bluuebunny/crossref_metadata_2025 huggingface dataset:
757Using smartphone technology to characterise associations between respiratory symptoms and pollen
Authors: Jones Penelope , Johnston Fay , Koolhof Iain , Gasparrini Antonio , Wheeler Amanda , Williamson Grant , Lucani Christopher , Campbell Sharon , Bowman David , Cooling Nick
Published: September 2021

Background

Pollen is a well-established trigger of asthma and allergic rhinoconjunctivitis, yet key gaps in our understanding remain. These include knowledge of concentration thresholds for symptoms, exposure-response associations through time, and the potential for interactions with other environmental stressors such as air pollution. Smartphone technology offers an opportunity to address these challenges using large datasets that capture individual symptoms in real time.

Methods

We analysed 44,820 symptom reports logged by 2,272 users of the AirRater app over four years to evaluate associations between daily respiratory symptoms and atmospheric concentrations of pollen in Tasmania, Australia. We used case time series, a novel methodology developed for app-sourced data. We adjusted for seasonality and meteorology and tested for interactions with particulate pollution (PM2.5).

Results

There was a non-linear association between pollen concentrations and respiratory symptoms for up to three days following exposure. Risk ratios (RR) were greatest on the same day, for total pollen increased steeply to a RR of 1.31 (95% CI: 1.26-1.37) at a concentration of 50 grains/m3 before plateauing. Associations with individual pollen taxa showed similar non-linear trends. There was an interaction with PM2.5, with effect estimates significantly higher when PM2.5 was >50 µg/m3 (p for interaction < 0.001).

Conclusions

The association between respiratory symptoms and airborne pollen was non-linear, greatest in magnitude on the day of exposure, and synergistic with air pollution.

Key messages

Smartphone symptom tracking offers a useful means of assessing dose-response relationships in environmental epidemiology.
182Higher preference for spicy foods increases the risk of central obesity: a prospective cohort study
Authors: Jung Candidate Sukyoung , Park Sohyun
Published: September 2021

Background

Central obesity, characterized by high waist circumference (WC), has been independently associated with higher chronic diseases and mortality risk. To date, controversial evidence is available concerning the beneficial effects of spicy foods on central obesity. We aimed to prospectively examine the association between preference for spicy foods and incident central obesity in Korean adults aged 40 and over.

Methods

We included 6,042 participants free of central obesity at baseline. Central obesity was defined as having WC ≥ 90 cm for men and ≥ 85 cm for women. As an exposure, preference for spicy foods was measured using a five-scale response option from the lowest to the highest preference and a Cox proportional hazard model was used to estimate the hazard ratios (HR) with confidence intervals (CI) for central obesity.

Results

During 45,654 person-years (median 9 years) of follow-up, 1,778 incident central obesity cases occurred. Compared to the lowest preference for spicy foods, the highest preference for spicy foods was associated with greater central obesity risk (HR = 1.43, 95% CI = 0.99-2.05, p trend=0.002). No interaction existed between preference for spicy foods and gender on central obesity incidence (p interaction > 0.05).

Conclusions

Appreciated for spicy foods was associated with an excess risk of central obesity incidence in Korean adults aged 40 years and older.

Key messages

These findings may provide informative evidence on primary prevention of central obesity, particularly for populations with a higher preference for spicy foods.
955Risk of drowning: the Japan Collaborative Cohort (JACC) Study
Authors: Kimura Takashi , Ikehara Satoyo , Tamakoshi Akiko
Published: September 2021

Background

In Japan, the unintentional drowning mortality rate among the elderly is exceptionally high. However, the risk factors for drowning in Japan are not fully understood. This study aims to explore the risk factors of drowning in Japan.

Methods

This study used data from the Japan Collaborative Cohort Study, a prospective cohort aged 40–79 years initiated 1988-1990. A total of 86,298 individuals (35,984 men and 50,314 women) completed a self-administered questionnaire and were mainly followed up by the end of 2009. We calculated hazard ratios (HRs) and 95% confidence intervals (95%CIs) for drowning according to age, body mass index, drinking habits, medical history, marital status, and years of education.

Results

A total of 194 drownings occurred during a median follow-up period of 18.9 years. The multivariable HRs (95%CIs) of drowning were 0.21 (0.10–0.45) for aged <50 years, 0.37 (0.21-0.65) for 50–59 years compared with 60–69 years, 3.08 (1.39–6.85) for bereaved compared with married, 3.39 (1.19-9.66) for with medical history of stroke compared without, and 3.18 (1.39–7.30) for current drinker with ≥69.0g ethanol/day compared with never drinker in men, 0.20 (0.09-0.43) for aged <50 years and 3.39 (1.19-9.66) for 50-59 years in women.

Conclusions

Younger people were found to have a lower risk of drowning. For men, bereavement, history of stroke, and current heavy drinking were found to have higher risk of drowning.

Key messages

In Japan, bereavement, a history of stroke, and heavy drinking among men found to have higher risk of drowning
1139Predictors of Unintended Pregnancy among Indian women: An analysis from NFHS-IV Survey
Authors: Kishun Jai
Published: September 2021

Background

Low levels of women’s decision-making over control of sexual intercourse, contraceptive use, domestic violence with intimate partners not only have impact on socioeconomic and cultural aspects but also on unintended pregnancies. Which create serious public health issues associated with physical, reproductive and mental health consequences. This study explores associations between domestic violence, maternity and sociodemographic characteristics with unintended pregnancies

Methods

Total 32428 married women aged between 15-49 years, who responded on current pregnancy wanted were observed in NFHS-IV (2015-16) survey data. Out of these, 3,842 found eligible for this study. Logistic regressions used for analysis using SPSS23 software.

Results

Mean age of 3,842 women respondents were 25.27 ± 4.97 years. 12.3% of them were unintended pregnancies. Women aged between 25-34 years (OR = 1.21, 95% CI: 0.99-1.48) and 35-49 years (OR = 1.50, 95% CI: 1.02-2.21) were more likely to have unintended pregnancy than 15–24 years. Working women were 7% (OR = 0.93, 95% CI: 0.73-1.18) less likely to have unintended pregnancy than not working. Women never used contraception were 1.4 times more likely to have unintended pregnancy. Ever face domestic violence were 1.71 times (OR = 1.71, 95% CI: 1.40-2.10) more likely to have unwanted pregnancy.

Conclusions

Sociodemographic disparities need to be addressed to promote reproductive health and welfare services. Preventing physical violence by intimate partners against women, could reduce unintended pregnancy.

Key messages

Improving women’s status through educational and occupational initiatives could contribute to reducing physical violence and incidence of unintended pregnancies
655Association between Crohn's disease onset and oral hygiene: a Japanese multicenter case-control study
Authors: Kondo Kyoko , Ohfuji Satoko , Watanabe Kenji , Yamagami Hirokazu , Fukushima Wakaba , Ito Kazuya , Suzuki Yasuo , Hirota Yoshio
Published: September 2021

Background

The prevalence of Crohn’s disease is increasing in Japan, but risk factors for this disease have yet to be characterized. A recent study using mice, indicated that Klebsiella strains in the oral cavity may be associated with inflammatory bowel disease. We investigated the association between oral hygiene and Crohn’s disease onset.

Methods

We conducted a multicenter case-control study and compared oral hygiene in 69 patients with newly diagnosed Crohn’s disease to that in 113 control patients (patients with other diseases matched for institution, age, and sex). The exposure variables were number of teeth, use of dentures, implant treatment, and frequency of brushing. A conditional logistic model was used to calculate odds ratios and 95% confidence intervals of these factors for Crohn’s disease onset.

Results

The decreased odds ratios of brushing teeth were observed with increasing daily frequency (trend for p = 0.039), with 0.52 (0.20–1.33) for twice daily brushings and 0.26 (0.07–0.97) for three or more daily brushings, (reference category: brushing no or once a day). No other oral hygiene factors were associated with the onset of Crohn's disease.

Conclusions

Our findings suggest that frequent brushing may have a protective association with the development of Crohn's disease.

Key messages

This result may provide a clue to the possible involvement of oral bacteria in the development of inflammatory bowel disease.
368Evaluation of myostatin as a possible regulator of the skeletal muscle-cortical bone interaction in adults
Authors: Kuriyama Nagato , Ozaki Etsuko , Koyama Teruhide , Matsui Daisuke , Watanabe Isao , Inaba Masaaki , Yamada Shinsuke , Horii Motoyuki , Uehara Ritei
Published: September 2021

Background

Bone mass was recently reported to be related to skeletal muscle mass in humans, and a decrease in cortical bone is a risk factor for osteoporosis. Since circulating myostatin is a factor that primarily controls muscle metabolism, this study examined the role of myostatin in blood in bone mass-skeletal muscle mass interactions.

Methods

The subjects were 375 middle-aged community residents with no history of osteoporosis or sarcopenia who participated in a health check-up. The subjects were divided into those with low cortical bone thickness (LCT) or low cancellous bone density (LBD) and those with normal values (NCT/NBD). Bone metabolism markers (BAP, TRACP-5b, etc.), skeletal muscle mass, serum myostatin levels, and lifestyle, were then compared between the groups.

Results

The percentage of diabetic participants and blood HbA1c, TRACP-5b, and myostatin levels were significantly higher, and the frequency of physical activity, skeletal muscle mass, grip strength, and leg strength were significantly lower in the LCT group than in the NCT group. The odds ratio of high myostatin in the LCT group compared with the NCT group was significant (2.26) even after adjusting for related factors. Significant differences were observed in the same items between the LBD and NBD groups as between the LCT and NCT groups, with no significant differences in skeletal muscle mass and serum myostatin levels. The serum myostatin level was significantly negatively correlated with cortical bone thickness and skeletal muscle mass.

Conclusions

Myostatin may regulate bone-skeletal muscle interactions and serve as a surrogate marker of cortical bone metabolism.

Key messages

The interaction between bone and skeletal muscle is reported to be important for preserving the activity of bone and muscle metabolism. Herein, we report for the first time that myostatin may regulate bone-skeletal muscle interactions and serve as a surrogate marker of cortical bone metabolism in adults.
512Challenges and opportunities to appropriate antibiotic prescribing: a survey of clinicians’ perceptions in Australia
Authors: Laka Mah , Milazzo Adriana , Merlin Tracy
Published: September 2021

Background

Emerging antibiotic resistance is significant threat to global public health. There is evidence on sub-optimal prescribing as a contributing factor to antibiotic resistance. This study aimed to identify behavioral determinants of antibiotic prescribing that may help design effective interventions.

Methods

A cross-sectional survey was undertaken with clinicians (hospital and primary care) in Australia from June–October 2019. Multivariate logistic regression was used to determine if clinicians’ characteristics, and guidelines’ use, are associated with barriers of appropriate antibiotic prescribing.

Results

Inappropriate prescribing behavior is not limited to clinicians’ practices, but also relate to patients’ expectation and clinical culture. Lack of data for evidence-based decision-making and diagnostic uncertainty contribute to sub-optimal antibiotic prescribing. Different care settings and clinicians’ experience influence perceptions of whether unavailability of information, delay in diagnostic results and patient expectations regarding treatment led to inappropriate prescribing behavior. Respondents in primary care and with less experience were more likely to consider that patient demands (primary care: OR 1.76, 95%CI 1.34–2.68 & experience (1-10 years): OR 1.34, 95%CI 1.07–1.59) and lack of data required for decision-making (primary care: OR 1.59, 95%CI 1.09–2.10 & experience (1-10 years): OR 1.63, 95%CI 1.13–1.87) are barriers to appropriate prescribing.

Conclusions

A complex network of social, contextual and clinical factors influence prescribing practices. A holistic approach addressing clinicians’ practices, setting requirements and patient expectations must be considered.

Key messages

For optimal antibiotic prescribing, there is a need to focus on contextual requirements, shared decision-making and availability of relevant information at point-of-care.
1212Examining the relationship between childhood adversity and mental health in older adults
Authors: Lian James , Kiely Kim M. , Anstey Kaarin J.
Published: September 2021

Background

There is a need to understand how early adversity is linked with mental health in older adults. The aim of this study was to 1) explore the optimal way to operationalise a scale of adverse childhood experiences (ACEs) and 2) examine the association between ACEs with depression and anxiety in older adulthood.

Methods

Data were from Wave 1 of the Personality and Total Health (PATH) Through Life Project (N = 7485, 51% women). Older adults aged 60-65 reported their childhood experiences of domestic adversity on a 17-item scale (e.g., physical abuse, neglect, poverty). Depression and anxiety were assessed using four validated screening instruments (GDS, GAS, MCS-12, PHQ-9). Three approaches to scoring the ACE scale were compared: i) cumulative risk, ii) factor analysis, and iii) latent class analysis (LCA). Linear regression models estimated associations between ACEs and mental health, adjusting for age, race, education, and gender.

Results

Childhood adversity was associated with late life depression and anxiety using the cumulative risk approach. Factor analysis produced latent factors of threat and deprivation, which were highly correlated, leading to problems with multicollinearity when estimating associations. Finally, LCA revealed three classes of ACEs: high adversity, low adversity, and parental maladjustment. High adversity and parental maladjustment were associated with higher levels of depression and anxiety symptoms compared to low adversity.

Conclusion

Different approaches to operationalising childhood adversity reveal that ACE exposure is associated with depression and anxiety in older adults. Future studies will utilise these methods to investigate links with cognitive decline and dementia.
198Prevalence of illicit substances in personal vaporisers on online cryptomarkets
Authors: Lim Miss Carmen , Leung Janni , Connor Jason , Hall Wayne , Cheng Brandon , Gartner Coral , Scheurer Roman , Chan Gary
Published: September 2021

Background

Personal vaporisers or e-cigarettes are gaining popularity as an alternative route of administration for illicit substances. Data from the Centers for Disease Control and Prevention on the recent epidemic of vaping related lung injuries has confirmed that victims had vaped blackmarket tetrahydracannabidiol, including some sourced from online cryptomarkets. We examined the diversity and prevalence of illicit substances in vaping products available from these marketplaces.

Methods

Vaping related listings were extracted from three online cryptomarkets (‘Agartha’, ‘Cryptonia’, and ‘Tochka’) using The Onion Router browser. Data collection occurred between October and November 2019.

Results

We identified 1929 listings from 201 unique sellers. The top product across the three markets were vape cartridges (range = 39.4% to 70.4%). The most common substance in these products was cannabis oil (range = 82.1% to 96.1%), followed by synthetic cannabinoids (range = 3.7% to 9.8%) and psychedelic substances (range = 0.2% to 6.4%). Vendors were primarily from the USA. Many products offered worldwide shipping (range = 42.4% to 96.3%).

Conclusions

Our study fills knowledge gaps by providing information on what vaping products are being sold through online cryptomarkets. Future studies should continue to monitor cryptomarkets to identify emerging trends of substances used in personal vaporisers.

Key messages

Online cryptomarkets provide a new way of monitoring emerging vaping trends and identify factors that contributes to the current vaping epidemic.
1467Interaction effects of multimorbidity and frailty on adverse health outcomes in elderly hospitalised patients
Authors: Lujic Sanja , Randall Deborah , Simpson Judy , Falster Michael , Jorm Louisa
Published: September 2021

Background

Multimorbidity and frailty are each known to be drivers of adverse outcomes, but their joint effects are less well known.

Methods

We used state-wide hospital and mortality data for persons aged ≥75 years, admitted during 2010-2012 in New South Wales, Australia, to ascertain multimorbidity, frailty risk and outcomes: prolonged length of stay (LOS), 30-day mortality and 30-day emergency readmission. We estimated the relative risk (RR) of each outcome using Poisson models with random intercept for hospital. Interactions on both additive and multiplicative scales were examined.

Results

Among 257,535 elderly inpatients, 33.6% had multimorbidity and elevated frailty risk, 14.7% had multimorbidity only, 19.9% had elevated frailty risk only and 31.8% had neither. Additive interactions were present for all outcomes, with a further multiplicative interaction for mortality and LOS. Mortality risk was 4.2 (95% CI 4.1 – 4.4), prolonged LOS 3.3 (95% CI 3.3 – 3.4) and readmission 1.8 (95% CI 1.7 – 1.9) times higher in patients with both factors present compared with patients with neither.

Conclusions

Multimorbidity and frailty coexist in older hospitalized patients and interact to increase the risk of adverse outcomes beyond the sum of their individual effects. Their joint effect should be considered in health outcomes research and when administering hospital resources.

Key messages

Multimorbidity and frailty coexist and interact to increase the risk of adverse outcomes in hospitalised patients. Research and health planners should consider their joint effects to ensure patients at the highest risk of adverse outcomes are identified.
801Apolipoprotein E (APOE) genotype-associated disease risks: a phenome-wide, registry-based, case-control study utilising the UK biobank
Authors: Lumsden Amanda , Mulugeta Anwar , Zhou Ang , Hyppönen Elina
Published: September 2021

Background

The APOE gene has three main alleles; APOE-E2, E3 and E4 (global frequencies: 8%, 78%, 14%) carrying differential risk for conditions such as dementia and cardiovascular disease. Due to the clinical significance of variation at this locus, we explored disease associations of APOE genotypes using a hypothesis-free, phenome-wide association study (PheWAS) approach.

Methods

Utilising medical and genetic data available from the UK Biobank for 337,484 white British participants aged 37–73 years, we screened for associations between APOE genotypes (E4E4, E3E4, E2E4, E2E3 and E2E2) and ≥825 disease outcomes, using E3E3 as a reference.

Results

Case-control PheWAS analyses revealed associations with 37 disease outcomes from 17 distinct conditions after multiple test correction. As expected, E4E4 and E3E4 associated with risk of Alzheimer’s disease (p < 10-46 for both), hypercholesterolemia (p < 10-17), and cardiovascular diseases (p < 10-4). Novel findings included E4-associated increased risk of chondrocalcinosis (E4E4), and protection against obesity (E4E4), type 2 diabetes (E4E4, E4E3), and chronic airway obstruction (E4E4; all p ≤ 3.2 × 10-4). Notably, E2E2 homozygosity augmented risks of peripheral vascular diseases, and cervical disorders (p ≤ 1·9 × 10-5).

Conclusions

PheWAS assessment of APOE-associated risk for a wide spectrum of diseases amongst this large, white British population, detected well-established, and novel APOE-disease associations warranting further validation.

Key messages

While APOE-E4 is risky for Alzheimer’s, and cardiovascular diseases, it may be protective against some metabolic conditions. While the E2 allele is often considered beneficial, homozygosity-associated risks may contribute to its relatively low prevalence.
692Association of drinking habits with TXNIP DNA methylation levels in leukocytes among general Japanese population
Authors: Maeda Keisuke , Yamada Hiroya , Munetsuna Eiji , Fujii Ryosuke , Yamazaki Mirai , Ando Yoshitaka , Mizuno Genki , Ishikawa Hiroaki , Ohashi Koji , Tsuboi Yoshiki , Hashimoto Shuji , Hamajima Nobuyuki , Suzuki Koji
Published: September 2021

Background

Thioredoxin-interacting protein (TXNIP) inhibits the activity of thioredoxin (TXN), leading to increased oxidative stress. Expression of the TXNIP gene is regulated by DNA methylation. However, no study has reported the influence of lifestyle factors on TXNIP DNA methylation. Our goal was to determine the association between drinking habits and TXNIP DNA methylation levels in the general Japanese population.

Methods

We conducted a cross-sectional study of 404 subjects (176 males and 228 females) participating in a health examination. Subjects were divided into non-, moderate (male: 1-39g; female: 1-19g ethanol/day) and heavy (male: ≥40g; female: ≥20g ethanol/day) drinkers based on self-reported drinking habits. We used a pyrosequencing assay to determine TXNIP DNA methylation levels in leukocytes.

Results

Among men, the mean TXNIP DNA methylation level in heavy drinkers (73.2%) was significantly lower than that in non- and moderate drinkers (non: 76.7%, p<0.001; moderate: 75.8%, p=0.024). In multiple linear regression analysis adjusted for confounding factors, TXNIP DNA methylation levels showed significant negative association with alcohol consumption per day and cumulative alcohol consumption in male current drinkers.

Conclusions

We found that heavy drinkers had TXNIP DNA hypomethylation compared to non- and moderate drinkers in men. Moreover, alcohol consumptions were also negatively associated with TXNIP DNA methylation levels in male current drinkers.

Key messages

Heavy drinkers had decreased levels of TXNIP DNA methylation compared to non- and moderate drinkers in men.
680NSAID use and ovarian cancer survival
Authors: Majidi Azam , Na Renhua , Jordan Susan , Obermair Andreas , Webb Penelope M
Published: September 2021

Background

Observational studies have reported survival benefits associated with non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin, and non-aspirin NSAIDs (NA-NSAIDs), especially new use post-diagnosis, in women with ovarian cancer (OC).

Methods

Participants were women aged 18-79 diagnosed with OC in Australia, 2012-2015. Information was gathered through self-completed 3-monthly questionnaires and prescription records. Exposure was defined as any use (NA-NSAIDs/regular-dose aspirin □1/week or daily low-dose aspirin) during the year pre-diagnosis and first year post-diagnosis. We measured overall survival from start of primary treatment (surgery/neoadjuvant chemotherapy) (pre-diagnosis use) or from 12 months after the start of therapy (post-diagnosis) until the earliest of date of death/last follow-up/5 years. Cox proportional hazards regression was used to estimate survival. We also applied inverse-probability of treatment weighting (IPTW), which balances comparison groups regarding potential confounders.

Results

We observed improved survival associated with pre-diagnosis use of aspirin/NA-NSAIDs ≥4 days/week (frequent-users) compared to < 1/week (hazard ratio [HR] =0.72, 95% confidence interval [CI]=0.54-0.97). The association was close to null for those who used medications 1-3 days/week. Similarly, we saw a 30-40% improvement in survival associated with post-diagnosis aspirin/NA-NSAID use, again driven by frequent users (HR = 0.61, 95%CI=0.42-0.88). Results were similar when we excluded pre-diagnosis users, restricted to women who received chemotherapy, or assessed cancer-specific and progression-free survival. Results from IPTW models were similar to adjusted models.

Conclusions

Our findings suggest aspirin/NA-NSAID use might improve survival in women with OC. Larger cohorts or, preferably, a randomised controlled trial could clarify these findings.

Key messages

Use of aspirin/NA-NSAIDs may improve OC survival.
889Association of maternal smoking during pregnancy and early-childhood with adult insomnia symptoms
Authors: Melaku Yohannes Adama , Appleton Sarah , Reynolds Amy , Gill Tiffany , Sweetman Alexander M , Micic Gorica , Stevens David J , Lack Leon , Adams Robert
Published: September 2021

Background

Evidence regarding the association between perinatal smoking and insomnia symptoms in adulthood is limited. Using the UK 1970 Birth Cohort Study, we determined the association of maternal smoking during pregnancy and early-childhood with insomnia symptoms at 42 years.

Methods

Participants were followed from birth (1970; N = 9020; male, 48%) and age 5 (1975; N = 8050; male, 47.9%) to 42 years (2012). Data on maternal smoking was collected at birth and age 5; difficulties initiating or maintaining sleep (DIMS) and DIMS plus daytime symptoms (tiredness, irritability, depression and nervousness) [DIMS plus] at age 42. We used a direct acyclic graph to select confounders. A log-binomial logistic regression, adjusted for confounders, was used to estimate the association. Missing data were imputed via multiple imputation.

Results

The prevalence of DIMS and DIMS plus was 32% and 25%, respectively. There was a 25% [odds ratio (OR)=1.25; 95% confidence interval (CI): 1.12-1.38)] and 23% [OR = 1.23; 95% CI: 1.09-1.38] increase in odds of DIMS and DIMS plus among participants whose mothers smoked during pregnancy compared to those whose mother did not. A 24% [OR = 1.24; 95% CI: 1.12-1.37] and 18% [OR = 1.18; 95% CI: 1.05-1.33] increase in odds of DIMS and DIMS plus respectively, was observed among participants who had smoking mothers at age 5. Intensity and duration of smoking had a dose-response relationship with insomnia symptoms.

Conclusions

Maternal smoking during pregnancy and early-childhood is associated with increased risk of adult insomnia symptoms.

Key messages

This study suggests that reducing maternal smoking may reduce the risk of adult insomnia.
68Maternal exposure to PM2.5 from a severe smoke event and birth outcomes in Victoria, Australia
Authors: Melody Shannon , Wills Karen , Ford Jane , Venn Alison , Johnston Fay
Published: September 2021

Background

The 2014 Hazelwood coal mine fire was an unprecedented six-week severe smoke event in the Latrobe Valley, southeastern Australia. We aimed to determine whether maternal exposure to fine particulate matter (PM2.5) attributable to the event was associated with adverse fetal growth or maturity, including birthweight, small for gestational age, term low birthweight or preterm birth.

Methods

A cohort of babies born within the affected region was defined used administrative perinatal data. Maternal average and peak PM2.5 was assigned to residential address at time of delivery using a chemical transport model. Maternal, infant, meteorological and temporal variables were included in final linear and log-binomial regression models.

Results

3,591 singleton livebirths were included; 763 were exposed in utero. Average PM2.5 exposure was 4.4 µg/m3 (IQR 2.1 µg/m3); average peak was 45.0 µg/m3 (IQR 35.1 µg/m3). No association between PM2.5 and fetal growth or maturity was observed. Gestational diabetes mellitus was an effect modifier in the relationship; babies of exposed gestational diabetic mothers were 97 grams heavier per 10 µg/m3 increase in average PM2.5 exposure (95%CI 74, 120 grams), compared to mothers without gestational diabetes.

Conclusions

Maternal PM2.5 exposure from a smoke event was not associated with adverse fetal growth or maturity. There was a trophic response amongst babies of mothers with gestational diabetes.

Key messages

Babies born to mothers with gestational diabetes may be more susceptible to the effects of smoke events on birthweight.
531Investigating systemic autoimmune diseases as a group of causes of death: mortality burden and comorbidities
Authors: Mitratza Marianna , Klijs Bart , Hak A Elisabeth , Kardaun Jan WPF , Kunst Anton E
Published: September 2021

Background

Systemic autoimmune diseases (SAIDs) have chronic trajectories and share characteristics of self-directed inflammation and aspects of clinical expression. Nonetheless, burden-of-disease studies rarely investigate them as a distinct category. This study aims to assess the mortality rate of SAIDs as a group and to evaluate co-occurring causes of death.

Methods

We used death certificate data in the Netherlands, 2013-2017, (N = 711,247) and constructed a SAIDs list (4-position ICD-10). The mortality rate of SAIDs as underlying Cause of Death (CoD), non-underlying CoD, and any-mention CoD was calculated. We estimated age-sex-standardized observed/expected ratios to assess comorbidities in deaths with SAID relative to the general deceased population.

Results

We observed 3,335 deaths with SAID on their death certificate (0.47% of all deaths). The mortality rate of SAID was 14.6 per million population as underlying CoD, 28.0 as non-underlying CoD, and 39.7 as any-mention CoD. The mortality rate was higher for females and increased exponentially with age. SAID-related deaths were positively associated with all comorbidities except for solid neoplasms and mental conditions. Particularly strong was the association with musculoskeletal (O/E=3.38,95% CI[2.98,3.82]), other genitourinary (O/E=2.73,95% CI[2.18,3.38]), blood (O/E=2.02,95% CI[1.70,2.39]), skin and subcutaneous tissue (O/E=1.95,95% CI[1.54,2.45]), and infectious diseases (O/E=1.85,95% CI[1.70,2.01]), as well as influenza (O/E=2.71,95% CI[1.74,4.03]).

Conclusions

Systemic autoimmune diseases constitute a rare group of causes of death, but contribute to mortality through multiple comorbidities. Classification systems could be adapted to better encompass these diseases as a category.

Key messages

Reclassification of readily available data provides useful estimates for the mortality burden of systemic autoimmune diseases in the population.
985Sex differences in the incidence of renal cell carcinoma: results from the EPIC cohort study
Authors: Muller David , Scelo Ghislaine , Riboli Elio
Published: September 2021

Background

Incidence of renal cell carcinoma (RCC) is two-fold higher in men compared with women. This ratio has been remarkably stable, both geographically and over time. We investigated whether established risk factors for RCC can explain the higher incidence in men.

Methods

230,399 participants in the EPIC cohort study with complete data for BMI, history of hypertension, and smoking variables were included. Cox regression models with age as the time-scale were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for sex.

Results

We identified 690 incident RCC cases. The marginal HR [95% CI] for men versus women was 2.30 [1.98, 2.69]. There was no strong evidence for interactions between hypertension, BMI, or smoking status and sex. Adjusting for BMI, hypertension and smoking variables did not materially affect the estimate (HR: 2.18 [1.85, 2.56]), accounting for only 10% of the observed excess risk. In contrast, smoking factors alone could account for 88% of the observed excess risk of lung cancer for men (marginal HR: 2.19 [2.02, 2.38]; adjusted HR: 1.14 [1.04, 1.25])

Conclusions

The two-fold higher incidence of RCC in men compared with women cannot be explained by established risk factors.

Key messages

Whilst obesity, hypertension, and smoking are established risk factors for RCC, they cannot account for the greater incidence among men compared with women. This indicates the presence of as yet unknown factors to which men are more susceptible than women.
990Seaweed intake and risk of cardiovascular disease: the Japan Public Health Center–based Prospective (JPHC) Study
Authors: Murai Utako , Yamagishi Kazumasa , Sata Mizuki , Kokubo Yoshihiro , Saito Isao , Yatsuya Hiroshi , Ishihara Junko , Inoue Manami , Sawada Norie , Iso Hiroyasu , Tsugane Shoichiro
Published: September 2021

Background

The minerals, vitamins, soluble dietary fibers, and flavonoids of seaweed are protective for preventing cardiovascular diseases. However, the association between seaweed intake and risk of cardiovascular disease has not been established. We examined the dietary intake of seaweed and its impact upon stroke and ischemic heart disease (IHD) risk among a Japanese study population.

Methods

We surveyed 40,707 men and 45,406 women from 2 large cohorts (age range: 40–69 y). Seaweed intake in the study subjects was estimated from the food frequency questionnaire at baseline (1990–1994). Stroke and IHD events were identified until the end of 2009 (Cohort I) or 2012 (Cohort II). The hazard ratios (HRs) (95% confidence intervals [CIs]) for incident cardiovascular disease (CVD) and its subtype were estimated using Cox proportional hazard models after stratification by area and adjustment for cardiovascular disease risk and dietary factors by sex.

Results

During 1,493,232 person-years of follow-up, 4,777 strokes and 1,204 IHD cases were identified. Among men, significant multivariable HRs (95% CIs) for almost daily consumption were seen in IHD (0.76 [0.58-0.99]; P-trend=0.04) compared to almost no seaweed consumption. Among women, such inverse associations were observed in incident IHD (0.56 [0.36-0.85]; P-trend=0.006). No significant associations were observed between seaweed intake and risk of stroke nor stroke subtypes among either men or women.

Conclusions

Seaweed intake has been shown to contribute to the prevention of IHD in a large Japanese cohort.

Key messages

Seaweed intake could be beneficial for prevention of IHD.
242Exploring health in the UK Biobank: cross-sectional analyses of sociodemographic, psychosocial, lifestyle and environmental factors
Authors: Mutz Julian , Roscoe Charlotte J , Lewis Cathryn M
Published: September 2021

Background

Our aim was to examine sociodemographic characteristics, psychosocial factors, lifestyle and environmental exposures associated with health.

Methods

The UK Biobank recruited >500,000 participants, aged 37-73, between 2006-2010. Data on 81 cancer and 443 non-cancer illnesses were used to classify participants by insurance health status (non-standard risk/standard risk). Long-standing illness (yes/no) and self-rated health (poor/fair/good/excellent) constituted secondary outcomes. Logistic and ordinal regression models were fit to estimate associations between explanatory variables and health.

Results

307,378 participants (mean age=56.1; 51.9% female) were selected for cross-sectional analyses. Low household income, high levels of neighbourhood deprivation, being male, loneliness and social isolation were associated with poor health. Walking frequency and engaging in vigorous-intensity physical activity were associated with positive health, whereas long sleep duration, high body mass index and smoking were associated with poor health. Alcohol intake less frequent than 1-2 times per week was associated with poor health. There was some evidence that high levels of airborne pollutants (PM2.5, PM10 and NO2) and noise (Lden) were associated with poor health, although findings were inconsistent once other factors had been adjusted for. Neighbourhood greenspace was associated with positive self-rated health.

Conclusions

Public health could put greater focus on non-medical factors such as loneliness, further encourage healthy lifestyle behaviours and weight management, and examine efforts to improve health outcomes of individuals in the lowest income groups.

Key message

Multiple sociodemographic, psychosocial, lifestyle and environmental factors are associated with health.
1485Trends and attributable burden of raised low-density lipoprotein cholesterol in South Africa
Authors: Neethling Ian , Peer Nasheeta , Cois Annibale , Nojilana Beatrice , Pacella Rosana , Bradshaw Debbie , Pillay-van Wyk Victoria
Published: September 2021

Background

LDL-C is a key contributor to cardiovascular disease (CVD), but the exact attributable disease risk in South Africa is not known. This study aimed to quantify the burden of disease attributable to LDL-C in South Africa for 2000, 2006 and 2012.

Methods

National mean LDL-C estimates were derived from 14 observational studies using a meta-regression model. LDL-C estimates together with relative risks from the Global Burden of Disease Study 2017 were used to calculate a potential impact fraction (PIF) and applied to IHD and ischaemic stroke estimates to calculate attributable deaths and disability-adjusted life years (DALYs). Uncertainty analysis was performed using Monte Carlo simulation.

Results

LDL-C declined between 2000 and 2012 in males (2.74 mmol/L to 2.58 mmol) and females (3.05 mmol/L to 2.91 mmol/L). Attributable DALYs increased between 2000 (N = 286 712) and 2006 (N = 315 125) but decreased thereafter in 2012 (N = 270 829). Attributable age-standardised death rates declined between 2000 and 2012 in males (98 per 100 000 to 78 per 100 000) and females (81 per 100 000 to 58 per 100 000).

Conclusions

The decreasing trend in the age-standardised attributable burden due to LDL-C can be lowered further with the introduction of additional population-based CVD prevention strategies.

Key messages

This study highlights that high LDL-C in South Africa is responsible for a large proportion of the emerging CVD and should be targeted by health planners to reduce disease burden.
1452A Cohort Study of Comorbidities of Diabetes in Regional Australia
Authors: Anyasodor Anayochukwu , Bwititi Phillip , Chen Thim , Nwose Uba
Published: September 2021

Background

Epidemic of diabetes mellitus and its complications poses a major global threat and the burden of type 2 DM (T2DM) is also a worldwide phenomenon. However, data to rationalize continuous health promotion at local context such as regional New South Wales are lacking, and this underscores the need for continued epidemiological study. This study investigated if poorly controlled T2DM coexists with comorbidities more than those with good glycaemic control.

Methods

This was a cohort study at a private General Practice in Orange NSW, Australia. The study involved 137 de-identified adults living with T2DM. HbA1c and other biochemical and haematological records were reviewed. Other data included clinical notes including comorbidities, and complications. The cohort was separated into 2 groups: well-controlled versus poor glycaemic control. The resulting data were analysed for frequency, using the statistical software for Microsoft Excel.

Results

There were 37/137 of the T2DM cohort with baseline HbA1c of ≤ 6.5%, implying 73% poor glycaemic control in the region, at first time of testing. According to the clinical notes, the well-controlled group showed 29.7% comorbidities, including 2.7% queried infection. Among the 100 cases with abnormal HbA1c, comorbidities were observed in 22% including 4% who had infections.

Conclusions

Our observation implies no less comorbidities in well-controlled diabetes. However, the higher percentage of infection among the poorly controlled group is confirmation of need for continuous health promotion among people living with diabetes.

Key messages

This primary health statistic suggests the need to monitor for comorbidities equally, whether poor or well-controlled diabetes
1450Exeperiential Note on Enhancing Epidemiological Studies through Supervision of Postgraduate Research on Scaffolded Thesis-by-Publication
Authors: Nwose Ezekiel Uba
Published: September 2021

Focus of Presentation

Most researchers are based in universities, and their research performance site is often metropolitan and urban cities. The effect is that scope of epidemiological studies has largely been without keen interest at the primary healthcare level. A pathway that this could have been addressed is teaching-research nexus in students’ research supervision. Hence in 2013, a research program was started and focused in primary health promotion. The program involved novel application of a known idea, whereby students do scaffold thesis-by-publication. Over the years, observations of students’ behaviour regarding the program are being made. This report narrates 7 years’ experience from Nigeria.

Findings

In the 7 years, 44 research students (3 PhDs, 20 Masters and 21 Hons) have passed through the program. Among the 21 Hons, 1 has volunteered to remain a collaborator and ‘unpaid’ Research Assistant in the program. Currently, 11 PhD candidates including 8/20 (40%) Masters’ degree graduates who are scaling up their work. In the year 2020, 4 of the PhD candidates have gone on to epidemiological study as well as primary healthcare performance evaluation of their local government areas in terms of public health problem of research interest. All students expressed being motivated by the publications.

Conclusions/Implications

Taking research students through thesis-by-publication journey is one approach to advance epidemiological studies. Making the students do the work on their own community advances health promotion, outreach to rural areas and primary health perspectives.

Key messages

Teaching-research nexus buoyed with thesis-by-publication can advance teaching and communication of epidemiology.
349Help after IPV experience, how much help do victims seek? Evidence from NDHS 2018
Authors: Olabumuyi Olayide , Uchendu Obioma , Awosika Olawale
Published: September 2021

Background

Poor reporting and help seeking has contributed to the burden of IPV. However, identified barriers to IPV help-seeking include social, economic and cultural factors. This study assessed the pattern and factors associated with help-seeking by women who experienced IPV in Nigeria.

Methods

Complex sample analysis of 2,033 women of reproductive age who had ever experienced IPV from the 2018 Nigeria Demographic and Health Survey (NDHS), was done to determine social, economic and cultural factors that predict IPV help-seeking among these women.

Results

Mean age of the women was 31.5 ± 7.8 years, a third (33.3%) had sought any form of help, 36.6% had full healthcare and 33.4% had full financial autonomy respectively. Help from partner’s family and women’s family were the most prevalent source of help sought (11.5% & 23.1% respectively). Women ≥ 40 years were 37% less likely to seek help compared to young persons (OR = 0.63; 95% CI = 0.42-0.92). Women with childhood experience of violence had higher odds (42%) of seeking help for IPV than those with no childhood experience (OR = 1.42; 95 % CI = 1.08-1.85).

Conclusions

Majority of women experiencing IPV do not seek any form of help. Age and childhood experience of violence are significant predictors for help-seeking by victims of IPV.

Key messages

IPV remains a hidden issue as majority of victims are not seeking help.

Efforts to make appropriate help for IPV victims should be intensified and commenced from childhood.
818Prediction of health effects of Asian dust using the MASINGAR in Japan
Authors: Onishi Kazunari , Sekiyama Tsuyoshi Thomas , Kurosaki Yasunori , kurozawa Youichi , Nojima Masanori
Published: September 2021

Background

Health effects of cross-border air pollutants and Asian dust are of significant concern in Japan. Currently, models predicting arrival of aerosols have not investigated the association between arrival predictions and health effects. We investigated the association between subjective health symptoms and data acquired from the Japan Meteorological Agency's (JMA's) the Model of Aerosol Species in the Global Atmosphere (MASINGAR) aerosol model with the objective of ascertaining if the data could be applied for predicting health effects.

Methods

Subjective symptom scores were collected using self-administered questionnaires and used with JMA model’s surface concentration data to conduct a risk evaluation using multiple linear mixed model, during 2013 to 2015. Altogether, 160 individuals provided 16226 responses. Data regarding climate (temperature, humidity, and atmospheric pressure) and environmental factors (NO2, SO2 and Ox) were used as covariates. We calculated the association between the surface dust concentration and symptoms.

Results

A strong association was also observed for nasal and cough symptoms (P for trend < 0.001). The differences in scores of nasal symptoms (sneezing and runny) of the highest quartile [Q4] vs. the lowest [Q1] were 0.039 (95% confidence interval (CI): 0.02–0.01, p < 0.05) and 0.046 (95% CI: 0.002–0.02, p < 0.05), respectively. The differences in scores of cough symptoms were 0.036 (95% confidence interval (CI): 0.002–0.01, p < 0.05).

Conclusions

This study suggests that predictive models for pollutants’ arrival can be used to capability to foresee and possibly prevent the health impact of long range transport of air pollutants, recommending the potential role of aerosol forecast models in health care. MASINGAR is Global Spectral Model (GSM), this have the potential that can contribute in health predictions all over the world.

Key messages

Asian dust, Health forecast, Allergic symptom
694Metabolic conditions have high prevalence in CHamoru men in a hyperuricemia feasibility study in Guam
Authors: Paulino Yvette C. , Camacho Frank , Merriman Tony , Matisoo-Smith Lisa , Paulino Tristan , Chennaux Jade SN , Mori Elua , Gosling Anna L.
Published: September 2021

Background

One-third of adults in the U.S. have metabolic syndrome, a combination of risk factors of chronic diseases such as heart disease, kidney disease, diabetes, and gout. These diseases are a burden for ethnic minorities, including Pacific Island peoples. Here, the metabolic conditions were described for a group of Pacific Island people, the CHamorus or natives of Guam, a U.S. Territory in the Mariana Islands in the Western Pacific.

Methods

A cross-sectional survey was conducted in Guam from August 2019 to January 2020. A non-random sample of 152 adults, ≥18 years old, with CHamoru ancestry were recruited and consented. Information collected included socio-demographics, metabolic history, lifestyle behaviors, height and weight, blood pressure, and non-fasting blood and urine. Statistical analyses included frequencies of metabolic conditions and Pearson’s Chi-square test for gender differences, alpha=0.05.

Results

Of the 152 CHamorus, 49.3% were male, 50% were female, and 0.7% was transgender. The mean age was 43±15.1 years. Mean education was 14.4±3.6 years and hyperuricemia he majority (69.7%) pursued postsecondary studies. Self-reported metabolic conditions included: diabetes (19.7%), gout (28.9%), hypertension (34.9%), dyslipidemia (17.8%), and heart conditions (9.9%). Compared to females, more males reported gout (40.5% versus 18.7%; P=.003) and measured to be hypertensive (48% versus 21.1%; P<.0001), hyperuricemic (58.9% versus 31.6%; P=.001), and obese (77.3% versus 46.1%; P<.0001).

Conclusion

Metabolic conditions were common among CHamorus, though gout, hypertension, hyperuricemia, and obesity were predominant in the men.

Key messages

Strategies to reduce the burden of metabolic conditions may be targeted to CHamoru men in this community.