Association of Apgar scores with death and neurologic disability

Apgar score was devised with the aim to standardize the assessment of newborns. It has been used worldwide to evaluate infants’ condition immediately after birth, to determine their need for resuscitation, and to evaluate the effectiveness of resuscitation. Apgar score was never intended for prediction of outcome beyond the immediate postnatal period; however, since low scores correlate with prenatal and perinatal adversities, multiple studies have examined the relation between the value of Apgar score and duration of low (<7) Apgar score and subsequent death or neurologic disability. This article reviews such studies. The author concludes that the overall evidence shows consistent association of low Apgar scores with increased risks of neonatal and infant death and with neurologic disability, including cerebral palsy, epilepsy, and cognitive impairment. Dose-response patterns have been shown for the value of Apgar score and duration of low score and the outcomes of mortality and neurologic disability. The association of Apgar score <7 at five minutes with increased risks of neurologic disability seems to persist many years postnatally. Some corresponding relative risk estimates are large (eg, four to seven for epilepsy or more than 20 for cerebral palsy), while others are modest (eg, 1.33 for impaired cognitive function). The absolute risks, however, are low (<5% in for most neurologic conditions), and majority of surviving babies with low Apgar scores grow up without disability. The low magnitude of absolute risks makes Apgar score a poor clinical predictor of long-term outcome. Nevertheless, the observed associations point to the importance of fetal and perinatal periods for neurodevelopment

The friction of the mundane: on the problematic marketization of the carbon stored by trees in the tropics

Carbon dioxide released from the burning of fossil fuels is a major concern of our times. There is now a political agreement that these emissions must decrease. So far one way forward has been to design and maintain carbon markets. As part of this process, trees in the tropics have been enrolled in peculiar transactions: actions such as reforesting a land of degraded savannah or preserving a piece of forest can produce tradable emission credits to offset against CO2 emissions in distant locations. Based on a multi-sited investigation of carbon offsetting, including fieldwork in the Congo, the paper presents a journey across different marketization sites where the enrolment of forest carbon into market exchanges can be seen to be at stake. Several operations are foregrounded, from United Nations negotiations and the measurement of carbon stocks, to business venture and legal work. The paper proposes a focus on the mundane that attends to details and frictions. This provides a deflationary story of the marketization of forest carbon, a story of contingencies and unexpected ramifications

On the difficulties of addressing collective concerns through markets: from market devices to accountability devices

In recent years market-based interventions have been positioned as the basis for addressing what the editors of this special issue have termed ‘collective concerns’ in fields as diverse as healthcare, the environment and crime. This paper considers the terms of such interventions and the market-like relations these terms pre-suppose. It does so through a comparison of two interventions: a market-based scheme to address concerns regarding electronic waste and a Social Impact Bond for children at-risk of going into care. Ideas from Science and Technology Studies are drawn on to explore the composition of market-based interventions, the terms established through accountability devices which decide on who and what gets to participate, and the consequences that follow

Carbon sink geopolitics

This paper offers an example of global politics in action by attending to the modalities and outcomes of United Nations negotiations on global warming. More precisely, the paper ethnographically traces how the capacity of tropical forests to be carbon sinks is turned into a matter of global concern. The focus is on a negotiated policy called Reducing Emissions from Deforestation and forest Degradation (REDD+) and its anchoring in the Democratic Republic of the Congo whose territory contains the second largest area of rainforest after Brazil. The paper proposes to discuss the importance of the promissory in climate actions, the multivalence of what is at stake and the porosity and resilience of national demarcation. To do so, it identifies three moments and sites of geopolitical re-composition: the formulation of international consensus, the work of preparatory agents, and the quest for metrological inclusiveness. These moments and sites point to the theatricality and semi-secrecy of United Nations negotiations, the mobilizing activity of expatriate consultants hired with overseas aid funding, and the unstable evidential grounds on which emission reduction efforts are based. The paper suggests that through this series of processes, the carbon stored by tropical forests becomes a matter of global exigenc

Existing data sources for clinical epidemiology: Aarhus University Prescription Database

Population-based prescription databases in Nordic countries have become a mainstay of epidemiologic research. Denmark has both national and regional population-based prescription databases. Aarhus University Prescription Database collects data on reimbursed medications dispensed at all community pharmacies of the North Denmark Region and the Central Denmark Region. The regions have a combined population of 1.8 million inhabitants, or one-third of the Danish population. Denmark’s primary health care sector, which includes general practitioners, specialists, and dentists, generates about 96% of the prescription sales, most of which are reimbursable and are dispensed by the community pharmacies. The Aarhus University Prescription Database combines the region’s pharmacy records in a single database, maintained and updated for research purposes. Each dispensation record contains patient-, drug-, and prescriber-related data. Dispensation records retain patients’ universal personal identifier, which allows for individual-level linkage to all Danish registries and medical databases. The linked data have many applications in clinical epidemiology, including drug utilization studies, safety monitoring, etiologic research, and validation studies

Validity of asthma diagnoses in the Danish National Registry of Patients, including an assessment of impact of misclassification on risk estimates in an actual dataset

Annette &amp;Oslash;stergaard Jensen1, Gunnar Lauge Nielsen2, Vera Ehrenstein11Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; 2Department of Medicine, Himmerland Hospital, Fars&amp;oslash;, DenmarkObjective: Asthma diagnoses recorded in the Danish National Registry of Patients (DNRP) are a misclassified measure of the actual asthma status. We quantified this misclassification and examined its impact on the results of an epidemiologic study on asthma.Study design and setting: We validated the DNRP asthma diagnoses against records of asthma diagnosed at medical examinations conducted during mandatory conscription evaluation. We had data on 22,177 male conscripts who were born from January 1st, 1977 to December 31st, 1983, in a conscription district in northern Denmark. We obtained asthma diagnoses recorded among the conscripts in the DNRP from January 1st, 1977 through December 31st, 2003. We estimated sensitivity, specificity, and positive predictive value (PPV) of the DNRP asthma diagnoses. We then conducted sensitivity analysis to quantify the impact of nondifferential misclassification on the rate ratios measuring the association between asthma and risks of different skin cancers.Results: The sensitivity of the DNRP for detecting an asthma diagnosis was 0.44 (95% confidence interval [CI]: 0.42&amp;ndash;0.47), the specificity was 0.98 (95% CI: 0.98&amp;ndash;0.99) and the PPV was 0.65 (95% CI: 0.62&amp;ndash;0.68). Both direct and inverse associations between asthma and the different types of skin cancers became more pronounced after correcting for the misclassification.Conclusion: The DNRP registered asthma diagnosis may be used to measure asthma status in epidemiologic studies seeking to estimate relative effects of asthma. Even at low values of DNRP sensitivity of asthma diagnoses were not sufficient to nullify observed relative associations in an actual dataset. The specificity of DNRP asthma diagnosis is high.Keywords: asthma, validity, registry data, epidemiolog

The logic of carbon substitution: from fossilised life to “cell factories”

This paper examines how researchers in biotechnology reflect on the challenges of turning microbes into what they call “cell factories”. These researchers use the tools of genome editing to harness the biochemistry of single cell organisms, such as bacteria, yeasts and microalgae, and tweak the enzymatic reactions of their metabolism. One research priority is to engineer microbes able to feed on agricultural residues and assemble drop-in compounds to be used in a range of commercial products, from drugs and food additives, to cosmetics, detergents and fuels. To justify financial support for such research, arguments about the need to move away from petroleum as a source of energy and feedstock for chemical synthesis are put forward, underpinned by concerns for climate change, resource renewability and energy security. Drawing on interviews with scientists, we explore what it means for them to make “cell factories” and discuss how they problematise the logic of carbon substitution that orientates their work. Biotechnology is expected to support a shift from one source of carbon, past life gone through slow geological cycles, to a different source of carbon, renewable biomass metabolised by living microbes. As scientists face unhappy cells, recalcitrant plant fibres and unfair competition from fossil-based processes, the promise of carbon substitution tends to be most convincing in the confined space of the lab where faith in biotechnology goes hand in hand with a pragmatic commitment to sustainability. We speculate that the researchers might be failed by the system that biotechnology seeks to (partially) replace, the conditions of which are shaped not around the material constraints of making “cell factories”, but around fossilised life cracked in ever-greater quantities

Quantifying the impact of unmeasured confounding in observational studies with the E value

The E value method deals with unmeasured confounding, a key source of bias in observational studies. The E value method is described and its use is shown in a worked example of a meta-analysis examining the association between the use of antidepressants in pregnancy and the risk of miscarriage

Social isolation and all-cause mortality: a population-based cohort study in Denmark.

Social isolation is associated with increased mortality. Meta-analytic results, however, indicate heterogeneity in effect sizes. We aimed to provide new evidence to the association between social isolation and mortality by conducting a population-based cohort study. We reconstructed the Berkman and Syme's social network index (SNI), which combines four components of social networks (partnership, interaction with family/friends, religious activities, and membership in organizations/clubs) into an index, ranging from 0/1 (most socially isolated) to 4 (least socially isolated). We estimated cumulative mortality and adjusted mortality rate ratios (MRR) associated with SNI. We adjusted for potential important confounders, including psychiatric and somatic status, lifestyle, and socioeconomic status. Cumulative 7-year mortality in men was 11% for SNI 0/1 and 5.4% for SNI 4 and in women 9.6% for SNI 0/1 and 3.9% for SNI 4. Adjusted MRRs comparing SNI 0/1 with SNI 4 were 1.7 (95% CI: 1.1-2.6) among men and 1.6 (95% CI: 0.83-2.9) among women. Having no partner was associated with an adjusted MRR of 1.5 (95% CI: 1.2-2.1) for men and 1.7 (95% CI: 1.2-2.4) for women. In conclusion, social isolation was associated with 60-70% increased mortality. Having no partner was associated with highest MRR