2 Minute Medicine Rewind January 22, 2024

Exposure to residential green and blue space and the natural environment is associated with a lower incidence of psychiatric disorders in middle-aged and older adults: findings from the UK Biobank

Evidence Rating Level: 2 (Good)

1. In this longitudinal study, exposure to green, blue, and natural spaces was beneficial for reducing the risk of developing psychiatric disorders among middle-aged and older adults.

Though there has been increasing awareness of the relationship between the environment and health, little is known about whether exposure to green spaces, blue spaces, and the natural environment (GBN) influences the risk of developing psychiatric disorders. Researchers aimed to assess this relationship among middle-aged and older adults. Data were collected from the UK biobank. 363,047 participants (women: 53.4%; mean age 56.7 ± 8.1 years) with no psychiatric disorders at baseline were included at the start of the study between 2006 and 2010. Exposure to GBN was measured using the residential addresses of the participants. A follow-up of 11.5 ± 2.8 years was conducted by assessing hospital and death records. 49,865 individuals were diagnosed with psychiatric disorders during the follow-up period. When compared to the lowest tertile of exposure, exposure to blue space at 300 m buffer (HR: 0.970, 95% CI: 0.948–0.992), natural environment at 300 m buffer (HR: 0.970, 95% CI: 0.948–0.992), and natural environment at 1000 m buffer (HR: 0.975, 95% CI: 0.952–0.999) in the highest tertile were associated with a significantly lower risk of incident psychiatric disorders. This study demonstrates that exposure to GBN is associated with a reduced risk of developing psychiatric disorders among middle-aged and older adults. A strength of this study is the large sample size facilitated by the UK biobank. Future research is needed to understand potential mechanisms that may be driving this association. 

Timing of Maternal COVID-19 Vaccine and Antibody Concentrations in Infants Born Preterm

Evidence Rating Level: 2 (Good)

1. In this prospective cohort study of pregnant individuals, receiving 3 or more doses of a COVID-19 vaccine before delivery was associated with greater antibody titers in maternal and cord blood, compared to vaccination with only 2 doses. 

Vaccination against COVID-19 reduces morbidity and mortality due to SARS-CoV-2 among pregnant individuals, with the additional benefit of transplacental antibody transfer. Little is known about the level of protection against SARS-CoV-2 for premature infants. Researchers aimed to compare levels of anti-Spike (anti-S) antibodies between preterm and full-term infants born to individuals who received at least 2 COVID-19 vaccine doses before delivery. The study excluded those with a history of COVID-19 infection or detectible anti–SARS–CoV–2 nucleocapsid antibodies. In total, 26 preterm and 184 full-term deliveries were included in this prospective cohort study. 121 participants received two vaccine doses and had a geometric mean concentration of maternal anti-S antibodies of 674 (95% CI, 577-787), compared to 8159 (95% CI, 6636-10 032) for the 99 participants who received 3 or more doses (P <.001). A similar dose-dependent response was observed in the cord blood samples, with cord anti-S antibody geometric mean concentrations of 1000 (95% CI, 874-1144) after 2 doses and 9992 (95% CI, 8381-11 914) after 3 or more doses (P < .001). When adjusting for vaccine timing before delivery, there was no significant difference between preterm and term cord samples. This study is limited by the relatively small sample size and lack of inclusion of infants born before the 3rd trimester. Overall, this study demonstrates that receiving 3 or more COVID-19 vaccine doses increases SARS-CoV-2 antibody titers and transplacental transfer to offspring, which are not impacted by gestational age.

Associations between long-term night shift work and incidence of chronic obstructive pulmonary disease: a prospective cohort study of 277,059 UK Biobank participants

Evidence rating level: 1 (Excellent)

1. Long-term exposure to night shift work was associated with a greater risk of developing chronic obstructive pulmonary disease. 

Chronic obstructive pulmonary disease (COPD) is the third leading cause of mortality worldwide. Tobacco smoking is known to be the largest risk factor for developing COPD, though recent research suggests that there are non-tobacco-related risk factors that have been overlooked. Night shift work is associated with a greater risk of developing several chronic diseases. Researchers aimed to assess whether long-term exposure to night shift work impacts the risk of developing COPD. In this prospective cohort study, 277,059 subjects (133,063 men [48.03%]; mean [SD] age, 52.71 [7.08] years) were included via the UK Biobank. In addition to collecting employment information, COPD-specific genetic risk scores (GRS) were calculated. The median follow-up period was 12.87 years. During this time, 6558 diagnoses of COPD were documented. There was an increasing trend of COPD incidence found from day work, irregular night shift work, to regular night shift work (P for trend < 0.001). Compared to day shift work, irregular night shift work was associated with an increased risk of developing COPD (HR, 1.28; 95% CI, 1.20-1.37). Similarly, compared to day shift work, regular night shift work was associated with an increased risk of developing COPD (HR, 1.49; 95% CI,1.35-1.66). Additionally, there was an additive interaction between permanent night shift work and GRS, as those with regular night shift work and high GRS had the greatest risk of COPD, compared to day shift workers with low GRS (HR, 1.90; 95% CI, 1.63-2.22). Strengths of this study include the large sample size, the prospective nature of the study, and the long-term follow-up period. A limitation of this study is that there was a lack of racial/ ethnic diversity, with mostly White participants. Overall, this study demonstrates that long-term exposure to night shift work is associated with an increased risk of developing COPD, and this risk is further increased when there is greater underlying genetic susceptibility. 

All cause and cause specific mortality in obsessive-compulsive disorder: nationwide matched cohort and sibling cohort study

Evidence rating level: 2 (Good)

1. Individuals with obsessive-compulsive disorder (OCD) had a higher risk of mortality, particularly due to unnatural cases. 

Obsessive-compulsive disorder (OCD) is a psychiatric disorder that is usually chronic and associated with a great deal of anxiety, often resulting in poor quality of life. Researchers aimed to assess the risk of all-cause and cause-specific mortality associated with OCD. In this population-based matched cohort, 61,378 individuals with OCD and 613,780 unaffected individuals were matched 1:10 based on sex, birth year, and country of residence. An additional sibling cohort included 34,085 individuals, of which 34,085 had OCD and 47,874 were unaffected siblings. The cohorts were followed for a median length of 8.1 years between 1973 and 2020. 4787 individuals with OCD and 30,619 without OCD died during the study period. After adjusting for several confounding variables, those with OCD had an increased risk of all-cause mortality (HR, 1.82; 95% CI,1.76-1.89), mortality due to natural causes (HR, 1.31; 95% CI, 1.27-1.37), and mortality due to unnatural causes (HR, 3.30; 95% CI, 3.05-3.57). Among unnatural deaths, suicide had the highest hazard ratio. A limitation of this study is that diagnoses were collected based on records from specialist care, with limited information from outpatient records compared to inpatient records, which may skew the data to include more severe cases of OCD. Overall, this study demonstrates that individuals with OCD had a higher risk of mortality, particularly due to unnatural cases. 

Occupational Sitting Time, Leisure Physical Activity, and All-Cause and Cardiovascular Disease Mortality

Evidence Rating Level: 1 (Excellent)

1. In this prospective cohort study, prolonged occupational sitting was associated with increased all-cause and cardiovascular disease mortality.

In 2020, the World Health Organization guidelines on physical activity recommended reducing sedentary behaviors. Unfortunately, sedentary behavior has become common in many modern workplaces, making it challenging to adhere to this recommendation. Researchers aimed to quantify health risks associated with prolonged occupational sitting and determine whether increased leisure time physical activity (LTPA) can reduce these risks. This prospective cohort study in Taiwan included 481,688 participants (mean [SD] age, 39.3 [12.8] years; 256 077 women [53.2%]), with a mean (SD) follow-up period of 12.85 (5.67 years). Data were collected on occupational sitting, LTPA, metabolic parameters, and other lifestyle factors. Occupational sitting was categorized into 3 groups: mostly sitting, alternating sitting and non-sitting, and mostly non-sitting. Researchers adjusted for several confounding variables including sex, age, education, smoking, drinking, and body mass index. Individuals in the mostly sitting category had 16% higher all-cause mortality (HR, 1.16; 95% CI, 1.11-1.20) and 34% increased mortality risk from cardiovascular disease (CVD) (HR, 1.34; 95% CI, 1.22-1.46) compared to those who were mostly nonsitting. This risk was not found for those in the alternating sitting and non-sitting category. For those who were mostly sitting in their occupations and engaging in low (15-30 minutes) or no (<15 minutes) LTPA, an increase in LTPA by 15 and 30 minutes per day, respectively, was associated with a mortality reduction to a similar level as those who were mostly non-sitting at work. A limitation of this study is that researchers relied on self-reporting of physical activity levels, which is a potential source of bias. Strengths of the study include the large sample size and prospective design. Overall, this study demonstrates that prolonged sitting associated with many modern occupations is associated with increased all-cause and CVD mortality, which can be combatted by increasing leisure-time physical activity. 

Image: PD

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