bluuebunny/crossref_metadata_2025 huggingface dataset:
382Association between nutrient supplementation and depressive symptom in Pregnancy: a multicenter prospective cohort study
Authors: Chen Yunli , Jiang Yu
Published: September 2021

Background

There are few researches about the association between nutrient supplementation and depressive symptom in pregnancy in large prospective cohort studies.

Methods

In Chinese Pregnant Women Cohort Study (CPWCS), twenty-four hospitals distributed in 15 provinces in China were selected as centre sites. Related information were collected in the first, second and third trimester respectively. Nutrient supplements include folic acid, vitamin D, calcium, iron, docosahexaenoic acid (DHA), dietary fiber, and probiotics. Edinburgh postnatal depression scale (EPDS) was used to assess the mood of depression. Univariable and multivariable Generalized Estimating Equation were applied to analyze the association of nutrient supplementation and depressive symptom in pregnancy.

Results

A total of 5759 pregnant women were included in our study. Results showed that 93.3%(5374/5759), 92.8%(5189/5591) and 94.2%(4056/4307) women supplemented one or more nutrients in the first, second and third trimester separately. The detection rates of antenatal depression was 30.77%(1772/5759), 28.13%(1573/5591) and 28.44%(1225/4307) separately. Multivariable analyses suggested that supplementing one or more nutrients was significantly associated with depression (OR = 0.812, p = 0.013). When analyzed separately, depression was negatively related to vitamin D (OR = 0.850, p = 0.001), calcium (OR = 0.880, p = 0.006), and DHA (OR = 0.903, p = 0.040), but not associated with supplement of folic acid, dietary fiber, iron, or probiotics.

Conclusions

Depressive symptom is highly prevalent among Chinese pregnant women, and supplement of vitamin D, calcium, and DHA are preventive factors of depressive symptom in pregnancy.

Key message

About a third of Chinese pregnant women have depressive symptom, and supplement of vitamin D, calcium, and DHA are preventive factors of depressive symptom in pregnancy.
1474Meteorologically favourable zones for the activities of seasonal influenza A and B in Hong Kong
Authors: Chun Chong Ka , Sheung Kay , Chan Paul , Lee Tsz-cheung
Published: September 2021

Background

Compared with temperate regions, the seasonality of influenza A and B in tropics and subtropics differs, for example, there are two peaks of influenza A virus activities in the summer and winter months, while influenza B peaked only in the winter months in Hong Kong. Given a potential effect from meteorological factors, we aim to develop a set of meteorologically favorable zones to predict the upsurge of activities of both influenza types.

Methods

Weekly numbers of laboratory-confirmed influenza A and B cases from January 1, 2004 to December 31, 2019 from cases admitted to three local hospitals were obtained. Meteorology data such as ambient temperature and relative humidity were collected from the Hong Kong Observatory. We employed a supervised discretization approach, classification and regression tree to identify the meteorologically favourable zones that optimize the prediction of influenza epidemics.

Results

The trained and validated areas-under-receiver-operating-characteristic-curve (AUROC) for the meteorologically favorable zones at 2-week ahead were 0.764 and 0.754 with a prediction sensitivity of 0.784 and 0.769, specificity of 0.616 and 0.635 respectively, showing a good performance. The prediction performances were generally similar among hospital-based prediction and the AUROCs kept >0.7 across all study sites.

Conclusions

The preliminary findings provide a support for developing a local-based risk alert for the upsurge of influenza activities in order to promote a public awareness of the influenza risk.

Key messages

While influenza seasonality in subtropics and tropics is not as strong as that in temperate regions, meteorological factors still crucial in predicting influenza epidemics.
369Womeńs empowerment benefits early childhood numeracy-literacy in 26 African countries
Authors: Coll Carolina , Ewerling Fernanda , Lynch John , Raj Anita , Victora Cesar , Barros Aluisio
Published: September 2021

Background

Every year more than 200 million children under-five years fail to achieve their full developmental potential in low- and middle-income countries. We explored whether mothers’ empowerment is associated with early childhood development in 26 African countries.

Methods

We used data from Demographic and Health Surveys and Multiple Indicator Cluster Surveys ranging from 2010 to 2018. Four developmental domains were assessed among children aged 36-59 months using the Early Childhood Development Index: literacy-numeracy, physical, learning and socioemotional. Women’s empowerment in attitude to violence, social independence and decision-making was evaluated using the SWPER Global, a validated survey-based index. We used logistic regression to estimate the associations between mother’s empowerment level in each domain and the development of their children controlled by wealth.

Results

Across all countries, 15·1% of the children were on track in the literacy-numeracy domain, 92·3% in physical, 81·3% in learning and 67·8% in socio-emotional. The odds of a child being on track in literacy-numeracy increased by 11%, 34% and 18%, with a one standard deviation increase in the scores of attitudes to violence, social independence and decision-making domains of empowerment, respectively. No effect of empowerment was observed for the other domains of child development in most countries.

Conclusions

We found a consistent and positive effect of mothers’ empowerment on the literacy-numeracy domain of child development. The null effects in other developmental domains may be related to lower variability in these outcomes, or to specific effects on literacy-numeracy.

Key messages

Womeńs empowerment has a potential to improve child development and their future human capital
613Monitoring chronic kidney disease evolution using frailty models
Authors: Ferreira Renato , Colugnati Fernando
Published: September 2021

Background

Frailty models improves traditional survival models such that a latent multiplicative effect is introduced on the risk function, representing non-observed characteristics such as genetic and behavioral. The aim of this study is to explore this kind of model on chronic kidney disease (CKD) monitoring for intermediary outcomes.

Methods

Using a retrospective cohort comprising 778 patients with diagnosed CKD, parametric survival models were adjusted for the months until decay of renal function ≥5mL as outcome. Models included diabetes, hypertension and CKDEPI as covariates. Latent effect were incorporated, with Gamma distribution, to the best model.

Results

Just diabetes presented relevant effect on outcome. Best model were Weibull. Without frailty component, estimated diabetes parameter was 0.70 (CI95% 0.54; 0.89), indicating diabetic patients present outcome 30% earlier than non-diabetic. When incorporating the Gamma fragility to the models, the effect was 0.75, (CI95% 0.61, 0.92), or 25% faster on diabetes. The 5 percent points difference between parameters on both models represent, on average, a 20-day difference, having the survival median time of 13 months as reference. It’s possible to address individual specific frailty, an important feature for clinical follow-up.

Conclusion

Including frailty on modeling made possible to know that in average diabetic patients would experience a fast decay in renal function earlier than what a traditional survival model could evidence. This may be crucial for clinical decision making. All models were adjusted using commercial software.

Key message

Modern clinical epidemiology must foster use of modern statistics
1370Introducing network analysis to measure early life adversity
Authors: De Vries Tjeerd Rudmer , Arends Iris , Rod Naja Hulvej , Oldehinkel Albertine J. , Bültmann Ute
Published: September 2021

Focus of Presentation

Many studies have investigated associations between early life adversity (ELA) and outcomes across the life course. A defining characteristic of ELA is its complex nature, as many individual adverse experiences (e.g., parental mental health problems, financial difficulties) co-occur and interact over time. Commonly used methods for measuring ELA have not been able to elucidate pathways through which individual AEs are associated with each other during early life. We propose using network analysis to overcome this research gap.

Findings

Figure 1 shows the conditional associations between AEs in childhood and adolescence in an undirected network model, based on empirical data from the longitudinal TRAILS cohort. First, we found that the network model allows us to explain co-occurrences between AEs. For example: the co-occurrence of parental illness and financial difficulties in childhood is likely due to parental unemployment. Second, we identified which AEs are associated over time, e.g., familial conflicts in childhood and adolescence are strongly associated, the latter being associated with parental divorce in adolescence.

Conclusions/Implications

These findings add to the literature by providing insight into how individual AEs are conditionally associated, in distinct developmental periods and over time. The findings can be used in future research on pathways between AEs and guide the development of interventions.

Key messages

Undirected network models are a promising alternative approach to measuring ELA that can provide insight into pathways through which AEs co-occur and interact over time.
787Multistate modelling to investigate the impact of recurrent malaria episodes on hospital admissions and mortality
Authors: Dini Saber , Douglas Nicholas , Poespoprodjo Jeanne Rini , Kenangalem Enny , Sugiarto Paulus , Plumb Ian , Price Ric , Simpson Julie
Published: September 2021

Background

Inadequate prevention and treatment of malaria can lead to reinfections and recurrent episodes, and for vivax malaria, further recurrences from the dormant liver stage. This study quantified the impact of recurrent malaria episodes on morbidity and mortality.

Methods

Routinely collected data were available from 68,381 malaria patients presenting to the primary referral hospital in Papua, Indonesia. A multi-state modelling framework, with Cox regression for transition rates, was employed to determine the risks of re-presentation to hospital, receiving in-patient treatment, and early (≤14 days post treatment)/late death following multiple malaria episodes.

Results

The risk of re-presentation to hospital increased from 34.7% (95%CI: 34.4%–35.1%) at first episode to 58.6% (57.5%–59.6%) following the third episode. Infection with vivax malaria increased the rate of re-presentation to hospital by 1.48-fold (Hazard Ratio 1.48; 95%CI 1.44–1.51) and late hospital in-patient admission by 1.17-fold (1.11–1.22), compared to falciparum. Falciparum malaria caused a higher overall rate of early death (1.54 (1.25–1.92)), however, after multiple episodes, there was a trend towards a greater rate of early death for vivax infection (1.91 (0.73–4.97)).

Conclusions

Recurrent episodes of malaria can cause substantial morbidity and mortality, highlighting the importance of prevention and effective treatments for both falciparum and vivax malaria.

Key messages

To achieve elimination of malaria in South-East Asia, where prevalence of vivax malaria is high, we must prioritise the radical cure of vivax to eliminate the liver-stage of this species that causes relapses of infection.
1274The application of simulation to quantifying the influence of bias in reproductive and perinatal epidemiology
Authors: Dunne Jennifer , Tessema Gizachew Assefa , Ognjenovic Milica , Pereira Gavin
Published: September 2021

Background

Establishing causal effects in reproductive and perinatal epidemiology is challenging due to the many selection and attrition processes from preconception to the postnatal period. Further challenging, is the potential for the misclassification of exposures, outcomes and confounders, contributing to measurement error. The application of simulation enables the illustration and quantification of the magnitude of various types of bias commonly found in observational studies.

Methods

A systematic search was conducted in PubMed, Medline, Embase, CINAHL and Scopus in August 2020. A gray literature search of Google and Google Scholar, followed by a search of the reference lists of included studies, was undertaken.

Results

Thirty-nine studies, covering information (n = 14), selection (n = 14), confounding (n = 9), protection (n = 1), and attenuation bias (n = 1) were identified. The methods of simulating data and reporting of results varied, with more recent studies including causal diagrams. Few studies included code for replication. Although there has been an increasing application of simulation in reproductive and perinatal epidemiology since 2015, overall this remains an underexplored area.

Conclusions

The studies demonstrated effectiveness in the quantification of multiple types of bias using simulation. The limited use implies that further effort is required to increase knowledge of the application of simulation, which will thereby improve causal interpretation in reproductive and perinatal studies.

Key messages

Practical guidance for researchers is required in the development, analysis and reporting of simulation methods for the quantification of bias.
1090The Brazilian farm-to-school regulatory policy: local governance correlates
Authors: Duran Ana Clara
Published: September 2021

Background

We explored whether local governance tools related to participatory democracy were associated with a better implementation of a farm-to-school regulation, which states that 30% of procured foods for the Brazilian National School Feeding Program (BNSFP) must come from family farming.

Methods

Longitudinal study with data on federal transfers to all Brazilian municipalities (n = 5.570) for the BNSFP from 2011 to 2017. The outcome was the percentage of those transfers used to procure foods from family farming. Participatory democracy measures included the presence of sectoral school feeding program councils and adherence to the National Food and Nutrition Security System (NFNS). Models were adjusted for total federal transfers to support family farming; the importance of federal transfers to the local economy; changes in land coverage devoted to family farming; municipal gross domestic product, and population size. We employed year and municipality fixed-effect linear models with clustered standard errors at the state level.

Results

Procurement from family farming rose from 16.5% [95%CI 16.0,17.0] in 2011 to 32.2% [95%CI 31.0, 33.5] in 2017. The presence of local sectoral school feeding program councils and local adherence to the NFNS were associated with a greater increase in the percentage of foods procured from family farming.

Conclusions

Local participatory democracy was associated with a better implementation of the farm-to-school regulation in Brazil.

Key message

Local participatory democracy measures influenced the implementation of the Brazilian national farm-to-school regulation. Our findings can help inform similar policies in other countries.
684Childhood Risk Factors and Adult Cardiovascular Disease Outcomes The International Childhood Cardiovascular Cohort (i3C) Consortium
Authors: Dwyer Terence , Raitakari Olli T. , Jacobs David , Woo Jessica G. , Urbina Elaine M. , Bazzano Lydia , Juonala Markus , Viikari Jorma , Chen Wei , Prineas Ronald , Steinberger Julia , Daniels Stephen , Sinaiko Alan , Venn Alison , Burns Trudy L. , Hu Tian
Published: September 2021

Background

Atherosclerosis develops silently for decades before adult cardiovascular disease (aCVD) occurs. There is currently no evidence directly linking childhood risk factors to aCVD outcomes.

Methods

i3C is an international consortium of 7 cohorts involving 40,709 participants enrolled between 1970-95 in childhood (age 3-19) who underwent measurement for BMI, SBP, total cholesterol, and triglycerides, and smoking (the last mostly in adolescence). Participants were followed by direct contact and review of medical records or death registry ascertainment through adulthood in 2014-19. 20,560 participants were found and interviewed or had died in the approximately 40 years since enrollment; 738 had a CVD event, confirmed by medical record review (n = 449) or death certificate ICD code (n = 289).

Results

Estimated hazard ratios (HRs) for childhood risk factors and their confidence intervals are displayed in the table below. The CIs excluded 1.0 for all these variables in the univariable analysis and, although the HRs were reduced in multivariable analysis which included all of these risk factors, the CIs still excluded 1.0.

Conclusion

Exposure to CVD risk factors in youth predicts adult CVD with implications for primordial CVD prevention.

Key messages

Intervention to reduce CVD risk factors in childhood is likely to reduce risk of adult CVD
1055The applicability of the Healthy Eating Index to measure Iranian diet quality
Authors: Ebrahimi Sara , Leech Rebecca , McNaughton Sarah , Livingstone Katherine
Published: September 2021

Background

Iranian diet quality has been evaluated using indices that are not based on Iranian dietary guidelines. This study examined the applicability of the Healthy Eating Index (HEI) by examining associations with sociodemographics, nutrient intakes and nutrient adequacy.

Methods

Household sociodemographics and dietary intakes (three 24-h dietary recalls) were collected in the cross-sectional National Comprehensive Study on Household Food Consumption Patterns and Nutritional Status 2001-2003. Household diet quality was calculated using the HEI. Regression analyses examined associations between diet quality and sociodemographics, nutrient intakes and nutrient adequacy.

Results

A total of 6584 households were included in this study. Age (β-coeff 2.11; 95% CI: 1.64, 2.44), education (β-coeff 4.58; 4.05, 5.11) and living in urban areas (β-coeff 2.87; 2.56, 3.19) (as reported by the household head) were positively associated with diet quality. Higher diet quality was associated with higher intake of protein (% energy) (β-coeff 0.08; 0.07, 0.08), calcium (mg/day) (β-coeff 12.10; 11.23, 12.98), iron (mg/day) (β-coeff 0.04; 0.02, 0.05), vitamin C (mg/day) (β-coeff 3.61; 3.45, 3.77) and fibre (g/day) (β-coeff 0.12; 0.11, 0.14), lower intake of sodium (mg/day) (β-coeff -83.45; -93.02, -73.88) and adequate intake of calcium (mg/day) (OR 1.10; 95% CI: 1.09, 1.12) and vitamin C (mg/day) (1.19; 1.18, 1.20).

Conclusions

Higher HEI was associated with a range of sociodemographics and better nutrient intakes and nutrient adequacy.

Key messages

HEI was applicable for assessing the diet quality of Iranian households.
443Factors associated with frailty in a relatively healthy community-dwelling older adults
Authors: Ekram A R M Saifuddin , Ryan Joanne , Espinoza Sara , Newman Anne , Murray Anne , Orchard Suzanne , Fitzgerald Sharyn , Ernst Michael , Woods Robyn
Published: September 2021

Background

Frailty is gaining importance as a predictor of disability and mortality in aged adults, and becoming frail poses a challenge for healthy aging. We investigated the prevalence and factors associated with pre-frail and frail status in a large study cohort of community-dwelling healthy older adults from Australia and the United States.

Methods

A total of 19,114 individuals (87% Australian and 56% women) aged 65 years or older enrolled in a primary prevention clinical trial were evaluated. Frailty status was classified using the modified Fried phenotype criteria comprising exhaustion, body mass index, grip strength, gait speed and physical activity. Prevalence and factors associated with frailty status (e.g., demographic characteristics and lifestyle factors) were reported using descriptive statistics along with a logistic regression model.

Results

At baseline, 39.0% (95% CI: 38.3, 39.7) of older trial participants were pre-frail and 2.2% (95% CI: 2.0, 2.4) were frail, respectively. Women were more likely to be frail (65.1% vs. 36.9%) and prefrail (58.0% vs. 42.0%) than men. Lower levels of education (<12 years), living alone, ethnic minorities, current smoking and past alcohol use were some of the factors which were common among frail or prefrail.

Conclusions

Despite being a relatively healthy cohort, more than one-third of the older trial participants were pre-frail, which was more prevalent among specific subgroups of individuals. This study emphasizes the high burden of the prefrailty status even among a healthy cohort of community-dwelling older people.

Key messages

The burden of prefrailty is high, even among a healthy cohort of older people in the communities.
22A Survey-Based Women's Empowerment Index for Low- and Middle-Income Countries: The SWPER Goes Global
Authors: Ewerling Fernanda , Raj Anita , Victora Cesar G , Hellwig Franciele , Coll Carolina VN , Barros Aluisio JD
Published: September 2021

Background

In 2017, a survey-based women's empowerment index (SWPER) was proposed for African countries, including three domains: social independence, decision making and attitude to violence. We explored the applicability of the SWPER in national health surveys from countries in other world regions.

Methods

We used data from the latest Demographic and Health Survey for 62 low- and middle-income countries (LMICs) since 2000, and adapted the indicator so that it could be used for any LMIC. Adaptations included the exclusion of women's working status and recategorization of the household decision-making related items. We compared the loading patterns obtained from principal components analysis for each country separately with those obtained in a pooled dataset with all countries combined. Country rankings based on the score of each SWPER domain were correlated with their rankings in the Gender Development Index (GDI) and the Gender Inequality Index (GII).

Results

Most countries presented similar patterns regarding item loadings for the three SWPER empowerment domains. Correlations between the country-specific and global individual-level scores were 0.89 or higher for all countries. Correlations between the country rankings according to SWPER and GDI were, respectively, 0.74, 0.71 and 0.67 for social independence, decision-making, and attitude to violence domains. The correlations were equal to 0.82, 0.67, and 0.44, respectively, with GDI.

Conclusions

The SWPER global is a suitable common measure of women's empowerment for LMICs, addressing the need for a single consistent survey-based indicator of women's empowerment and allowing wider comparisons across countries and world regions.
904Physical fitness across the life-course and the metabolic syndrome in mid-adulthood
Authors: Fraser Brooklyn , Blizzard Leigh , Buscot Marie-Jeanne , Schmidt Michael , Dwyer Terence , Venn Alison , Magnussen Costan
Published: September 2021

Background

Low physical fitness, including muscular strength and cardiorespiratory fitness (CRF), is a risk factor for the metabolic syndrome (MetS). However, it is unknown how physical fitness at different life stages contributes to the development of MetS.

Methods

Included were 783 Childhood Determinants of Adult Health Study participants who between 1985 and 2019 had measures of physical fitness (muscular strength: dominant grip strength; CRF: 1.6km run or physical work capacity at 170 beats per minute) at three life stages (childhood=7–15 years, young-adulthood=26–36 years, mid-adulthood=36–49 years) and had their MetS status assessed using the harmonised definition in mid-adulthood. The Bayesian relevant life-course exposure model, a novel statistical analytic technique, quantified associations between physical fitness at each life stage with MetS and estimated the maximum accumulated effect of physical fitness across the life-course.

Results

The contribution of muscular strength at each life stage with MetS in mid-adulthood was equal (childhood=36%, young-adulthood=31%, mid-adulthood=33%), whereas for CRF the greatest contribution was from childhood and mid-adulthood (childhood=41%, young-adulthood=20%, mid-adulthood=39%). A one standard deviation increase in cumulative physical fitness across the life-course was associated with 36–55% reduced odds of MetS (muscular strength: OR = 0.64, 95%Credible Interval=0.40,0.95; CRF: OR = 0.45, 95%Credible Interval=0.30,0.64).

Conclusions

As physical fitness at each life stage was associated with MetS in mid-adulthood, strategies aimed at increasing both childhood and adult physical fitness levels could improve future health.

Key messages

Increased participation in both aerobic and muscle-strengthening activities, beginning in childhood and extending into adulthood, could be encouraged to help prevent MetS.
367Association between dietary fatty acid intake, serum levels of fatty acids and ABCA1 DNA methylation
Authors: Fujii Ryosuke , Yamada Hiroya , Munetsuna Eiji , Yamazaki Mirai , Mizuno Genki , Ando Yoshitaka , Maeda Keisuke , Tsuboi Yoshiki , Ohashi Koji , Ishikawa Hiroaki , Hagiwara Chiharu , Wakai Kenji , Hashimoto Shuji , Hamajima Nobuyuki , Suzuki Koji
Published: September 2021

Background

Although previous studies have demonstrated that n-3 polyunsaturated fatty acids (PUFA) are inversely associated with a risk of CVD through gene expression, recent evidence suggests that it may arise from changes in DNA methylation. Therefore, we investigated whether dietary FA intake and serum FA levels are associated with ATP-binding cassette transporter A1 (ABCA1), a gene associated with HDL-cholesterol metabolism.

Methods

A total of 298 subjects (137 men, mean age of 63.2) without clinical history and medication participated in this cross-sectional study. We used the pyrosequencing method to measure DNA methylation levels at 8 CpG sites within ABCA1 gene and calculated mean DNA methylation level. Dietary FA intake were assessed with the food frequency questionnaire.

Results

We found that ABCA1 DNA methylation levels were significantly lower with higher dietary intake of n-3PUFA (β = –5.75, p = 0.001), which is observed both in men (β = –4.85, p = 0.001) and women (β = –7.24, p = 0.007). In addition, ABCA1 DNA methylation levels were significantly lower with higher serum levels of n-3PUFA in men (β = –2.78, p = 0.05), but not in women (β = 1.61, p = 0.31).

Conclusions

The results suggest that higher dietary n-3 PUFA intake and serum levels of n-3 PUFA are associated with lower ABCA1 DNA methylation in a Japanese population.

Key messages

Higher dietary n-3 PUFA intake can be a prevention from dyslipidemia and CVD via low level of ABCA1 DNA methylation
511Effects of educational activities prior to school entry are more important for socioeconomically disadvantaged children
Authors: Gialamas Angela , Haag Dandara , Mittinty Murthy , Lynch John
Published: September 2021

Background

We examined whether time in educational activities at 2-3 years and language ability at school entry differed among children from diverse socioeconomic backgrounds.

Methods

Data were drawn from the Longitudinal Study of Australian Children (n = 4253). Educational activities were collected using time-use diaries. Household income was measured using parent self-report. Language ability was assessed using the Peabody Picture Vocabulary Test. Marginal structural models with inverse probability of treatment weights were used to assess modification of the effect of time spent in educational activities on language ability by income.

Results

Children exposed to both <30 minutes/day in educational activities and being in a low-income household were at greater risk of poorer outcomes than the simple sum of their independent effects. Compared with children who spent ≥30 minutes/day in educational activities and from higher-income households, children who experienced <30 minutes/day from low-income households had a 2.30 (95% CI: 1.88, 2.80) higher risk of having lower language ability. The Relative Excess Risk Due to Interaction of 0.15 (95% CI:-0.15, 0.67) was greater than zero indicating a super-additive effect measure modification by income.

Conclusions

Our results suggest that boosting time in educational activities to 30 minutes/day would benefit the lower-income group relatively more than the higher-income group.

Key messages

If there was an intervention of sufficient dose to increase the amount of time spent in educational activities to 30 minutes/day for children in the lower-income group, the risk of children having lower language ability at school entry could be reduced by 45%.
388Investigating the utility of the customised fetal growth chart: a pragmatic randomised controlled trial
Authors: Gibbons Kristen , Beckmann Michael , Flenady Vicki , Gardenre Glenn , Gray Peter
Published: September 2021

Background

To determine if the routine use of a customised fetal growth chart, when compared to a standard growth chart, reduces the risk of adverse pregnancy outcome through increased detection of adverse growth.

Methods

A double-blind, single centre, randomised controlled trial was conducted. All women with a singleton pregnancy receiving routine antenatal care through hospital clinics were included and randomised to either a standard growth chart (SC) or a customised growth chart (CC). Serial measurements of symphyseal fundal height (SFH) were plotted onto the chart in the electronic clinical record; pre-programmed alerts notified the clinician when growth or size required review. The primary outcome measure was a composite perinatal morbidity/mortality outcome.

Results

3993 women were recruited; 45.4% nulliparous; 50.0% Caucasian, 17.8% Asian; 34.9% were overweight/obese prior to pregnancy; average 30 (SD 5.5) years old. The median (IQR) number of growth alerts was 2 (0-3) for both groups (p = 0.378); there was no difference in the total number of ultrasounds per pregnancy (median [IQR] 3 [2-4] for both groups, p = 0.266). There was no significant difference in primary composite outcome (CC 6.4%, SC 7.5%, p = 0.171) or individual components, apart from stillbirth (CC n = 1 0.05%, SC n = 8 0.4%, p = 0.039).

Conclusions

Use of a CC resulted in no difference in primary outcome, number of growth alerts or number of ultrasounds.

Key messages

In a large, pragmatic RCT use of a CC in conjunction with serial SFH measurements may infer some benefit over a SC, particularly in relation to stillbirth.
163Lunch establishments are associated to metabolic phenotypes in Brazilian adults: CUME project
Authors: Domingos Ana Luiza Gomes , Miranda Aline Elizabeth da Silva , Mattar Jéssica Bevenuto , Hermsdorff Helen Hermana Miranda , Pimenta Adriano Marçal , Bressan Josefina
Published: September 2021

Background

Studies have shown the relationship between food environment and obesity, but few explore metabolic phenotypes as outcomes.

Methods

We studied 4,311 adults (2,916 women, 1,395 men, with a mean age of 35.9 ± 9.4 y) from the Cohort of Universities in Minas Gerais, Brazil. Participants were classified as obese (BMI ≥ 30 kg/m²) or non-obese. Additionally, metabolic phenotypes were classified as healthy and unhealthy (≥ 1 conditions) based on the prevalence of hypertension, diabetes mellitus, hypercholesterolemia and hypertriglyceridemia. We also evaluated the type of food establishment where participants usually had lunch. Multinomial logistic regression analyzes were used to assess the relationship between lunch establishments and metabolic phenotypes, using the Metabolically Healthy Non-Obesity as reference category.

Results

The Metabolically Healthy Obese (MHO) phenotype represented 4.6% and 40.5% of the total sample and obese population, respectively. We found no associations between having lunch at home, in university restaurants or à la carte restaurants with metabolic phenotypes. Having lunch at large fast-food chains increased 1.88 (95% 1.22 - 2.90) times the chance of healthy obese phenotype and 1.56 (95% 1.03 - 2.37) times the chance of unhealthy obese phenotype.

Conclusions

The food habit of having lunch in unhealthy food establishments was associated with obesity, regardless of the classification of the metabolic phenotype.

Key messages

The habit of having lunch in fast food restaurants is associated with obesity.

Metabolically healthy obesity can be a transient state up to the unhealthy phenotype. This population must also be the target of nutritional interventions.
204Effects of adiposity on the human proteome: Mendelian randomization study using individual-level data
Authors: Goudswaard Lucy , Bell Joshua , Hughes David , Walter Klaudia , Soranzo Nicole , Butterworth Adam , Hers Ingeborg , Timpson Nicholas
Published: September 2021

Background

Variation in body mass index (BMI) is associated with cardiometabolic health outcomes such as diabetes, but the mechanism(s) leading from BMI to disease remain unclear. This study used proteomic data measured by SomaLogic from healthy adults from the INTERVAL study to explore the effect of BMI on 3,622 unique plasma proteins using observational and genetically informed methods.

Methods

Linear regression models were used, complemented by one-sample Mendelian randomization (MR) analyses. A BMI genetic risk score (GRS) comprised of 654 SNPs from a recent genome-wide association study (GWAS) of adult BMI was used in both observational and MR analysis.

Results

Observationally, BMI was associated with 1,576 proteins at p <1.4x10-5 including leptin and sex hormone binding globulin (SHBG). The BMI-GRS was positively associated with BMI (R2=0.028) but not with reported confounders. MR analysis indicated a causal association between each standard deviation increase in BMI and eight unique proteins at p <1.4x10-5, including leptin (0.63 SD, 95% CI 0.48-0.79, p = 1.6x10-15) and SHBG (-0.45 SD, 95% CI -0.65 to -0.25, p = 1.4x10-5). There was strong agreement in the direction and magnitude of observational and MR estimates (R2 = 0.33).

Finally, there was evidence that proteins which showed associations with BMI were enriched in cardiovascular disease.

Conclusions

This study provides evidence for a profound impact of higher adiposity on the human proteome. Such protein alterations could be important mechanistic drivers of obesity-related diseases.

Key messages

Changes in plasma proteins could be important intermediates between obesity and the onset of disease.
942Global Indigenous and Tribal Peoples Data Governance in Health Research: A systematic review
Authors: Griffiths Kalinda , Wallace Tessa , Vajdic Claire , Jorm Louisa
Published: September 2021

Background

Despite a broad range of research using Indigenous specific data, there is limited research to describe what constitutes data governance. To identify priorities and monitor progress in health, data is critical. Accurate collection and appropriate analysis of population level data is necessary in understanding population distributions of health and wellbeing. The aim of this review is to provide a comprehensive understanding of the current literature describing Indigenous Data Governance (IDG) processes in health research.

Methods

A comprehensive a-priori search strategy has been developed and submitted for registration through PROSPERO(APP170033). Literature will be sourced from bibliographic databases, review articles, key journals, conference proceedings, grey literature and referrals by key experts up until 01/2020 and synthesised (through meta-study and meta-aggregation approaches) in accordance with PRISMA guidelines.

Results

Once completed, a descriptive overview along with discussion on IDG processes in decision making specific to health research will be synthesized. IDG 'interventions' may include, but are not limited to, community advisory committees, Indigenous leadership, or institutional and/or project policies pertaining to decision making processes in the use of data in health research.

Conclusions

This review will provide evidence of definitions and procedures specific to IDG in the literature and how IDG, as a process, is operationalised in Indigenous health research across the globe.

Key messages

Preliminary Key messages include the lack of IDG processes described in the literature and the need for the development of guidelines to support researchers in operationalising Indigenous Data Sovereignty.
261Can a physical activity supportive environment reduce socioeconomic inequities in incident coronary heart disease?
Authors: Gullon Pedro , Bilal Usama , Hirsch Jana A. , Rundle Andrew , Judd Suzanne , Safford Monika , Lovasi Gina S.
Published: September 2021

Background

This research aims to: (1) explore the contribution of physical activity supportive environments to income inequities in coronary heart disease (CHD) incidence, and (2) investigate whether income inequities in CHD incidence are modified by physical activity supportive environments.

Methods

We used data from the REGARDS study, which recruited US-residents aged 45 or older between 2003 and 2007. Our analyses included participants at risk for incident CHD (n = 20808), followed until December 31st 2014. We categorized household income and treated it as ordinal: (1) $75,000+, (2) $35,000-$74,000, (3) $20,000-$34,000, and (4) <$20,000. We operationalized physical activity supportive environments within a 1-km residential buffer as density of walkable destinations and physical activity facilities, and proportion green land cover. Cox models were estimated the adjusted association of income with incident CHD, and tested effect modification by environment variables.

Results

We found a 17% (95% CI 8% to 25%) increased hazard of CHD per decrease in household income category. After adjusting for physical activity environments, the HR was attenuated by 3% (HR = 1.15), and the income-CHD association was stronger in areas lacking walking destinations (HR = 1.54 vs 1.16).

Conclusions

Physical activity supportive environments, especially those with walking destinations, may moderate associations between household income and CHD.

Key messages

Low-income individuals have greater risk of developing CHD, however, the built environment has a small moderating effect on this association. Income inequities in CHD were also noted to be higher in areas with no walking destinations
1270The Contribution of Lifestyle Patterns to Clustering of Elevated Depressive Symptoms within Birth Cohorts
Authors: Gueltzow Maria , Bijlsma Maarten J , van Lenthe Frank J , Myrskylä Mikko
Published: September 2021

Background

Some birth cohorts experience a larger burden of depression than others. We hypothesize that lifestyle, i.e. BMI, alcohol consumption, smoking and physical activity, are potential drivers of these generational differences.

Methods

We analyzed data from US adults aged 50-80 years enrolled in the Health and Retirement Study (N = 163,760 person-years). Birth cohort effects were estimated with the age-period-cohort model approach according to Carstensen. Consequently, we assessed the contribution of lifestyle factors by comparing the predicted probability of elevated depressive symptoms to a counterfactual scenario in which all birth cohorts are assigned the lifestyle factor distribution of the 1945 cohort (counterfactual decomposition analysis). We stratified all analyses by sex and ethnicity.

Results

BMI contributes to an increased probability of elevated depressive symptoms of up to 32.7% (95%CI: 190.9-11.23%, 1923 cohort) for cohorts born before 1927 and a decrease of up to 16.7% (95%CI: 0.5-26.8, 1964 cohort) for cohorts born after 1959. Contributions are most pronounced in females and white/Caucasians. Alcohol consumption contributes up to 20% (95%CI: 0.8%;45.3%, 1925 cohort) to cohort effects of elevated depressive symptoms, whereas the magnitude differs by ethnicity. We found no evidence for contributions of smoking or physical activity.

Conclusions

Birth cohort effects of elevated depressive symptoms can be partly explained by lifestyle. In particular, mental health of females and the white/Caucasian population may have suffered from the increase in obesity levels in the US.

Key messages

BMI and alcohol consumption, but not smoking or physical activity, contribute to birth cohort differences in depression risk.
701To estimate contraceptive prevalence rate and unmet need for family planning in rural Shimla
Authors: Gupta Anmol
Published: September 2021

Background

The utilization of family planning services has improved over the decade, but still the SDG’s health target to ensure universal access to sexual and reproductive health care services is yet to be achieved.

Methods

A cross-sectional study was undertaken in the rural field practice area of Department of Community Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India, from July 2018 to June 2019. Total sample size calculated was 410. Random sampling was used to select eligible couple to whom a predesigned, pretested, semi-structured and anonymous interview schedule was administered after taking consent.

Results

The mean age of the participants was 28.9 ± 5.9 years. The modern contraceptive prevalence rate (mCPR) was found to be 67.7% among women of reproductive age group (15-49 years). Male condom (36%), followed by female sterilisation (30%) were the most common methods preferred.

Conclusions

Besides male condoms and female sterilisation, other methods of contraception were adopted by meagre number of women. Though, the unmet need for family planning was lesser in this study, still, efforts are needed to plunge it, for ameliorating the contraceptive prevalence rate. Also, the availability of basket of contraceptive choices in government sector need sheer assiduity.

Key messages

The continuing IEC activity related to family planning methods need to be upsurged, so that the available contraceptives reach the community by and large. The government system of provision of contraceptives may be made accessible and convenient, so that the beneficiaries are inclined to utilise these services.
268An online survey of sexual health, knowledge and behaviour of young South Australians
Authors: Harfield Stephen , Elliott Salenna , Housen Tambri , Ward James
Published: September 2021

Background

Since 2010 rates of sexually transmitted infections (STIs-chlamydia, gonorrhoea and syphilis) have been increasing among young Australians. Most STIs are diagnosed in young people aged 16-29 and rates of diagnosis are higher among Aboriginal people than non-Aboriginal people. Little information exists to understand social and behavioural issues associated with increasing rate of STIs, especially in South Australia and among Aboriginal peoples.

Methods

We undertook an online cross-sectional survey of sexual health, knowledge and behaviour of young South Australians aged 16-29 years during a six-week period in 2019. Descriptive analysis, univariate and adjusted logistic regression models were used to compare Aboriginal and non-Aboriginal participants.

Results

In total 2,380 South Australians participated in the “Let’s Talk About It” (LTAI-2019); 52% were female, the median age was 20 years (IQR:17-24) and 10% of participants identified as Aboriginal. Regression analysis suggested among both Aboriginal and non-Aboriginal participants being female (aOR 2.41, CI:1.07-3.51, & 3.03, 2.17-4.23 respectively) and not using a condom during last sexual encounter (2.33, 1.03-5.29 & 1.62, 1.15-2.27) were associated with ever being tested for an STI and having two or more sexual partners in the past 12 months (1.37, 0.67-7.45 & 3.13, 1.31-7.45) was associated with testing positive for an STI.

Conclusions

LTAI-2019 is the first study to describe factors associated with STIs among young South Australians. It is evident that young people are engaged in behaviours which increase their risk of acquiring STIs. Public health action which considers these behaviours particularly those that target young Aboriginal people is required.

Key messages

LTAI 2019 is the first study to describe current sexual health, knowledge, behaviours and access to health services for STIs and related issues amongst young South Australians. It provides evidence that is useful for informing both public health practice and policy, and the development of STIs preventative health programs.
264Antibiotic use associated with acute gastroenteritis in Australian primary care
Authors: He Wen-Qiang , Kirk Martyn , Hall John , Liu Bette
Published: September 2021

Background

Inappropriate antibiotic use is a global health concern as it increases antibiotic resistance. Antibiotics are not routinely recommended for treating acute gastroenteritis, non-typhoidal salmonella and campylobacter infections. We investigated adherence to these recommendations in primary care.

Methods

We used a large electronic database of primary care records to identify presentations for acute gastroenteritis, non-typhoidal salmonella and campylobacter infections and antibiotic prescribing from 1st Jan 2013 to 31 December 2018. We estimated the proportions of cases prescribed antibiotics according to various characteristics and examined the antibiotics prescribed.

Results

A total of 86998, 1106, and 1952 participants were identified with acute gastroenteritis, non-typhoidal salmonella, and campylobacter infections and correspondingly 10% (8720/86998), 40% (437/1106), and 57% (1118/1952) of these cases were prescribed antibiotics in the period up to 5 days post-diagnosis. Patients residing in outer regional/remote areas and those from Northern Territory and Queensland were more likely to be prescribed antibiotics than those residing in major cities and those from other states (p < =0.04). No dominant antibiotic class was prescribed for acute gastroenteritis. Quinolones (28.6%) and macrolides (27.0%) were the most frequently prescribed antibiotics for non-typhoidal salmonella, and macrolides (69%) were the predominant antibiotics prescribed for campylobacter.

Conclusion

The high proportion of antibiotics dispensed in the general population with acute gastroenteritis, non-typhoidal salmonella and campylobacter infections suggests that antimicrobial stewardship needs to include better education and awareness around treatment guidelines for such infections.

Key messages

Antibiotics use was common for Australian population with acute gastroenteritis, particularly those with non-typhoidal salmonella and campylobacter infections.