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

antidiabetics statins and the risk of amyotrophic lateral sclerosis

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Joint modelling of bivariate longitudinal data : Application to the recovery of sexual function and urinary continence

(E0871) The following methodological issues occur in the context of the longitudinal study of sexual dysfunction and urinary incontinence after radical prostatectomy: (i) high dropout rate due to the extremely sensitive nature of the investigated outcomes; (ii) correlation between the two outcomes; (iii) non-linearity of the recovery trajectories. To address all these issues, we propose the use of a joint modelling approach, including a bivariate linear mixed model with splines for the two outcomes and a proportional hazards model for the time to dropout. We applied the model to data from consecutive patients underwent robotic-assisted radical prostatectomy at European institute of oncology from May 2015 to July 2016. Preand post-surgical sexual and urinary functional conditions were evaluated using the expanded prostate cancer index composite questionnaire. Six hundred forty three patients were included in the analysis. At one year after surgery, only 55% of patients returned the questionnaire. Parameters estimation was based on the maximisation of the likelihood function achieved through the implementation of an EM algorithm. A Gauss Hermite approximation was also used for some of the integrals involved. To assess the effect of nonrandom dropout mechanisms on the parameter estimates, we calculated the index of local sensitivity to non-ignorability

Cardiorenal outcomes among patients with atrial fibrillation treated with oral anticoagulants

Rationale & Objective: Direct oral anticoagulants (DOACs) have progressively replaced vitamin K antagonists (VKAs) for stroke prevention in pa-tients with nonvalvular atrial fibrillation (AF). DOACs cause fewer bleeding complications, but their other advantages, particularly related to kid-ney outcomes, remain inconclusive. We studied the risks of chronic kidney disease (CKD) pro-gression and acute kidney injury (AKI) after DOAC and VKA administration for nonvalvular AF.Study Design: Retrospective cohort study. Setting & Participants: Cohort study of Swedish patients enrolled in the Stockholm Creatinine Measurements (SCREAM) project with a diag-nosis of nonvalvular AF during 2011-2018. Exposure: Initiation of DOAC or VKA treatment.Outcome: Primary outcomes were CKD pro-gression (composite of >30% estimated glomer-ular filtration rate [eGFR] decline and kidney failure) and AKI (by diagnosis or KDIGO-defined transient creatinine elevations). Secondary outcomes were death, major bleeding, and the composite of stroke and systemic embolism.Analytical Approach: Propensity score weighted Cox regression was used to balance 50 baseline confounders. Sensitivity analyses included falsification end points, subgroups, and estima-tion of per-protocol effects.Results: We included 32,699 patients (56% initiated DOAC) who were observed for a me-dian of 3.8 years. Their median age was 75 years, 45% were women, and 27% had an eGFR <60 mL/min/1.73 m2. The adjusted HRs for DOAC versus VKA were 0.87 (95% CI, 0.78-0.9 8) for the risk of CKD progression and 0.88 (95% CI, 0.80-0.97) for AKI. HRs were 0.77 (95% CI, 0.67-0.8 9) for major bleeding, 0.93 (95% CI, 0.78-1.11) for the composite of stroke and systemic embolism, and 1.04 (95% CI, 0.95-1.14) for death. The results were similar across subgroups of age, sex, and baseline eGFR when restricting to patients at high risk for thromboembolic events and when censoring follow up at treatment discontinuation or change in type of anticoagulation.Limitations: Missing information on time in ther-apeutic range and treatment dosages.Conclusions: Among patients with nonvalvular AF treated in routine clinical practice compared with VKA use, DOAC use was associated with a lower risk of CKD progression, AKI, and major bleeding but a similar risk of the composite of stroke, systemic embolism, or death.Clinical epidemiolog

The effects of processing and mastication on almond lipid bioaccessibility using novel methods of in vitro digestion modelling and micro-structural analysis

A number of studies have demonstrated that consuming almonds increases satiety but does not result in weight gain, despite their high energy and lipid content. To understand the mechanism of almond digestion, in the present study, we investigated the bioaccessibility of lipids from masticated almonds during in vitro simulated human digestion, and determined the associated changes in cell-wall composition and cellular microstructure. The influence of processing on lipid release was assessed by using natural raw almonds (NA) and roasted almonds (RA). Masticated samples from four healthy adults (two females, two males) were exposed to a dynamic gastric model of digestion followed by simulated duodenal digestion. Between 7·8 and 11·1 % of the total lipid was released as a result of mastication, with no significant differences between the NA and RA samples. Significant digestion occurred during the in vitro gastric phase (16·4 and 15·9 %) and the in vitro duodenal phase (32·2 and 32·7 %) for the NA and RA samples, respectively. Roasting produced a smaller average particle size distribution post-mastication; however, this was not significant in terms of lipid release. Light microscopy showed major changes that occurred in the distribution of lipid in all cells after the roasting process. Further changes were observed in the surface cells of almond fragments and in fractured cells after exposure to the duodenal environment. Almond cell walls prevented lipid release from intact cells, providing a mechanism for incomplete nutrient absorption in the gut. The composition of almond cell walls was not affected by processing or simulated digestion