Invited commentary: Evolution of social networks, health, and the role of epidemiology

Almost 40 years ago, Berkman and Syme demonstrated that social networks were related to the risk of early mortality (Am J Epidemiol. 1979;109(2):186-204). Their study was highly innovative because they directly measured and quantified social networks in a large prospective population-based survey with mortality follow-up. The results of the study showed robust network gradients, whereby those with fewer networks and weaker social ties had significantly higher mortality rates. The important influence of social networks that Berkman and Syme noted many years ago is likely to heighten in the future, as demographic characteristics shift and individuals become more inclined to socialize through online platforms instead of real-world interactions. Berkman and Syme's research in 1979 continues to play a key role in shaping recent efforts to uncover the influence of social networks on health. Looking back on their findings may help epidemiologists better understand the importance of both online and offline networks for population health today

Is the microbe - Dementia hypothesis finally ready for a treatment trial?

[No abstract available

Introduction to the Symposium: Causal Inference and Public Health

Assessing the extent to which public health research findings can be causally interpreted continues to be a critical endeavor. In this symposium, we invited several researchers to review issues related to causal inference in social epidemiology and environmental science and to discuss the importance of external validity in public health. Together, this set of articles provides an integral overview of the strengths and limitations of applying causal inference frameworks and related approaches to a variety of public health problems, for both internal and external validity

Social Determinants of Influenza Illness and Outbreaks in the United States

Social determinants-such as education, race/ethnicity, socioeconomic status, access to health care services and vaccination, neighborhood-level stressors, and workplace or school policies-can impact influenza illness and outbreaks in the United States. To reduce transmission and disparities in influenza infection, policies should focus on removing existing vaccination barriers and supporting equitable social policies

Race/Ethnic and Educational Disparities in the Association Between Pathogen Burden and a Laboratory-Based Cumulative Deficits Index

Background: Disparities in adult morbidity and mortality may be rooted in patterns of biological dysfunction in early life. We sought to examine the association between pathogen burden and a cumulative deficits index (CDI), conceptualized as a pre-clinical marker of an unhealthy biomarker profile, specifically focusing on patterns across levels of social disadvantage. Methods: Using the data from the National Health and Nutrition Examination Survey 2003–2004 wave (aged 20–49 years), we examined the association of pathogen burden, composed of seven pathogens, with the CDI. The CDI comprised 28 biomarkers corresponding to available clinical laboratory measures. Models were stratified by race/ethnicity and education level. Results: The CDI ranged from 0.04 to 0.78. Nearly half of Blacks were classified in the high burden pathogen class compared with 8% of Whites. Among both Mexican Americans and other Hispanic groups, the largest proportion of individuals were classified in the common pathogens class. Among educational classes, 19% of those with less than a high school education were classified in the high burden class compared with 7% of those with at least a college education. Blacks in the high burden pathogen class had a CDI 0.05 greater than those in the low burden class (P < 0.05). Whites in the high burden class had a CDI only 0.03 greater than those in the low burden class (P < 0.01). Discussion: Our findings suggest there are significant social disparities in the distribution of pathogen burden across race/ethnic groups, and the effects of pathogen burden may be more significant for socially disadvantaged individuals. © 2019, W. Montague Cobb-NMA Health Institute

Effect of hand hygiene on infectious diseases in the office workplace: A systematic review

Background: Extensive data suggests that hand hygiene is a critical intervention for reducing infectious disease transmission in the clinical setting. However, it is unclear whether hand hygiene is effective at cutting down on infectious illnesses in non-clinical workplaces. The aim of this review is to assess the current literature concerning the effects of hand-washing interventions on infectious disease prevention among employees in nonclinical, office-based workplaces. Methods: In compiling this review, PubMed, Scopus, and Business Source Premier were examined for studies published from 1960 through 2016. Results: Eleven studies (eight experimental, two observational, one a simulation) were identified as eligible for inclusion. Hand-hygiene interventions at various levels of rigor were shown to reduce self-reported illness symptoms. Conclusions: Hand hygiene is thought to be more effective against gastrointestinal illness than it is against respiratory illness, but no clear consensus has been reached on this point. Minimal hand-hygiene interventions seem to be effective at reducing the incidence of employee illness. Along with reducing infections among employees, hand-hygiene programs in the workplace may provide additional benefits to employers by reducing the number of employee health insurance claims and improving employee morale. Future research should use objective measures of hand hygiene and illness, and explore economic impacts on employers more fully

Use of archived neonatal bloodspots for examining associations between prenatal exposure to potentially traumatic or stressful life events, maternal herpesvirus infection and lifetime history of generalized anxiety disorder in offspring

Background: Lifetime prevalence of anxiety disorders is over 30% among U.S. adolescents, warranting further investigation into early life risk factors for such conditions. We conducted a pilot study to examine the role that maternal herpesvirus infection may play in the pathway between maternal trauma and stress during pregnancy and offspring generalized anxiety disorder (GAD). Methods: Participants included 69 women in the Detroit Neighborhood Health Study with data on past exposure to 19 potentially traumatic (PTEs) and 9 stressful life events (SLEs). Lifetime history of GAD in the youngest biologic child between 6 and 17 years old born in Michigan (i.e., index child) of each woman was ascertained via the Diagnostic Interview Schedule for Children, 4th edition, parent version. We obtained written informed consent from participants for retrieval of archived neonatal bloodspot samples corresponding to their index child from the Michigan Neonatal Biobank (MNB) and testing of these samples for markers of maternal herpes simplex virus (HSV)-1 and cytomegalovirus (CMV) seropositivity. Logistic regression was used to examine the association between maternal PTEs or SLEs during pregnancy and offspring GAD. Results: A total of 18.1 and 31.9% of women experienced =1 PTE or SLE during pregnancy, respectively, and 10.8% of offspring met the criteria for lifetime history of GAD. We obtained maternal consent for retrieval of and tested bloodspot samples corresponding to the index child of 22 women (38.0%), of which 4.5 and 40.9% were seropositive for HSV-1 and CMV, respectively. We observed positive, although not statistically significant associations between =1 PTE or SLE during pregnancy and offspring lifetime history of GAD. While a greater proportion of offspring with lifetime history of GAD were born to women seropositive for CMV and HSV-1, compared to those without lifetime history, these differences were not statistically significant and we did not further examine the mediating role of maternal herpesvirus seropositivity in this pathway.Conclusion: Findings from this study support the feasibility of utilizing neonatal bloodspots archived in the MNB to examine the role of herpesviruses as mediators between maternal trauma or stress during pregnancy and offspring anxiety disorders in larger Michigan cohorts. © 2016 Simanek, Uddin, Yolken and Aiello

Investigating pathogen burden in relation to a cumulative deficits index in a representative sample of US adults

Pathogen burden is a construct developed to assess the cumulative effects of multiple, persistent pathogens on morbidity and mortality. Despite the likely biological wear and tear on multiple body systems caused by persistent infections, few studies have examined the impact of total pathogen burden on such outcomes and specifically on preclinical markers of dysfunction. Using data from two waves of the National Health and Nutrition Examination Survey, we compared three alternative methods for measuring pathogen burden, composed of mainly persistent viral infections, using a cumulative deficits index (CDI) as an outcome: single pathogen associations, a pathogen burden summary score and latent class analyses. We found significant heterogeneity in the distribution of the CDI by age, sex, race/ethnicity and education. There was an association between pathogen burden and the CDI by all three metrics. The latent class classification of pathogen burden showed particularly strong associations with the CDI; these associations remained after controlling for age, sex, body mass index, smoking, race/ethnicity and education. Our results suggest that pathogen burden may influence early clinical indicators of poor health as measured by the CDI. Our results are salient since we were able to detect these associations in a relatively young population. These findings suggest that reducing pathogen burden and the specific pathogens that drive the CDI may provide a target for preventing the early development of age-related physiological changes. © 2018 Cambridge University Press

Prevalence of Escherichia coli carriage in the oropharynx of ambulatory children and adults with and without upper respiratory symptoms

[No abstract available

Physical Activity, Sedentary Behavior, and Retirement: The Multi-Ethnic Study of Atherosclerosis

Introduction: Physical activity and sedentary behavior are major risk factors for chronic disease. These behaviors may change at retirement, with implications for health in later life. The study objective was to describe longitudinal patterns of moderate to vigorous and domain-specific physical activity and TV watching by retirement status. Methods: Participants in the Multi-Ethnic Study of Atherosclerosis (n=6,814) were recruited from six U.S. communities and were aged 45–84 years at baseline. Retirement status and frequency and duration of domain-specific physical activity (recreational walking, transport walking, non-walking leisure activity, caregiving, household, occupational/volunteer) and TV watching were self-reported at four study exams (2000 to 2012). Fixed effect linear regression models were used to describe longitudinal patterns in physical activity and TV watching by retirement status overall and stratified by socioeconomic position. Analyses were conducted in 2017. Results: Of 4,091 Multi-Ethnic Study of Atherosclerosis participants not retired at baseline, 1,012 (25%) retired during a median of 9 years follow-up. Retirement was associated with a 10% decrease (95% CI= –15%, –5%) in moderate to vigorous physical activity and increases of 13% to 29% in recreational walking, household activity, and TV watching. Among people of low socioeconomic position, the magnitude of association was larger for moderate to vigorous physical activity. Among people of high socioeconomic position, the magnitude of association was larger for non-walking leisure and household activity. Conclusions: The retirement transition was associated with changes in physical activity and TV watching. To inform intervention development, future research is needed on the determinants of behavior change after retirement, particularly among individuals of low socioeconomic position. © 2018 American Journal of Preventive Medicin