bluuebunny/crossref_metadata_2025 huggingface dataset:
484Reduced glomerular filtration rate and risk of stroke
Authors: Oh Doctor Chang-mo , Ryoo Jae-Hong
Published: September 2021

Background

Although chronic kidney disease is recognized as an independent risk factor for cerebrovascular disease, its association with hemorrhagic and ischemic stroke remains controversial.

Methods

A retrospective cohort study conducted using the National Health Insurance Service-National Sample Cohort, which is representative of the entire Korean population. Overall, 196,005 Korean who were not diagnosed with ischemic and hemorrhagic stroke before 2009 were included from 2009 to 2013. The eGFR was divided into six categories (≥90, 75–89, 60–74, 45–59, 30–44, <30 mL/min/1.73 m2). The Kaplan-Meier plot was illustrated to compare the cumulative incidence of ischemic stroke and hemorrhagic stroke. Cox proportional hazard model was used to estimate the hazard ratio (HR) of eGFR for risk of ischemic and hemorrhagic stroke.

Results

During an average of 4.36 years follow-up period, 2,236 and 668 people were diagnosed with newly ischemic stroke and hemorrhagic stroke, respectively. Among people with eGFR>90 mL/min/1.73 m2, age and sex adjusted incidence rate for ischemic stroke was 452.3 per 100,000 person-years, whereas the adjusted incidence rate for ischemic stroke among people eGFR with 30-44 and 45 mL/min/1.73m2 was 833.5 and 617.7 per 100,000 person-years, respectively. After adjusting for multiple covariates, the adjusted HR for ischemic stroke increased with decreasing eGFR (p for trend=0.005). However, there was no significant dose-response relationship between eGFR and risk of hemorrhagic stroke.

Conclusions

Reduced glomerular filtration rate less than 45 mL/min/1.73 m2 was associated with an increased risk of ischemic stroke but not hemorrhagic stroke.

Key messages

Reduction in kidney function had inverse dose-response relationship with the risk of ischemic stroke, but not with the hemorrhagic stroke. Especially, the risk of ischemic stroke was markedly increased from estimated glomerular filtration rate < 45 mL/min/1.73 m2.
936Descriptive study of healthy life expectancy in all secondary medical areas in Japan
Authors: Ojima Toshiyuki , Hosokawa Rikuya , Myojin Tomoya , Aida Jun , Kondo Katsunori , Kondo Naoki
Published: September 2021

Background

Healthy life expectancy (HLE) is an index combined with mortality and morbidity. Monitoring HLE is useful to assess and stimulate health promotion policies/programmes. Though HLE in national or prefectural areas have often been observed, further data in smaller areas are required. The aim of the study is to reveal descriptive features of HLE in secondary medical areas, that is almost same as public health centre jurisdictions and median of population is 214 thousand, in Japan.

Methods

HLE by gender in all 341 secondary medical areas were calculated using Sullivan method. Population data was used from resident registry. Mortality data was from vital statistics of total death in 2016-2018. Data of proportions of unhealthy people was from long-term care insurance data in 2017 using proportion of people with care level 2 (almost bed ridden level) or more severe. Finally, maps of HLE of all of Japan were drawn.

Results

Means (standard deviations, maximums, minimums, means of ranges of 95% confidence intervals) of HLE at birth are 79.21 (0.86, 81.36, 76.90, 0.92) and 83.75 (0.62, 85.45, 81.99, 0.80) years for males and females, respectively. Areas with short HLE were prevalent in Tohoku region (northern part), while that with long HLE in Chubu region (central part).

Conclusions

Descriptive features of HLE in smaller areas of all of Japan can be firstly clarified.

Key messages

Monitoring HLE in local areas would be feasible and useful in some countries. Precision of HLE of areas of these population size would be acceptable.
1031Predictors of Lung function change over the life course: a systematic review
Authors: Okyere Daniel , Waidyatillake Nilakshi , Bui Dinhi , Lowe Adrian , Perret Jenny , Lodge Caroline , Dharmage Shyamali
Published: September 2021

Background

Throughout life, lung function increases, peaks, plateaus and declines. These phases can be influenced by several exposures. Despite the growing body of evidence, the association between these factors and lung function change over the lif course has not been systematically reviewed.

Methods

Using a pre-defined protocol, two authors independently identified publications related to lung function trajectories and extracted relevant information. We included studies that identified/developed/modelled/reported lung function trajectories based on at least three-time points. Due to heterogeneity in the exposures and methods used to model lung function trajectories, it was not possible to conduct a meta-analysis.

Results

A total of 12 population-based cohort studies met the inclusion criteria. Of these, 10 were birth cohorts. 4 studies used cluster analysis techniques to develop trajectories while the others used generalized linear interactive modelling. Eight factors were identified, by 2 or more studies, as predictors for reduced lung growth, decline and/or persistently low trajectories. They were low birth weight and parental asthma (n = 2); childhood asthma and allergic sensitization (n = 4); childhood lower respiratory tract infections and childhood persistent wheezing, and environmental tobacco smoke (n = 3); and childhood eczema (n = 2).

Conclusions

Our review identified risk factors for lung function change that have been consistent at least across two studies.

Key messages

These findings suggest preventive measures directed at childhood asthma and infections, and tobacco exposure will help promote lung health and prevent unhealthy lung function trajectories.
400Overactive bladder with/without urinary incontinence and falls in the community-dwelling elderly
Authors: Omae Kenji , Kurita Noriaki , Takeshima Taro , Naganuma Toru , Takahashi Sei , Yoshioka Takashi , Ohnishi Tsuyoshi , Ito Fumihito , Hamaguchi Sugihiro , Fukuhara Shunichi
Published: September 2021

Background

Little is known about the fall risk of older adults with overactive bladder (OAB), especially in the absence of urgency incontinence (UI).

Methods

This prospective cohort study included 630 community-dwelling, independent older adults 75 years old or older who attended a health check-up in 2017 with a 1-year follow-up. The associations of OAB with and without UI (OAB-wet and OAB-dry) with a fall history, and future fall risk compared to no OAB were assessed using logistic regression models. The contribution of OAB as a predictor of falls was examined using a random forest and decision tree approach.

Results

Of the 577 analyzed participants (median age 79 years), 273 were men. The prevalence of OAB-dry and OAB-wet at baseline was 15% and 14%, respectively. Multivariable logistic regression analysis revealed that both OAB-dry and OAB-wet were associated with a higher likelihood of prior falls (adjusted ORs vs no OAB 2.03 and 2.21, respectively; 95% CI 1.23–3.37 and 1.29–3.78, respectively). Among the 363 participants without a fall history, the adjusted ORs (95% CIs) of OAB-dry and OAB-wet for the occurrence of falls during the 1-year follow-up were 2.74 (1.19–6.29) and 1.35 (0.47–3.87), respectively. The tree-based approach used for all participants showed that OAB was an important predictor of falls in adults without a fall history.

Conclusions

OAB, even in the absence of UI, is an important predictor of falls in older adults with a low absolute fall risk.

Key messages

Our findings suggest that OAB is a risk factor for falls in the community-dwelling elderly irrespective of the presence of UI.
602Prevalence of cancer history and association with risk factors in a healthy older population
Authors: Orchard Suzanne , Lockery Jessica , Gibbs Peter , Polehkina Galina , Wolfe Rory , Zalcberg John , Haydon Andrew , McNeil John , Nelson Mark , Reid Christopher , Kirpach Brenda , Murray Anne , Woods Robyn
Published: September 2021

Background

The ASPirin in Reducing Events in the Elderly (ASPREE) study randomised healthy older individuals to 100mg aspirin or placebo, with clinical outcomes and disability-free survival endpoints. Detailed baseline data provides a rare opportunity to explore cancer burden and association with known cancer risk factors in this population.

Methods

At enrolment (2010-2014), self-reported personal cancer history, cancer type and cancer risk factor data were sought from 19,114 participants (Australia, n = 16,703; U.S., n = 2,411). Participants were healthy and expected to survive 5 years.

Results

Of those reporting a prior cancer diagnosis (18% women, 22% men), women were diagnosed younger (16% vs 6% of diagnoses <50 years). Cancer prevalence increased with age. Prostate and breast cancer history were higher in U.S. participants; melanoma and colorectal cancer were higher in Australian participants. Cancer history prevalence was not associated with any common risk factors, but was associated with poor health ratings in men. Blood and breast cancer history was more common with past aspirin use.

Conclusions

Personal cancer history in healthy older ASPREE participants was as expected for the most common cancer types in the respective populations. The lack of alignment with known risk factors is attributable to survivor bias, driven by entry criteria, and to possible molecular differences in cancer between elderly and younger people.

Key messages

As the prevalence of cancer increases with age, the lack of alignment with known risk factors implies other factors play a significant role.
447Decoding the effect of neighbourhood on arterial health (DEpICT): Preliminary results on neighbourhood self-evaluation
Authors: Panayiotou Andrie , Photiou Galateia , Panagiotakos Demosthenis , Middleton Nicos
Published: September 2021

Background

DEpICT is an ongoing exploratory, observational, cross-sectional study in community-dwelling individuals in Limassol, Cyprus aiming to combine individual-level and community-level risk factors to decode their effect on arterial health (stiffness) as measured with pulse wave velocity (PWV).

Methods

Participants are >40 years and living in the same address for ≥5 years. They provide personal information on quality of life and mental health (SF-12 and GHQ-12), physical activity (IPAQ), adherence to Mediterranean diet (MedDiet) and sociodemographic. Arterial stiffness is measured as PWV. Neighborhood is self-assessed using the “Place Standard” Tool, as well as independent neighborhood audit with the newly-developed CyNoTes tool.

Results

Mean age of the first 176 participants (53%male) was 55.2 (±8.6). All participants rated their health between excellent/very good (50.5%) and good/modest (49.5%), however participants with a higher net family income reported significantly better health (p for trend=0.02), with 61.4% reporting very good/excellent health in those earning >2000E Vs 40.2% in those earning ≤ 2000E/m (p = 0.005). Out of 14 constructs in “Place”, “Public transport” and “Participation and sense of control” were rated lowest (3.1 ± 1.9 and 3.1 ± 1.8) and “Identity and sense of belonging” and “Safety” highest (4.1 ± 1.9 and 4.5 ± 1.8). Out of these, family income was associated with “Safety” (p = 0.005) and self-health with “Participation and sense of control”.

Conclusions

Participants rate social and safety aspects of their neighborhood higher than build aspects.

Key messages

Participants express the need for more public engagement in community decision-making; sense of lacking control may affect individual health.
663“To tell or not to tell...” Practice of (non)disclosure and collusion of cancer in India
Authors: Parsekar Shradha S. , Nair Suma
Published: September 2021

Introduction

Collusion and concealing cancer diagnosis is often practiced in India. To get more insights on the perception and practice of disclosing cancer diagnosis, a qualitative study was conducted in south India.

Methods

In-depth interviews were conducted separately among women diagnosed with breast cancer and their caregivers. Prior permissions from hospital administration and ethical clearance was obtained. Using purposive sampling, 39 caregivers and 35 women diagnosed with breast cancer were recruited from tertiary care hospital.

Results

Families practiced collusion so as to protect the patient from emotional consequence viz. shock, fear of death and uncertainty about prognosis and treatment. This practice was more common among families who had patient with advanced stage of illness and/or 49 years of age and above. Collusion was mostly seen among Participants concealed the cancer diagnosis from social contacts such as extended family, friends and neighbor. Resultant codes pertaining to nondisclosure were; ‘too many questions’, ‘avoid courtesy visits’, ‘negative suggestions’, ‘perceived stigma’, ‘obstacle in child’s marriage’, and ‘shock’.

Conclusions

Disclosing cancer diagnosis is considered as ‘bad news’ however, withholding information about health status of patient is not ethically appropriate. Additionally, nondisclosure resulted in diminished support from social contacts. Concordance between cancer diagnosis and patients’ ability to deal with the information is important.

Key messages

Although nondisclosure of cancer diagnosis and prognosis violates patient autonomy, it was perceived to be beneficial for the patient. A pragmatic disclosure strategy complemented with tailored counselling would be a feasible paradigm.
1340A Trial of Modern Sample Frames and Modes: The WA Health and Wellbeing Surveillance System
Authors: Patterson Candice , Dombrovskaya Mikhalina , Landrigan Tim
Published: September 2021

Background

The Health and Wellbeing Surveillance System (HWSS) monitors the health status of the WA population. Its reliance on a landline sample frame and Computer Assisted Telephone Interview (CATI) must shift to mobile phone sample frames and novel online completion options, improving the representativeness of the HWSS data to the WA population.

Methods

Concurrent surveys in 2020 were run using three sample frames, the 2013 Electronic White Pages (EWP), the WA Electoral Roll (WAER) and a Sensis consumer database. The survey modes explored included CATI, online, and dual mode. Responses were weighted to the WA population. Response rates were compared between frames and modes. Differences in demographics, health risk factors, conditions and behaviours were investigated by comparing prevalence estimates and logistic regression modelling.

Results

Response rates were 20% for EWP CATI, 41% for Sensis CATI, 16% for Sensis online, and 10% for WAER online. Compared to EWP, the WAER and Sensis frame respondents were younger, had higher incomes and better education. Online respondents had higher prevalence of high psychological distress and lower prevalence of smoking compared with CATI.

Conclusions

The WAER and Sensis consumer database are valid sample frame options for the future of the HWSS. CATI gave the highest response rates, yet respondent differences by frame and mode were evident. WA Health is further exploring these options of modern sample frames and survey modes in 2021.

Key messages

Population health surveillance systems must modernise their sample frames and data collection modes to continue to provide reliable health prevalence estimates.
154Physical inactivity, socioeconomic position and type 2 diabetes in Nepal: a structural equation modelling analysis
Authors: Paudel Susan , Tran Thach , Owen Alice , Smith Ben
Published: September 2021

Background

Type 2 diabetes mellitus (T2DM) is emerging as a major public health challenge in Nepal. Behavioural, social and economic changes are likely to play a part in the rise of this chronic disease, as they are in many developing countries. A better understanding of the relationship between physical activity (PA), social and economic factors and T2DM can inform the design of prevention programs.

Methods

This study analysed data from 1977 Nepalese adults aged 40-69 years from the 2013 WHO STEPS survey. Socioeconomic position was determined based on education, occupation and ethnic group. Participants’ fasting blood glucose level was used to ascertain their diabetes status. Structural equation modelling was conducted to identify the regression pathways between PA, socioeconomic position, anthropometric and metabolic variables and T2DM.

Results

The overall prevalence of T2DM was 9% with almost double the burden among urban residents (17 %). Socioeconomic position (0.338), waist circumference (0.250), triglycerides (0.115) and hypertension (0.129) had a statistically significant direct effect on T2DM. PA had an indirect effect on T2DM mediated by waist circumference (-0.015). The indirect effects of socioeconomic position on T2DM were mediated by body mass index, waist circumference, triglycerides and total cholesterol.

Conclusion

Policies and programs to address T2DM in Nepal should address the factors contributing to unhealthy weight status, particularly among those of higher socioeconomic status.

Key message

Among Nepalese adults, higher socioeconomic position has a significant direct effect on T2DM, while both PA and higher socioeconomic position have significant indirect effects.
894Molecular epidemiology: building causal evidence within highly dimensioned studies
Authors: Ponsonby Anne-Louise
Published: September 2021

Focus of Presentation

This presentation provides a practical perspective on molecular epidemiologic analysis within a single high dimensional study to consider a causal question.

Findings

The work steps include special issues. Those include composite exposures and understanding of collinearity across predictors. Laboratory artefact needs to be minimised. Non-causal confounding is also important. This can occur when a factor is a determinant of outcome and the underlying association between exposure and the factor is non-causal. That is, the association arises due to chance, confounding or other bias rather than reflecting that exposure and the factor are causally related. The influence of laboratory processing features must be accounted for. This can be achieved by pre-processing measures to remove artefact or controlling for process factors. The work plan should allow the evaluation of alternative non-causal explanations for observed exposure-disease associations and strategies to obtain the highest level of causal inference possible within the study.

Conclusions/Implications

A systematic approach is required to work through a question a question set and obtain insights on not only the exposure-disease association but the multifactorial causal structure of the underlying data where possible. The appropriate inclusion of molecular findings will enhance the quest to better understand multifactorial disease causation in modern observational epidemiological studies.

Key messages

A systematic set of work steps is outlined to assess whether detected exposure-disease associations have a low and high likelihood of being attributed to non-causal and causal explanations respectively.
1419Cancer mortality burden and quality of life in Argentina: geographical pattern and measures of association
Authors: Pou Sonia Alejandra , Niclis Camila , Tumas Natalia , Aballay Laura Rosana , Diaz Maria del Pilar
Published: September 2021

Background

Health outcomes are often related to the conditions in which people live. Previous studies indicated that cancer mortality is non-randomly distributed between social groups and regions in Argentina. We aimed to analyze geographical pattern of mortality due to the most prevalent cancers in Argentina (2013-2015), from a quality of life approach.

Methods

Age-standardized mortality rates (ASMR) for specific cancer types (breast, lung, prostate, colon, cervix, stomach) was estimated by direct method (2013-2015 period). Mortality maps at a departmental scale (n = 511) were constructed by using a Getis-Ord Hot Spot spatial analysis. A Quality of Life Index (QLI, continuous score) for Argentina 2010 was used. Poisson mixed models with a random intercept were performed to estimate IRRs (relative risk) as measures of association.

Results

Breast, lung, and colon cancers show the most clear ASMR geographical patterns, which locate an extensive cold spot (lower and correlated rates) in the northwestern region of Argentina and a hot spot (higher and correlated rates) in the Pampeana (center-east) region . Particularly, breast and cervix cancers showed confronting mortality geographic patterns and opposite relationships with the departmental QLI (IRR 1.23 and 0.78, respectively). A direct association was found for lung (IRR 1.46/1.15 for women/men) and colon cancer (IRR 1.57/1.49 for women/men).

Conclusions

Results evidence geographic disparities in cancer mortality burden linked to the quality of life of populations at departmental scale in Argentina.

Key messages

Geographic disparities in cancer mortality are linked to the quality of life in Argentina.

Mortality-QLI relationship varies according the cancer type.
965The estimated impact of improved breast screening tests targeted at women with dense breasts
Authors: Procopio Pietro , Velentzis Louiza , Dennis Petrie A , Mann G Bruce , Kavanagh Anne M , Ray Watson A , Saxby Karinna , Korevaar Elizabeth , Carr Sarah , Bromley Hannah , Canfell Karen , Nickson Carolyn
Published: September 2021

Background

There is increasing interest in risk-based breast cancer screening, including interventions to improve outcomes for women with mammographically dense breasts.

Methods

Policy1-Breast is a continuous-time, multiple-cohort micro-simulation whole-population model which incorporates breast cancer risk, life-course breast density, menopause, hormone therapy use and screening participation. Outcomes include cancer diagnoses and characteristics (invasive/DCIS, tumour size, grade), mode of detection (screen-detected/interval/other) and mortality (breast cancer and other cause). Policy1-Breast validates well against key observed clinical outcomes in Australia. We estimate changes in outcomes within and outside the BreastScreen program upon the introduction of a hypothetical screening test with improved sensitivity for women with dense breasts.

Results

We estimate that introducing in year 2020 a screening test for women in the highest quintile of breast density at age 50 that halves the masking effect of their breast density would, by 2026-2030, increase diagnosis rates of population-level invasive cancers ( 10%) and screen-detected cancers (20%) and decrease rates of interval cancers (17%) and community-detected cancers (6%).

Conclusions

Targeted screening tests with improved sensitivity for women with dense breasts are expected to markedly reduce interval cancers and other cancers diagnosed outside the BreastScreen program, while increasing all cancer diagnoses due to increased rates of screen-detected cancers.

Key messages

Specialised breast cancer screening tests directed at women with very high breast density are expected to reduce interval cancers and increase overall cancer diagnoses. Population simulation models such as Policy1-Breast can complement trial evidence by evaluating a range of scenarios and estimating short and long-term implications.
356Impact of site-specific and patient-specific factors in explaining HbA1c variation in Australian diabetes centres
Authors: Quigley Matthew , Earnest Arul , Szwarcbard Naomi , Wischer Natalie , Andrikopoulos Sofianos , Green Sally , Zoungas Sophia
Published: September 2021

Background

Management of glycaemia remains the mainstay of optimal diabetes care. As reported by the Australian National Diabetes Audit (ANDA) average glycaemia is suboptimal for many people living with diabetes. Whether centre-specific factors influence HbA1c variation among patients attending Australian primary, secondary or tertiary diabetes centres, is not known.

Methods

Data for 5,872 people with Type 1 or Type 2 diabetes (DM1/DM2) was collected for ANDA over a 4-6 week period. A linear mixed-effects model was built to examine the relative contribution of centre-specific (type of centre, location and volume of patients) and patient-specific factors in explaining variation in HbA1c, by diabetes type.

Results

Mean age of the cohort was 57.5±17.2 years, median disease duration 14 years (7,21) with 47% female. For people with DM1, number of patients was the only centre-specific factor that significantly contributed to HbA1c variation (p = 0.019). In contrast, for people with DM2, type of centre significantly contributed toHbA1c variation (p < 0.001). Patient-specific factors contributing to HbA1c variation included prior hyperglycaemic emergencies, being a non-smoker and Aboriginal or Torres Strait Islander status.

Conclusions

Unlike patient factors, centre factors such as type, location and volume of patients appear to have less actionable impact on HbA1c variation.

Key messages

Centre-level interventions to target patient-specific factors (such as sick day management education to prevent acute hyperglycaemia, smoking cessation programs and culturally appropriate diabetes education) rather than centre-specific factors may be more important for improving glycaemia.
585Do Australian livestock farmers perceive Q fever prevention differently from animal science and veterinary students?
Authors: Rahaman Rezanur , Burgess Teresa , Milazzo Adriana , Marshall Helen , Chaber Anne-Lise , Crabb Deane , Bi Peng
Published: September 2021

Background/Objective

To identify the issues around the prevention of Q fever as understood by trainee animal health practitioners and livestock farmers and to compare their varying perceptions.

Methods

An online survey with an open question seeking participants’ suggestions about Q fever prevention was distributed among all animal science and veterinary students enrolled at the University of Adelaide and members of Livestock SA representing livestock farmers during March-September 2019. Students were recruited through their University course whilst livestock farmers were recruited by advertisements and direct emails. Thematic analysis of the data followed the Braun and Clarke framework.

Results

Two major themes arose in each group, whilst each group identified similar themes and sub themes, there was a differing emphasis on the importance of these. Both students and farmers viewed Q fever vaccination is important, but barriers included excessive cost for students while access to a vaccine provider and general practitioners’ inadequate knowledge were emphasized by farmers. Awareness was another major theme: students – generalized lack of awareness amongst themselves and the public; farmers – increasing public awareness is crucial.

Conclusions

Both groups recognized the importance of Q fever vaccination and viewed subsidy an enabler, but students’ perceptions were shaped by the high cost of the vaccine while farmers were most concerned with the impacts of the disease. Findings underscore that strengthening targeted and community awareness programs coupled with a subsidy could promote increased uptake of Q fever vaccination.

Key messages

Increasing awareness and subsidized vaccination could merit Q fever prevention approaches including vaccination.
553Stage at diagnosis for six major cancers in China with comparison to the United States
Authors: Ran Xianhui , Zeng Hongmei , Zhang Siwei , An Lan , Zheng Rongshou , Wei Wenqiang , He Jie
Published: September 2021

Background

To explore the distribution and factors associated with cancer stage at diagnosis, we conducted a multi-center hospital-based study in China.

Methods

38 hospitals were selected to set up the Chinese cancer clinical database. Detailed stage information was collected from clinical records and focus on cancers of the lung, stomach, colon-rectum, liver, female breast, and esophagus diagnosed during 2016-2017. We compared the stage distribution with the US by data from Surveillance, Epidemiology, and End Results database during the same period.

Results

Overall 69632 first diagnosed cancer cases were analyzed. The proportion of cancer patients in stage I varies by cancer site, with highest in breast (28%) and lowest in liver (13%). The proportion of cancer cases at stage I was generally higher in women (OR:1.7,95%CI:1.6-1.8), in young (<65 years) (OR:1.2,1.1-1.2) and in subjects having Chinese Urban Insurances (OR:1.9,1. 8-2.0). Except for esophageal cancer, the other five major cancers in China had more advanced stage than in the US.

Conclusions

Socio-demographic inequalities exist in stage at diagnosis for major cancer cases in China. Early detection interventions are especially needed to be targeted on patients with higher risk of advance disease diagnosis.

Key messages

Multi-center hospital-based study on cancer stage distribution in China shows that women, young, and those with Chinese Urban Insurance were more likely to be diagnosed with early stage. Stage distribution in China was generally more advanced compared with cancer patients in the US.
355Tuberculosis care cascade in an indigenous population of a Colombian region
Authors: Márquez Iader Alfonso Rodríguez , Hoyos Kelly Yoana Tello , Pereda María del Pilar Torres , Salazar Bertha Leonor Guzmán , Pérez Freddy , Pasaje Jhon Edwin Polanco
Published: September 2021

Background

It is estimated, there are around 370 million indigenous people in the world. For 2017, 5.4% of tuberculosis cases in Colombia occurred in the indigenous population (IP), while in the Cauca region, it was 32% and only 19.3% of new cases were detected. This is the second region with the highest proportion of IP in Colombia. This could affect the fulfillment of the aims of the Colombian Strategic Plan Towards the End of TB. Our aim was to evaluate the pulmonary tuberculosis (PTB) care cascade in IP of Cauca and identified gaps in the cascade.

Methods

Mixed methods (explanatory sequential desing). In the quantitative phase, the care cascade was evaluated. In the qualitative phase we sought to explain the gaps in the cascade. Tuberculosis program information and semi-structured interviews were used.

Results

In the care cascade in IP, 202 cases of presumptive PTB (New smear-positive expected) were estimated. A gap of undiagnosed cases of 47.5% was found (n = 96). This gap was explained by poor quality of the Acid-Fast Bacillus Smear, failures in the identification of presumptive tuberculosis, limited access to diagnostic methods, poor training and high turnover of healthcare workers were identified as possible explanations.

Conclusions

The efforts of the tuberculosis control program in the IP should focus on reducing the gap of undiagnosed cases.

Key messages

The PTB in IP could affect the fulfillment of the goals of the program.

Approximately half of the expected cases were not detected during 2016-2017.
1218Estimating the causal effect of mobility on Dengue during the COVID-19 pandemic
Authors: Roster Kirstin , Connaughton Colm , Rodrigues Francisco A
Published: September 2021

Background

The COVID-19 pandemic led to a reduction in human mobility which occurred randomly (in time) and is not linked to any other Dengue risk factors. This gives rise to a quasi-experimental situation to assess the impact of mobility reduction on Dengue Fever in Brazilian cities using propensity score matching.

Methods

We match weeks during the peak pandemic period for 37 cities in São Paulo state with comparable prior periods based on instruments for mosquito population size and human susceptibility. By matching within cities, we also control for city-level characteristics, such as landscape or population density. We compute propensity scores using logistic regression and Random Forests and implement both one-to-one and one-to-many matching with calipers.

Results

We compare the Sample Average Treatment Effect on the Treated (SATT) across models and find variation in the direction of the causal effect. In 12 cities, mobility reductions are linked to more Dengue cases, while fewer cases are reported in 9 cities. The remaining cities are sensitive to the model chosen.

Conclusions

The SATT of mobility on Dengue varies across the cities in our sample, with more cities experiencing an increase in cases during the COVID-19 pandemic.

Key messages

A quasi-experimental analysis suggests that there is a a causal effect of mobility on Dengue that varies across cities in São Paulo state.
1032A Critical Assessment of Typologies of Conflict and their Relevance to Public Health Research
Authors: Saad Ghada , Damaj Yara , Tabaja Malak , DeJong Jocelyn
Published: September 2021

Background

Performing multi-country comparisons of the impact of armed conflict on health is not straightforward given the absence of an agreed definition of armed conflict and the multitude of categorizations/typologies identifying conflict-affected settings. Our analysis provides a critical review of available typologies to assess their usefulness for public health research.

Methods

Through a two-step comprehensive literature review, we identified available conflict-related typologies and performed a further multiple-database literature review to identify literature critiquing these typologies. Based on this information and our critical systematic assessment, we recommended optimal typologies for use in public health research.

Results

We identified 28 conflict-related typologies that we evaluated systematically to arrive at four typologies that are most suited for public health researchers examining for example, the effects of conflict on maternal and child health. These are the Uppsala Conflict Data Program, Heidelberg Institute of International Conflict Research (HIIK)-Conflict Barometer, Major Episodes of Political Violence and the Global Peace Index. These typologies are global in scope, address all types of violence, are regularly updated and do not include health/development indicators within their definitions.

Conclusion

All retrieved typologies have limitations, there are critiques of how conflicts and their intensity rankings are defined. Nevertheless, the four selected typologies provide useful tools for researchers aiming to make multi-country comparisons of the impact of armed conflict on health.

Key messages

There is no single agreed typology that provides a comprehensive picture of armed conflict across diverse settings. The most suitable typologies need to be complemented by in-country qualitative situation assessments.
144Identification of non-vaccinated children using decision trees
Authors: Santos Thiago Melo , Cata-Preta Bianca , Victora Cesar G , Barros Aluisio J D
Published: September 2021

Background

Non-vaccinated children are a particularly vulnerable and understudied group. Machine learning algorithms, such as decision trees, might be useful for identifying subgroups with high prevalence of zero dose (neither BCG, polio, DPT nor measles vaccines received).

Methods

We developed Classification and Regression Tree models using data from DHS surveys of India 2015 and Chad 2014 in order to identify risk groups of zero dose.

Results

The first split variable for India was the child’s place of delivery, followed by the mother’s tetanus vaccination status for the higher-risk subgroup of children born in noninstitutional facilities. For Chad, administrative region was selected, and two high zero dose regions were defined. For those regions, children whose mother did not receive any dose of tetanus vaccine were also considered a higher-risk subgroup.

Conclusions

Two trees were created with only two splits each. Subgroups with zero dose prevalence higher than 40% were identified.

Key messages

Decision trees might be valuable tools for exploratory data analysis and risk groups identification in epidemiological research.
771FUCS National Meeting of Colombian Health Research Seedbeds: our history 2004-2019
Authors: Castro Carlos , Segura Omar , Vivas Laura
Published: September 2021

Background

Comparative history applied to health education may be a tool to understand institutional key processes within our national health research evolution. In Colombia, first groups of undergraduates interested in research emerged in 1996, being called seedbeds. Universitary Foundation of Health Sciences (FUCS) developed its own seedbeds and created a National Meeting (NM) to join others as network. Objective here is to describe its evolution and perspectives along a 15-year timespan (2004-2019).

Methods

Ethically approved qualitative hermeneutic-interpretative research using content analysis, compared history and interviews to key figures. Data came from digital files with FUCS policies (statutes, education plans and rules), FUCS High Council meetings acts and audiovisual material directly pertaining the NM; files were condensed using Endnote X9 and NVivo 12 to generate categories, benchmarks and timeline.

Results

Three stages emerged: a) conception (2004-2009), seedbed was an external construct adopted by FUCS since formative research was embedded in its teaching activities; b) blooming (2010-2014), FUCS offices and areas participated in developing regulations and giving administrative/financial support, 19 seedbeds in 4 faculties were created, and first two NMs were advertised and executed, c) growth (2015-onwards) devoted to “maintenance & consolidation”, with three events, country-wide participants from 57 universities and 370 research projects exhibited (2019).

Conclusions

The NM reflect FUCS institutional development and progress in teaching and promoting research through organized, dynamic and productive undergraduate research seedbeds.

Key messages

In Colombia, undergraduate seedbeds are promoted as paramount educational activity; in this endeavour, FUCS national meetings have become centre-piece after 15 years.
1407Erectile dysfunction among type 2 diabetes patients and its correlates
Authors: Shanmugasundaram Vignesh Viswanath
Published: September 2021

Background

Erectile Dysfunction (ED), is a common complication in type 2 diabetic men. Present study was undertaken to investigate the association between demographic factors, metabolic parameters and medication use with ED among type 2 diabetics.

Methods

This was a cross-sectional study. Married men aged 20-60 years with a diagnosis of type 2 diabetes attending the outpatient unit of Department of Endocrinology at PSG Hospitals during the months of May and June 2019 were enrolled. The severity of erectile function was assessed using the validated International Index of Erectile Function (IIEF-5) questionnaire. All subjects were evaluated based on demographic factors, clinical parameters and medications used.

Results

Out of the 204 patients enrolled, 65 (31.86%) were found to have ED. ED was significantly associated with patients who were having less physical activity, hypertension, obesity and diabetic retinopathy. A significant increase in the prevalence of ED with duration of diabetes was observed. In patients with diabetes, for 1-5, 6-10 and 11-30 years, the prevalence was 24.1%, 27.7% and 53.1% respectively.

Conclusions

For type 2 diabetes, increasing duration of diabetes poses a greater risk for ED. Hypertension, less physical activity and some medications increase the prevalence of ED.

Key messages

Our results suggest that health care providers who address sexual dysfunction issues with their diabetic patients early may be able to reduce the severity or delay the onset of ED by implementing intensive lifestyle changes as the first step management for type 2 diabetes.
956Cumulative low-tar exposure was still associated with increased lung cancer risk from Japanese case-control study
Authors: Shimatani Keiichi , Ito Hidemi , Matsuo Keitaro , Tajima Kazuo , Takezaki Toshiro
Published: September 2021

Background

Tar concentration in cigarette brands is chronologically decreasing in the USA and Japan. However, studies investigating lung cancer risk with cumulative tar exposure in Western and Asian countries are insufficient. To investigate the risk of lung cancer with cumulative cigarette tar exposure, we conducted a case-control study among Japanese current smokers.

Methods

This study used data from the US-Japan lung cancer joint study in 1993–1998. The number of the subjects was 282 histologically confirmed lung cancer cases and 162 hospital and 227 community controls, and two control groups were combined. The information regarding tar concentration was obtained from the published documents and additional estimation using the equation of regression. Cumulative tar concentration was calculated by multiplying the annual value of tar concentration by year and brand. The odds ratios (ORs) and 95% confidence intervals for lung cancer with cumulative tar exposure were estimated using a logistic model.

Results

The OR with cumulative tar exposure was higher in higher exposed smokers (>45.6 × 105mg, 8.10, 4.74–13.7) than in lower exposed smokers (≤45.6 × 105mg, 3.37, 1.92–5.92), and increasing trend of the ORs was significant (p < 0.001). The stratification analysis showed higher ORs among those with higher cumulative tar exposure regardless of inhalation, duration of smoking filtered cigarettes, and histological type.

Conclusions

This study showed that cumulative tar exposure is a dose-dependent indicator for lung cancer risk, and low-tar exposure was still associated with increased cancer risk.

Key messages

Low-tar tobacco is still associated with increased lung cancer risk.
522Occupational chemical exposures in pregnancy and fetal growth: evidence from the Born in Bradford Study
Authors: Shirangi Adeleh , Wright John , Blair Eve M , McEachan Rosemary RC , Nieuwenhuijsen Mark J
Published: September 2021

Background

Understanding the effect of occupational exposure to endocrine disrupting chemicals (EDC) during pregnancy on inadequate fetal growth as measured by small-for-gestational age (SGA) and as measured by percentage of optimal birth weight (POBW) is not well understood.

Methods

We studied 4142 pregnant women who were in paid employment during pregnancy and participated in a population-based, prospective 2007–2011 birth cohort study, the Born in Bradford Study, with an estimated participation of 80%. Job titles were coded at 26–28 weeks' gestation at a 4-digit level according to 353 unit groups in the 2000 UK Standard Occupational Classification. They were then linked to expert judgment on exposure to each of ten EDC groups as assessed through a job exposure matrix. A modified Poisson regression was used to assess the risk of POBW and SGA associated with an increased risk of chemical exposures.

Results

The frequency of POBW<85 significantly increased for mothers exposed to pesticides [adjusted risk ratio (RRadj) 3.72, 95% confidence interval (CI) 1.40–9.91] and phthalates (RRadj 3.71, 95% CI 1.62–8.51). There was a 5-fold increase risk of SGA for mothers exposed to pesticides (RRadj 5.45, 95% CI 1.59–18.62). Veterinary nurses and horticultural trades were most frequently associated with exposure to pesticides while hairdressers, beauticians, and printing machine minders were associated with phthalates.

Conclusion

Maternal occupational exposure to estimated concentrations of pesticides and phthalates is associated with impaired fetal growth.

Key messages

The POBW is useful in measuring inadequate fetal growth in study of occupational chemical exposures.
977Mechanistic within-host modelling to fast-track the selection of new antimalarial combination therapies
Authors: Simpson Julie , Dini Saber , Zaloumis Sophie , Price David , McCarthy James , Cherkaoui Mohammed , Kummel Anne , Gobeau Nathalie
Published: September 2021

Background

The efficacy of artemisinin-based combination therapies (ACTs), currently the first-line antimalarial treatments, is declining due to the emergence of resistance of malaria parasites to these drugs. This has led drug development initiatives to search for novel combination therapies to replace the failing ACTs. We developed a biologically informed within-host model, validated against data from volunteer infection studies, to guide critical drug development decisions.

Methods

A within-host model was developed, linking drug concentrations of two novel antimalarial drugs, OZ439 and DSM265, to their combined killing action and accounting for differential killing of these compounds against stages of the parasite’s lifecycle. Data collected from malaria-infected volunteers treated with OZ439–DSM265 were used to estimate the model parameters in a hierarchical Bayesian framework. Posterior-predictive simulations of the model were used to determine the dosing regimen required to cure >90% patients.

Results

The results showed that 800 mg of OZ439 combined with 450 mg of DSM265, which are within the safe and tolerable dose range, can provide day 42 cure rates >90%, despite the estimated antagonistic interaction between the drugs. The importance of accommodating parasite age specificity of drug action was demonstrated.

Conclusions

The dosing regimens for the combination of OZ439-DSM265 determined from our data-informed in silico model suggest this compound may be a suitable candidate to replace failing ACTs.

Key messages

Assessing various scenarios within a simulation framework allows discovery of robust dosing regimens, accelerating the drug development process and ensuring efficient allocation of resources for phase 2 and 3 clinical trials.
509Healthy-lifestyle-scores associated with lower subsequent fatigue risk in multiple sclerosis using inverse probability treatment weighting
Authors: Weiland Tracey , Simpson-Yap Steve , Nag Nupur , Jelinek George , Taylor Keryn , Neate Sandra , Bevens William , De Livera Alysha
Published: September 2021

Background

Several lifestyle factors have been associated with the onset and progression of multiple sclerosis (MS). Combining these lifestyle factors into scoring indices is an efficient way to assess their collective relationship with clinical outcomes. We examined the association of two lifestyle scores with clinically significant fatigue and change thereof over two years’ follow-up.

Methods

Data on sociodemographic, lifestyle and clinical characteristics surveyed from the international HOLISM cohort of people with MS at baseline and 2.5-year follow-up. Fatigue was defined by Fatigue Severity Scale (FSS), and healthy lifestyle by the Healthy Lifestyle Index Score (HLIS), and SNAP (Smoking, Nutrition, Alcohol, Physical Activity) score. Analyses by standard logistic and inverse probability treatment weighting (IPTW) models adjusted for age, sex, MS type, disability, comorbidity number, immunomodulatory medication use, prescription antifatigue medication use, and ongoing relapse symptoms; change in fatigue models also adjusted for baseline fatigue.

Results

1,160 participants completed the FSS questionnaire at both timepoints, and roughly 62% had fatigue at each timepoint. By logistic regression, baseline HLIS and SNAP were each associated with lower risk of being fatigued at follow-up, persisting on adjustment. Using doubly-robust IPTW these associations were attenuated but high HLIS (OR = 0.89, 95% CI = 0.81-0.97) and SNAP (OR = 0.82, 95% CI = 0.73-0.90) were each associated with lower risk of fatigue at follow-up. Evaluating change in fatigue, however, there was no consistent association of either HLIS or SNAP score by either statistical method.

Conclusions

In this sample of people with MS, healthy lifestyle scores were associated with less fatigue 2.5 years later, though not with change in fatigue over this interval.