bluuebunny/crossref_metadata_2025 huggingface dataset:
1262Burden of disease and injury in Australia
Authors: Gourley Michelle ,   Australian Burden of Disease Study team
Published: September 2021

Background

Burden of disease describes the impact of living with and dying prematurely from different diseases or injuries. The Australian Burden of Disease Study (ABDS) 2018 estimated the health impact of 219 diseases and injuries on the Australian population.

Methods

Burden of disease measures years of healthy life lost from living with (non-fatal) and dying prematurely from (fatal) disease and injury. Fatal and non-fatal burden combined provides the total burden, measured in disability-adjusted life years (DALY). One DALY equals 1 year of healthy life lost. Disease burden was estimated for the years 2018, 2015, 2011 and 2003 for Australia.

Results

In 2018, 5.0 million years of healthy life were lost from disease and injury. Living with illness or injury caused more total disease burden than dying prematurely (52% vs 48%). Between 2003 and 2018, total burden decreased by 13%, driven by less premature deaths. Disease groups with the biggest absolute reductions in burden (DALY rate) were cardiovascular diseases and cancers. The five leading causes of burden were coronary heart disease, back pain, dementia, chronic obstructive pulmonary disease and lung cancer. Males experienced more burden than females for most age groups.

Conclusions

Overall burden of disease declined between 2003 and 2018, due to a large reduction in burden from dying prematurely. Living with the impact of chronic diseases contributed substantial burden in Australia in 2018.

Key messages

Living with illness or injury accounts for most of the disease burden in Australia. There have been improvements in fatal burden since 2003.
1359Changes in work and health of Australians during the COVID-19 pandemic: a longitudinal cohort study
Authors: Griffiths Daniel , Sheehan Luke , Vreden Caryn van , Petrie Dennis , Whiteford Peter , Sim Malcolm , Collie Alex
Published: September 2021

Background

Following pandemic-related work loss, some people could return to work as restrictions eased, whilst localised lockdowns resulted in further loss of work. The long-term health effects of work loss within the pandemic remain unexplored, in addition to whether any health effects are persistent upon returning to work.

Methods

A prospective longitudinal cohort study of 2603 Australians monitored changes in health and work across four surveys during March-December 2020. Outcomes described psychological distress, and mental and physical health. Linear mixed regression models examined associations between changes in health and experiences of work loss, and return to work, over time.

Results

Losing work during the early pandemic stages was associated with long-term poorer mental health, which began to recover over time. Physical health deteriorated over time, greater for people not working at baseline. Being out of work was associated with poorer mental health, but better physical health. These effects were larger for people that had recently lost work than for people with sustained work loss, and retaining employment played a protective role.

Conclusions

Work cessation during the pandemic led to poor health outcomes and had long-lasting effects. Returning to work benefits mental health but may reduce physical activity in the short-term. We encourage the provision of accessible mental health supports immediately following loss of work, and for people with prolonged work loss.

Key messages

Remaining employed whilst not working partly ameliorates negative mental health impacts. Those experiencing persistent work loss, and the newly out-of-work, are most vulnerable to ill mental health.
76Past dental visits and incidence of head and neck cancers: a systematic review and meta-analysis
Authors: Gupta Bhawna
Published: September 2021

Background

The aim of this study was to conduct a quantitative assessment of any independent association between past dental visits/check-ups and incidence of cancers of HN/upper aero-digestive tract (UADT) and oral cavity worldwide.

Methods

PubMed, CINAHL, and Cochrane databases were searched for all observational studies published until August 2017 that assessed an association of past dental visits/dental check-ups among the incident cases of HNC/UADT cancers. Three different meta-analyses were conducted: two based on the incident cancer reported in the studies (HNCs/cancers of UADT and oral cavity); another included all studies irrespective of the type of cancer reported with the frequency of past dental visits as subgroups.

Results

Sixty-two articles were reviewed in full, but only 38 were eligible for inclusion. Under the random effects model, odds of past never/irregular/ not frequent dental visits were greater in HNC cases and oral cancer cases as compared to the hospital based/ population-based controls [HNCs-unadjusted odds ratio (OR) 2.24; 95% confidence interval (CI) 1.89 to 2.65) and (oral cancers—OR 1.93; 95% CI 1.47 to 2.52]. There was no publication bias in our study.

Conclusion

This systematic review and meta-analysis indicates that individuals with never/irregular/not frequent dental visits are more likely to be incident cases of HNCs/UADT cancers.

Key message

Regular/frequent dental visits, at least annually, can aid in reducing the public health burden of head and neck cancers (HNCs) by facilitating earlier detection of the disease.
41Thyroid Cancers in Fukushima: Critical Review and Analysis of the 1st and 2nd Round Examination
Authors: Hamaoka Yutaka
Published: September 2021

Background

After the Fukushima–Daiichi nuclear power plant (NPP) disaster, thyroid ultrasound examination (TUE) has been performed in subjects who were aged ≤18 years. Previous studies reported controversial results. Through critical review, three limitations were identified: arbitrary grouping of 59 municipalities, 2) usage of region as proxy of dose, and 3) separate analyse of the 1st and 2nd round data.

Methods

To overcome these limitations, this study examined the relationship between radiation dose and the number of participants with thyroid malignancy, using publicly available municipality level data (N = 59). To analyse two wave screening data, multi-level random-effect Poisson regression model was applied. The number of participants with thyroid malignancy was explained by dose estimates. Interaction between dose and screening round dummy (0 for the 1st and 1 for the 2nd) was also introduced to take into account latency.

Results

Interaction terms between external dose (Akahane et al. 2013) and screening round dummy were positive and significant (β = 0.681, z = 2.05). Similar results were obtained for UNSCEAR estimated thyroid dose (UNSCEAR 2013) (β = 0.128, z = 2.24) and re-estimated thyroid dose (Suzuki et al. 2018) (β = 0.215, z = 2.42).

Conclusions

These robust results are consistent with the conjecture that the 1st round TUE is the “baseline” that will not correlated with radiation level and the 2nd round TUE detected thyroid cancer caused by radiation from Fukushima NPP that distributed heterogeneously among regions.

Key messages

This was an ecological study at the municipality level, the results should be examined with individual level data.
209Novel indicator of air pollution control efficacy: analysis of 196 countries from 2000 to 2016
Authors: Han Chunlei
Published: September 2021

Background

PM2.5 concentration is different with the same CO2 emission across countries, which might because of different air pollution control efficacy. But there is no indicator to reflect the level of air pollution control efficacy in previous studies. We aimed to develop such an indicator, and to evaluate its global and temporal distribution and its association with country-level health metrics.

Methods

A novel indicator, PM2.5 concentration per unit per capita CO2 emission (PC), was developed to show the air pollution control efficacy. We estimated and mapped the global average distribution of PC and PC changes during 2000-2016 of 196 countries for the first time. Gini coefficient was used to show the inequity of PC among different countries. Pearson correlation coefficients and Generalized Additive Mixed Model (GAMM) were used to evaluate the relationship between PC and health metrics.

Results

PC varied by country with an inverse association with GDP per capita. PC showed a declining trend globally from 2000 to 2016. The most remarkable decreases were observed for countries in Central Africa like Chad, Democratic Republic of Congo and Niger, then China and India. The international inequality of PC has also decreased. The Pearson correlation coefficients between PC and life expectancy at birth (LE), Infant-mortality rate (IMR), Under-five mortality rate (U5MR) and logarithm of GDP per capita(LPGDP) were -0.566, 0.646, 0.659,-0.585 respectively(all P-values <0.05). Compared with PM2.5 and CO2, PC could explain more variation of LE, IMR and U5MR.

Conclusions

PC might be a good indicator of air pollution control efficacy and was related to important health indicators. Our findings provide a new way to interpret health equity across the globe from the point of air pollution control efficacy.

Key messages

air pollution, climate change, health equity, air pollution control efficacy our study developed a novel air pollution control efficacy indicator named PM2.5 concentration per unit per capita CO2 emission (PC). In the context of global climate change, PC is a good indicator to deal with air pollution for policymakers.
767The hospital frailty risk score (HFRS) predicts complications in older surgical patients
Authors: Harvey Lara , Toson Barbara , Norris Christina , Harris Ian , Gandy Robert , Close Jacqueline
Published: September 2021

Background

Frailty increases the risk of post-operative complications in older patients, however clinical assessment of frailty is not routinely undertaken. We aimed to evaluate whether the Hospital Frailty Risk Score (HFRS), calculated using data available from ICD-10 coded electronic records at time of admission, could be used to identify patients at risk of complications.

Methods

Hospital and death data for individuals aged >50 years, admitted for surgery to all hospitals in NSW, Australia 2016-2017 were linked. Hospital-acquired complications (HACs) were identified using 16 categories. Logistic regression models were used to quantify influence of explanatory variables; age, sex, comorbidity, urgency of admission and HFRS on risk of HACs, and model performance assessed.

Results

Of the 150,355 hospitalisations, 12.3% resulted in a complication. Infections (6.1%) and delirium (3.3%) were the most common complications. 30-day mortality was higher following complication (12.5% vs 1.8%, p < 0.0001). Emergency surgery was the strongest predictor for >1 complication (OR 2.67, 95%CI 2.57-2.78), followed by multimorbidity (OR 1.90, 95%CI 1.78-2.02) and high HFRS (OR 1.57, 95%CI 1.48-1.66). The fully-fitted model provided acceptable discrimination (AUC 0.72, 95%CI 0.72-0.73).

Conclusions

The HFRS was strongly associated with complications following surgery. Used in conjunction with age, sex, urgency and comorbidity the HFRS predicted complications with 72% accuracy.

Key messages

This is the first study to validate the use of HFRS as a screening tool to identify frail patients at risk of developing complications following surgery. The HFRS provides hospitals with an inexpensive, systematic method to screen for high-risk patients at time of admission.
1184Combined association of living alone and dietary variety with mental health in older Japanese adults
Authors: Hata Toshiki ,   Akihiko Kitamura,   Satoshi Seino,   Yui Tomine,   Mariko Nishi,   Takumi Abe,   Yuri Yokoyama,   Miki Narita,   Shoji Shinkai
Published: September 2021

Background

We examined whether dietary variety (DV) might alleviate poor mental health (MH) of living-alone (LA) older adults.

Methods

Cross-sensational data from 15073 (7566 men; 7507 women) residents aged 65-84 years were assessed using the WHO-Five Well-being Index to determine poor MH (defined by a score ≤ 12) and DV (low and high DV defined by a score ≤ 3 and ≥ 4, respectively). Participants were divided into living together with high DV (G1), living together with low DV (G2), LA with high DV (G3), and LA with low DV (G4). Logistic regression analyses stratified by gender were performed to examine the association of poor MH with LA and DV.

Results

Prevalence of LA, low DV, and poor MH were 13.6%, 63.3%, and 26.1%, respectively, in men, and 21.2%, 54.6%, and 24.8%, respectively, in women. Compared with the G1, the multivariate-adjusted odds ratios (ORs) (95% confidence intervals) for worse MH were 1.69 (1.49-1.93) for G2, 2.04 (1.50-2.78) for G3, and 3.34 (2.70-4.11) for G4 in men. Corresponding ORs were 1.73 (1.52-1.96), 1.02 (0.83-1.26), and 1.66 (1.36-2.01) in women.

Conclusions

The association of poor MH with LA was more apparent in older adults with low DV than in those with high DV; however, this association differed with gender.

Key message

Eating a variety of food may help alleviate the negative effects of living alone on mental health in older adults.
763Validity of algorithms for identifying five chronic conditions in MedicineInsight, Australian national primary care data
Authors: Havard Alys , Chidwick Kendal , Daniels Benjamin , Thistlethwaite Jill , Myton Rimma , Blogg Suzanne , Wall Margaret , Quick Lisa , Pollack Allan , Manski-Nankervis Jo-Anne
Published: September 2021

Background

MedicineInsight is a database containing de-identified electronic health records (EHRs) from over 700 Australian general practices. To support the trust placed in analyses of MedicineInsight data, additional evidence regarding the accuracy of the data is needed.

Methods

This study measures the validity of algorithms available in MedicineInsight that identify patients with depression, anxiety, asthma, type 2 diabetes and osteoporosis. Fifty practices met eligibility criteria regarding patient load and location, five were randomly selected and four agreed to participate. Within each practice, 250 patients aged ≥ 40 years were randomly selected. This age restriction increased the prevalence of the evaluated conditions, thereby optimising statistical power. Trained staff review the full EHR for these patients, including progress notes and correspondence, which are not available in MedicineInsight because they may contain identifiable information.

Results

With data collection almost complete, the target sample size will not be attainable. Power calculations indicate the current sample of 479 should provide adequate precision. For each condition of interest, the sensitivity, specificity, positive predictive value and negative predictive value of the algorithm is calculated. The full EHR review is the gold standard against which the algorithms are benchmarked.

Conclusions

The findings will indicate whether these algorithms demonstrate adequate accuracy to be used for research and decision-making.

Key messages

This additional understanding regarding the accuracy of MedicineInsight data will facilitate the interpretation of analyses of MedicineInsight data and guide improvements to the algorithms.
318Earlier migration, better cognition? The role of urbanization in bridging the urban-rural cognition gaps
Authors: Ye Xin , Zhu Dawei , He Ping
Published: September 2021

Background

With the process of population aging and urbanization, a vast amount of studies has confirmed the increasing urban-rural cognitive inequality. While less is known about the extent to which cognition gaps can be explained by birth inequality and urbanization. This study aimed to examine the role of urbanization and related factors in bridging the cognition gaps for middle-aged and older adults in China.

Methods

Based on the national representative China Health and Retirement Longitudinal Study (CHARLS) 2015, the Blinder-Oaxaca decomposition method was employed to decompose the cognition gaps. We quantified both the explained and unexplained parts of the cognition gaps, as well as the absolute and relative attribution of related factors.

Results

We found significant cognition gaps between urban and rural samples. Among the rural sample, the fully-urbanized and the semi-urbanized had better cognition than the non-urbanized. The fully-urbanized migrating at the age of 0-17 years old showed higher cognition scores than those migrating at 18+ years old. Besides urban-rural inequality and urbanization disparities, the cognition gaps could be largely explained by their socioeconomic status, and in part by their demographic background, physical functioning, life styles, social support and childhood status.

Conclusions

Urban-rural migration have a lasting effect in bridging the cognitive gaps in middle-aged and older adults, and those who migrating had more improvements in cognition than those migrating in adulthood. Public health actions targeting cognitive disparities could benefit from focusing on inequalities in urban-rural social and economic recourses.

Key messages

Rural-to-urban migration can bridge the urban-rural cognitive gaps in Chinese middle-aged and older adults.

In the rural-to-urban migration groups, people migrating in childhood had more improvements in cognition than those migrating in adulthood.
1035COVID-19: Boom or bust?
Authors: Hegde Aditya , Medhi Adori , Pendharkar Ojas , Hegde Aditya
Published: September 2021

Background

In the final weeks of 2019, a SARS-CoV-2 virus slipped furtively from animal to human in China. As of March 13, there have been 1,34,918 confirmed cases, out of which 4,990 is the death count. We are predicting extinction or explosion of the virus from the current realization of a Galton Watson process.

Methods

Based on the region wise reported number of cases, total was calculated. The observed offspring distribution was found by calculating the difference between the total number of cases in consecutive days. Hence the distribution modelled using Sequential Probability Ratio Tests (SPRT) to predict whether extinction or explosion will occur for the current realization of the process. Kolmogorov-Smirnov test was performed on the data to check the distribution of fit.

Results

We assume conservative approach of SPRT. The geometric distribution fits to the data taken from January 2020 to March 12, 2020. The SPRT on the offspring distribution predicts extinction of the disease if the number of cases reported on a new day are less than 58 then the disease will extinct, and will explode if more than 9,990 cases.

Conclusions

Our results show that if COVID-19 transmission is established, understanding the effectiveness of control measures in different settings will be crucial for understanding the likelihood that transmission can eventually be effectively mitigated.

Key messages

Our analysis highlights the value of recording individual cases and analyzing geographically heterogeneous data of COVID-19. Our results also have implications for estimation of transmission dynamics using the number of exported cases from a specific area.
194Nonlinear isocaloric substitution analysis in nutritional epidemiology: An example using the UK Biobank data
Authors: Ho Frederick , Gray Stuart , Petermann-Rocha Fanny , Mathers John , Pell Jill , Celis-Morales Carlos
Published: September 2021

Background

Intake of macronutrients and its components are associated with mortality and morbidity. Isocaloric substitution analysis is a tool to examine how changing the source of energy intake (e.g. from saturated to monounsaturated fat) is associated with health. However, conventional methods assume linearity, which may be untrue in many cases. This paper presents a nonlinear alternative, using UK Biobank data as an example data set.

Methods

Nonlinear isocaloric substitution analysis was conducted using penalised cubic splines in Cox proportional hazard models. In the UK Biobank, 195,658 participants completed at least one dietary questionnaire and were included in the analyses. Diet was assessed using the Oxford WebQ, a web-based 24-hour recall questionnaire. Prospective all-cause mortality was derived from on linked death records.

Results

More than half of the associations between macronutrient intake and all-cause mortality were nonlinear. Nonlinear isocaloric substitution analysis provides effect sizes conditional on the current intake, while conventional analysis provides an average over the whole range of intake. For example, conventional isocaloric substitution estimated no effect of replacing sugar with starch. However, the nonlinear method revealed that replacing sugar with starch was associated with a higher risk when the current starch intake was greater than 30% of total energy, and with a lower risk when current intake was less than 25%.

Conclusions

Nonlinear isocaloric substitution provides an alternative to conventional isocaloric substitution analysis when the underlying association is nonlinear.

Key messages

Nonlinear associations are common in nutritional epidemiology. In such cases, nonlinear isocaloric substitution analyses should be used.
472Long-term effectiveness of 3-dose primary course and 4-year booster dose of pertussis vaccine in Australia
Authors: Jayasundara Duleepa , Sheridan Sarah , Randall Deborah , Campbell Patricia , Edmond Karen , Liu Bette , McIntyre Peter B , Gidding Heather F , Wood James G
Published: September 2021

Background

Australia’s National Immunisation Program recommended a 3-dose primary Diphtheria-Tetanus-Pertussis (DTP) vaccination course at 2, 4 and 6 months and a booster dose at 4 years during 2003-2015. We examined vaccine effectiveness by time since doses 3 and 4, as studies to date have shown conflicting results.

Methods

Perinatal, immunisation, pertussis notification and death data were linked for 1,086,319 infants born in two Australian states in 2003-2012. Administration of DTP doses 3 and 4 from 5.5-7 months and 47-53 months respectively, was considered age-appropriate. Adjusted Cox proportional hazards models with time-varying vaccination status were used to estimate vaccine effectiveness (VE = 1–hazard ratio) against notified pertussis post age-appropriate doses 3 and 4 compared to unvaccinated children, with additional benefit of dose 4 compared to receipt of primary course alone.

Results

Dose 3 VE declined from 79% (CI 75%-83%) from 0-6 months to 64% (CI 60%-67%) at 6-36 months and 45% (CI 31%-56%) at 36-42 months post-vaccination. Compared to unvaccinated children, VE after dose 4 declined from 83% (CI 80%-86%) at 0-12 months to 67% (CI 60%-72%) and 55% (CI 46%-63%) in the following two 12-month periods post-vaccination. When compared to dose 3, the relative VE for dose 4 was 58% (CI 51%-64%) in 0-18 months post-vaccination.

Conclusion and Key messages

Our study adds to previous Australian evidence for substantial waning of vaccine induced immunity against pertussis over a 3-year period following dose 3. VE was significantly higher in the 18 months following dose 4 compared to receipt of primary course alone.
1219Translating epidemiological findings to end rheumatic heart disease in Australia: the ERASE project
Authors: Katzenellenbogen Assoc Judith , Stacey Ingrid , Wade Vicki , Haynes Emma , Bessarab Dawn
Published: September 2021

Focus of Presentation

Rheumatic fever (RF) and rheumatic heart disease (RHD) are endemic among Indigenous Australians. End RHD in Australia: Study of Epidemiology (ERASE) aimed to characterize contemporary RF/RHD epidemiology. Using multi-jurisdictional linked data from several administrative sources, we undertook sub-studies covering diverse epidemiological questions, requiring substantial methods development. Mixed methods further identified barriers/facilitators to inform system redesign. Our multi-disciplinary collaboration supported diverse initiatives to contribute to policy at government, service and community/stakeholder levels. We show how findings from ERASE were applied/translated to address the impact of RF/RHD in Australia.

Findings

Academic: >15 papers and commentaries/editorials provided the backbone to translational outputs and methods sharing. PhD students have ongoing projects using ERASE datasets.

Advocacy: ERASE epidemiological and economic information supported the Endgame Strategy (roadmap for eliminating RHD in Australia by 2031) presented to government.

Health professionals: ERASE data contributed to Australian RF/RHD guidelines. Slides of results/interpretation are publically-available on the RHDAustralia website. Student lectures integrate biomedical and culturally-informed perspectives.

Indigenous stakeholder engagement: involves (1)presentations to peak Indigenous-controlled organisations (2)co-designed resources (booklets/slides) for capacity-building of RHDAustralia’s national Champions4Change network (3)research workshops to promote two-way learning and health literacy/numeracy. Challenges remain regarding strengths-based approaches when reporting high disparities.

Conclusions/Implications

Strong translational commitment and national multi-disciplinary networks of Indigenous and non-Indigenous collaborators ensured ERASE generated multiple outputs that continue to inform training, practice, policy and community health literacy.

Key messages

Build translation and broad collaboration into study from the start.
1220Barriers to care for people who use crystal methamphetamine
Authors: Kershaw Steph , Chapman Cath , Birrell Louise , Champion Katrina , Deen Hannah , Stapinski Lexine , Kay-Lambkin Honorary Frances , Teesson Maree , Newton Nicola
Published: September 2021

Background

Crystal methamphetamine (‘ice’) causes significant societal harm in Australia and is perceived by the public to be the drug of most concern nationally. Although effective treatments exist, it is estimated that only a third of people dependent on amphetamine-type stimulants receive treatment each year. Barriers to care may for people who use ice can include psychosocial (e.g., knowledge, attitudinal) and structural barriers. This study aimed to look at the perceived and actual barriers to care for Australians, as well as help-seeking behaviours among people who use ice.

Methods

An online survey was conducted among 2,110 Australians including people with lived experience, health workers, affected family members/friends and community members. All participants were asked about perceived barriers to care. People with lived experience were asked additional questions about help seeking.

Results

Attitudinal reasons were the highest perceived barrier to care among 63.1% of participants, followed by knowledge (21.9%). People with lived experience were more likely to endorse attitudinal barriers (OR 1.35), whereas health workers were more likely to endorse knowledge related barriers (OR 0.69). Among people with lived experience who had sought help, 74.5% had visited a counsellor/psychologist and 60.6% had asked help from a family member/friend.

Conclusions

Understanding and reducing barriers to care is essential to reduce the harms associated with the drug. It is important to support families and friends as they are often asked to help or support a loved one using ice.

Key messages

It is important to understand and reduce the perceived and actual barriers to care for people who use ice. This is essential to reduce the harms associated with the drug.
208The Effect of General vs. Regional Anesthesia on Early Postoperative Mortality in Hip Arthroplasty Patients
Authors: Khan Irfan , Noman Raihan , Markatia Nabeel , Pelaez Juan Ruiz , Vega Pura Rodriguez de la , Castro Grettel
Published: September 2021

Background

There is conflicting evidence in the literature regarding whether type of anesthesia (regional vs. general) is associated with postoperative mortality in patients undergoing hip arthroplasty. The present study compares mortality between general or regional anesthesia administered to patients undergoing either total (THA) or partial hip arthroplasty (PHA).

Methods

A retrospective cohort was assembled using the 2015-2016 American College of Surgeons National Surgical Quality Improvement Program database. Adult patients undergoing hip arthroplasty under general or regional anesthesia were included. Adjusted odds of 30 days all-cause postoperative mortality according to type of anesthesia were estimated by fitting multiple logistic regression models that included potential confounders and effect modifiers.

Results

A total of 60,897 patients were included. Given that the interaction between type of anesthesia and type of arthroplasty was statistically significant, separated models were fitted for each type of arthroplasty. There was no evidence of an association between type of anesthesia and postoperative mortality in hip arthroplasty patients regardless of whether the arthroplasty was partial (OR = 0.85; CI 0.59-1.22) or total (OR = 0.68; CI 0.43-1.08).

Conclusion

The overall postoperative mortality in adult hip arthroplasty patients is low. Our findings support that mortality is not different between patients receiving regional vs general anesthesia regardless of type of hip arthroplasty (total vs. partial).

Key Message

In patients undergoing total hip arthroplasty or partial hip arthroplasty, the use of general or regional anesthesia does not impact early postoperative mortality.
1202Examining the mental health effect of caring among adolescents using augmented inverse probability treatment weighting
Authors: King Tania , Singh Ankur , Disney George
Published: September 2021

Background

Caring exerts significant impacts on the lives of those providing care, however there has been limited quantitative analysis of the mental health impacts on young carers. This research aimed to estimate the effect of informal caring at age 14/15 years on mental health at age 18/19 years.

Methods

Data was drawn from Waves 5, 6, 8 (2012-2018) of the Longitudinal Study of Australian Children. Effects of caring on mental health were assessed using augmented inverse probability treatment weighting, with adjustment for potential confounders. Caring was assessed with both a binary (any caring vs none), and a three-category variable (no caring, less than daily caring, daily caring).

Results

In complete case models, binary caring at age 14/15 years was associated with poorer mental health at age 18/19 years, with an average treatment effect (ATE) of 1.10 (95%CI 0.37, 1.83). The ATE of daily caring compared to no caring at age 14/15 years of age was 1.94 (95%CI 0.48, 3.39), and caring less than daily (compared to no caring) was associated with a treatment effect of 0.83(95%CI 0.06, 1.61). Associations were robust to several sensitivity analyses.

Conclusions

These results suggest there is a mental health impact of caring in adolescence on mental health four years later.

Key messages

These results highlight the need for support for young carers. Such support is particularly essential for those providing more intensive caring.
745Probability-proportional-to-size cluster sampling as an effective methodology for large-scale participant recruitment
Authors: Kiran Suresh , Kamath Asha , Bellur Rajashekhar , Krishnan Gopee
Published: September 2021

Background

We demonstrate the utility of Probability-Proportional-to-Size Cluster Sampling (PPS-CS) to select participants/sites for large scale surveys.

Methods

Post ethical and administrative clearance, PPS-CS was carried-out to estimate the prevalence of ‘sublexical dyslexia’, a reading impairment in children from III-VII grades in Udupi district of India. Schools were regarded as clusters. By performing PPS-CS, calculated sample size of 1812 children was systematically recruited. Sampling frame: List of all 1256 schools in Udupi district was retrieved. Kannada medium schools were shortlisted, which yielded 128 schools later classified individually as urban or rural.

Results

Strength of schools was retrieved and cumulative strength (cs) was derived. With an average school size of 105 for rural and 98 for urban cluster, 18 schools were required to meet the sample size. Owing to a ratio of 3.5:1 of rural-to-urban students, 14 rural and 4 urban schools were selected. Ratio of ‘cs’ to ‘number-of-schools-required’ gave a sampling interval (SI) of 758 for rural, and 662 for urban cluster. A random number (R) was selected between one and SI. First school picked was that with cs > =R. Second was that with cs > =SI+R. The third was with cs > =(SI+R at II school)+SI. Progressively, 18 schools were identified.

Conclusions

With disproportionate sizes of clusters, PPS-CS ensured that selected participants reflect population estimates accordingly. Prevalence of sublexical dyslexia in Udupi district was therefore accurately estimated using PPS-CS.

Key messages

Large-scale studies on healthcare or businesses may be effectively carried-out using PPS-CS!
1430Guideline-based cardiovascular disease risk assessment among Indigenous Australians in a general practice setting
Authors: Koye Digsu , Lamb Karen , Lee Ping-Wen , Kotevski Aneta , Haurat Javier , Turner Maureen , Ebsworth Gabrielle , Druce Tanya , Bryant Karen , Price Eloise , Taylor Georgia , Simpson Julie , Burchill Luke
Published: September 2021

Background

HealthGap is a population-based cohort study aiming to understand health inequities in cardiovascular disease (CVD) risk between Indigenous and non-Indigenous Australians. We examined guideline-based CVD risk assessment in Victoria.

Methods

NPS MedicineInsight, the largest Australian primary health care dataset, provided data on CVD risk factors (age, gender, smoking status, diabetes, systolic blood pressure (SBP), total and HDL cholesterol) and Aboriginal or Torres Strait Islander (Indigenous) status. The percentage of patients who had all risk factors measured was calculated and compared by Indigenous status.

Results

In total, 7,928 of 1,435,111 patients were classified as Indigenous. The percentage of patients with measured cholesterol was slightly lower for Indigenous (total cholesterol=31.4%, HDL=26.9%) than non-Indigenous patients (total cholesterol=35.6%, HDL=31.8%). However, more Indigenous patients had SBP measured (65.6% vs. 59.8%). Diabetes diagnosis was higher among Indigenous patients (6.2% vs. 3.6%).

There was a small difference in the proportions with all risk factors measured between Indigenous and non-Indigenous patients (24.1% vs. 26.6%). Among Indigenous patients aged at least 35 years who should have had their risk assessment measured, 41.9% had all risk factors measured, while 50.7% of the non-Indigenous Australians (aged ≥45 years) had all risk factors measured.

Conclusions

Overall, the proportion of people with all CVD risk factors measured was smaller for Indigenous compared to non-Indigenous people.

Key messages

Fewer than half of Indigenous Australians have CVD risk factors captured in a primary health care setting. This has implications for health care policy and programs seeking to improve CV health outcomes among Indigenous Australians.
575Factor affecting job satisfaction and organizational commitment among primary health care providers in Delhi, India
Authors: Kumar Pawan
Published: September 2021

Background

The purpose of present study was to explore the factors affecting job satisfaction and organizational commitment of primary health care providers working in Government health facilities of Delhi, India.

Methods

Study was conducted on a sample of 333 health care providers who were selected using multistage simple random sampling technique. Factor analysis of job satisfaction scale, statistical test like multiple regression, correlation tests were applied using SPSS version 18.

Results

The seven factors affecting job satisfaction emerged from the factor analysis which are; privileges attached with job, interpersonal relation and cooperation, working environment, patient relationship, organization facilities, career development and human resource issues. Nature of job whether regular or contractual explains 25.1% of variance in the job satisfaction of staff (R Square= 0.251, p = 0.000). Nature of job along with level of education of health care providers is affecting 26.5% of variance in job satisfaction (R Square= 0.265, p = 0.015). For organization commitment type of job whether regular or contractual is responsible for 44.7% of variance in the commitment (R square 0.447; p = 0.000) and experience of health care providers is affecting 29.0% of variance in commitment (R square= 0.290; p = 0.000). Other predictors of organization commitment are salary, job security, working environment, appreciation of work and career growth.

Conclusion

The findings strongly suggest that the mode of entry of employee, privileges, career growth and working atmosphere contribute substantially to the job satisfaction and organization commitment.

Key messages

Appropriate changes are required at the policy level to keep the human resource satisfied and committed to the organization keeping in consideration the factors responsible for them.
196Association of longitudinal lifestyle patterns with diabetes risk among sedentary and not-sedentary workers
Authors: Kuwahara Keisuke , Nakagawa Tohru , Yamamoto Shuichiro , Honda Toru , Hayashi Takeshi , Mizoue Tetsuya
Published: September 2021

Background

Evidence from observational studies is limited regarding longitudinal patterns of lifestyles and diabetes onset. In occupational settings, physical activity at work is an important factor to consider when implementing health promotion.

Methods

This is a cohort study among 25,646 workers without diabetes in Japan. We calculated lifestyle scores using 5 low-risk lifestyle factors: no-smoking, avoiding heavy alcohol use, engaging exercise, avoiding sleep deprivation, and keeping healthy weight, yielding the total score of 0 to 5 each year. We identified lifestyle patterns over 3 years by group-based trajectory modelling. Diabetes was defined by blood glucose, HbA1c, or self-report. Hazard ratios (95% confidence intervals) for incident diabetes were calculated using Cox regression.

Results

We detected five lifestyle patterns from a whole sample. During a mean follow-up of 6.6 years, 2,223 developed diabetes. Overall, healthier lifestyles were associated with a lower diabetes risk. Among sedentary workers, the multivariable-adjusted hazard ratios (95% confidence intervals) were 1.00 (reference) for persistently unhealthy pattern, 0.70 (0.60, 0.80) for persistently moderately healthy pattern, 0.45 (0.38, 0.53) for persistently mostly healthy pattern, 0.38 (0.28, 0.52) for improved to completely healthy pattern, and 0.24 (0.17, 0.32) for persistently completely healthy pattern. Similar results were obtained among not-sedentary workers.

Conclusions

Healthier lifestyles were associated with a lower risk of developing diabetes among participants who were sedentary at work and those who were not sedentary at work, respectively.

Key messages

Adherence to healthy lifestyles is important to prevent diabetes for working adults regardless of occupational physical activity level.
1150Changes in job security and mental health over 14 waves of a working population survey
Authors: LaMontagne Anthony D. , Punnett Laura , Too Lay San
Published: September 2021

Background & Methods

We examined whether job security improvements were associated with improvements in mental health in a large Australian nationally representative panel study. We used both within-person fixed effects (FE) and random effects (RE) regression to analyse data from 14 annual waves covering calendar years 2002—2015 (19,169 persons, 106,942 observations). Mental Health Inventory-5 scores were modeled in relation to self-reported job security (categorical, quintiles), adjusting for age, year, education, and job change in the past year.

Results

Both FE and RE models showed stepwise improvements in MHI-5 scores with improving job security, with stronger exposure-outcome relationships in the RE models and for men compared to women. The RE coefficients for improvements in job security in males were 2.06 [1.67, 2.46] for one quintile, steadily increasing for two- (3.94 [3.54, 4.34]), three- (5.82 [5.40, 6.24]), and four- (7.18 [6.71, 7.64]) quintile improvements. The FE model for males produced slightly smaller coefficients, reaching a maximum of 5.55 [5.06, 6.05]. Supplementary analyses investigated whether six waves of cumulative exposure to job security (higher value = higher security) predicted MHI-5 score (improvement in mental health) in the seventh wave: results showed a strong dose-response (beta cumulative security was 0.60 [0.53-0.68]), with the difference between lowest and highest values of exposure corresponding to a 14-point increase in MHI-5 score.

Conclusions

These analyses, with improved causal inference over previous observational research, showed that improving job security is strongly associated with decreasing depression and anxiety symptoms.

Key messages

Policy and practice intervention to improve job security could benefit population mental health.
353Do police-involved deaths increase homicide rates in the post-Ferguson Era? Evidence from 44 US cities
Authors: Lane Tyler
Published: September 2021

Background

Starting in 2014, homicide rates increased in several US cities, reversing a two-decade downward trend. A number of commentators blamed the events of Ferguson, Missouri, where police killed Michael Brown, leading to protests and greater scrutiny of similar events in other cities. It is still unclear whether effect is causal and what the mechanism would be.

Methods

Using the FBI’s Uniform Crime Reporting database, I derived 2011-2019 crime data from 44 US cities where protests followed a local police-involved death. The main outcome was homicide. Assaults are potentially similar as a conflict-resolution strategy, though reporting is more discretionary than homicides. Differences in effect between homicide and assault were used as a proxy for underreporting and an indicator legal cynicism. Effects were tested using interrupted time series and combined with meta-analyses. Meta-regressions were used to test the moderating effects of external investigations and sociodemographic factors.

Results

Homicides increased 26% (99% CI: 15%, 36%). Assaults also increased, though the effect was 15% lower than the homicides (-27%, -4%). No tested factor significantly effects.

Conclusions

Where police-involved deaths lead to protests, homicide rates increase. The findings support de-legitimisation of police as a causal mechanism, but not de-policing.

Key messages

Police-involved deaths can lead to increased homicides. Cities where police-community tensions are already high may be particularly vulnerable to homicide rate increases following police-involved deaths.
229Step-downs reduce workers’ compensation payments to encourage return to work. Are they effective?
Authors: Lane Tyler , Sheehan Luke , Gray Shannon , Collie Alex
Published: September 2021

Background

Workers’ compensation systems throughout Australia implement “step-downs,” which cut the amount paid to injured workers after they have received benefits for several months. Though initially introduced to control rising insurance premiums, step-downs are currently justified as an incentive return to work. Whether they have this effect has never been formally tested.

Methods

Using administrative claims data, we applied a regression discontinuity study design to test whether step-downs affected weekly scheme exit rates, a proxy for return to work, within eight state, territory, and Commonwealth workers’ compensation systems. We also examined effects by injury type (fractures, musculoskeletal, mental health, and other trauma). To derive generalised effects, we combined results using meta-analyses and conducted meta-regressions to determine whether timing or magnitude of step-downs significantly moderated effects.

Results

Step-downs reduced scheme exit by 0.86 percentage points (95% CI: -1.45, -0.27). Neither timing nor magnitude of step-downs was a significant effect moderator. There were significant effects in fractures (-0.84, 95% CI: -1.61, -0.07) and sensitivity analysis suggested possible effects within mental health and musculoskeletal conditions.

Conclusions

The negative effects suggest some workers’ compensation recipients anticipate step-downs and return to work early to avoid a reduction in income. However, the effects were small and suggest step-downs have marginal practical significance. We conclude that step-downs are generally ineffective as a return to work policy initiative.

Key messages

Reducing the amount of compensation paid to injured workers has a minor incentivising effect on their return to work rates.
1238Estimating the non-specific effects of seasonal influenza vaccine on RSV-hospitalisations in children
Authors: Le Huong , Blyth Christopher , Gidding Heather , Snelling Tom , Fathima Parveen , Moore Hannah
Published: September 2021

Background

Seasonal influenza vaccine is effective against influenza hospitalisations, but little is known about non-specific effects on other respiratory pathogens with similar seasonal patterns. We aimed to assess the causal impact of seasonal influenza vaccine on laboratory-confirmed hospitalisations for respiratory syncytial virus (RSV) in children using an instrumental variable (IV) strategy.

Methods

We used population-based probabilistically linked data on births, childhood immunisations, deaths, hospitalisations, perinatal and statewide microbiology data (2000-2013) in Western Australia (WA). Our analysis cohort included children up to age 7 years. We exploited WA’s unique preschool influenza vaccination policy commencing in 2008 and used this as an instrument for vaccination status. We estimated a system of two simultaneous probit equations: determinants of influenza vaccine uptake, and determinants of RSV-confirmed hospitalisation.

Results

Influenza vaccine coverage was low prior to 2008 but increased to 33.7% in children aged 6-23 months in 2009. RSV-hospitalisations ranged from 3.5/1000 children (12-23 months) to 6.4/1000 (6-12 months). Receipt of seasonal influenza vaccine reduced RSV-hospitalisations in the population cohort of children aged <2 years by an average of 0.21% in the same year (p < 0.001).

Conclusions

To our knowledge, this is the first analysis utilising an IV estimation strategy to assess the impact of influenza vaccine on RSV-hospitalisations. We estimated a small, but highly statistically significant impact that warrants further investigation using contemporary data.

Key messages

RSV is a leading cause of childhood morbidity. The role of influenza vaccine offering cross protection to RSV could be further explored prior to RSV vaccines being commercially available.