bluuebunny/crossref_metadata_2025 huggingface dataset:
1522Health Literacy and Public Awareness and Its Effect on COVID-19 Prevention: A Systematic Review
Authors: Singh Akhilesh Vikram , Balachandran Parvathy
Published: September 2021

Background

Considering the current COVID-19 pandemic due to SARS-CoV-2, it is necessary to estimate the role of health awareness, severity of disease impact on coronavirus patients and follow the approved disease preventive practices to improve the quality of health. This study aims to provide a systematic literature review on the health literacy awareness among the general population about SARS-CoV-2 and its impact on COVID-19 prevention.

Methods

We performed an extensive literature search on health literacy among public related to COVID-19. Relevant articles from PubMed and Cochrane databases were extracted and evaluated by applying appropriate key search terms to obtain the information published from January 2020 to April 2021. We included data based on observational and questionnaire-based studies and gathered information on participant's characteristics, health literacy and awareness, fear of COVID-19, and health-related behaviours.

Results

The most eligible studies were identified from the available literature (N = 39) searched through using appropriate key terms. The literature analysis showed that social media and interacting personally with a community of friends are the primary sources that spread pandemic information related COVID-19 pandemic and its severity.

Conclusion

Globally, social media is a major platform for disseminating and promoting health literacy about COVID-19 among the general population. It is suggestable to bring a more robust approach for a larger population who have educational disparity for better prevention of this communicable disease.

Key Message

A rapid health awareness among the general public unaware of the seriousness of the COVID-19 pandemic is imperative and also to encourage COVID appropriate behaviors for better control of COVID-19.
708Incidence of congenital anomalies in children born after assisted reproduction in the Czech Republic
Authors: Sipek Antonin , Gregor Vladimir , Klaschka Jan , Maly Marek , Sipek Antonin
Published: September 2021

Background

The number of children conceived by assisted reproduction techniques (ART) is increasing in the Czech Republic. However, several studies reported increased incidence of congenital anomalies in ART conceived children. The main goal of this study was to evaluate this theoretical risk using population-based data from Czech medial registries.

Methods

The retrospective epidemiological analysis was performed using data from the National Registry of Congenital Anomalies and National Registry of Newborns, run by the Institute of Health Information and Statistics of the Czech Republic. All diagnoses of congenital anomalies (Q00-Q99) were included. We compared the incidences of congenital anomalies in naturally conceived children and ART conceived children born in the Czech Republic during 5 years period (2013-2017). Statistical analysis was performed by Fisher's exact test.

Results

During the selected period there were 547 675 children born in the Czech Republic (531 064 were naturally conceived children and 16 611 were ART conceived children). The incidence of congenital anomalies was 3.90% in naturally conceived children group and 4.35% in ART conceived children. This difference is statistically significant (p = 0.003).

Conclusions

In our population-based study, we confirmed a significantly higher general incidence of congenital anomalies in ART conceived children.

Key messages

The general incidence of congenital anomalies in ART conceived children is higher (compared to the incidence of congenital anomalies in naturally conceived children). Possible causes of this phenomenon shall be further analysed.
282Social isolation and incident coronary heart disease in two large UK prospective studies
Authors: Smith Robert , Barnes Isobel , Green Jane , Reeves Gillian , Beral Valerie , Floud Sarah
Published: September 2021

Background

Social isolation is associated with CHD mortality but evidence of association with incident CHD is mixed. We prospectively examined this association in the Million Women Study (MWS) and UK Biobank (UKB).

Methods

481,946 MWS and 456,612 UKB participants reported on social isolation (living alone, little contact with family/friends/groups). Excluding those reporting previous CHD or stroke, participants were followed for incident CHD using linkage to hospital admission and death records. Cox regression yielded relative risks (RR) by 3 levels of social isolation, adjusted for relevant confounders.

Results

During 7 years follow-up in the MWS and UKB, there were 42,402 first coronary heart disease events in total (of which 1,834 were fatal without an associated hospital admission). After adjustment, social isolation was not associated with hospital admission for first CHD events (combined RR for both studies: RR = 1.01, 95% CI: 0.98–1.04). However, the risk of fatal first CHD events without an associated hospital admission was substantially higher in the most isolated group than the least isolated group (1.86 [1.63–2.12]) This association with fatal first CHD events was driven by the association with living alone.

Conclusions

Social isolation was not associated with increased risk of first CHD hospital admissions but was associated with increased risk of death from CHD.

Key messages

Social isolation is likely not a risk factor for developing CHD, but people living alone may be at greater risk of dying from a coronary event than those not living alone.
436Food addiction, mental health and substance-use during a transition period: Data from 6,700 Australian 12/13-year-olds
Authors: Smout Scarlett , Gardner Lauren , Newton Nicola , Champion Katrina , Chapman Cath , Slade Tim , Sunderland Matthew , Thornton Louise , Kay-Lambkin Frances , Teesson Maree
Published: September 2021

Background

Early adolescence is a challenging transition period where mental ill-health and experimentation with alcohol and tobacco often increases. Some foods and eating behaviours can be addictive in a way that is comparable to addictive substances. Few studies have examined the prevalence of food addiction in young people, and none have measured it with mental ill-health and substance-use.

Methods

6,700 Year 7 students across NSW, WA and QLD completed the baseline questionnaire for “Health4Life” (Mage=12.7±0.5, 49%F). The prevalence of, and associations between, food addiction (YFAS-C), anxiety (PROMIS-A), depression (PHQ-A), psychological distress (K6), discretionary food/drink intake (SPANS) and alcohol and tobacco use were examined.

Results

Respondents who met diagnostic criteria for food addiction (5.2%, n = 272) were significantly more likely to screen positively for anxiety (X23=315.4, P < 0.001), probable major depression (X21=299.9, P < 0.001) and psychological distress at levels of serious mental illness (X21=238.885, P < 0.001). They were also significantly more likely to have consumed a full standard drink and smoked tobacco in the past 6-months (X21=53.8, P < 0.001 and X21=29.7, P < 0.001, respectively) and to consume high amounts of sugar-sweetened beverages (X21=15.2, P < 0.001), discretionary foods (X22=26.4, P < 0.001) and energy drinks (X25=28.4, P < 0.001). Relative risks ranged 1.29-4.35.

Conclusions

Findings suggest a strong link between food addiction, substance use, discretionary food and drink consumption and mental ill-health in early adolescence. Further analysis will model multivariable relationships whilst controlling for affluence, BMI and gender.

Key messages

Links between food addiction, substance use and mental ill-health are found in the largest sample of adolescents screened for these variables worldwide.
1175Work stress and loss of years lived without chronic disease; an 18-year prospective cohort study
Authors: Sørensen Jeppe K. , Framke Elisabeth , Pedersen Jacob , Alexanderson Kristina , Bonde Jens P. , Farrants Kristin , Flachs Esben M. , Magnusson Hanson Linda L. , Nyborg Solja T. , Kivimäki Mika , Rugulies Reiner
Published: September 2021

Background

Aim: To examine the association of work stress with future chronic disease incidence and loss of chronic disease-free life years in the Danish workforce.

Method

A population-based prospective register-based cohort study of all employees aged 30-59 in 2000 in Denmark, without chronic diseases at baseline (n = 1,592,491). Using job exposure matrices, we assessed exposure to work stress by a combined measure of job strain and effort-reward imbalance. We estimated the risk of incident hospital-diagnosed chronic disease or death (i.e., type 2 diabetes, coronary heart disease, stroke, cancer, asthma, chronic obstructive pulmonary disease, heart failure, and dementia) during 18 years of follow-up and corresponding chronic disease-free life expectancy.

Results

Individuals working in occupations with high risk of both job strain and effort-reward imbalance had a slightly higher risk of future incident chronic disease compared to those in occupations with low risk of both stressors. The hazard ratio was 1.04 (95% CI 1.02 to 1.05) in women and 1.12 (95% CI 1.11 to 1.14) in men. The corresponding loss in chronic disease-free life expectancy was 0.25 years in women and 0.84 years in men.

Conclusion

Working in occupations with a high risk of work stress was associated with a small loss of years lived without chronic disease compared to working in occupations with low risk of work stress.

Key messages

According to our findings, employees in occupations with high risk of work stress live slightly shorter lives free of chronic diseases compared to employees in occupations with low risk of work stress.
843Hepatitis C in South Australia and Northern Territory: a population-based linkage study
Authors: Stephens Jacqueline , Bradley Clare , Elliott Salenna , Dore Gregory , Grebely Jason , Alavi Maryam , Kennedy Brendan , Tong Steven , Ward James
Published: September 2021

Background

In Australia, the notification rate for hepatitis C is five times greater among Aboriginal and Torres Strait Islander peoples than nonIndigenous populations. Infection with Hepatitis C virus is associated with increased morbidity, mortality and health-related costs. However simple, tolerable and short-duration HCV therapies with extremely high efficacy are available.

Methods

Overall, this project aims to identify inequities in hepatitis C healthcare for Aboriginal and Torres Strait Islander peoples across South Australia (SA) and Northern Territory (NT). By using 19 routinely collected health administration datasets, we will evaluate hepatitis C diagnoses, treatment uptake, and treatment outcomes, with focus on identifying patterns in healthcare access among Aboriginal and Torres Strait Islander people in SA since 1992 or in NT since 1999 using probabilistic data linkage methodology in a secured online environment.

Results

The study population includes all hepatitis C notifications recorded in SA and NT, totaling more than 25,000 cases. Preliminary findings will be reported including incidence of hospitalisation, mortality, and morbidity by Aboriginal and Torres Strait Islander status.

Conclusions

Now that highly effective direct acting anti-viral treatments are available, it is crucial to ensure key affected populations, including Aboriginal and Torres Strait Islander people, have access to these novel biomedical approaches.

Key messages

This project is of national importance to address hepatitis C related morbidity and mortality in Australia, particularly among Aboriginal and Torres Strait Islander peoples. Findings will underpin future policy to reduce the burden of hepatitis C across SA and NT populations.
516Association of dietary diversity with all-cause mortality by body mass index in Japanese older adults
Authors: Takabayashi Saeka , Hirata Takumi , Zhao Wenjing , Kimura Takashi , Ukawa Shigekazu , Tsushita Kazuyo , Wakai Kenji , Kawamura Takashi , Ando Masahiko , Tamakoshi Akiko
Published: September 2021

Background

Dietary diversity is thought to reduce risk of malnutrition although it is also linked to obesity. We examined whether dietary diversity is associated with all-cause mortality in Japanese elderly by body mass index (BMI).

Methods

The current study included 2,944 people aged 64-65 years who participated in the NISSIN project in 1996-2005. Dietary diversity was measured by the Food Variety Score (FVS) which calculates frequency of all food items consumed daily using a self-administered food frequency questionnaire. Participants were divided into tertiles according to their FVS (1st: low, 2nd: middle, 3rd: high). Multivariate adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using the Cox proportional hazard regression model. In stratified analysis, BMI was used to divide the participants into 3 groups: lean (BMI <20), normal (BMI 20–24.9), and overweight/obese (BMI ≥ 25).

Results

Overall, 454 (30.7%) men and 222 (15.2%) women died over the median follow-up period of 16.6 years. No significant association between FVS and all-cause mortality was observed overall. However, when grouped by BMI, in the lean, multivariate adjusted HRs were 0.32 (CI: 0.17-0.59) in the middle FVS and 0.41 (CI: 0.19 -0.91) in the high FVS, compared with the low FVS. No significant association was found for normal and overweight/obese.

Conclusions

These findings indicate dietary diversity should be promoted for lean older adults.

Key messages

BMI should be considered when promoting dietary diversity.
748Misclassification of interpregnancy interval attributable to miscarriages/induced abortions: quantifying its impact on preterm births
Authors: Tessema Gizachew , Håberg Siri E , Pereira Gavin , Magnus Maria C
Published: September 2021

Background

A paucity of studies explored how intervening pregnancy events (miscarriages and induced abortions) contribute to interpregnancy interval (IPI) misclassification and whether this misclassification translates into bias in the estimated effect of IPI on adverse birth outcomes.

Methods

We included identified three national registries (Birth Register, the General Practitioner, and Patient Register) to obtain information on registered pregnancies (n = 167,012), with at least two consecutive pregnancies per mother, occurring between 2008 and 2016 in Norway. We computed two IPIs, one that accounted only two consecutive pregnancies ending after 20 weeks of gestation (standard IPI definition) and the other that accounted two consecutive pregnancies with various outcomes including miscarriages/induced abortions (corrected IPI definition). We independently assessed the association between the two IPIs and preterm births (PTB). Log binomial regression analysis was conducted. Relative risks (aOR) and 95% confidence interval (CI) were estimated.

Results

In the study, 4.7% of births were PTB. While 11.7% of pregnancies occurred <6 months in the corrected IPI definition, the proportion reduced to 4.4% in the standard IPI definition, with over 60% of IPIs were misclassified. After adjusting for confounders, there was a modest overestimation of risk of PTB for pregnancies following short IPI (<6 months) (RR = 1.76, 95% CI: 1.60-1.95) for the standard IPI definition as compared to the risk of PTB (RR = 1.52, 95% CI: 1.41-1.65) following short IPI in the corrected IPI definition.

Conclusions

There was a significant misclassification bias associated with miscarriages/induced abortions which should not be ignored when assessing the effect of IPI on PTB.
1191Endogenous hormones and risk of invasive breast cancer in pre- and post-menopausal women
Authors: Tin Sandar Tin , Reeves Gillian K , Key Timothy J
Published: September 2021

Background

Some endogenous hormones have been associated with breast cancer risk, but the nature of these relationships is not fully understood. We investigated the associations between serum concentrations of testosterone, sex hormone binding globulin (SHBG), insulin-like growth factor-1 (IGF-1) and oestradiol (pre-menopausal women only) and the risk of invasive breast cancer using data from UK Biobank.

Methods

We included 30,565 pre-menopausal and 133,294 post-menopausal women in this analysis. Hormone concentrations were measured in serum collected between 2006 and 2010, and incident cancer cases were identified through linkage to cancer and death registries. Multivariable Cox proportional hazards models were used, and hazard ratios (HRs) were corrected for regression dilution bias using repeat measures collected in about 5,000 women four years after recruitment (except for oestradiol).

Results

During a median follow-up of 7.1 years, 527 pre-menopausal and 2,997 post-menopausal women were diagnosed with invasive breast cancer. Cancer risk was positively associated with testosterone in post-menopausal women (HR per 0.5 nmol/L increment: 1.18; 95% CI: 1.14, 1.23) but not in premenopausal women (pheterogeneity=0.03), and with IGF-1 (HR per 5 nmol/L increment: 1.18; 1.02, 1.35 (pre-menopausal) and 1.07; 1.01, 1.12 (post-menopausal); pheterogeneity=0.2), and inversely associated with SHBG (HR per 30 nmol/L increment: 0.96; 0.79, 1.15 (pre-menopausal) and 0.89; 0.84, 0.94 (post-menopausal); pheterogeneity=0.4). Oestradiol was not associated with risk, but there were study limitations for this hormone.

Conclusions

This study confirms associations of testosterone, IGF-1 and SHBG with breast cancer risk, with heterogeneity by menopausal status for testosterone.

Key messages

Breast cancer risk was positively associated with testosterone and inversely associated with SHBG in post-menopausal women, and positively associated with IGF-1 in both pre- and post-menopausal women.
631Benefits of not smoking during pregnancy for Aboriginal women and their babies
Authors: Torvaldsen Siranda , Ibiebele Ibinabo , Ford Jane , Randall Deborah , Morris Jonathan , Meharg David , Mitchell Jo , Milat Andrew , Torvaldsen Siranda
Published: September 2021

Background

To provide evidence for targeted smoking cessation policy, the aim of this study was to compare pregnancy outcomes of Aboriginal mothers who reported not smoking during pregnancy with those who reported smoking.

Methods

This population-based retrospective cohort study used linked data from routinely collected datasets. Not smoking during pregnancy was the exposure of interest among all New South Wales Aboriginal women who became mothers of singleton babies in 2010–2014. Unadjusted and adjusted relative risks (aRR) and 95%CIs from modified Poisson regression were used to examine associations between not smoking during pregnancy and maternal and perinatal outcomes including severe morbidity, inter-hospital transfer, perinatal death, preterm birth and small-for-gestational age. Population attributable fractions (PAFs) were calculated using adjusted relative risks.

Results

Compared with babies born to mothers who smoked during pregnancy, babies born to non-smoking mothers had a lower risk of all adverse perinatal outcomes including perinatal death (aRR=0.58, 95%CI 0.44–0.76), preterm birth (aRR=0.58, 95%CI 0.53–0.64) and small-for-gestational age (aRR=0.35, 95%CI 0.32–0.39). PAFs(%) were 27% for perinatal death, 26% for preterm birth and 48% for small-for-gestational-age. Compared with women who smoked during pregnancy (n = 8,919), those who did not smoke (n = 9,235) had a lower risk of being transferred to another hospital (aRR=0.76, 95%CI 0.66–0.89).

Conclusions

Babies born to women who did not smoke had much lower risks of all adverse perinatal outcomes.

Key messages

Between a quarter and a half of adverse perinatal outcomes in this population could potentially be prevented by an effective smoking cessation program.
1303Sexually transmitted infections: Risk indicator among people who inject drugs treated on methadone in Myanmar?
Authors: Tun Sun , Vicknasingam B , Singh Darshan
Published: September 2021

Background

HIV can be transmitted through the sexual route. This study explores the association of sexually transmitted infections (STI) with other infections, risky and illicit drug-use behaviour among people who inject drugs (PWIDs) treated on methadone.

Method

A total of 210 respondents from five cities across Myanmar were recruited through stratified random sampling for this cross-sectional study. Respondents were screened for illicit drug use.

Results

A lifetime history of STI was reported at 21.5% (n = 45/209) and 3% reported recent STI. More than half (53%, n = 104/197) used a condom with their sexual partners at last sex. Respondents with STI history was associated with a longer methadone treatment duration, HIV infection, Hepatitis B, tuberculosis (TB) treatment history, heroin and benzodiazepine use, those who tested negative for cannabis (THC) use (p < 0.05). However, STI is not significantly associated with ATS use and incarceration history.

Stepwise logistic regression showed respondents with longer methadone treatment duration, HIV infection, Hepatitis B infection and TB treated history had higher odds of being infected with STI (p < 0.05). Those who had STI in the last year had hepatitis B, hepatitis C, and shared their needle and syringe in the last 30 days (p < 0.05).

Conclusion

Proper interventions are needed to curb STI transmissions among PWIDs treated on methadone and those who continue to engage in risky HIV behaviours.

Key message

Addressing preventive and treatment measures are also crucial for STI and other associated infections among PWIDs.
1306Methadone dose affects service satisfaction of HIV infected PWIDs treated on methadone in Myanmar
Authors: Tun Sun , Vicknasingam B. , Singh Darshan
Published: September 2021

Background

HIV prevalence among people who inject drugs (PWIDs) in Myanmar was 34.9%. This analysis identifies how methadone dose affects treatment satisfaction of HIV patients.

Method

A total of 210 patients on methadone at least 6 months were recruited from five cities using stratified random sampling in Myanmar. Verona Service Satisfaction Scale for Methadone-Treatment (VSSS-MT) was administered to identify service satisfaction and urine samples were collected for identification of illicit drugs.

Results

More than one-third (36.5%, n = 76) received high-dose (above 80mg/day), while the rest 63.5% received low-dose (less than 80mg/day). Almost half, 47% reported hepatitis C, 37% had reported HIV, and 16% had HIV and HCV. Among HIV cases, 68 (92%) were on antiretroviral therapy (ART). Myanmar’s (ART) regimen: tenofovir, emtricitabine and efavirenz accounted for 86% which need a methadone dose adjustment. The majority, 89% were satisfied with the current methadone service. Specifically, 89.5% for professional skills, 91.9% satisfied for basic intervention and 74.6% satisfied for specific intervention (e.g. individual rehabilitation and psychotherapy) categories. Treatment satisfaction was estimated 2-times higher among HIV negative compared to HIV positive patients after adjusted dosage (IRR=0.49, p = 0.000).

Conclusion

Significant dose adjustment is required for ART with Nonnucleoside Reverse Transcriptase Inhibitors (NNRTIs). High dose adjustment is important for methadone patients on antiretroviral therapy with enzyme inducers.

Key message

Estimated treatment satisfaction varies with infection status after adjusting for dose. Continuous treatment assessments are vital for HIV/HCV co-infections for effective service delivery.
914Progress towards achieving the 2020 goals for Neglected Tropical Diseases in the Asia-Pacific region
Authors: Nery Susana Vaz
Published: September 2021

Focus and outcomes for participants

Neglected tropical diseases (NTDs) are a group of communicable diseases caused by a variety of infectious agents including virus, bacteria and parasites. They are prevalent in 149 countries in the tropics and affect more than one billion people living in disadvantaged communities, further limiting their social and economic development. For several NTDs, including the ones that are the focus of this symposium, the main strategy for control consists of preventive chemotherapy: the large-scale administration of drugs to entire communities or specific population groups, without prior individual diagnosis.

In this symposium we will present the progress made in several countries in the Asia-Pacific region towards the control of 5 NTDs (lymphatic filariasis, scabies, schistosomiasis, soil-transmitted helminths and trachoma) largely through the scale-up of preventive chemotherapy. We will also describe the contribution of operational research to optimise control and elimination of these infections.

At the end of the symposium, participants will be able to:

Rationale for the symposium, including for its inclusion in the

In 2012 the World Health Organization endorsed ambitious targets towards control and elimination of NTDs. to be reached by the end of 2020. Although not all of those targets will be reached there was remarkable progress in coverage of preventive chemotherapy worldwide with millions of doses of medications such as albendazole, ivermectin and ddiethylcarbamazine distributed annually or bi-annually to populations at risk. In early 2020 WHO released the new roadmap for NTDs, that sets new targets to achieve by 2030. Developed with extensive stakeholder consultation this roadmap aims to build on the momentum created since 2012 to further advance the progress made against NTDs. This symposium will review the current burden of NTDs in the region, summarise the successes achieved and present evidence from operational research that is contributing to the achievement of the WHO targets.

Presentation program

Names of presenters

Associate Professor Susana Vaz Nery, The Kirby Institute – University of New South Wales

Professor John Kaldor, The Kirby Institute – University of New South Wales

Associate Professor Colleen Lau, Research School of Population Health – Australian National University

Professor Andrew Steer, Murdoch Children's Research Institute

Professor Vicente J Belizario, College of Public Health, University of the Philippines Manila

Names of facilitator or chair

Associate Professor Susana Vaz Nery
906Can mammographic density add value to the Gail model in risk-stratifying women in BreastScreen Australia?
Authors: Velentzis Louiza , Procopio Pietro , Carr Sarah , Devereux Lisa , Mann Bruce , James Paul , Lee Grant , Wellard Cameron , Arzhaeva Yulia , Nickson Carolyn
Published: September 2021

Background

There is significant interest in personalised, risk-based breast cancer screening. This requires high quality risk assessment. The ‘Gail model’ risk assessment tool has been validated on over 40,000 BreastScreen Australia participants. We assess whether adding mammographic density (MD) information improves risk stratification on that cohort.

Methods

We used questionnaire data, baseline MD readings (using AutoDensity) and linked screening and cancer registry records from 40,158 BreastScreen Australia participants aged 50–69 years (via the lifepool cohort). We investigated incident invasive breast cancer rates by quintiles of Gail model scores, MD, and combinations of Gail and MD.

Results

Gail scores and MD values were weakly correlated (r≤0.02). Gail and MD were each strong predictors of incident breast cancer, but stronger predictors when used in combination. For example, the odds ratio for incident invasive breast cancer was 3.6 (95%CI 2.5-6.3) for the 17% of women in the upper two quintiles of both Gail and MD scores compared to the 17% of women in the lower two quintiles of both scores. In comparison, the odds ratio for breast cancer between same-size (each 17%) upper and lower groups for Gail score alone was 2.5 (95%CI 1.8-3.4), and for MD 1.9 (95%CI 1.2-2.9).

Conclusions

Combining Gail and MD categories improves risk stratification on BreastScreen Australia participants, compared to using Gail or MD alone.

Key messages

While questionnaire data and MD measures are each strong predictors of future invasive breast cancer among BreastScreen Australia participants, risk prediction is stronger when questionnaire and MD measures are combined.
1189Sociodemographic, clinical and morbidity factors associated with COVID 19 mortality : A retrospective observational study
Authors: Verma Anjana
Published: September 2021

Background

The mortality from COVID 19 in India is low, as compared to western countries, but the steady increase in number of cases is a worrying sign. The objectives of this study were to identify and quantify the association between sociodemographic and clinical characteristics with mortality in patients with COVID-19 at a tertiary care hospital in Udaipur, Rajasthan.

Material and methods

This retrospective observational study involved 824 patients hospitalized for COVID 19 at a tertiary hospital in Udaipur, who were discharged or who died. Electronic medical records were accessed and information about age, gender, residence, religion, socioeconomic status, history of exposure, clinical characteristics on admission, co morbidities and outcomes (discharged or died). Associations between mortality and baseline characteristics were determined as hazard ratios (HR) calculated using Cox regression model.

Results

Mortality was 5.82% in our study. The mean age was 48.14 ± 16.2 years. The median time from time of admission to discharge was 8 days (IQR 5–11), whereas the median time to death was 5 days (IQR 4–10). The variables found to be associated with higher mortality were age (HR 1.17; 95% CI % 1.15-1.24), residing in urban area (HR 1.29; 95% CI 1.17–2.15), diabetes mellitus (HR 1.3; CI 1.02-5.57) and patients having both Diabetes and Hypertension (HR 2.4; CI 1.69-3.14).

Conclusion

Sociodemographic variables and comorbidities impact the mortality among COVID 19 patients. The variables most clearly associated with a greater hazard of death were older age, urban area, diabetes and having both diabetes and hypertension.
370Measuring pneumococcal conjugate vaccine impact in a low-resource setting with minimal baseline data
Authors: Mollendorf Claire von , Lim Ruth , Choummanivong Molina , Sychareun Vanphanom , Vilivong Keoudomphone , Lai Jana Y.R. , Chan Jocelyn , Dunne Eileen M. , Phommachanh Sysavanh , Moore Kerryn , Ortika Belinda D. , Gray Amy , Weaver Rupert , Mayxay Mayfong , Phetsouvanh Rattanaphone , Datta Siddhartha S. , Fox Kimberley , Newton Paul N. , Kim Mulholland E. , Nguyen Cattram D. , Dance David A.B. , Satzke Catherine , Xeuatvongsa Anonh , Russell Fiona M.
Published: September 2021

Background

We aimed to measure 13-valent pneumococcal conjugate vaccine (PCV13) impact on various pneumococcal endpoints with minimal baseline data.

Methods

PCV13 was introduced in October 2013 in Lao People’s Democratic Republic. We implemented studies to evaluate PCV13 impact: retrospective record review of pneumonia cases for three years pre-PCV13; prospective study of acute respiratory infection (ARI) for 4.5 years post-PCV to demonstrate effectiveness against hypoxic pneumonia; invasive pneumococcal disease (IPD) surveillance (2004-2019); carriage in children hospitalised with ARI (2013-2019); and community carriage surveys pre- and two years post-PCV13.

Results

Annual incidence of hospitalized pneumonia pre-PCV13 in children 2-59 months was 1,530 (95% confidence interval [CI] 1,477-1,584) per 100,000. Vaccine effectiveness against hypoxic pneumonia was 37% (95% CI 6-57%). In children <5 years, 85% (11/13) of IPD cases were due to PCV13 serotypes pre-PCV13, and 43% (3/7) post-PCV13; and in individuals ≥5 years, 61% (27/44) and 42% (17/40), respectively. In hospitalised children, vaccine type carriage prevalence reduced from 20.0% (95% CI 15.2-24.9%) in 2013 to 12.8% (95% CI 8.5-17.1%) in 2019 with increasing vaccine coverage. Results were consistent with community carriage studies.

Conclusions

Despite limited baseline data in Laos, we found evidence of PCV13 impact using a variety of methods. Our approach could be used in similar settings to augment existing WHO guidelines.

Key messages

A combination of methods may be useful to determine the impact of vaccine introduction in countries with limited surveillance.
1210Understanding the effect of Helicobacter pylori infection on gastroesophageal reflux disease and Barrett’s oesophagus
Authors: Wang Miss Sabrina , Dashti Ghazaleh , Hodge Allison , Kendall Bradley , Dixon-Suen Suzanne , Giles Graham , Milne Roger , English Dallas
Published: September 2021

Background

Helicobacter pylori (H.pylori) infection causes atrophic gastritis and gastric cancer. Ironically, decreased gastric acid production in those with atrophic gastritis might reduce harmful gastroesophageal refluxate, thereby reducing gastroesophageal reflux disease (GERD) and Barrett’s oesophagus (BE) risk.

Methods

In two nested case-control studies with 425 GERD and 169 BE cases, we compared sex-specific GERD and BE risk in H.pylori seronegative participants with seropositive participants. Where seronegativity was associated with increased BE risk, we quantified the effect mediated by GERD using a Monte Carlo simulation-based g-computation approach to estimate interventional effects. Moreover, we classified participants into gastritis types using serum pepsinogen-I and gastrin-17 data.

Results

For men, H.pylori seronegativity was associated with 1.69-fold (CI:1.03-2.75) and 2.14-fold (CI:1.18-3.88) higher odds for GERD and BE respectively. Five (33%) out of the 15 per 1000 excess BE risk from being seronegative was mediated by GERD. No association was observed for women. Among those seropositive, the proportion with atrophic antral gastritis was higher for men than for women (68% vs 56%; p = 0.015).

Conclusions

H.pylori seronegativity was associated with increased GERD and BE risk for men but not women, which could be partly explained by the higher proportion of H.pylori-associated atrophic antral gastritis in men. Evidence of GERD mediating seronegativity’s effect on BE supports this explanation.

Key messages

Whilst H.pylori infection might reduce GERD and BE risk, this is potentially a by-product of atrophic gastritis, a risk factor for gastric cancer. Treating GERD could partly reduce the excess BE risk for seronegative individuals.
1259Adherence to healthy diet reduces mortality associated with systemic inflammation
Authors: Wang Yoko , Page Amanda , Gill Tiffany , Melaku Yohannes Adama
Published: September 2021

Background

Systemic inflammation is a precursor of many chronic diseases that contributes to morbidity and mortality. In this study, we examined the joint association of systemic inflammation and diet quality with all-cause mortality.

Methods

A total of 27,305 adults (mean age = 50 years, male: 50.6%) from the National Health and Nutrition Examination Survey (1999-2010 and 2015-2018) were included in the study. A serum inflammatory marker, C-reactive protein (CRP), was measured. The Healthy Eating Index-2015 (HEI-15) was computed. Multivariable logistic regression analysis was used to determine the cross-sectional association between HEI-15 and inflammation. Multivariable Cox proportional hazard models were performed to assess the risk of all-cause mortality associated with the joint classification of inflammation and diet quality.

Results

In the cross-sectional study, a higher tertile of HEI-15 was associated with reduced odds of inflammation (OR = 0.85, 95% CI: 0.78-0.93) in all participants. Similar results were observed in obese and non-obese groups. In the prospective study (median follow-up = 9.4 years), a higher adherence to HEI-15 was associated with a reduced risk of mortality. Compared to non-obese group, obese participants with high levels of inflammation had a higher risk of all-cause mortality (HR = 1.26, 95% CI: 1.08-1.47; HR = 1.60, 95% CI: 1.19-2.17, respectively).

Conclusions

A higher adherence to HEI-15 was associated with reduced inflammation. Higher diet quality may reduce mortality risks associated with inflammation, particularly in non-obese groups and obese participants with moderate inflammation.

Key messages

Adhering to a high quality diet may mitigate the mortality risk associated with increased inflammation.
658Familial aggregation of melanoma by anatomic site of occurrence
Authors: Ward Sarah , Drill Esther N , Begg Colin B
Published: September 2021

Background

Evidence is emerging that melanoma has distinct etiologic pathways and subtypes, characterized by factors like anatomic site. For example, older men have more head and neck melanomas, and younger women more leg melanomas. Family history is a strong risk factor and familial risk genes have been identified. We therefore aimed to investigate familial aggregation of melanoma from an etiologic heterogeneity perspective, to determine whether melanoma subtypes aggregate within families.

Methods

Using population-level linked health data, we examined the extent to which melanomas in first-degree relatives (FDRs) of cases shared the same body site of occurrence. FDR-pairs diagnosed with melanoma were identified using the Western Australian Cancer Registry and genealogical Family Connections System. Site was categorized as head/neck, trunk/arms, or legs. We identified 1,006 pairs of tumours from 677 family pairs and used Chi-Squared tests to evaluate familial aggregation by site. Degrees of etiologic heterogeneity of individual site-pairs were characterized by site concordance odds ratios.

Results

Familial aggregation by site was statistically significant (P = 0.01). However, only the site pairings of head/neck versus trunk/arms showed strong evidence of familial concordance (OR = 1.7, 95% CI 1.1-1.7). Trends were broadly similar in same-sex pairs.

Conclusions

Results show modest evidence of familial aggregation of melanoma by site, with overall evidence of aggregation but inconsistent patterns between sites.

Key messages

Strong etiologic differences in incidence between anatomic sites for age and sex may be more strongly influenced by non-genetic factors, such as familial patterns of sun exposure.
761Characterisation and clustering of diseases by their association with well-known risk factors
Authors: Webster Anthony , Gaitskell Kezia , Turnbull Iain , Cairns Ben , Clarke Robert
Published: September 2021

Background

Data-driven classifications are improving statistical power, refining prognoses, and improving our understanding of autoimmune, respiratory, infectious, and neurological diseases. Classifications have used molecular information, age of incidence, and sequences of disease onset (“disease trajectories”). Here we consider whether associations with easily-measured established risk factors such as height and BMI can usefully characterise disease.

Methods

UK Biobank data and their linked hospital episode statistics were used to study 172 common age-related diseases. A proportional hazards model was used to estimate associations with potential risk-factors and to adjust for well-known confounders. Diseases were compared and hierarchically clustered using novel but rigorous multivariate statistical methods.

Results

For diseases affecting both sexes, over 38% can be uniquely identified by their associations with risk factors. Equivalent diseases often clustered adjacently. After an FDR multiple-testing adjustment, roughly 5% have statistically significant differences. Similar remarks applied to several symptoms of unknown cause. Many clustered diseases are associated with a shared, known pathogenesis, others suggest likely but unconfirmed causes.

Conclusions

Risk factors for disease can be surprisingly precise and can be used to cluster diseases in a meaningful way. Risk factors for men and women may differ for some diseases. Several symptoms of unknown cause have disease-specific, statistically significant risk factors.

Key messages

Big datasets and modern statistics are providing new insights into the relationships between diseases and their associations with risk-factors. Diseases can be identified and clustered by their associations with well-known risk factors.
97Effectiveness of baby-friendly workplace support interventions on exclusive breastfeeding in Kenya: a propensity score-weighted analysis
Authors: Kimani-Murage Elizabeth , Wilunda Calistus , Zerfu Tadesse , Macharia Teresia , Kamande Eva , Gacheru Peter , Donfouet Hermann , Kiige Laura , Jabando Susan , Dinga Lynette , Samburu Betty , Atinda Joyce , Lilford Richard , Griffiths Paula , Jackson Debra , Begin France , Moloney Grainne
Published: September 2021

Background

Exclusive breastfeeding (EBF) during the first six months of life is crucial for optimising child’s growth, development and survival. Mother’s employment may hinder optimal breastfeeding. We assessed the effectiveness of a workplace support intervention on EBF in Kenya.

Methods

This quasi-experimental study employing a pre-post intervention design was conducted between 2016 and 2018 on an agricultural farm in Kericho County. The intervention targeted pregnant/breastfeeding women residing on the farm and consisted of: day-care centers, sensitization on available workplace baby-friendly policies, and home-based nutritional counselling of pregnant and breastfeeding women. The effect of the interventions on EBF was estimated using propensity score weighting.

Results

The study included 223 and 146 mother-infant dyads in the non-treated (pre-intervention) and treated (intervention) groups, respectively. The prevalence of EBF was 20.2% in the non-treated group and 80.8% in the treated group; corresponding to a 4-fold increased probability of EBF (RR 3.99; 95% CI 2.95–5.15). In age-stratified results, the effect of the interventions was stronger among children aged 3-5 months (RR 8.13; 95% CI 4.23–15.64) than among those aged < 3 months (RR 2.79; 95% CI 2.09–3.73).

Conclusions

The baby-friendly workplace support intervention promoted EBF especially beyond three months in this setting.

Key messages

Maintaining EBF while working is more likely when employers provide the support that women need to do so. Workplace policies and programmes to support women to combine work with breastfeeding are needed.
385Prospective associations between serum homocysteine, folate, vitamin B12 and risk of metabolic syndrome
Authors: Woo Hye Won , Shin Min-Ho , Kim Yumi , Choi Bo-Youl , Kim M-iKyung
Published: September 2021

Background

Both elevated homocysteine (Hcy) and metabolic syndrome (MetS) are associated with cardio-metabolic disease. However, the potential causality in the association between Hcy and MetS is unclear, and there is uncertainty about the importance of serum level of folate and vitamin B12 for MetS. The aim of this study was to determine the prospective associations between serum homocysteine, folate and vitamin B12, and incidence of MetS in a community-based cohort of Korean adults aged ≥ 40 years.

Methods

We measured serum Hcy, folate and vitamin B12 in 2,895 participants (1,187 men and 1,708 women) who did not have MetS. During follow-up (10,043 person-years), 471 MetS cases were newly diagnosed.

Results

Higher Hcy levels were positively associated with risk of MetS (adjusted incidence rate ratio, IRR 1.87; 95% CI, 1.07–3.25 for ≥15 compared with <10 μmol/L of Hcy in men; IRR 1.81; 95% CI, 1.06–3.08 for ≥10 compared with <5 μmol/L of Hcy in women). However, serum folate was not associated with MetS, and higher serum vitamin B12 levels were associated with a statistically significant protection of MetS in men only (IRR 0.61; 95% CI, 0.42–0.90; P for trend=0.0082 in the highest tertile).

Conclusions

Hcy levels were positively associated in men and women, and serum vitamin B12 was inversely associated with risk of MetS in men but not in women. Serum folate do not seem to be a protective marker for MetS.

Key messages

Our results extend previously reported associations of Hcy with MetS, and the absence of associations of folate with MetS.
930Development and feasibility of a mHealth supported Comprehensive Intervention Model (“CIMmH”) for esophageal cancer patients
Authors: Xu He , Xv He , Guo Yan
Published: September 2021

Background

Esophageal cancer patients often experience a clinically relevant deterioration of quality of life (QoL) after esophagectomy due to malnutrition, lack of physical exercise, and psychological problems. This study aims to evaluate the feasibility and efficacy of a comprehensive intervention model using the mHealth system (CIMmH) on the mobile platform that offers accessible nutritional, exercise, and psychosocial support to esophageal cancer patients after esophagectomy.

Methods

Twenty esophageal cancer patients were invited to join the CIMmH for 12 weeks. The CIMmH included an online component and an offline consultation component. The participants were assessed before surgery and at 1-month and 3-month intervals after esophagectomy. QoL, depressive symptoms, anxiety, stress, nutrition, and physical fitness were measured.

Results

Sixteen out of 20 (80%) completed the program. One month after esophagectomy, the global health scale significantly decreased while fatigue, pain, and dyspnea increased. At the 3-month follow-up, only pain, difficulty with eating, dry mouth and trouble with talking were significantly worse than the baseline. All other dimensions in the QoL returned to the preoperative level. Weight and BMI were reduced throughout the study and no significant changes were observed in physical fitness. Depressive symptoms significantly increased one month after surgery.

Conclusions

The CIMmH had good feasibility and demonstrated encouraging preliminary efficacy for enhancing recovery after surgery among esophageal cancer patients in China.

Key messages

Esophageal cancer, Quality of life, Nutrition, Physical exercise, Psychological support, Mobile Health (mHealth)
1511CIMmH, an mHealth Comprehensive Intervention Model for esophageal cancer patients: A Multi-center RCT Protocol
Authors: Xu He , Guo Yan , Zeng Yu , Li Yiran , Zhu Mengting
Published: September 2021

Background

Post-esophagectomy patients often experience a clinically relevant deterioration of quality of life after esophagectomy due to malnutrition, impaired exercise capacity, and psychological problems. The widespread use of mobile health (mHealth) has been increasingly promising for interdisciplinary healthcare givers to deliver efficient and potential cost-effective interventions in cancer patients. However, comprehensive interventions delivered by mHealth with a rigorous design of randomized controlled trial in post-esophagectomy patients were scarce.

Methods

This study developed the first comprehensive intervention model by mHealth with a parallel RCT design, providing nutrition, physical exercise, and psychological support for post-esophagectomy patients. A total of 120 patients will be randomized into the intervention group or the control group receiving treatment as usual. Participants in the intervention group will receive the 3-month intervention of the CIMmH program via the enhanced WeChat platform and by specialists (offline). The online program includes nutrition guidelines, physical exercise instructions, and psychological courses. All participants will be assessed at baseline, 1, and 3 months after esophagectomy. The primary outcomes are health-related QOL, weight, and physical fitness measured by 6-minute walking distance. Secondary outcomes include nutritional biomarkers, body composition, strength, interleukin-6, depressive symptoms, anxiety, and coping.

Discussion

This study is among the first efforts to innovatively develop a comprehensive intervention program to prompt rehabilitation in post-esophagectomy patients. Once proven effective, CIMmH could be integrated into the management of post-esophagectomy patients.

Key messages

Esophageal cancer, QOL, Nutrition, Physical exercise, Psychological support, mHealth