Mediating Factors in the Association of Maternal Educational Level With Pregnancy Outcomes: A Mendelian Randomization Study.

Importance: Lower educational attainment is associated with increased risk of adverse pregnancy outcomes, but it is unclear which pathways mediate this association. Objective: To investigate the association between educational attainment and pregnancy outcomes and the proportion of this association that is mediated through modifiable cardiometabolic risk factors. Design, Setting, and Participants: In this 2-sample mendelian randomization (MR) cohort study, uncorrelated (R2 < 0.01) single-nucleotide variants (formerly single-nucleotide polymorphisms) associated with the exposure (P < 5 × 10-8) and mediators and genetic associations with the pregnancy outcomes from genome-wide association studies were extracted. All participants were of European ancestry and were largely from Finland, Iceland, the United Kingdom, or the US. The inverse variance-weighted method was used in the main analysis, and the weighted median, weighted mode, and MR Egger regression were used in sensitivity analyses. In mediation analyses, the direct effect of educational attainment estimated in multivariable MR was compared with the total effect estimated in the main univariable MR analysis. Data were extracted between December 1, 2022, and April 30, 2023. Exposure: Genetically estimated educational attainment. The mediators considered were genetically estimated type 2 diabetes, body mass index, smoking, high-density lipoprotein cholesterol level, and systolic blood pressure. Main Outcomes and Measures: Ectopic pregnancy, hyperemesis gravidarum, gestational diabetes, preeclampsia, preterm birth, and offspring birth weight. Results: The analyses included 3 037 499 individuals with data on educational attainment, and those included in studies on pregnancy outcomes ranged from 141 014 for ectopic pregnancy to 270 002 with data on offspring birth weight. Each SD increase in genetically estimated educational attainment (ie, 3.4 years) was associated with an increased birth weight of 42 (95% CI, 28-56) g and an odds ratio ranging from 0.53 (95% CI, 0.46-0.60) for ectopic pregnancy to 0.81 (95% CI, 0.71-0.93) for preeclampsia. The combined proportion of the association that was mediated by the 5 cardiometabolic risk factors ranged from -17% (95% CI, -46% to 26%) for hyperemesis gravidarum to 78% (95% CI, 10%-208%) for preeclampsia. Sensitivity analyses accounting for pleiotropy were consistent with the main analyses. Conclusions and Relevance: In this MR cohort study, intervening for type 2 diabetes, body mass index, smoking, high-density lipoprotein cholesterol level, and systolic blood pressure may lead to reductions in several adverse pregnancy outcomes associated with lower levels of education. Such public health interventions would serve to reduce health disparities attributable to social inequalities.

Spatio-Temporal Evolution and Influencing Factors of Ecological Well-Being Performance from the Perspective of Strong Sustainability: A Case Study of the Three Gorges Reservoir Area, China.

The concept of strong sustainability suggests that natural capital is irreplaceable and emphasizes that human natural consumption cannot exceed the carrying capacity of the ecological environment. In the realistic context of tightening resource constraints and ecological degradation, how to explore the optimal economic and well-being output under certain ecological constraints has become an important topic in sustainability research. Ecological well-being performance (EWP) can comprehensively reflect the efficiency of natural resources and ecological inputs into the well-being level and has become an important tool for sustainable development research. Based on strong sustainability, this paper constructs an EWP evaluation index system. It decomposes EWP into two stages: ecological economy and economic well-being, which opens the "black box" of the ecological well-being conversion process. PCA-DEA, the network super-efficiency Epsilon-based measure (Network SEBM) model, and Geodetector are used to dynamically measure the EWP in the Three Gorges Reservoir Area (TGRA) from 2010 to 2020 and analyze its spatial and temporal characteristics and influencing factors. The results show that (1) temporally, the EWP in the TGRA shows an increasing trend from 2010 to 2020, but the overall level is low. Spatially, it shows a high pattern in the east and low in the west, and spatial differences are gradually decreasing; (2) ecological economic efficiency is significantly lower than economic well-being efficiency, and ecological economic efficiency is the main reason limiting the improvement in EWP in the TGRA. The ecological well-being situation of the TGRA is not optimistic; (3) there is an overall problem of excessive ecological input and insufficient per-capita GDP and well-being output in the TGRA, and decisions should be made according to local conditions; (4) the level of economic development has an EWP level that plays a dominant role and also has a greater relationship with the policy system, socioeconomic conditions, and natural environment.

A Risk Assessment Tool for Identifying Osteoporosis in Older Women with Type 2 Diabetes Mellitus.

PURPOSE: To develop a simple and clinically useful assessment tool for osteoporosis in older women with type 2 diabetes mellitus (T2DM). METHODS: A total of 601 women over 60 years of age with T2DM were enrolled in this study. The levels of serum sex hormones and bone metabolism markers were compared between the osteoporosis and non-osteoporosis groups. The least absolute shrinkage and selection operator regularization (LASSO) model was applied to generate a risk assessment tool. The risk score formula was evaluated using receiver operating characteristic analysis and the relationship between the risk score and the bone mineral density (BMD) and T-value were investigated. RESULTS: Serum sex hormone-binding globulin (SHBG), cross-linked C-telopeptide of type 1 collagen (CTX), and osteocalcin (OC) were significantly higher in the osteoporosis group. After adjustment for age and body mass index (BMI), SHBG was found to be correlated with the T-value or BMD. Then, a risk score was specifically generated with age, BMI, SHBG, and CTX using the LASSO model. The risk score was significantly negatively correlated with the T-value and BMD of the lumbar spine, femoral neck, and total hip (all P<0.05). CONCLUSION: A risk score using age, BMI, SHBG, and CTX performs well for identifying osteoporosis in older women with T2DM.

Publishing at any cost: a cross-sectional study of the amount that medical researchers spend on open access publishing each year.

OBJECTIVE: To estimate the financial costs paid by individual medical researchers from meeting the article processing charges (APCs) levied by open access journals in 2019. DESIGN: Cross-sectional analysis. DATA SOURCES: Scopus was used to generate two random samples of researchers, the first with a senior author article indexed in the 'Medicine' subject area (general researchers) and the second with an article published in the ten highest-impact factor general clinical medicine journals (high-impact researchers) in 2019. For each researcher, Scopus was used to identify all first and senior author original research or review articles published in 2019. Data were obtained from Scopus, institutional profiles, Journal Citation Reports, publisher databases, the Directory of Open Access Journals, and individual journal websites. MAIN OUTCOME MEASURES: Median APCs paid by general and high-impact researchers for all first and senior author research and review articles published in 2019. RESULTS: There were 241 general and 246 high-impact researchers identified as eligible for our study. In 2019, the general and high-impact researchers published a total of 914 (median 2, IQR 1-5) and 1471 (4, 2-8) first or senior author research or review articles, respectively. 42% (384/914) of the articles from the general researchers and 29% (428/1471) of the articles from the high-impact medical researchers were published in fully open access journals. The median total APCs paid by general researchers in 2019 was US$191 (US$0-US$2500) and the median total paid by high-impact researchers was US$2900 (US$0-US$5465); the maximum paid by a single researcher in total APCs was US$30115 and US$34676, respectively. CONCLUSIONS: Medical researchers in 2019 were found to have paid between US$0 and US$34676 in total APCs. As journals with APCs become more common, it is important to continue to evaluate the potential cost to researchers, especially on individuals who may not have the funding or institutional resources to cover these costs.