Association between choline supplementation and Alzheimer’s disease risk: a systematic review protocol

Background and aimsThere is growing evidence suggesting choline intake might have beneficial effects on cognitive function in the elderly. However, some studies report no relationship between choline intake and cognitive function or improvement in Alzheimer’s disease patients. This protocol is for a systematic review of choline intake and Alzheimer’s disease that aims to assess the comparative clinical effectiveness of choline supplementation on Alzheimer’s disease risk.Methods and analysisliterature search will be performed in PubMed, MEDLINE, EMBASE, CINAHL, Scopus, Cochrane, and the Web of Science electronic databases from inception until October 2023. We will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies will be included if they compared two different time points of choline biomarkers measures in men or women (65+) with Alzheimer’s Disease. The risk of bias in the included studies will be assessed within the Covidence data-management software.ResultsThis review will summarize the clinical trial and quasi-experimental evidence of choline intake on Alzheimer’s disease risk for adults aged 65+. The results from all eligible studies included in the analysis will be presented in tables, text, and figures. A descriptive synthesis will present the characteristics of included studies (e.g., age, sex of participants, type, length of intervention and comparator, and outcome measures), critical appraisal results, and descriptions of the main findings.DiscussionThis systematic review will summarize the existing evidence on the association between Choline intake and AD and to make recommendations if appropriate. The results of this review will be considered with respect to whether there is enough evidence of benefit to merit a more definitive randomized controlled trial. The results will be disseminated through peer-reviewed journals population.ConclusionThis protocol outlines the methodology for a systematic review of choline intake and AD. The resulting systematic review from this protocol will form an evidence-based foundation to advance nutrition care for individuals with AD or poor cognitive function.Systematic review registrationhttp://www.crd.york.ac.uk/PROSPERO, identifier CRD42023395004

UUnderstanding Program Engagement and Attrition in Child Abuse Prevention

Engaging and retaining families is a common challenge when serving families at high risk. McCurdy and Daro’s (2001) Integrated Theory of Parental Involvement (ITPI) proposes factors that impact engagement and retention in services. While several studies have found varying family demographic and risk factors to be associated with family engagement in home-based services, (withheld citation for purpose of review) identified program and provider characteristics that predicted engagement and retention (withheld citation for purpose of review). Specifically, SafeCare (SC) had greater enrollment (4 times) and retention (8.5 times) rates than services as usual (SAU), likely due to SC’s skill-based approach targeting desired topics. As a follow-up to this quantitative study, we conducted separate focus groups with parents who engaged and who failed to engage in SC (N= 16) and SAU (N=18). Provider characteristics (e.g., caring, experienced with children, nonjudgmental) was the strongest themes for engagement across groups. Program and provider flexibility and providers’ persistent support for parents despite life chaos facilitated retention. Results suggest that provider characteristics and program approach are key in engagement of families in home-based services. These results suggest expansion of the ITPI to address social context. Results suggestfocusing on specific provider characteristics and program approach for work force and program development to increase program engagement and decrease attrition

Maternal major depression disorder misclassification errors: Remedies for valid individual‐ and population‐level inference

Abstract Individual and population level inference about risk and burden of MDD, particularly maternal MDD, is often made using case‐finding tools that are imperfect and prone to misclassification error (i.e. false positives and negatives). These errors or biases are rarely accounted for and lead to inappropriate clinical decisions, inefficient allocation of scarce resources, and poor planning of maternal MDD prevention and treatment interventions. The argument that the use of existing maternal MDD case‐finding instruments results in misclassification errors is not new; in fact, it has been argued for decades, but by and large its implications and particularly how to correct for these errors for valid inference is unexplored. Correction of the estimates of maternal MDD prevalence, case‐finding tool sensitivity and specificity is possible and should be done to inform valid individual and population‐level inferences

Are we validly assessing major depression disorder risk and associated factors among mothers of young children? A cross-sectional study involving home visitation programs.

Failure to account for misclassification error accruing from imperfect case-finding instruments can produce biased estimates of suspected major depression disorder (MDD) risk factor associations. The objective of this study was to estimate the impact of misclassification error on the magnitude of measures of association between suspected risk factors and MDD assessed using the Center of Epidemiological Studies on Depression-Short Form during the prenatal and postnatal periods. Baseline data were collected from 520 mothers participating in two home visitation studies in Oklahoma City between 2010 and 2014. A Bayesian binomial latent class model was used to compare the prevalence proportion ratio (PPR) between suspected risk factors and MDD with and without adjustment for misclassification error and confounding by period of MDD symptom on-set. Adjustment for misclassification error and confounding by period of MDD on-set (prenatal vs postnatal) showed that the association between suspected risk factors and MDD is underestimated (-) and overestimated (+) differentially in different source populations of low-income mothers. The median bias in the magnitude of PPR estimates ranged between -.47 (95% Bayesian Credible Intervals [BCI]: -10.67, 1.90) for intimate partner violence to +.06 (95%BCI: -0.37, 0.47) for race/ethnicity among native-born US residents. Among recent Hispanic immigrants, bias ranged from -.77 (95%BCI: -15.31, 0.96) for history of childhood maltreatment to +.10 (95%BCI: -0.17, 0.39) for adequacy of family resources. Overall, the extent of bias on measures of association between maternal MDD and suspected risk factors is considerable without adjustment for misclassification error and is even higher for confounding by period of MDD assessment. Consideration of these biases in MDD prevention research is warranted

Social risk factors for pediatric asthma exacerbations: A systematic review

Objective: This systematic review aims to identify social risk factors that influence pediatric asthma exacerbations. Methods: Cohort studies published between 2010 and 2020 were systematically searched on the OVID Medline, Embase, and PsycInfo databases. Using our established phased inclusion and exclusion criteria, studies that did not address a pediatric population, social risk factors, and asthma exacerbations were excluded. Out of a total of 707 initially retrieved articles, 3 prospective cohort and 6 retrospective cohort studies were included. Results: Upon analysis of our retrieved studies, two overarching domains of social determinants, as defined by Healthy People 2030, were identified as major risk factors for pediatric asthma exacerbations: Social/Community Context and Neighborhood/Built Environment. Social/Community factors including African American race and inadequate caregiver perceptions were associated with increased risk for asthma exacerbations. Patients in high-risk neighborhoods, defined by lower levels of education, housing, and employment, had higher rates of emergency department readmissions and extended duration of stay. Additionally, a synergistic interaction between the two domains was found such that patients with public or no health insurance and residence in high-risk neighborhoods were associated with excess hospital utilization attributable to pediatric asthma exacerbations. Conclusion: Social risk factors play a significant role in influencing the frequency and severity of pediatric asthma exacerbations

Decision tree‐based rules outperform risk scores for childhood asthma prognosis

Background: There are no widely accepted prognostic tools for childhood asthma; this is in part due to the multifactorial and time-dependent nature of mechanisms and risk factors that contribute to asthma development. Our study objective was to develop and evaluate the prognostic performance of conditional inference decision tree-based rules using the Pediatric Asthma Risk Score (PARS) predictors as an alternative to the existing logistic regression-based risk score for childhood asthma prediction at 7 years in a high-risk population. Methods: The Canadian Asthma Primary Prevention Study data were used to develop, compare, and contrast the prognostic performance (area under the curve [AUC], sensitivity, and specificity) of conditional inference tree-based decision rules to the pediatric asthma risk score for the prediction of childhood asthma at 7 years. Results: Conditional inference decision tree-based rules have higher prognostic performance (AUC: 0.85; 95% CI: 0.81, 0.88; sensitivity = 47%; specificity = 93%) than the pediatric asthma risk score at an optimal cutoff of ≥6 (AUC: 0.71; 95% CI: 0.67, 0.76; sensitivity = 60%; specificity = 74%). Moreover, the pediatric asthma risk score is not linearly related to asthma risk, and at any given pediatric asthma risk score value, different combinations of its pediatric asthma risk score clinical variables differentially predict asthma risk. Conclusion: Conditional inference tree-based decision rules could be a useful childhood asthma prognostic tool, providing an alternative way to identify unique subgroups of at-risk children, and insights into associations and effect mechanisms that are suggestive of appropriate tailored preventive interventions. However, the feasibility and effectiveness of such decision rules in clinical practice is warranted

Body mass index trajectories and mortality risk in Japan using a population-based prospective cohort study: the Japan Public Health Center-based Prospective Study

Background: Recent studies have found that long-term changes in weight during adulthood are associated with a high risk of mortality. The objective of this study was to characterize body mass index (BMI) trajectories during adulthood and to examine the association between BMI trajectories and risk of death in the Japanese population. Methods: The data were extracted from Japan Public Health Center-based Prospective Study-a population-based prospective cohort study in Japan with participants aged 40-69 years followed over 20 years. The participants were categorized into multiple BMI trajectory groups using the latent class growth model. The Cox proportional-hazards model was conducted using all-cause mortality and cause-specific mortality as outcomes and the identified BMI trajectory groups as a predictor. In total, 65 520 participants were included in the analysis. Results: Six BMI trajectory groups were identified: underweight stable (Group 1), low-to-high normal (Group 2), high-to-low normal (Group 3), normal to overweight (Group 4), overweight to normal (Group 5) and normal to obese (Group 6). Our Cox models showed a higher hazard (risk) of all-cause mortality among participants in the BMI-declining groups [Group 3, adjusted hazard ratio (aHR): 1.10, 95% CI: 1.05-1.16; Group 5, aHR: 1.16, 95% CI: 1.08-1.26], underweight stable group (Group 1, aHR: 1.27, 95% CI: 1.21-1.33) and normal to obese group (Group 6, aHR: 1.22, 95% CI: 1.13-1.33) than Group 2 (low-to-high normal BMI trajectory). Conclusions: Stable underweight and weight loss were associated with a high risk of mortality, both of which were uniquely observed in a Japanese population