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Byline: Saskia J. Velde (1), Jos W. R. Twisk (1,2), Willem Mechelen (1,3), Han C. G. Kemper (1) Keywords: Adulthood; Birth weight; Bone densitometry; Bone ultrasound; Fat-free mass; Musculoskeletal health Abstract: The results of recent epidemiological studies suggest that birth weight is related to adult bone mineral status. Since birth weight might also be related to muscle strength and fat-free mass, which are important determinants of bone health, the aim of this study was to investigate the following: is birth weight related to bone mineral content (BMC) and bone mineral density (BMD) at the lumbar level, at the hip and of the total body, and to structural properties of the heel bone, to fat-free mass (FFM) and to muscle strength, at the age of 36 years? Two hundred and eighty-two subjects (162 women) underwent dual X-ray absorptiometry (DEXA) measurement for the assessment of BMC and BMD at different sites and the FFM and/or measurement of the structural properties of the heel bone, which were estimated with speed of sound (H-SOS) and broadband ultrasound attenuation. Muscle strength was assessed with two fitness tests (static arm-pull, and high jump). Information on birth weight was gathered by means of a questionnaire. The data were analyzed by application of multiple linear regression. Birth weight was positively related to FFM. In a crude model, birth weight was found to be positively associated with BMC, but not after adjustment for adult body weight. No significant associations were found between birth weight and muscle strength or birth weight and BMD. Furthermore, birth weight was inversely related to H-SOS. No other relationships were observed. Results support the fetal origins hypothesis that lower birth weight is related to lower BMC and FFM, but not that birth weight is associated with BMD and muscle strength. Furthermore, FFM was not identified as a link between birth weight and musculoskeletal health. Author Affiliation: (1) Institute for Research in Extramural Medicine, VU University Medical Center, Officia 1, De Boelelaan 7, 1083 HJ, Amsterdam, The Netherlands (2) Department of Clinical Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands (3) Department of Social Medicine and Body@Work Research Center For Physical Activity, Work And Health TNO-VU, VU University Medical Center, Amsterdam, The Netherlands Article History: Registration Date: 10/11/2003 Received Date: 04/04/2003 Accepted Date: 31/10/2003 Online Date: 18/12/2003

Background: Gastric acid-suppressive therapy has been suggested to increase the risk for intestinal carriage of MDR Enterobacterales, but there is scarce community-based evidence substantiating this risk.Objectives: To investigate if acid-suppressant use is associated with a risk of intestinal carriage of ESBL and carbapenemase-producing Enterobacterales (ESBL-E) in the open population, and to assess possible modifying factors.Methods: Within the framework of a nationwide seroprevalence study, we identified a population-based cross-sectional cohort comprising 2746 adults (≥18 years), who provided stool specimens between February 2016 and June 2017. Specimens were tested by phenotypic assays and confirmatory genotype analysis to detect carriage of ESBL-E. Covariate data were extracted from self-administered questionnaires. ORs and 95% CIs were estimated using multivariable multilevel logistic regression, controlling for confounders informed by directed acyclic graphs.Results: Among 2746 participants, 316 (11.5%) used acid suppressants; the prevalence of ESBL-E carriage was 7.4% (95% CI, 6.1%-8.6%). Current use of acid suppressants was not associated with ESBL-E carriage (adjusted OR [aOR], 1.05; 95% CI, 0.64-1.74); lifestyle and comorbidity did not modify this association. A higher BMI (≥25 kg/m2) (aOR, 1.42 [95% CI, 1.02-1.98]), non-Western ethnic origin (aOR, 1.96 [95% CI, 1.34-2.87]), travel to Eastern-Mediterranean, Western-Pacific or South-East Asia regions (aOR, 3.16 [95% CI, 1.71-5.83]) were associated with ESBL-E carriage. Sensitivity analyses confirmed these results; spline analysis supported a BMI-associated risk.Conclusions: In this open population study, current use of acid suppressants was not associated with ESBL-E carriage. Travel to high-endemic regions and non-Western ethnicity were confirmed as risk factors, while a higher BMI emerged as a potential new risk for ESBL-E carriage. [ABSTRACT FROM AUTHOR]

Background: The incidence of metachronous contralateral inguinal hernia (MCIH) is high in infants with an inguinal hernia (5-30%), with the highest risk in infants aged 6 months or younger. MCIH is associated with the risk of incarceration and necessitates a second operation. This might be avoided by contralateral exploration during primary surgery. However, contralateral exploration may be unnecessary, leads to additional operating time and costs and may result in additional complications of surgery and anaesthesia. Thus, there is no consensus whether contralateral exploration should be performed routinely.Methods: The Hernia-Exploration-oR-Not-In-Infants-Analysis (HERNIIA) study is a multicentre randomised controlled trial with an economic evaluation alongside to study the (cost-)effectiveness of contralateral exploration during unilateral hernia repair. Infants aged 6 months or younger who need to undergo primary unilateral hernia repair will be randomised to contralateral exploration or no contralateral exploration (n = 378 patients). Primary endpoint is the proportion of infants that need to undergo a second operation related to inguinal hernia within 1 year after primary repair. Secondary endpoints include (a) total duration of operation(s) (including anaesthesia time) and hospital admission(s); (b) complications of anaesthesia and surgery; and (c) participants' health-related quality of life and distress and anxiety of their families, all assessed within 1 year after primary hernia repair. Statistical testing will be performed two-sided with α = .05 and according to the intention-to-treat principle. Logistic regression analysis will be performed adjusted for centre and possible confounders. The economic evaluation will be performed from a societal perspective and all relevant costs will be measured, valued and analysed.Discussion: This study evaluates the effectiveness and cost-effectiveness of contralateral surgical exploration during unilateral inguinal hernia repair in children younger than 6 months with a unilateral inguinal hernia.Trial Registration: ClinicalTrials.gov NCT03623893 . Registered on August 9, 2018 Netherlands Trial Register NL7194. Registered on July 24, 2018 Central Committee on Research Involving Human Subjects (CCMO) NL59817.029.18. Registered on July 3, 2018. [ABSTRACT FROM AUTHOR]

Background: Confounding bias is a common concern in epidemiological research. Its presence is often determined by comparing exposure effects between univariable- and multivariable regression models, using an arbitrary threshold of a 10% difference to indicate confounding bias. However, many clinical researchers are not aware that the use of this change-in-estimate criterion may lead to wrong conclusions when applied to logistic regression coefficients. This is due to a statistical phenomenon called noncollapsibility, which manifests itself in logistic regression models. This paper aims to clarify the role of noncollapsibility in logistic regression and to provide guidance in determining the presence of confounding bias.Methods: A Monte Carlo simulation study was designed to uncover patterns of confounding bias and noncollapsibility effects in logistic regression. An empirical data example was used to illustrate the inability of the change-in-estimate criterion to distinguish confounding bias from noncollapsibility effects.Results: The simulation study showed that, depending on the sign and magnitude of the confounding bias and the noncollapsibility effect, the difference between the effect estimates from univariable- and multivariable regression models may underestimate or overestimate the magnitude of the confounding bias. Because of the noncollapsibility effect, multivariable regression analysis and inverse probability weighting provided different but valid estimates of the confounder-adjusted exposure effect. In our data example, confounding bias was underestimated by the change in estimate due to the presence of a noncollapsibility effect.Conclusion: In logistic regression, the difference between the univariable- and multivariable effect estimate might not only reflect confounding bias but also a noncollapsibility effect. Ideally, the set of confounders is determined at the study design phase and based on subject matter knowledge. To quantify confounding bias, one could compare the unadjusted exposure effect estimate and the estimate from an inverse probability weighted model. [ABSTRACT FROM AUTHOR]