bluuebunny/crossref_metadata_2025 huggingface dataset:
350Perception of Nigerian women on violation of Traditional Gender Role-related IPV
Authors: Olabumuyi Olayide , Uchendu Obioma , Akinbobola Ebunoluwa , Awosika Olawale
Published: September 2021

Background

Violation of Traditional Gender Roles (TGR) by women has been perceived as a justifiable reason for perpetrating Intimate Partner Violence (IPV). Although higher among males, opinions among women regarding violation of TGR as a justification for IPV vary. This study assessed the perception of Nigerian women on violation of TGR that predispose to IPV.

Methods

Secondary analysis of the 2018 Nigeria Demographic and Health Survey (NDHS) was done. Complex sample analysis of a subset of 41,821 women of reproductive age was done using SPSS version 23. Descriptive and inferential statistics were done and multivariate logistic regression model was fitted to identify predictors of poor perception of violation of TGR

Result

Mean age of the respondents was 30.9 ± 7.9years and 10.6% had childhood experience of domestic violence. Poor perception of TGR was found among 28.9% of women with the highest proportion of women with poor perception (46.2%) coming from the north central geo-political zone. The odds of poor perception of TGR-related IPV was 1.4 times and 4.9 times higher among those with childhood experience of domestic violence [OR = 1.4; 95% CI = 1.139-1.694] and women from the North Eastern geopolitical zone [OR = 4.9; 95% CI = 3.696-6.503] respectively.

Conclusion

Predictors of poor perception of TGR violation among one-third of women of reproductive age in Nigeria are childhood experience of violence and place of residence.

Key message

IPV reduction interventions should appropriately address perception of TGR among different at risk population.
1107Dietary polyphenol intake and differentiated thyroid cancer risk: a population-based case-control study in New Caledonia
Authors: Paquet Melanie , Baron-Dubourdieu Dominique , Guénel Pascal , Truong Thérèse
Published: September 2021

Background

Aetiology of differentiated thyroid cancer is poorly understood. Among the risk factors strongly suspected to be involved in thyroid carcinogenesis are dietary factors. Recent evidence suggests polyphenols (i.e., natural bioactive compounds found in plant species), and their anticancer properties, may deserve closer epidemiological attention. Therefore, we examined the association between polyphenol intake levels and thyroid cancer risk in New Caledonia – a Pacific archipelago with some of the highest recorded thyroid cancer incidence rates in the world.

Methods

Food frequency questionnaire information from a population-based case-control study was used. Daily lignan and flavonoid intakes, expressed as aglycone equivalents, were estimated using Phenol-Explorer and relevant USDA databases. Unconditional logistic regression analyses were performed on data from 324 histologically confirmed cases of papillary or follicular carcinoma, diagnosed from 1993 to 1999, and 402 controls. Polyphenol intakes were analysed as both continuous and categorical variables (quartiles).

Results

Estimated median flavonoid and lignan intakes were 351.0 and 2.6 mg, respectively. When adjusting for sex, age, ethnic community, province of residence, BMI, smoking status, alcohol consumption and energy intake, no association with differentiated thyroid cancer risk was observed for flavonoids (OR = 1.06, 95% CI: 0.66, 1.70; comparing extreme quartiles), but a negative association was demonstrated for lignans (ORQ4vs.Q1=0.60, 95% CI: 0.37, 0.96; comparing extreme quartiles).

Conclusions

Our findings suggest that lignans may exert a protective effect on differentiated thyroid cancer. However, large-scale cohort studies and further analytical data on lignans are required to confirm this association.

Key messages

Lignans may play a role in thyroid carcinogenesis.
326Flavonoid intake and ischemic stroke incidence in the Danish Diet, Cancer, and Health Cohort
Authors: Parmenter Ben , Dalgaard Frederik , Murray Kevin , Cassidy Aedin , Bondonno Catherine P , Lewis Joshua R , Croft Kevin D , Kyrø Cecilie , Gislason Gunnar , Scalbert Augustin , Tjønneland Anne , Overvad Kim , Hodgson Jonathan M , Bondonno Nicola P
Published: September 2021

Background

Flavonoid-rich foods may contribute to a lower risk of ischemic stroke through their anti-inflammatory, anti-atherogenic, and anti-thrombotic properties. We aimed to examine the relationship between flavonoid intake and ischemic stroke incidence in participants from the Danish Diet, Cancer, and Health study.

Methods

In this prospective cohort study, 55,169 Danish citizens without a prior ischemic stroke (median [IQR] age at enrolment of 56 [52 – 60] years), were followed for 21 [20 – 22] years. Baseline flavonoid intake was estimated from food frequency questionnaires using the Phenol-Explorer database. Incident cases of stroke were identified from Danish nation-wide public health registries. Associations between quintiles of flavonoid intake and incident ischemic stroke were assessed using Cox proportional hazard models adjusting for age, sex, BMI, smoking status, physical activity, alcohol intake, education, and income.

Results

During follow-up, 4,317 individuals experienced an ischemic stroke. Compared to participants in quintile one and after multivariable adjustments, those in quintile five for intake of total flavonoids, flavonols and oligo+polymers had a 12% [HR (95% CI): 0.88 (0.81, 0.96)], 10% [0.90 (0.82, 0.98)], and 18% [0.82 (0.75, 0.89)], lower risk of ischemic stroke incidence, respectively. Intake of flavan-3-ol monomers, anthocyanins, flavanones and flavones were not associated with incident ischemic stroke.

Conclusions

A moderate habitual intake of flavonoids, in particular the flavonol and flavan-3-ol oligo+polymer subclasses, is associated with a lower risk of ischemic stroke.

Key messages

Flavonoid rich foods appear protective against ischemic stroke.
865The dynamics of SES-related health inequality across the lifecycle and the role of selective mortality
Authors: Petrie Dennis , Allanson Paul , Chen Linkun , Gerdtham Ulf
Published: September 2021

Background

The positive cross-sectional association between health and SES often strengthens at younger ages before peaking at middle ages and then weakening at older ages. Selective mortality is a possible reason for the weakening relationship at older ages but current evidence for this is limited.

Methods

This paper uncovers the changing nature of the inter-dependence between SES and health over the lifecycle by further developing and applying longitudinal inequality decomposition techniques which account for mortality. We examine changes in SES-related health inequality for rolling age cohorts by gender for Australia (using the Household, Income and Labour Dynamics in Australia (HILDA) survey) and the United Kingdom (using the Understanding Society survey).

Results

We find for young men in both countries that the simultaneous co-movement in both health and income plays the major role in increasing health inequalities. At middle ages the poor start to lose health more quickly than the rich but at older ages selective mortality plays the major role with the poor more likely to die than the rich which also has an indirect effect of making morbidity losses seem less concentrated among the poor.

Conclusions

Selective mortality plays a major role in weakening the relationship between SES and health at older ages. Past studies have missed identifying the full effect of selective mortality.

Key messages

SES-related health inequalities accumulate throughout the lifecycle, even in older ages.
1305Early chronic inflammation and behavioural problems in children at age two: a longitudinal study
Authors: Pham Cindy , Bekkering Siroon , O'Hely Martin , Thomson Sarah , Collier Fiona , Symeonides Christos , Saffery Richard , Burgner David , Ponsonby Anne-Louise
Published: September 2021

Background

Inflammation has been suggested to contribute to the pathogenesis of adult mental illness and been implicated mechanistically in childhood behavioural problems like internalising and externalising symptoms. High-sensitive C-reactive protein (hsCRP) and glycoprotein acetyls (GlycA) are biomarkers of chronic low-grade inflammation. We aimed to investigate whether hsCRP and GlycA, and environmental factors that influence these inflammatory biomarkers, were associated with internalising and externalising behaviours in early childhood.

Methods

The Barwon Infant Study is a population-derived birth cohort recruited using an unselected antenatal sampling frame in Victoria, Australia. Infant bloods collected at birth and 12-month were analysed for hsCRP by ELISA and GlycA by NMR. Environmental factors were derived from questionnaires undertaken antenatally to four years postnatally. Internalising and externalising behaviours at age two were measured by the Child Behaviour Checklist. Associations between inflammatory biomarkers and behavioural outcomes were assessed by multivariable regression analyses adjusted for relevant factors.

Results

Increased GlycA levels at birth (GlycAbirth)(β = 5.22 T-score units; 95% confidence interval (CI)(1.22, 9.21; P=0.01) and decreased GlycA levels at 12 months (GlycA12months)(β=-6.47 T-score units; 95% CI(-11.44, -1.50); P=0.01) were associated with increased internalising behaviours at age two. Association persisted for GlycAbirth, but not for GlycA12months when adjusted for GlycA at both time points within the same model. Weak associations were observed for hsCRP at both time points and externalising behaviours at age two.

Conclusions

Our findings document an association between increased GlycAbirth and greater internalising behaviours in children aged two years. Elevated early chronic inflammation may be an important pathway in adverse behavioural development in children.

Key messages

Increased GlycA levels at birth is associated with greater internalising behaviours in children at age two years.
226Health-related quality of life and all-cause mortality among older people: a prospective cohort study
Authors: Phyo Aung Zaw Zaw , Ryan Joanne , Gonzalez-Chica David , McNeil John , Woods Robyn , Nelson Mark , Murray Anne , Lockery Jessica , Gasevic Danijela , Stocks Nigel , Freak-Poli Rosanne ,   On behalf of ASPREE Investigator Group
Published: September 2021

Background

Health-related quality of life (HRQoL) is a measure of an individual’s self-perceived health status. Few studies have examined HRQoL as a risk factor for mortality. This study examined whether HRQoL predicts all-cause mortality in older community-dwelling individuals from Australia and the United States enrolled in the Aspirin in Reducing Events in the Elderly (ASPREE) trial, and if this association varies across gender.

Methods

The 19,106 persons aged 65–98 years and free of known major life-limiting disease, who completed the 12-item short form (SF-12) HRQoL at ASPREE-baseline (2010–2014) were followed prospectively until 2017 for all-cause mortality. Cox proportional-hazard models were used to determine the association between the physical (PCS) and mental component scores (MCS) of HRQoL and all-cause mortality, adjusting for sociodemographic factors, health-related behaviours, and clinical measures.

Results

There were 1,052 deaths over a median 4.7-year of follow-up, with 11.9 events per 1,000 person-years. A 10-unit increase in PCS was associated with a 17% decrease in all-cause mortality (95%CI: 0.77, 0.89). MCS was not associated with all-cause mortality. There was no evidence these associations were different between males and females (P-values for interaction: PCS 0.13 and MCS 0.44).

Conclusions

PCS, but not MCS, was inversely associated with all-cause mortality in this large cohort of healthy older individuals.

Key messages

Our findings support the decision of the Australian Commission on Safety and Quality in Health Care to incorporate the SF-12 into the routine collection of Patient Reported Outcome Measures as a policy goal for the Australian health system.
741Life expectancy among persons with a disease: the Life Years Lost method and R-package ‘lillies’
Authors: Plana-Ripoll Oleguer , McGrath John J
Published: September 2021

Focus of Presentation

Life Years Lost represent the reduction in life expectancy for a group of persons, e.g. those with a disease. Calculation of life expectancy among those with a disease is not straightforward for diseases that are not present at birth, and previous studies considered a fixed age-of-onset, e.g. 15 years. A recently-introduced method takes into account the real age-of-onset, and allows to decompose differences according to different causes of death. The aim of this communication is to introduce the Life Years Lost method and the associated R package ‘lillies’.

Findings

The method uses age at onset for each person with a disease as its starting point and estimates the expected residual lifetime at that age using age-specific mortality rates among the diseased. The number of excess Life Years Lost is estimated by comparing the expected residual lifetime with that of the reference population of same age. A single estimate of excess Life Years Lost is estimated as the average of all the person-specific Life Years Lost, and is interpreted as the average number of Life Years Lost that patients with a given disease experience in excess to those experienced by a reference population of same age.

Conclusions/Implications

The Life Years Lost method provides accurate estimates of reduced life expectancy in persons with a disease and allows to decompose the total reduction into specific causes of death.

Key messages

The implementation of the Life Years Lost method – which can be used with individual-level data (e.g. electronic healthcare records) or summary data – overcomes past limitations in the estimation of life expectancy for time-varying conditions.
1417Geographical differentials and trends in obesity burden in Argentina: a socio-demographic approach
Authors: Aballay Laura Rosana , Baker Julia Wirtz , Haluszka Eugenia , Muñoz Fabián Leonardo , Niclis Camila , Pou Sonia Alejandra
Published: September 2021

Background

In Argentina, there is evidence suggesting the obesity prevalence follows a social gradient. We analyze geographical differentials and trends in obesity burden according to socio-demographic conditions in Argentina (2005-2013).

Methods

The geographical distribution (n = 24 provinces) of the obesity burden in adult population of Argentina in 2005, 2009, and 2013 was analyzed by using mapping techniques. The National Survey of Chronic Diseases Risk Factors datasets were used to estimate and map the age-standardized prevalence of obesity (ASPO) and group-specific prevalence (% obesity) by province and year. Population groups were defined according to socio-demographic factors: age, sex, income level, education, and poverty level (by unsatisfied basic needs –UBN).

Results

Most of the provinces had an increasing ASPO between 2005 and 2013. In 2013, 75% of the provinces showed an ASPO above 20% in men, while 50% of the provinces exceed this ASPO value in women. In both sexes, the middle-aged group presented the most unfavorable situation. Overall, all the socio-demographic groups considered showed growing trends in obesity prevalence, although there were geographical disparities. Among the middle-income level population, a marked rising change was observed from 2009 to 2013. The population with incomplete primary education presented higher prevalence for all the years studied compared to the population with university education.

Conclusions

Since 2005, there was an overall increase in obesity prevalence in Argentina, with persistence of geographical disparities according to socio-demographical conditions.

Key messages

An overall rising trend in obesity prevalence was observed in Argentina.

Geographical disparities by social groups were observed.
1418Geographic disparities in temporal trends for the most prevalent cancer types in Argentina, 1996-2015
Authors: Niclis Camila , Pou Sonia Alejandra , Aballay Laura Rosana , Diaz Maria del Pilar
Published: September 2021

Background

There are significant differences in cancer mortality burden along time and between regions, related to changes in individual and contextual conditions. We aimed to analyze the geographic pattern and temporal trend of cancer mortality in Argentina, simultaneously, by using mapping techniques.

Methods

Age-standardized mortality rates (ASMR, direct method) and average annual percent change (APC, joinpoint regression method) in 1996-2015 were estimated for breast, lung, prostate, colon, cervix, stomach and total cancer in Argentina. Mortality maps were constructed (provincial level, n = 24) for the 2013-2015 period, overlapping temporal trend information (1996-2015), using ascending or decreasing arrows for rising (positive) or decreasing (negative) APC, respectively; the arrow size was proportional to the APC magnitude.

Results

Both sexes show a similar geographical pattern in cancer ASMR characterized by higher rates in the central and southern Argentinian provinces, and lower rates in the northern provinces. However, men present higher rates than women (ASMRs between 85-158/100,000 deaths/year, and between 67-99/100,000, respectively). Most of tumour sites presented negative APC in most provinces, with geographical disparities on their magnitude. Nevertheless, lung cancer in women (mean APC=1.4%) and colon cancer (1.5% in men and 2.1% in women) showed increasing mortality trends.

Conclusions

Overall, cancer shows favorable mortality temporal trends, with heterogeneity between provinces in the APC magnitude. Maps suggest that geographical disparities may be linked to social inequalities.

Key messages

Geographical pattern in cancer ASMR was similar by sex, although with higher rates in men. Cancer sites show decreasing mortality trends, except female lung cancer and colon cancer.
1277Reasons for quarantine and positivity rate among quarantined Health Care Workers (HCWs) in North India
Authors: Prashar Naveen , Singh Rahuldeep , Mohindra Ritin , Suri Vikas , Bhalla Ashish , Biswal Manisha , Lakshmi PVM.
Published: September 2021

Background

WHO has declared the COVID-19 as Pandemic on 11th March, 2020. It is important to break the chain of transmission by quarantining the persons with high-risk exposure. Understanding the reasons for quarantine will help in reducing the exposures and thus reducing the chances of quarantine.

Methods

A validated risk assessment tool based on National Centre for Disease Control guidelines was used for the risk assessment of HCWs. The forms of HCWs who underwent risk assessment between April-November, 2020 were analyzed for reasons of quarantine. The positivity rates among high-risk and low-risk groups were compared.

Results

Out of 1414 HCWs who were assessed, 345 were categorized as high-risk exposure and were quarantined. The most common reasons for quarantine were performance of aerosol generating procedure without recommended personal protection equipment (PPE) (34%), exposure to COVID-19 positive patient without mask for more than 20 minutes at the distance less than 1 m (30%) and having food/tea together (27%). The positivity rate was 8.4% among high-risk and 1.9% among low-risk exposure group (p-value: <0.001). The positivity among low risk category was more in the second half (19/466; 4.1%) as compared to first half (1/603; 0.2%) of the study period. This might be due to exposure from non-hospital sources as second half coincides with first wave of the pandemic.

Conclusion

Not using recommended PPE and having tea/food breaks together were the most common reasons for quarantine.

Key messages

Strict enforcement of recommended PPE and scattered tea and food breaks can reduce high-risk exposures.
895The Incidence, Prevalence and Life expectancy for prediabetes and diabetes in Hong Kong
Authors: Quan Jianchao , Yuen Yuet Hin , Ng Carmen
Published: September 2021

Background

The increasing global trend of diabetes and prediabetes necessitates timely estimation of disease burden.

Methods

We obtained patient data on demographics, laboratory readings; attendances (inpatient, outpatient and emergency care) and prescribed medications from the Hong Kong Hospital Authority. Age-standardized incidence, prevalence and mortality rates were calculated from 2007 to 2017. Rates were adjusted for age and gender using the Hong Kong 2017 mid-year population as the standard population. Abridged life tables were constructed using the Chiang II method to estimate life expectancy. We applied bootstrapping with resampling to derive confidence intervals.

Results

We identified 604,319 people with type 2 diabetes and 944,522 with prediabetes. Age-standardized incidence for diabetes exhibited an overall decreasing trend from 2007 to 2017, falling from 8.34 per 1000 person-years (95% CI: 8.25 to 8.44) to 4.72 per 1000 person-years (95% CI: 4.65 to 4.78). The age-standardized mortality rate for diabetes and prediabetes decreased over the same period. Similar trends were observed for both genders, with females having lower prevalence, incidence and mortality rates compared to males for both diabetes and prediabetes. Life expectancy slightly increased from 2007 to 2017 for people with diabetes.

Conclusions

Decreases in incidence rates and mortality rates for diabetes and prediabetes were observed from 2207 to 2017. Life expectancy for people with type 2 diabetes improved from 2007 to 2017, similar to observed trends in the general population.

Key messages

Despite improvements in mortality rates for people with diabetes, the gap in life expectancy with the general population has not narrowed.
457A mixed methods approach to understanding Adverse Childhood Experiences (ACEs) in Munsieville, South Africa
Authors: Quinn Megan , Cummings Colleen , Stinson Jill
Published: September 2021

Focus of Presentation

Adverse Childhood Experiences (ACEs) have been shown to increase health risk behaviors and negative health outcomes. ACE surveys have been well documented in high income countries, but have been less widely used in low and middle-income countries. The current project included three phases and used a mixed methods study design to understand ACEs in Munsieville, South Africa. The first phase included focus groups to modify the World Health Organization’s ACE International Questionnaire (ACE-IQ) for cultural competence and relevance. The second phase included a community wide survey using the adapted ACE-IQ. The third phase closed the feedback loop and disseminated the findings to the community to identify steps to build a trauma-informed community.

Findings

Focus groups identified 23 questions and four response options for modification and two questions for deletion. Survey results (N = 917) showed ACEs are common in Munsieville: 53.7% had a guardian die, 30.1% lived with someone who abused substances or alcohol, 54.7% experienced emotional abuse, 41.4% physical abuse, 11.5% reported sexual abuse. Most people did not report their abuse (74.6%). Community violence was common with 75.3% witnessing someone being beaten up and 58.7% witnessing someone being stabbed or shot.

Conclusions/Implications

The community recommended providing training on trauma, creating a center that would serve as a safe, centralized location for services, and identifying key stakeholders and partners in the community to build a trauma-informed system of care.

Key messages

The mixed methods approach proved valuable to understand and describe the prevalence of ACEs, provide feedback to the community, and determine community driven next steps.
431ACEs and Resilience in University Students in the Appalachian Region of the United States
Authors: Quinn Megan , Bernard Julia , McCook Judy , Yasin Meira
Published: September 2021

Background

Adverse childhood experiences (ACEs) are associated with health outcomes. Resilience factors provide opportunities to mitigate ACEs. This study aimed to understand ACEs and resilience in students at a university in the United States.

Methods

Students in the 2018-2019 health explorations course completed an online questionnaire (N = 82). Descriptive statistics were completed for all variables. ACE score was created by adding yes responses to ACE questions (range 0-10). Resilience scores were calculated using the Devereux Adult Resilience Scale (DARS, range 20-46). Simple and multiple linear regression were completed with ACE and resilience as outcome measures. Age, gender, family structure, and profession were used as predictors.

Results

Mean age was 18.4 (SD 1.9%), majority of respondents were female (89%), white (92.7%), rural (55.3%), and single (95.1%). Mean ACE score was 1.63 (SD = 1.99) with 40% reporting no ACEs, 26% three or more, and 18% four or more. DARS score (N = 77) had a mean of 39.29 (SD = 6.14). Age resulted in a slight increase in ACE score, β = 0.20, p < 0.1, however, none of the predictors were significantly associated with ACE score. Future professions classified as helping professions resulted in a significant increase in DAR score, β = 3.91, p < 0.01.

Conclusions

The response rate was low (20.5%), however, this pilot study provided insights into adversities and resilience factors of first-year students. Future research should include a larger, more diverse sample.

Key messages

Understanding ACEs and resilience in college students is necessary to mitigate and address ACEs early in adulthood.
732Epidemiology of Geriatric Injury in Bangladesh: Findings from a National Survey
Authors: Rahman Farah Naz , Hossain Jahangir , Fazlur Rahman AKM
Published: September 2021

Background

Everyday 2591 elderly people die due to injury worldwide. The complications and consequences of injury is different and worse than that of other age-groups. Yet little is known about the injury scenario of elderly population of Bangladesh. This paper aim to describe the epidemiology of geriatric injury of Bangladesh which will help policy-makers to undertake interventions for this vulnerable-group.

Methods

Bangladesh Health and Injury Survey 2016, a nationwide cross-sectional survey was carried out among 299,216 residents to identify the injury-related mortality and morbidity. Injury data among the population aged 60-years and above was extracted and analyzed for this study.

Results

Injury was found to cause 3.9% of the total deaths among elderly population of Bangladesh. Mortality and morbidity rate due to injury was found 157 (95%CI 112- 216) per 100,000 elderly populations and 129 (95%CI 124-133) per 1000 elderly population respectively. Fatality rate was 182.6 among urban population and 147 among rural population. Fall was identified as the leading cause of injury deaths and morbidity. It caused 47.2% of all fatality followed by Transport-injury (19.4%) and Suicide (13.9%). Among all fatally injured, 72.2% victims received treatment from health-service providers and among these 58.3% (n = 21) went to registered doctors.

Conclusions

Fall is the leading cause of injury related mortality and morbidity among elderly of Bangladesh. A significant amount of deaths also occurred due to RTI and suicide. Further in-depth research and interventions are needed to minimize the preventable burden of fatality and morbidity among this vulnerable-group.

Key messages

Elderly, Injury, Epidemiology, Bangladesh
1483A meta-analysis of the serial interval and generation time of COVID-19 transmission
Authors: Rampal Sanjay , Jayaraj Vivek Jason , Chong Diane Woei Quan , Ng Chiu-Wan
Published: September 2021

Background

Variation of the estimated serial interval and generation time introduces heterogeneity in COVID-19 transmission models. We conducted a systematic review and meta-analysis to estimate more precise serial intervals and generation times of COVID-19.

Methods

A literature search was conducted using the WHO Global COVID-19 Literature database from 1 January 2020 to 30 April 2021. A single reviewer performed the data extraction. A random-effects model was used to pool the estimates. Subgroup analysis was performed to check the estimates for heterogeneity by geographical region and the presence of lockdown measures.

Results

A total of 222 articles were retrieved of which 73 articles were included based on the selection criteria. Serial intervals were reported in 65 articles that provided 75 unique estimates from 16,805 transmission pairs. Generation intervals were reported in 9 articles that provided 9 unique estimates from 1,150 transmission pairs. The pooled serial interval was 5.00 days (95% CI: 4.68, 5.33). The pooled generation time was 4.37 days (95% CI: 3.58, 5.16). The serial interval estimates did not vary by either geographical region (P > 0.05) or the presence of lockdown measures (P > 0.05).

Conclusions

This analysis provides more precise pooled serial and generation intervals that may decrease misspecifications of future transmission models.

Key messages

Epidemiological parameters are crucial components in estimating the dynamics of COVID-19 transmission. Periodically updating serial and generation time intervals are important to reduce model misspecification for a new disease such as COVID-19.
1013How has change in gestational diabetes diagnosis affected pregnancy outcomes?
Authors: Randall Deborah , Morris Jonathan , Kelly Patrick , Glastras Sarah
Published: September 2021

Background

Gestational diabetes mellitus (GDM) incidence is increasing in Australia, influenced by new diagnostic criteria gradually implemented from 2011. We aimed to identify whether the change was associated with increased obstetric intervention and/or improved outcomes.

Methods

Linked perinatal, hospital and deaths data from New South Wales identified singleton births, 33-41 weeks, 2006-2015. Adjusted Poisson modelling predicted the GDM incidence trajectory post-2011 without the diagnostic change and estimated the post-2011 “additional GDM” cases. Actual rates of interventions and outcomes for GDM-diagnosed pregnancies were compared with predicted scenarios where the “additional GDM” group was assumed to have the same rate as (ie clinically same as): (A) the “previous GDM” group <2011; (B) the “non-GDM” group <2011; or (C) the “non-GDM” group ≥2011.

Results

GDM incidence more than doubled over the study period. Actual planned birth, Caesarean and macrosomia rates were consistent with Scenario A, ie higher intervention rates, but lower macrosomia than B and C. Neonatal hypoglycaemia was lower than Scenario A, closer to B and C. Actual perinatal deaths were lower than predicted by all scenarios, showing improvement for all with GDM, not only “additional” cases. Maternal and neonatal morbidity rates were within the confidence bounds for all three predicted scenarios.

Conclusions

Our study suggests that the widely adopted new diagnostic criteria for GDM are associated with increased obstetric intervention rates and lower macrosomia rates but with no clear impacts on maternal or neonatal morbidity.

Key messages

A diagnostic criteria change has identified more GDM pregnancies without clear benefit for outcomes.
1291Adapting a randomized trial design to develop epidemiology studies for pesticide exposure
Authors: Reed Jennifer E. ,   S. Eliza Dunn (Halcomb)
Published: September 2021

Focus of Presentation

Pesticides are chemicals, synthetic or natural, used to mitigate damage caused by pests. They play an important role in agriculture and public health. For a pesticide to be put on the market it must undergo a series of tests required by regulatory agencies to show with reasonable certainty that human exposures will not result in harm. Randomized trials are considered the gold standard for epidemiological study design. It is not ethical to conduct such studies to investigate human health outcomes of pesticide exposure. With increasing abundance of observational epidemiological literature there is an opportunity to leverage these studies for regulatory decision making. This presentation will describe a hypothetical randomized trial design to identify opportunities to adapt elements of experimental epidemiology to address some of the challenges unique to studies of health outcomes following pesticide exposure.

Findings

Elements warranting further development include analytic methods mimicking randomization, blinding, defining control groups, and introducing increased precision to outcome and exposure classifications. Efforts should aim to define generalizability and determine ways to report findings appropriate for regulatory use.

Conclusions/Implications

Epidemiologists must leverage analytic techniques, and increase dialogue among academics, industry stakeholders and regulators to adapt experimental epidemiology methods to ensure safety of agricultural pesticides.

Key messages

Work is needed to adapt experimental epidemiological methods to investigate human health outcomes of pesticide exposure. Focus areas for adaptation include randomization, blinding, control selection, exposure and outcome definitions, generalizability, and reporting.
619Can social inclusion improve health and educational outcomes for youth experiencing disadvantage?
Authors: Renner Heidi , Rowland Bosco , Toumbourou John , Hutchinson Delyse
Published: September 2021

Focus of presentation

Disparity in access to education is a recognised social determinant of health outcomes worldwide. Young people experiencing disadvantage often experience considerably more problems in their health and educational outcomes. The objective of this project, from a social epidemiological perspective, is to investigate whether social inclusion confers the potential to disrupt inequities by improving school completion for vulnerable young people experiencing disadvantage.

Findings

It is expected that groups with high vulnerability (represented by disadvantage indicators) will have poorer educational trajectories, with lower levels of school completion. It is also expected that this effect will be moderated by the level of social inclusion, such that vulnerable groups with high levels of social inclusion will have higher levels of school completion as compared to vulnerable groups with lower levels of social inclusion. It is also expected that other factors will influence the development of social inclusion, such that the developmental pattern of, and change in, social inclusion from childhood to adolescence may have a unique effect on school completion.

Conclusions/Implications

Identifying whether social inclusion can moderate the impact of vulnerability on school completion provides the opportunity to inform future interventions and has the potential to provide evidence to government and thus influence policy.

Key messages

Social inclusion may be a vital key to understanding the effect of disadvantage on health and educational pathways for young people in Australia, and an avenue for disrupting inequities.
880Dietary inflammatory index and the risk of adult depression symptoms
Authors: Shakya Prem , Melaku Yohannes Adama , Page Amanda J , Adams Robert J , Shivappa Nitin , Hébert James R , Gill Tiffany K
Published: September 2021

Background

The link between diet, inflammation and depressive symptoms (DepS) are of increasing interest. The study aims to assess the association between the dietary inflammatory index (DII®) and DepS using the North-West Adelaide Health Study (NWAHS) cohort and update the previous meta-analysis.

Methods

A total of 1743 (mean□SD age 56.6±13.6 years, 51% female) and 859 (mean□SD age 58.4±12.1 years, 52.6% female) of NWAHS participants were included for cross-sectional and longitudinal analysis respectively. DII was determined using food frequency questionnaires, and the Center for Epidemiologic Studies Depression Scale (CES-D) assessed DepS. Log- and negative binomial regression were used to assess the association between quartiles of DII and DepS.

Results

In a fully adjusted model, higher DII score (i.e. pro-inflammatory diet) was associated with 79% increase in odds of reporting DepS (ORQuartile4vs1:1.79; 95% CI: 1.14-2.81; ptrend=0.026). Men with higher DII had two-fold higher odds of DepS (ORQuartile4vs1:2.27; 95% CI: 1.02-5.06; ptrend=0.089). Women with higher DII had an 81% increase in odds of DepS (ORQuartile4vs1:1.81; 95% CI: 1.01-3.26; ptrend=0.068). These associations were consistent in the longitudinal analysis. The meta-analysis (n = 12) showed that a pro-inflammatory diet was associated with a 45% increase in odds of having DepS (ORQuartile4vs1:1.45; 95% CI: 1.20,1.74, p-value<0.01).

Conclusions

A pro-inflammatory diet was positively associated with increased risk of DepS. Our findings support the current evidence that shows the role of pro-inflammatory diet in DepS.

Key messages

Increase the consumption of anti-inflammatory diet to reduce depressive symptoms
265Global diabetes trends and associated socioeconomic, lifestyle and health indicators from 1990 to 2017
Authors: Shirai Yoshiro , Imai Tomoko , Sezaki Ayako , Miyamoto Keiko , Kawase Fumiya , Abe Chisato , Inden Ayaka , Kato Takumi , Sanada Masae , Shimokata Hiroshi
Published: September 2021

Background

This longitudinal ecological study was conducted to determine the global trends in the age-standardised prevalence of type 2 diabetes mellitus (T2DM) and its association with socioeconomic, lifestyle and health indicators.

Methods

Data pertaining to the age-standardised prevalence of T2DM (rates per 100,000) and socioeconomic, lifestyle and health indicators were obtained from several international databases. Data available from 1990 to 2017 for 139 countries with populations of 1 million or greater were analysed, followed by estimation of slopes for T2DM prevalence in each country. The longitudinal association between T2DM and the standardised variables of socioeconomic, lifestyle and health indicators was fitted using a generalised linear mixed-effects model with random intercept for each country and random slope for year.

Results

The country-specific age-standardised prevalence of T2DM decreased significantly in 9 countries, remained unchanged in 11 countries and increased significantly in 119 countries. The estimated standardised effect of age-standardised education for T2DM was the largest at − 524.5 (SE; 109.9), followed by − 514.8 (SE; 95.6) for physical activity and 398.8 (SE; 45.8) for body mass index (BMI) (P < 0.0001 for all).

Conclusions

The factors strongly associated with global T2DM prevalence and trends were years of education, followed by physical activity and BMI. This study also provides a basis for investigating public health approaches to control the increase in global T2DM prevalence.

Key messages

The promotion of policies that reduce international educational disparities may have the potential to reduce the global increase in the number of patients with T2DM.
1142Maternal health care beyond childbirth: A study of gaps in post-natal maternal care in India
Authors: Shukla Anktia
Published: September 2021

Background

In recent years India has made groundbreaking progress in achieving universal institutional deliveries however the country failed to mirror this success in the postnatal period too.

Method

Data is utilized from nationally representative survey National Family Health Survey (2015-16). A quantitative analysis of available information is presented here.

Results

According to National family health survey (2015-16), 83% women received antenatal care (ANC) at least once, 79% had institutional delivery and only 65% had post-natal check-up. Surprisingly, postnatal-checkup was not universal even among mothers who had c-sections, around 10-15% women who had c-section did not receive post-natal check. The PNC coverage was worse in the states with high maternal mortality- Assam, Uttar Pradesh, Rajasthan and Madhya Pradesh. PNC was lowest among home deliveries followed by deliveries in sub-center health facilities.

Conclusion

Though a pool of data is available on coverage and quality of care on different components of antenatal care and child-delivery very little evidence is available on the frequency of contact and quality of postnatal care. One of the major contributor of maternal deaths in India is postpartum hemorrhage. Yet it is the postpartum period when coverage and programs are at their lowest along the continuum of care.

Key messages

Above mentioned evidence calls for focus on comprehensive PNC package, evidence generation on PNC care and improving linkages between deliveries at home/lower levels facilities and PNC.
1325Longitudinal epidemiology of MS in the Greater Hobart region, 1961 to 2019
Authors: Simpson-Yap Steve , Atvar Roberts , Taylor Bruce
Published: September 2021

Background

The Greater Hobart region (42.3°S) of Tasmania has the highest frequencies of MS in Australia, this consistent across studies conducted over the last half century. However, the degree of excess compared to mainland sites like Newcastle (32.5°S) has declined over time.

Methods

Cases were recruited from clinic-based samples and other multiple other data sources. Prevalence date was 1 June 2019. 2019 prevalence and 2009-19 incidence and mortality rates were estimated. Prevalence and incidence and mortality rates were age/sex-standardised to the 1961 and 1954 Hobart populations, respectively, to allow longitudinal comparisons. Female:male prevalence and incidence sex-ratios were also assessed. Differences between timepoints were assessed using Poisson regression.

Results

472 MS cases (female:71.4%) resident on prevalence day were identified, a crude prevalence=212.3/100,000 (155.8 age/sex-standardised), 57% increase vs 2009 and 388.0% vs 1961. The 2009-19 incidence rate=7.56/100,000 person-years (7.03 age/sex-standardised), 91% increase vs 2001-9 and 218.1% vs 1951-61. The 2009-19 mortality rate was 2.25/100,000 person-years (1.12 age/sex-standardised), comparable to 2001-9 (1.00). The age/sex-standardised prevalence-sex-ratio was 2.61, comparable to 2009 (2.65), but the incidence-sex-ratio was 2.68, 31% increase vs 2001-9 (2.05).

Conclusions

Prevalence and incidence continue to be high in Hobart, although the differences compared to lower-latitude Newcastle have attenuated significantly. Changes in lifestyle may underlie the deterioration of the latitudinal gradient of MS in Australia. Further investigation is required to define the factors that drive these associations.

Key messages

MS prevalence and incidence are still highest in Australia in southern Tasmania but the latitudinal variation is declining.
125Clinical & demographic determinants of self-reported diet program adherence in people living with multiple sclerosis
Authors: Jakaria Mohamed , Nag Nupur , Jelinek George , Weiland Tracey , Neate Sandra , Bevens Will , Simpson-Yap Steve
Published: September 2021

Background

A range of diets have been recommended for people living with MS, ranging from low or no-meat Swank-inspired diets, to the modified Palaeolithic Wahls diet. While the clinical efficacy of these diets to modulate MS progression is uncertain, the popularity of these diets amongst people living with MS is manifest.

Methods

Data derived from the 5-year review of the HOLISM international cohort study. Self-reported adherence to diets were queried, ranging 1-5. Adherence was restricted to ≥ 12months adherence, and then dichotomised: those reporting 4-5/5 adherence defined 2nd-most adherent, 3-5/5 adherence defined 3rd-most adherent. Determinants of adherence were evaluated by log-binomial regression, adjusted for age, sex, socioeconomic status (SES), education, and fatigue. Due to low numbers, only the Overcoming MS (OMS), Swank and Wahls diets were quantitatively evaluated.

Results

458/952 (48.1%) reported following MS-specific diets for ≥12months; 61.8% followed OMS, 12.7% Swank, 3.5% Wahls, 0.9% Ashton-Embry, 0.9% McDougal, 5.7% other. OMS adherence (2nd-most) was more common among males, higher SES, lower disability, less fatigue, and fewer comorbidities. Wahls adherence (2nd-most) was more common among participants with progressive MS or greater disability. Swank adherence (2nd-most) did not vary by any parameter. Analogous results were found using the 3rd-most adherent definition.

Conclusions

These results indicate that MS-specific diet adherence is common in this patient population, but uptake is highly heterogenous between demographic and clinical subgroups. Further study of diet uptake among MS patients is indicated, particularly as the efficacy of these diets in MS is yet uncertain.

Key messages

There is evidence for a marked tribalisation of diet adherence between the OMS, Swank, and Wahls diets, the former being more common among less clinically active RRMS participants and Wahls more common among more clinically active progressive participants.
989Relationship between housing tenure and cigarette smoking among adolescents – A population-based study
Authors: Singh Ankur , Simons Koen , Li Yuxi , Bentley Rebecca
Published: September 2021

Background

Cigarette smoking leads to significant morbidity and pre-mature mortality. We examined the relationship between housing tenure at ages 15, 16, 17 and 18 and smoking five years later using data from a well-established cohort study.

Methods

We analysed the data on 15-18-year-old adolescents (n = 2305) from the Household Income and Labour Dynamics in Australia (HILDA) survey. We applied augmented inverse probability treatment weights to maximise exchangeability between those in social housing and homeowners, and private renters. By estimating potential outcomes for the exposed and unexposed, we compared risk of smoking five years later on both absolute and relative scale. Baseline covariates included household income, age at study entry, sex, family type, smoking at baseline and highest household education.

Results

Adolescents in social housing had an increased risk of current smoking five years later (average treatment effect (ATE): 0.24, 95% CI: 0.02, 0.47) than homeowners. On the relative scale those in social housing had 2.23 times (95% CI: 1.08, 3.39) higher risk of being a smoker than homeowners. Those in social housing also had an increased risk of being a smoker (ATE: 0.14, 95%CI: 0.04, 0.25) than private renters. On the relative scale we estimated that those in social housing had 1.46 times (95% CI: 1.09, 1.83) higher risk of smoking than private renters.

Conclusions

Adolescents in social housing have a higher risk of smoking than those living in owned or private rented homes.

Key messages

Tobacco control efforts must target adolescent in social housing for reducing inequalities in cigarette smoking.
747Incidence of anencephaly in the Czech Republic: Long-term population based study
Authors: Sipek Antonin , Gregor Vladimir , Klaschka Jan , Maly Marek , Sipek Antonin
Published: September 2021

Background

Anencephaly is a lethal anomaly of the central nervous system from the group of neural tube defects. The main goal of our study was to evaluate the incidence of anencephaly (and its possible trends) during the 53 years period.

Methods

For this study, we used data from the National Registry of Congenital Anomalies of the Czech Republic. We analysed the incidence of anencephaly in births and in prenatally diagnosed cases during the 1964-2016 period. We also evaluated maternal age in these cases. The statistical analysis was performed by Poisson regression and Fisher's exact test.

Results

During the study period there were 6 891 062 children born in the Czech Republic. Among those, 1232 children were born with anencephaly. Another 966 cases of anencephaly were diagnosed during prenatal diagnosis and these pregnancies were electively terminated, the total number of anencephaly cases was 2198. The total incidence of anencephaly significantly decreased during the study period (p = 0.0136). The incidence in births decreased significantly as well (p < 0.001). We found statistically higher incidence of anencephaly in elder mothers (42 years and over).

Conclusions

Gradual implementation of ultrasound prenatal diagnostics started in the 80s of the last century and lead to a very significant decrease in the incidence of anencephaly cases in births. Additionally, the total incidence of anencephaly decreased significantly as well.

Key messages

Incidence of anencephaly in births decreased rapidly with gradual implementation of population wide ultrasound screening.