Methods to assess seasonal effects in epidemiological studies of infectious diseases—exemplified by application to the occurrence of meningococcal disease

AbstractSeasonal variation in occurrence is a common feature of many diseases, especially those of infectious origin. Studies of seasonal variation contribute to healthcare planning and to the understanding of the aetiology of infections. In this article, we provide an overview of statistical methods for the assessment and quantification of seasonality of infectious diseases, as exemplified by their application to meningococcal disease in Denmark in 1995-2011. Additionally, we discuss the conditions under which seasonality should be considered as a covariate in studies of infectious diseases. The methods considered range from the simplest comparison of disease occurrence between the extremes of summer and winter, through modelling of the intensity of seasonal patterns by use of a sine curve, to more advanced generalized linear models. All three classes of method have advantages and disadvantages. The choice among analytical approaches should ideally reflect the research question of interest. Simple methods are compelling, but may overlook important seasonal peaks that would have been identified if more advanced methods had been applied. For most studies, we suggest the use of methods that allow estimation of the magnitude and timing of seasonal peaks and valleys, ideally with a measure of the intensity of seasonality, such as the peak-to-low ratio. Seasonality may be a confounder in studies of infectious disease occurrence when it fulfils the three primary criteria for being a confounder, i.e. when both the disease occurrence and the exposure vary seasonally without seasonality being a step in the causal pathway. In these situations, confounding by seasonality should be controlled as for any confounder

Partner bereavement and risk of chronic urticaria, alopecia areata and vitiligo:cohort studies in the UK and Denmark

The pathogeneses of skin diseases are not fully understood. Psychological stress has been proposed to be associated with skin diseases, but the epidemiological evidence is limited [1, 2]. We have recently reported the associations between partner bereavement (an extreme life stressor) and psoriasis, atopic eczema and melanoma [3, 4]. In this study, we further investigated whether partner bereavement was associated with urticaria, alopecia areata, or vitiligo

Use of negative control outcomes to assess the comparability of patients initiating lipid-lowering therapies

Purpose: Clinical trials have demonstrated efficacy of proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) in reducing risk of cardiovascular disease events, but effectiveness in routine clinical care has not been well-studied. We used negative control outcomes to assess potential confounding in an observational study of PCSK9i versus ezetimibe or high-intensity statin. Methods: Using commercial claims, we identified U.S. adults initiating PCSK9i, ezetimibe, or high-intensity statin in 2015–2018, with other lipid-lowering therapy (LLT) use in the year prior (LLT cohort) or atherosclerotic cardiovascular disease (ASCVD) in the past 90 days (ASCVD cohort). We compared initiators of PCSK9i to ezetimibe and high-intensity statin by estimating one-year risks of negative control outcomes influenced by frailty or health-seeking behaviors. Inverse probability of treatment and censoring weighted estimators of risk differences (RDs) were used to evaluate residual confounding after controlling for covariates. Results: PCSK9i initiators had lower one-year risks of negative control outcomes associated with frailty, such as decubitus ulcer in the ASCVD cohort (PCSK9i vs. high-intensity statin RD = −3.5%, 95% confidence interval (CI): −4.6%, −2.5%; PCSK9i vs. ezetimibe RD = −1.3%, 95% CI: −2.1%, −0.6%), with similar but attenuated associations in the LLT cohort. Lower risks of accidents and fractures were also observed for PCSK9i, varying by cohort. Risks were similar for outcomes associated with health-seeking behaviors, although trended higher for PCSK9i in the ASCVD cohort. Conclusions: Observed associations suggest lower frailty and potentially greater health-seeking behaviors among PCSK9i initiators, particularly those with a recent ASCVD diagnosis, with the potential to bias real-world analyses of treatment effectiveness

Influence of animal fat substitution by vegetal fat on Mortadella-type products formulated with different hydrocolloids

Meat has played a crucial role in human evolution and is an important component of a healthy and well-balanced diet on account of its nutritional properties, its high biological value as a source of protein, and the vitamins and minerals it supplies. We studied the effects of animal fat reduction and substitution by hydrogenated vegetal fat, sodium alginate and guar gum. Fatty acid composition, lipid oxidation, color and instrumental texture as well as the sensorial difference between low, substituted-fat and the traditional formulations for mortadella-type products were analyzed. Both substitution and reduction of animal fat decreased the saturated fatty acids percentage from 40% down to 31%. A texture profile analysis showed differences between the formulations. Furthermore, lipid oxidation values were not significant for treatments as regards the type and quantity of fat used while the use of sodium alginate and guar gum reduced the amounts of liquid released after cooking. Animal fat substitution does cause, however, a difference in overall sensorial perception compared with non-substituted products. The results confirm the viability of substituting vegetal fat for animal fat