BACKGROUND & AIMS: :The HET-MN assay (hen's egg test for micronucleus induction) is different from other in vitro genotoxicity assays in that it includes toxicologically important features such as absorption, distribution, metabolic activation, and excretion of the test compound. As a promising follow-up to complement existing in vitro test batteries for genotoxicity, the HET-MN is currently undergoing a formal validation. To optimize the validation, the present study describes a critical analysis of previously obtained HET-MN data to check the experimental design and to identify the most appropriate statistical procedure to evaluate treatment effects. Six statistical challenges (I-VI) of general relevance were identified, and remedies were provided which can be transferred to similarly designed test methods: a Williams-type trend test is proposed for overdispersed counts (II) by means of a square-root transformation which is robust for small sample sizes (I), variance heterogeneity (III), and possible downturn effects at high doses (IV). Due to near-to-zero or even zero-count data occurring in the negative control (V), a conditional comparison of the treatment groups against the mean of the historical controls (VI) instead of the concurrent control was proposed, which is in accordance with US-FDA recommendations. For the modified Williams-type tests, the power can be estimated depending on the magnitude and shape of the trend, the number of dose groups, and the magnitude of the MN counts in the negative control. The experimental design used previously (i.e. six eggs per dose group, scoring of 1000 cells per egg) was confirmed. The proposed approaches are easily available in the statistical computing environment R, and the corresponding R-codes are provided.

背景与目标： : HET-MN测定 (用于微核诱导的鸡蛋测试) 与其他体外遗传毒性测定的不同之处在于，它包括毒理学上重要的特征，例如吸收，分布，代谢活化和测试化合物的排泄。作为补充现有的体外遗传毒性测试电池的有希望的后续行动，HET-MN目前正在进行正式验证。为了优化验证，本研究描述了对先前获得的het-mn数据的严格分析，以检查实验设计并确定最合适的统计程序来评估治疗效果。确定了六个具有一般相关性的统计挑战 (i-vi)，并提供了可以转移到类似设计的测试方法的补救措施: 通过平方根变换，针对过度分散的计数 (II) 提出了威廉姆斯型趋势检验，该方法对于小样本量 (I)，方差异质性 (III) 以及高剂量下可能的下降效应 (IV) 具有鲁棒性。由于阴性对照 (V) 中出现接近零甚至零计数的数据，因此提出了治疗组与历史对照 (VI) 的平均值的条件比较，而不是并发对照，这是根据US-FDA的建议。对于改良的Williams型测试，可以根据趋势的大小和形状，剂量组的数量以及阴性对照中MN计数的大小来估计功率。确认了先前使用的实验设计 (即每个剂量组六个卵，每个卵1000个细胞的评分)。所提出的方法在统计计算环境R中很容易获得，并提供了相应的R代码。

BACKGROUND & AIMS: BACKGROUND:This study examined the criterion validity of the online Active Australia Survey, using accelerometry as the criterion, and whether self-report bias was related to level of activity, age, sex, education, body mass index and health-related quality of life. METHODS:The online Active Australia Survey was validated against the GENEActiv accelerometer as a direct measure of activity. Participants (n = 344) wore an accelerometer for 7 days, completed the Active Australia Survey, and reported their health and demographic characteristics. A Spearman's rank coefficient examined the association between minutes of moderate-to-vigorous physical activity recorded on the Active Australia Survey and GENEActiv accelerometer. A Bland-Altman plot illustrated self-report bias (the difference between methods). Linear mixed effects modelling was used to examine whether participant factors predicted self-report bias. RESULTS:The association between moderate-to-vigorous physical activity reported on the online Active Australia Survey and accelerometer was significant (rs = .27, p < .001). Participants reported 4 fewer minutes per day on the Active Australia Survey than was recorded by accelerometry (95% limits of agreement -104 - 96 min) but the difference was not significant (t(343) = -1.40, p = .16). Self-report bias was negatively associated with minutes of accelerometer-recorded moderate-to-vigorous physical activity and positively associated with mental health-related quality of life. CONCLUSIONS:The online Active Australia Survey showed limited criterion validity against accelerometry. Self-report bias was related to activity level and mental health-related quality of life. Caution is recommended when interpreting studies using the online Active Australia Survey.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:In self-controlled case series (SCCS), the event should not condition the probability of subsequent exposure. If this assumption is not met, an important bias could take place. The association of hip/femur fracture (HFF) and use of benzodiazepines (BDZ) has a bidirectional causal relationship and can serve as case study to investigate the impact of this methodological issue. OBJECTIVES:To assess the magnitude of bias introduced in a SCCS when HFF conditions the posterior exposure to BDZ and explore ways to correct it. METHODS:Four thousand four hundred fifty cases of HFF who had at least one BZD prescription were selected from the primary care health record database BIFAP. Exposure to BZD was divided into non-use, current, recent, and past use. Conditional Poisson regression was used to estimate incidence rate ratios (IRRs) of HFF among current vs non-use/past, adjusted for age. To investigate possible event-exposure dependence, a pre-exposure time of different lengths (15, 30, and 60 days) was excluded from the reference category to evaluate the IRR. RESULTS:IRR of HHF for current use was 0.79 (0.72-0.86); removing 30 days, IRR was 1.43 (1.31-1.57). Removing 15 days, IRR was 1.29 (1.18-1.41), and removing 60 days, IRR was 1.56 (1.42-1.72). A pre-exposure period up to 182 days was necessary to remove such effect giving an IRR of 1.64 (1.48-1.81). CONCLUSIONS:HFF remarkably conditioned the use of BDZs resulting in seriously biased IRRs when this association was studied through a SCCS design. The use of pre-exposure periods of different lengths helped to correct this error.

背景与目标：

BACKGROUND & AIMS: :To reduce PCR bias derived from a primer mismatch, the effect of the annealing temperature on the product ratio was investigated by denaturing gradient gel electrophoresis analysis of PCR products from a mixture of perfect-match and one-mismatch templates. These templates were generated by PCR from Pediococcus acidilactici for one mismatch and Micrococcus luteus for the perfect match. PCRs showed that the bias was reduced at lower temperatures. An environmental sample was also examined.

背景与目标： : 为了减少源自引物错配的PCR偏差，通过对来自完全匹配和一错配模板的混合物的PCR产物进行变性梯度凝胶电泳分析，研究了退火温度对产物比例的影响。这些模板是通过PCR从酸性小球菌中产生的，以进行一次错配，而黄体微球菌则是完美匹配。PCRs显示，在较低的温度下，偏压降低了。还检查了环境样品。

BACKGROUND & AIMS: :In comparative clinical studies, a common goal is to assess whether an exposure, or intervention, affects the outcome of interest. However, just as important is to understand the mechanism(s) for how the intervention affects outcome. For example, if preoperative anemia was shown to increase the risk of postoperative complications by 15%, it would be important to quantify how much of that effect was due to patients receiving intraoperative transfusions. Mediation analysis attempts to quantify how much, if any, of the effect of an intervention on outcome goes though prespecified mediator, or "mechanism" variable(s), that is, variables sitting on the causal pathway between exposure and outcome. Effects of an exposure on outcome can thus be divided into direct and indirect, or mediated, effects. Mediation is claimed when 2 conditions are true: the exposure affects the mediator and the mediator (adjusting for the exposure) affects the outcome. Understanding how an intervention affects outcome can validate or invalidate one's original hypothesis and also facilitate further research to modify the responsible factors, and thus improve patient outcome. We discuss the proper design and analysis of studies investigating mediation, including the importance of distinguishing mediator variables from confounding variables, the challenge of identifying potential mediators when the exposure is chronic versus acute, and the requirements for claiming mediation. Simple designs are considered, as well as those containing multiple mediators, multiple outcomes, and mixed data types. Methods are illustrated with data collected by the National Surgical Quality Improvement Project (NSQIP) and utilized in a companion paper which assessed the effects of preoperative anemic status on postoperative outcomes.

背景与目标： : 在比较临床研究中，一个共同的目标是评估暴露或干预是否会影响感兴趣的结果。但是，同样重要的是要了解干预如何影响结果的机制。例如，如果术前贫血显示15% 增加术后并发症的风险，那么重要的是量化患者接受术中输血的影响程度。中介分析试图量化干预对结果的影响 (如果有的话) 通过预先指定的中介或 “机制” 变量 (即位于暴露与结果之间的因果途径上的变量) 进行多少。因此，暴露对结果的影响可以分为直接和间接或介导的影响。当两个条件为真时，要求调解: 暴露影响调解人，调解人 (针对暴露进行调整) 影响结果。了解干预如何影响结果可以验证或使一个人的原始假设无效，还可以促进进一步的研究以修改负责因素，从而改善患者的结果。我们讨论了调查中介的研究的正确设计和分析，包括区分中介变量和混杂变量的重要性，在暴露是慢性还是急性时识别潜在中介的挑战以及要求调解的要求。考虑了简单的设计，以及包含多个介体，多个结果和混合数据类型的设计。方法用国家外科质量改进项目 (NSQIP) 收集的数据进行说明，并在一篇同伴论文中使用，该论文评估了术前贫血状态对术后结果的影响。

BACKGROUND & AIMS: :Previous investigators have suggested that screening-related biases may explain associations between postmenopausal hormone use and breast cancer. To investigate these biases, we studied postmenopausal women in the Nurses' Health Study from 1988 to 1994. Hormone use is associated with increased subsequent screening. Among women not screened in the previous 2 years, the probability difference, comparing current hormone users with others, for having mammography in the following 2 years is 19.5%; among women previously screened, the difference is 4.9%. These differences persist after control for other factors. If the increase in screening is causal, screening by mammogram could be intermediate in the causal pathway to breast cancer diagnosis. To deal with this problem, we restrict attention to a subset of the cohort in which the effect of postmenopausal hormone use on screening is small (women previously screened). In this subset, the rate ratio comparing breast cancer rates among current postmenopausal hormone users with others is 1.28. In a sensitivity analysis, the bias could not by itself plausibly account for the associations in our data. Our data provide evidence of an association between postmenopausal hormone use and breast cancer that is not solely the product of a detection bias.

背景与目标： : 先前的研究人员认为，与筛查相关的偏见可能解释了绝经后激素使用与乳腺癌之间的关联。为了调查这些偏见，我们在护士健康研究1988年1994年中研究了绝经后妇女。激素的使用与后续筛查的增加有关。在过去2年中未进行筛查的女性中，将当前的激素使用者与其他人进行比较，在接下来的2年中进行乳房x线检查的概率差异为19.5%; 在先前筛查的女性中，差异为4.9%。在控制了其他因素之后，这些差异仍然存在。如果筛查的增加是有原因的，则通过乳房x线照片进行筛查可能是乳腺癌诊断的因果途径的中间环节。为了解决这个问题，我们将注意力集中在绝经后激素使用对筛查的影响很小的队列中的一个子集 (以前筛查过的女性)。在这个子集中，比较当前绝经后激素使用者与其他人的乳腺癌发病率的比率是1.28的。在敏感性分析中，偏差本身无法合理地解释我们数据中的关联。我们的数据提供了绝经后激素使用与乳腺癌之间关联的证据，而这不仅是检测偏倚的产物。

BACKGROUND & AIMS: :Several biological systems such as the biomechanics of human heart, locomotion, and phyllotaxis of plants present a harmonic behavior because their fractal structure are associated to the golden ratio. The golden ratio (Φ = 1.618033988749…), also known as Phi, golden mean, golden section or divine proportion, is an irrational constant found in various forms in nature and recently has been used in many health areas. However, there is no literature on a specific statistical test to identify the golden ratio structures. To validate the results from each survey, it is necessary that statistical techniques be correctly selected and implemented, and the absence of a test to identify the golden ratio may undermines the scientific papers which have this goal. Since the golden number is a ratio, some tests have been wrongly applied in its identification. The objective of this paper is to present and to evaluate methods for identification of golden ratio. Four tests were evaluated: t-Student with ratio statistic (TR), with delta statistic (TΔ), with difference statistic (TED), and Wilcoxon test with statistic difference (WD). Data simulating different samples sizes (n = 2-200) and variability scenarios were used. The tests were assessed regarding type I error rate and power. For TΔ, type I error rate increased along with sample size and variability, achieving 50% in the scenario of relative standard deviation of 12.5% and 20.0% for line segments of lengths a and b, and sample size equal 200. This test also showed lower power when compared to the others in all scenarios. Similarly, for TR, the type I error rate was sensitive to the increasing in sample size, varying from 5 to 60%. On the other hand, WD and TED were associated to low type I error rates (around 5%) and high power (6.1% for sample size equal 2-100% for sample size equal 200). The TΔ and TR were inadequate to identify the golden ratio, since they did not controlled the type I error rate and/or presented low power, leading to possible erroneous conclusions. Therefore WD and TED, both with statistical of difference, appeared as the most appropriate methods to test golden ratio structures.

背景与目标： : 几种生物系统，例如人类心脏的生物力学，植物的运动和叶序形成了调和行为，因为它们的分形结构与黄金比例有关。黄金比例 (Φ   =   1.618033988749…)，也称为Phi，黄金中庸，黄金分割或神圣比例，是自然界中各种形式的非理性常数，最近已在许多健康领域使用。然而，没有关于确定黄金比例结构的特定统计检验的文献。为了验证每次调查的结果，有必要正确选择和实施统计技术，而缺乏确定黄金比例的测试可能会破坏具有此目标的科学论文。由于黄金数字是一个比率，因此在识别时错误地应用了一些测试。本文的目的是介绍和评估黄金分割率的识别方法。评估了四个测试: 具有比率统计 (TR) 的t学生，具有增量统计 (t Δ)，具有差异统计 (TED) 和具有统计差异 (WD) 的Wilcoxon检验。使用了模拟不同样本大小 (n   =   2-200) 和可变性场景的数据。对测试进行了I型错误率和功率评估。对于t Δ，I型错误率随着样本大小和变异性而增加，在长度为a和b的线段的12.5% 和20.0% 的相对标准偏差的情况下实现了50%，并且样本大小200相等。与所有情况下的其他测试相比，该测试还显示出较低的功率。同样，对于TR，I型错误率对样本量的增加敏感，从5到60% 不等。另一方面，WD和TED与低I型错误率 (约5%) 和高功率 (样本大小等于2-100%，样本大小等于200的6.1%) 相关。T Δ 和TR不足以识别黄金比例，因为它们没有控制I型错误率和/或呈现低功率，从而导致可能的错误结论。因此，WD和TED都具有统计学差异，是测试黄金比例结构的最合适方法。

BACKGROUND & AIMS: BACKGROUND:The identification of cell-free fetal DNA (cffDNA) facilitated non-invasive prenatal screening (NIPS) through analysis of cffDNA in maternal plasma. However, challenges regarding its clinical implementation become apparent. Factors affecting fetal fraction should be clarified to guide its clinical application. RESULTS:A total of 13,661 pregnant subjects with singleton pregnancies who undertook NIPS were included in the study. Relationship of gestational age, maternal BMI, and maternal age with the cffDNA fetal fraction in maternal plasmas for NIPS was investigated. Compared with 13 weeks (12.74%) and 14-18 weeks group (12.73%), the fetal fraction in gestational ages of 19-23 weeks, 24-28 weeks, and more than 29 weeks groups significantly increased to 13.11%, 16.14%, and 21.17%, respectively (P < 0.01). Compared with fetal fraction of 14.54% in the maternal BMI group of < 18.5 kg/m2, the percentage of fetal fraction in the group of 18.5-24.9 kg/m2 (13.37%), 25-29.9 kg/m2 (12.20%), 30-34.9 kg/m2 (11.32%), and 35-39.9 kg/m2 (11.57%) decreased significantly (P < 0.01). Compared with the fetal fraction of 14.38% in the group of 18-24 years old, the fetal fraction in the maternal age group of 25-29 years old group (13.98%) (P < 0.05), 30-34 years old group (13.18%) (P < 0.01), 35-39 years old group (12.34%) (P < 0.01), and ≥ 40 years old (11.90%) group (P < 0.01) decreased significantly. CONCLUSIONS:The percentage of fetal fraction significantly increased with increase of gestational age. Decreased fetal fraction with increasing maternal BMI was found. Maternal age was also negatively related to the fetal fraction.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:The analysis of DNA methylation is a key component in the development of personalized treatment approaches. A common way to measure DNA methylation is the calculation of beta values, which are bounded variables of the form M/(M+U) that are generated by Illumina's 450k BeadChip array. The statistical analysis of beta values is considered to be challenging, as traditional methods for the analysis of bounded variables, such as M-value regression and beta regression, are based on regularity assumptions that are often too strong to adequately describe the distribution of beta values. RESULTS:We develop a statistical model for the analysis of beta values that is derived from a bivariate gamma distribution for the signal intensities M and U. By allowing for possible correlations between M and U, the proposed model explicitly takes into account the data-generating process underlying the calculation of beta values. Using simulated data and a real sample of DNA methylation data from the Heinz Nixdorf Recall cohort study, we demonstrate that the proposed model fits our data significantly better than beta regression and M-value regression. CONCLUSION:The proposed model contributes to an improved identification of associations between beta values and covariates such as clinical variables and lifestyle factors in epigenome-wide association studies. It is as easy to apply to a sample of beta values as beta regression and M-value regression.

背景与目标：

BACKGROUND & AIMS: OBJECTIVES:A number of observational studies have reported that, in patients with chronic obstructive pulmonary disease (COPD), β blockers (BBs) decrease risk of mortality and COPD exacerbations. To address important methodological concerns of these studies, we compared the effectiveness and safety of cardioselective BBs versus non-dihydropyridine calcium channel blockers (non-DHP CCBs) in patients with COPD and acute coronary syndromes (ACS) using a propensity score (PS)-matched, active comparator, new user design. We also assessed for potential unmeasured confounding by examining a short-term COPD hospitalisation outcome. SETTING AND PARTICIPANTS:We identified 22 985 patients with COPD and ACS starting cardioselective BBs or non-DHP CCBs across 5 claims databases from the USA, Italy and Taiwan. PRIMARY AND SECONDARY OUTCOME MEASURES:Stratified Cox regression models were used to estimate HRs for mortality, cardiovascular (CV) hospitalisations and COPD hospitalisations in each database after variable-ratio PS matching. Results were combined with random-effects meta-analyses. RESULTS:Cardioselective BBs were not associated with reduced risk of mortality (HR, 0.90; 95% CI 0.78 to 1.02) or CV hospitalisations (HR, 1.06; 95% CI 0.91 to 1.23), although statistical heterogeneity was observed across databases. In contrast, a consistent, inverse association for COPD hospitalisations was identified across databases (HR, 0.54; 95% CI 0.47 to 0.61), which persisted even within the first 30 days of follow-up (HR, 0.55; 95% CI 0.37 to 0.82). Results were similar across a variety of sensitivity analyses, including PS trimming, high dimensional-PS matching and restricting to high-risk patients. CONCLUSIONS:This multinational study found a large inverse association between cardioselective BBs and short-term COPD hospitalisations. The persistence of this bias despite state-of-the-art pharmacoepidemiologic methods calls into question the ability of claims data to address confounding in studies of BBs in patients with COPD.

背景与目标：

BACKGROUND & AIMS: OBJECTIVE:To compare the characteristics and survival of participants and nonparticipants in a community-based study of myocardial infarction (MI). PARTICIPANTS AND METHODS:Residents of Olmsted County, MN, who presented with elevated cardiac troponin T levels from September 1, 2002, through December 31, 2005, were prospectively enrolled and classified with standardized criteria for MI. With specific Institutional Review Board approval, the medical records of patients with MI who did not provide consent but who had given general research authorization were reviewed, as was done for their consenting peers. RESULTS:During the study period, 2277 individuals with elevated cardiac troponin T levels were approached, of whom 1863 (82 percent) consented to participate. Among the 414 nonparticipants, 375 (91 percent) had general research authorization. Of the 558 with general research authorization who met the criteria for incident (ie, first-ever) MI, 67 (12 percent) refused to participate. These participants tended to be older (mean plus or minus SD age, 71 plus or minus 14 vs 67 plus or minus 15 years; P equals .04), were more likely to be of races other than white (9 percent vs 2 percent; P equals .01), and had more comorbidities, including peripheral vascular disease (P equals .02), chronic pulmonary disease (P equals .06), heart failure (P equals .07), and impaired creatinine clearance (P equals .02). No significant differences were detected in cardiovascular risk factors or MI characteristics. During a median follow-up of 517 days, nonparticipants experienced increased mortality rates compared with participants (hazard ratio, 1.97; 95 percent confidence interval, 1.21 to 3.20), which was largely attributable to their older age and excess comorbidities (adjusted hazard ratio, 1.43; 95 percent confidence interval, 0.86 to 2.35). CONCLUSION:In this community-based study of MI, nonparticipants experienced worse survival rates than participants largely because of differences in demographic and clinical characteristics. These differences should be kept in mind when interpreting study results, particularly if participation is low.

背景与目标：

BACKGROUND & AIMS: :A systematic review of PDE-5 inhibitors for erectile dysfunction was performed to evaluate the utility of quantitative methods for identifying and exploring the influence of bias and study quality on pooled outcomes from meta-analyses. We included 123 randomized controlled trials (RCTs). Methodological quality was poorly reported. All three drugs appeared highly effective. Indirect adjusted analyses showed no differences between the three drugs. Funnel plots and statistical tests showed no evidence of small-study effects for sildenafil whereas there was evidence of such bias for tadalafil and vardenafil. Adjustment for missing studies using trim and fill techniques did not alter the pooled estimates substantially. The exclusion of previous sildenafil nonresponders was associated with larger treatment effects for tadalafil. This investigation was hampered by poor reporting of methodological quality, a low number of studies, heterogeneity and large effect sizes. Despite such limitations, a comprehensive assessment of biases should be a routine in systematic reviews.

背景与目标： : 对勃起功能障碍的PDE-5抑制剂进行了系统评价，以评估定量方法在鉴定和探索偏倚和研究质量对荟萃分析汇总结果的影响方面的实用性。我们纳入了123随机对照试验 (RCTs)。方法学质量报道不佳。这三种药物都非常有效。间接校正分析显示三种药物之间没有差异。漏斗图和统计测试没有证据表明西地那非的小研究效果，而有证据表明他达拉非和伐地那非存在这种偏倚。使用trim和fill技术对缺失研究进行的调整不会显着改变汇总的估计值。排除先前的西地那非无反应者与他达拉非更大的治疗效果相关。这项研究受到方法质量报告不佳，研究数量少，异质性和大效应大小的阻碍。尽管有这些限制，但对偏见的全面评估应该是系统审查的常规。

BACKGROUND & AIMS: :Exposimeters are increasingly applied in bioelectromagnetic research to determine personal radiofrequency electromagnetic field (RF-EMF) exposure. The main advantages of exposimeter measurements are their convenient handling for study participants and the large amount of personal exposure data, which can be obtained for several RF-EMF sources. However, the large proportion of measurements below the detection limit is a challenge for data analysis. With the robust ROS (regression on order statistics) method, summary statistics can be calculated by fitting an assumed distribution to the observed data. We used a preliminary sample of 109 weekly exposimeter measurements from the QUALIFEX study to compare summary statistics computed by robust ROS with a naïve approach, where values below the detection limit were replaced by the value of the detection limit. For the total RF-EMF exposure, differences between the naïve approach and the robust ROS were moderate for the 90th percentile and the arithmetic mean. However, exposure contributions from minor RF-EMF sources were considerably overestimated with the naïve approach. This results in an underestimation of the exposure range in the population, which may bias the evaluation of potential exposure-response associations. We conclude from our analyses that summary statistics of exposimeter data calculated by robust ROS are more reliable and more informative than estimates based on a naïve approach. Nevertheless, estimates of source-specific medians or even lower percentiles depend on the assumed data distribution and should be considered with caution.

背景与目标： : exposimeter越来越多地应用于生物电磁研究中，以确定个人射频电磁场 (rf-emf) 暴露。exposimeter测量的主要优点是它们对研究参与者的方便处理以及大量的个人暴露数据，这些数据可以针对多个rf-emf源获得。但是，低于检测限的大部分测量值对数据分析是一个挑战。使用稳健的ROS (顺序统计回归) 方法，可以通过将假定的分布拟合到观察到的数据来计算汇总统计。我们使用了来自QUALIFEX研究的每周109次exposition测量的初步样本，将由稳健的ROS计算的汇总统计数据与天真方法进行了比较，其中低于检测极限的值被检测极限的值代替。对于总rf-emf暴露，对于第90个百分位数和算术平均值，天真方法和稳健ROS之间的差异适中。但是，天真的方法大大高估了较小的RF-EMF源的暴露贡献。这导致低估了人群中的暴露范围，这可能会使对潜在暴露-反应关联的评估产生偏差。我们从分析中得出的结论是，与基于幼稚方法的估计相比，由稳健的ROS计算出的exposition数据的汇总统计信息更可靠，更有用。尽管如此，特定于源的中位数甚至更低的百分位数的估计取决于假定的数据分布，应谨慎考虑。

BACKGROUND & AIMS: :Current literature and clinical guidelines do not include pregnant women as an a priori risk group for COVID-19. However, a gender vision of health begs the question: Why are pregnant women not considered a risk group for COVID-19? The answer is clear: historically, most community scientific studies have not considered female gender, or pregnancy as a state, to be a focus of special interest or effort. Unfortunately, this bias seems to be maintained in the COVID-19 epidemic: most current guidelines for diagnosing SARS-CoV-2 infection during pregnancy apply the same standard criteria as for the general population. This pandemic is an opportunity to begin redressing this historic gender bias against pregnant women, and to achieve this, we recommend two actions that are easy to implement, and would have a large impact. First, routinely test for SARS-CoV-2 infection in all pregnant women with clinical or epidemiological suspicion, regardless of gestational age or the clinical severity. Second, routinely test for SARS-CoV-2 infection in all pregnant women at admission for delivery. These actions are essential to understand the true impact of COVID-19 throughout pregnancy, and will improve how we manage many aspects of pre- and postnatal care. It is the scientific community's responsibility to guide, even to anticipate, the recommendations of our respective governments' health policies. If we do not agree to consider pregnant women as a distinct priority subgroup of the population during this pandemic, once again we will miss an opportunity to overcome this historic bias.

背景与目标： : 目前的文献和临床指南没有将孕妇作为新型冠状病毒肺炎的先验风险人群。然而，性别对健康的看法回避了一个问题: 为什么孕妇不被认为新型冠状病毒肺炎的风险群体？答案很明确: 从历史上看，大多数社区科学研究都没有将女性性别或怀孕视为一种状态，作为特别感兴趣或努力的重点。不幸的是，这种偏见似乎在COVID-19流行病中得以维持: 目前大多数诊断怀孕期间SARS-CoV-2感染的指南都采用与普通人群相同的标准。这场大流行是一个机会，可以开始纠正这种针对孕妇的历史性性别偏见，为了实现这一目标，我们建议采取两项易于实施并产生重大影响的行动。首先，对所有有临床或流行病学怀疑的孕妇进行常规SARS-CoV-2感染检测，无论胎龄或临床严重程度如何。第二，在所有孕妇入院分娩时常规检测SARS-CoV-2感染情况。这些行动对于了解新型冠状病毒肺炎在整个怀孕期间的真正影响至关重要，并将改善我们如何管理产前和产后护理的许多方面。科学界有责任指导甚至预测我们各自政府卫生政策的建议。如果我们不同意在这场大流行期间将孕妇视为人口中的一个独特的优先群体，我们将再次错过克服这一历史性偏见的机会。

BACKGROUND & AIMS: :Gestational weight gain (GWG) is an important predictor of adverse pregnancy outcomes including gestational diabetes, preterm birth, delivery by caesarean and post-partum weight retention. The Institute of Medicine guidelines on GWG are widely adopted, and GWG is widely researched as an outcome of interest in lifestyle interventions during pregnancy. However, estimation of prepregnancy weight and measurement of weight prior to delivery introduce bias into measures of GWG. This review discusses the sources of bias in measures of GWG and the potential effect of bias on the relationship between adverse pregnancy outcomes associated with GWG. Bias in measures of GWG can be minimized by using measured weight at the first antenatal appointment in early pregnancy rather than self-reported prepregnancy weight and by adjusting for gestational age when the last weight is collected earlier than the delivery date. Bias owing to gestational age is an important potential confounder in the relationship between GWG and adverse pregnancy outcomes.

背景与目标： : 妊娠体重增加 (GWG) 是不良妊娠结局的重要预测指标，包括妊娠糖尿病，早产，剖腹产和产后体重保持。医学研究所关于GWG的指南被广泛采用，并且GWG被广泛研究，这是对怀孕期间生活方式干预的兴趣的结果。但是，孕前体重的估计和分娩前体重的测量将偏差引入了GWG的测量中。这篇综述讨论了GWG测量中偏倚的来源以及偏倚对与GWG相关的不良妊娠结局之间关系的潜在影响。通过在怀孕初期首次产前预约时使用测量的体重，而不是自我报告的孕前体重，以及在分娩日期之前收集最后一次体重时调整胎龄，可以最大程度地减少GWG测量的偏差。由于胎龄引起的偏见是GWG与不良妊娠结局之间关系的重要潜在混杂因素。