nigeria: a multilevel analysis of contextual- and individual-level factors

Objective: To assess the role of rural–urban migration in the risks of under-five death; to identify possible mechanisms through which migration may influence mortality; and to determine individual- and community-level relationships between migration status and under-five death. Method: Multilevel Cox regression analysis was used on a nationally representative sample of 6029 children from 2735 mothers aged 15–49 years and nested within 365 communities from the 2003 Nigeria Demographic and Health Survey. Hazard ratios with 95% confidence intervals were used to express the measures of association between the characteristics, and intra-class coefficients were used to express the measures of variation. Results: Children of rural non-migrant mothers had significantly lower risks of under-five death than children of rural–urban migrant mothers. The disruption of family and community ties, low socio-economic position and vulnerability, and the difficulties migrants face in adapting into the new urban environment, may predispose the children of rural–urban migrants to higher mortality. Conclusion: Our results stress the need for community-level and socio-economic interventions targeted at migrant groups within urban areas to improve their access to health care services, maternal education, as well as the general socio-economic situation of women

Mediterranean Diet Score and prostate cancer risk in a Swedish population-based case–control study

Several individual components of the Mediterranean diet have been shown to offer protection against prostate cancer. The present study is the first to investigate the association between adherence to the Mediterranean diet and the relative risk of prostate cancer. We also explored the usefulness of the Mediterranean Diet Score (MDS) in a non-Mediterranean population. FFQ data were obtained from 1482 incident prostate cancer patients and 1108 population-based controls in the Cancer of the Prostate in Sweden (CAPS) study. We defined five MDS variants with different components or using either study-specific intakes or intakes in a Greek reference population as cut-off values between low and high intake of each component. Unconditional logistic regression was used to estimate the relative risk of prostate cancer for high and medium v. low MDS, as well as potential associations with the individual score components. No statistically significant association was found between adherence to the Mediterranean diet based on any of the MDS variants and prostate cancer risk (OR range: 0·96–1·19 for total prostate cancer, comparing high with low adherence). Overall, we found little support for an association between the Mediterranean diet and prostate cancer in this Northern European study population. Despite potential limitations inherent in the study or in the build-up of a dietary score, we suggest that the original MDS with study-specific median intakes as cut-off values between low and high intake is useful in assessing the adherence to the Mediterranean diet in non-Mediterranean populations

Propensity score methodology for confounding control in health care utilization databases

Propensity score (PS) methodology is a common approach to control for confounding in nonexperimental studies of treatment effects using health care utilization databases. This methodology offers researchers many advantages compared with conventional multivariate models: it directly focuses on the determinants of treatment choice, facilitating the understanding of the clinical decision-making process by the researcher; it allows for graphical comparisons of the distribution of propensity scores and truncation of subjects without overlapping PS indicating a lack of equipoise; it allows transparent assessment of the confounder balance achieved by the PS at baseline; and it offers a straightforward approach to reduce the dimensionality of sometimes large arrays of potential confounders in utilization databases, directly addressing the “curse of dimensionality” in the context of rare events. This article provides an overview of the use of propensity score methodology for pharmacoepidemiologic research with large health care utilization databases, covering recent discussions on covariate selection, the role of automated techniques for addressing unmeasurable confounding via proxies, strategies to maximize clinical equipoise at baseline, and the potential of machine-learning algorithms for optimized propensity score estimation. The appendix discusses the available software packages for PS methodology. Propensity scores are a frequently used and versatile tool for transparent and comprehensive adjustment of confounding in pharmacoepidemiology with large health care databases

Metformin and the risk of renal cell carcinoma: a case-control analysis

Metformin use has been associated previously with a decreased risk of cancer, but its association with renal cell carcinoma has not yet been investigated in observational studies. We aimed to explore the association between the use of metformin and other antidiabetic drugs and the risk of renal cell carcinoma (RCC). We carried out a case-control analysis in the UK-based Clinical Practice Research Datalink. We included individuals with an incident RCC between January 1995 and December 2013 younger than the age of 90 years. Six controls per case were matched on age, sex, calendar time, general practice, and number of years of active history in the Clinical Practice Research Datalink before the index date. We included BMI, smoking, alcohol consumption, hypertension, and diabetes mellitus as potential confounders in a multivariate model using conditional logistic regression to calculate odds ratios with 95% confidence intervals, and we carried out a sensitivity analysis restricted only to diabetic cases and controls. Long-term use of metformin was not associated with an altered relative risk of RCC (≥30 prescriptions, adjusted odds ratio 1.18, 95% confidence interval 0.88-1.58), nor was use of other antidiabetic drugs. Results in the sensitivity analysis including only diabetic cases and controls were largely the same. Use of metformin or other antidiabetic drugs was not associated with a materially altered risk of RCC. Further studies are warranted

Exercise Addiction in Athletes and Leisure Exercisers: The Moderating Role of Passion

Background and aims Recently, empirical research has linked obsessive passion to the etiology of exercise addiction, and the conceptual reason behind the fact that the latter is more prevalent in athletes than leisure exercisers has been challenged. The aim of this study was to determine the link between exercise addiction and harmonious passion, obsessive passion, and dedication to sports, in the context of athletic levels. A sample comprised of low- and high-level competitive athletes and non-competitive leisure exercisers (n = 313) was examined, in a cross-sectional design, in which participants completed the Spanish validated versions of the Exercise Addiction Inventory (Sicilia, Alías-García, Ferriz, & Moreno-Murcia, 2013) and Passion Scale (Chamarro et al., 2015). Results Obsessive passion and dedication to sports emerged as strong predictors of exercise addiction. Competitive athletes scored higher than leisure exercisers on all measures. Athletes competing at low and high levels only differed in dedication to their sports from each other. Team-sports athletes reported greater harmonious and obsessive passions, and dedication to sports, but not different exercise addictions, than people taking part in individual sports. Conclusions The concept of exercise addiction is not a plain and independent construct and may not reflect a psychological dysfunction in the athletic population. Athletes could interpret exercise addiction screening-items differently from non-athletes. Athletes in team sports report greater passion and dedication than those practicing individual sports

Correlates of total physical activity among middle-aged and elderly women

Information on correlates of total physical activity (PA) levels among middle-aged and elderly women is limited. This article aims to investigate whether total daily PA levels are associated with age, body mass index, smoking, drinking status, and sociodemographic factors

Prospective study of job stress and risk of infections in Swedish adults

ObjectivesPsychological stress may influence both susceptibility and severity of infections. Although work-related stress is a widespread concern among many employees, few studies have been conducted with the focus on work stressors and infections. We therefore aimed to investigate this association in a prospective cohort study.MethodsOur study included 25 029 employed individuals who filled-out a questionnaire in September 1997 and were followed through record linkages until retirement or December 2016. Work stress was assessed at baseline using a Swedish version of the Demand-Control Questionnaire, whereas hospital contacts related to infections were identified from the National Patient Register. We fitted extensions of the standard Cox model to account for recurrent infections.ResultsIn total, we observed 8257 infections. Individuals in the third tertile of job demand had a 13% higher hazard of infections (HR=1.13; 95% CI=1.03 to 1.24) compared with individuals in the first tertile, specifically an increased incidence of upper respiratory tract infections (HR=1.15; 95% CI=1.00 to 1.33) and urinary tract infections (HR=1.31; 95% CI=1.09 to 1.57) was found. Employees with the highest job control (third tertile) had no lower risk of infections than individuals in the lowest tertile (HR=1.02; 95% CI=0.92 to 1.13). When combining the demand and control dimensions into job strain scale, no association between high job strain and infections was observed (HR=1.08; 95% CI=0.97 to 1.21).ConclusionHigh job demand, but not low job control, is associated with an increased occurrence of infections. No difference was observed in workers with high strain jobs compared with those with low strain jobs