Abstract: Objective: To examine the scientific literature on mask-use as source control to protect others from respiratory infections before and after the onset of the COVID-19 pandemic. Design: Systematic review. Methods: We examined primary research on mask usage as a means of source control to protect others by reducing the spread of respiratory diseases and contrasted the literature published before the onset of the COVID-19 pandemic with that published afterward. Articles were obtained through a search of PubMed and a review of article references. March 1, 2020 was selected as the cutoff date to distinguish between the pre-COVID-19 and post-COVID-19 periods. Results: 195 articles met our inclusion criteria. The sample included 55 articles on source control published before the start of the COVID-19 pandemic, and 140 articles published after the pandemic began, representing a 154.5% increase. The percentage of randomized control trials (RCT) and cluster RCTs declined by 94.9% (p<0.001), representing only 1.4% of the post-pandemic literature. The percentage of studies conducted on human subjects declined by 48.8% (p<0.001), and the percentage of studies in healthcare facilities declined by 64.5% (p=0.019). One in 5 post-pandemic studies (21.4%) were conducted in “real world” settings; 1 in 10 post-pandemic studies (10.0%) were done with computer modeling. Study authors were significantly more supportive of masks as source control in the post-pandemic literature. Conclusions: The quality of evidence in the published literature on masks as source control is lower after the start of the COVID-19 pandemic, with notable shifts in methodologies, research subjects, setting, and author tone.

Abstract: Objective: To assess the evidence underlying the Centers for Disease Control and Prevention (CDC) indoor safety guidance for lightning storms. Design: Systematic Review of peer-reviewed literature. Setting: Google Scholar, PubMed, and Web of Science (through 2023). Participants: Reports of indoor death or injury from lightning strike. Main outcome measures: The number of deaths and injuries from lightning-related activities. Results: A majority of the 15 articles identified were retrospective reviews of data from death certificates, medical records, and newspaper reports; 5 articles were based on single case reports. Reports of injuries from lightning while indoors are exceedingly rare; death from lightning while indoors is essentially non-existent in modern times. No evidence exists that supports the given advice. Conclusions: Current U.S. lightning avoidance tips may inadvertently portray indoor spaces as unsafe, despite their protective advantage. Guidelines should place less emphasis on indoor situations and highlight controllable risks, such as behavior in outdoor and recreation situations.

Abstract: Importance: Consistent, evidence-based communication is critical to building trust and maintaining credibility of public health agencies. Objective: To identify any significant changes in the mainstream media’s presentation of public health advice for flu prevention before and after the COVID-19 pandemic. Design, Setting, and Participants: A systematic search in Factiva of top ten U.S. newspapers by circulation, using two search periods, 2018-2019 and 2021-2022. Articles with flu prevention advice were identified, abstracted for media outlet, reporter, date. Articles were coded for the specific advice provided. Main Measure(s): Number of recommendations for flu prevention, frequency of each recommendation; percent of recommendations aligned with CDC guidelines for each period. Changes in frequency of each recommendation. Differences determined using 2-proportion Z-tests, p-value 0.05 significance. Results: 128 articles with 244 recommendations for pre-COVID period; 122 articles with 296 recommendations post-COVID. 96.3% of recommendations in alignment with CDC guidelines pre-COVID. 63.9% of recommendations in alignment with CDC during post-COVID timeframe. Percentage of articles with advice to mask for flu increased by 1,494.8% (p=<0.00001). 14.5% decline in percentage of articles advising flu vaccine (p=0.002). 495.5% increase in percentage of articles recommending social distancing (p=0.001). 1,368.9% increase in percentage articles recommending increased ventilation (p=0.0004).Advice to cover cough/sneeze declined by 52.8% (p=0.041); advice to disinfect surfaces declined by 76.7% (p=0.038). Conclusions and Relevance: Expert advice on flu prevention as presented in top 10 U.S. newspapers changed significantly during the COVID-19 pandemic. The strategies discussed more frequently are not currently recommended by CDC. This is relevant information for public health leaders as they address ongoing issues of trust and credibility. Key Points: Question: Are there significant differences between the mainstream media’s presentation of expert advice for flu prevention before and after the COVID-19 pandemic? Findings: A systematic search of the top ten U.S. newspapers by circulation found that the percentage of total articles with advice to use a face mask for flu prevention increased by 1,494.8% from the pre-to post-COVID period, while the percentage of total articles advising a flu vaccine decreased by 14.5%. Other significant findings include an increase in advice to social distance (494.5%), an increase in advice to improve ventilation (1,368.9%), a decline in advice to cover your cough (58.2%) and a decline in advice to disinfect surfaces (76.7%). The strategies discussed more frequently are not currently recommended by Centers for Disease Control (CDC) for flu prevention. Meaning: Significant changes in public health advice on flu prevention, as presented by high-circulation U.S. newspapers, occurred during the COVID-19 pandemic, resulting in less consistency with CDC recommendations for flu prevention.

Objectives

Past research has established that the Multigroup Ethnic Identity Measure (MEIM) exhibits measurement invariance across diverse ethnic groups. However, relatively little research has evaluated whether this measure is invariant across generational status. Thus, the present study evaluates the invariance of the MEIM across foreign-born, second-generation, and later-generation respondents.

Method

A large, ethnically diverse sample of college students completed the MEIM as part of an online survey (N = 9,107; 72.8% women; mean age = 20.31 years; SD = 3.38).

Results

There is evidence of configural and metric invariance, but there is little evidence of scalar invariance across generational status groups.

Conclusions

This study suggests that the MEIM has an equivalent factor structure across generation groups, indicating it is appropriate to compare the magnitude of associations between the MEIM and other variables across foreign-born, second-generation, and later-generation individuals. However, the lack of scalar invariance suggests that mean-level differences across generational status should be interpreted with caution. (PsycINFO Database Record

The relationship between folate and colorectal cancer (CRC) risk is unclear. We investigated the association of two biomarkers of folate status, plasma folate and red blood cell (RBC) folate, with CRC risk using a nested case-control design in the Women's Health Initiative Observational Study. Postmenopausal women (n = 93,676) aged 50-79 years were enrolled in the Women's Health Initiative Observational Study (1993-1998). A fasting blood draw and extensive health, dietary and lifestyle data were collected upon enrollment. Through 2008, 988 incident CRC cases were reported and confirmed with medical records adjudication. Cases and controls were matched on age (± 3 years), enrollment date (± 1 year), race/ethnicity, blood draw date (± 6 months) and hysterectomy status. Plasma and RBC folate were determined by radio assay. Folate biomarker values were divided into quartiles, and conditional logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CI) for the associations of folate with total CRC, by tumor site and by stage at diagnosis. Additional analyses examined whether risks varied across time periods corresponding to the United States folic acid fortification policy: prefortification (1994-1995), perifortification (1996-1997) and postfortification (1998). ORs for overall CRC risk comparing Q4 vs. Q1 were 0.91 (95% CI 0.67-1.24) and 0.91 (95% CI 0.67-1.23) for RBC and plasma folate, respectively. There were no changes in risk attributable to food supply fortification. These results do not support an overall association of folate with CRC risk and suggest that folic acid fortification of the US food supply did not alter the associations in these postmenopausal women.

Background

Investigations of folate-mediated one-carbon metabolism (FOCM) genes and gene-nutrient interactions with respect to colorectal cancer (CRC) risk are limited to candidate polymorphisms and dietary folate. This study comprehensively investigated associations between genetic variants in FOCM and CRC risk and whether the FOCM nutrient status modified these associations.

Methods

Two hundred eighty-eight candidate and tagging single-nucleotide polymorphisms (SNPs) in 30 FOCM genes were genotyped for 821 incident CRC case-control matched pairs in the Women's Health Initiative Observational Study cohort. FOCM biomarkers (red blood cell [RBC] folate, plasma folate, pyridoxal-5'-phosphate [PLP], vitamin B12, and homocysteine) and self-reported alcohol consumption were measured at the baseline. Conditional logistic regression was implemented; effect modification was examined on the basis of known enzyme-nutrient relations.

Results

Statistically significant associations were observed between CRC risk and functionally defined candidate SNPs of methylenetetrahydrofolate dehydrogenase 1 (MTHFD1; K134R), 5-methyltetrahydrofolate-homocysteine methyltransferase reductase (MTRR; P450R), and PR domain containing 2 with ZNF domain (PRDM2; S450N) and a literature candidate SNP of thymidylate synthase (TYMS; g.676789A>T; nominal P < .05). In addition, suggestive associations were noted for tagging SNPs in cystathionine-β-synthase (CBS), dihydrofolate reductase (DHFR), DNA (cytosine-5-)-methyltransferase 3β (DNMT3B), methionine adenosyltransferase I α (MAT1A), MTHFD1, and MTRR (nominal P < .05; adjusted P, not significant). Significant interactions between nutrient biomarkers and candidate polymorphisms were observed for 1) plasma/RBC folate and folate hydrolase 1 (FOLH1), paraoxonase 1 (PON1), transcobalamin II (TCN2), DNMT1, and DNMT3B; 2) plasma PLP and TYMS TS3; 3) plasma B12 and betaine-homocysteine S-methyltransferase 2 (BHMT2); and 4) homocysteine and methylenetetrahydrofolate reductase (MTHFR) and alanyl-transfer RNA synthetase (AARS).

Conclusions

Genetic variants in FOCM genes are associated with CRC risk among postmenopausal women. FOCM nutrients continue to emerge as effect modifiers of genetic influences on CRC risk.

Folate-mediated one-carbon metabolism is essential for DNA synthesis, repair, and methylation. Perturbations in one-carbon metabolism have been implicated in increased risk of some cancers and may also affect inflammatory processes. We investigated these interrelated pathways to understand their relation. The objective was to explore associations between inflammation and biomarkers of nutritional status and one-carbon metabolism. In a cross-sectional study in 1976 women selected from the Women's Health Initiative Observational Study, plasma vitamin B-6 [pyridoxal-5'-phosphate (PLP)], plasma vitamin B-12, plasma folate, and RBC folate were measured as nutritional biomarkers; serum C-reactive protein (CRP) and serum amyloid A (SAA) were measured as biomarkers of inflammation; and homocysteine and cysteine were measured as integrated biomarkers of one-carbon metabolism. Student's t, chi-square, and Spearman rank correlations, along with multiple linear regressions, were used to explore relations between biomarkers; additionally, we tested stratification by folic acid fortification period and multivitamin use. With the use of univariate analysis, plasma PLP was the only nutritional biomarker that was modestly significantly correlated with serum CRP and SAA (ρ = -0.22 and -0.12, respectively; P < 0.0001). Homocysteine (μmol/L) showed significant inverse correlations with all nutritional biomarkers (ranging from ρ = -0.30 to ρ = -0.46; all P < 0.0001). With the use of multiple linear regression, plasma PLP, RBC folate, homocysteine, and cysteine were identified as independent predictors of CRP; and PLP, vitamin B-12, RBC folate, and homocysteine were identified as predictors of SAA. When stratified by folic acid fortification period, nutrition-homocysteine correlations were generally weaker in the postfortification period, whereas associations between plasma PLP and serum CRP increased. Biomarkers of inflammation are associated with PLP, RBC folate, and homocysteine in women. The connection between the pathways needs to be further investigated and causality established. The trial is registered at clinicaltrials.gov as NCT00000611.

Few studies have examined associations between plasma choline metabolites and risk of colorectal cancer. Therefore, we investigated associations between plasma biomarkers of choline metabolism [choline, betaine, dimethylglycine, and trimethylamine N-oxide (TMAO)] and colorectal cancer risk among postmenopausal women in a case-control study nested within the Women's Health Initiative Observational Study. We selected 835 matched case-control pairs, and cases were further stratified by tumor site (proximal, distal, or rectal) and stage (local/regional or metastatic). Colorectal cancer was assessed by self-report and confirmed by medical records over the mean of 5.2 years of follow-up. Baseline plasma choline metabolites were measured by LC/MS-MS. In multivariable-adjusted conditional logistic regression models, plasma choline tended to be positively associated with rectal cancer risk [OR (95% confidence interval, CI)(highest vs. lowest quartile) = 2.44 (0.93-6.40); P trend = 0.08], whereas plasma betaine was inversely associated with colorectal cancer overall [0.68 (0.47-0.99); P trend = 0.01] and with local/regional tumors [0.64 (0.42-0.99); P trend = 0.009]. Notably, the plasma betaine:choline ratio was inversely associated with colorectal cancer overall [0.56 (0.39-0.82); P trend = 0.004] as well as with proximal [0.66 (0.41-1.06); P trend = 0.049], rectal [0.27 (0.10-0.78); P trend = 0.02], and local/regional [0.50 (0.33-0.76); P trend = 0.001] tumors. Finally, plasma TMAO, an oxidative derivative of choline produced by intestinal bacteria, was positively associated with rectal cancer [3.38 (1.25-9.16); P trend = 0.02] and with overall colorectal cancer risk among women with lower (vs. higher) plasma vitamin B12 levels (P interaction = 0.003). Collectively, these data suggest that alterations in choline metabolism, which may arise early in disease development, may be associated with higher risk of colorectal cancer. The positive association between plasma TMAO and colorectal cancer risk is consistent with an involvement of the gut microbiome in colorectal cancer pathogenesis.