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  • 1.
    Martinez Perez, Guillermo
    et al.
    Univ Zaragoza, Fac Hlth Sci, Dept Physiat & Nursing, E-50009 Zaragoza, Spain..
    Mubanga, Mwenya
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala Univ, Uppsala, Sweden..
    Tomas Aznar, Concepcion
    Univ Zaragoza, Fac Hlth Sci, Dept Physiat & Nursing, E-50009 Zaragoza, Spain..
    Bagnol, Brigitte
    Univ Witwatersrand, Dept Anthropol, ZA-2050 Johannesburg, South Africa..
    Zambian Women in South Africa: Insights Into Health Experiences of Labia Elongation2015In: Journal of Sex Research, ISSN 0022-4499, E-ISSN 1559-8519, Vol. 52, no 8, p. 857-867Article in journal (Refereed)
    Abstract [en]

    Labia minora elongation consists in the manual stretching of the inner lips of the external genitalia. This practice is documented in east and southern Africa. The experiences of African women in the diaspora practicing elongation are not thoroughly understood. The purpose of this qualitative study was to explore the health harms and benefits associated with this practice of Zambian women who have migrated to Cape Town, South Africa. Twenty women and seventeen men participated in this study. Between December 2013 and May 2014, in-depth interviews and natural group discussions were conducted with the participants. The focus of this article is to report on the emic of the women related to notions of health, hygiene, and well-being. Labial elongation is perceived as a practice involving minor, short-term adverse effects that can be prevented by following some basic hygiene. Overall, personal and social value is placed on this practice because of its reported benefits for the sexual health of men and women, and for women's femininity and self-image. Further research is necessary on how female genital modifications influence Zambians' sexual preferences to inform the development of culturally appropriate health promotion interventions.

  • 2.
    Mubanga, Mwenya
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology.
    Dog Ownership and Cardiovascular Disease2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The relationship between pet ownership and human health has been studied extensively; however, the effect of dog ownership on human health has had conflicting results. The overall aim of this research project was to investigate the impact of dog ownership, and the death of the dog, on human cardiovascular health and all-cause mortality.

    Study I was a population-based study investigating the association between dog ownership with the risk of cardiovascular disease (CVD) and death. Of 3,432,153 individuals included, dog ownership (13.1%) was associated with a lower risk of CVD- and all-cause death by 23% and 20%, respectively. In single-person households, there was an inverse association between dog ownership and incident CVD, as well as a stronger inverse association with CVD-death and all-cause death.

    Study II was a population-based study investigating the association between dog ownership and initiation of treatment for cardiovascular risk factors in 2,026,865 adults. Dog ownership (14.6%) was associated with a slightly elevated risk of initiating treatment (2%) for hypertension and dyslipidaemia, but not for diabetes mellitus. However, some evidence for residual confounding was found.

    Study III investigated the risk of death after hospitalization for a first-ever acute myocardial infarction (n=181,696) or first-ever ischemic stroke (n=157,617) in two population-based cohorts. Dog ownership was associated with a 20% to 24% lower risk of all-cause mortality and CVD-death, respectively.

    In Study I-III, ownership of hunting breed dogs was associated with the lowest risk of the outcomes, while owning dogs of mixed pedigree was associated with worse cardiovascular health.

    Study IV found evidence of an increased risk of CVD after the loss of a life-insured pet (dog or cat; n=147,251) during the first week, 3-6 months after and 6-12 months after pet-loss.

    This thesis has used the Swedish population and health registers to investigate the relationship between various aspects of dog ownership and cardiovascular risk. By using defined, quantifiable end-points and robust statistical methods, this project has made an important contribution to the body of research underlying the positive relationship between dog ownership and cardiovascular health, paving the way for further research into causal mechanisms.

    List of papers
    1. Dog ownership and the risk of cardiovascular disease and death: a nationwide cohort study
    Open this publication in new window or tab >>Dog ownership and the risk of cardiovascular disease and death: a nationwide cohort study
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    2017 (English)In: Scientific Reports, E-ISSN 2045-2322, Vol. 7, no 1, article id 15821Article in journal (Refereed) Published
    Abstract [en]

    Dogs may be beneficial in reducing cardiovascular risk in their owners by providing social support and motivation for physical activity. We aimed to investigate the association of dog ownership with incident cardiovascular disease (CVD) and death in a register-based prospective nation-wide cohort (n = 3,432,153) with up to 12 years of follow-up. Self-reported health and lifestyle habits were available for 34,202 participants in the Swedish Twin Register. Time-to-event analyses with time-updated covariates were used to calculate hazard ratios (HR) with 95% confidence intervals (CI). In single- and multiple-person households, dog ownership (13.1%) was associated with lower risk of death, HR 0.67 (95% CI, 0.65-0.69) and 0.89 (0.87-0.91), respectively; and CVD death, HR 0.64 (0.59-0.70), and 0.85 (0.81-0.90), respectively. In single-person households, dog ownership was inversely associated with cardiovascular outcomes (HR composite CVD 0.92, 95% CI, 0.89-0.94). Ownership of hunting breed dogs was associated with lowest risk of CVD. Further analysis in the Twin Register could not replicate the reduced risk of CVD or death but also gave no indication of confounding by disability, comorbidities or lifestyle factors. In conclusion, dog ownership appears to be associated with lower risk of CVD in single-person households and lower mortality in the general population.

    National Category
    Public Health, Global Health, Social Medicine and Epidemiology Cardiac and Cardiovascular Systems
    Identifiers
    urn:nbn:se:uu:diva-334415 (URN)10.1038/s41598-017-16118-6 (DOI)000415658600066 ()29150678 (PubMedID)
    Funder
    Swedish Research Council Formas, 2013-1673
    Available from: 2017-11-23 Created: 2017-11-23 Last updated: 2022-09-15Bibliographically approved
    2. Dog ownership and Cardiovascular Risk Factors: a nationwide prospective register-based cohort study
    Open this publication in new window or tab >>Dog ownership and Cardiovascular Risk Factors: a nationwide prospective register-based cohort study
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    2019 (English)In: BMJ Open, E-ISSN 2044-6055, Vol. 9, article id 23447Article in journal (Refereed) Published
    Abstract [en]

    Objective To study the association between dog ownership and cardiovascular risk factors.

    Design A nationwide register–based cohort study and a cross-sectional study in a subset.

    Setting A cohort of 2 026 865 participants was identified from the Register of the Total Population and linked to national registers for information on dog ownership, prescribed medication, hospital admissions, education level, income and country of birth. Participants were followed from 1 October, 2006, to the end of the study on 31 December, 2012, assessing medication for a cardiovascular risk factor, emigration and death. Cross-sectional associations were further assessed in 10 110 individuals from the TwinGene study with additional adjustment for professional level, employment status, Charlson comorbidity index, disability and tobacco use.

    Participants All Swedish residents aged 45–80 years on 1 October, 2006.

    Main outcome measures Initiation of medication for hypertension, dyslipidaemia and diabetes mellitus.

    Results After adjustment for confounders, the results indicated slightly higher likelihood of initiating antihypertensive (HR, 1.02; 95% CI, 1.01 to 1.03) and lipid-lowering treatment (HR, 1.02; 95% CI, 1.01 to 1.04) in dog owners than in non-owners, particularly among those aged 45–60 years and in those owning mixed breed or companion/toy breed dogs. No association of dog ownership with initiation of treatment for diabetes was found in the overall analysis (HR, 0.98; 95% CI, 0.95 to 1.01). Sensitivity analyses in the TwinGene cohort indicated confounding of the association between dog ownership and prevalent treatment for hypertension, dyslipidaemia and diabetes mellitus, respectively, from factors not available in the national cohort, such as employment status and non cardiovascularchronic disease status.

    Conclusions In this large cohort study, dog ownership was associated with a minimally higher risk of initiation of treatment for hypertension and dyslipidaemia implying that the previously reported lower risk of cardiovascular mortality among dog owners in this cohort is not explained by reduced hypertension and dyslipidaemia. These observations may suffer from residual confounding despite access to multiple important covariates, and future studies may add valuable information.

    Keywords
    cardiovascular risk, hypertension, dog ownership, diabetes, registers
    National Category
    Cardiac and Cardiovascular Systems Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:uu:diva-357625 (URN)10.1136/bmjopen-2018-023447 (DOI)000471144900063 ()30850401 (PubMedID)
    Funder
    Swedish Research Council, 2017-00641Swedish Research Council Formas, 2013-1673Göran Gustafsson Foundation for Research in Natural Sciences and Medicine
    Available from: 2018-08-19 Created: 2018-08-19 Last updated: 2023-08-28Bibliographically approved
    3. Dog ownership and mortality after a major cardiovascular event – a register-based prospective study
    Open this publication in new window or tab >>Dog ownership and mortality after a major cardiovascular event – a register-based prospective study
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    (English)In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685Article in journal (Refereed) Submitted
    Keywords
    mortality, dog ownership, major cardiovascular event
    National Category
    Medical and Health Sciences
    Research subject
    Epidemiology
    Identifiers
    urn:nbn:se:uu:diva-357626 (URN)
    Available from: 2018-08-19 Created: 2018-08-19 Last updated: 2018-08-21
    4. The impact of death of a pet on major acute cardiovascular risk in the owner: a register-based cohort study
    Open this publication in new window or tab >>The impact of death of a pet on major acute cardiovascular risk in the owner: a register-based cohort study
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    (English)Manuscript (preprint) (Other academic)
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-357627 (URN)
    Available from: 2018-08-19 Created: 2018-08-19 Last updated: 2018-08-21
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  • 3.
    Mubanga, Mwenya
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology.
    Byberg, Liisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Egenvall, Agneta
    Department of Clinical Sciences, Division of Ruminant Medicine and Veterinary Epidemiology, Swedish University of Agricultural Sciences.
    Ingelsson, Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA..
    Fall, Tove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology.
    Dog ownership and mortality after a major cardiovascular event – a register-based prospective studyIn: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685Article in journal (Refereed)
  • 4.
    Mubanga, Mwenya
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Byberg, Liisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Egenvall, Agneta
    Swedish Univ Agr Sci, Div Ruminant Med & Vet Epidemiol, Dept Clin Sci, Uppsala, Sweden.
    Ingelsson, Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab. Stanford Univ, Sch Med, Div Cardiovasc Med, Dept Med, Stanford, CA 94305 USA;Stanford Univ, Stanford Cardiovasc Inst, Stanford, CA 94305 USA;Stanford Univ, Stanford Diabet Res Ctr, Stanford, CA 94305 USA.
    Fall, Tove
    Uppsala University, Science for Life Laboratory, SciLifeLab. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology.
    Dog Ownership and Survival After a Major Cardiovascular Event: A Register-Based Prospective Study2019In: Circulation. Cardiovascular Quality and Outcomes, ISSN 1941-7713, E-ISSN 1941-7705, Vol. 12, no 10, article id e005342Article in journal (Refereed)
    Abstract [en]

    Background: Dog ownership is associated with increased physical activity levels and increased social support, both of which could improve the outcome after a major cardiovascular event. Dog ownership may be particularly important in single-occupancy households where ownership provides substitutive companionship and motivation for physical activity.

    Methods and Results: We used the Swedish National Patient Register to identify all patients aged 40 to 85 presenting with an acute myocardial infarction (n=181 696; 5.7% dog ownership) or ischemic stroke (n=154 617; 4.8% dog ownership) between January 1, 2001 and December 31, 2012. Individual information was linked across registers for cause of death, sociodemographic, and dog ownership data. We evaluated all-cause mortality and risk of recurrent hospitalization for the same cause until December 31, 2012. Models were adjusted for socioeconomic, health, and demographic factors at study inclusion such as age, marital status, the presence of children in the home, area of residence, and income, as well as all registered comorbidities and hospitalization for cardiovascular disease in the past 5 years. Dog owners had a lower risk of death after hospitalization for acute myocardial infarction during the full follow-up period of 804 137 person-years, with an adjusted hazard ratio (HR) of 0.67 (95% CI, 0.61 to 0.75) for those who lived alone, and HR of 0.85 (95% CI, 0.80 to 0.90) for those living with a partner or a child. Similarly, after an ischemic stroke, dog owners were at lower risk of death during the full follow-up of 638 219 person-years adjusted HR of 0.73 (95% CI, 0.66 to 0.80) for those who lived alone and HR of 0.88 (95% CI, 0.83 to 0.93) for those living with a partner or a child. We further found an association of dog ownership with reduced risk of hospitalization for recurrent myocardial infarction (HR, 0.93; 95% CI, 0.87 to 0.99).

    Conclusions: We found evidence of an association of dog ownership with a better outcome after a major cardiovascular event. Although our models are adjusted for many potential confounders, there are also unmeasured confounders such as smoking that prevent us from drawing conclusions regarding a possible causal effect.

  • 5.
    Mubanga, Mwenya
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Byberg, Liisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Egenvall, Agneta
    Department of Clinical Sciences, Division of Ruminant Medicine and Veterinary Epidemiology, Swedish University of Agricultural Sciences.
    Sundström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Epidemiology.
    Magnusson, Patrik K
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm.
    Ingelsson, Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab. Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA..
    Fall, Tove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Dog ownership and Cardiovascular Risk Factors: a nationwide prospective register-based cohort study2019In: BMJ Open, E-ISSN 2044-6055, Vol. 9, article id 23447Article in journal (Refereed)
    Abstract [en]

    Objective To study the association between dog ownership and cardiovascular risk factors.

    Design A nationwide register–based cohort study and a cross-sectional study in a subset.

    Setting A cohort of 2 026 865 participants was identified from the Register of the Total Population and linked to national registers for information on dog ownership, prescribed medication, hospital admissions, education level, income and country of birth. Participants were followed from 1 October, 2006, to the end of the study on 31 December, 2012, assessing medication for a cardiovascular risk factor, emigration and death. Cross-sectional associations were further assessed in 10 110 individuals from the TwinGene study with additional adjustment for professional level, employment status, Charlson comorbidity index, disability and tobacco use.

    Participants All Swedish residents aged 45–80 years on 1 October, 2006.

    Main outcome measures Initiation of medication for hypertension, dyslipidaemia and diabetes mellitus.

    Results After adjustment for confounders, the results indicated slightly higher likelihood of initiating antihypertensive (HR, 1.02; 95% CI, 1.01 to 1.03) and lipid-lowering treatment (HR, 1.02; 95% CI, 1.01 to 1.04) in dog owners than in non-owners, particularly among those aged 45–60 years and in those owning mixed breed or companion/toy breed dogs. No association of dog ownership with initiation of treatment for diabetes was found in the overall analysis (HR, 0.98; 95% CI, 0.95 to 1.01). Sensitivity analyses in the TwinGene cohort indicated confounding of the association between dog ownership and prevalent treatment for hypertension, dyslipidaemia and diabetes mellitus, respectively, from factors not available in the national cohort, such as employment status and non cardiovascularchronic disease status.

    Conclusions In this large cohort study, dog ownership was associated with a minimally higher risk of initiation of treatment for hypertension and dyslipidaemia implying that the previously reported lower risk of cardiovascular mortality among dog owners in this cohort is not explained by reduced hypertension and dyslipidaemia. These observations may suffer from residual confounding despite access to multiple important covariates, and future studies may add valuable information.

    Download full text (pdf)
    fulltext
  • 6.
    Mubanga, Mwenya
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Byberg, Liisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Nowak, Christoph
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab. Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
    Egenvall, Agneta
    Department of Clinical Sciences, Division of Ruminant Medicine and Veterinary Epidemiology, Swedish University of Agricultural Sciences, Uppsala, Sweden.
    Magnusson, Patrik K
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Ingelsson, Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab. Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA.
    Fall, Tove
    Uppsala University, Science for Life Laboratory, SciLifeLab. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology.
    Dog ownership and the risk of cardiovascular disease and death: a nationwide cohort study2017In: Scientific Reports, E-ISSN 2045-2322, Vol. 7, no 1, article id 15821Article in journal (Refereed)
    Abstract [en]

    Dogs may be beneficial in reducing cardiovascular risk in their owners by providing social support and motivation for physical activity. We aimed to investigate the association of dog ownership with incident cardiovascular disease (CVD) and death in a register-based prospective nation-wide cohort (n = 3,432,153) with up to 12 years of follow-up. Self-reported health and lifestyle habits were available for 34,202 participants in the Swedish Twin Register. Time-to-event analyses with time-updated covariates were used to calculate hazard ratios (HR) with 95% confidence intervals (CI). In single- and multiple-person households, dog ownership (13.1%) was associated with lower risk of death, HR 0.67 (95% CI, 0.65-0.69) and 0.89 (0.87-0.91), respectively; and CVD death, HR 0.64 (0.59-0.70), and 0.85 (0.81-0.90), respectively. In single-person households, dog ownership was inversely associated with cardiovascular outcomes (HR composite CVD 0.92, 95% CI, 0.89-0.94). Ownership of hunting breed dogs was associated with lowest risk of CVD. Further analysis in the Twin Register could not replicate the reduced risk of CVD or death but also gave no indication of confounding by disability, comorbidities or lifestyle factors. In conclusion, dog ownership appears to be associated with lower risk of CVD in single-person households and lower mortality in the general population.

    Download full text (pdf)
    fulltext
  • 7.
    Mubanga, Mwenya
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology.
    Mariosa, Daniela
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology.
    Egenvall, Agneta
    Department of Clinical Sciences, Division of Ruminant Medicine and Veterinary Epidemiology, Swedish University of Agricultural Sciences.
    Ingelsson, Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA..
    Fang, Fang
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm. Sweden..
    Byberg, Liisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Fall, Tove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology.
    The impact of death of a pet on major acute cardiovascular risk in the owner: a register-based cohort studyManuscript (preprint) (Other academic)
  • 8.
    Perez, Guillermo Martinez
    et al.
    Univ Zaragoza, Fac Hlth Sci, Zaragoza, Spain..
    Mubanga, Mwenya
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Aznar, Concepcion Tomas
    Univ Zaragoza, Fac Hlth Sci, Zaragoza, Spain..
    Bagnol, Brigitte
    Univ Witwatersrand, Dept Anthropol, Johannesburg, South Africa..
    Grounded Theory: A Methodology Choice to Investigating Labia Minora Elongation Among Zambians in South Africa2015In: International Journal of Qualitative Methods, E-ISSN 1609-4069, Vol. 14, no 4Article in journal (Refereed)
    Abstract [en]

    A study on how Zambian migrants living in Cape Town perceive and experience the implications of labial elongation on women's health was conducted. Labia minora elongation (LME) is a genital modification that some women in east and southern Africa practice. This tradition is not common in Western Cape province (southwestern part of South Africa). The aim of this article is to discuss the methodological choices made in the design and conduct of this study, in which a White European male interviewed the female study participants on the health implications of a practice that is considered a woman's private issue. Constructivist grounded theory informed by a feminist perspective was chosen as the most suitable methodological approach to enable cogeneration of knowledge with the female participants. The methods and tools used by the lead investigator facilitated access to the participants' emic views. Grounded theory methodology holds the potential to be an appropriate methodological approach for researchers who seek to erode the power imbalances influencing research processes that aim to explore the associated meanings and health implications of female genital modifications, such as LME, as narrated by the women who practice them.

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  • 9.
    Yi-Ting, Lin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Kaohsiung Med Univ, Coll Med, Grad Inst Clin Med, Kaohsiung, Taiwan;Kaohsiung Med Univ, Coll Med, Fac Med, Kaohsiung, Taiwan;Kaohsiung Med Univ Hosp, Dept Family Med, Kaohsiung, Taiwan.
    Wu, Ping-Hsun
    Kaohsiung Med Univ, Coll Med, Grad Inst Clin Med, Kaohsiung, Taiwan;Kaohsiung Med Univ, Coll Med, Fac Med, Kaohsiung, Taiwan;Kaohsiung Med Univ Hosp, Dept Internal Med, Div Nephrol, 100 Shih Chuan 1st Rd, Kaohsiung 807, Taiwan.
    Lee, Hei-Hwa
    Kaohsiung Med Univ Hosp, Dept Lab Med, Kaohsiung, Taiwan.
    Mubanga, Mwenya
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology.
    Chen, Cheng-Sheng
    Kaohsiung Med Univ, Coll Med, Dept Psychiat, Kaohsiung, Taiwan;Kaohsiung Med Univ, Kaohsiung Med Univ Hosp, Dept Psychiat, Kaohsiung, Taiwan.
    Kuo, Mei-Chuan
    Kaohsiung Med Univ, Coll Med, Fac Renal Care, Kaohsiung, Taiwan;Kaohsiung Med Univ Hosp, Dept Internal Med, Div Nephrol, 100 Shih Chuan 1st Rd, Kaohsiung 807, Taiwan.
    Chiu, Yi-Wen
    Kaohsiung Med Univ, Coll Med, Fac Renal Care, Kaohsiung, Taiwan;Kaohsiung Med Univ Hosp, Dept Internal Med, Div Nephrol, 100 Shih Chuan 1st Rd, Kaohsiung 807, Taiwan.
    Kuo, Po-Lin
    Kaohsiung Med Univ, Coll Med, Grad Inst Clin Med, Kaohsiung, Taiwan.
    Hwang, Shang-Jyh
    Kaohsiung Med Univ, Coll Med, Fac Med, Kaohsiung, Taiwan;Kaohsiung Med Univ Hosp, Dept Internal Med, Div Nephrol, 100 Shih Chuan 1st Rd, Kaohsiung 807, Taiwan;Natl Hlth Res Inst, Inst Populat Sci, Miaoli, Taiwan.
    Indole-3 acetic acid increased risk of impaired cognitive function in patients receiving hemodialysis2019In: Neurotoxicology, ISSN 0161-813X, E-ISSN 1872-9711, Vol. 73, p. 85-91Article in journal (Refereed)
    Abstract [en]

    Patients receiving hemodialysis (HD) have a higher risk of cognitive impairment and dementia than the general population. The accumulation of uremic toxins in the brain causes uremic encephalopathy, however, limited data exists to elucidate the effect of protein-bound uremic toxins on cognitive function. Here we investigate the effect of indole-3 acetic acid (IAA) and hippuric acid (HA), two different protein-bound uremic toxins from amino acid derivatives, on cognitive function by Silico and in a clinical study. Prevalent HD patients were enrolled in two independent hospitals. Serum IAA and HA were measured using mass spectrometry. Cognitive performance was measured using Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Cognitive Abilities Screening Instrument (CASI) by trained psychologists. Using silico data to predict the effect of blood-brain barrier penetration was performed. The silico data demonstrated that IAA and HA had positive blood-brain barrier penetration ability. Amongst the 230 HD patients, serum IAA was associated with poor MMSE score (beta = -0.90, 95% CI -1.61 to -0.19) and poor CASI score (beta = -3.29, 95% CI -5.69 to -0.88) in stepwise multiple linear regression analysis. In logistic regression model, Serum IAA was also associated with cognitive impairment based on MMSE definition (OR, 1.96, 95% CI 1.10, 3.5) and CASI definition (OR, 2.09, 95% CI 1.21, 3.61). There was no correlation between Serum HA levels and cognitive function status. In conclusion, IAA, not HA, was associated with cognitive impairment in HD patients. Further large scale and prospective studies are needed to confirm our findings.

  • 10.
    Yi-Ting, Lin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Kaohsiung Med Univ, Coll Med, Grad Inst Clin Med, Kaohsiung, Taiwan;Kaohsiung Med Univ, Coll Med, Fac Med, Kaohsiung, Taiwan;Kaohsiung Med Univ Hosp, Dept Family Med, Kaohsiung, Taiwan.
    Wu, Ping-Hsun
    Kaohsiung Med Univ, Coll Med, Grad Inst Clin Med, Kaohsiung, Taiwan;Kaohsiung Med Univ, Coll Med, Fac Med, Kaohsiung, Taiwan;Kaohsiung Med Univ Hosp, Dept Internal Med, Div Nephrol, Kaohsiung, Taiwan.
    Liang, Shih-Shin
    Kaohsiung Med Univ, Coll Life Sci, Dept Biotechnol, Kaohsiung, Taiwan.
    Mubanga, Mwenya
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology.
    Yang, Yuan-Han
    Kaohsiung Med Univ, Kaohsiung Municipal Ta Tung Hosp, Dept Neurol, Kaohsiung, Taiwan.
    Hsu, Ya-Ling
    Kaohsiung Med Univ, Coll Med, Grad Inst Med, Kaohsiung, Taiwan.
    Kuo, Mei-Chuan
    Kaohsiung Med Univ, Coll Med, Fac Med, Kaohsiung, Taiwan;Kaohsiung Med Univ Hosp, Dept Internal Med, Div Nephrol, Kaohsiung, Taiwan.
    Hwang, Shang-Jyh
    Kaohsiung Med Univ, Coll Med, Fac Med, Kaohsiung, Taiwan;Kaohsiung Med Univ Hosp, Dept Internal Med, Div Nephrol, Kaohsiung, Taiwan;Natl Hlth Res Inst, Inst Populat Sci, Miaoli, Taiwan.
    Kuo, Po-Lin
    Kaohsiung Med Univ, Coll Med, Grad Inst Clin Med, Kaohsiung, Taiwan.
    Protein-bound uremic toxins are associated with cognitive function among patients undergoing maintenance hemodialysis2019In: Scientific Reports, E-ISSN 2045-2322, Vol. 9, article id 20388Article in journal (Refereed)
    Abstract [en]

    Patients with chronic kidney disease have a greater risk of cognitive impairment. Cerebral uremic solute accumulation causes uremic encephalopathy; however, the association of protein-bound uremic toxins on cognitive function remains unclear. The present study aimed to investigate the association of two protein-bound uremic toxins, namely indoxyl sulfate (IS) and p-cresyl sulfate (PCS), on cognitive function in patients receiving hemodialysis (HD) for at least 90 days. Circulating free form IS and PCS were quantified by liquid chromatography/mass spectrometry. Mini-Mental State Examination (MMSE) and Cognitive Abilities Screening Instrument (CASI) were used to evaluate cognitive function. In total, 260 HD patients were recruited with a mean age of 58.1 +/- 11.3 years, of which, 53.8% were men, 40% had diabetes, and 75.4% had hypertension. The analysis revealed that both free IS and free PCS were negatively associated with the CASI score and MMSE. After controlling for confounders, circulating free IS levels persisted to be negatively associated with MMSE scores [beta = -0.62, 95% confidence interval (CI): -1.16 to -0.08] and CASI scores (beta = -1.97, 95% CI: -3.78 to -0.16), mainly in the CASI domains of long-term memory, mental manipulation, language ability, and spatial construction. However, there was no correlation between free PCS and total MMSE or total CASI scores after controlling for confounders. In conclusion, circulating free form IS, but not PCS is associated with lower cognitive function test scores in HD patients. Thus, a further study is needed to evaluate whether a decrease in free IS levels can slow down cognitive decline in HD patients.

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