Public Health Commons^™

Maternal Occupational Exposure To Selected Organic And Chlorinated Solvents And Delivery Of Small-For-Gestational Age Or Preterm Infants, Kristen W. Van Buren, Carissa M. Rocheleau, I‐Chen Chen, Tania A. Desrosiers, Wayne T. Sanderson, Maria D. Politis, Elizabeth C. Ailes, The National Birth Defects Prevention Study

UK CARES Faculty Publications

Background: Potential reproductive effects of organic solvent exposure during pregnancy remain unclear. We investigated the association between maternal occupational exposure during pregnancy to six chlorinated solvents, three aromatic solvents, and Stoddard solvent, and delivery of preterm infants or those born small‐ for‐gestational age (SGA).

Methods: In this case–control study of SGA and preterm birth (PTB) nested within the National Birth Defects Prevention Study (NBDPS) from 1997 to 2011, we analyzed data from 7504 singleton live births without major birth defects and their mothers. Self‐reported information on jobs held in the periconceptional period was assessed for solvent exposure. Unconditional logistic regression …

Co-Creating A Responsive, Sustainable, And Equitable Community Health Model For Older Adults With Chronic Diseases, Rachel M. Gallo Mph

Children, Youth, & Families

In 2022, the Bangor YMCA received a grant from the Maine Health Access Foundation’s (MeHAF) Systems Improvement and Innovation Responsive Grants Program for their “Co-Create Responsive, Sustainable, and Equitable Community Health Models for Older Adults with Chronic Diseases” project. This project aimed to “engage older adults with chronic disease conditions and their care partners to collectively identify new ways to connect people to community resources and to co-create community-based continuum of care systems to support the physical, emotional, and mental well-being of people in [their] communities of focus”.

The University of Southern Maine’s Data Innovation Project (DIP) at the Catherine …

Fostering Patient Safety: Importance Of Nursing Documentation, Shamsa Samani, Salma Amin Rattani

School of Nursing & Midwifery

Background: Nurses are professionally accountable for assessing and documenting patients’ vital signs. Nurses failing to fulfill this responsibility position their patients at risk. This paper presents two real-life cases pertaining to patients’ safety resulting in fatal outcomes, leading to the professional, legal, and ethical liability of nurses as the providers of patient care.
Objective: This paper focuses on the role of organizational culture in fostering patient safety specifically in monitoring and documentation of patients’ vital signs and early recognition of warning signs.
Methodology: A comprehensive literature search was conducted using various databases, examining the significance of vital signs monitoring and …

Right To Informed Consent, Right To A Doula: An Evidence-Based Solution To The Black Maternal Mortality Crisis In The United States, Cecilia Landor

Michigan Journal of Gender & Law

This Note seeks to build on existing research about how to improve childbirth in the United States for women, particularly for Black women, given the United States’ extremely high maternal mortality rate. Through examining the history and characteristics of American and Western childbirth, it seeks to explore how the current birth framework contributes to maternal mortality. To fight this ongoing harm, I suggest increasing access to doulas— nonmedical support workers who provide “continuous support” to the birthing person.

Through this Note I seek to build on the research of others by identifying the ways medicalized birth practices fail women, particularly …

Prenatal Depression And Breastfeeding Practices Healthy Start Participants, 2019-2022, Peyton Ashleigh Mosher

Theses and Dissertations

Background: Breastfeeding has health benefits for both mother and child, but breastfeeding practices among Black and lower-income women are the poorest in the United States. Few studies have examined the associations between maternal prenatal depression and breastfeeding duration, even fewer among a predominantly low-income Black population. Objective: To explore the association between prenatal depression and breastfeeding practices among low-income Black women during the COVID-19 pandemic.

Methods: Prospective cohort data from Midlands Healthy Start (MHS) was analyzed to examine women’s depression symptoms during pregnancy and their breastfeeding initiation and duration through two and six months. Perinatal depressive symptoms were identified using …

Institute Of Public Health Newsletter- Volume 5, Issue 2, Institute Of Public Health (Iph)

Institute of Public Health Newsletter (IPHNL) and Other Publications

No abstract provided.

Differentially Expressed Genes In Dental Pulp Tissues Of Individuals With Symptomatic Irreversible Pulpitis With And Without History Of Covid-19, Han Na Cho, Leticia Chaves De Souza, Cleverick Johnson, John R Klein, Timothy C Kirkpatrick, Renato Silva, Ariadne Letra

Faculty, Staff and Student Publications

Introduction: Increased levels of proinflammatory markers have been reported in tissues of individuals with Coronavirus Disease 2019 (COVID-19). We hypothesize that inflamed dental pulp tissues of individuals with previous history of COVID-19 may present a differential inflammatory gene expression profile in comparison with individuals who never had COVID-19.

Materials and methods: Dental pulp tissues were collected from 27 individuals referred for endodontic treatment due to symptomatic irreversible pulpitis. Of these, 16 individuals had a history of COVID-19 (6 months to 1 year post infection) and 11 individuals had no previous history of COVID-19 (controls). Total RNA from pulp tissue samples …

The Viral Picture Of Well-Being: Biggest Concerns, Losses, And Unintended Gifts Of Covid-19 In The Philippines, Ma Teresa Tuason, Kelly Perniciaro, Richel Lamadrid, Jego Mallillin, C. Dominik Güss

Ateneo School of Medicine and Public Health Publications

The COVID-19 pandemic revealed more than anticipated about global human functioning and resiliency. This Philippines-based study replicated a recent U.S. COVID analysis on psychological well-being (PWB). Factors examined herein were grouped into categories for analysis: 1) predictors of PWB, 2) areas of greatest stress or worry (biggest concerns), 3) perceived or real losses across SES, and 4) identified “unintended gifts” across PWB. Participants (n = 1345) were volunteers who responded to an online survey from August to September 2021, peak of the Delta variant. Three general groups of predictors (biological, psychological, and socio-economic) contributed to PWB. A regression model containing …

Oxygen Therapy Education To Improve Oxygen Safety In The Emergency Department: A Quality Improvement Project, Latania Wolfe

DNP Projects

Background and Significance: Oxygen is often administered in emergency departments (ED) in US without the nurses and other healthcare staff inputting orders for this medication. This gap in placing orders poses a risk to patient safety and poses a regulation issue.

Purpose: The goal of this quality improvement project is to increase the rate of orders placed for patients using oxygen in ED staff by 12% from March 1, 2023 to May 31, 2023.

Methods: The Model for Improvement guided this quality improvement project. Two PDSA cycles were completed.

Results: PDSA #1 Completed SWOT analysis and used information to …

Strategies For Improving Mental Health And Wellbeing Used By Adults Ageing With Hiv From The Kenyan Coast: A Qualitative Exploration, Peter Mwangala, Ryan G. Wagner, Charles R. Newton, Amina Abubakar

Institute for Human Development, East Africa

Background: Physical and mental health problems are common among older adults living with HIV (OALWH). Adaptive coping strategies play a vital role in improving these adults' mental health and well-being despite the deleterious effects of HIV and ageing. However, in sub-Saharan Africa, limited evidence exists on the commonly utilized coping strategies in this population. We explore the coping strategies used by Kenyan OALWH to improve their mental health and wellbeing.

Methods: Semi-structured in-depth interviews were conducted between October and December 2019 with 56 participants: 34 OALWH (53% female), 11 healthcare providers (63% female) and 11 primary caregivers (73% female) in …

Establishing A Routine Process Of Medication Reconciliation In A Rural Primary Care Clinic To Address Unnecessary Polypharmacy In Patients 65 And Older, Jessica Kirkwood-Harp

Doctor of Nursing Practice Projects

Background: Medication safety by reducing the proportion of older adults who use inappropriate medications is a Healthy People 2030 goal (Office of Disease Prevention and Health Promotion, n.d.(a)). The research for this proposal supported an established medication reconciliation (MR) to reduce errors and adverse drug events (ADEs). Consistent MR is essential for patient safety and positive patient outcomes in rural outpatient primary care clinics, as these patients possess multiple comorbidities.

Purpose: This Doctor of Nursing Practice (DNP) quality improvement project (QIP) established a routine MR process within a rural primary care clinic with reduced unnecessary polypharmacy and decreased risk of …

Exploration Of The Association Between Obesogenic Environments And Childhood Overweight/Obesity Rates In Rural Counties In The United States, Kara Lea Ferguson Davis

Theses and Dissertations

Rising obesity rates, particularly among children, pose a significant public health concern. Of particular concern is the prevalence of childhood obesity in rural communities, with up to 38% of rural children classified as overweight or obese, compared to 30% of urban children. Rural communities often lack the typical built environment characteristics associated with increased physical activity rates and healthy eating behaviors. Further, research on obesogenic environments within rural areas is limited. This study aimed to address this research gap by examining the association between obesogenic environment features and childhood overweight/obesity rates across the urban-rural continuum.

Simple and multiple linear regression …

Healthy Eating And Physical Activity: Analysing Soweto’S Young Adults’ Perspectives With An Intersectionality Lens, Gudani Mukoma, Edna Bosire, Sonja Klingberg, Shane A. Norris

Brain and Mind Institute

Background and objectives: Non-communicable diseases (NCDs) are taking a toll on Africa’s youth at younger ages than in other regions. These are attributed to risk factors that usually advance in adolescence, such as unhealthy diets and reduced physical activity. Young adults in South Africa, particularly women, tend to be sedentary, consume energy-dense diets low in micronutrients, and are more likely to develop NCDs much earlier in life than those in high-income countries. With an intersectionality perspective, this study explored young adults’ barriers and solutions to addressing these risk factors in Soweto.

Setting: Soweto, Johannesburg, South Africa, is one …

The Occupational Impacts That Sexual Assault Has On Female College Students, Breannah Scheiderman, Amy Lyons-Brown

Summer 2023 Virtual OTD Capstone Symposium

This mixed methods study outlines some of the occupational impacts that sexual assault has on female college students. Data was collected by both a survey and personal testimonies from readily available experiences. This paper introduces the problem and some things that can be done from an occupational therapy perspective.

Effects Of A School-Based Gardening, Cooking, And Nutrition Cluster Randomized Controlled Trial On Unprocessed And Ultra-Processed Food Consumption, Matthew R Jeans, Matthew J Landry, Sarvenaz Vandyousefi, Erin A Hudson, Marissa Burgermaster, Molly S Bray, Joya Chandra, Jaimie N Davis

Faculty, Staff and Student Publications

BACKGROUND: School-based gardening and nutrition education interventions report improvements in dietary intake, notably through fruit and vegetables. However, gardening, cooking, and nutrition randomized controlled trials are limited in evaluating dietary quality, and none have examined processed food consumption to date.

OBJECTIVES: The study examined the effects of Texas Sprouts (TX Sprouts), a gardening, cooking, and nutrition education intervention, compared with control on unprocessed and ultra-processed food (UPF) consumption in predominately low-income Hispanic children.

METHODS: TX Sprouts was a school-based cluster randomized controlled trial that consisted of 16 elementary schools randomly assigned to either the TX Sprouts intervention (n = 8 …

Compensation Cycle Consistent Generative Adversarial Networks (Comp-Gan) For Synthetic Ct Generation From Mr Scans With Truncated Anatomy, Yao Zhao, He Wang, Cenji Yu, Laurence E Court, Xin Wang, Qianxia Wang, Tinsu Pan, Yao Ding, Jack Phan, Jinzhong Yang

Faculty, Staff and Student Publications

BACKGROUND: MR scans used in radiotherapy can be partially truncated due to the limited field of view (FOV), affecting dose calculation accuracy in MR-based radiation treatment planning.

PURPOSE: We proposed a novel Compensation-cycleGAN (Comp-cycleGAN) by modifying the cycle-consistent generative adversarial network (cycleGAN), to simultaneously create synthetic CT (sCT) images and compensate the missing anatomy from the truncated MR images.

METHODS: Computed tomography (CT) and T1 MR images with complete anatomy of 79 head-and-neck patients were used for this study. The original MR images were manually cropped 10-25 mm off at the posterior head to simulate clinically truncated MR images. Fifteen …

A Comparative Effectiveness Study On Opioid Use Disorder Prediction Using Artificial Intelligence And Existing Risk Models, Sajjad Fouladvand, Jeffery Talbert, Linda Phyliss Dwoskin, Heather M. Bush, Amy L. Meadows, Lars E. Peterson, Yash R. Mishra, Steven K. Roggenkamp, Fei Wang, Ramakanth Kavuluru, Jin Chen

Markey Cancer Center Faculty Publications

Opioid use disorder (OUD) is a leading cause of death in the United States placing a tremendous burden on patients, their families, and health care systems. Artificial intelligence (AI) can be harnessed with available healthcare data to produce automated OUD prediction tools. In this retrospective study, we developed AI based models for OUD prediction and showed that AI can predict OUD more effectively than existing clinical tools including the unweighted opioid risk tool (ORT). Data include 474,208 patients’ data over 10 years; 269,748 were females with an average age of 56.78 years. Cases are prescription opioid users with at least …

Lung And Colorectal Cancer Disparities In Appalachian Kentucky: Spatial Analysis On The Influence Of Education And Literacy, Nicole Robertson Mph, Todd Burus, Lauren Hudson, Pamela C. Hull, Lee Park, Nathan L. Vanderford

Markey Cancer Center Faculty Publications

Low educational attainment and high cancer incidence and mortality rates have long been a challenge in Appalachian Kentucky. Prior studies have reported disparities in cancer incidence and mortality between Appalachian and non-Appalachian populations, but the influence of education on this disparity has not been extensively studied. Herein, all cancers and two cancer sites with available screenings (colorectal and lung) were joined with education indicators (educational attainment and literacy) and one geographic indicator across all 120 Kentucky counties. This dataset was used to build choropleth maps and perform simple linear and spatial regression to assess statistical significance and to measure the …

Insurance Status And Cancer Staging, Time To Treatment, And Mortality: Examining Cancers Of The Breast, Colon, And Lung, Gabriel A. Benavidez

Theses and Dissertations

Introduction: When examining cancer outcomes, timely detection and treatment are critical factors for favorable prognoses. Previous studies have shown that individuals with public health insurance, specifically Medicaid, have worse cancer outcomes than those with private insurance. While differences in socioeconomic status may account for this disparity, one potential area for further investigation is the effect of Medicaid enrollment timing on cancer outcomes. In some states, individuals may not be eligible for Medicaid until after their cancer diagnosis, potentially nullifying health insurance benefits. This analysis examines the impact of Medicaid enrollment timing on cancer outcomes by comparing patients not enrolled in …

Meet Me In The Middle: A Scoping Review On Understanding Adolescent Needs In Climate Communication, Gwendolyn Monica Hoff Anderson

Master's Projects and Capstones

The greatest effects of climate change are likely to be felt by youth. Young people are disproportionately affected by climate change due to their critical developmental stage and lack of power, and they experience both higher severity and prevalence of mental health issues related to climate change. Strong emotions have long been recognized as potential catalysts for action, or they may lead to paralyzing feelings of being overwhelmed. Climate communication is a critical tool to spark climate concern and encourage action. Activism, in turn, may help youth manage their anxiety about climate change. This scoping review examines emerging evidence on …

Interactive Associations Of Eczema With Glutathione S-Transferase Genes In Relation To Autism Spectrum Disorder And Its Severity In Jamaican Children, Sepideh Saroukhani, Maureen Samms-Vaughan, Jan Bressler, Minjae Lee, Courtney Byrd-Williams, Manouchehr Hessabi, Megan L Grove, Sydonnie Shakespeare-Pellington, Katherine A Loveland, Mohammad H Rahbar

Faculty, Staff and Student Publications

BACKGROUND: Comorbidity of eczema with autism spectrum disorder (ASD) is increasing. We investigated the associations of eczema and its possible interaction with polymorphisms in glutathione S-transferase (GST) genes in relation to ASD and ASD severity.

METHOD: Using data from 344 1:1 age- and sex-matched ASD cases and typically developing controls, we assessed additive and interactive associations of eczema with GST genes in relation to ASD by applying conditional logistic regression models, and in relation to ASD severity in ASD cases as measured by the Autism Diagnostic Observation Schedule-2nd Edition (ADOS-2) total and domain-specific comparison scores (CSs) by fitting general linear …

Parametric Delineation Uncertainties Contouring (Pduc) Modeling On Ct Scans Of Prostate Cancer Patients, Vi Ly, Lizhong Liu, Carlos Cardenas, Sean Maroongroge, Brian De, Daniel El Basha, Laurence Court, Xi Luo

Faculty, Staff and Student Publications

PURPOSE: Variability in contouring contributes to large variations in radiation therapy planning and treatment outcomes. The development and testing of tools to automatically detect contouring errors require a source of contours that includes well-understood and realistic errors. The purpose of this work was to develop a simulation algorithm that intentionally injects errors of varying magnitudes into clinically accepted contours and produces realistic contours with different levels of variability.

METHODS: We used a dataset of CT scans from 14 prostate cancer patients with clinician-drawn contours of the regions of interest (ROI) of the prostate, bladder, and rectum. Using our newly developed …

Evaluating Dynamic Discrimination Performance Of Risk Prediction Models For Survival Outcomes, Jing Zhang, Jing Ning, Ruosha Li

Faculty, Staff and Student Publications

Risk prediction models for survival outcomes are widely applied in medical research to predict future risk for the occurrence of the event. In many clinical studies, the biomarker data are measured repeatedly over time. To facilitate timely disease prognosis and decision making, many dynamic prediction models have been developed and generate predictions on a real-time basis. As a dynamic prediction model updates an individual's risk prediction over time based on new measurements, it is often important to examine how well the model performs at different measurement times and prediction times. In this article, we propose a two-dimensional area under curve …

Association Of Timing Of Moderate-To-Vigorous Physical Activity With Changes In Glycemic Control Over 4 Years In Adults With Type 2 Diabetes From The Look Ahead Trial, Jingyi Qian, Qian Xiao, Michael P Walkup, Mace Coday, Melissa L Erickson, Jessica Unick, John M Jakicic, Kun Hu, Frank A J L Scheer, Roeland J W Middelbeek, Look Ahead Research Group

Faculty, Staff and Student Publications

OBJECTIVE: We aimed to determine the association of the time-of-day of bout-related moderate-to-vigorous physical activity (bMVPA) with changes in glycemic control across 4 years in adults with overweight/obesity and type 2 diabetes.

RESEARCH DESIGN AND METHODS: Among 2,416 participants (57% women; mean age, 59 years) with 7-day waist-worn accelerometry recording at year 1 or 4, we assigned bMVPA timing groups based on the participants' temporal distribution of bMVPA at year 1 and recategorized them at year 4. The time-varying exposure of bMVPA (≥10-min bout) timing was defined as ≥50% of bMVPA occurring during the same time period (morning, midday, afternoon, …

Stress-Induced Changes In Autonomic Reactivity Vary With Adolescent Violence Exposure And Resting-State Functional Connectivity, Heather E Dark, Nathaniel G Harnett, Adam M Goodman, Muriah D Wheelock, Sylvie Mrug, Mark A Schuster, Marc N Elliott, Susan Tortolero Emery, David C Knight

Faculty, Staff and Student Publications

Exposure to violence during childhood can lead to functional changes in brain regions that are important for emotion expression and regulation, which may increase susceptibility to internalizing disorders in adulthood. Specifically, childhood violence exposure can disrupt the functional connectivity among brain regions that include the prefrontal cortex (PFC), hippocampus, and amygdala. Together, these regions are important for modulating autonomic responses to stress. However, it is unclear to what extent changes in brain connectivity relate to autonomic stress reactivity and how the relationship between brain connectivity and autonomic responses to stress varies with childhood violence exposure. Thus, the present study examined …

Exploring The Interactions Between Sars-Cov-2 And Host Proteins, Sojan Shrestha

School of Biological Sciences: Dissertations, Theses, and Student Research

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of the current pandemic, Coronavirus Disease 2019 (COVID-19). SARS-CoV-2 is considered to be of zoonotic origin; it originated in non-human animals and was transmitted to humans. Since the early stage of the pandemic, however, the evidence of transmissions from humans to animals (reverse zoonoses) has been found in multiple animal species including mink, white-tailed deer, and pet and zoo animals. Furthermore, secondary zoonotic events of SARS-CoV-2, transmissions from animals to humans, have been also reported. It is suggested that non-human hosts can act as SARS-CoV-2 reservoirs where accumulated …

Epidemiology Of Nonsyndromic, Orofacial C/Lefts In Texas: Differences By Cleft Type And Presence Of Additional Defects, Maria Luisa Navarro Sanchez, Michael D Swartz, Peter H Langlois, Mark A Canfield, A J Agopian

Faculty, Staff and Student Publications

To describe the current epidemiology of nonsyndromic cleft palate alone (CP) and cleft lip with or without cleft palate (CL ± P) in Texas and examine differences in the characteristics of infants with CP and CL ± P based on the presence/absence of additional defects. We used data from the Texas Birth Defects Registry, a statewide active birth defect surveillance system, from 1815 cases with CP and 5066 with CL ± P, without a syndrome diagnosis (1999-2014 deliveries). All live births in Texas were used for comparison. Poisson regression was used to calculate crude and adjusted prevalence ratios (aPR) for …

Arsenic Metabolism, Diabetes Prevalence, And Insulin Resistance Among Mexican Americans: A Mendelian Randomization Approach, Margaret C Weiss, Yu-Hsuan Shih, Molly Scannell Bryan, Brian P Jackson, David Aguilar, Eric L Brown, Goo Jun, Craig L Hanis, Maria Argos, Robert M Sargis

Faculty, Staff and Student Publications

BACKGROUND: Differences in arsenic metabolism capacity may influence risk for type 2 diabetes, but the mechanistic drivers are unclear. We evaluated the associations between arsenic metabolism with overall diabetes prevalence and with static and dynamic measures of insulin resistance among Mexican Americans living in Starr County, Texas.

METHODS: We utilized data from cross-sectional studies conducted in Starr County, Texas, from 2010-2014. A Mendelian randomization approach was utilized to evaluate the associations between arsenic metabolism and type 2 diabetes prevalence using the intronic variant in the arsenic methylating gene, rs9527, as the instrumental variable for arsenic metabolism. to further assess mechanisms …

Antithrombin, Protein C, And Protein S: Genome And Transcriptome-Wide Association Studies Identify 7 Novel Loci Regulating Plasma Levels, Yuekai Ji, Gerard Temprano-Sagrera, Lori A Holle, Allison Bebo, Jennifer A Brody, Ngoc-Quynh Le, Kadri Kangro, Michael R Brown, Angel Martinez-Perez, Colleen M Sitlani, Pierre Suchon, Marcus E Kleber, David B Emmert, Ayse Bilge Ozel, Dre'von A Dobson, Weihong Tang, Dolors Llobet, Russell P Tracy, Jean-François Deleuze, Graciela E Delgado, Martin Gögele, Kerri L Wiggins, Juan Carlos Souto, James S Pankow, Kent D Taylor, David-Alexandre Trégouët, Angela P Moissl, Christian Fuchsberger, Frits R Rosendaal, Alanna C Morrison, Jose Manuel Soria, Mary Cushman, Pierre-Emmanuel Morange, Winfried März, Andrew A Hicks, Karl C Desch, Andrew D Johnson, Paul S De Vries, Charge Consortium Hemostasis Working Group, Invent Consortium, Alisa S Wolberg, Nicholas L Smith, Maria Sabater-Lleal

Faculty, Staff and Student Publications

BACKGROUND: Antithrombin, PC (protein C), and PS (protein S) are circulating natural anticoagulant proteins that regulate hemostasis and of which partial deficiencies are causes of venous thromboembolism. Previous genetic association studies involving antithrombin, PC, and PS were limited by modest sample sizes or by being restricted to candidate genes. In the setting of the Cohorts for Heart and Aging Research in Genomic Epidemiology consortium, we meta-analyzed across ancestries the results from 10 genome-wide association studies of plasma levels of antithrombin, PC, PS free, and PS total.

METHODS: Study participants were of European and African ancestries, and genotype data were imputed …

A Mendelian Randomization Study Of Genetic Liability To Post-Traumatic Stress Disorder And Risk Of Ischemic Stroke, Opeyemi Soremekun, Clarisse Musanabaganwa, Annette Uwineza, Maddalena Ardissino, Skanda Rajasundaram, Agaz H Wani, Stefan Jansen, Jean Mutabaruka, Eugene Rutembesa, Chisom Soremekun, Cisse Cheickna, Mamadou Wele, Joseph Mugisha, Oyekanmi Nash, Eugene Kinyanda, Dorothea Nitsch, Myriam Fornage, Tinashe Chikowore, Dipender Gill, Derek E Wildman, Leon Mutesa, Monica Uddin, Segun Fatumo

Faculty, Staff and Student Publications

Observational studies have shown an association between post-traumatic stress disorder (PTSD) and ischemic stroke (IS) but given the susceptibility to confounding it is unclear if these associations represent causal effects. Mendelian randomization (MR) facilitates causal inference that is robust to the influence of confounding. Using two sample MR, we investigated the causal effect of genetic liability to PTSD on IS risk. Ancestry-specific genetic instruments of PTSD and four quantitative sub-phenotypes of PTSD, including hyperarousal, avoidance, re-experiencing, and total symptom severity score (PCL-Total) were obtained from the Million Veteran Programme (MVP) using a threshold P value (P) of <5 >× 10