bluuebunny/crossref_metadata_2025 huggingface dataset:
951Can cancer-related health literacy predict cancer preventive behaviours?
Authors: Lee Patricia Chiaotzu , Mao Ayan , Dong Pei , Wang Kun , Qiu Wuqi
Published: September 2021

Background

Health literacy has direct relevance to outcomes in patients with cancer. An adequate level of health literacy may increase uptake of screening and other supportive cancer prevention programs, which may contribute to improved outcomes. However, existing literature is limited in measuring cancer-specific health literacy and its role in cancer prevention. This study aims to investigate the relationship between cancer-related health literacy and cancer preventive behaviours through a population survey in Beijing, China.

Methods

A cross-sectional design was utilised to collect survey data such as respondents’ sociodemographic characteristics, cancer-related health literacy, cancer status and cancer prevention behaviours. Logistic regression modelling was applied to identify significant sociodemographic predictors for cancer literacy. Multinomial logistic regression analysis was further performed to determine the association between cancer-related health literacy and cancer preventive behaviours after adjusting for effects from sociodemographic variables.

Results

The findings confirmed that cancer-related health literacy was significant in predicting participants’ cancer preventive behaviours, including individual’s cancer information seeking behaviour, intention to participate in cancer screenings, early diagnosis and treatments. In addition, the results also showed that respondents’ gender, age, education, household income, residential region and cancer status were significantly associated with their levels of cancer-related health literacy.

Conclusions/Key messages

The results of this study have provided useful evidence on the importance of applying cancer-related health literacy to predict individual’s cancer preventive behaviours. The study has also identified the variations in cancer literacy between different sub-population groups. Future studies can develop targeted health promotion and education campaigns for more effective cancer prevention.
633Poorly controlled diabetes is a predictor of colorectal cancer survival
Authors: Li Ming , Roder David
Published: September 2021

Background

Epidemiological studies have shown diabetes associated with increased risk of colorectal cancer. This study investigates the impact of a pre-cancer diabetes-related hospitalization record on colorectal cancer survival.

Methods

A retrospective cohort of 13190 colorectal cancer patients recorded on the South Australian Cancer Registry in 2003-2013 were examined. Diabetes-related hospitalization histories were obtained using linked inpatient data. Colorectal cancer deaths were available for 2003-2013. The association of survival from colorectal cancer with diabetes-related hospitalization history was assessed using competing risk analysis, adjusting for sociodemographic factors and cancer stage at diagnosis.

Results

2765 patients with colorectal cancer (26.5%) had a history of hospital admission for diabetic complications, the most common being multiple complications (32%), followed by kidney and eye complications. The 5- and 10-year cancer survival probabilities were 63% and 56% in those with a diabetes complication history, significantly lower than 66% and 60% for patients without these complications (adjusted sub hazard ratio 1.11, 95% CI 1.02-1.20). Risk of colorectal cancer death was lower when theses diabetes-related hospitalizations were earlier than the year of cancer diagnosis - i.e., adjusted SHR 0.80, 95% CI 0.66-0.97 for 3-5 and 0.76, 95% CI 0.59-0.98 for 6+ years before the cancer diagnosis compared with same-year hospitalizations.

Conclusions

Colorectal cancer patients with a history of diabetes-related hospitalization have poorer survival, particularly if these hospitalizations were in the same year as the cancer diagnosis.

Key messages

Poorly controlled diabetes histories predict increased risk of colorectal cancer mortality.
1444Housing disadvantage in childhood and health: A systematic review
Authors: Li Yuxi , Singh Ankur , Alfonzo Ludmila , Bentley Rebecca
Published: September 2021

Background

Housing has been recognised as one of the important determinants of health outcomes. However, little is known of the contribution of these pathways to children’s health and wellbeing and their pattern of health throughout life. This review aims to provide a synthesis of longitudinal studies linking experiences of disadvantaged housing in childhood to health outcomes.

Methods

A literature search was performed on four databases including Medline, EMBASE, PsycINFO, and Web of Science from 2000 to 2020. Peer-reviewed longitudinal studies assessing the association between housing disadvantage in childhood and subsequent physical and mental health were included. The methodological quality of selected studies was appraised using the ROBINS-I tool. A narrative synthesis was developed due to study heterogeneity.

Results

Forty-five cohort studies were included, and no randomised controlled trial met the inclusion criteria. The majority of the studies was evaluated to have a moderate risk of bias. Across the studies, while many relationships remained mixed, consistent evidence of detrimental impact was identified between: poor housing conditions and mortality; inadequate heating and respiratory illness; frequent residential moves and psychiatric mortality and morbidity. Little evidence is found between overcrowding in childhood and health outcomes.

Conclusions

Evidence from longitudinal studies indicates that poor housing experience in childhood may impact health later in life.

Key messages

The findings stressed housing as a key social determinant of child health, and interventions designed to mitigate housing disadvantage may have significant health gains across the life span
976Screening for cervical cancer with Human Papillomavirus testing: stand-alone is preferable over co-testing with cytology
Authors: Liang Linda , Einzmann Thomas , Zeissig Sylke Ruth , Franzen Arno , Schwarzer Katja , Schauberger Gunther , Schriefer Dirk , Radde Kathrin , Ikenberg Hans , Snijders Peter JF , Meijer Chris JLM , Kirkpatrick Charles J , Koelbl Heinz , Blettner Maria , Klug Stefanie J
Published: September 2021

Background

Cervical cancer screening can be conducted with cytology and Human Papillomavirus (HPV) testing but few studies have compared the latter directly to concomitant testing (co-testing). We compared these strategies to determine appropriate screening.

Methods

Within a randomised population-based cohort study conducted around Mainz, Germany, eligible women (≥30 years) were screened via Pap smear, liquid-based cytology (LBC) and HPV testing (HC2) and HPV genotyped post hoc (PCR). These tests formed three strategies: cytology (Pap or LBC) and HPV (HC2 or PCR) stand-alone and co-testing. Screen positives and 5% negative women were invited to colposcopy. Absolute and relative sensitivity, specificity, false positive rates (FPR) and number needed to colposcopy to detect one lesion (NNC) were calculated. Estimates were crude and verification bias-adjusted using stratified sampling with bootstrapped confidence intervals.

Results

Of 2,627 screened women, cytology stand-alone demonstrated lowest sensitivities (47%) and highest specificities (97%-99%) while HPV stand-alone demonstrated higher sensitivities (79%-95%) but lower specificities (94%-95%). Co-testing increased sensitivity (84%-99%) but not specificity (92%-95%). Relative sensitivities were similar between crude and adjusted estimates, with greater detection via HPV-based strategies. Specificity of co-testing with LBC relative to HPV stand-alone was near unity (0.99, 95% CI 0.99-1.00) but significantly lower than unity with Pap co-testing. FPR and NNC were greatest under co-testing.

Conclusions

HPV stand-alone screening in women over 30 years appears appropriate over co-testing as a screening strategy.

Key messages

Co-testing for cervical cancer does not appear to add any benefit in detection and may introduce unnecessary harms compared to HPV stand-alone screening.
291Serum albumin levels reversed the impact of higher resting heart rate on cardiovascular mortality
Authors: Liu Yiwei
Published: September 2021

Background

Higher resting heart rate (RHR) has been proved as a risk factor for all-cause and cardiovascular disease (CVD) mortality. However, few studies discussed its synergy with other markers on mortality prediction. Our study focused on whether the impact of RHR on CVD mortality is affected by serum albumin (SA) in Japanese general population.

Methods

We followed 8,307 participants without history of CVD from a Japanese general population. We divided participants according to quartiles of RHR [Q1(<62), Q2(62-68), Q3(69-76), and Q4(>76)], then we used Cox proportional hazard model adjusting for age, gender, BMI, blood glucose, blood pressure, anti-hypertensive treatment, total cholesterol, smoking and alcohol drinking status for estimating CVD mortality. Furthermore, we stratified the participants according to median value of SA (4.4 mg/dL) to conduct subgroup analysis.

Results

During a 29-year follow-up, 1,030 deaths due to CVD were detected. Compared to Q1 group, hazard ratios [95% confidence interval] in each RHR group for CVD mortality was Q2: 0.87 [0.74-1.04], Q3: 1.01 [0.85-1.20], Q4: 0.98 [0.83-1.16]. In lower SA group, Q2: 0.90[0.72-1.13], Q3: 0.99 [0.80-1.25], Q4: 1.27 [1.03-1.58], meanwhile in higher SA group, Q2: 0.83 [0.63-1.09], Q3: 0.99 [0.77-1.29], Q4: 0.65 [0.49-0.85].

Conclusions

Higher RHR was associated with increased risk for CVD mortality in individuals with lower SA, meanwhile the reversed relationship shown in those with higher SA.

Key messages

The impact of RHR on CVD mortality might be influenced by SA in a Japanese general population.
536Patterns of change in lifestyle behaviours following childbirth
Authors: Makama Maureen , Lim Siew , Hill Briony , Skouteris Helen , Teede Helena , Boyle Jacqueline , Hodge Allison , Earnest Arul , Moran Lisa
Published: September 2021

Background

Lifestyle behaviours may worsen following childbirth due to barriers such as time constraints and reduced prioritization of personal health. We therefore aimed to assess the patterns of change in weight and lifestyle behaviours following childbirth in a longitudinal community-based cohort.

Methods

Data from surveys 3 and 5 (ages 25-30 and 31-36 years) of the 1973-8 birth cohort of the Australian Longitudinal Study on Women’s Health were used. We assessed changes in weight, energy intake, diet (diet quality, macronutrients and micronutrients), physical activity and sitting time in parous women compared to those who remained nulliparous by survey 5 using one-way analysis of covariance.

Results

Of 4927 nulliparous women at survey 3, 2503 became parous by survey 5. Over 6 years, parous women had an increase in weight (1 kg; 95%CI 0.50, 1.54), higher energy intake (833.3 kJ/day; 95%CI 706.07, 960.52), better diet quality (1.4 units; 95%CI 0.81, 2.08), lower physical activity (-370.5 METmin/day; 95%CI -427.07, -313.87) and less sitting time (-1.8 hours/day; 95%CI -1.93, -1.60) than nulliparous women on adjusted analyses. On stratification of parity, the improvement in diet quality was only present in primiparous women and sitting time decreased with higher parity.

Conclusion

There is a worsening in weight and some lifestyle behaviours following childbirth in Australian women. While higher parity was associated with further decreases in sitting time, improvements in diet quality were not maintained.

Key message

Women need support to maintain healthy lifestyle behaviours amidst the challenges of caring for children, particularly with increasing family size.
943Impact of maternal factors, pregnancy complications, and birth outcomes on the neonate metabolome
Authors: Mansell Toby , Collier Fiona , Ellul Susan , Burgner David , Saffery Richard ,   Barwon Infant Study Investigator Team
Published: September 2021

Background

Metabolic health in early life is critical for healthy development and can have long-lasting ramifications of risk of disease into adulthood. While many exposures during pregnancy are linked to altered fetal development and/or risk of disease in adult offspring, the molecular mechanisms underpinning these associations are poorly characterised. We aimed to describe the association between pregnancy/birth exposures and neonate metabolomics profile.

Methods

Metabolomics in cord blood plasma from 912 neonates in the Barwon Infant Study was quantified using the Nightingale Health NMR platform. Questionnaire and clinical data collected included maternal anthropometry, pregnancy complications, mode of delivery and infant anthropometry at birth. Linear regression models were used to investigate the relationship between these factors and 70 neonate metabolomics measures.

Results

Infant sex, gestational age, birth weight, and exposure to labour during birth were associated with differences across a wide range of metabolites. Exposure to gestational diabetes was associated with increased ketone bodies (acetoacetate and 3-hydroxybutyrate), and this relationship persisted after adjustment for other maternal and pregnancy exposures including maternal BMI. Maternal BMI was modestly associated with increased neonate triglycerides and inflammation.

Conclusions

Birth outcomes show compelling evidence for wide-spread differences in neonate metabolites in cord blood serum, and exposure to gestational diabetes is associated with increased ketone bodies. Further work is required to understand the biological processes underpinning these relationships and to determine if differences in metabolites persist later into childhood.

Key messages

Sex, gestational age, birthweight and exposure to labour are linked to metabolomics differences in cord blood plasma. Gestational diabetes is associated with increased neonate ketone bodies.
765The impact of childhood hearing loss on language and psychosocial outcomes: The LOCHI study
Authors: Marnane Vivienne , Marnane Vivienne , Dillon Harvey , Seeto Mark
Published: September 2021

Background

The Longitudinal Outcomes of Children with Hearing Impairment (LOCHI) study is a prospective study commenced in 2005 that was aimed to examine the effect of age of hearing loss identification and intervention on outcomes for children with hearing loss, such as language and psychosocial development. Permanent childhood hearing loss has a significant impact on child development.

Methods

450 children identified with permanent sensorineural hearing loss prior to 3 years of age in New South Wales, Queensland and Victoria completed comprehensive speech, language and audiological assessments at defined age intervals. Multiple regression analysis and structural equation modelling (SEM) were completed to determine factors influencing outcomes at 5 and 9 years of age.

Results

Regression models indicated outcomes were significantly influenced by age of hearing loss intervention, nonverbal cognitive ability, maternal education level and communication mode. A significant predictive effect of early language skill was seen on later language development. SEM found that the impact of age of hearing loss intervention on language outcomes was mediated by its effect on cognitive development and speech perception. Language ability influenced psychosocial development.

Conclusions

Early identification and intervention of hearing loss improves language and psychosocial development, via its influence on cognitive development and speech perception.

Key messages

Early hearing loss identification and intervention improves language and psychosocial development for children with permanent sensorineural hearing loss. Evidence from the LOCHI study has guided clinical management guidelines of children with hearing loss.
1365Does pain self-efficacy influence initial bending following exercise in adults with chronic low back pain?
Authors: McManus Fiona , Pranata Adrian , Simpson Julie A. , Farragher Joshua , Crofts Samuel , Wu Wen , Bryant Adam
Published: September 2021

Background

Differences in pain self-efficacy between individuals with chronic low back pain (CLBP) may partly explain why response to exercise varies. The aim of this study was to determine if pain self-efficacy influences initial forward bending following an exercise intervention in adults with CLBP.

Methods

A total of 69 adults (18-65 years old) with moderate-severe CLBP-related disability who presented to a primary care physiotherapy clinic in Melbourne, Australia underwent baseline assessment of pain self-efficacy, pain intensity and kinesiophobia, prior to participation in one of two 12-week exercise interventions. Two outcome measures (lumbar and hip flexion range of motion (ROM) over the first quarter of forward bending from stance), were assessed at baseline, 6 and 12-weeks. Multiple linear mixed-effects modelling was performed for each outcome measure.

Results

For every 10-point increase in baseline pain self-efficacy, lumbar flexion ROM during initial bending decreased by an estimated mean 0.51 (95% CI: -1.41, 0.39) and 0.94 (95% CI: -1.75, -0.13) degrees at 6 and 12-weeks, respectively. Similarly, hip flexion ROM during initial bending decreased by an estimated mean 1.64 (95% CI: -3.70, 0.41) and 1.43 (95% CI: -3.34, 0.48) degrees at 6 and 12-weeks, respectively, per 10-point increase in baseline pain self-efficacy.

Conclusions

Pain self-efficacy did not influence initial forward bending following a 12-week exercise intervention. As the exercises were not targeted to improve bending, further research is required to verify these findings.

Key message

Pain self-efficacy may not explain variations in initial forward bending following an exercise intervention in adults with CLBP.
113Social gradient in health literacy among primary healthcare users in Cyprus
Authors: Middleton Nicos , Andreou Nicolas , Papastavrou Evridiki , Middleton Nicos
Published: September 2021

Background

From a notion concentrated on the ability to understand health information, health literacy (HL) has become a broad concept, considered a critical determinant of community health. The HLS-EU-measures perceived HL based on a theoretical model of the concept.

Methods

This study explored the metric properties of the tool in a new European setting among a convenience sample of 300 healthcare users in a state General Hospital, including the construct and known-group validity by social position and health-related behaviours.

Results

While factor analysis did not reveal the 12 theoretical subscales, there was a meaningful 3-factor structure (52.1% variance): “access to information”, “prevention and health promotion” and “user-provider interaction”. The postulated four cognitive skills (access, understand, appraise, apply) were evident within each domain (healthcare, prevention, health promotion), and vice versa. Overall, HL was problematic in 50.7% of participants with a steep gradient by social position. Alcohol consumption and physical activity were associated with HL, but not being overweight (mean BMI 26.8, SD: 5.2) or smoking (45.6% current or past smokers), which were generally prevalent.

Conclusions

HLS-EU-Q47 supports at least partly the theoretical construct of HL. The social gradient supports the criterion validity of the tool and highlights an important aspect of health inequality.

Key messages

HLS-EU-Q47 is a valid measure of perceived health literacy

There was a steep gradient in low health literacy by social position
112Neighbourhood environment and health-related quality of life, Limassol, Cyprus
Authors: Ellina Panayiota , Middleton Nicos , Kleopa Daphne , Panayiotou Andrie , Nicolaou Christiana , Lambrinou Ekaterini , Kouta Christiana
Published: September 2021

Background

The extent and magnitude of socio-geographical inequalities in health in Cyprus is not clear as neither “place” nor “health inequalities” feature on the public health agenda.

Methods

In the context of a wider Neighbourhood Environment and Health programme, the magnitude of inequality in health-related quality of life (HRQoL) among Limassol citizens was explored in a door-to-door SF-36 survey of residents aged 45-64 (N = 450, 50:50 gender quota) across 45 randomly selected neighbourhoods stratified by socio-economic disadvantage and profiled using a culturally-adapted Systematic Social Observation neighbourhood audit tool.

Results

The social gradient was steeper for physical than mental component scores of HRQoL irrespective of the indicator of social position. Education and income captured the gradient better in women, and occupational-based social class in men, with large effect (0.7-1 SD) on the SF-36 scale at opposite ends of the continuum. Lower HRQoL and more adverse health behaviours observed in disadvantaged neighborhoods according to census area-level measures and neighbourhood audit profiles, with generally larger differences in women.

Conclusions

This study profiled the variability in the urban neighbourhood environment,and documented the magnitude of social gradient in health and health-related quality of life in a representative sample of late working-life population in Cyprus.

Key messages

Social gradient in health behaviours and quality of life in late working-life Cypriot population.

Gradient apparent in both men and women across individual and neighborhood measures of social position.
1484Selection bias in COVID-19 research: Prospective analyses of two UK cohort studies
Authors: Fernández-Sanlés Alba , Carter Alice , Millard Louise , Smith Dan , Griffith Gareth , Clayton Gemma , Hughes Rachel , Morris Tim , Lawlor Deborah , Tilling Kate , Borges Maria Carolina ,   on behalf of the COVIDITY working group
Published: September 2021

Background

Non-random sampling could bias estimates of association in observational studies but the extent to which this occurs in studies of SARS-CoV-2 infection/COVID-19 severity is not well established.

Methods

Using ALSPAC and UK Biobank we investigated pre-pandemic predictors of selection (i.e. having data on SARS-CoV-2 infection and COVID-19 severity from self-report and/or health record linkage). We conducted empirical analyses and simulations to explore the potential presence, direction and magnitude of bias due to selection when estimating the association of BMI with SARS-CoV-2 infection and COVID-19 severity.

Results

A broad range of characteristics related to selection in both cohorts, sometimes in opposite directions. We found bias in all simulated scenarios, mostly of small magnitude. Both the direction and magnitude of bias was influenced by the presence of an effect of BMI on SARS-CoV-2 infection and COVID-19 severity and the control group definition used (e.g. assuming no effect of BMI on SARS-CoV-2 infection our main simulation showed bias equivalent to an estimated odds ratio of 0.99 when using non-infected controls but 1.16 when using controls combining non-infected and non-assessed).

Conclusions

Despite small amounts of bias in most scenarios, a control group definition including those non-assessed (e.g. non-tested) can induce more bias. In large samples such as UK Biobank the statistical power means incorrect conclusions could be made.

Key messages

Observational studies estimating associations of factors with SARS-CoV-2 or COVID-19 may be biased due to non-random selection into the analytic sample.
88The Role of Visceral Adiposity in the Metabolic Phenotype of multi-ethnic South-East Asian population
Authors: Mina Theresia ,   The HELIOS Study team, ES Lee , Lee Jimmy , Loh Marie , Ngeow Joanne , Elliott Paul , Riboli Elio , Chambers John
Published: September 2021

Background

Ethnic Asians are known to exhibit worse metabolic phenotypes as compared to Caucasians despite lower body mass index1, 2. Ethnic South-Asians and Malays were also found to display greater insulin resistance than Chinese3. One potential biological mechanism for this phenomenon is the inter-ethnic differences in the visceral adiposity deposition4. Here we hypothesised that visceral adiposity contributes to ethnic differences in metabolic phenotype more than subcutaneous adiposity.

Methods

We quantified total, subcutaneous and visceral adipose deposition (BMI, waist circumferences, Dual-energy X-ray absorptiometry [DEXA]) and metabolic phenotypes (blood pressure, fasting glucose and lipid profile, HbA1c) in 3403 participants. Analyses were adjusted for age, and sex.

Results

Participants were 40.6% male, mean age 49.7±11.4 years, Chinese: Malays: South-Asians in 72:9:19 ratio. Ethnic Malays and South-Asians had raised blood pressure, fasting glucose, triglycerides, HbA1c, reduced HDL, and higher total and visceral fat than Chinese (P < 0.001), independent of covariates. Increased adiposity was strongly associated with poorer metabolic phenotype (all P < 0.0001), with strongest associations found amongst visceral Fat Mass Index (□□95%CI]=0.48[0.20;0.23]) and android/gynoid ratio (□[95%CI]=0.55[1.31;1.63]) with triglycerides levels. Visceral adiposity contributed 17-40% (all P < 0.0001) to the variance in the associations of ethnic Malays and South-Asians with metabolic phenotypes, 3-7% higher than subcutaneous adiposity.

Conclusions

Visceral adiposity contributes to poorer metabolic phenotype in ethnic Malays and South Asians as compared to Chinese.

Key messages

Visceral adiposity expansion is an important determinant of metabolic health in Asian populations.
1442The burden of COVID-19 in Australia in 2020
Authors: Moon Lynelle , Reynolds Anna , Gourley Michelle
Published: September 2021

Background

During 2020, there were nearly 28,500 cases of COVID-19 in Australia. Burden of disease estimates for COVID-19 have not been calculated for the Australian population. Burden of disease data on COVID-19 provide valuable information on the impact of the disease, including both fatal and non-fatal effects.

Methods

Burden of disease is measured using the summary measure disability-adjusted life years (DALYs). One DALY is 1 year of ‘healthy life’ lost due to illness (Years Lived with Disability) and/or death (Years of Life Lost)—the more DALYs associated with a disease or injury, the greater the burden. The analysis draws on Australian deaths, incidence and severity, as well as methods and other inputs developed in other countries reflecting current understanding about this new disease.

Results

There were over 8,300 DALYs lost due to COVID-19 in 2020 in Australia; 97% of the disease burden arose from fatal cases. Males lost an average of 10.7 years, and females 8.1 years, due to dying from COVID-19, using an aspirational life expectancy. The burden of disease estimates for Australia for COVID-19 are much lower than the leading diseases causing burden.

Conclusions

The relatively low burden for COVID-19 in Australia in 2020 compared to other diseases and other countries reflects the success Australia had in containing the virus.

Key messages

Most of the burden due to COVID-19 in Australia was fatal. Burden of disease estimates for COVID-19 in Australia for 2020 are much lower than the leading diseases.
839A novel approach to investigating poor growth in a longitudinal study of infants in PNG
Authors: Moreira Clarissa , Scoullar Michelle , Peach Elizabeth , Fidelis Ruth , Melepeia Pele , Pomat William , Siba Peter , Crabb Brendan , Robinson Leanne ,   HMHB Study Team, Agius Paul , Beeson James
Published: September 2021

Background

Children in Papua New Guinea (PNG) experience high rates of malnutrition and poor growth - nearly half of children under 5 are stunted and 16% wasted.

Methods

We investigated predictors of infant growth over the first year of life using longitudinal data from mothers and infants in PNG. Between 2015 and 2018, 699 pregnant women were enrolled. At delivery, one, 6- and 12-months post-partum blood samples and anthropometric measurements were taken from mothers and infants. Using structural equation modelling with full information maximum likelihood, multivariate latent growth curve (LGC) modelling for infant weight and length (i.e. simultaneous estimation) was undertaken, and maternal factors that influenced growth investigated.

Results

A quadratic function for growth (weight and height) was estimated. Boys were larger at birth (49cm, 3.2kg vs. 48cm, 3.0kg; Wald χ2(2) =15.3, p<0.001) and gained more weight and length monthly (Wald χ2(4) =68.4, p<0.001). Maternal height, MUAC and number of antenatal healthcare visits were associated with birth weight and length, but not growth. Maternal nutrition and infections, breastfeeding and complementary feeding were not associated with birth size or growth.

Conclusions

Maternal height and MUAC and antenatal healthcare were associated with birth size and no maternal factors were associated with growth. Prenatal interventions to improve postnatal infant growth may be challenging in this environment

Key messages

Compared to conventional LGC analysis, multivariate LGC modelling using SEM provides less biased estimates of infant growth and factors associated with growth, particularly in the presence of missing data and infant-specific weight and height heterogeneity.
662Factors associated with smoking continuation and indoor smoking among pregnant women’s partners
Authors: Murakami Keiko , Obara Taku , Ishikuro Mami , Ueno Fumihiko , Noda Aoi , Kuriyama Shinichi
Published: September 2021

Background

Secondhand smoke by partners is a major source of exposure for non-smoking women. However, factors associated with smoking continuation and indoor smoking among pregnant women’s partners remain unknown.

Methods

We used data from 6348 partners of non-smoking pregnant women who participated in the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study in Japan from 2013 to 2017. Partners’ age, educational attainment, equivalent household income, and pregnant women’s smoking history (never, quitting before pregnancy awareness, quitting after pregnancy awareness) were used as explanatory variables. Multivariate logistic regression analyses were conducted to examine the associations between these variables and smoking continuation/indoor smoking of partners.

Results

Among 6348 partners, 2506 partners had been smokers at pregnancy awareness. Among them, the prevalence of smoking continuation after pregnancy awareness was 92.0%. Partners whose wives had quitted smoking after pregnancy awareness were less likely to continue smoking than partners whose wives had never smoked; the odds ratio was 0.57 (95% confidence interval, 0.41–0.80). Among partners who continued smoking, the prevalence of indoor smoking was 30.7%. Partners with ≤high school education were more likely to smoke indoors than partners with ≥university education; the odds ratio was 1.60 (95% confidence interval, 1.23–2.07).

Conclusions

Women’s smoking cessation after pregnancy awareness was associated with decreased risk of partners’ smoking continuation, and lower level of partners’ education was associated with increased risk of partners’ indoor smoking.

Key messages

Interventions for both women and their partners may be effective in reducing secondhand smoke exposure during pregnancy.
1396Trends in household food expenditure patterns by ethnic and income group in New Zealand
Authors: Nghiem Nhung , Teng Andrea , Cleghorn Cristina , Wilson Nick
Published: September 2021

Background

Dietary factors are one of the most important risk factors for health loss worldwide, however there is very limited information on dietary trends in New Zealand (NZ) and whether inequities in dietary patterns are changing.

Methods

We employed a validated economic dataset, the Household Economic Survey (HES), which was designed to provide information on impacts of policy-making in NZ. Three HES waves in 2006/07, 2009/10 and 2012/13 (n = 9030) were used to examine the trends in household expenditure for key food groups by income-level and ethnicity.

Results

Overall, food expenditure per capita increased by 1% annually. In absolute terms, low-income households spent around half that of high-income households on food, but with no relative differences out of the total food expenditure or income. Māori households (Indigenous population) tended to spend less money compared to the other households, both in absolute and relative terms (ie, on healthy food including fruit and vegetables, and nuts and seeds, but with relatively more expenditure on processed meats). Similar food expenditure patterns by income-level and ethnicity persisted over time.

Conclusions

HES data were useful for understanding trends in food expenditure patterns, in the absence of nutrition survey data, but limitations remain. Assuming food consumption is highly correlated to expenditure, diet inequities do not seem to have improved during this recent time period.

Key messages

Public policies that aim to support healthy diets for all might need to involve changes to the food environment and involve government support for culturally appropriate Māori-led interventions.
134Trends and projections of Treatment as Prevention strategy in Africa and progress towards UNAIDS targets
Authors: Nguyen Phuong , Le Phuong , Onishi Kazunari , Nguyen Huy , Gilmour Stuart
Published: September 2021

Background

Africa is lagging behind in progress toward global HIV/AIDS elimination targets. We estimated trends in and projections of annual HIV testing and condom use at last higher-risk sex; and calculated the probability of reaching key UNAIDS’s target.

Methods

We included 114 nationally-representative datasets in 38 African countries from DHS and MICS with 1456224 sexually active adults age 15-49 from 2003 to 2018. We applied Bayesian mixed effect models to estimate the coverage of annual HIV testing and condom use at last higher-risk sex for every country and year to 2030; and the probability of reaching UNAIDS testing and condom use targets of 95% coverage by 2030.

Results

Seven countries saw downward trends in annual HIV testing and four saw decreases in condom use at higher-risk sex, while most countries have upward trends in both indicators. The highest coverages of testing in 2030 are predicted in Swaziland, Uganda and Lesotho. Meanwhile, Swaziland, Lesotho, and Namibia will have the highest proportion of condom use in 2030. The probabilities of reaching targets were very low for both HIV testing (0%-28.5%) and condom use (0%-12.1%).

Conclusions

We observed limited progress on annual HIV testing and condom use at last higher-risk sex in Africa, and little prospect of reaching global targets for HIV/AIDS elimination.

Key messages

Although some global sponsor agencies are considering withdrawal from supporting Africa, more considerable attention to funding and expanding testing and treatment are needed if HIV/AIDS elimination in Africa is to become more than a distant dream.
1347Mental health status of health care workers during the COVID-19 outbreak: An International Study
Authors: Nicolaou Christiana , Menikou Joanna , Gloster Andrew , Karekla Maria , Kassianos Angelos
Published: September 2021

Background

The COVID-19 pandemic is a massive health crisis affecting our planet, with over 166,346,635 confirmed cases and 3,449,117 deaths globally till 24 May 2021. The COVID-19 pandemic is a massive health crisis which has brought enormous physical and psychological pressure. Mental health care for health care workers (HCWs), should receive serious consideration. The aim of this study was to determine mental health outcomes of HCWs and to examine known predictors of outcomes during the first pandemic wave.

Methods

1,556 HCWs who participated in the COVID-19 IMPACT project, an international online survey examining the behavioral and psychological impacts of COVID-19 among 9,565 people from 78 countries/regions and 18 languages. Outcomes assessed were stress, depression symptoms and sleep changes. Predictors examined included sociodemographic factors, and perceived social support.

Results

Results demonstrated that, half of the HCWs had moderate levels of perceived stress and depression symptoms. Predictors associated with higher HCWs’ stress and depression symptoms included female gender, not having children, living with parents, lower educational background and having lower social support. Half of the HCWs (n = 800, 51.4%) continued to sleep about the same and one in four slept more or slept less. Positive predictors of sleep changes were being older, widower, not working, living with parents, and having children. Surprisingly, HCWs had less perceived stress and depression and higher levels of perceived social support than the general population.

Conclusions

The need for establishing ways to mitigate mental health risks and adjust psychological intervention and support of HCWs, seems to be significant as the pandemic continues.

Keywords: health care workers, COVID – 19, pandemic, mental health, psychological problems
1002Job insecurity and health-related quality of life - a cross-sectional study in Sweden
Authors: Norström Fredrik
Published: September 2021

Background

Research shows that concern about job loss impacts negatively on health. However, no studies have examined how job loss affects health-related quality of life. The aim of this study is to examine how job insecurity affects health-related quality of life among Swedish employees.

Methods

The sample comprised 967 participants (39%) out of 2,500 randomly selected individuals. They answered a questionnaire that included a question about the risk of involuntary unemployment during the following three years and the EuroQol 5 dimensions (EQ-5D) instrument. EQ-5D responses were translated to a quality-adjusted life year (QALY) score with anchor points 1 (perfect health) and 0 (death). Of employed respondents without recent unemployment, 83 considered themselves to have at least some risk of unemployment, while 602 felt at most a small risk of unemployment. Inverse probability-weighted propensity scores were used in the analyses to estimate a risk difference. Gender, age, education level, marital status, and previous health were included as covariates.

Results

There was a statistically significant lower QALY score by 0.068 points for those with job insecurity compared with those without job insecurity. There were also statistically significantly more problems due to job insecurity for usual activities (9.5% more), pain/discomfort (13.3% more), anxiety/depression (16.6% more), and EQ-5D’s Visual Analogue Scale (4.5 point lower score).

Conclusions

There was a strong indication that job insecurity affects health-related quality of life. Further studies are needed to better understand how job insecurity affects health.

Key messages

More stable job positions should be prioritized by policy makers.
1148Determinants of adherence to clinic appointments among Tuberculosis and HIV co-infected individuals, Johannesburg, South Africa
Authors: Nhandara Ruvimbo , Ayele Birhanu , Ozougwu Lovelyn , Sigwadhi Lovemore , Nyasulu Peter
Published: September 2021

Background

Tuberculosis (TB) is one of the leading cause of morbidity and mortality among people living with HIV/AIDS. The growing burden of TB/HIV co-infection continues to strain the healthcare system due to association with long duration of treatment. This is a catalyst for poor treatment adherence, which is a major public health challenge due to its propensity to drive drug resistance. This study evaluated the effects of treatment duration on adherence to treatment among TB/HIV co-infected patients.

Method

This was a cross sectional study that involved 10427 patients’ ≥18 years of age with HIV infection and co-infected with TB. We measure adherence to clinic appointments as ’good’ if ≥ 90% and poor if < 90%. We used multivariate logistic regression to evaluate factors associated with adherence to clinic appointments.

Results

1528 patients were co-infected with TB, of these 17.4% of them attained good adherence to clinic appointments. Patients with TB/HIV co-infection who were on treatment for a longer period were less likely to adhere to clinic appointments (AOR: 0.98 95% CI: 0.97, 0.99). This confirms the notion that advanced disease has a negative impact on adherence to clinic attendance for follow up reviews.

Conclusions

Duration on treatment among TB/HIV co-infected patients is associated with treatment adherence. It is therefore vital to reinforce public health intervention that would enhance sustained treatment adherence and mitigate its impact on development of drug resistance.
664ICT use and participation in community support activities among the elderly in Japan
Authors: Ohta Akiko , Nishina Motoko , Motohashi Chiemi , INoue Naoko , Miyazaki Takashi , Takahashi Mihoko , Uemura Makiko , Kamei Midori
Published: September 2021

Background

Text: Information and Communication Technology (ICT) use has penetrated the daily lives of individuals as well as the activities of public organizations. We examined the cross-sectional association between ICT use and participation in community support activities in the elderly aged 65-74 for building community social capital in the current active aging policy of Japan.

Methods

Text: The target population was all residents aged 65-74 years without disabilities in a municipality, Japan. The self-administered questionnaires were mailed to 5,163 individuals in 2018. A Total of 2,283 persons responded (response rate, 44.2%). Participants provided information on basic characteristics, ICT use, and intention to participate in community support activities for the elderly.

Results

Text: A total of 1,089 (47.7%) persons showed positive intention to participate in community support activities for the elderly. Respondents who used a smartphone daily were 768 (33.6%). The proportion of participants with positive intention to participate in community support activities was 55.9% for those who used smartphones daily, whereas 42.8% for those who did not. Respondents who used the website, LINE, or QR codes were more likely to participate in community support activities than those who did not.

Conclusions

Text: Elderly people who utilize ICT frequently were more likely to participate in community support activities. ICT use among the elderly may be useful for building relationships of mutual assistance in the community.

Key messages

Text: ICT helps mutual assistance among the elderly in communities.
425Artificial Intelligence Approaches to Type 2 Diabetes Risk Prediction and Exploration of Predictive Factors
Authors: Ooka Tadao , Yokomichi Hiroshi , Yamagata Zentaro
Published: September 2021

Background

Major barriers exist in incorporating artificial intelligence into epidemiology, particularly in data interpretation. Thus, we examined the application of highly interpretable machine-learning methods— Random Forest (RF) and Sparse Logistic Regression (SLR)— to a large-scale health check-up dataset, examining the advantages of creating prediction models using these.

Methods

This study involved 392,791 participants who underwent healthcare checkups in Japan from 1999 to 2018. Participants who received diabetes treatment, or had an HbA1c level of 6.5% or higher, were excluded. The objective variable examined was type 2 diabetes onset over five years. Each prediction model was created using 26 health status items over three consecutive years. We examined three analytical methods to compare their predictive powers: RF, SLR, and a multivariate stepwise logistic regression (MSLR) as a conventional method. Variable Importance (VI) was calculated in the RF analysis, with Standard Regression Coefficients (SRC) being calculated in the SLR and MSLR analyses.

Results

Predictive accuracy is highest in the SLR model (AUC:0.955), followed by the RF model (AUC:0.949), and then the MSLR model (AUC:0.939). The RF model measures blood glucose, HbA1c, height, red blood cells, and aspartate transaminase with a higher predictive power. In the SLR model, HbA1c, blood glucose, systolic blood pressure, HDL-Cholesterol, and age have higher SRC.

Conclusions

Machine learning techniques enable more accurate diabetes risk predictions than existing methods and suggest new ways of identifying associated predictors.

Key messages

Applying machine-learning methods to health check-up data achieves a high accuracy in predicting type 2 diabetes while maintaining data interpretability.
313Long-acting bronchodilators and risk of acute coronary syndrome
Authors: Parkin Lianne , Williams Sheila , Sharples Katrina , Barson David , Horsburgh Simon , Jackson Rod , Dummer Jack
Published: September 2021

Background

There is concern that long-acting bronchodilators (long-acting muscarinic antagonists [LAMAs]) and long-acting beta2-agonists [LABAs]) may further increase the already elevated risk of cardiovascular events in patients with chronic obstructive pulmonary disease (COPD). Guidelines recommend stepwise escalation from one to two long-acting bronchodilators in patients with uncontrolled symptoms, but information about the impact of this treatment intensification on acute coronary syndrome (ACS) risk is limited.

Methods

We undertook a nested case-control study using national administrative data to estimate the risk of ACS in users of dual LAMA and LABA therapy, and users of LABA monotherapy, relative to users of LAMA monotherapy. The underlying study cohort comprised patients aged >45 years who initiated long-acting bronchodilator therapy for COPD between 2006 and 2013 (n = 83,417). Cases were patients diagnosed with fatal or non-fatal ACS after cohort entry (n = 5,399). Up to 10 controls per case, matched by age, sex, date of cohort entry, and COPD severity, were randomly selected from the study cohort using risk set sampling. Odd ratios and 95% confidence intervals were estimated using conditional logistic regression.

Results

Relative to current use of LAMA monotherapy, the adjusted odds ratios for current use of dual LAMA and LABA therapy, and of LABA monotherapy, were 1.28 (95% CI 1.13–1.44) and 1.0 (95% CI 0.91–1.10), respectively.

Conclusions

Use of two long-acting bronchodilators rather than LAMA monotherapy, is associated with a higher risk of ACS, while the risks associated with LAMA and LABA monotherapy are comparable.

Key messages

The clinical benefit of adding a second long-acting bronchodilator to LAMA or LABA monotherapy is modest and, at the same time, is associated with an increased risk of ACS in a patient group already at high risk.
1014Maternal educational qualification and child’s birth weight: Findings from Office for National Statistics Longitudinal Study
Authors: Pikhartova Jitka , Stuchbury Rachel , Shelton Nicola
Published: September 2021

Background

Lower maternal education was found to be associated with lower child’s birthweight which in turn was a possible risk factor for later poor health. Presented research aims to assess the association between maternal education and singleton’s birthweight in large UK data, accounting for characteristics such child’s gender, parity, maternal age, partnership status, ethnicity, and household socioeconomic characteristics.

Methods

Using England and Wales Office for National Statistics Longitudinal Study (ONS-LS), data from over 240,000 children born since 1981 to ONS-LS sample mothers were used. Maternal education was derived into 3 categories (below secondary, complete secondary education, degree and higher).

Results

Crude analysis confirmed significant association between the level of education and birthweight in each Census cohort (p < 0.001). In adjusted models, the education gradient was partly explained but remained strongly significant, and substantially increased over the years: for example, the birthweight difference between those with below secondary educated mothers and those with degree increased from 29 to 92 grams (p for change<0.001).

Conclusions

Our findings support previous evidence using different, usually smaller, population samples. Children of mothers with no or low qualification are more prone to be born with lower birthweight leading potentially into health disadvantages in their later life. Our results suggest that the inequalities in birth weight increased over the last 35 years.

Key messages

Low levels of maternal education predicts low birthweight in children.