bluuebunny/crossref_metadata_2025 huggingface dataset:
432Recurrent stillbirth: a population-based study from South Australia
Authors: Smithers Lisa , Lamont Kathleen , Bhattacharya Sohinee
Published: September 2021

Background

In high-income countries, stillbirth is a relatively rare event occurring in < 1% of pregnancies. Recurrent stillbirth is even rarer. Our objective was to explore the prevalence of stillbirth and recurrent stillbirth, factors associated with stillbirth and whether a stillbirth in first pregnancy influences the time to subsequent pregnancy.

Methods

This population-based study involved routinely-collected administrative data on singleton births in South Australia from 1998 to 2015 (n = 333,785). Stillbirth was defined as pregnancies >20 weeks gestation or weighing >400 grams. Univariable and multivariable logistic regression was used to explore associations between sociodemographic factors and stillbirth. Cox proportional hazard was used to explore time to pregnancy.

Results

0.7% of all first pregnancies and 0.6% of all second pregnancies were stillbirths. Of women in their second pregnancy, <10 experienced recurrent stillbirth. In univariable analyses, higher odds of stillbirth in second pregnancies were associated with younger and older maternal age (<20 or ≥ 40 years), being single, unemployed, smoking, shorter inter-pregnancy intervals and numerous medical conditions (e.g. diabetes or hypertension). Multivariable models were unstable due to too few data. The hazard ratio for women who previously experienced a stillbirth compared with livebirth was 1.14 (95%CI 0.39, 3.32).

Conclusions

Studying recurrent stillbirth is especially difficult due to the rare nature of the problem, limiting progress on developing evidence-based advice for women who experience stillbirth in their first pregnancy.

Key messages

Recurrent stillbirth is challenging to study due to the rareness of the problem but could be addressed by careful pooling of large administrative datasets.
1065Diesel exposure and bladder cancer in contemporary Western Australian miners
Authors: Sodhi-Berry Nita , Franklin Peter , Peters Susan , Reid Alison , Musk Arthur (Bill) , Fritschi Lin , Vermeulen Roel , de Klerk Nicholas
Published: September 2021

Background

Diesel engine exhaust (DEE) is classified as a potential carcinogen for bladder cancer in humans by the International Agency for Research on Cancer. We aimed to compare bladder cancer incidence in Western Australian miners against the general population and determine if there was an association with DEE, measured as Elemental Carbon.

Methods

A whole-of-population cohort of 218,846 Western Australian miners employed during 1996-2013 was followed-up until June-2017. DEE exposure data was derived from work histories and collated with administrative State-wide cancer and death data. Standardised Incidence Ratios (SIRs) were calculated to compare rates with the general population. A nested case-control study design with matching on attained age was used. Conditional logistic regression was done to calculate Odds Ratios (ORs) for cumulative Elemental Carbon exposure (unlagged and 15-year lagged), after adjusting for smoking pack-years.

Results

Ninety cases (88 males) were observed and 180,377 controls selected. Miners had lower bladder cancer incidence than the general population (Observed=90; Expected=135.60; SIR:0.66, 95%CI:0.53-0.80). Within miners, DEE exposure was not found to be statistically significantly associated with bladder cancer (unlagged: OR = 0.75, 95%CI: 0.43-1.31; and 15-year lagged: OR = 0.59, 95%CI:0.25-1.40), after adjusting for smoking pack-years (unlagged and lagged OR:1.02, 95%CI:1.01-1.03).

Conclusions

Miners had lower risk of bladder cancer than the general population. DEE exposure was not associated with bladder cancer in this nested case-control study of contemporary Western Australian miners.

Key messages

Diesel engine exhaust was not found to be associated with bladder cancer in miners.
791Health Promotion in High School curriculum: Brazil and Canada
Authors: Souza Israel
Published: September 2021

Focus of Presentation

Searching on documents about High School (or Secondary) education we found some differences in both curriculum, Brazil and Canada. High School in Brazil has three year (grade 10 to 12). In other hand, High School in Canada has four years (grade 9 to 12). The main focus of this work is a comparison about how “health promotion” appears in High School curriculum in Brazil and Ontario-CA, in especial at Physical Education curriculum.

Findings

In Brazilian High School, Physical Education curriculum is mandatory. However the key-words “health” appears 11 times in a federal document (Ministry of Education) with 241 pages. Key-words like “health promotion” appear one time and “social determinants” none. Ontario-CA have a Health and Physical Education curriculum. In this case, the key-words “health” appears more than 1000 times in a province document (Ministry of Education) with 224 pages. Key-words like “health promotion” appear 14 times and “social determinants” 3 times.

Conclusions/Implications

Text Physical Education curriculum in Brazil need to emphasize “health promotion” contents as a life condition and physical literacy and health literacy. Meantime, Ontario-CA curriculum show a few content about “social determinants” which is a core concept in “health promotion” studies.

Key messages

Text High School curriculum need emphasize “health promotion” and “social determinants” as a core concept for a physical literacy and health literacy.
775Should pain scales be combined
Authors: Stanhope Jessica , Weinstein Philip
Published: September 2021

Background

Pain is often measured by asking people to rate their pain intensity at its worst, on average, and at its least, for the last 7 days using numeric rating scales. The three ratings are summed to produce a composite measure. The validity and reliability of this composite measure has not been examined using modern psychometric methods in any population. We examined the validity and reliability of this pain intensity measure for use with professional musicians, university music and science students, and university staff, all of whom had reported experiencing musculoskeletal symptoms in the last 7 days.

Methods

Data were collected using a questionnaire survey. The validity and reliability of the composite pain measure were examined using Rasch analysis. Differential item functioning was examined for age, gender, student status, musician status, and socioeconomic status.

Results

While the data fit one of the Rasch models, after several response categories were collapsed, differential item functioning was present. There was no solution found that fit one of the Rasch models, without differential item functioning.

Conclusions

Despite the recommendation for the three number ratings scales for pain to be combined, using Rasch analysis showed that this was not a valid approach for our study population. Our findings highlight the importance of using Rasch analysis to examine the utility of measures.

Key messages

Rasch analysis is a useful method for investigating the validity and reliability of scales. Combining pain ratings cannot be assumed to produce a valid and reliable measure.
169Folic acid intake and dementia - a 27-year global longitudinal study
Authors: Suzuki Norie , Shirai Yoshiro , Abe Chisato , Imai Tomoko , Sezaki Ayako , Miyamoto Keiko , Kawase Fumiya , Inden Ayaka , Kato Takumi , Sanada Masayo , Shimokata Hiroshi
Published: September 2021

Background

Folate deficiency increases serum homocysteine and may cause cognitive impairment. However, there have been no international longitudinal studies that examined the association between folic acid intake and dementia. We investigated the longitudinal association between folate intake and the prevalence of dementia using global data during 27 years.

Methods

Prevalence of Alzheimer’s disease and other dementias and folic acid intake by country were obtained from the Global Burden of Disease (GBD) 2017 database. The longitudinal associations between folic acid intake and prevalence of dementia was examined using linear mixed effect model during 27 years from 1990 to 2017 in 151countries with populations of 1 million or greater. The effects of folic acid, year and interaction of folic acid and year were estimated controlling for covariates including socio-economic variables and life-style variables.

Results

Fixed effects of folic acid was highly significant (mean and SE; -33.1±7.1, p < 0.001) and interaction of folic acid and survey year was also significant (0.90±0.13, p < 0.001). Slope of folic acid for dementia prevalence was significant in 1990 and the slope has decreased with the year and has become not significant after 2011.

Conclusions

Folic acid was associated with the prevalence of dementia, but weakened over the years.

Key messages

Although folic acid intake has been associated with the of dementia, the risk of dementia may be increasingly related to factors other than nutrition.
167Epidemiology of food choking deaths in Japan: Time trends and regional variations
Authors: Taniguchi Yuta , Iwagami Masao , Sakata Nobuo , Watanabe Taeko , Abe Kazuhiro , Tamiya Nanako
Published: September 2021

Background

We aimed to investigate the nationwide epidemiology of food choking deaths in Japan.

Methods

Using Japan Vital Statistics death data (2006-2016), we identified food choking deaths based on the 10th revision of the International Statistical Classification of Diseases code W79 (Inhalation and ingestion of food causing obstruction of respiratory tract). The demographics of people with food choking deaths; temporal trend of food choking deaths by the year (overall and by age group) and the day of year; and prefecture variations, were reported.

Results

52,366 people experienced food choking deaths (median age, 82 years, 53% were men, and 57% occurred at home). The highest number of food choking deaths occurred in January 1, 2, and 3, in that order; and lowest in June. Despite a constant total number of cases at around 4000 yearly, the incidence proportion declined from 16.2 to 12.1 per 100,000 population from 2006 to 2016 among people aged 75-84 years. The proportion peaked at 53.5 (2008) and decreased to 43.6 (2016) among people aged ≥85 years. Prefecture variations occurred in the number of food choking deaths, highest in Niigata and lowest in Kyoto.

Conclusions

The results suggest targets (by age group, region, and day of the year) for the prevention of food choking deaths. Time trends and regional variations may be related to the consumption of Japanese rice cake (mochi), known as a major cause of food suffocation in Japan.

Key messages

The number of food choking deaths in Japan was highest on New Year’s Day.
1204Modelling impact of targeted hepatitis B treatment for culturally and linguistically diverse populations in Australia
Authors: Taye Belaynew , Valery Patricia , Clark Paul
Published: September 2021

Background

Antiviral treatment gap in culturally and linguistically diverse (CALD) populations may be a barrier progress in national elimination. Using modelling, we estimated and predicted the impact of antiviral treatment and migration on HBV burden, and HBV-related mortality in CALD populations in Australia.

Methods

We developed a dynamic, deterministic mathematical model using three antiviral treatment scale-up scenarios - the baseline treatment, intermediate treatment scale-up (80% of eligible by 2030), and optimistic scale-up (20% of all HBV by 2022) to predict the incidence of HBV infection, liver cirrhosis, hepatocellular carcinoma, and HBV-related mortality in four groups of people according to their country of birth.

Results

The number of chronic HBV cases will remain similar, and HBV-related morbidity and mortality will increase if the baseline approach is followed to 2030. Implementing an optimistic treatment scale-up could reduce the number of new cases of liver cirrhosis (30% in European-born, and 40% in Asia-Pacific-born) by 2030. Following the optimistic scale-up approach, the incidence of HCC decreased by 30% and a 15%-25% reduction in HCC-related mortality could be achieved in the four population subgroups by 2030.

Conclusions

Following the current antiviral treatment coverage, HBV elimination targets in migrants may not be achieved. A rapid treatment scale-up approach reduces HBV incidence, liver cirrhosis and HCC.

Key messages

Targeted antiviral treatment for migrants with HBV using rapid scale-up reduces HBV-related disease and mortality and contributes to achievement of national elimination targets.
1397Clinical status of consulting COVID 19 cases and fatal outcome in a Cameroon regional hospital
Authors: Nighie Ketina Hirma Tchio , Ateudjieu Jerome
Published: September 2021

Background

Due to its high attack rate, COVID 19 is responsible for a high number of deaths despite its relatively low lethality rate. This study was conducted to assess the relationship between time to consultation, presence of respiratory complications at hospital admission and fatal outcome of COVID 19 cases.

Methods

This was a case control design study which collected data from records of all COVID 19 patients admitted in Bafoussam Regional Hospital from March 2020 to April 2021. The association between the delay in seeking care, dyspnoea and blood oxygen level at admission, and fatal outcome was assessed by estimating crude and adjusted odd ratio.

Results

Of 400 included patients, 239 (59.75%) were male, 84 (23.73%) health professionals and 144 (36.0%) aged 64 years and above. The mean duration of hospitalization was 11.39 days and 120 (30.0%) admitted patient died. Seeking care during or before the end of the first day of symptom onset significantly reduced the risk (Adjusted (A) OR = 0.4 (0.16-0.98)) of fatal outcome, whereas waiting three (AOR=0.6(0.31-1.16))or seven days (AOR=0.91(0.47-1.75)) did not change this risk. Dyspnoea (AOR=2.71(1.38-5.29)) or oxygen level <95% (AOR=22.87(2.99-174.76)) significantly increased the risk of fatal outcome.

Conclusions

Health interventions contributing for early detection and connection of COVID 19 cases to care before respiratory complications occur are expected to reduce mortality in COVID 19 patients.
1289Decline in duration, satisfaction and sleep quality among informal caregivers of stroke survivors, 18-months post-stroke
Authors: Teixeira Phd Filipa , Moura Ana , Alves Elisabete
Published: September 2021

Background

Data on stroke caregivers’ sleep is scarce. We aimed to assess changes in duration, satisfaction and sleep quality among informal caregivers of stroke survivors.

Methods

Informal caregivers (n = 126) of stroke survivors hospitalized between September 2018 and August 2019 in the 12 Stroke Units of the North of Portugal were invited to participate in the study, 18 months’ post-stroke. Sociodemographic and sleep characteristics (duration, satisfaction and quality) were collected through structured questionnaires. Odds ratios and 95% confidence intervals (95%CI) were estimated through logistic regression, adjusted for age and sex. Answers to open-ended questions were synthetized using content analysis.

Results

Due to care provision, informal caregivers reported sleeping, on average (SD), significantly less hours (7.0 (1.7) vs. 6.4 (1.8); p < 0.001). Since its beginning, caregivers’ satisfaction with their sleep decreased approximately 30%. Changes in sleep quality, namely difficulties in falling asleep and constant interruptions during sleep, were reported by almost 70% of caregivers. Only 6.4% described the prescription of medication to sleep after beginning care provision. Participants who returned to work (adjusted OR = 0.34; 95%CI:0.16-0.76) and with a monthly income above 1000€ (adjusted OR = 0.29; 95%CI:0.13-0.66) were less likely to report changes in sleep quality.

Conclusions

A decline in duration, satisfaction and sleep quality of informal caregivers of stroke survivors, 18 months’ post-stroke, was observed. Changes in sleep quality revealed socioeconomic inequalities, highlighting the need to prevent adverse health outcomes related to sleep disturbance.

Key messages

Sleep health dimensions of stroke caregivers should be considered an additional dimension of the post-stroke care services.
1481Epidemiology of membranous nephropathy in thirteen Asia-Pacific nations using an incidence-to-prevalence model
Authors: Thakur Shilpa , Isherwood Alison
Published: September 2021

Background

Primary membranous nephropathy (PMN) is the leading cause of nephrotic syndrome. Several studies conducted in Asia-Pacific region report the incidence of PMN. However, there is a paucity of peer-reviewed published prevalence data for this condition.

Methods

A literature review was conducted using PubMed and Clarivate’s Cortellis database from 1/1/1980 to 1/11/2019) to identify country-specific, age- and gender-specific diagnosed incidence rates and observed survival data-point inputs for use in our incidence- prevalence model. For countries lacking published incidence data, logical extrapolations were made, applying the incidence from countries based on comparable geography and healthcare access.

Results

The diagnosed prevalence of PMN varies substantially between the countries under study, from 15 per million population (PMP), in the Philippines to 277 PMP in China in 2021. The number of diagnosed prevalent cases of PMN in the countries under study will increase by 21% over 2021-2031 with highest growth in Vietnam (34%) and lowest in Australia (9%).

Conclusions

The prevalence of PMN is expected to increase over the next ten years due to population aging, changes in population size, and improvements in survival in the countries under study. Limited registry and published prevalence data for these countries is highlighting the need for increasing awareness and research for this rare disease.

Key messages

This study provides the insights into the current and future trends in the prevalence of PMN in next 10-years (2021-2031) which was otherwise not reported in the published literature
1433Community Health Workers for non-communicable diseases: a systematic review and meta-analysis
Authors: Thapa Rajshree , Thrift Amanda , Mishra Shiva Raj , Zaman Sojib Bin , Zengin Ayse
Published: September 2021

Background

We evaluated the effectiveness of various community health workers (CHWs)-led interventions for several non-communicable diseases (NCD) risk-factors in both low- to middle-income countries (LMICs) and high-income countries (HICs).

Methods

We included interventions by CHWs targeting the uptake of services for NCDs and conducted meta-analyses of randomized controlled trials. Net differences in blood pressure (BP), glycated hemoglobin (HbA1c), fasting blood glucose, triglycerides, low-density lipoprotein-cholesterol (LDL-C) cholesterol, and body mass index (BMI) were calculated between intervention and control groups .

Results

Seventy-three studies were included. CHWs-led interventions were effective in reducing systolic BP -2.94 mmHg [95% CI: -4.28 to -1.59; I2=73%], diastolic BP -1.59 mmHg [-2.54 to -0.64; 81% ], HbA1c% -0.31 [-0.45 to -0.17; 52%], and triglycerides -8.32 mg/dl [-13.54 to -3.10; 0.0%]. The mean change in HbA1c% was detectable in studies undertaken in HICs [-0.35 (-0.45 to -0.1)] but not in LMICs [-0.03 (-0.21 to 0.15)]. Interventions targeting diabetes were also effective in reducing systolic BP by -2.30 mmHg (-4.22 to -0.38). There was no evidence that these interventions reduced BMI or LDL-C.

Conclusions

Engagement of CHWs is an effective strategy to reduce BP. They are also effective in reducing HbA1c and triglycerides in HICs; but further research is needed in LMICs. It also appears that interventions led by CHWs may be effective in reducing more than one risk factor simultaneously.

Key messages

Engaging CHWs is an important strategy to combat the growing burden of hypertension.
377Smoking, blood pressure, and body mass index to estimate healthy life expectancy: NIPPON DATA90
Authors: Tsukinoki Rumi , Hayakawa Takehito , Kadota Aya , Murakami Yoshitaka , Miura Katsuyuki , Okayama Akira , Okamura Tomonori , Ueshima Hirotsugu ,   the NIPPON DATA90 Research Group
Published: September 2021

Background

Healthy life expectancy (HLE) is an important measure of an ageing society. We estimated HLE based on combinations of smoking, blood pressure (BP), and body mass index (BMI) in the Japanese population using a multistate life table.

Methods

A nationwide cohort study of Japan was performed using NIPPON DATA90 (N = 6,676) with the Katz Activities of Daily Living Index as the HLE endpoint. Combinations of smoking (non-smokers and smokers), BP (2018 ESC/ESH Guidelines classification), and BMI (underweight, normal, and overweight) were developed, and the group-specific HLEs were calculated using a multistate life table.

Results

At age 65, smokers had shorter HLE than non-smokers for all BMI and BP groups. The HLE of men who were overweight, hypertensive (Grade 2 or 3), and smokers was 14.05 years (95% confidence interval: 15.77-21.36); in contrast, the HLE of men who were normal weight, normotensive, and non-smokers was 19.04 years (16.46-21.61). Among all BMI and smoking status groups, HLE decreased linearly as BP increased regardless of sex. The HLE distribution showed a slight inverted U-shape as BMI increased in both sexes.

Conclusions

This study showed that HLE at age 65 was considerably shorter in smokers and individuals with higher BP. Furthermore, both underweight and overweight had modest effects on HLE at age 65.

Key messages

HLE was considerably shorter in smokers and individuals with higher BP. In addition, both underweight and overweight had modest effects on HLE.
346Experience of intimate partner violence among Nigerian women: evidence from 2018 NDHS
Authors: Uchendu Obioma , Olabumuyi Olayide , Awosika Olawale
Published: September 2021

Background

Women’s perception, decision-making power and childhood experiences are factors associated with their experience of intimate partner violence (IPV). This study assessed the IPV experiences of Nigerian women of reproductive age across the geo-political zones and the factors associated with their experience of IPV.

Methods

Using the 2018 Nigeria Demographic and Health Survey (NDHS), complex sample analysis of a subset of 8,163 women of reproductive age who were currently in union was done using SPSS version 23. Respondents and partners demographic profile, their childhood experience and perception of IPV was fitted into the multivariate regression model.

Result

Mean age of the respondents was 31.3 ± 8.2 years. Childhood experience of domestic violence and poor perception of IPV was reported by 9.9% and 28.9% respectively. Over a third (35.5%) had experienced one form of IPV. The odds of experiencing IPV was 1.4 times and 3.3 times higher among those with poor perception of IPV [OR = 1.38; 95% CI = 1.184-1.597] and had childhood experience of domestic violence [OR = 3.29; 95% CI = 2.706-3.990] respectively.

Conclusion

About a third of women of reproductive age group in Nigeria experiences IPV. Childhood experience of IPV and poor perception of IPV were significant predictors of IPV experience.

Key message

Childhood experience of domestic violence may influence individuals’ perception of IPV which may be accepted as a norm as they grow. Interventions at reducing IPV should start from childhood to change the perception of IPV as being acceptable.
31Effect of Health Education on Knowledge of Tuberculosis among patent Medicine vendors in Enugu
Authors: Udeh Simon Chijioke
Published: September 2021

Background

Tuberculosis remains a serious public health threat to people of all sexes and ages in Nigeria. Any intervention that could improve the knowledge of tuberculosis and treatment services is expected to improve case finding and ultimately the cure rates. The world health organization global Tuberculosis report, 2014 shows that Enugu recorded slight increase in all cases of Tuberculosis and reporting remains low. The aim of this study is to determine the effect of a health education intervention on knowledge and management of tuberculosis among patent medicine vendors in Enugu

Methods

This is an educational interventional study carried out among 400 patent medicine vendors in Enugu. The baseline data on knowledge and management practice was determined using an interviewer-administered semi-structured.

Results

we found out that level of education was significantly associated with TB-related knowledge and management. The baseline study shows that the patent medicine vendors (PMVs) have poor knowledge of Tuberculosis prior to this study. This agreed to the preliminary investigation which shows that they contribute 65.6% to increase in multi-drug resistant TB, poor case finding /reporting in Enugu. The post assessment results, shows increase in knowledge of tuberculosis and management of TB among the PMVs

Conclusions

The health education impacted significantly on the knowledge of the PMVs on Tuberculosis. Therefore, emphasis should be laid to more train and retrain the PMVs in toward improving TB case detection.

Key messages

Health education, Knowledge, tuberculosis, PMVs
1510Development and validation of a Job Exposure Matrix for work related risk factors for COVID-19
Authors: Veldhoven Karin van , Basinas Ioannis , Hengel Karen Oude , Burdorf Alex , Pronk Anjoeka , Peters Susan , Schlünssen Vivi , Stockholm Zara Ann , Kolstad Henrik Albert , van Tongeren Martie
Published: September 2021

Background

Studies have shown a higher mortality due to COVID-19 amongst certain professions. The risk of becoming infected with SARS-CoV-2 and the occupational conditions associated with this, have not been studied extensively. This study aimed to develop and validate a Job Exposure Matrix (JEM) to assess the risk of COVID-19 in the workplace.

Methods

Researchers from three European countries defined six dimensions (four transmission determinants, two mitigation measures) to classify occupational risk. A combination of national statistics and expert judgement was used to classify ISCO-08 codes in no, low, elevated, or high risk for each dimension. Two data driven aspects of precarious work were also included and classified in four categories. The JEM was translated to SOC2010-codes and validated by comparing it to UK infection survey data and ONS estimates of exposure based on ONET data.

Results

A slightly increasing proportion of COVID-19 cases was observed with increasing risk scores in each dimension of the JEM. There was a high correlation between the JEM and the ONS estimates for physical proximity (r = 0.71) and exposure to COVID-19 or SARS-CoV-2 infection (r = 0.80)

Conclusions

Successful development and initial validation of this JEM has resulted in a useful tool for risk assessment of COVID-19 in the workplace. Further validation exercises will continue.

Key messages

This publicly available JEM can play a key role in the essential assessment of occupational contribution to the total burden of the COVID-19 pandemic.
1075Patterns, determinants and socioeconomic inequalities in eating healthy in Kenya
Authors: Wambiya Elvis Omondi Achach , Mohamed Shukri , Kisia Lyagamula , Pierre Hermann Donfouet Pythagore
Published: September 2021

Background

Kenya is undergoing an epidemiological transition marked by an increase in the burden of non-communicable diseases (NCDs) with unhealthy diet being a key risk factor. This study sought to identify patterns, determinants and socioeconomic inequalities in healthy food consumption in Kenya.

Methods

A secondary analysis of the Kenya Integrated Household Budget Survey 2015/2016 (KIHBS) data was conducted. A healthy diet indicator (HDI) was computed from food consumption information using principal component analysis (PCA) based on WHO and FAO recommendations. Multivariable probit regression was used to identify determinants of eating healthy. The concentration index (CI) method was used to identify socioeconomic inequalities in eating healthy overall, by gender and residence using household aggregate consumption per adult equivalent.

Results

The final sample consisted of 21, 512 households. Two thirds of them were rural and majority were male-headed (66%). 49% of households were eating healthy countrywide. HDI scores increased with increasing socioeconomic status overall, by gender and residence. Households with higher socioeconomic status (0.30, p < 0.01), rural (0.20, p < 0.01), in union (0.07, p < 0.01) and Christian (0.16, p < 0.01) were more likely to eat healthy while male-headed (-0.04, p < 0.01), Muslim (-0.07, p < 0.05) and households whose household-heads had lower education status (-0.09, p < 0.01) were less likely to eat healthy. Eating healthy was concentrated among the rich overall, by gender and residence.

Conclusions

A large proportion of Kenyans are consuming unhealthy foods with the rich eating healthier than the poor.

Key messages

Interventions are required to promote healthy dietary patterns and reduce socioeconomic inequality in eating healthy.
278Sources and health risk of exposure to neonicotinoids in Chinese children: A biomonitoring-based stud
Authors: Wang Hexing , Yang Dongjian , Fang Hongji , Han Minghui , Tang Chuanxi , Wu Jingui , Chen Yue , Jiang Qingwu
Published: September 2021

Background

Recent studies have suggested an extensive exposure to neonicotinoids in human, but the sources and health risk of exposure to neonicotinoids remains little known in children.

Methods

After 309 school children were selected in 2019 from a dynamic child cohort established in Shanghai, East China, detailed data about basic information, intake of drinking water, and food consumption were collected and 12 typical neonicotinoids and metabolites were determined in morning urine. Sources of exposure to neonicotinoids were explored by binary/ordinal logistic regression model. Health risk was assessed by hazard quotient (HQ) and hazard index (HI).

Results

Except for imidaclothiz, thiacloprid, and 5-OH-imidacloprid, other six neonicotinoids and three metabolites were detected in 81.3% of urine samples overall. After adjusted for potential confounders, Thiamethoxam was more detected in children consuming more fresh vegetables (odds ratio (OR): 2.93, 95% confidence interval (CI): 1.21,7.14) and its subgroup (Chinese cabbage (OR: 2.00, 95%CI: 0.89,4.46) and nori and kelp (OR: 2.25, 95%CI:1.21,4.17)). Clothianidin showed a similar association with fresh vegetables and its subgroup to thiamethoxam. N-desmethyl-acetamiprid were detected in children drinking type water more (OR: 1.84, 95%CI: 1.10,3.06). The maximum HQ and HI were 0.3522 and 0.5187, respectively, and 2.8% of children had HIs between 0.1 and 1.

Conclusions

Tap water and fresh vegetables were potential exposure sources. A low health risk was posed on Chinese children by neonicotinoids. Given limited data about the adverse effects of neonicotinoids on human, sufficient attention should be paid to the exposure to these compounds and potential health effects.

Key messages

Tap water and fresh vegetables were exposure sources and a low health risk was posed on Chinese children by neonicotinoids.
998Use of antibiotics in pregnancy and ear infection trajectories in children
Authors: Wang Jing , Wang Jing
Published: September 2021

Background

Exposure to antibiotics during pregnancy can exercise a teratogenic effect on foetuses. Middle ear infection represents the most common cause of physician visits for sick children. Its patterns may be partly explained by antibiotics use during pregnancy. This study aimed to investigate the associations between antibiotics use in pregnancy and ear infection trajectories.

Methods

Design & Participants: Birth cohort assessed biennially from 2004 to 2014 spanning ages 0-1 to 10-11 years in the Longitudinal Study of Australian Children. Measures: Mothers-reported antibiotics use in pregnancy; Parent-reported ongoing ear infections (waves 1 to 6). Analysis: Latent class models identified ear infection trajectories. Multinomial logistic regression quantified associations between antibiotics use in pregnancy and ear infection trajectories.

Results

of the 4500 included children (mean age at baseline wave 0.7 years, 51.3% boys), 10.4% had parent-reported antibiotics use in pregnancy. Four probability trajectories of ear infection emerged: “consistently low” (86.2%), “moderate to low” (5.6%), “low to moderate” (6.7%), and “consistently high” (1.4%). Antibiotics use in pregnancy was associated children following “moderate to low” (OR 1.8, 95% CI 1.3 to 2.6) and “consistently high” (OR 2.1, 95% CI 1.1 to 4.0) trajectories.

Conclusions

Antibiotics use in pregnancy increases the risk of persistent and early ear infections in the offspring, implying that reducing unnecessary antibiotics use during pregnancy may prevent childhood ear infections. Additional information on classes and timing of antibiotics exposure at different stages of pregnancy and ear infections resistance could further explain this relationship and inform interventional studies.

Key messages

Antibiotics use in pregnancy is associated with an increased risk of persistent and early ear infections in the offspring.
1206Will access to Covid-19 vaccine in Aotearoa be equitable for priority populations?
Authors: Whitehead Jesse , Scott Nina , Carr Polly Atatoa , Lawrenson Ross
Published: September 2021

Background

This research examines the equity implications of the geographic distribution of COVID-19 vaccine delivery locations in Aotearoa New Zealand under five potential scenarios: (1) stadium mega-clinics; (2) Community Based Assessment Centres; (3) GP clinics; (4) community pharmacies; and (5) schools.

Methods

We mapped the distribution of Aotearoa New Zealand’s population and the location of potential vaccine delivery facilities under each scenario. Geostatistical techniques identified population clusters for Māori, Pacific and people aged 65 years and over. We calculated travel times between all potential facilities and each Statistical Area 1 in the country. Descriptive statistics indicate the size and proportion of populations that could face significant travel barriers when accessing COVID-19 vaccinations.

Results

Several areas with significant travel times to potential vaccine delivery sites were also communities identified as having an elevated risk of COVID-19 disease and severity. All potential scenarios for vaccine delivery, with the exception of schools, resulted in travel barriers for a substantial proportion of the population. Overall, these travel time barriers disproportionately burden Māori, older communities and people living in areas of high socioeconomic deprivation.

Conclusions

The equitable delivery of COVID-19 vaccines is key to an elimination strategy. However, if current health services and facilities are used without well-designed and supported outreach services, then access to vaccination is likely to be inequitable.

Key messages

Organisations need to proactively plan for equity, including the delivery of COVID-19 vaccines. A social justice approach should be prioritised, and in Aotearoa Te Tiriti o Waitangi obligations must be met.
179Selecting health need indicators for spatial equity analysis of primary health care in New Zealand
Authors: Whitehead Jesse , Pearson Amber , Lawrenson Ross , Atatoa-Carr Polly
Published: September 2021

Background

Populations with high needs often have poor health care access. Defining need is challenging, with no agreed-upon indicator of health need for primary care based spatial equity research in New Zealand. We examined seven potential indicators and tested for evidence of the Inverse Care Law in the Waikato region.

Methods

Indicators were identified through a systematic literature review and scored according to ten selection criteria. Indicators were mapped and analysed using GIS. Spearman’s correlations were calculated between indicators, and clusters of high need identified through spatial autocorrelation. The impact of incorporating indicator-based-weightings into an accessibility model was tested using ANOVA and Spearman’s correlations. GP service spatial equity was assessed by comparing clusters of access and need, and quantified through the Gini coefficient.

Results

While smoking rates met the most selection criteria, ambulatory sensitive hospitalisation (ASH) rates were significantly correlated with all indicators. Health needs were significantly clustered, but incorporating indicator weightings into the spatial accessibility analysis did not impact accessibility scores. A misalignment of access and need, and Gini coefficient of 0.281 suggests that services are not equitably distributed.

Conclusions

ASH rates seem a robust indicator of health need. However, data access issues may restrict their use. High need clusters vary spatially according to the indicator used.

Key messages

GIS techniques can identify ‘hot-spots’ of need, but these can be masked in accessibility models. Indicators should be carefully selected according to the research question.
582Cost-effectiveness of AC-TH compared with TCH in new adjuvant therapy of breast cancer
Authors: Xu Qiao Ping ,   Health statistics researcher Yuanyuan LI,   The Attending Pharmacist Jiejing ZHU, Liu Jian , LI Qingyu , YAN Wei
Published: September 2021

Background

To analyze the cost-effectiveness of Doxorubicin/cyclophosphamide/Paclitaxel/trastuzumab (AC-TH) and Docetaxel/Carboplatin/trastuzumab (TCH).

Methods

A Markov model was built to simulate the process of breast cancer events and death occurred in both AC-TH and TCH armed patients and to choose a suitable chemotherapy method. Data were collected from the clinical trials, some publicized literatures and patients’ diaries of a large Chinese comprehensive hospital. The cost-effectiveness analysis of two regimens and sensitivity analysis were performed using a Markov model.

Results

We identified 41 breast cancer patients at Hangzhou First People’s Hospital, among whom 15 (60%) had a partial response for AC-TH treatment and 13 (81.25%) had a partial response for TCH treatment. No cardiac toxicity was observed. Hematologic grade 3 or 4 toxicities were observed in 1 of 28 patients. Nonhematologic grade 3 or 4 toxicities with a reverse pattern were observed in 6 of 29 patients. The mean QALY gain per patient compared with TCH was 0.25 with ACTH, while the incremental costs were $US 13,142. The incremental cost-effectiveness ratio (ICER) of AC-TH versus TCH was $US 52,565 per QALY gained.

Conclusions

TCH neoadjuvant chemotherapy was feasible and active in HER2-overexpressing breast cancer patients in terms of the pathological complete response, complete response, and partial response rates and manageable toxicities.

Key messages

breast cancer; neoadjuvant chemotherapy; pharmaceutical economics; Markov model; cost-effectiveness analysis.
477Long-term exposure to low PM2.5 and NO2 and all-cause mortality in Australia: a difference-in-differences analyses
Authors: Xu Rongbin , Li Shanshan , Abramson Michael , Guo Yuming
Published: September 2021

Background

Although many cohort studies have documented the long-term effects of ambient air pollution on mortality, but they suffer from residual confounding, being unable to control unmeasured confounders, and are often not population representative. A recently developed variant of difference-in-difference (DID) approach is promising to address these limitations.

Methods

We collected annual all-cause death data from 2,193 statistical areas level-2 (SA2) in Australia during 2001-2015. Area-level annual mean concentrations of PM2.5 and NO2 were derived from widely used grid (0.01°×0.01° and 0.1°×0.1°, respectively) datasets. The variant of DID method was used to evaluate the causal relationship between annual PM2.5 and NO2 and all-cause mortality. We further developed this method by considering non-linear associations and lag impacts using distributed lag non-linear model.

Results

The impacts of low PM2.5 (1.94-12.00 µg/m3) and NO2 (0-7.41 µg/m3) on all-cause mortality were non-linear and lasted for 0-3 year and 0-6 year, respectively. The moving average PM2.5 (0-3 year) and NO2 (0-6 year) showed non-significant impacts below the thresholds (4.44 µg/m3 and 1.10 µg/m3) observed, while every 1 µg/m3 increase above the thresholds were associated with 2.4% (95%CI: 1.6-3.3%) and 9.4% (95%CI: 7.9-10.8%) increase in all-cause mortality, respectively. We estimated that 3.0% (95%CI: 2.0-3.9%) and 9.9% (8.3-11.3%) deaths were attributable to PM2.5 and NO2, respectively.

Conclusions

We further developed the causal DID model and documented the deadly impacts of long-term exposure to low PM2.5 and NO2 with thresholds and lag periods.

Key messages

Long-term exposure to low PM2.5 and NO2 are still deadly but have thresholds.
1066Increased Risk of Suicide among Cancer Survivors Who Developed a Second Primary Malignancy
Authors: Yang Huazhen , Wang Chengshi , Lu Donghao , Song Huan
Published: September 2021

Background

Cancer diagnosis entails substantial psychological distress and is associated with dramatically increased risks of suicide and psychiatric disorders. However, little is known about the suicide risk among cancer survivors who developed a second primary malignancy (PCa-2).

Methods

Using the Surveillance, Epidemiology, and End Results database, we conducted a population-based cohort study, including 7,169,704 patients with first primary malignancy (PCa-1) and 686,174 PCa-2 patients diagnosed from January 1, 1975, through December 31, 2016. Compared with patients with PCa-1, we measured the hazard ratios (HRs) of completed suicide after receiving a PCa-2 diagnosis, using Cox proportional hazard models.

Results

10,938 and 937 completed suicides were identified among PCa-1 and PCa-2 patients, respectively. The HR of suicide deaths was 1.24 [95% confidence interval (CI), 1.15-1.32] after a PCa-2 diagnosis, compared with PCa-1 patients (adjusted for demographic factors, state, and tumor characteristic). The risk elevation was most pronounced when PCa-2 was prostate cancer (HR 1.37, 95% CI 1.18-1.60); and PCa-2 patients diagnosed between 60 to 75 years old had highest increased relative risk of suicide (HR 1.35, 95% CI 1.23-1.49).

Conclusions

Compared with patients with first primary cancer, cancer survivors receiving a PCa-2 diagnosis, particularly of prostate cancer or at age 60-75, are at increased risk of suicide. These findings emphasize the need to support and carefully monitor cancer survivors for PCa-2.

Key messages

Patients with PCa-2 are at a higher risk of suicide compared with patients with PCa-1, especially for PCa-2 diagnosed at age 60 to 75 or PCa-2 of prostate.
673Is weight more informative than body mass index for breast cancer risk
Authors: Ye Zhoufeng , Dite Gillian , Hopper John
Published: September 2021

Background

Our previous work on body mass index (BMI) and breast cancer risk found that the association depended on menopausal status but not on familial risk (Hopper, JL., et al, 2018). We now consider whether weight is a more informative risk factor for breast cancer than BMI.

Methods

We used data from the Prospective Family Study Cohort, a consortium of international prospective cohorts that are enriched for familial risk of breast cancer and include 16,035 unaffected women from 6701 families. Participants were followed for up to 20 years (mean 10.5 years) and there were 896 incident breast cancers with a mean age at diagnosis of 55.7 years. Cox regression was used to model risk associations as a function of age, menopausal status and underlying familial risk. We calculated robust confidence intervals by clustering by family. Model comparisons were made using the Bayesian Information Criterion (BIC).

Results

In repeating the best-fitting model from our original analyses, but using weight instead of BMI, we found that the log likelihood for the model using weight was 1.92 units greater than for the model using BMI (difference in BIC = 3.84). Therefore, the data are almost 50 times more likely under the model using weight.

Conclusions

The study found positive evidence that weight gives more information on risk than does BMI.

Key messages

Analysing breast cancer risk in terms of weight, rather than only BMI, might give greater insight and results that are easier to convey to the public.
338Modelling the population distribution of patient-reported outcomes using electronic health records: a UK study
Authors: Yu Dahai , Jordan Kelvin , Bailey James , Peat George , Wilkie Ross
Published: September 2021

Background

Patient Reported Outcome Measures (PROM) collected in surveys allow understanding of the health at the population-level. We aimed to test the feasibility of estimating health status as measured by PROMs through ecological prediction models which use local linked survey and primary care electronic health records (EHR) and applying the models to national EHR.

Methods

3,710 musculoskeletal consulters registered in 11 general practiced in North Staffordshire, UK and consented the linkage of their survey PROM (high impact pain, (HICP)) with EHR were included in this study. HICP was modelled by EHR predictors covering demographic, lifestyle risk factors, musculoskeletal diagnostic/problems, analgesic prescriptions, comorbidities, and deprivation. Final set of predictors were selected through backward elimination (p > 0.1). Individual-level prediction models (binary logistic regression) were fitted and evaluated in terms of model fit statistics (AIC, BIC, R-square), discrimination (C-statistics) and calibration-slope with internal validation. The final model was cross-mapped to a national UK primary EHR database (Clinical Practice Research Database) to obtain national population estimates of high impact pain.

Results

The C-statistics and calibration-slope of the final model was 0.77 (95% confidence interval: 0.70-0.79) and 1.00 (0.92-1.08), respectively. The estimated HICP was 51.2% overall among 49,788 UK musculoskeletal consulters and matched hypothesised variation by gender, age, deprivation and geographical regions.

Conclusions

Estimation of population-level health status as measured by PROM using EHR appears feasible and has potential application in assessing health inequalities. Further independent external validation studies are warranted.

Key messages

Primary care EHR data could be modelled to predict population-level PROMs.
1256Psychological impacts of COVID-19 pandemic on individuals living with multiple sclerosis: a rapid systematic review
Authors: Zarghami Amin , Hussain Akhtar , Campbell Julie , Ezegbe Chigozie , van der Mei Ingrid , Taylor Bruce , Claflin Suzi
Published: September 2021

Background

People living with multiple sclerosis (PwMS) are considered potentially vulnerable to the mental health effects of the COVID-19 pandemic, as they may be subject to increased social isolation. We aimed to systematically review the current evidence on the impact of the COVID-19 pandemic on mental health outcomes among PwMS.

Methods

We searched four major databases (Medline, EMBASE, PsychInfo and Scopus). We included peer-reviewed primary research studies using validated quality of life (QoL) and psychometric screening tools reporting data on the prevalence of mental health disorders, the severity of psychological symptoms and contributing demographic and clinical factors for PwMS during the COVID-19 pandemic.

Results

Our initial search yielded 121 records; 12 articles were included. Most were conducted during the peak of the pandemic-related lockdown in the host country via an online platform. The included studies used a variety of outcome assessment tools and study designs. The main mental health outcomes were depression, anxiety, stress, sleep quality and QoL. As a result, although the prevalence of mental health issues such as depression and anxiety appear to be high among PwMS during the pandemic, the impact of the pandemic on mental health among PwMS remains unclear.

Conclusions

Although mental health issues such as anxiety and depression appear fairly common among PwMS during the pandemic, the relationship between the pandemic and mental health among PwMS remains unclear.

Key messages

Despite a high prevalence of mental health issues among PwMS during the pandemic, the relationship between the pandemic and mental health remains unclear.