Publications by authors named "Lina Zgaga"

113 Publications

Media Representations of Science during the First Wave of the COVID-19 Pandemic: A Qualitative Analysis of News and Social Media on the Island of Ireland.

Int J Environ Res Public Health 2021 09 10;18(18). Epub 2021 Sep 10.

Discipline of Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, D02 Dublin, Ireland.

COVID-19 is arguably the most critical science communication challenge of a generation, yet comes in the wake of a purported populist turn against scientific expertise in western societies. This study advances understanding of science-society relations during the COVID-19 pandemic by analysing how science was represented in news and social media coverage of COVID-19 on the island of Ireland. Thematic analysis was performed on a dataset comprising 952 news articles and 603 tweets published between 1 January and 31 May 2020. Three themes characterised the range of meanings attached to science: 'Defining science: Its subjects, practice and process', 'Relating to science: Between veneration and suspicion' and 'Using science: As solution, policy and rhetoric'. The analysis suggested that the COVID-19 pandemic represented a platform to highlight the value, philosophy, process and day-to-day activity of scientific research. However, the study also identified risks the pandemic might pose to science communication, including feeding public alienation by disparaging lay understandings, reinforcing stereotypical images of scientists, and amplifying the politicisation of scientific statements.
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http://dx.doi.org/10.3390/ijerph18189542DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8470699PMC
September 2021

An observational and Mendelian randomisation study on vitamin D and COVID-19 risk in UK Biobank.

Sci Rep 2021 09 14;11(1):18262. Epub 2021 Sep 14.

Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK.

A growing body of evidence suggests that vitamin D deficiency has been associated with an increased susceptibility to viral and bacterial respiratory infections. In this study, we aimed to examine the association between vitamin D and COVID-19 risk and outcomes. We used logistic regression to identify associations between vitamin D variables and COVID-19 (risk of infection, hospitalisation and death) in 417,342 participants from UK Biobank. We subsequently performed a Mendelian Randomisation (MR) study to look for evidence of a causal effect. In total, 1746 COVID-19 cases (399 deaths) were registered between March and June 2020. We found no significant associations between COVID-19 infection risk and measured 25-OHD levels after adjusted for covariates, but this finding is limited by the fact that the vitamin D levels were measured on average 11 years before the pandemic. Ambient UVB was strongly and inversely associated with COVID-19 hospitalization and death overall and consistently after stratification by BMI and ethnicity. We also observed an interaction that suggested greater protective effect of genetically-predicted vitamin D levels when ambient UVB radiation is stronger. The main MR analysis did not show that genetically-predicted vitamin D levels are causally associated with COVID-19 risk (OR = 0.77, 95% CI 0.55-1.11, P = 0.160), but MR sensitivity analyses indicated a potential causal effect (weighted mode MR: OR = 0.72, 95% CI 0.55-0.95, P = 0.021; weighted median MR: OR = 0.61, 95% CI 0.42-0.92, P = 0.016). Analysis of MR-PRESSO did not find outliers for any instrumental variables and suggested a potential causal effect (OR = 0.80, 95% CI 0.66-0.98, p-val = 0.030). In conclusion, the effect of vitamin D levels on the risk or severity of COVID-19 remains controversial, further studies are needed to validate vitamin D supplementation as a means of protecting against worsened COVID-19.
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http://dx.doi.org/10.1038/s41598-021-97679-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8440633PMC
September 2021

Publisher Correction: Power determination in vitamin D randomised control trials and characterising factors affecting it through a novel simulation-based tool.

Sci Rep 2021 Jun 22;11(1):13387. Epub 2021 Jun 22.

Discipline of Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, Tallaght Cross, Tallaght, Dublin 24, Ireland.

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http://dx.doi.org/10.1038/s41598-021-92486-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8219691PMC
June 2021

Bordering on crisis: A qualitative analysis of focus group, social media, and news media perspectives on the Republic of Ireland-Northern Ireland border during the 'first wave' of the COVID-19 pandemic.

Soc Sci Med 2021 08 15;282:114111. Epub 2021 Jun 15.

Discipline of Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, Ireland. Electronic address:

Rationale: International border controls were among the earliest and most effective of measures to constrain transmission of COVID-19. However, such measures are complex when established borders are open yet politically contested, as for the border that divides the Republic of Ireland (ROI) from Northern Ireland (NI). Understanding how this border affected the everyday lives of both populations during the pandemic is important for informing the continued development of effective responses to COVID-19 and future health crises.

Objective: This multi-methods study aimed to explore public perspectives on how the ROI-NI border affected experiences of and responses to the 'first wave' of the pandemic.

Method: The study collated data from focus groups (n = 8), news articles (n = 967), and Twitter posts (n = 356) on the island of Ireland, which mentioned the ROI-NI border in relation to COVID-19. Thematic analysis was used to explore the range of perspectives on the role played by the border during the early months of the pandemic.

Results: Analysis identified three themes: Cross-Border Interdependencies illustrated the complexity and challenges of living near the border; Interpretations of Cross-Border Policy Disparities showed that lay publics perceived NI and ROI policy approaches as discordant and politicised; and Responses to Cross-Border Policy Disparities revealed alternating calls to either strengthen border controls, or pursue a unified all-island approach.

Conclusions: Results reveal clear public appetite for greater synchronisation of cross-border pandemic responses, emphasise the specific vulnerability of communities living near the border, and highlight the risk of long-term socio-political repercussions of border management decisions taken during the pandemic. Findings will inform implementation of pandemic responses and public health policies in jurisdictions that share a porous land border.
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http://dx.doi.org/10.1016/j.socscimed.2021.114111DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8412461PMC
August 2021

Power determination in vitamin D randomised control trials and characterising factors affecting it through a novel simulation-based tool.

Sci Rep 2021 05 24;11(1):10804. Epub 2021 May 24.

Discipline of Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, Tallaght Cross, Tallaght, Dublin 24, Ireland.

Thousands of observational studies have linked vitamin D deficiency with numerous diseases, but randomised controlled trials (RCTs) often fail to show benefit of supplementation. Population characteristics and trial design have long been suspected to undermine power but were not systematically investigated. We propose a flexible generative model to characterise benefit of vitamin D supplementation at the individual level, and use this to quantify power in RCTs. The model can account for seasonality and population heterogeneity. In a simulated 1-year trial with 1000 participants per arm and assuming a 25-hydroxyvitamin D (25OHD) increase of 20 nmol/L due to the intervention, with baseline 25OHD in the population of 15, 35, 50, 60 and 75 nmol/L, the power to detect intervention effect was 77%, 99%, 95%, 68% and 19%, respectively. The number of participants required per arm to achieve 80% power according to baseline 25OHD of 15-60 nmol/L was 1200, 400, 600 and 1400, respectively. As expected, larger increases in 25OHD due to supplementation improved power in certain scenarios. For a population baseline of 50 nmol/L, with 1500 participants in each arm, there was 100% power to detect a 20 nmol/L 25OHD increase while it was 76% for a 10 nmol/L increase. Population characteristics and trial design, including temporal considerations, have a dramatic impact on power and required sample size in vitamin D RCTs.
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http://dx.doi.org/10.1038/s41598-021-90019-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8144427PMC
May 2021

Differential genetic influences over colorectal cancer risk and gene expression in large bowel mucosa.

Int J Cancer 2021 09 2;149(5):1100-1108. Epub 2021 Jun 2.

MRC Human Genetics Unit, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK.

Site-specific variation in colorectal cancer (CRC) incidence, biology and prognosis are poorly understood. We sought to determine whether common genetic variants influencing CRC risk might exhibit topographical differences on CRC risk through regional differences in effects on gene expression in the large bowel mucosa. We conducted a site-specific genetic association study (10 630 cases, 31 331 controls) to identify whether established risk variants exert differential effects on risk of proximal, compared to distal CRC. We collected normal colorectal mucosa and blood from 481 subjects and assessed mucosal gene expression using Illumina HumanHT-12v4 arrays in relation to germline genotype. Expression quantitative trait loci (eQTLs) were explored by anatomical location of sampling. The rs3087967 genotype (chr11q23.1 risk variant) exhibited significant site-specific effects-risk of distal CRC (odds ratio [OR] = 1.20, P = 8.20 × 10 ) with negligible effects on proximal CRC risk (OR = 1.05, P = .10). Expression of 1261 genes differed between proximal and distal colonic mucosa (top hit PRAC gene, fold-difference = 10, P = 3.48 × 10 ). In eQTL studies, rs3087967 genotype was associated with expression of 8 cis- and 21 trans-genes. Four of these (AKAP14, ADH5P4, ASGR2, RP11-342M1.7) showed differential effects by site, with strongest trans-eQTL signals in proximal colonic mucosa (eg, AKAP14, beta = 0.61, P = 5.02 × 10 ) and opposite signals in distal mucosa (AKAP14, beta = -0.17, P = .04). In summary, genetic variation at the chr11q23.1 risk locus imparts greater risk of distal rather than proximal CRC and exhibits site-specific differences in eQTL effects in normal mucosa. Topographical differences in genomic control over gene expression relevant to CRC risk may underlie site-specific variation in CRC. Results may inform individualised CRC screening programmes.
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http://dx.doi.org/10.1002/ijc.33616DOI Listing
September 2021

Study protocol for the COvid-19 Toolbox for All IslaNd (CONTAIN) project: A cross-border analysis in Ireland to disentangle psychological, behavioural, media and governmental responses to COVID-19.

HRB Open Res 2020 15;3:48. Epub 2021 Feb 15.

Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, Ireland, D24 DH74, Ireland.

COVID-19 represents a serious challenge to governments and healthcare systems. In addition to testing/contact tracing, behavioural and social responses such as handwashing and social distancing or cocooning are effective tools for mitigating the spread of the disease. Psychological (e.g., risk perceptions, self-efficacy) and contextual factors (government, public health messaging, etc.) are likely to drive these behaviours. Collated real-time information of these indicators strengthens local, national and international public health advice and messaging. Further, understanding how well public health and government messages and measures are understood, communicated via (social) media and adhered to is vital. There are two governments and public health jurisdictions on the island of Ireland, the Republic of Ireland (ROI) and Northern Ireland (NI). This represents an opportunity to explore implications of differing measures and messaging across these two jurisdictions as they relate to COVID-19 on two similar populations. The expert research team are drawn from a range of disciplines in the two countries. This project has four nested studies: Assessment of key behavioural, social and psychological factors through a large, prospective representative telephone survey of individuals aged over-18 on a weekly basis over eight weeks (n=3072); and conduct qualitative focus groups over the same period.Interrogation of social media messaging and formal media responses in both jurisdictions to investigate the spread of (mis)information.Modelling data from Studies 1 and 2, plotting the psychosocial/behavioural and media messaging information with international, ROI and NI incidence and mortality data. Conducting an assessment of health policy transfer in an attempt to incorporate the most significant public health and political insights from each jurisdiction. The CONTAIN project will develop an evidence-based toolbox for targeting public health messaging and political leadership and will be created for use for the anticipated second wave of COVID-19, and subsequently for future epidemics/pandemics.
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http://dx.doi.org/10.12688/hrbopenres.13105.2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7898359PMC
February 2021

Heterogeneity of the Effect of Vitamin D Supplementation in Randomized Controlled Trials on Cancer Prevention.

Authors:
Lina Zgaga

JAMA Netw Open 2020 11 2;3(11):e2027176. Epub 2020 Nov 2.

Department of Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, Republic of Ireland.

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http://dx.doi.org/10.1001/jamanetworkopen.2020.27176DOI Listing
November 2020

The effect of vitamin D supplementation on survival in patients with colorectal cancer: systematic review and meta-analysis of randomised controlled trials.

Br J Cancer 2020 11 15;123(11):1705-1712. Epub 2020 Sep 15.

MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK.

Background: Low circulating vitamin D levels are associated with poor colorectal cancer (CRC) survival. We assess whether vitamin D supplementation improves CRC survival outcomes.

Methods: PubMed and Web of Science were searched. Randomised controlled trial (RCTs) of vitamin D supplementation reporting CRC mortality were included. RCTs with high risk of bias were excluded from analysis. Random-effects meta-analysis models calculated estimates of survival benefit with supplementation. The review is registered on PROSPERO, registration number: CRD42020173397.

Results: Seven RCTs (n = 957 CRC cases) were identified: three trials included patients with CRC at outset, and four population trials reported survival in incident cases. Two RCTs were excluded from meta-analysis (high risk of bias; no hazard ratio (HR)). While trials varied in inclusion criteria, intervention dose and outcomes, meta-analysis found a 30% reduction in adverse CRC outcomes with supplementation (n = 815, HR = 0.70; 95% confidence interval (CI): 0.48-0.93). A beneficial effect was seen in trials of CRC patients (progression-free survival, HR = 0.65; 95% CI: 0.36-0.94), with suggestive effect in incident CRC cases from population trials (CRC-specific survival, HR = 0.76; 95% CI: 0.39-1.13). No heterogeneity or publication bias was noted.

Conclusions: Meta-analysis demonstrates a clinically meaningful benefit of vitamin D supplementation on CRC survival outcomes. Further well-designed, adequately powered RCTs are needed to fully evaluate benefit of supplementation in augmenting 'real-life' follow-up and adjuvant chemotherapy regimens, as well as determining optimal dosing.
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http://dx.doi.org/10.1038/s41416-020-01060-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7686489PMC
November 2020

Platelet function/reactivity testing and prediction of risk of recurrent vascular events and outcomes after TIA or ischaemic stroke: systematic review and meta-analysis.

J Neurol 2020 Oct 9;267(10):3021-3037. Epub 2020 Jun 9.

Department of Neurology, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland.

Background: The prevalence of ex vivo 'high on-treatment platelet reactivity (HTPR)' and its relationship with recurrent vascular events/outcomes in patients with ischaemic cerebrovascular disease (CVD) is unclear.

Methods: A systematic review and meta-analysis was performed in accordance with the PRISMA statement. MEDLINE, EMBASE and Cochrane Library were searched for completed manuscripts until May 2019 on TIA/ischaemic stroke patients, ≥ 18 years, treated with commonly-prescribed antiplatelet therapy, who had platelet function/reactivity testing and prospective follow-up data on recurrent stroke/TIA, myocardial infarction, vascular death or other cerebrovascular outcomes. Data were pooled using random-effects meta-analysis. Primary outcome was the composite risk of recurrent stroke/TIA, myocardial infarction or vascular death. Secondary outcomes were recurrent stroke/TIA, severe stroke (NIHSS > 16) or disability/impairment (modified Rankin scale ≥ 3) during follow-up.

Results: Antiplatelet-HTPR prevalence was 3-65% with aspirin, 8-56% with clopidogrel and 1.8-35% with aspirin-clopidogrel therapy. Twenty studies (4989 patients) were included in our meta-analysis. There was a higher risk of the composite primary outcome (OR 2.93, 95% CI 1.90-4.51) and recurrent ischaemic stroke/TIA (OR 2.43, 95% CI 1.51-3.91) in patients with vs. those without 'antiplatelet-HTPR' on any antiplatelet regimen. These risks were also more than twofold higher in patients with vs. those without 'aspirin-HTPR' and 'dual antiplatelet-HTPR', respectively. Clopidogrel-HTPR status did not significantly predict outcomes, but the number of eligible studies was small. The risk of severe stroke was higher in those with vs. without antiplatelet-HTPR (OR 2.65, 95% CI 1.00-7.01).

Discussion: Antiplatelet-HTPR may predict risks of recurrent vascular events/outcomes in CVD patients. Given the heterogeneity between studies, further prospective, multi-centre studies are warranted.
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http://dx.doi.org/10.1007/s00415-020-09932-yDOI Listing
October 2020

Fitting Marginal Structural and G-Estimation Models Under Complex Treatment Patterns: Investigating the Association Between De Novo Vitamin D Supplement Use After Breast Cancer Diagnosis and All-Cause Mortality Using Linked Pharmacy Claim and Registry Data.

Am J Epidemiol 2020 03;189(3):224-234

Studies have shown that accounting for time-varying confounding through time-dependent Cox proportional hazards models may provide biased estimates of the causal effect of treatment when the confounder is also a mediator. We explore 2 alternative approaches to addressing this problem while examining the association between vitamin D supplementation initiated after breast cancer diagnosis and all-cause mortality. Women aged 50-80 years were identified in the National Cancer Registry Ireland (n = 5,417) between 2001 and 2011. Vitamin D use was identified from linked prescription data (n = 2,570). We sought to account for the time-varying nature of vitamin D use and time-varying confounding by bisphosphonate use using 1) marginal structural models (MSMs) and 2) G-estimation of structural nested accelerated failure-time models (SNAFTMs). Using standard adjusted Cox proportional hazards models, we found a reduction in all-cause mortality in de novo vitamin D users compared with nonusers (hazard ratio (HR) = 0.84, 95% confidence interval (CI): 0.73, 0.99). Additional adjustment for vitamin D and bisphosphonate use in the previous month reduced the hazard ratio (HR = 0.45, 95% CI: 0.33, 0.63). Results derived from MSMs (HR = 0.44, 95% CI: 0.32, 0.61) and SNAFTMs (HR = 0.45, 95% CI: 0.34, 0.52) were similar. Utilizing MSMs and SNAFTMs to account for time-varying bisphosphonate use did not alter conclusions in this example.
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http://dx.doi.org/10.1093/aje/kwz243DOI Listing
March 2020

Phenome-wide Mendelian-randomization study of genetically determined vitamin D on multiple health outcomes using the UK Biobank study.

Int J Epidemiol 2019 10;48(5):1425-1434

Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.

Background: Vitamin D deficiency is highly prevalent across the globe. Existing studies suggest that a low vitamin D level is associated with more than 130 outcomes. Exploring the causal role of vitamin D in health outcomes could support or question vitamin D supplementation.

Methods: We carried out a systematic literature review of previous Mendelian-randomization studies on vitamin D. We then implemented a Mendelian Randomization-Phenome Wide Association Study (MR-PheWAS) analysis on data from 339 256 individuals of White British origin from UK Biobank. We first ran a PheWAS analysis to test the associations between a 25(OH)D polygenic risk score and 920 disease outcomes, and then nine phenotypes (i.e. systolic blood pressure, diastolic blood pressure, risk of hypertension, T2D, ischaemic heart disease, body mass index, depression, non-vertebral fracture and all-cause mortality) that met the pre-defined inclusion criteria for further analysis were examined by multiple MR analytical approaches to explore causality.

Results: The PheWAS analysis did not identify any health outcome associated with the 25(OH)D polygenic risk score. Although a selection of nine outcomes were reported in previous Mendelian-randomization studies or umbrella reviews to be associated with vitamin D, our MR analysis, with substantial study power (>80% power to detect an association with an odds ratio >1.2 for per standard deviation increase of log-transformed 25[OH]D), was unable to support an interpretation of causal association.

Conclusions: We investigated the putative causal effects of vitamin D on multiple health outcomes in a White population. We did not support a causal effect on any of the disease outcomes tested. However, we cannot exclude small causal effects or effects on outcomes that we did not have enough power to explore due to the small number of cases.
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http://dx.doi.org/10.1093/ije/dyz182DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6857754PMC
October 2019

Refractive error and vision problems in children: association with increased sedentary behavior and reduced exercise in 9-year-old children in Ireland.

J AAPOS 2019 06 16;23(3):159.e1-159.e6. Epub 2019 May 16.

Department of Ophthalmology, Galway University Hospital, Ireland.

Purpose: To investigate whether refractive error and vision problems in children are associated with increased sedentary behavior and reduced participation in physical activity and sport and, secondarily, to examine the relationship between vision problems and body mass index.

Methods: This was a cross-sectional study of the first wave of the Growing Up in Ireland (GUI) Study, a nationally representative study of children in Ireland. Data was collected between August 2007 and May 2008. Body mass index (BMI) was calculated at the time of the interview. The presence of a vision problem requiring treatment, including refractive error, was detected by report of the primary care giver, usually the mother. Association between vision problems and sedentary behavior, physical activity, and level of participation in sports was investigated in adjusted regression analysis.

Results: A total of 8,568 children (mean age, 9 ± 0.13 years; 4,024 [48.68%] males) were included. The presence of refractive error or a vision problem was reported for 1,000 (11.68%) children. The majority of children had normal weight, but 1,497 (17.5%) were overweight, and 446 (5.2%) were obese. A positive association between vision problems and sedentary behavior (P = 0.00089) and an inverse association with exercise (P = 0.01) were found. Overall, vision problems were not associated with BMI.

Conclusions: In this study cohort, refractive error and vision problems were associated with increased sedentary behavior and decreased physical activity, although no causal relationship was established.
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http://dx.doi.org/10.1016/j.jaapos.2018.12.011DOI Listing
June 2019

Association analyses identify 31 new risk loci for colorectal cancer susceptibility.

Nat Commun 2019 05 14;10(1):2154. Epub 2019 May 14.

Wellcome Centre for Human Genetics, McCarthy Group, Roosevelt Drive, Oxford, OX3 7BN, UK.

Colorectal cancer (CRC) is a leading cause of cancer-related death worldwide, and has a strong heritable basis. We report a genome-wide association analysis of 34,627 CRC cases and 71,379 controls of European ancestry that identifies SNPs at 31 new CRC risk loci. We also identify eight independent risk SNPs at the new and previously reported European CRC loci, and a further nine CRC SNPs at loci previously only identified in Asian populations. We use in situ promoter capture Hi-C (CHi-C), gene expression, and in silico annotation methods to identify likely target genes of CRC SNPs. Whilst these new SNP associations implicate target genes that are enriched for known CRC pathways such as Wnt and BMP, they also highlight novel pathways with no prior links to colorectal tumourigenesis. These findings provide further insight into CRC susceptibility and enhance the prospects of applying genetic risk scores to personalised screening and prevention.
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http://dx.doi.org/10.1038/s41467-019-09775-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6517433PMC
May 2019

National incidence of eyelid cancer in Ireland (2005-2015).

Eye (Lond) 2019 10 11;33(10):1534-1539. Epub 2019 Apr 11.

Sligo University Hospital, Sligo, Ireland.

Aims: We report on the incidence of cutaneous eyelid tumours in Ireland over the 11-year-period from 2005 to 2015, we identify associations between demographic factors and cutaneous eyelid tumour risk.

Methods: Skin cancers, including basal cell carcinoma (BCC), squamous cell carcinoma (SCC), melanoma, and other cancers, located on the eyelid or canthus according to ICD-10 coding, as registered by the National Cancer Registry of Ireland (NCRI), were captured from the period 2005 to 2015. Age standardised rates (ASR) were calculated according to the European Standard Population (2013). Longitudinal data analysis using linear regression, and associations with age and sex were evaluated with the statistics program R.

Results: There were 4824 patients diagnosed with eyelid BCC during the study period, the ASR in men and women was mean 15.87 and 13.49 per 100,00, respectively. The relative risk for eyelid BCC in men compared with women was 1.18, age was associated with incidence. There were 528 patients diagnosed with SCC; the ASR of eyelid SCC in men and women was 2.10 and 1.39 per 100,000, respectively, and increased in women annually (β = 0.07, p = 0.0005). The relative risk for eyelid SCC in men compared with women was 1.51, and age was exponentially associated with SCC. Melanoma and other eyelid tumours were uncommon-50 and 55 cases, respectively.

Conclusion: Incidence of both BCC and SCC increases with age and male sex. The incidence of eyelid SCC is increasing in women, and under age 50, eyelid BCC is more common in women than men.

Synopsis: We describe the recent incidence of eyelid cancers in Ireland, from National Cancer Registry Data. We find eyelid BCC, and also SCC, are associated with increased age. Rate of eyelid SCC is increasing in women.
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http://dx.doi.org/10.1038/s41433-019-0437-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7002498PMC
October 2019

Higher Post-Operative Serum Vitamin D Level is Associated with Better Survival Outcome in Colorectal Cancer Patients.

Nutr Cancer 2019 4;71(7):1078-1085. Epub 2019 Apr 4.

Discipline of Public Health and Primary Care, Institute of Population Health, Trinity College, University of Dublin , Dublin , Ireland.

25-Hydroxyvitamin D (25-OHD) may have a prognostic value in colorectal cancer (CRC) patients. However, as 25-OHD concentration is strongly impacted by surgery, it is uncertain what is the most reliable time-point for 25-OHD assessment, pre- or post-operative. Therefore, we examined 515 CRC patients (AJCC I-III) who underwent surgery. Blood samples were collected either pre-operatively ( = 286; median = 1 day before surgery) or post-operatively ( = 229; median = 8 days). Serum 25-OHD concentration was determined by liquid chromatography-tandem mass spectrometry. Association between 25-OHD and survival was tested in the whole cohort, followed by stratified analyses in pre- and post-operatively sampled. Median 25-OHD in the cohort was 36.7 nmol/L and median follow-up time was 5.9 years. There were no differences between pre- and post-operative cohort in age, sex, 25-OHD, AJCC stage, or localization of tumor. After adjustment, higher 25-OHD (>50 nmol/L) was associated with better overall survival only in post-operative (HR = 0.53; 95% CI: 0.33-0.84;  = 0.006), but not in pre-operative cohort (HR = 1.13; 95% CI: 0.77-1.65;  = 0.53). In conclusion, higher post-operative 25-OHD levels were associated with better survival outcome in CRC patients, while no such association was found for pre-operative levels. Time-point of blood collection should be addressed carefully in future research as it might affect the prognostic value of 25-OHD in CRC.
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http://dx.doi.org/10.1080/01635581.2019.1597135DOI Listing
June 2020

Five-year standardised mortality ratios in a cohort of homeless people in Dublin.

BMJ Open 2019 01 25;9(1):e023010. Epub 2019 Jan 25.

Department of Public Health and Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Dublin, Ireland.

Objective: To calculate standardised mortality ratios (SMRs) for a cohort of homeless people in the Dublin region over a 5-year period and to examine leading causes of death.

Setting: Homeless services reporting deaths from homeless persons in their care across the Dublin Homeless Region.

Methods: Death data among people who experience homelessness was acquired from the Dublin Region Homeless Executive (2011-2015) and validated from both death certificates and records from the Dublin Coroner's Office.

Participants: Two hundred and nine deaths were recorded; of these 201 were verified (n=156 males, 77.6%). Deaths that could not be verified by certificate or coroners record were excluded from the study.

Results: SMRs were 3-10 times higher in homeless men and 6-10 times higher in homeless women compared with the general population. Drug and alcohol-related deaths were the leading cause of death, accounting for 38.4% of deaths in homeless individuals. These were followed by circulatory (20%) and respiratory causes (13%).

Conclusion: Mortality rates among homeless persons are exceptionally high. Services and programmes, particularly housing and those targeting overdose and alcoholism, are urgently needed to prevent premature mortality in this vulnerable population.
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http://dx.doi.org/10.1136/bmjopen-2018-023010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6352814PMC
January 2019

25-Hydroxyvitamin D Measurement in Human Hair: Results from a Proof-of-Concept study.

Nutrients 2019 Feb 18;11(2). Epub 2019 Feb 18.

Department of Biochemistry, St James's Hospital, Dublin 8, Ireland.

Vitamin D deficiency has been implicated in numerous human diseases leading to an increased interest in assessing vitamin D status. Consequentially, the number of requests for vitamin D measurement keeps dramatically increasing year-on-year. Currently, the recognised best marker of vitamin D status is the concentration of the 25-hydroxyvitamin D (25(OH)D₃) in the blood circulation. While providing an accurate estimate of vitamin D status at the point in time of sampling, it cannot account for the high variability of 25(OH)D₃ concentration. In this proof of concept study we set out to provide evidence that 25(OH)D₃ can be extracted from hair samples in a similar fashion to steroid hormones. Two of the authors (L.Z. and M.H.) provided hair samples harvested from the crown area of the scalp and the third author (E.L.) provided beard samples. These samples, cut into 1 cm lengths, were weighed, washed and dried. 25(OH)D was extracted using a previously published steroid hormones extraction procedure. Blood samples were taken from the subjects at the same time all tissue samples were analysed using liquid-chromatography mass spectrometry. Hair samples showed presence of quantifiable 25(OH)D₃ with concentrations ranging from 11.9⁻911 pg/mg. The beard sample had a concentration of 231 pg/mg. Serum levels of 25(OH)D₃ ranged from 72⁻78 nmol/L. The results presented here confirm the feasibility of measuring 25(OH)D₃ in hair samples. The findings warrant further validation and development and have the potential to yield valuable information relating to temporal trends in vitamin D physiology.
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http://dx.doi.org/10.3390/nu11020423DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6412768PMC
February 2019

Sunshine is an Important Determinant of Vitamin D Status Even Among High-dose Supplement Users: Secondary Analysis of a Randomized Controlled Trial in Crohn's Disease Patients.

Photochem Photobiol 2019 07 12;95(4):1060-1067. Epub 2019 Mar 12.

Department of Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, Dublin, Republic of Ireland.

Sunshine is considered to be the most important source of vitamin D. Due to an increased risk of skin cancer, sun avoidance is advised, but this directly contributes to the high prevalence of vitamin D deficiency. The simple solution is to advise vitamin D supplementation. The aim of this study was to examine the absolute and relative contribution of sunshine and supplementation to vitamin status. This study was a secondary analysis of an RCT of 92 Crohn's disease patients in remission (49% female, median age = 44). Participants were randomized to 2000 IU day of vitamin D3 or placebo for 1 year, with 25-hydroxyvitamin D (25(OH)D) being measured at baseline and every 4 months. Based on participant's place of residence, daily ambient UVB dose at wavelengths that can induce vitamin D synthesis (D-UVB) was obtained. Cumulative and weighted ambient D-UVB (cw-D-UVB) exposure prior to each blood draw was calculated for each participant. Linear regression analysis and multilevel modeling were used to examine the association between UVB exposure, supplementation and 25(OH)D concentration. There was considerable annual variation in D-UVB, cw-D-UVB and 25(OH)D. Both supplementation and cw-D-UVB were found to be strongly associated with 25(OH)D: in multilevel model, an increase of approximately 6 nmol L for every 100 kJ m in cw-D-UVB was found, among those receiving placebo and supplementation (P < 0.0001). Treatment was associated with increase of 23 nmol L (P < 0.0001). Sunshine is an important determinant of 25(OH)D concentration, even in those who are taking high-dose vitamin D supplements and reside at a higher mid-latitude location.
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http://dx.doi.org/10.1111/php.13086DOI Listing
July 2019

Urinary soluble CD163 and monocyte chemoattractant protein-1 in the identification of subtle renal flare in anti-neutrophil cytoplasmic antibody-associated vasculitis.

Nephrol Dial Transplant 2020 02;35(2):283-291

Trinity Health Kidney Centre, Trinity College Dublin, Dublin, Ireland.

Background: Prior work has shown that urinary soluble CD163 (usCD163) displays excellent biomarker characteristics for detection of active renal vasculitis using samples that included new diagnoses with highly active renal disease. This study focused on the use of usCD163 in the detection of the more clinically relevant state of mild renal flare and compared results of usCD163 testing directly to testing of urinary monocyte chemoattractant protein-1 (uMCP-1).

Methods: Patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV, n = 88) were identified within a serially sampled, longitudinal and multicentre cohort. Creatinine-normalized usCD163 and uMCP-1 levels were measured by enzyme-linked immunosorbent assay and, both alone and in combination, were compared between times of active renal AAV and during remission and/or active non-renal AAV.

Results: Samples from 320 study visits included times of active renal vasculitis (n = 39), remission (n = 233) and active extrarenal vasculitis (n = 48). Median creatinine levels were 0.9 mg/dL [interquartile range (IQR) 0.8-1.2] in remission and 1.4 mg/dL (IQR 1.0-1.8) during renal flare. usCD163 levels were higher in patients with active renal vasculitis compared with patients in remission and those with active extrarenal vasculitis, with median values of 162 ng/mmol (IQR 79-337), 44 (17-104) and 38 (7-76), respectively (P < 0.001). uMCP-1 levels were also higher in patients with active renal vasculitis compared with patients in remission and those with active extrarenal vasculitis, with median values of 10.6 pg/mmol (IQR 4.6-23.5), 4.1 (2.5-8.4) and 4.1 (1.9-6.8), respectively (P < 0.001). The proposed diagnostic cut-points for usCD163 and uMCP-1 were 72.9 ng/mmol and 10.0 pg/mmol, respectively. usCD163 and uMCP-1 levels were marginally correlated (r2 = 0.11, P < 0.001). Combining novel and existing biomarkers using recursive tree partitioning indicated that elevated usCD163 plus either elevated uMCP-1 or new/worse proteinuria improved the positive likelihood ratio (PLR) of active renal vasculitis to 19.2.

Conclusion: A combination of usCD163 and uMCP-1 measurements appears to be useful in identifying the diagnosis of subtle renal vasculitis flare.
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http://dx.doi.org/10.1093/ndt/gfy300DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8205505PMC
February 2020

Exploring causality in the association between circulating 25-hydroxyvitamin D and colorectal cancer risk: a large Mendelian randomisation study.

BMC Med 2018 08 14;16(1):142. Epub 2018 Aug 14.

Colon Cancer Genetics Group, Medical Research Council Human Genetics Unit, Medical Research Council Institute of Genetics & Molecular Medicine, Western General Hospital, The University of Edinburgh, Edinburgh, EH4 2XU, UK.

Background: Whilst observational studies establish that lower plasma 25-hydroxyvitamin D (25-OHD) levels are associated with higher risk of colorectal cancer (CRC), establishing causality has proven challenging. Since vitamin D is modifiable, these observations have substantial clinical and public health implications. Indeed, many health agencies already recommend supplemental vitamin D. Here, we explore causality in a large Mendelian randomisation (MR) study using an improved genetic instrument for circulating 25-OHD.

Methods: We developed a weighted genetic score for circulating 25-OHD using six genetic variants that we recently reported to be associated with circulating 25-OHD in a large genome-wide association study (GWAS) meta-analysis. Using this score as instrumental variable in MR analyses, we sought to determine whether circulating 25-OHD is causally linked with CRC risk. We conducted MR analysis using individual-level data from 10,725 CRC cases and 30,794 controls (Scotland, UK Biobank and Croatia). We then applied estimates from meta-analysis of 11 GWAS of CRC risk (18,967 cases; 48,168 controls) in a summary statistics MR approach.

Results: The new genetic score for 25-OHD was strongly associated with measured plasma 25-OHD levels in 2821 healthy Scottish controls (P = 1.47 × 10), improving upon previous genetic instruments (F-statistic 46.0 vs. 13.0). However, individual-level MR revealed no association between 25-OHD score and CRC risk (OR 1.03/unit log-transformed circulating 25-OHD, 95% CI 0.51-2.07, P = 0.93). Similarly, we found no evidence for a causal relationship between 25-OHD and CRC risk using summary statistics MR analysis (OR 0.91, 95% CI 0.69-1.19, P = 0.48).

Conclusions: Despite the scale of this study and employing an improved score capturing more of the genetic contribution to circulating 25-OHD, we found no evidence for a causal relationship between circulating 25-OHD and CRC risk. Although the magnitude of effect for vitamin D suggested by observational studies can confidently be excluded, smaller effects sizes and non-linear relationships remain plausible. Circulating vitamin D may be a CRC biomarker, but a causal effect on CRC risk remains unproven.
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http://dx.doi.org/10.1186/s12916-018-1119-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6090711PMC
August 2018

Free Children's Visits and General Practice Attendance.

Ann Fam Med 2018 05;16(3):246-249

Department of Public Health and Primary Care, Trinity College Dublin, Dublin, Ireland.

Purpose: In July 2015, all children aged younger than 6 years gained free access to daytime and out-of-hours general practice services in the Republic of Ireland. Although 30% previously had free access, 70% did not.

Methods: To examine subsequent changes in service use, we retrospectively analyzed anonymized visitation data from 8 general practices in North Dublin providing daytime service and their local out-of-hours service, comparing the 1 year before and the 1 year after introduction of free care.

Results: In the year after granting of free general practice care for children younger than 6 years, 9.4% more children attended the daytime services and 20.1% more children were seen in the out-of-hours services. Annual number of visits by patients increased by 28.7% for daytime services and by 25.7% for out-of-hours services, translating to 6,682 more visits overall. Average visitation rate for children this age increased from 2.77 visits per year to 3.25 visits per year for daytime services, but changed little for out-of-hours services, from 1.52 visits per year to 1.59 visits per year.

Conclusions: Offering free childhood general practice services led to a dramatic increase in visits. This increase has implications for future health care service planning in mixed public and privately funded systems.
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http://dx.doi.org/10.1370/afm.2229DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5951254PMC
May 2018

Health Care Utilisation by Bullying Victims: A Cross-Sectional Study of A 9-Year-Old Cohort in Ireland.

Healthcare (Basel) 2018 Feb 25;6(1). Epub 2018 Feb 25.

Department of Public Health and Primary Care, Trinity College Dublin, Dublin, Ireland.

Children frequently refrain from disclosing being bullied. Early identification of bullying by healthcare professionals in children may prevent adverse health consequences. The aim of our study was to determine whether Health Care Utilisation (HCU) is higher in 9-year-olds who report being bullied and factors influencing type of HCU. The study consists of cross-sectional surveys of Child Cohort of Irish National Longitudinal Study of Children (Wave 1), 8,568 9-year-olds, and their carers. Being bullied was assessed by a self-reported questionnaire completed by children at home. HCU outcomes consisted of the following: visits to GP, Mental Health Practitioner (MHP), Emergency Department (ED), and nights in hospital by parent interview. Bivariate logistic regression and gender-stratified Poisson models were used to determine association. Victimisation by bullying independently increased visits to GP (OR 1.13, 95% confidence interval (CI): 1.03 to 1.25; p = 0.02), MHP (OR 1.31, 95% CI: 1.05 to 1.63; p = 0.02), though not ED visits (OR 0.99, 95% CI: 0.87 to 1.13; p = 0.8) or nights in hospital (OR 1.07 95% CI: 0.97 to 1.18; p = 0.2), adjusting for underlying chronic condition(s) and socio-demographic confounders. Victimised girls made higher GP visits (RR 1.14, 95% CI: 1.06 to 1.23; p < 0.001) and spent more nights in hospital (RR 1.10, 95% CI: 1.04 to 1.15; p < 0.001). Victimised boys were more likely to contact MHPs (RR 1.21, 95% CI: 1.02 to 1.44; p = 0.03). 9-year-old bullied subjects were more likely to utilise primary care services than non-bullied 9-year-olds. Different HCU patterns were observed according to gender and gender differences in the presentation of victimisation. Our findings may lead to the development of clinical practice guidelines for early detection and appropriate management of bullied children.
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http://dx.doi.org/10.3390/healthcare6010019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5872226PMC
February 2018

Annual Ambient UVB at Wavelengths that Induce Vitamin D Synthesis is Associated with Reduced Esophageal and Gastric Cancer Risk: A Nested Case-Control Study.

Photochem Photobiol 2018 07 21;94(4):797-806. Epub 2018 Apr 21.

Department of Public Health and Primary Care, Trinity College Dublin, The University of Dublin, Dublin, Ireland.

Vitamin D has been shown to be beneficial at reducing the risk of cancer; however, studies examining esophageal and gastric cancer have been scarce and findings inconsistent. The UK Biobank cohort was used for this nested case-control study (N = 3732). Primary, incident esophageal and gastric cancer cases diagnosed after recruitment were identified via linkage to National Cancer Registries. Tropospheric Emissions Monitoring Internet Service database was used to calculate ambient annual UVB dose (D-UVB). Conditional logistic regression was used to investigate the relationship between annual ambient D-UVB and risk of esophageal and gastric cancer, and odds ratios (ORs) are reported. In total, 373 esophageal and 249 gastric cancer cases and 3110 age- and gender-matched controls were included in the study. We found a strong inverse association between annual ambient D-UVB and odds of developing esophageal or gastric cancer: Compared to the lowest tertile, OR for the highest tertile was 0.64 (95%CI:0.51-0.79) in adjusted analysis. The association was strengthened when restricted to esophageal cancer (OR = 0.60; 95%CI:0.45-0.80) and esophageal adenocarcinoma cases (OR = 0.48; 95%CI: 0.34-0.68). Similar results were found in unadjusted and stratified analysis. In conclusion, ambient UVB radiation is inversely associated with the development of esophageal and gastric cancer, even in a high-latitude country.
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http://dx.doi.org/10.1111/php.12915DOI Listing
July 2018

Genome-wide association study in 79,366 European-ancestry individuals informs the genetic architecture of 25-hydroxyvitamin D levels.

Nat Commun 2018 01 17;9(1):260. Epub 2018 Jan 17.

Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, 9609 Medical Center Drive, Bethesda, MD, 20892, USA.

Vitamin D is a steroid hormone precursor that is associated with a range of human traits and diseases. Previous GWAS of serum 25-hydroxyvitamin D concentrations have identified four genome-wide significant loci (GC, NADSYN1/DHCR7, CYP2R1, CYP24A1). In this study, we expand the previous SUNLIGHT Consortium GWAS discovery sample size from 16,125 to 79,366 (all European descent). This larger GWAS yields two additional loci harboring genome-wide significant variants (P = 4.7×10 at rs8018720 in SEC23A, and P = 1.9×10 at rs10745742 in AMDHD1). The overall estimate of heritability of 25-hydroxyvitamin D serum concentrations attributable to GWAS common SNPs is 7.5%, with statistically significant loci explaining 38% of this total. Further investigation identifies signal enrichment in immune and hematopoietic tissues, and clustering with autoimmune diseases in cell-type-specific analysis. Larger studies are required to identify additional common SNPs, and to explore the role of rare or structural variants and gene-gene interactions in the heritability of circulating 25-hydroxyvitamin D levels.
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http://dx.doi.org/10.1038/s41467-017-02662-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5772647PMC
January 2018

A naturalistic longitudinal analysis of post-detoxification outcomes in opioid-dependent patients.

Drug Alcohol Rev 2018 04 20;37 Suppl 1:S339-S347. Epub 2017 Sep 20.

Department of Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, Dublin, Ireland.

Introduction And Aims: To provide an assessment of outcomes in a cohort of opioid-dependent patients post-detoxification.

Design And Methods: This study employed an observational longitudinal cohort design. Patients who completed detoxification in the three major Drug Dependency Units in Ireland during a 14-month period were included in the study (n = 143). Patients opting for one of the three pathways post-detoxification (inpatient aftercare, outpatient aftercare or no formal aftercare) were assessed in the final week of detoxification and followed up after 3, 6 and 9 months. The primary outcome was abstinence following detoxification.

Results: A Cox (adjusted) model indicated participants who opted for outpatient aftercare treatment lapsed/relapsed at a rate of 52% higher than the inpatient aftercare group (hazard ratio = 1.52, 95% confidence interval 0.75-3.08, P = 0.24). Moreover, time to lapse/relapse was considerably shorter for the no formal aftercare group (hazard ratio = 7.68, 95% confidence interval 4.30-13.73, P = 5.75 × 10 ). Abstinence rates for outpatient aftercare and inpatient aftercare are about equal after 9 months.

Discussion And Conclusion: Patients who opt for aftercare post-detoxification have significantly better outcomes at follow up when compared to no formal aftercare. In addition, patients' intention to attend aftercare affected their outcomes regardless of eventual treatment path.
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http://dx.doi.org/10.1111/dar.12597DOI Listing
April 2018

Pre-diagnostic statin use, lymph node status and mortality in women with stages I-III breast cancer.

Br J Cancer 2017 Aug 18;117(4):588-596. Epub 2017 Jul 18.

Statistical and Pharmcoepidemiology Research Group, Population Health Sciences Division, Royal College of Surgeons in Ireland, Dublin D02 DH60, Ireland.

Background: Recent meta-analyses suggest that pre-diagnostic statin use is associated with reduced breast cancer-specific mortality. Studies have shown that high breast tumour expression of the statin target (3-hydroxy-3-methylglutaryl coenzyme-A reductase) is associated with lymph-node negative cancer. Therefore, we examined the association between pre-diagnostic statin use and; lymph node status, breast cancer-specific and all-cause mortality.

Methods: Women with stages I-III breast cancer were identified from the National Cancer Registry of Ireland (N=6314). Pre-diagnostic statin users were identified from linked prescription claims data (N=2082). Relative risks were estimated for associations between pre-diagnostic statin use and lymph node status. Hazard ratios (HR) were estimated for associations between pre-diagnostic statin use and breast cancer-specific and all-cause mortality.

Results: Pre-diagnostic statin use was not associated with lymph node negative status at diagnosis. In multivariate analyses, pre-diagnostic statin use was associated with reduced all-cause (HR 0.78 95% confidence interval (CI) 0.69, 0.89) and breast cancer-specific mortality (HR 0.81 95% CI 0.68, 0.96). This reduction in cancer-specific mortality was greatest in statin-users with oestrogen (ER) receptor-positive tumours (HR 0.69 95% CI 0.55, 0.85).

Conclusion: Patients with pre-diagnostic statin exposure had a significant reduction in breast cancer-specific mortality, which was even more pronounced in women with ER+ tumours.
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http://dx.doi.org/10.1038/bjc.2017.227DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5558692PMC
August 2017

The Prevalence of Oropharyngeal Dysphagia in Adults Presenting with Temporomandibular Disorders Associated with Rheumatoid Arthritis: A Systematic Review and Meta-analysis.

Dysphagia 2017 Oct 16;32(5):587-600. Epub 2017 May 16.

Department of Clinical Speech and Language Studies, Trinity College Dublin, 7-9 South Leinster Street, Dublin 2, Ireland.

Temporomandibular disorders (TMDs) are the most frequent non-dental orofacial pain disorders and may be associated with rheumatoid arthritis (RA), resulting in oropharyngeal dysphagia (OD). However, clinicians' understanding of involvement with OD caused by RA-related TMDs is limited and the methodological quality of research in this field has been criticised. Therefore, the aim of this study was to systematically review the prevalence of oral preparatory and oral stage signs and symptoms of OD in adults presenting with TMDs associated with RA. A systematic review of the literature was completed. The following electronic databases were searched from inception to February 2016, with no date/language restriction: EMBASE, PubMed, CINAHL, Web of Science, Elsevier Scopus, Science Direct, AMED, The Cochrane Database of Systematic Reviews, and ProQuest Dissertations and Theses A & I. Grey literature and reference lists of the included studies were also searched. Studies reporting the frequency of OD in adults presenting with TMD and RA were included. Study eligibility and quality were assessed by three independent reviewers. Methodological quality was assessed using the Down's and Black tool. The search yielded 19 eligible studies. Typical difficulties experienced by RA patients included impaired swallowing (24.63%), impaired masticatory ability (30.69%), masticatory pain (35.58%), and masticatory fatigue (21.26%). No eligible studies reported figures relating to the prevalence of weight loss. Eligible studies were deemed on average to be of moderate quality. Study limitations included the small number of studies which met the inclusion criteria and the limited amount of studies utilising objective assessments. Valid and reliable prospective research is urgently required to address the assessment and treatment of swallowing difficulties in RA as TMJ involvement may produce signs and symptoms of OD.
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http://dx.doi.org/10.1007/s00455-017-9808-0DOI Listing
October 2017

Ambient UVB Dose and Sun Enjoyment Are Important Predictors of Vitamin D Status in an Older Population.

J Nutr 2017 05 22;147(5):858-868. Epub 2017 Mar 22.

Department of Public Health and Primary Care and

UVB-induced skin synthesis is considered the key source of vitamin D, yet exposure to UVB is poorly accounted for in epidemiological studies. The aim of this study was to examine the association of serum 25-hydroxyvitamin D [25(OH)D] concentration with accurately measured ambient UVB dose, sun enjoyment, supplements, and other factors. An all-Irish cohort of community-dwelling participants aged >60 y [median age: 73; 67% female; median 25(OH)D: 54.5 nmol/L] was used. Participants from this large, cross-sectional study completed a questionnaire to provide information on demographic factors and lifestyle (including supplement use and sun enjoyment). The Tropospheric Emission Monitoring Internet Service database was used to extract the daily ambient UVB dose at wavelengths that could induce vitamin D synthesis (D-UVB) over Ireland (latitude: 51°N-55°N). Blood sampling occurred throughout the year. Ambient exposure at the place of residence was calculated for each participant individually. Associations between determinants and serum 25(OH)D concentration were examined in a multivariate model. Random forest analysis was used to establish prediction models of vitamin D deficiency, and area under the curve (AUC) is shown. In total, 5138 individuals were included. Median D-UVB was 63 mJ/cm, which varied between seasons and latitudes, despite the small latitude differential. Vitamin D supplementation (β = 27.7; < 10 × 10), D-UVB (β = 1.58 per 1000 mJ/cm; < 10 × 10), and sun enjoyment (β = 6.6; < 0.001) were strongly positively associated with serum 25(OH)D. Those who avoided sunshine were largely at risk of deficiency (<40 nmol/L), whereas those who enjoyed sunshine tended to be vitamin D sufficient (≥50 nmol/L). D-UVB and sun enjoyment improved prediction of deficiency in non-supplement-taking individuals; the overall AUC improved by 3.5%. D-UVB and sun enjoyment are important predictors of vitamin D status, even in this elderly population at northern latitudes. Accurate estimation of ambient UVB can help to further clarify the role of other determinants of vitamin D status and inform sunshine recommendation guidelines.
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http://dx.doi.org/10.3945/jn.116.244079DOI Listing
May 2017

Patterns of Smoking Behaviour in Low-Income Pregnant Women: A Cohort Study of Differential Effects on Infant Birth Weight.

Int J Environ Res Public Health 2016 10 29;13(11). Epub 2016 Oct 29.

School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin 4, Ireland.

Maternal smoking accounts for 20%-30% of low birth weight (BW). Second-Hand Smoke (SHS) also negatively affects BW. This cohort study explored the differential effect of smoking patterns during pregnancy on infant BW. Smoking status for 652 self-reported smokers attending public ante-natal clinics was assessed at baseline (V1 first ante-natal visit), 28-32 weeks (V2) and one week after birth (V3). Multivariable generalised linear regression models tested smoking patterns (continuing to smoke, sustained quitting, partial quitting) on BW adjusting for household smoking and other co-variates. Total quitting showed a median increase of 288 g in BW (95% CI (confidence intervals): 153.1-423 g, < 0.001), compared to partial quitting (147 g, (95% CI: 50-244 g), < 0.003). In partial quitters, increased BW was observed only in females 218 g, (95% CI: 81-355 g), = 0.002). Household SHS showed a specific negative influence on pre-term but not term BW. This study suggests that, for low-income women, quitting or partial quitting during pregnancy both have a positive influence on infant BW. Whether others in the household smoke is also important.
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http://dx.doi.org/10.3390/ijerph13111060DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5129270PMC
October 2016
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