Hormone physiology and sleep dynamics among BaYaka foragers of the Congo Basin: Gendered associations between nighttime activity, testosterone, and cortisol.

Sleep quality is an important contributor to health disparities and affects the physiological function of the immune and endocrine systems, shaping how resources are allocated to life history demands. Past work in industrial and post-industrial societies has shown that lower total sleep time (TST) or more disrupted nighttime sleep are linked to flatter diurnal slopes for cortisol and lower testosterone production. There has been little focus on these physiological links in other socio-ecological settings where routine sleep conditions and nighttime activity demands differ. We collected salivary hormone (testosterone, cortisol) and actigraphy-based sleep data from Congolese BaYaka foragers (N = 39), who have relatively short and fragmented nighttime sleep, on average, in part due to their typical social sleep conditions and nighttime activity. The hormone and sleep data collections were separated by an average of 11.23 days (testosterone) and 2.84 days (cortisol). We found gendered links between nighttime activity and adults' hormone profiles. Contrary to past findings in Euro-American contexts, BaYaka men who were more active at night, on average, had higher evening testosterone than those with lower nighttime activity, with a relatively flat slope relating nighttime activity and evening testosterone in women. Women had steeper diurnal cortisol curves with less disrupted sleep. Men had steeper cortisol diurnal curves if they were more active at night. BaYaka men often hunt and socialize when active at night, which may help explain these patterns. Overall, our findings indicate that the nature of nighttime activities, including their possible social and subsistence contexts, are potentially important modifiers of sleep quality-physiology links, meriting further research across contexts.

Impact of Hydrocodone Rescheduling on Dental Prescribing of Opioids.

INTRODUCTION: In the United States, dentists frequently prescribe hydrocodone. In October 2014, the US Drug Enforcement Administration rescheduled hydrocodone from controlled substance schedule III to II, introducing more restricted prescribing and dispensing regulations, which may have changed dental prescribing of opioids. OBJECTIVE: The study aim was to evaluate the impact of the hydrocodone rescheduling on dental prescribing of opioids in the United States. METHODS: This was a cross-sectional study of opioids prescribed by dentists between October 2012 and October 2016, using the IQVIA Longitudinal Prescription Dataset. Monthly dentist-based opioid prescribing rate (opioid prescription [Rx]/1,000 dentists) and monthly average opioid dosages per prescription (mean morphine milligram equivalent per day [MME/d]) were measured in the 24 mo before and after hydrocodone rescheduling in October 2014 (index or interruption). An interrupted time-series analysis was conducted using segmented ordinary least square regression models, with Newey-West standard errors to handle autocorrelation. RESULTS: Dentists prescribed 50,412,942 opioid prescriptions across the 49 mo. Hydrocodone was the most commonly prescribed opioid pre- and postindex (74.9% and 63.8%, respectively), followed by codeine (13.8% and 21.6%), oxycodone (8.1% and 9.5%), and tramadol (2.9% and 4.8%). At index, hydrocodone prescribing immediately decreased by -834.8 Rx/1,000 dentists (95% confidence interval [CI], -1,040.2 to -629.4), with increased prescribing of codeine (421.9; 95% CI, 369.7-474.0), oxycodone (85.3; 95% CI, 45.4-125.2), and tramadol (111.8; 95% CI, 101.4-122.3). The mean MME increased at index for all opioids except for hydrocodone, and dosages subsequently decreased during the postindex period. CONCLUSION: Following the rescheduling, dentist prescribing of hydrocodone declined while prescribing of nonhydrocodone opioids increased. Understanding the impact of this regulation informs strategies to ensure appropriate prescribing of opioids for dental pain. KNOWLEDGE TRANSFER STATEMENT: The study findings can be used by policy makers to make informed decisions in developing future risk mitigation strategies aimed to regulate opioid prescribing behaviors. Furthermore, dentist-specific resources and guidelines are needed subsequent to these policies in order to meet the dental population needs.

Validation of medical service insurance claims as a surrogate for ascertaining vitiligo cases.

The epidemiology of vitiligo, especially its disease burden on the healthcare system, can be assessed indirectly by analyzing health insurance claims data. Validating this approach is integral to ensuring accurate case identification and cohort characterization. The primary aim of this study was to develop and validate an indirect measure of vitiligo ascertainment using health insurance claims data. These data were used secondarily to identify demographic characteristics, body site involvement, vitiligo subtypes, disease associations, and treatments. This study assessed the validity of identifying vitiligo from billing claims within a Canadian provincial universal health insurance program, versus vitiligo cases accrued from direct medical chart reviews. Claims-based algorithms combining ICD-9-CM diagnostic code 709 with treatment-specific data were derived and tested to identify vitiligo patients. This was compared against cases arising from the manual review of medical records of 606 patient with a diagnostic code for "dyschromia" (ICD-9-CM diagnostic code 709) from January 1 to December 31, 2016. Based on the chart reviews, 204 (33.7%) patients were confirmed to have vitiligo. 42 separate claims-based algorithms combining ICD-9-CM diagnostic code 709 with treatment data specific to vitiligo were modeled and individually tested to evaluate their accuracy for vitiligo ascertainment. One algorithm achieved a sensitivity, specificity, PPV and NPV of 86.8% (95% CI 82.1-91.4), 92.5% (95% CI 90.0-95.1), 85.5% (95% CI 80.7-90.3), and 93.2% (95% CI 90.8-95.7), respectively. There was a 2.2 female-to-male ratio. The most common medical treatments were tacrolimus (74.5%) and topical corticosteroids (54.3%). Hypertension (24.2%) and hypothyroidism (19.6%) were the predominant co-morbidities associated with vitiligo. Health insurance claims data can be used to indirectly ascertain vitiligo for epidemiologic purposes with relatively high diagnostic performance between 85.5 and 93.2%.

Sex differences and shifts in body composition, physical activity, and total energy expenditure across a 3-month expedition.

OBJECTIVES: An energetically demanding environment like a wilderness expedition can lead to potent stressors on human physiology and homeostatic balance causing shifts in energy expenditure and body composition. These shifts likely have consequences on overall health and performance and may potentially differ by sex. It is therefore critical to understand the potential differential body composition and energy expenditure changes in response to a novel and challenging environment in both males and female bodies. METHODS: Data were collected from 75 healthy individuals (female = 41; ages 18-53) throughout a 3-month long expedition in the American Rockies. Body mass, body fat, and lean muscle mass were measured before, during, and after the course. Physical activity intensity and energy expenditure were also measured in a subset of participants using the wGT3X-BT Actigraph wrist monitor and an accompanying Bluetooth heart rate monitor. RESULTS: Over the 3-month period, individuals initially experienced declines in body mass, body fat percentage, and lean muscle mass. Participants partially rebounded from these deficits to maintain overall body mass with a slight recomposition of body fat and lean muscle mass. Our data also demonstrated that sex moderated total energy expenditure, where females experienced a modest decline whereas males experienced an increase in energy expenditure from the beginning to the end of the course. CONCLUSIONS: Understanding changes in energy storage in the body and variation in energy expenditure between sexes during a 3-month expedition has critical implications for maintaining health and performance in an energetically demanding environment where resources may be scarce.

Sex differences in daily activity intensity and energy expenditure and their relationship to cortisol among BaYaka foragers from the Congo Basin.

OBJECTIVES: The pooling of energetic resources and food sharing have been widely documented among hunter-gatherer societies. Much less is known about how the energetic costs of daily activities are distributed across individuals in such groups, including between women and men. Moreover, the metabolic physiological correlates of those activities and costs are relatively understudied. MATERIALS AND METHODS: Here, we tracked physical activity, energy expenditure (EE), and cortisol production among Congo Basin BaYaka foragers engaged in a variety of daily subsistence activities (n = 37). Given its role in energy mobilization, we measured overall daily cortisol production and short-term cortisol reactivity through saliva sampling; we measured physical activity levels and total EE via the wGT3X-bt actigraph and heart rate monitor. RESULTS: We found that there were no sex differences in likelihood of working in common activity locations (forest, garden, house). Across the day, women spent greater percentage time in moderate-to-vigorous physical activity (%MVPA) and had lower total EE than men. Females with higher EE (kCal/hr) produced greater cortisol throughout the day. Though not statistically significant, we also found that individuals with greater %MVPA had larger decreases in cortisol reactivity. DISCUSSION: BaYaka women sustained higher levels of physical activity but incurred lower energetic costs than men, even after factoring in sex differences in body composition. Our findings suggest that the distribution of physical activity demands and costs are relevant to discussions regarding how labor is divided and community energy budgets take shape in such settings.

Fatherhood, egalitarianism, and child health in two small-scale societies in the Republic of the Congo.

OBJECTIVES: The study goals were to (a) characterize the cultural model of fatherhood among the BaYaka, a community of egalitarian foragers in the Republic of the Congo; (b) test if BaYaka fathers' quality in relation to the cultural model predicts their children's energetic status; and (c) compare the variance in BaYaka children's energetic status to that of children of neighboring Bondongo fisher-farmers, among whom there is less cooperative caregiving, less resource sharing, and greater social inequality. METHODS: We used informal interviews to establish the cultural model of fatherhood, which we used to build a peer ranking task to quantify father quality. Children's energetic status was assessed by measuring height, weight, and triceps skinfold thickness. We then tested for associations between father quality scores derived from the ranking task and children's energetic status using ordinary least squares regression. Equality of variance tests were used to compare BaYaka and Bondongo children's energetic statuses. RESULTS: The BaYaka described fathers as responsible for acquiring resources and maintaining marital harmony, welcoming others to the community and sharing well with them, and teaching their children about the forest. Agreement on men's quality in these domains was high, but father quality did not significantly predict children's energetic status. BaYaka children had lower variance in energetic status overall compared to Bondongo children. CONCLUSIONS: We suggest that the core BaYaka values and practices that maintain egalitarian social relations and distribution of resources help buffer children's health and well-being from variation in their fathers' qualities in culturally valued domains.

Extracorporeal shock wave lithotripsy versus ureteroscopy for management of pediatric nephrolithiasis in upper urinary tract stones: multi-institutional outcomes of efficacy and morbidity.

INTRODUCTION: As the incidence of pediatric nephrolithiasis rises, understanding the efficacy and morbidity of surgical treatment options is critical. Currently, there are limited comparative data assessing shock wave lithotripsy (SWL) and ureteroscopy (URS) outcomes in children. OBJECTIVE: The objective of this study was to compare stone clearance, 30-day emergency department visits, and the number of general anesthetics required per stone treatment for both modalities. STUDY DESIGN: A multi-institutional retrospective review of children presenting for either URS or SWL between 2000 and 2017 was performed. Stone clearance, need for retreatment, the number of anesthetics, as well as the number and reason for emergency room visit were captured and compared between groups. Multivariate statistical analysis accounting for age, stone location, stone diameter, pre-intervention stent, and provider volume was performed for adjusted analysis. RESULTS: A total of 84 SWL and 175 URS procedures were included. Complete stone clearance and rates of residual stone fragments <4 mm after final procedure for SWL were 77.0% and 90.8% and for URS were 78.5% and 91.7%, respectively. Retreatment rates for both procedures were not significantly different (17.9% SWL vs. 18.9% URS, P = 0.85). Children who underwent SWL had lower rates of emergency room visits for infections (0% vs. 5.1%, P = 0.03) and flank pain (3.6% vs. 10.9%, P = 0.05) and required fewer general anesthetics per treatment (1.2 vs. 2.0, P < 0.01) than those who underwent URS (Figure). DISCUSSION: Stone clearance after both the initial and final treatments and need for repeat interventions were similar between surgical modalities. However, SWL carries less morbidity than URS. Specifically, patients who underwent SWL experienced lower rates of ED visits for urinary tract infection and for flank pain, parallel to conclusions in current comparative literature. In addition, SWL requires less general anesthetics (2.0 vs. 1.2), secondary to lower rates of ureteral stent placement and removal. Data on the potential risk of general anesthetics to neurodevelopment support thoughtful utilization of these medications. Limitations of this study include its retrospective nature and the prolonged 20-year time period over which data were collected. CONCLUSIONS: When adjusting for confounders, SWL and URS achieve similar stone clearance. In the setting of equivalent efficacy, considerations regarding necessity of repeat interventions, morbidity of anesthesia, and complications should be integrated into clinical practice.

Heterogeneous health profiles and healthcare utilization of the middle-aged and elderly with multiple health insurance schemes in China.

OBJECTIVES: China is facing an escalating demand of healthcare services from the middle-aged and elderly. Compared with the traditional view of health on symptoms and diseases, this study aimed to assess the heterogeneous health profiles of middle-aged and elderly Chinese by a person-centered approach. Furthermore, this study examined the effects of health profiles and associated factors on healthcare utilization within the context of China's multiple health insurance schemes. STUDY DESIGN: The study used the 2015 data of China Health and Retirement Longitudinal Study, a nationwide population-based sample of people aged 45 years and older. METHODS: Latent class analysis (LCA) was adopted to identify the heterogeneous health profiles. Two-part models were adopted to assess the effects of associated factors on healthcare utilization. RESULTS: Among 15,250 Chinese aged 45 years and older, six heterogeneous health profiles were identified and labeled as 'Quite Healthy', 'Relatively Healthy', 'Comprehensive Comorbidities', 'Functional Impairment', 'Severe Disability', and 'Relatively Frail'. The Relatively Frail profile was the heaviest healthcare user. The Severe Disability profile took the least use of outpatient services but had relatively high utilization of inpatient services and outpatient expenditure. The Comprehensive Comorbidities profile tended to have the smallest effect on the frequency of visits for both inpatient and outpatient services, but its effect on outpatient expenditure was high. After controlling for health profiles, the significant effects of different health insurance programs on healthcare utilization were discussed. CONCLUSIONS: Introducing health profiles by the person-centered approach of LCA has provided a holistic understanding of complex healthcare demands for middle-aged and elderly Chinese. It is valuable for policy makers to improve healthcare resource allocation targeted for the middle-aged and elderly.

Speed breeding orphan crops.

KEY MESSAGE: This review explores how speed breeding protocols that hasten plant growth and development could be applied to shorten breeding cycles and accelerate research activities in orphan crops. There is a growing need for the agri-food sector to sustainably produce larger quantities of higher-quality food, feed and fuel using fewer resources, within the context of changing agroclimatic conditions. Meeting this challenge will require the accelerated development and dissemination of improved plant varieties and substantial improvement of agricultural practices. Speed breeding protocols that shorten plant generation times can hasten breeding and research to help fulfil the ever-increasing demands. Global agri-food systems rely on a relatively small number of plant species; however, there are calls to widen the scope of globally important crops to include orphan crops, which are currently grown and used by the world's poorest people or marketed as niche products for affluent consumers. Orphan crops can supply global diets with key nutrients, support economic development in the world's poorest regions, and bolster the resilience of the global agri-food sector to biotic and abiotic stresses. Little research effort has been invested in orphan crops, with farmers growing landraces that are sourced and traded through poorly structured market systems. Efforts are underway to develop breeding resources and techniques to improve orphan crops. Here, we highlight the current efforts and opportunities to speed breed orphan crops and discuss alternative approaches to deploy speed breeding in the less-resourced regions of the world. Speed breeding is a tool that, when used together with other multidisciplinary R&D approaches, can contribute to the rapid creation of new crop varieties, agricultural practices and products, supporting the production and utilisation of orphan crops at a commercial scale.

Speed breeding in growth chambers and glasshouses for crop breeding and model plant research.

'Speed breeding' (SB) shortens the breeding cycle and accelerates crop research through rapid generation advancement. SB can be carried out in numerous ways, one of which involves extending the duration of plants' daily exposure to light, combined with early seed harvest, to cycle quickly from seed to seed, thereby reducing the generation times for some long-day (LD) or day-neutral crops. In this protocol, we present glasshouse and growth chamber-based SB approaches with supporting data from experimentation with several crops. We describe the conditions that promote the rapid growth of bread wheat, durum wheat, barley, oat, various Brassica species, chickpea, pea, grass pea, quinoa and Brachypodium distachyon. Points of flexibility within the protocols are highlighted, including how plant density can be increased to efficiently scale up plant numbers for single-seed descent (SSD). In addition, instructions are provided on how to perform SB on a small scale in a benchtop growth cabinet, enabling optimization of parameters at a low cost.

Lifetime socioeconomic status and early life microbial environments predict adult blood telomere length in the Philippines.

OBJECTIVES: Psychosocial stress is postulated to hasten senescence in part by accelerating the shortening of telomere length (TL). One pathway through which this may happen is via increasing inflammation and innate immune system activation-a pathway which recent studies suggest acts more strongly for those who grew up in low microbial environments. Thus, we hypothesized that: (1) Psychosocial stress will be inversely associated with TL, (2) early life microbial environments will predict TL, and (3) microbial environments will moderate the association between psychosocial stress and TL. METHODS: We utilized data from the Cebu Longitudinal Health and Nutrition Survey based in the Philippines (N = 1410). We determined early life microbial environments by season of birth and exposure to animal feces. Psychosocial stress measures included perceived stress in adulthood, lifetime socioeconomic status (SES), and parental instability in childhood. TL was measured in blood from young adults by qPCR. RESULTS: Contrary to predictions, we found that higher SES was associated with shorter TL and no association of TL with the other stress variables. Individuals born in the higher microbial exposure season had shorter TL, but early life microbial environments did not moderate the association between psychosocial stress and TL. CONCLUSIONS: The unexpected inverse association between SES and TL suggests that higher SES, while indexing lower psychosocial stress, may impact TL more strongly through nonstress factors in the Philippines, such as unhealthy behavior. The inverse association between microbial environments and TL is consistent with other evidence connecting early life infections to decreased life expectancies.

Combined effects of diabetes and low household income on mortality: a 12-year follow-up study of 505 677 Korean adults.

AIM: To examine the effects of diabetes, low income and their combination on mortality in the Korean population. METHODS: We analysed a total of 505 677 people (53.9% male) aged 40-79 years old from the National Health Insurance Service-National Health Screening (NHIS-HEALS) cohort. Ten levels of household income were used as indicators of economic status. Diabetes was defined as elevated fasting blood glucose (≥ 6.9 mmol/l) and/or use of glucose-lowering drugs or insulin. Covariates of age, sex, BMI, smoking and Charlson Comorbidity Index were determined at baseline. Outcomes were total and cause-specific mortality over 12 years. Cox's proportional hazard regression models were used to estimate hazard ratios (HRs) for mortality according to the presence of diabetes, household income and their combination. RESULTS: Lower household income was associated with higher mortality from all causes, cardiovascular disease, cancer and non-cancer non-cardiovascular causes. Excessive mortality due to low incomes was observed in both people with and without diabetes. In men, the adjusted HR [95% confidence interval (CI)] of mortality was 1.38 (1.34 to 1.42) for low-income only, 1.48 (1.42 to 1.55) for diabetes only and 1.95 (1.86 to 2.05) for diabetes and low-income combined, relative to the normal glucose and high income group. Corresponding HR (95% CI) in women were 1.19 (1.14 to 1.24), 1.54 (1.44 to 1.64) and 1.87 (1.75 to 2.01), respectively. CONCLUSION: Both low household income and the presence of diabetes independently increase the risk of mortality, but their combined effects on mortality may be different between men and women.

Positive effects of refugee presence on host community nutritional status in Turkana County, Kenya.

OBJECTIVES: Refugee camps are often assumed to negatively impact local host communities through resource competition and conflict. We ask instead whether economic resources and trade networks associated with refugees have benefits for host community health and nutrition. To address this question we assess the impacts of Kakuma Refugee Camp in northwest Kenya, comparing anthropometric indicators of nutritional status between Turkana communities in the region. METHODS: Participants were recruited at four sites in Turkana County (N = 586): Kakuma Town, adjacent to Kakuma Refugee Camp; Lorugum, an area with sustained economic development; Lokichoggio, formerly host to international NGOs, and now underdeveloped; and Lorengo, an undeveloped, rural community. We evaluated nutritional status using summed skinfold thickness and body mass index (BMI). Structured interviews provided contextual data. RESULTS: Age-controlled multiple regression models reveal two distinct skinfold thickness profiles for both sexes: comparatively elevated values in Kakuma and Lorugum, and significantly lower values in Lorengo and Lokichoggio. BMI did not vary significantly by location. Despite better nutritional status, a large proportion of Kakuma residents still report worries about basic needs, including hunger, health, and economic security. CONCLUSIONS: Kakuma Refugee Camp is associated with better host community energetic status indicators, compared to other relevant, regional sites varying in development and resources. Based on global nutritional standards, observed differences likely represent meaningful disparities in overall health. We suggest that access to cereals via refugee trade networks and employment might mediate this relationship. However, perceptions of refugees as illegitimate interlopers maintain a high psychological burden.

Tavaborole in Difficult-to-Treat Onychomycosis Cases: A Post-hoc Assessment of Phase III Subjects.

Toenail onychomycosis is a chronic fungal infection that often requires prolonged treatment in order to effectively manage pathogenic organisms and obtain a clear nail. Traditionally, certain clinical features of onychomycosis, including the presence of substantial lateral disease, focal fungal masses, yellow/brown streaks, and extensive nail involvement (ie, >50%), indicate a poor treatment prognosis and have proven difficult-to-treat with oral or traditional topical therapies. Owing to the novel features of topical tavaborole, we sought to understand the potential utility of tavaborole in difficult-to-treat onychomycosis. A blinded, post-hoc assessment of Phase III trials was conducted, focusing on initial presentation, midpoint assessment (24 weeks), and final outcomes (52 weeks) in subjects identified as having difficult-to-treat onychomycosis and treated for 48 weeks with once-daily application of either tavaborole 5% solution or vehicle. Our post-hoc analysis identified 84 difficult-to-treat cases (tavaborole 5%; n=60; vehicle, n=24) in subjects with toenail onychomycosis due to Trichophyton rubrum or Trichophyton mentagrophytes. No subjects identified as difficult-to-treat and treated with vehicle achieved a complete cure, while 6 subjects treated with tavaborole 5% attained a completely clear nail and negative mycology. Similarly, 7 subjects treated with tavaborole 5% solution achieved an almost complete cure (≤10% involvement and negative mycology) while 1 subject on vehicle achieved an almost complete cure. We present a case series of 4 patients, of varying age and difficult-to-treat clinical features, which responded positively to tavaborole 5% solution. Three of the subjects achieved complete cure after being treated with tavaborole 5%, with one additional subject (an 88-year-old female) achieving an almost complete clear nail by treatment end. The outcomes presented here may not be reflective of patients that may present with these clinical characteristics. Additional investigations would be useful in order to assess the value of topical tavaborole 5% solution in difficult-to-treat clinical presentations of onychomycosis.

J Drugs Dermatol. 2017;16(10):1016-1021.

Temporary work and depressive symptoms in South Korean workers.

BACKGROUND: In many countries, including South Korea, labour market changes have led to an increase in unstable, temporary jobs. There is evidence that workers in such jobs may experience poorer mental health than those in more stable employment. AIMS: To investigate the association between temporary employment and depressive symptoms in South Korean workers. METHODS: We analysed data from the 2010-2014 Korean Welfare Panel Study (KOWEPS). Employment type was categorized into workers paid per day of labour (day labourers), those on short-term contracts (fixed-term workers) and permanent workers. The association between employment type and depressive symptoms, measured using the Center for Epidemiological Studies Depression scale (CES-D 11), was examined using the generalized estimating equation model. RESULTS: A total of 3756 workers aged 20-59 were included in the 2010 baseline population. Day labourers had the highest mean CES-D 11 score, followed by fixed-term workers and permanent workers. With the day labourer group as reference, fixed-term workers (ß: -1.5027, P < 0.001) and permanent workers (ß: -2.1848, P < 0.001) showed statistically significant decreases in depression scores. CONCLUSIONS: Compared with day labourers, fixed-term workers and permanent workers had progressively lower depression scores. The findings of this study suggest that mental health inequalities based on employment type exist in South Korea.