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1. Longitudinal Associations of Clinical and Biochemical Head Injury Biomarkers With Head Impact Exposure in Adolescent Football Players

   https://doi.org/10.1001/jamanetworkopen.2023.16601  

   Zuidema, Taylor R; Bazarian, Jeffrey J; Kercher, Kyle A; Mannix, Rebekah; Kraft, Reuben H; Newman, Sharlene D; Ejima, Keisuke; Rettke, Devin J; Macy, Jonathan T; Steinfeldt, Jesse A; et al (May 2023, JAMA Network Open)

   ImportanceConsequences of subconcussive head impacts have been recognized, yet most studies to date have included small samples from a single site, used a unimodal approach, and lacked repeated testing. ObjectiveTo examine time-course changes in clinical (near point of convergence [NPC]) and brain-injury blood biomarkers (glial fibrillary acidic protein [GFAP], ubiquitin C-terminal hydrolase-L1 [UCH-L1], and neurofilament light [NF-L]) in adolescent football players and to test whether changes in the outcomes were associated with playing position, impact kinematics, and/or brain tissue strain. Design, Setting, and ParticipantsThis multisite, prospective cohort study included male high school football players aged 13 to 18 years at 4 high schools in the Midwest during the 2021 high school football season (preseason [July] and August 2 to November 19). ExposureA single football season. Main Outcomes and MeasuresThe main outcomes were NPC (a clinical oculomotor test) and serum levels of GFAP, UCH-L1, and NF-L. Participants’ head impact exposure (frequency and peak linear and rotational accelerations) was tracked using instrumented mouthguards, and maximum principal strain was computed to reflect brain tissue strain. Players’ neurological function was assessed at 5 time points (preseason, post–training camp, 2 in season, and postseason). ResultsNinety-nine male players contributed to the time-course analysis (mean [SD] age, 15.8 [1.1] years), but data from 6 players (6.1%) were excluded from the association analysis due to issues related to mouthguards. Thus, 93 players yielded 9498 head impacts in a season (mean [SD], 102 [113] impacts per player). There were time-course elevations in NPC and GFAP, UCH-L1, and NF-L levels. Compared with baseline, the NPC exhibited a significant elevation over time and peaked at postseason (2.21 cm; 95% CI, 1.80-2.63 cm;P < .001). Levels of GFAP and UCH-L1 increased by 25.6 pg/mL (95% CI, 17.6-33.6 pg/mL;P < .001) and 188.5 pg/mL (95% CI, 145.6-231.4 pg/mL;P < .001), respectively, later in the season. Levels of NF-L were elevated after the training camp (0.78 pg/mL; 95% CI, 0.14-1.41 pg/mL;P = .011) and midseason (0.55 pg/mL; 95% CI, 0.13-0.99 pg/mL;P = .006) but normalized by the end of the season. Changes in UCH-L1 levels were associated with maximum principal strain later in the season (0.052 pg/mL; 95% CI, 0.015-0.088 pg/mL;P = .007) and postseason (0.069 pg/mL; 95% CI, 0.031-0.106 pg/mL;P < .001). Conclusions and RelevanceThe study data suggest that adolescent football players exhibited impairments in oculomotor function and elevations in blood biomarker levels associated with astrocyte activation and neuronal injury throughout a season. Several years of follow-up are needed to examine the long-term effects of subconcussive head impacts in adolescent football players. 

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2. US Abortion Bans and Fertility

   https://doi.org/10.1001/jama.2024.28527  

   Bell, Suzanne O; Franks, Alexander M; Arbour, David; Anjur-Dietrich, Selena; Stuart, Elizabeth A; Ben-Michael, Eli; Feller, Avi; Gemmill, Alison (April 2025, JAMA)

   ImportanceAbortion bans may lead to births among those who are unable to overcome barriers to abortion. The population-level effects of these policies, particularly their unequal impacts across subpopulations in the US, remain unclear. ObjectiveTo assess heterogeneity in the association of abortion bans with changes in fertility in the US, within and across states. Design, Setting, and ParticipantsDrawing from birth certificate and US Census Bureau data from 2012 through 2023 for all 50 states and the District of Columbia, this study used a bayesian panel data model to evaluate state-by-subgroup-specific changes in fertility associated with complete or 6-week abortion bans in 14 US states. The average percent and absolute change in the fertility rate among females aged 15 through 44 years was estimated overall and by state, and within and across states by age, race and ethnicity, marital status, education, and insurance payer. ExposureComplete or 6-week abortion ban. Main outcome and MeasuresFertility rate (births per 1000 reproductive-aged females) overall and by subgroups. ResultsThere were an estimated 1.01 (95% credible interval [CrI], 0.45-1.64) additional births above expectation per 1000 females aged 15 through 44 years (reproductive age) in states following adoption of abortion bans (60.55 observed vs 59.54 expected; 1.70% increase; 95% CrI, 0.75%-2.78%), equivalent to 22 180 excess births, with evidence of variation by state and subgroup. Estimated differences above expectation were largest for racially minoritized individuals (≈2.0%), unmarried individuals (1.79%), individuals younger than 35 years (≈2.0%), Medicaid beneficiaries (2.41%), and those without college degrees (high school diploma, 2.36%; some college, 1.58%), particularly in southern states. Differences in race and ethnicity and education across states explain most of the variability in the state-level association between abortion bans and fertility rates. Conclusion and RelevanceThese findings provide evidence that fertility rates in states with abortion bans were higher than would have been expected in the absence of these policies, with the largest estimated differences among subpopulations experiencing the greatest structural disadvantages and in states with among the worst maternal and child health and well-being outcomes. 

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3. Thyroid hormone replacement therapy patterns in pregnant women and perinatal outcomes in the offspring

   https://doi.org/10.1002/pds.4927  

   Frank, Anna S; Lupattelli, Angela; Matteson, David S; Meltzer, Helle Margrete; Nordeng, Hedvig (January 2020, Pharmacoepidemiology and Drug Safety)

   Abstract PurposeIt remains unknown to what degree thyroid hormone replacement therapy (THRT) during and initiation after pregnancy determines pregnancy outcomes. The present study primarily aimed to quantify the impact of THRT patterns (including trajectories) on gestational age, birth weight, and head circumference of infants. The secondary aim was to compare results of trajectory with traditional analysis. MethodsWe combined data from the Norwegian Mother, Father and Child Cohort Study (MoBa) to other Norwegian registry data and the Norwegian Environmental Biobank. The study population included 54 020 women enrolled in MoBa in 2005 to 2008. On the basis of prescription records, we classified women into nonhypothyroid (n = 51 390; reference group), THRT after delivery (n = 1397), or medicated (n = 1233) groups. Applying Group‐Based‐Trajectory Models (GBTMs), we determined THRT trajectories among women in the medicated group. Propensity score weighting linked multiple treatment groups to pregnancy outcomes. ResultsPatterns were identified among women using medication during (Decreasing‐Low, Increasing‐Medium, Constant‐Medium, and Constant‐High) and after pregnancy. Women in the Increasing‐Medium (adjusted Odds Ratio [aOR] = 1.69; 95% Confidence Interval [CI], 1.06‐2.73) and the THRT after delivery (aOR = 1.19; 95% CI, 1.01‐1.42) groups had increased risk of giving birth to an LGA infant. In the traditional analysis, only women in the THRT after delivery group showed increased risk for an LGA infant (aOR = 1.19; 95% CI, 1.00‐1.42). We found no other differential effect among the five THRT patterns on the other outcomes. ConclusionsWomen with THRT after delivery or late onset THRT treatment showed increased risk of LGA infants. 

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4. Climate change, extreme events, and increased risk of salmonellosis: foodborne diseases active surveillance network (FoodNet), 2004-2014

   https://doi.org/10.1186/s12940-021-00787-y  

   Morgado, Michele E.; Jiang, Chengsheng; Zambrana, Jordan; Upperman, Crystal Romeo; Mitchell, Clifford; Boyle, Michelle; Sapkota, Amy R.; Sapkota, Amir (September 2021, Environmental Health)

   Abstract BackgroundInfections with nontyphoidalSalmonellacause an estimated 19,336 hospitalizations each year in the United States. Sources of infection can vary by state and include animal and plant-based foods, as well as environmental reservoirs. Several studies have recognized the importance of increased ambient temperature and precipitation in the spread and persistence ofSalmonellain soil and food. However, the impact of extreme weather events onSalmonellainfection rates among the most prevalent serovars, has not been fully evaluated across distinct U.S. regions. MethodsTo address this knowledge gap, we obtainedSalmonellacase data forS.Enteriditis,S.Typhimurium,S.Newport, andS.Javiana (2004-2014; n = 32,951) from the Foodborne Diseases Active Surveillance Network (FoodNet), and weather data from the National Climatic Data Center (1960-2014). Extreme heat and precipitation events for the study period (2004-2014) were identified using location and calendar day specific 95^thpercentile thresholds derived using a 30-year baseline (1960-1989). Negative binomial generalized estimating equations were used to evaluate the association between exposure to extreme events and salmonellosis rates. ResultsWe observed that extreme heat exposure was associated with increased rates of infection withS.Newport in Maryland (Incidence Rate Ratio (IRR): 1.07, 95% Confidence Interval (CI): 1.01, 1.14), and Tennessee (IRR: 1.06, 95% CI: 1.04, 1.09), both FoodNet sites with high densities of animal feeding operations (e.g., broiler chickens and cattle). Extreme precipitation events were also associated with increased rates ofS.Javiana infections, by 22% in Connecticut (IRR: 1.22, 95% CI: 1.10, 1.35) and by 5% in Georgia (IRR: 1.05, 95% CI: 1.01, 1.08), respectively. In addition, there was an 11% (IRR: 1.11, 95% CI: 1.04-1.18) increased rate ofS. Newport infections in Maryland associated with extreme precipitation events. ConclusionsOverall, our study suggests a stronger association between extreme precipitation events, compared to extreme heat, and salmonellosis across multiple U.S. regions. In addition, the rates of infection withSalmonellaserovars that persist in environmental or plant-based reservoirs, such asS.Javiana andS.Newport, appear to be of particular significance regarding increased heat and rainfall events. 

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5. Association of male fatty acid intake with fecundability among couples planning pregnancy

   https://doi.org/10.1093/humrep/dead100  

   Geller, Ruth J; Wesselink, Amelia K; Koenig, Martha R; Eisenberg, Michael L; Tucker, Katherine L; Hatch, Elizabeth E; Wise, Lauren A (May 2023, Human Reproduction)

   Abstract STUDY QUESTIONTo what extent is male fatty acid intake associated with fecundability among couples planning pregnancy? SUMMARY ANSWERWe observed weak positive associations of male dietary intakes of total and saturated fatty acids with fecundability; no other fatty acid subtypes were appreciably associated with fecundability. WHAT IS KNOWN ALREADYMale fatty acid intake has been associated with semen quality in previous studies. However, little is known about the extent to which male fatty acid intake is associated with fecundability among couples attempting spontaneous conception. STUDY DESIGN, SIZE, DURATIONWe conducted an internet-based preconception prospective cohort study of 697 couples who enrolled during 2015–2022. During 12 cycles of observation, 53 couples (7.6%) were lost to follow-up. PARTICIPANTS/MATERIALS, SETTING, METHODSParticipants were residents of the USA or Canada, aged 21–45 years, and not using fertility treatment at enrollment. At baseline, male participants completed a food frequency questionnaire from which we estimated intakes of total fat and fatty acid subtypes. We ascertained time to pregnancy using questionnaires completed every 8 weeks by female participants until conception or up to 12 months. We used proportional probabilities regression models to estimate fecundability ratios (FRs) and 95% CIs for the associations of fat intakes with fecundability, adjusting for male and female partner characteristics. We used the multivariate nutrient density method to account for energy intake, allowing for interpretation of results as fat intake replacing carbohydrate intake. We conducted several sensitivity analyses to assess the potential for confounding, selection bias, and reverse causation. MAIN RESULTS AND THE ROLE OF CHANCEAmong 697 couples, we observed 465 pregnancies during 2970 menstrual cycles of follow-up. The cumulative incidence of pregnancy during 12 cycles of follow-up after accounting for censoring was 76%. Intakes of total and saturated fatty acids were weakly, positively associated with fecundability. Fully adjusted FRs for quartiles of total fat intake were 1.32 (95% CI 1.01–1.71), 1.16 (95% CI 0.88–1.51), and 1.43 (95% CI 1.09–1.88) for the second, third, and fourth vs the first quartile, respectively. Fully adjusted FRs for saturated fatty acid intake were 1.21 (95% CI 0.94–1.55), 1.16 (95% CI 0.89–1.51), and 1.23 (95% CI 0.94–1.62) for the second, third, and fourth vs the first quartile, respectively. Intakes of monounsaturated, polyunsaturated, trans-, omega-3, and omega-6 fatty acids were not strongly associated with fecundability. Results were similar after adjustment for the female partner’s intakes of trans- and omega-3 fats. LIMITATIONS, REASONS FOR CAUTIONDietary intakes estimated from the food frequency questionnaire may be subject to non-differential misclassification, which is expected to bias results toward the null in the extreme categories when exposures are modeled as quartiles. There may be residual confounding by unmeasured dietary, lifestyle, or environmental factors. Sample size was limited, especially in subgroup analyses. WIDER IMPLICATIONS OF THE FINDINGSOur results do not support a strong causal effect of male fatty acid intakes on fecundability among couples attempting to conceive spontaneously. The weak positive associations we observed between male dietary fat intakes and fecundability may reflect a combination of causal associations, measurement error, chance, and residual confounding. STUDY FUNDING/COMPETING INTEREST(S)The study was funded by the National Institutes of Health, grant numbers R01HD086742 and R01HD105863. In the last 3 years, PRESTO has received in-kind donations from Swiss Precision Diagnostics (home pregnancy tests) and Kindara.com (fertility app). L.A.W. is a consultant for AbbVie, Inc. M.L.E. is an advisor to Sandstone, Ro, Underdog, Dadi, Hannah, Doveras, and VSeat. The other authors have no competing interests to report. TRIAL REGISTRATION NUMBERN/A. 

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