bluuebunny/crossref_metadata_2025 huggingface dataset:
1437Rates of low value care in NSW public hospitals: variation between public and private inpatients
Authors: Costa Juliana de Oliveira , Pearson Sallie-Anne , Elshaug Adam , Gool Kees van , Jorm Louisa , Falster Michael
Published: September 2021

Background

Low value care (LVC) services have limited or no benefit to patients, and curtailing LVC can curb unnecessary spending and improve the quality of care. Some public hospitals in Australia have financial incentives to perform procedures for patients with private health insurance, yet little is known if there are differences in LVC between public and private patients.

Methods

We performed a retrospective analysis of New South Wales public hospital data from January 2013 to June 2018. We measured hospital-specific rates of five LVC services and compared rates within each public hospital by patient funding status (private or public), descriptively and using random-slope multilevel models.

Results

Overall rates of LVC varied between services, ranging from 0.3 to 30.8 procedures per 1,000 eligible patients for hyperbaric oxygen therapy and vertebroplasty, respectively. There was large variation in rates of the LVC services between hospitals, and a few hospitals had higher rates of LVC among private than public patients. However, we found no consistent association between patient funding status and LVC services: private patients had lower rates of knee arthroscopic debridement than public patients (aOR:0.56) and higher rates of low value vertebroplasty for osteoporotic spinal fractures (aOR:1.08), hyperbaric oxygen therapy (aOR:1.53) and oophorectomy (aOR:1.77); all statistically non-significant.

Conclusions

Private patient funding may contribute to LVC in some public hospitals, but it was not consistently associated with higher rates of the five LVC services measured.

Key messages

Reducing LVC services requires investigating the role of health-system factors at both the global- and local-level.
1394Better Cardiac Care Data Linkage Project: utilising cross-jurisdictional data to improve patient-flow capture
Authors: Farber Rachel , Igic Branislav , Alfaro-Ramirez Maria , Nelson Michael , Khanlari Sarah , Francis Catherine , Taylor Lee
Published: September 2021

Background

For patients experiencing acute myocardial infarction (AMI), particularly ST-elevation myocardial infarction (STEMI), timely revascularisation is important to optimise prognosis. The AMI patient journey often involves presentation to the closest appropriate facility and transfers between hospitals, including across jurisdictions. The Better Cardiac Care (BCC) dataset consists of cross-jurisdictional linked ambulance, emergency, hospital, outpatient, deaths, Medicare and Pharmaceutical Benefits Scheme records for residents of New South Wales (NSW), Australia. This dataset will be updated annually.

Methods

The BCC dataset comprises 332 million records, from 18 datasets, across 6 jurisdictions. For NSW residents hospitalised for STEMI between 2013 to 2018, we compared the number of STEMI hospitalisations, the proportion of patients receiving revascularisation procedures, and the time to procedures using only NSW records versus records from all jurisdictions and Medicare Benefits Scheme.

Results

Compared with NSW hospital data, including data from other jurisdictions increased the ascertainment of STEMI hospitalisations by 8.0% and procedures by 11.2% for NSW residents. This increase was greatest for residents living near state borders, increasing the number of STEMI hospitalisations by up to 210% and the percentage receiving procedures by up to 70%.

Conclusions

Cross-jurisdictional data is essential to understand patient journeys of residents who live in border areas and to evaluate patient care for STEMI and AMI more broadly.

Key messages

The BCC dataset is a vital asset that enables a more comprehensive view of care for AMI than has been possible to date.
263Disability and inequality on the social determinants of health: data, data gaps, and policy implications
Authors: Fortune Nicola , Badland Hannah , Clifton Shane , Emerson Emeritus Eric , Stancliffe Emeritus Roger , Llewellyn Gwynnyth
Published: September 2021

Focus of Presentation

People with disability experience inequality in relation to social determinants of health such as employment, education and housing. Under the UN Convention on the Rights of Persons with Disabilities, Australia must collect data to assess fulfilment of its Convention obligations and to identify and address barriers faced by people with disability in exercising their rights. The objective of our research was to determine the extent to which such data are currently available.

Findings

With input from people with disability, we developed a monitoring framework and indicators to measure inequalities between Australians with and without disability in relation to social determinants of health. National data sources that included a disability identifier were available to report on 73% of the 128 indicators. For example, in the domain ‘Employment’, national data were available for indicators of labour force status, long-term unemployment, leave entitlements, and employment in high-skill jobs. Data were not available for the following indicators: under-employment, access to job design modifications, and disability-related discrimination in the workplace.

Conclusions/Implications

It is currently not possible to quantify inequalities between Australians with and without disability, track change over time, or identify factors that can inform effective policy responses for indicators where we lack national data that include a disability identifier.

Key messages

Addressing data gaps, including by facilitating disability identification in existing data collections, is essential for tackling disability-related inequalities on social determinants of health and meeting our obligations under the UN Convention on the Rights of Persons with Disabilities.
918Building the evidence base for australia’s veteran population
Authors: Gates Louise , Petricevic Mark , Gorman Patrick
Published: September 2021

Background

There is a wealth of existing research on Australia’s veteran population. However, much of the existing research seeks to answer questions on specific issues, veterans of specific conflicts, or of veterans who use the Department of Veterans’ Affairs services, with little to no information beyond these specific populations.

Methods

Several large administrative datasets including the Pharmaceutical Benefits Schedule (PBS), Causes of Death and Specialist Homelessness Services were linked with Defence information to enable analysis of veterans’ information against a range of topics, such as cause of death, health service and homelessness service use. Comparisons were made between the Australian Population as a whole and the veteran population.

Results

Results show some similarities and some differences between the veteran population and the whole Australian population. Results are disaggregated between those who are currently serving, in the reserves and ex-serving as well as by service type and other variables.

Conclusions

These results have helped to improve what is known about the broader veteran community. They provide important context for policy makers to understand how best to service the veteran community that was previously unknown, and help identify areas for more detailed research and exploration.

Key messages

Data linkage provides an important opportunity to understand the specific health and welfare needs of veterans who are otherwise difficult to identify in large administrative datasets. Comparison of veterans’ health and welfare service use with the broader Australian population provides important information for policy makers.
32Do the risks of Lynch syndrome-related cancers depend on the parent-of-origin of the mutation?
Authors: Gemechu Shimelis , van Vliet Christine M. , Win Aung Ko , Figueiredo Jane C. , Marchand Loic Le , Gallinger Steven , Newcomb Polly A. , Hopper John L. , Lindor Noralane M. , Jenkins Mark A. , Dowty James G.
Published: September 2021

Background

Individuals who carry pathogenic mutations in DNA mismatch repair (MMR) genes have high risks of cancer, and small studies have suggested that these risks depend on the sex of the parent from whom the mutation was inherited. We have conducted the first large study of such a parent-of-origin effect (POE).

Methods

Our study was based on all MMR gene mutation carriers and their relatives in the Colon Cancer Family Registry, comprising 18,226 people. The POE was estimated as a hazard ratio (HR) using a segregation analysis approach that adjusted for ascertainment. HR = 1 corresponds to no POE and HR > 1 corresponds to higher risks for maternal mutations.

Results

For all MMR genes combined, the estimated POE HRs were 1.02 (95% confidence interval (CI) 0.75-1.39, p = 0.9) for male colorectal cancer, 1.12 (95% CI 0.81-1.54, p = 0.5) for female colorectal cancer and 0.84 (95% CI 0.52-1.36, p = 0.5) for endometrial cancer. Separate results for each MMR gene were similar.

Conclusions

Despite being well-powered, our study did not find any evidence that cancer risks for MMR gene mutation carriers depend on the parent-of-origin of the mutation. Based on current evidence, we don’t recommend that POEs be incorporated into the clinical guidelines or advice for such carriers.

Key messages

MMR gene mutations inherited from the maternal and paternal side confer similar risks of developing colorectal and endometrial cancer.
971Ethnicity and Cardiovascular Disease in the Australian Population
Authors: Georgousopoulou Ekavi , Lord Sally
Published: September 2021

Focus of Presentation

Cardiovascular disease (CVD) risk prediction is recommended for Australians over 45 and Indigenous Australians over 35 years of age. UK evidence for the QRISK tool suggests that including ethnic background as a moderator, improves risk prediction. Australian risk-charts do not account for ethnicity, despite the diversity of the population. Our aim was to compare CVD prevalence among Australian ethnic groups, defined by country of birth and summarized in the following regions: 1.Oceania and Antarctica, 2.North-West-, 3.Southern and Eastern Europe, 4.North Africa and Middle East, 5.South-East-, 6.North-East-, 7.Southern and Central Asia, 8.America and 9.Sub-Saharan Africa.

Findings

Aggregated data from the Australian Health Survey Core Content–Risk Factors and Health Conditions 2011-12 TableBuilder of Australian Bureau of Statistics were representative of approximately 21.5M Australians according to weights’ analysis; however, age standardisation was impossible. Ischemic CVD prevalence for Australians born in Oceania and Antarctica was approximately 2.6%, North-West Europe 5.1%, Southern and Eastern Europe 6.7%, North Africa and Middle East 4.3%, South-East Asia 1.3%, north-East Asia 0.3%, South and Central Asia 1.2%, America 2.3% and Sub-Saharan Africa 1.2%. In all ethnic sub-groups, males represented 51-83% of individuals with CVD.

Conclusions/Implications

Country of birth may be used as a proxy of ethnic background for investigating potential socio-cultural CVD risk factors and if accounted for, might increase risk-charts’ performance.

Key messages

Australians’ ethnic background is associated with CVD prevalence. Including ethnicity in risk-tools might increase accuracy in CVD risk prediction.
1456Changes in dietary patterns from preconception to during pregnancy and its association with socio-demographic factors
Authors: Gete Dereje , Waller Michael , Mishra Gita
Published: September 2021

Background

Little is known about the changes in dietary patterns from preconception to during pregnancy, nor of their association with socio-demographic and lifestyle factors. This study, therefore, examined dietary patterns changes from preconception to during pregnancy and their associations with socio-demographic and lifestyle factors.

Methods

This study used data from the Australian Longitudinal Study on Women’s Health (ALSWH), a population-based prospective cohort study. Women’s dietary patterns were assessed using Healthy Eating Index-2015 (HEI-2015) score and the four patterns obtained from the factor analysis (meats, high-fats, and sugar; vegetable and grains; traditional vegetable; and fruit patterns). Multivariable linear regression and repeated measures mixed-effect models were used.

Results

Women’s scores increased on the ‘HEI-2015’, ‘traditional vegetable’, and ‘fruit’ patterns while the ‘vegetable and grains’ decreased from preconception to during pregnancy. Women with higher education were more likely to increase their HEI-2015 score and fruit consumption from preconception to during pregnancy respectively (β = 2.31, 95%CI: 0.02, 4.60) and (β = 23.78, 95%CI: 4.58, 42.97), than those with lower educational status. Single women were more likely to increase the consumption of vegetables and grains compared to married women (β = 76.08, 95% CI: 20.83, 131.32). Women with higher income had a greater increase in the HEI-2015 score than those with lower income (β = 3.02, 95% CI: 0.21, 5.83).

Conclusion

The findings indicate that there have been marked dietary changes from preconception to during pregnancy. Changes in healthy dietary patterns were influenced by education, marital status, and income.

Key messages

Early shaping of adequate dietary behaviours before pregnancy is very important for the mothers and their children's health since pre-conception diets have a critical role in placental and foetal tissue developments.
557Outcomes of Indigenous multifetal and singleton pregnancies: complications, medical care, birth experience and infant health
Authors: Gibberd Alison , Tyler Jessica , Preen David , Falster Kathleen , Hanly Mark , Clarke Marilyn , McNamara Bridgette , Eades Sandra
Published: September 2021

Background

Perinatal outcomes for singleton pregnancies are poorer, on average, for Aboriginal people than non-Aboriginal people, but little is known about Aboriginal multifetal pregnancies. Yet multifetal pregnancies and births are often more complicated and have poorer outcomes than singleton pregnancies. We describe the pregnancies, births and outcomes for Aboriginal twins born in Western Australia (WA) and New South Wales (NSW) with comparisons to Aboriginal singletons (WA and NSW) and non-Aboriginal births (NSW).

Methods

Whole-population birth and hospital records were linked for births during 2000-2013 (WA) and 2002-2008 (NSW). Descriptive statistics are reported for demographics, maternal health, pregnancy complications, births and infant outcomes.

Results

Pregnancy complications were more common among mothers of Aboriginal twins than Aboriginal singletons (e.g. 17% of mothers of WA twins had hypertension/pre-eclampsia/eclampsia vs 8% for singletons) but similar to mothers of NSW non-Aboriginal twins. Most Aboriginal twins were born in principal referral, women’s or large public hospitals. The hospitals were often far from the mother’s home (e.g. 31% of mothers of WA Aboriginal twins gave birth at hospitals located >3 hours by road from their home). Outcomes were worse for Aboriginal liveborn twins than Aboriginal singletons and non-Aboriginal twins (e.g. 58% of NSW Aboriginal twins were preterm versus 9% of Aboriginal singletons and 49% non-Aboriginal twins).

Conclusions

Mothers of Aboriginal twins faced significant challenges during the pregnancy, birth and the postnatal period in hospital.

Key messages

In addition to accessible specialist medical care, these mothers may need extra practical and psychosocial support throughout their journey.
996Factors predicting retention among people accessing outpatient methadone maintenance therapy in Tshwane, South Africa
Authors: Gloeck Natasha Rachel , Harris Bernice , Webb Elizabeth , Scheibe Andrew
Published: September 2021

Background

In South Africa, increasing illicit opioid use and associated health challenges can be managed with opioid substitution therapy (OST), like methadone, provided it is prescribed at the recommended dose and duration. The Community Oriented Substance Use Programme (COSUP) provides free methadone to patients with Opiod Use Disorder across Tshwane, South Africa on need-based criteria.

Methods

A retrospective cohort using secondary data of patients treated with methadone at eight COSUP sites. The factors associated with the retention of 575 participants for the period December 2016 to September 2018 were analysed.

Results

Participants on lower methadone doses had decreased odds of being retained (0 to 20mg: adjusted odds ratio (aOR) 0.25, p-value (p)=0.002, 95% Confidence Interval (CI) 0.10 - 0.61; 20 to 40mg: aOR 0.20, p < 0.001, 95% CI 0.08 - 0.49). Participants receiving free methadone had 3.75 the odds to be retained (p < 0.001, 95% CI 2.47 - 5.70). Inner-city participants had 5.19 the odds to be retained (p < 0.001, 95% CI 2.99 - 9.03). White participants had 3.39 the odds of being retained (p = 0.001, 95% CI 1.64 - 7.00). Injecting heroin users had 0.63 the odds of being retained (p = 0.032; 95% CI 0.41 - 0.96).

Conclusions

Methadone doses above 50mg, access to free methadone, accessing care within the inner-city and the white population group were positively associated with retention. Injecting drug use was negatively associated.

Key messages

Provision of free methadone at adequate doses can aid in retaining patients within an outpatient OST programme.
1360Health impacts of a 4 month community-wide lockdown: a prospective longitudinal study in Victoria, Australia
Authors: Griffiths Daniel , Sheehan Luke , Vreden Caryn van , Petrie Dennis , Sim Malcolm , Collie Alex
Published: September 2021

Background

In response to the second wave of COVID-19 in Australia a 4 month community-wide lockdown resulted in Victoria, Australia. We explored the health impacts during lockdown and following its conclusion.

Methods

A cohort of 898 working-age Australians enrolled in a national longitudinal cohort study, completing surveys prior to, during, and following a Victorian lockdown during the southern hemisphere winter and early spring 2020. Mixed linear regression models examined health outcomes during and following the lockdown. Generalised estimating equations assessed changes in several determinants of health such as social interactions, engagement in work and finances.

Results

The Victorian lockdown had negative consequences for mental health and increased levels of psychological distress. These health impacts coincided with greater social isolation and cessation of work. Following the conclusion of lockdown, outcomes assessing mental health, work and social interactions had recovered to an extent whereby no significant long-lasting effects were identified compared to pre-lockdown conditions.

Conclusions

Extended community lockdowns have adverse health consequences. Governments should weigh the potential health impacts of lockdown with the benefits of reducing COVID-19 transmission. Services and programs to reduce the negative impacts of lockdown may include increases in mental health care, encouraging safe social interactions and financial support to maintain employment relationships. Longer-term follow-up is required to identify any persistent health effects of community lockdowns.

Key messages

Lockdowns result in adverse health consequences, and some quickly recover. Timely services and programs are encouraged to reduce negative impacts of lockdowns such as mental health supports and promoting safe interactions.
69Effect of smoking on treatment outcomes among newly diagnosed Tuberculosis patients in Shimla city India
Authors: Gupta Anmol , Kumar Vineet
Published: September 2021

Background

World health organization in 2015 had adopted “End TB Strategy” aimed at ending the global TB epidemic by 2035. Tobacco smoking has been reported to be associated with many aspects of TB disease, including increased vulnerability to being infected, recurrence with TB and related mortality.

Methods

A prospective cohort study was carried out among newly diagnosed tuberculosis patients of Shimla city which is the capital of Himachal Pradesh, a northern state of India. Data related to smoking status was collected using the standard questionnaire which was used for collection of data regarding tobacco use in Global Adult Tobacco Survey (GATS). Details of the participant’s final treatment outcomes after end of standardized treatment of 6 months was collected from the treatment records of the patients.

Results

72 TB patients were included as study subjects. The prevalence of smoking came out to be 37.5%. In our analyses, the risk of unfavorable treatment outcomes was higher among smokers (p value 0.049), Smokeless tobacco users (p value 0.031) and those with history of harmful alcohol use (p value 0.002).

Conclusions

There is high prevalence of smoking among TB patients and risk factors associated with unfavorable treatment outcome are smoking, Smokeless tobacco and history of harmful alcohol use.

Key messages

Smoking and smokeless tobacco cessation programmes need to be targeted at Tuberculosis patients. Tuberculosis patients with alcohol related problems should be identified at the time of diagnosis and should be attached with de-addiction centre
23Multiple Chronic Conditions: Need for Ongoing Research
Authors: Gupta Sangeeta
Published: September 2021

Background

Increasing burden of Multiple Chronic Conditions (MCC) is a global priority. However, lack of a consistent definition makes it a challenge to compare burden of MCC amongst countries. The objective of this study is twofold: 1) to present research on the prevalence of MCC among US adults and 2) to reopen a global dialogue on potential areas for intervention including a consensus on the taxonomy of MCC.

Methods

Combined data for 2015 through 2018 from Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor and Surveillance system (n = 1373755) were analyzed to determine prevalence of MCC. Adults were categorized as having 0, 1, 2, or 3 or more of the following diagnosed chronic conditions: angina, arthritis, asthma, cancer, chronic kidney disease, chronic obstructive pulmonary disease, diabetes, high blood pressure, high cholesterol, myocardial infarction (heart attack), obesity, or stroke.

Results

More than 61% of US adults had at least 1 of the 12 selected chronic conditions. Furthermore, 47.8 percent of US adults had MCC. For US adults with 2 chronic conditions, the MCC dyad with the highest prevalence was arthritis and obesity. Among adults with 3 or more chronic conditions, the MCC triad of arthritis, asthma, and obesity was the most prevalent.

Conclusions

The findings of this study contribute information to the field of MCC research in response to the need for ongoing surveillance.

Key messages

Ongoing MCC research efforts will provide a much needed paradigm shift in management of chronic conditions in the public health domain.
1177Lest we lose focus: ongoing analyses of adverse childhood experiences in COVID-19 era
Authors: Gupta Sangeeta
Published: September 2021

Background

Toxic stress caused by adverse childhood experiences (ACEs) has been definitively linked to adverse health outcomes across lifespan. Prolonged COVID-19 pandemic stress affecting mental and physical health across the nation, has been postulated to amplify occurrence of ACEs and exacerbate negative health outcomes in this vulnerable population. This study provides a comparison of pre COVID (year 2019) and COVID (year 2020) data on ACE’s and health outcomes.

Methods

2019 and 2020 Behavioral Risk Factor Surveillance System data were analyzed to estimate the prevalence of childhood adversity and association with health behaviors and outcomes. Logistic regression was performed using SAS complex survey procedures.

Results

In 2019,

nearly one in four adults reported high ACE scores (≥3). High ACE scores were more prevalent among women, multiracial/minority race groups, bisexual, lesbian/gay sexually oriented, younger age group, adults, less educated, and with lower income. Comparison analyses with 2020 data has begun and is expected to be completed in time for conference presentation.

Conclusions

Ongoing focus on ACEs mitigation and/or prevention efforts is critical to better health and higher socioeconomic attainment across lifespan. COVID-19 pandemic has escalated and put a spotlight on this call . Adults with preexisting ACEs are especially vulnerable. Compounded toxic stress with limited access to health care can expedite development or worsening of chronic conditions in these susceptible groups.

Key messages

Targeted efforts to identify and protect at-risk ACEs populations from the negative impact of COVID 19 pandemic are essential.
1165Multiple Chronic Conditions: Need for Ongoing Research
Authors: Gupta Sangeeta
Published: September 2021

Background

Increasing burden of Multiple Chronic Conditions (MCC) is a global priority. However, lack of a consistent definition makes it a challenge to compare burden of MCC amongst countries. The objective of this study is twofold: 1) to present research on the prevalence of MCC among US adults and 2) to reopen a global dialogue on potential areas for intervention including a consensus on the taxonomy of MCC.

Methods

Combined data for 2015 through 2018 from Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor and Surveillance system (n = 1373755) were analyzed to determine prevalence of MCC. Adults were categorized as having 0, 1, 2, or 3 or more of the following diagnosed chronic conditions: angina, arthritis, asthma, cancer, chronic kidney disease, chronic obstructive pulmonary disease, diabetes, high blood pressure, high cholesterol, myocardial infarction (heart attack), obesity, or stroke.

Results

More than 61% of US adults had at least 1 of the 12 selected chronic conditions. Furthermore, 47.8 percent of US adults had MCC. For US adults with 2 chronic conditions, the MCC dyad with the highest prevalence was arthritis and obesity. Among adults with 3 or more chronic conditions, the MCC triad of arthritis, asthma, and obesity was the most prevalent.

Conclusions

The findings of this study contribute information to the field of MCC research in response to the need for ongoing surveillance.

Key messages

Ongoing MCC research efforts will provide a much needed paradigm shift in management of chronic conditions in the public health domain.
252Development and validation of a breast cancer absolute risk prediction model in Chinese population
Authors: Han Yuting , Lv Jun , Yu Canqing , Guo Yu , Bian Zheng , Hu Yizhen , Yang Ling , Chen Yiping , Du Huaidong , Zhao Fangyuan , Wen Wanqing , Shu Xiao-Ou , Xiang Yongbing , Gao Yu-Tang , Zheng Wei , Chen Junshi , Chen Zhengming , Huo Dezheng , Li Liming
Published: September 2021

Background

Compared with developed countries, breast cancer in China is characterized by a rapidly escalating incidence rate, lower survival rate, and vast geographic variation. However, there is no national validated model in China to aid early detection yet.

Methods

A large nation-wide prospective cohort, China Kadoorie Biobank (CKB), was used to evaluate relative and attributable risks. A total of 300,824 women free of prior cancer were recruited during 2004-2008 and followed up to 31 December 2016. Absolute risks were calculated by incorporating national age- and residence-specific incidence and non-breast cancer mortality rates. We used an independent large prospective cohort, Shanghai Women's Health Study (SWHS), to externally validate the calibration and discriminating accuracy.

Results

During a median of 10.2 years of follow-up in the CKB, 2,287 cases were observed. The final model included education, BMI, height, family history of cancer, parity, and age at menarche. The model was well-calibrated in both the CKB and the SWHS, yielding expected/observed ratios of 1.00 (95% confidence interval (CI), 0.96-1.04) and 0.94 (95% CI, 0.89-0.99), respectively. After eliminating the effect of age and residence, the adjusted areas under the curve were 0.615 (95% CI, 0.600-0.630) and 0.585 (95% CI, 0.564-0.605), respectively.

Conclusions

Based only on non-laboratory predictors, our model has an excellent calibration and moderate discriminating capacity. The model may be a useful tool to raise individuals’ awareness and aid risk-stratified screening and prevention strategies.

Key messages

We developed a breast cancer prediction model for Chinese women, which performed well in internal and external validation.
1463Impact of missing outcome data in meta-analyses of lifestyle interventions during pregnancy to reduce postpartum-weight-retention
Authors: Harris Rebecca , Batterham Marijka , Neale Elizabeth , Ferreira Isabel
Published: September 2021

Background

High risk of bias associated with missing outcome data (MOD) in meta-analyses (MAs) of the effects of lifestyle interventions during pregnancy on postpartum weight retention (PPWR), casts doubt on whether such interventions can be relied upon as truly effective, since estimates are deemed valid only if MOD was missing at random (MAR).

Methods

We conducted a systematic overview of MAs to examine the impact of MOD on the estimation of meta-analytic summary intervention effects and conducted sensitivity analyses using pattern mixture models and informative missingness parameters (describing how the outcome in the missing participants may be related to the outcome in the completers), to ascertain the robustness of the estimates to reasonable deviations from the MAR assumption.

Results

Three relevant MAs were identified, all with high MOD rates in the RCTs included (median>30%), and all reporting beneficial intervention effects on PPWR (in kg) estimated based on complete case analyses: [-0.78 (95%CI: -1.39,-0.16), -0.81 (-1.57,-0.06), and -0.94 (-1.52,-0.37)] in MAs of any lifestyle, exercise, or diet + exercise interventions, respectively. In plausible scenarios where the outcome for the intervention group in participants with vs without MOD was worse (by 0.5kg), effect estimates were attenuated in all and no longer significant in 2 of the MAs [-0.58 (-1.29,0.13), -0.70 (-1.50,0.10) and -0.88 (-1.73,-0.02)].

Conclusions

Statistical significance was retained when all 19 RCTs identified across MAs were meta-analysed: -0.63 (-0.17,-0.08).

Key messages

The clinical relevancy of effects of this magnitude remains unclear.
191Two approaches to teaching epidemiology online for capacity building in developing countries
Authors: Sengupta Paramita , Myles Puja , Heller Emeritus Richard
Published: September 2021

Background

Contributing to a mission to build Public Health capacity in developing countries, two online epidemiology courses are offered: a tutor facilitated Master’s level module ‘Introduction to Epidemiology’, and a free self-study ‘Basic Epidemiology’ Open Online Course (OOC). We report differences between these two.

Methods

Student demographics on enrolled students were abstracted. A follow-up online survey of former students was performed in January 2020.

Results

Among 772 students on the Master’s and 619 students on the OOC courses: respectively 29% and 39% were female; 36% and 38% were medical practitioners; 80% and 43% were from Africa.

For 64% of OOC students this was their first time learning online; 17% completed the course. 82% of students formally enrolled on a Master’s programme passed the module.

The majority of survey respondents reported that the courses had helped with reading articles critically (81% Master’s; 67% OOC) and improving professional practice (75% Master’s; 67% OOC); though fewer felt that the courses helped them perform their own research (67% Master’s; 51% OOC). The majority (87% Masters; 79% OOC) would recommend the course to others.

Conclusions

Online epidemiology courses have the ability to reach a wide audience in the developing world and contribute to capacity building. While both Master’s facilitated and self-study online courses were evaluated positively by students, the completion and potential impact was higher for the former.

Key messages

Online courses reaching wide audiences can help build global capacity in epidemiology
1003Modifiable risk factors and incidence of diabetes mellitus progressing in the prediabetic Population
Authors: Hong Kwan , Yu Eun Sun , Chun Byung Chul
Published: September 2021

Background

Although the prevention of diabetes mellitus is important, factors related to its progression in the prediabetic population are rarely revealed. This study aimed to estimate the rate of progression and uncover the modifiable risk factors leading to progression.

Methods

We constructed a group from the National Health Screening Cohort, consisting of adults who received national health screening tests in 2002. After selecting a prediabetic population, we classified them into two groups based on their diabetes progression after a 13-year follow up. The adjusted incidence rate was estimated, and the Cox proportional hazard modelling was performed to identify risk factors for progression.

Results

The progression rate of diabetes in the prediabetic population (88,330) was 22.85% (20,184), with an adjusted incidence rate of 25.18 (95% confidence interval, CI: 24.44 – 26.02) per 1,000 person-year, ages 40-64 and 25.69 (95% CI: 24.46 – 26.95) in those 65 or older. Among modifiable risk factors, smoking showed the highest hazard ratio, 1.21 (95% CI: 1.16 – 1.25), followed by BMI and alcohol consumption with hazard ratios of 1.06 (95% CI: 1.06 – 1.07) and 1.06 (95% CI: 1.02 – 1.09), respectively.

Conclusions

Considering the high progression rate of the prediabetic population, modifiable risk factors, such as smoking, should be managed.

Key messages

The progression rate of the prediabetic population was 25–26% per 1,000 person-year. At the 13-year follow up, modifiable risk factors, such as smoking, BMI, and alcohol consumption, affected the prediabetic population.
1232Relationship between leucine metabolism and executive function development: the GUSTO cohort
Authors: Huang Jian
Published: September 2021

Background

Molecular biomarkers for cognitive function have also been widely investigated. However, few investigated early development of executive function (EF) comprehensively, which is a higher-level of cognitive function responsible for coordinating other cognitive ability.

Methods

We investigated the metabolomic biomarkers for EF in a multi-ethnicity birth cohort in Singapore. Circulating level of 165 metabolites were quantified using a nuclear magnetic resonance (NMR)-based metabolomics platform in 457 and 524 children at age 6 and 8 years. EF was assessed in 495 children (∼7 years) using parent-reported Behavior Rating Inventory of Executive Function, Second Edition. We incorporated genetic data and performed mediation analysis to investigate the role of rs1260326 (GCKR) in the relationship between leucine metabolism and EF.

Results

Higher circulating level of leucine was consistently associated with poorer EFs (Initiate, Working Memory, Plan/Organize, Task-Monitor, and Organization of Materials) after adjusting for age, sex, maternal ethnicity, maternal educational level, household income at recruitment, and child body-mass index (BMI). Comparing to CT genotype, CC genotype in rs1260326 is potentially associated with poorer EFs. But these associations were not mediated via circulating leucine level or BMI. Higher circulating leucine exerts effect on EFs and part of the effect may be via impact on BMI. Leucine-BMI interaction may exist in CT subgroup.

Conclusions

Our analysis suggested that leucine exerts harmful effect on EF, but at a lower level, leucine-BMI interaction may counteract with the effect of leucine.

Key messages

Higher level of circulating leucine was associated with poorer EF.

Leucine-BMI interaction influences the leucine-EF association.
127Topical antibiotics used to prevent infection in the ICU: an accidental natural herd exposure experiment
Authors: Hurley James
Published: September 2021

Background

Multiple studies of topical antibiotics applied to ICU patients appear to show potent infection prevention effects versus studies of other interventions. However, the effect is less apparent for studies using non-concurrent (NCC) versus concurrent controls (CC) implying the possibility of a herd effect.

Methods

206 studies of infection prevention among ICU patients, sourced from 15 systematic reviews were stratified into those using topical antibiotics with NCC versus with CC versus studies of other prevention methods. The event rates were summarised using generalized estimating equations and compared to other studies without an intervention (literature benchmark).

Results

The summary effect sizes for pneumonia and mortality prevention derived in the systematic reviews were replicated.

The mean ICU mortality incidence for topical antibiotic study CC control groups (28.5%; 95% CI, 25.0-32.3; n = 41) is higher versus a literature benchmark (23.7%; 19.2%-28.5%; n = 34), versus NCC control groups (23.5%; 19.3-28.3; n = 14) and versus topical antibiotic intervention groups (24.4%; 22.1 – 26.9; n = 62). In meta-regression models adjusted for group mean age and publication year, CC group membership within a topical antibiotic study remains associated with higher mortality (p = 0.027).

Conclusions

Within topical antibiotic studies, the CC control group mortality incidences are inexplicably high, whereas the intervention group incidences are paradoxically similar to a literature-derived benchmark.

Key messages

An adverse herd effect is apparent for topical antibiotics used to prevent infection among ICU patients.
1091Evaluation of symptom screening methods for tuberculosis: secondary analysis of Mongolian nationwide tuberculosis prevalence survey
Authors: Ichimura Yasunori , Purev Bayasgalan , Boldoo Tsolmon , Dambaa Naranzul , Sovd Tugsdelger
Published: September 2021

Background

Symptom screening for tuberculosis (TB) is a key component for identifying TB suspects and TB cases, particularly in resource-limited countries. This study aimed to evaluate the effectiveness of symptom screening using TB-related symptoms including the standard symptom screening criterion of chronic cough: cough for two weeks or more, to identify TB cases in the general population.

Methods

This study is a secondary analysis of the nationwide population-based, cross-sectional survey for TB prevalence in Mongolia in 2014-2015. Each TB-related symptom was compared between bacteriologically confirmed TB cases and bacteriologically negative participants.

Results

Of the 50,309 adults who received symptom screening, 248 were diagnosed as bacteriologically confirmed TB cases. The sensitivity and specificity of standard symptom screening of cough for two weeks or more were 20.6% and 95.3%, respectively. The higher sensitivity and lower specificity were reported in chronic sputum: sputum for two weeks or more (22.2% and 93.6%, respectively), in prolonged fever: fever for four days or more (21.4% and 95.0%, respectively), in weight loss (36.3% and 89.3%, respectively), in combination with standard symptom screening. TB cases had more chronic cough (OR 2.78, 95% CI: 1.83-4.22), chronic sputum (OR 1.67, 95% CI: 1.06-2.65), prolonged fever (OR 3.46, 95% CI: 1.90-6.28) and “weight loss” (OR 3.73, 95% CI: 2.77-5.02).

Conclusions

The addition of TB-related symptoms, namely, chronic sputum, fever and weight loss to the standard symptom screening criterion, may facilitate the detection of more TB cases efficiently.

Key messages

The utility of TB-related symptom screening may improve detection of TB cases.
572Randomized Controlled Trial Investigating the Effect of an Educational Intervention on Paternal Postpartum Depression Risk
Authors: Ichinose Yuichi , Urayama Kevin , Okamura Makoto , Sugiura Naomi , Suto Maiko , Sasaki Hatoko , Takehara Kenji
Published: September 2021

Background

Postpartum paternal depression (PPPD) is under-acknowledged worldwide compared to maternal depression, despite PPPD prevalence being reported to be just as high. Although PPPD has clear health consequences, even on other family members, preventive methods have been under-studied. We investigated the association between an educational intervention and risk of PPPD.

Methods

We performed a parallel-group, randomized controlled trial in an obstetrics clinic in Japan that included expecting fathers and their pregnant partners at 28-32 weeks gestation. The intervention comprised an educational booklet created for fathers that was distributed during pregnancy. For the primary outcome, Edinburg Postnatal Depression Scale (EPDS) was administered at one and three months post-delivery, and EPDS of 8 or greater was considered at risk for depression.

Results

In total, the intervention and control groups comprised 286 and 282 couples, respectively. At follow-up, depressive symptoms were observed in 7.2% of fathers in the intervention group and 9.8% in the control group (odds ratio [OR] = 0.71, 95% confidence interval [CI] = 0.36-1.36). Logistic regression in an adjusted analysis showed a reduced, but non-significant risk of PPPD (odds ratio=0.61, 95% confidence interval=0.31-1.20).

Conclusions

In the first PPPD intervention study of its kind in Japan, our study suggests that distributing the educational booklet to fathers may be helpful in general, but may not be enough to significantly influence the risk of a major condition like PPPD.

Key messages

A more personalized preventive approach beyond the simple administration of a booklet may be necessary to significantly impact PPPD occurrences.
1042Trends in area-level socioeconomic inequalities of lung cancer mortality by age group in Japan: 1995-2014
Authors: Ito Yuri , Fukui Keisuke , Kondo Naoki , Katanoda Kota , Nakaya Tomoki , Sobue Tomotaka
Published: September 2021

Background

During the long-term economic recession, health inequalities have been concerned in Japan. Among cancer mortality rates, the widest socioeconomic inequalities of municipal mortality was observed in lung cancer. Our aim was to examine the trends in the inequality by sex and age group.

Methods

We used the areal deprivation index (ADI) to determine area-level socio-economic position at the municipality level. We calculated age-standardised lung cancer mortality rate by sex, age group (<60/60-74/75+) and ADI quintile group using the vital statistics data. Joinpoint regression models were applied to estimate the average annual percentage changes for the last five years. We also calculated absolute index and relative index of inequalities.

Results

Among men, a clear socioeconomic gradient in lung cancer mortality was observed for all age groups, but among women, ‘J-shape’ gradients in which Q2 or Q3 had the lowest mortality were observed. For women aged 60-74 years, increasing trends of mortality were observed in more deprived groups (Q3-Q5). Men over 75 years showed noticeably decreasing trends in mortality, while women showed no decrease. Absolute inequalities in women were smaller than those in men, but relative inequalities showed widening trends for all age groups.

Conclusions

We identified widening area-level gaps in all age groups and stable/increasing trends in lung cancer mortality of the 60-74 year age group.

Key messages

It is important to monitor mortality trends and their gaps of lung cancer mortality among deprivation groups to identify vulnerable subpopulations in order to help tackle the health inequalities.
1464Application of Webinars for popularizing Occupational Health Epidemiology during the Covid-19 Pandemic in India
Authors: Jain Rajiv Kumar
Published: September 2021

Focus of Presentation

The process and results of popularizing Occupational Health Epidemiology amongst Occupational Health practitioners in India during the covid-19 Pandemic in India through Webinars

Findings

The 25 webinars of average duration of 90 minutes, with contents relating to Covid-19 Epidemiology in India, generated immense interest amongst Occupational Health Practitioners with reference to innovative methods of data collection, analysis of data, results dissemination and integration of results in occupational Health practice during pandemic of Covid-19 in India.

Conclusions/Implications

Occupational Health Epidemiology is a neglected discipline in India. Innovative method of use of webinars amongst Occupational Health practitioners can be used for popularizing the methods, data analysis and results dissemination etc. It is expected that this interest shall be sustained in Post Pandemic period and the discipline of Occupational Health Epidemiology will get its rightful place amongst Occupational Health practitioners in India leading to research initiatives and application of results in the practice of Occupational Health in India.
1492Ordering the chaos: The global clustering of COVID-19 incidence and mortality
Authors: Jayaraj Vivek Jason , Rampal Sanjay , Ng Chiu-Wan , Chong Diane Woei Quan
Published: September 2021

Background

The propagation of COVID-19 has been dynamic across countries and time. We utilised a temporal clustering approach in exploring trends of incidence and mortality across 202 countries.

Methods

COVID-19 case and death data between 1 January 2020 and 30 April 2021 were extracted from open-source data repositories. A partitional clustering algorithm, using Euclidean distances and partition around medoids, was utilised in exploring 14-day incidence and mortality rates across 202 countries. Inter-cluster comparisons were carried out using the 14-day incidence and mortality rates across clusters.

Results

Country-specific trends of incidence and mortality across the study period were agglomerated into one of six clusters. The overall trend of incidence and mortality during this period peaked between November 2020 and January 2021. However, four of the six clusters have an upward trajectory. Countries in cluster four, mostly situated in Europe, reported the highest overall incidence of 192 cases per 100,000 population (95% CI: 166, 220). Countries in cluster three, a mix of countries from South America, Eastern Europe, and Africa, were observed to have the highest overall mortality rate of 32 deaths per 1,000,000 population (95% CI: 23, 45).

Conclusions

The high global burden of disease and inequity in vaccine access highlights the need for a consolidated global effort in mitigating the pandemic.

Key messages

Increasing trajectories of incidence and mortality in Asia, South America, and Africa suggest that the worst of the pandemic may be ahead of us.