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Book ; Online: White Paper - Verbesserung des Record Linkage für die Gesundheitsforschung in Deutschland

Intemann, Timm / Kaulke, Knut / Kipker, Dennis-Kenji / Lettieri, Vanessa / Stallmann, Christoph / Schmidt, Carsten O. / Geidel, Lars / Bialke, Martin / Hampf, Christopher / Stahl, Dana / Lablans, Martin / Franke, Martin / Kraywinkel, Klaus Peter / Kieschke, Joachim / Bartholomäus, Sebastian / Näher, Anatol-Fiete / Tremper, Galina / Lambarki, Mohamed / March, Stefanie /

Prasser, Fabian / Haber, Anna Christine / Drepper, Johannes / Schlünder, Irene / Kirsten, Toralf / Pigeot, Iris / Sax, Ulrich / Buchner, Benedikt / Ahrens, Wolfgang / Semler, Sebastian Claudius

2023

Abstract: Die personenbezogene Verknüpfung von unterschiedlichen, gesundheitsbezogenen Daten mit dem Ziel einen Forschungsdatensatz zu erstellen, wird als Record Linkage bezeichnet. Diese Daten zu einer Person können bei voneinander getrennten Datenhaltern ... ...

Institution	NFDI4Health - Nationale Forschungsdateninfrastruktur für personenbezogene Gesundheitsdaten
Author's details	nfdi4health ; Autorenliste: Timm Intemann, Knut Kaulke, Dennis-Kenji Kipker, Vanessa Lettieri, Christoph Stallmann, Carsten O. Schmidt, Lars Geidel, Martin Bialke, Christopher Hampf, Dana Stahl, Martin Lablans, Florens Rohde, Martin Franke, Klaus Kraywinkel, Joachim Kieschke, Sebastian Bartholomäus, Anatol-Fiete Näher, Galina Tremper, Mohamed Lambarki, Stefanie March, Fabian Prasser, Anna Christine Haber, Johannes Drepper, Irene Schlünder, Toralf Kirsten, Iris Pigeot, Ulrich Sax, Benedikt Buchner, Wolfgang Ahrens, Sebastian C. Semler ; Konzept: Wolfgang Ahrens, Timm Intemann, Knut Kaulke, Iris Pigeot, Sebastian C. Semler ; Überprüfung und Überarbeitung: Wolfgang Ahrens, Johannes Drepper, Anna Christine Haber, Timm Intemann, Knut Kaulke, Toralf Kirsten, Stefanie March, Iris Pigeot, Fabian Prasser, Sebastian C. Semler
Abstract	Die personenbezogene Verknüpfung von unterschiedlichen, gesundheitsbezogenen Daten mit dem Ziel einen Forschungsdatensatz zu erstellen, wird als Record Linkage bezeichnet. Diese Daten zu einer Person können bei voneinander getrennten Datenhaltern vorliegen. Auf diese Weise lassen sich wissenschaftliche Fragestellungen beantworten, die wegen des beschränkten Variablenumfangs mit einer Datenquelle alleine nicht zu beantworten wären. Diese verknüpften Daten entfalten ein riesiges Potential für die Gesundheitsforschung, um Prävention, Therapie und Versorgung der Bevölkerung zu verbessern. Da es sich dabei um sensible Daten handelt, gelten strenge Rechtsvorschriften um vor potenziellen Missbrauch zu schützen. Die derzeitigen rechtlichen Gegebenheiten schränken allerdings die Nutzung der Gesundheitsdaten für die Forschung so stark ein, dass ihr Potenzial für eine Verbesserung von Prävention und Versorgung bisher nicht ausgeschöpft werden kann. Record Linkage wird in Deutschland dadurch erschwert bzw. in vielen Fällen sogar unmöglich gemacht, dass es im Gegensatz zu Ländern keinen eindeutigen personenbezogenen Identifikator gibt, der eine Zusammenführung über verschiedene Datenkörper hinweg ermöglichen würde. Zudem sind in Deutschland interoperable Lösungen nicht vorhanden, um ein umfassendes studien- und datenkörperübergreifendes Record Linkage in einer gesicherten Umgebung durchführen zu können. Dem berechtigten Interesse auf Schutz der personenbezogenen Daten steht z. B. das Interesse entgegen, Risiken und Nutzen von Behandlungen zu erforschen und diese zur Verbesserung der gesundheitlichen Versorgung zu nutzen. Bei der Durchführung von Record Linkage-Projekten steht die Wissenschaft vor großen Herausforderungen. Oftmals wird von Datenhaltern oder Datenschützern für die Verknüpfung personenbezogener Daten die informierte Einwilligung der einzelnen Studienteilnehmenden gefordert, selbst wenn dies nicht erforderlich ist, z. B. weil klare gesetzliche Regelungen fehlen. Hinzu kommt eine unterschiedliche Auslegung der gesetzlichen Rahmenbedingungen durch Datenschutzbehörden. Zweitens erlauben die Informationen der zu verknüpfenden Datenquellen oft keine exakte Verknüpfung. So ist die Datensatzverknüpfung nicht nur ein rechtliches, sondern auch eine methodische Herausforderung. Insgesamt ist festzuhalten, dass das Record Linkage für die Gesundheitsforschung in Deutschland gegenwärtig weit hinter den Standards anderer europäischer Länder hinterherhinkt. So müssen für jeden Anwendungsfall und jedes Record Linkage-Projekt einzelfallspezifische Lösungen entwickelt, geprüft, ggf. modifiziert und – falls positiv beschieden – umgesetzt werden. Die Limitationen und Möglichkeiten dieser unterschiedlichen und spezifisch auf verschiedene Anwendungsfelder zugeschnittenen Ansätze werden diskutiert und es werden die Voraussetzungen beschrieben, die erfüllt sein müssen, um einen forschungsfreundlicheren Ansatz für die personenbezogene Datensatzverknüpfung zwischen verschiedenen Datenquellen in Deutschland zu erreichen. Dabei werden auch entsprechende Empfehlungen an den Gesetzgeber formuliert. Das White Paper soll die Grundlage für eine Verbesserung des Record Linkage für die Gesundheitsforschung in Deutschland schaffen. Es zielt darauf ab, praktikable Lösungen für die personenbezogene Datensatzverknüpfung von unterschiedlichen Datenquellen anzubieten, die im Einklang mit der europäischen Datenschutzgrundverordnung stehen.
Keywords	Data Linkage ; Data Sharing ; FAIR-Prinzipien ; Forschungsdateninfrastruktur ; Unique Identifier
Subject code	610
Language	German
Size	1 Online-Ressource (167 Seiten), Diagramme
Publisher	nfdi4health
Publishing place	Köln
Publishing country	Germany
Document type	Book ; Online
Note	Sofern nicht anders angegeben, sind die Inhalte dieses Dokuments lizenziert unter einer Creative Commons Namensnennung-Nichtkommerziell 4.0 International Lizenz (CC BY-NC 4.0) ; Open Access
HBZ-ID	HT030347625
DOI	10.4126/FRL01-006461895
Database	Repository for Life Sciences

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Article ; Online: Cause and Association: Missing the Forest for the Trees.

Begg, Melissa D / March, Dana

American journal of public health

2018 Volume 108, Issue 5, Page(s) 620

Language	English
Publishing date	2018-04-03
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	121100-6
ISSN	1541-0048 ; 0090-0036 ; 0002-9572
ISSN (online)	1541-0048
ISSN	0090-0036 ; 0002-9572
DOI	10.2105/AJPH.2018.304366
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Article ; Online: Patient Self-Assessment of Walking Ability and Fracture Risk in Older Australian Adults.

Bliuc, Dana / Tran, Thach / Alarkawi, Dunia / Chen, Weiwen / Alajlouni, Dima A / Blyth, Fiona / March, Lyn / Blank, Robert D / Center, Jacqueline R

JAMA network open

2024 Volume 7, Issue 1, Page(s) e2352675

Abstract: Importance: The relationship between self-reported walking limitation, a proxy of muscle function, and fracture risk has not been investigated.: Objective: To examine the association between a self-reported walking limitation of 1000 m or less and 5- ... ...

Abstract	Importance: The relationship between self-reported walking limitation, a proxy of muscle function, and fracture risk has not been investigated. Objective: To examine the association between a self-reported walking limitation of 1000 m or less and 5-year risk of fracture. Design, setting, and participants: This prospective cohort study compared individuals with various degrees of walking ability limitation at 1000 m (a little limitation and a lot of limitation) and those without limitation (no limitation) accounting for age, falls, prior fractures, and weight. Participants from the ongoing population-based Sax Institute 45 and Up Study were followed from recruitment (2005-2008) for 5 years (2010-2013). Data analysis was conducted from July 2020 to September 2023. Exposure: Self-reported walking limitation. Main outcomes and measures: Incident fracture and site-specific fractures (hip, vertebral, and nonhip nonvertebral [NHNV] fractures). Results: Among the 266 912 participants enrolled in the 45 and Up Study, 238 969 were included, with 126 015 (53%) women (mean [SD] age, 63 [11] years) and 112 954 (47%) men (mean [SD] age, 61 [11] years). Approximately 20% reported a degree of limitation in walking 1000 m or less at baseline (39 324 women [24%]; 23 191 men [21%]). During a mean (SD) follow-up of 4.1 (0.8) years, 7190 women and 4267 men experienced an incident fracture. Compared with participants who reported no walking limitations, a little limitation and a lot of limitation were associated with higher risk of fracture (a little limitation among women: hazard ratio [HR], 1.32; 95% CI, 1.23-1.41; a little limitation among men: HR, 1.46; 95% CI, 1.34-1.60; a lot of limitation among women: HR, 1.60; 95% CI, 1.49-1.71; a lot of limitation among men: HR, 2.03; 95% CI, 1.86-2.22). Approximately 60% of fractures were attributable to walking limitation. The association was significant for hip, vertebral, and NHNV fracture and ranged between a 21% increase to a greater than 219% increase. Conclusions and relevance: In this cohort study of 238 969 participants, self-reported walking limitations were associated with increased risk of fracture. These findings suggest that walking ability should be sought by clinicians to identify high-risk candidates for further assessment.
MeSH term(s)	Adult ; Male ; Humans ; Female ; Aged ; Middle Aged ; Australia/epidemiology ; Cohort Studies ; Prospective Studies ; Self-Assessment ; Academies and Institutes ; Fractures, Bone/epidemiology
Language	English
Publishing date	2024-01-02
Publishing country	United States
Document type	Journal Article
ISSN	2574-3805
ISSN (online)	2574-3805
DOI	10.1001/jamanetworkopen.2023.52675
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Article ; Online: Health Perceptions, Multimorbidity, and New Fractures and Mortality Among Patients With a Fracture.

Alarkawi, Dunia / Tran, Thach S / Chen, Weiwen / March, Lyn M / Blyth, Fiona M / Blank, Robert D / Bliuc, Dana / Center, Jacqueline R

JAMA network open

2024 Volume 7, Issue 4, Page(s) e248491

Abstract: ... medication records. Data analysis was reported between March and September 2023.: Exposures: Charlson ...

Abstract	Importance: A high proportion of patients who sustain a fracture have multimorbidity. However, the association of multimorbidity with postfracture adverse outcomes, such as subsequent fractures and premature mortality, has not been widely explored. Objective: To examine the association of multimorbidity and self-rated health with subsequent fractures and mortality after fracture. Design, setting, and participants: This prospective cohort study included participants from New South Wales, Australia, in the Sax Institute's 45 and Up Study (n = 267 357). Participants were recruited from July 2005 to December 2009 and followed up from the date of the incident fracture until subsequent fracture, death, or the end of the study (April 2017), whichever occurred first, with questionnaire data linked to hospital admission and medication records. Data analysis was reported between March and September 2023. Exposures: Charlson Comorbidity Index (CCI) score and self-rated health (SRH). Main outcomes and measures: The main outcomes were subsequent fracture or mortality after an incident fracture. Associations between SRH measures and subsequent fracture and mortality were also assessed. All analyses were stratified by sex given the different fracture and mortality risk profiles of females and males. Results: Of 25 280 adults who sustained incident fractures, 16 191 (64%) were female (mean [SD] age, 74 [12] years) and 9089 (36%) were male (mean [SD] age, 74 [13] years). During a median follow-up time of 2.8 years (IQR, 1.1-5.2 years), 2540 females (16%) and 1135 males (12%) sustained a subsequent fracture and 2281 females (14%) and 2140 males (24%) died without a subsequent fracture. Compared with a CCI score of less than 2, those with a CCI score of 2 to 3 had an increased risk of subsequent fracture (females: hazard ratio [HR], 1.16 [95% CI, 1.05-1.27]; males: HR, 1.25 [95% CI, 1.09-1.43]) and mortality (females: HR, 2.19 [95% CI, 1.99-2.40]; males: HR, 1.89 [95% CI, 1.71-2.09]). Those with a CCI score of 4 or greater had greater risks of subsequent fracture (females: HR, 1.33 [95% CI, 1.12-1.58]; males: HR, 1.48 [95% CI, 1.21-1.81]) and mortality (females: HR, 4.48 [95% CI, 3.97-5.06]; males: HR, 3.82 [95% CI 3.41-4.29]). Self-rated health was also significantly associated with subsequent fracture and mortality. Those reporting the poorest health and quality of life had the highest subsequent fracture risks, and their mortality risks were even higher. Conclusions and relevance: In this cohort study, both CCI and SRH measures were associated with increased risk of subsequent fractures and mortality after fracture, underscoring the importance of managing the care of patients with comorbidities who sustain a fracture.
MeSH term(s)	Humans ; Male ; Female ; Aged ; Prospective Studies ; Fractures, Bone/epidemiology ; Fractures, Bone/mortality ; New South Wales/epidemiology ; Multimorbidity ; Middle Aged ; Aged, 80 and over
Language	English
Publishing date	2024-04-01
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	2574-3805
ISSN (online)	2574-3805
DOI	10.1001/jamanetworkopen.2024.8491
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Article ; Online: Denosumab and Mortality in a Real-World Setting: A Comparative Study.

Alarkawi, Dunia / Tran, Thach / Chen, Weiwen / March, Lyn M / Blyth, Fiona M / Blank, Robert D / Bliuc, Dana / Center, Jacqueline R

Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research

2023 Volume 38, Issue 12, Page(s) 1757–1770

Abstract: Denosumab (Dmab) is increasingly prescribed worldwide. Unlike bisphosphonates (BPs), its effect on mortality has yet to be well explored. This study examined the association between Dmab and all-cause mortality compared with no treatment in subjects with ...

Abstract	Denosumab (Dmab) is increasingly prescribed worldwide. Unlike bisphosphonates (BPs), its effect on mortality has yet to be well explored. This study examined the association between Dmab and all-cause mortality compared with no treatment in subjects with a fracture and BPs in subjects without a fracture. The study population was from the Sax Institute's 45 and Up Study (n = 267,357), a prospective population-based cohort with questionnaire data linked to hospital admissions (Admitted Patients Data Collection [APDC] data were linked by the Centre for Health Record Linkage), medication records (Pharmaceutical Benefits Scheme [PBS] provided by Services Australia), and stored securely (secure data access was provided through the Sax Institute's Secure Unified Research Environment [SURE]). The new-user cohort design with propensity-score (PS) matching was implemented. In the fracture cohort, Dmab and oral BP users were matched 1:2 to no treatment (Dmab: 617 women, 154 men; oral BPs: 615 women, 266 men). In the no-fracture cohort, Dmab users were matched 1:1 with oral BPs and zoledronic acid (Zol) users (Dmab:oral BPs: 479 men, 1534 women; Dmab:Zol: 280 men, 625 women). Mortality risk was measured using sex-specific pairwise multivariable Cox models. In the fracture cohort, compared with no treatment, Dmab was associated with 48% lower mortality in women (hazard ratio [HR] = 0.52, 95% confidence interval [CI] 0.36-0.72) but not in men. Oral BPs were associated with 44% lower mortality in both sexes (women HR = 0.56, 95% CI 0.42-0.77; men HR = 0.56, 95% CI 0.40-0.78). In the no-fracture cohort, compared with BPs, Dmab was associated with 1.5- to 2.5-fold higher mortality than oral BPs (women HR = 1.49, 95% CI 1.13-1.98; men HR = 2.74; 95% CI 1.82-4.11) but similar mortality to Zol. Dmab in women and oral BPs were associated with lower post-fracture mortality than no treatment. However, Dmab users had generally higher mortality than oral BP users in those without fractures. © 2023 American Society for Bone and Mineral Research (ASBMR).
MeSH term(s)	Male ; Humans ; Female ; Bone Density Conservation Agents/therapeutic use ; Denosumab/therapeutic use ; Prospective Studies ; Diphosphonates/therapeutic use ; Zoledronic Acid/therapeutic use ; Fractures, Bone/epidemiology
Chemical Substances	Bone Density Conservation Agents ; Denosumab (4EQZ6YO2HI) ; Diphosphonates ; Zoledronic Acid (6XC1PAD3KF)
Language	English
Publishing date	2023-12-15
Publishing country	England
Document type	Journal Article
ZDB-ID	632783-7
ISSN	1523-4681 ; 0884-0431
ISSN (online)	1523-4681
ISSN	0884-0431
DOI	10.1002/jbmr.4930
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Article ; Online: Antiresorptive Medication Use Is not Associated With Acute Cardiovascular Risk: An Observational Study.

Bliuc, Dana / Tran, Thach / Chen, Weiwen / Alarkawi, Dunia / Alajlouni, Dima A / Blyth, Fiona / March, Lyn / Blank, Robert D / Center, Jacqueline R

The Journal of clinical endocrinology and metabolism

2022 Volume 108, Issue 5, Page(s) e110–e119

Abstract: Context: Bisphosphonates have been reported to be cardioprotective in some, but not all, studies. It is unknown whether denosumab (Dmab) use protects against cardiovascular events (CVEs).: Objective: To determine whether oral bisphosphonate (oBP) or ... ...

Abstract	Context: Bisphosphonates have been reported to be cardioprotective in some, but not all, studies. It is unknown whether denosumab (Dmab) use protects against cardiovascular events (CVEs). Objective: To determine whether oral bisphosphonate (oBP) or Dmab use is associated with CVEs in persons with incident fracture. Methods: Participants with an incident minimal trauma fracture from the Sax Institute's 45 and Up Study, a population-based cohort from NSW, Australia, were followed between 2005/2009 and 2017. Questionnaire data were linked to hospital admissions (Admitted Patients Data Collection [APDC]) by the Centre for Health Record Linkage). Medicare Benefit Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) data sets were provided by Services Australia. Data was stored in a secure computing environment (Secure Unified Research Environment). Fractures, CVEs, and comorbidities were identified from the APDC and oBP and Dmab medication from the PBS. oBP and Dmab users were matched to never users (NoRx) by propensity scores. The main outcome measures were association between oBP and Dmab with CVE (acute myocardial infarction, unstable angina, cerebrovascular accident, and transient ischemic attack) and were determined using a stratified Cox's proportional hazards model. Results: There were 880 pairs of oBP and NoRx (616 women) and 770 pairs of Dmab and NoRx (615 women) followed for ∼4.3 years. CVE risk was similar for oBP and NoRx Hazard Ratios (HR) women, 0.88 [95% CI 0.65-1.18]; men, 1.07 [95% CI 0.72-1.57]). Similar findings were obtained for Dmab (Hazard Ratios (HR) women, 1.08 [95% CI 0.78-1.50]; men, 1.55 [95% CI 0.96-2.48]). Conclusion: oBP and Dmab use was not associated with CVEs.
MeSH term(s)	Aged ; Female ; Humans ; Male ; Bone Density Conservation Agents/adverse effects ; Bone Density Conservation Agents/therapeutic use ; Diphosphonates/adverse effects ; Diphosphonates/therapeutic use ; Heart Disease Risk Factors ; National Health Programs ; Risk Factors
Chemical Substances	Bone Density Conservation Agents ; Diphosphonates
Language	English
Publishing date	2022-11-21
Publishing country	United States
Document type	Journal Article ; Observational Study ; Research Support, Non-U.S. Gov't
ZDB-ID	3029-6
ISSN	1945-7197 ; 0021-972X
ISSN (online)	1945-7197
ISSN	0021-972X
DOI	10.1210/clinem/dgac669
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Article ; Online: The association between multimorbidity and osteoporosis investigation and treatment in high-risk fracture patients in Australia: A prospective cohort study.

Bliuc, Dana / Tran, Thach / Chen, Weiwen / Alarkawi, Dunia / Alajlouni, Dima A / Blyth, Fiona / March, Lyn / Ensrud, Kristine E / Blank, Robert D / Center, Jacqueline R

PLoS medicine

2023 Volume 20, Issue 1, Page(s) e1004142

Abstract: Background: Multimorbidity is common among fracture patients. However, its association with osteoporosis investigation and treatment to prevent future fractures is unclear. This limited knowledge impedes optimal patient care. This study investigated the ...

Abstract	Background: Multimorbidity is common among fracture patients. However, its association with osteoporosis investigation and treatment to prevent future fractures is unclear. This limited knowledge impedes optimal patient care. This study investigated the association between multimorbidity and osteoporosis investigation and treatment in persons at high risk following an osteoporotic fracture. Methods and findings: The Sax Institute's 45 and Up Study is a prospective population-based cohort of 267,153 people in New South Wales, Australia, recruited between 2005 and 2009. This analysis followed up participants until 2017 for a median of 6 years (IQR: 4 to 8). Questionnaire data were linked to hospital admissions (Admitted Patients Data Collection (APDC)), emergency presentations (Emergency Department Data Collection (EDDC)), Pharmaceutical Benefits Scheme (PBS), and Medicare Benefits Schedule (MBS). Data were linked by the Centre for Health Record Linkage and stored in a secured computing environment. Fractures were identified from APDC and EDDC, Charlson Comorbidity Index (CCI) from APDC, Dual-energy X-ray absorptiometry (DXA) investigation from MBS, and osteoporosis treatment from PBS. Out of 25,280 persons with index fracture, 10,540 were classified as high-risk based on 10-year Garvan Fracture Risk (age, sex, weight, prior fracture and falls) threshold ≥20%. The association of CCI with likelihood of investigation and treatment initiation was determined by logistic regression adjusted for education, socioeconomic and lifestyle factors). The high-risk females and males averaged 77 ± 10 and 86 ± 5 years, respectively; >40% had a CCI ≥2. Only 17% of females and 7% of males received a DXA referral, and 22% of females and 14% males received osteoporosis medication following fracture. A higher CCI was associated with a lower probability of being investigated [adjusted OR, females: 0.73 (95% CI, 0.61 to 0.87) and 0.43 (95% CI, 0.30 to 0.62); males: 0.47 (95% CI, 0.33 to 0.68) and 0.52 (0.31 to 0.85) for CCI: 2 to 3, and ≥4 versus 0 to 1, respectively] and of receiving osteoporosis medication [adjusted OR, females: 0.85 (95% CI, 0.74 to 0.98) and 0.78 (95% CI, 0.61 to 0.99); males: 0.75 (95% CI, 0.59 to 0.94) and 0.37 (95% CI, 0.23 to 0.53) for CCI: 2 to 3, and ≥4 versus 0 to 1, respectively]. The cohort is relatively healthy; therefore, the impact of multimorbidity on osteoporosis management may have been underestimated. Conclusions: Multimorbidity contributed significantly to osteoporosis treatment gap. This suggests that fracture risk is either underestimated or underprioritized in the context of multimorbidity and highlights the need for extra vigilance and improved fracture care in this setting.
MeSH term(s)	Male ; Female ; Humans ; Aged ; Prospective Studies ; Multimorbidity ; National Health Programs ; Osteoporosis/complications ; Osteoporosis/drug therapy ; Osteoporosis/epidemiology ; Osteoporotic Fractures/epidemiology ; Osteoporotic Fractures/prevention & control ; Australia/epidemiology ; Absorptiometry, Photon
Language	English
Publishing date	2023-01-17
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2185925-5
ISSN	1549-1676 ; 1549-1277
ISSN (online)	1549-1676
ISSN	1549-1277
DOI	10.1371/journal.pmed.1004142
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Article ; Online: Deficient butyrate-producing capacity in the gut microbiome is associated with bacterial network disturbances and fatigue symptoms in ME/CFS.

Guo, Cheng / Che, Xiaoyu / Briese, Thomas / Ranjan, Amit / Allicock, Orchid / Yates, Rachel A / Cheng, Aaron / March, Dana / Hornig, Mady / Komaroff, Anthony L / Levine, Susan / Bateman, Lucinda / Vernon, Suzanne D / Klimas, Nancy G / Montoya, Jose G / Peterson, Daniel L / Lipkin, W Ian / Williams, Brent L

Cell host & microbe

2023 Volume 31, Issue 2, Page(s) 288–304.e8

Abstract: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is characterized by unexplained debilitating fatigue, cognitive dysfunction, gastrointestinal disturbances, and orthostatic intolerance. Here, we report a multi-omic analysis of a geographically ...

Abstract	Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is characterized by unexplained debilitating fatigue, cognitive dysfunction, gastrointestinal disturbances, and orthostatic intolerance. Here, we report a multi-omic analysis of a geographically diverse cohort of 106 cases and 91 healthy controls that revealed differences in gut microbiome diversity, abundances, functional pathways, and interactions. Faecalibacterium prausnitzii and Eubacterium rectale, which are both recognized as abundant, health-promoting butyrate producers in the human gut, were reduced in ME/CFS. Functional metagenomics, qPCR, and metabolomics of fecal short-chain fatty acids confirmed a deficient microbial capacity for butyrate synthesis. Microbiome-based machine learning classifier models were robust to geographic variation and generalizable in a validation cohort. The abundance of Faecalibacterium prausnitzii was inversely associated with fatigue severity. These findings demonstrate the functional nature of gut dysbiosis and the underlying microbial network disturbance in ME/CFS, providing possible targets for disease classification and therapeutic trials.
MeSH term(s)	Humans ; Fatigue Syndrome, Chronic/metabolism ; Fatigue Syndrome, Chronic/microbiology ; Gastrointestinal Microbiome ; Butyrates ; Bacteria/genetics ; Metabolomics
Chemical Substances	Butyrates
Language	English
Publishing date	2023-03-08
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	2278004-X
ISSN	1934-6069 ; 1931-3128
ISSN (online)	1934-6069
ISSN	1931-3128
DOI	10.1016/j.chom.2023.01.004
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Article ; Online: The association between multimorbidity and osteoporosis investigation and treatment in high-risk fracture patients in Australia

Dana Bliuc / Thach Tran / Weiwen Chen / Dunia Alarkawi / Dima A Alajlouni / Fiona Blyth / Lyn March / Kristine E Ensrud / Robert D Blank / Jacqueline R Center

PLoS Medicine, Vol 20, Iss 1, p e

A prospective cohort study.

2023 Volume 1004142

Abstract: Background Multimorbidity is common among fracture patients. However, its association with osteoporosis investigation and treatment to prevent future fractures is unclear. This limited knowledge impedes optimal patient care. This study investigated the ... ...

Abstract	Background Multimorbidity is common among fracture patients. However, its association with osteoporosis investigation and treatment to prevent future fractures is unclear. This limited knowledge impedes optimal patient care. This study investigated the association between multimorbidity and osteoporosis investigation and treatment in persons at high risk following an osteoporotic fracture. Methods and findings The Sax Institute's 45 and Up Study is a prospective population-based cohort of 267,153 people in New South Wales, Australia, recruited between 2005 and 2009. This analysis followed up participants until 2017 for a median of 6 years (IQR: 4 to 8). Questionnaire data were linked to hospital admissions (Admitted Patients Data Collection (APDC)), emergency presentations (Emergency Department Data Collection (EDDC)), Pharmaceutical Benefits Scheme (PBS), and Medicare Benefits Schedule (MBS). Data were linked by the Centre for Health Record Linkage and stored in a secured computing environment. Fractures were identified from APDC and EDDC, Charlson Comorbidity Index (CCI) from APDC, Dual-energy X-ray absorptiometry (DXA) investigation from MBS, and osteoporosis treatment from PBS. Out of 25,280 persons with index fracture, 10,540 were classified as high-risk based on 10-year Garvan Fracture Risk (age, sex, weight, prior fracture and falls) threshold ≥20%. The association of CCI with likelihood of investigation and treatment initiation was determined by logistic regression adjusted for education, socioeconomic and lifestyle factors). The high-risk females and males averaged 77 ± 10 and 86 ± 5 years, respectively; >40% had a CCI ≥2. Only 17% of females and 7% of males received a DXA referral, and 22% of females and 14% males received osteoporosis medication following fracture. A higher CCI was associated with a lower probability of being investigated [adjusted OR, females: 0.73 (95% CI, 0.61 to 0.87) and 0.43 (95% CI, 0.30 to 0.62); males: 0.47 (95% CI, 0.33 to 0.68) and 0.52 (0.31 to 0.85) for CCI: 2 to 3, ...
Keywords	Medicine ; R
Subject code	360
Language	English
Publishing date	2023-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Social disorder and diagnostic order: the US Mental Hygiene Movement, the Midtown Manhattan study and the development of psychiatric epidemiology in the 20th century.

March, Dana / Oppenheimer, Gerald M

International journal of epidemiology

2014 Volume 43 Suppl 1, Page(s) i29–42

Abstract: Recent scholarship regarding psychiatric epidemiology has focused on shifting notions of mental disorders. In psychiatric epidemiology in the last decades of the 20th century and the first decade of the 21st century, mental disorders have been perceived ... ...

Abstract	Recent scholarship regarding psychiatric epidemiology has focused on shifting notions of mental disorders. In psychiatric epidemiology in the last decades of the 20th century and the first decade of the 21st century, mental disorders have been perceived and treated largely as discrete categories denoting an individual's mental functioning as either pathological or normal. In the USA, this grew partly out of evolving modern epidemiological work responding to the State's commitment to measure the national social and economic burdens of psychiatric disorders and subsequently to determine the need for mental health services and to survey these needs over time. Notably absent in these decades have been environmentally oriented approaches to cultivating normal, healthy mental states, approaches initially present after World War II. We focus here on a set of community studies conducted in the 1950s, particularly the Midtown Manhattan study, which grew out of a holistic conception of mental health that depended on social context and had a strong historical affiliation with: the Mental Hygiene Movement and the philosophy of its founder, Adolf Meyer; the epidemiological formation of field studies and population surveys beginning early in the 20th century, often with a health policy agenda; the recognition of increasing chronic disease in the USA; and the radical change in orientation within psychiatry around World War II. We place the Midtown Manhattan study in historical context--a complex narrative of social institutions, professional formation and scientific norms in psychiatry and epidemiology, and social welfare theory that begins during the Progressive era (1890-1920) in the USA.
MeSH term(s)	Diagnostic and Statistical Manual of Mental Disorders ; Epidemiology/history ; Health Policy ; History, 19th Century ; History, 20th Century ; History, 21st Century ; Hospitals, Psychiatric/history ; Mental Disorders/diagnosis ; Mental Disorders/epidemiology ; Mental Disorders/history ; Mental Health ; Mental Health Services/history ; Mental Health Services/organization & administration ; New York City ; Psychiatry/history ; Research ; United States
Language	English
Publishing date	2014-07-15
Publishing country	England
Document type	Historical Article ; Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	187909-1
ISSN	1464-3685 ; 0300-5771
ISSN (online)	1464-3685
ISSN	0300-5771
DOI	10.1093/ije/dyu117
Database	MEDical Literature Analysis and Retrieval System OnLINE

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