bluuebunny/crossref_metadata_2025 huggingface dataset:
Predicting olfactory loss in chronic rhinosinusitis using machine learning
Authors: Ramakrishnan Vijay R , Arbet Jaron , Mace Jess C , Suresh Krithika , Shintani Smith Stephanie , Soler Zachary M , Smith Timothy L
Published: September 2021

Objective

Compare machine learning (ML)-based predictive analytics methods to traditional logistic regression in classification of olfactory dysfunction in chronic rhinosinusitis (CRS-OD) and identify predictors within a large multi-institutional cohort of refractory CRS patients.

Methods

Adult CRS patients enrolled in a prospective, multi-institutional, observational cohort study were assessed for baseline CRS-OD using a smell identification test (SIT) or brief SIT (bSIT). Four different ML methods were compared to traditional logistic regression for classification of CRS normosmics versus CRS-OD.

Results

Data were collected for 611 study participants who met inclusion criteria between 2011 April and 2015 July. Thirty-four percent of enrolled patients demonstrated olfactory loss on psychophysical testing. Differences between CRS normosmics and those with smell loss included objective disease measures (CT and endoscopy scores), age, sex, prior surgeries, socioeconomic status, steroid use, polyp presence, asthma, and aspirin sensitivity. Most ML methods performed favorably in terms of predictive ability. Top predictors include factors previously reported in the literature, as well as several socioeconomic factors.

Conclusion

Olfactory dysfunction is a variable phenomenon in CRS patients. ML methods perform well compared to traditional logistic regression in classification of normosmia versus smell loss in CRS, and are able to include numerous risk factors into prediction models. Several actionable features were identified as risk factors for CRS-OD. These results suggest that ML methods may be useful for current understanding and future study of hyposmia secondary to sinonasal disease, the most common cause of persistent olfactory loss in the general population.
Rapid Emergence and Spread of Severe Acute Respiratory Syndrome Coronavirus 2 Gamma (P.1) Variant in Haiti
Authors: Tagliamonte Massimiliano S , Mavian Carla , Zainabadi Kayvan , Cash Melanie N , Lednicky John A , Magalis Brittany Rife , Riva Alberto , Deschamps Marie Marcelle , Liautaud Bernard , Rouzier Vanessa , Fitzgerald Daniel W , Pape Jean William , Morris J Glenn , Salemi Marco
Published: September 2021

After an initial wave of coronavirus disease 2019 (COVID-19) in Haiti in summer 2020 (primarily lineage B.1), seropositivity for anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin G (IgG) was ~40%. Variant P.1 (gamma) was introduced in February 2021, with an initially limited introduction followed by exponential local dissemination within this unvaccinated population with prior exposure to earlier SARS-CoV-2 lineages.
Similar Antibody Responses Against Severe Acute Respiratory Syndrome Coronavirus 2 in Individuals Living Without and With Human Immunodeficiency Virus on Antiretroviral Therapy During the First South African Infection Wave
Authors: Snyman Jumari , Hwa Shi Hsia , Krause Robert , Muema Daniel , Reddy Tarylee , Ganga Yashica , Karim Farina , Leslie Alasdair , Sigal Alex , Ndung’u Thumbi ,   COVID-19 Mechanisms and Multi-omics at the Intersection of TB and HIV in KwaZulu-Natal (COMMIT-KZN Team), Archary Moherndran , Dullabh Kaylesh J , Goulder Philip , Harling Guy , Harrichandparsad Rohen , Herbst Kobus , Jeena Prakash , Khoza Thandeka , Klein Nigel , Kløverpris Henrik , Madansein Rajhmun , Marakalala Mohlopheni , Mazibuko Matilda , Moshabela Mosa , Mthabela Ntombifuthi , Naidoo Kogie , Ndhlovu Zaza , Nyamande Kennedy , Padayatchi Nesri , Patel Vinod , Smit Theresa , Steyn Adrie , Wong Emily
Published: September 2021

Background

There is limited understanding of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pathogenesis in African populations with a high burden of infectious disease comorbidities such as human immunodeficiency virus (HIV). The kinetics, magnitude, and duration of virus-specific antibodies and B-cell responses in people living with HIV (PLWH) in sub-Saharan Africa have not been fully characterized.

Methods

We longitudinally followed SARS-CoV-2–infected individuals in Durban, KwaZulu-Natal, South Africa, and characterized SARS-CoV-2 receptor-binding domain-specific immunoglobulin (Ig) M, IgG, and IgA weekly for 1 month and at 3 months post-diagnosis. Thirty of 72 (41.7%) were PLWH, 25/30 (83%) of whom were on antiretroviral therapy (ART) with full HIV suppression. Plasma neutralization was determined using a live virus neutralization assay, and antibody-secreting cell population frequencies were determined by flow cytometry.

Results

Similar seroconversion rates, time to peak antibody titer, peak magnitude, and durability of anti–SARS-CoV-2 IgM, IgG, and IgA were observed in people not living with HIV and PLWH with complete HIV suppression on ART. In addition, similar potency in a live virus neutralization assay was observed in both groups. Loss of IgA was significantly associated with age (P = .023) and a previous diagnosis of tuberculosis (P = .018).

Conclusions

Similar antibody responses and neutralization potency in people not living with HIV and PLWH on stable ART in an African setting suggest that coronavirus disease 2019 (COVID-19) natural infections may confer comparable antibody immunity in these groups. This provides hope that COVID-19 vaccines will be effective in PLWH on stable ART.
Evolution of Coronavirus Disease 2019 (COVID-19) Symptoms During the First 12 Months After Illness Onset
Authors: Wynberg Elke , van Willigen Hugo D G , Dijkstra Maartje , Boyd Anders , Kootstra Neeltje A , van den Aardweg Joost G , van Gils Marit J , Matser Amy , de Wit Marije R , Leenstra Tjalling , de Bree Godelieve , de Jong Menno D , Prins Maria ,   RECoVERED Study Group, Agard Ivette , Ayal Jane , Cavdar Floor , Craanen Marianne , Davidovich Udi , Deuring Annemarieke , van Dijk Annelies , Ersan Ertan , del Grande Laura , Hartman Joost , Koedoot Nelleke , Lebbink Romy , Loomans Dominique , Makowska Agata , du Maine Tom , de Man Ilja , van der Meij Lizenka , van Polanen Marleen , Oud Maria , Reid Clark , Storey Leeann , van Wijk Marc
Published: September 2021

Background

Few robust longitudinal data on long-term coronavirus disease 2019 (COVID-19) symptoms are available. We evaluated symptom onset, severity and recovery across the full spectrum of disease severity, up to one year after illness onset.

Methods

The RECoVERED Study is a prospective cohort study based in Amsterdam, the Netherlands. Participants aged ≥18 years were enrolled following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnosis via the local public health service and from hospitals. Standardized symptom questionnaires were completed at enrollment, 1 week and month later, and monthly thereafter. Clinical severity was defined according to World Health Organization (WHO) criteria. Kaplan-Meier methods were used to compare time from illness onset to symptom recovery, by clinical severity. We examined determinants of time to recovery using multivariable Cox proportional hazards models.

Results

Between 11 May 2020 and 1 May 2021, 342 COVID-19 patients (192 [56%] male) were enrolled, of whom 99/342 (29%) had mild, 145/342 (42%) moderate, 56/342 (16%) severe, and 42/342 (12%) critical disease. The proportion of participants who reported at least 1 persistent symptom at 12 weeks after illness onset was greater in those with severe/critical disease (86.7% [95% confidence interval {CI} = 76.5–92.7%]) compared to those with mild or moderate disease (30.7% [95% CI = 21.1–40.9%] and 63.8% [95% CI = 54.8–71.5%], respectively). At 12 months after illness onset, two-fifths of participants (40.7% [95% CI = 34.2–7.1]) continued to report ≥1 symptom. Recovery was slower in female compared to male participants (adjusted hazard ratio [aHR] 0.65 [95% CI = .47–.92]) and those with a body mass index [BMI]  ≥30kg/m2 compared to BMI <25kg/m2 (hazard ratio [HR] 0.62 [95% CI = .39–.97]).

Conclusions

COVID-19 symptoms persisted for one year after illness onset, even in some individuals with mild disease. Female sex and obesity were the most important determinants of speed of recovery from symptoms.
Association of E484K Spike Protein Mutation With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in Vaccinated Persons: Maryland, January–May 2021
Authors: Feder Kenneth A , Patel Ami , Vepachedu Venkata R , Dominguez Catherine , Keller Eric N , Klein Liore , Kim Curi , Blood Tim , Hyun Judie , Williams Thelonious W , Feldman Katherine A , Mostafa Heba H , Morris C Paul , Ravel Jacques , Duwell Monique , Blythe David , Myers Robert
Published: September 2021

Among 9048 people infected with SARS-CoV-2 between January and May 2021 in Maryland, in regression-adjusted analysis, SARS-CoV-2 viruses carrying the spike protein mutation E484K were disproportionately prevalent among persons infected after full vaccination against COVID-19 compared with infected persons who were not fully vaccinated (aOR, 1.96; 95% CI: 1.36–2.83).
Adalimumab and Infliximab Impair SARS-CoV-2 Antibody Responses: Results from a Therapeutic Drug Monitoring Study in 11 422 Biologic-Treated Patients
Authors: Chanchlani Neil , Lin Simeng , Chee Desmond , Hamilton Benjamin , Nice Rachel , Arkir Zehra , Bewshea Claire , Cipriano Bessie , Derikx Lauranne A A P , Dunlop Allan , Greathead Louise , Griffiths Rachel L , Ibraheim Hajir , Kelleher Peter , Kok Klaartje B , Lees Charlie W , MacDonald Jonathan , Sebastian Shaji , Smith Philip J , McDonald Timothy J , Irving Peter M , Powell Nick , Kennedy Nicholas A , Goodhand James R , Ahmad Tariq
Published: September 2021

Background and Aims

Infliximab attenuates serological responses to SARS-CoV-2 infection. Whether this is a class effect, or if anti-tumour necrosis factor [anti-TNF] level influences serological responses, remains unknown.

Methods

Seroprevalence and the magnitude of SARS-CoV-2 nucleocapsid antibody responses were measured in surplus serum from 11 422 (53.3% [6084] male; median age 36.8 years) patients with immune-mediated inflammatory diseases, stored at six therapeutic drug monitoring laboratories between January 29 and September 30, 2020. Data were linked to nationally held SARS-CoV-2 PCR results to July 11, 2021.

Results

Rates of PCR-confirmed SARS-CoV-2 infection were similar across treatment groups. Seroprevalence rates were lower in infliximab- and adalimumab- than vedolizumab-treated patients (infliximab: 3.0% [178/5893], adalimumab: 3.0% [152/5074], vedolizumab: 6.7% [25/375], p = 0.003). The magnitude of SARS-CoV-2 reactivity was similar in infliximab- vs adalimumab-treated patients (median 4.30 cut-off index [COI] [1.94–9.96] vs 5.02 [2.18–18.70], p = 0.164), but higher in vedolizumab-treated patients (median 21.60 COI [4.39–68.10, p < 0.004). Compared to patients with detectable infliximab and adalimumab drug levels, patients with undetectable drug levels [<0.8 mg/L] were more likely to be seropositive for SARS-CoV-2 antibodies. One-third of patients who had PCR testing prior to antibody testing failed to seroconvert, all were treated with anti-TNF. Subsequent positive PCR-confirmed SARS-CoV-2 was seen in 7.9% [12/152] of patients after a median time of 183.5 days [129.8–235.3], without differences between drugs.

Conclusion

Anti-TNF treatment is associated with lower SARS-CoV-2 nucleocapsid seroprevalence and antibody reactivity when compared to vedolizumab-treated patients. Higher seropositivity rates in patients with undetectable anti-TNF levels support a causal relationship, although confounding factors, such as combination therapy with a immunomodulator, may have influenced the results.
Unexpected genomic features of high current density-producing Geobacter sulfurreducens strain YM18
Authors: Fujikawa Takashi , Ogura Yoshitoshi , Ishigami Koki , Kawano Yoshihiro , Nagamine Miyuki , Hayashi Tetsuya , Inoue Kengo
Published: September 2021

Geobacter sulfurreducens produces high current densities and it has been used as a model organism for extracellular electron transfer studies. Nine G. sulfurreducens strains were isolated from biofilms formed on an anode poised at –0.2 V (vs SHE) in a bioelectrochemical system in which river sediment was used as an inoculum. The maximum current density of an isolate, strain YM18 (9.29 A/m2), was higher than that of the strain PCA (5.72 A/m2), the type strain of G. sulfurreducens, and comparable to strain KN400 (8.38 A/m2), which is another high current-producing strain of G. sulfurreducens. Genomic comparison of strains PCA, KN400 and YM18 revealed that omcB, xapD, spc and ompJ, which are known to be important genes for iron reduction and current production in PCA, were not present in YM18. In the PCA and KN400 genomes, two and one region(s) encoding CRISPR/Cas systems were identified, respectively, but they were missing in the YM18 genome. These results indicate that there is genetic variation in the key components involved in extracellular electron transfer among G. sulfurreducens strains.
1. Formation, classification, and registration of companies
Authors: Hannigan Brenda
Published: September 2021

This chapter considers the mechanics of formation and registration as well as the various types of companies which may be formed. The focus is on registered companies, registered under the Companies Act 2006. The chapter considers the role of the registrar of companies and the public registry and the types of companies which can be registered. The key categories are companies limited by shares and limited by guarantee. Private and public companies limited by shares as well as corporate groups are all considered. The chapter also looks briefly at alternative vehicles for business, such as partnerships, limited partnerships and limited liability partnerships.
9. Duty to act within constitution and powers
Authors: Hannigan Brenda
Published: September 2021

The Companies Act 2006 (CA 2006) requires directors: to act in accordance with the constitution (defined s 257) and to exercise powers for the purposes for which they are conferred. This chapter focuses on s 171. The discussion covers the constitutional division of power within a company, types of authority, statutory protection of third parties, and exercise of a power for an improper purpose. Much of the discussion is of the important agency rules which govern directors’ authority, considering in particular the extent to which third parties can rely on the apparent or ostensible authority of an individual director or directors. The circumstances in which third parties are put on inquiry are considered. The statutory protection afforded to third parties by CA 2006, s 40 is also examined. The proper purpose doctrine is an important constraint on abuse of power by directors and the application of the doctrine is addressed in detail.
10. Duty to promote the success of the company
Authors: Hannigan Brenda
Published: September 2021

The Companies Act 2006 (CA 2006) s. 172(1) requires directors to act to promote the success of the company. This chapter separates that duty into its component elements: the duty to act in good faith, promoting the success of the company for the benefit of the members as a whole, having regard to stakeholders (including employees), and considering creditors’ interests. The position of a nominee director in this scheme is considered. The pluralist debate which preceded the enactment of s 172 is addressed as well as the recent addition of further reporting obligations in order to strengthen the provision. The new s 172 statement is considered. The chapter explores in detail the evolving jurisprudence around s 172(3) and the need to have regard to creditors’ interest in certain circumstances.
12. Duty to avoid a conflict of interest
Authors: Hannigan Brenda
Published: September 2021

This chapter discusses the director’s duty to avoid a situation in which he has, or can have, a personal interest conflicting, or which possibly may conflict, with the interests of those whom he is bound to protect (the no-conflict rule); and the equally inflexible rule that, without consent, a person in a fiduciary position is not entitled to profit from that position (the no-profit rule or, more accurately no secret profit rule). These key obligations are discussed in detail, exploring the extent of the strict duty to avoid a conflict and the judicial attitude to breaches of duty. The need for disclosure and authorisation is discussed. Benefits from third parties and conflicts from proposed transactions with the company are also addressed.
15. Directors’ liabilities and vulnerable transactions on insolvency
Authors: Hannigan Brenda
Published: September 2021

This chapter considers directors’ liabilities on a company going into insolvency. Redress for breach of duty by directors is available through summary action for misfeasance (IA 1986, s 212), fraudulent trading (ss 213, 246ZA), and wrongful trading (ss 214, 246ZB). The scope of these provisions is considered in detail together with the relevant case law. Wrongful trading is potentially a valuable remedy but it is somewhat underused. It may be advantageous instead to challenge certain transactions by the directors prior to insolvency; for example, as transactions at an undervalue (s 238) or preferences (s 239). More broadly, the overall conduct of the directors is reviewed in order to determine whether disqualification is appropriate on the grounds, usually, that they are unfit. All of these matters are addressed in this chapter.
17. Decision-making and company meetings
Authors: Hannigan Brenda
Published: September 2021

Shareholders typically exercise their voting power during the general meetings of the company, in the form of resolutions passed at such meetings. For private companies, the expectation is that they will not hold meetings, but use written resolutions. This chapter considers the mechanisms for meetings for public and traded companies. The chapter discusses voting entitlement, proxies, and corporate representatives. It considers the main types of resolutions, especially written resolutions for private companies, as well as ordinary and special resolutions. Meeting procedures including notice and convening requirements are discussed. There is a detailed look at the important Duomatic principle of informal shareholder assent in place of a resolution.
19. The unfairly prejudicial remedy and the minority shareholder
Authors: Hannigan Brenda
Published: September 2021

The most important minority shareholder remedy is the unfairly prejudicial petition under Companies Act 2006 (CA 2006), s 994. This chapter examines petitioning on the grounds of unfair prejudice; the boundaries to unfairly prejudicial conduct; the court’s power to grant relief; and petitioning for a winding-up order on the just and equitable ground under IA 1986, s 122(1)(g). The extensive case law on the section is considered in detail. The courts look to breaches of the terms on which the business should be conducted including breaches of the CA 2006, but also breaches of the agreements underlying the parties’ relationships. Such underlying commitments are most commonly found in quasi-partnerships. The chapter examines the quasi-partnership in detail. The remedy most commonly provided by the court is a purchase order and the chapter looks at the valuation issues around such orders. It also considers the alternative remedy of a winding up on the just and equitable ground.
897Environmental contamination of Coxiella burnetii in and around an endemically infected goat farm
Authors:   Hasanthi Abeykoon Abeykoon Mudiyanselage, Hou Kangwei , Vincent Gemma A. , Stevenson Mark A. , Firestone Simon M. , Wiethoelter Anke
Published: September 2021

Background

Coxiella burnetii is the cause of Q fever, a zoonotic disease spread by aerosol transmission. This study investigated C. burnetii environmental contamination in and around an endemically infected, intensively managed dairy goat farm in Victoria, Australia.

Methods

Dust, soil and water were collected in and around kidding pens. Samplings were collected before, during and after each kidding season. Soil was sampled along a 500 m transect from the main kidding pen in the predominant wind direction to assess the risk of C. burnetii spread from the main farm shed as a point source. DNA extraction and quantitative PCRs targeting the IS1111 and com1 genes were performed. Analyses are ongoing to describe the change in the frequency of C. burnetii positive environmental samples as a function of distance from the main farm shed.

Results

Dust inside the kidding pen contained C. burnetii DNA at all time points, with higher loads during the kidding seasons. Soil samples were positive for both PCR targets and were evenly dispersed within close ranges (500 m) from the main farm shed. Only those water samples taken from close to the main farm shed were positive.

Conclusions

C. burnetii was readily found in dust and soil in and around a farm shed where coxiellosis was endemic. Further environmental sampling will allow us to estimate the distance over which C. burnetii contamination occurs around a known point source.

Key messages

Results of this study will provide information critical for estimating Q fever risk around livestock facilities.
1227Colorectal cancer risk prediction models incorporating lifestyle and biomarker data: Results from the EPIC cohort
Authors: Aleksandrova Krasimira , Reichmann Robin , Jenab Mazda , Rinaldi Sabina , Kaaks Rudolf , de-Mesquita Bas Bueno- , Riboli Elio , Gunter Marc
Published: September 2021

Background

Colorectal cancer represents a major public health concern and there is a worrying tendency of increasing incidence rates among younger people in the last decades. Risk stratification of high-risk individuals may aid targeted disease prevention. We therefore aimed to evaluate the predictive value of a wide range of lifestyle and biomarker variables using data within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort.

Methods

A range of lifestyle, anthropometric and dietary variables in 329,885 participants in the EPIC cohort were evaluated as potential predictors for risk of colorectal cancer over 10 years. Biomarker measurements of 41 parameters were available for 1,320 CRC cases and 1,320 controls selected using incidence density matching. Best sets of predictors were selected using elastic net regularization with bootstrapping. Random survival forest was applied as a novel technique to validate the set of selected predictors taking variable interactions into account.

Results

The results suggested a set of lifestyle factors including age, waist circumference, height, smoking, alcohol consumption, physical activity, vegetables, dairy products, processed meat, and sugar and confectionary that showed good discrimination (Harrell's C-index: 0.710) and excellent calibration. The analyses further revealed a set of biomarkers that increased the predictive performance beyond age, sex and lifestyle factors.

Conclusions

Risk prediction models based on lifestyle and biomarker data may prove useful in the identification of individuals at high risk for colorectal cancer.

Key messages

Risk prediction models incorporating lifestyle and biomarker data could contribute to developing strategies for targeted colorectal cancer prevention.
1493Trends of Rotavirus Gastroenteritis during a Conflict Time, Yemen, 2014-2019
Authors: Ghaleb Yasser , alkuhlani Sharaf , Serouri Abdul Wahed Al , Ghaleb Yasser
Published: September 2021

Background

The Rotavirus Gastroenteritis (RVG) is a contagious vaccine-preventable disease that contributes to the high morbidity and mortality among under 5 children. In Yemen, Rotavirus Surveillance System (RVS) was launched in 2007 as sentinel surveillance and the vaccine was introduced in 2012. However, the current protracted conflict led to a significant breakdown of health services including immunization and water, sanitation and hygiene. The aim is to describe the pattern of RVG during the conflict time: 2014-2019.

Methods

2014-2019 RVS data that covers demographic variables, clinical symptoms, vaccination status and laboratory results were analyzed using Epi.info 7.2.

Results

6,663 suspected RVG cases were reported. The most affected age group was 9-12 months and cases were higher among males (59%). RVG shows a seasonal pattern where RVG was predominantly reported in the cold season. Only 24% needed admission due to severe dehydration. Only 65% of cases were vaccinated, of them 85% received two doses. The case fatality rate was 1.1%, and was significantly higher among unvaccinated (1.8 vs. 0.6%, P < 0.0001). Of the 5,875 samples collected, only one third found positive to Rotavirus where the predominant genotypes were G12 P [8] and G 2 P [4].

Conclusions

The findings highlight that RVG is still an ongoing cause of morbidity among under 5 children in Yemen that upsurges with the low Rotavirus immunization coverage. Therefore, boosting immunization coverage together with other diarrhea prevention strategies are required. Furthermore, ongoing surveillance is important to monitor the RVG epidemiology and to evaluate vaccine effectiveness against the currently circulating genotypes.

Key messages

It is First research about rota that done in Yemen during conflict so it gives opportunity for future increased scientific rigor, outcomes-focused research, and health informatics.

It provides policy makers by recommendation for improving public health and surveillance system during crisis.
750Hospital admissions for patients with rheumatoid arthritis in Western Australia hospitals have declined over time
Authors: Almutairi Khalid ,   FRACP, Rheumatology Johannes Nossent,   UWA, Public Health David Preen,   FRACP Helen Keen,   RACP, Rheumatology and Gerontology Charles Inderjeeth
Published: September 2021

Background

Rheumatoid arthritis (RA) imposes a considerable burden on society in terms of morbidity, long-term disability, and costs. RA prevalence is poorly described in Australia, and linked health datasets can provide a more meaningful picture for RA epidemiology in the Australian population.

Methods

We extracted data on all patients identified in the WA Hospital Morbidity Data Collection between 1995 and 2014, with the International Classification of Diseases (ICD) codes for RA (ICD 10 M05.00–M06.99, and the corresponding ICD 9 codes). We estimated period prevalence rates per 1000 hospital separations and annual average percentage changes, with the total number of hospital separations each year.

Results

A total of 17,125 patients were admitted to WA hospitals with a diagnostic code for RA over the study period (1995-2014). The total number of hospital separations for RA patients was 50,353, indicating an average of three hospital separations per patient over twenty years. The RA prevalence was 3.4 per 1000 separations over the study period, with a -2.89% annual average decrease since 1995.

Conclusion

These data demonstrate that hospitalisation for RA has decreased considerably in WA over the last two decades. As this decrease roughly coincides with the introduction of biological drug treatment for RA, the reduced need for hospital admission is likely due to improvements in RA management.

Key messages

The RA prevalence was 3.4 per 1000 separations over the study period (1995-2014).
749The global prevalence of Rheumatoid Arthritis: A meta-analysis
Authors: Almutairi Khalid ,   Johannes Nossent,   David Preen,   Helen Keen,   Charles Inderjeeth
Published: September 2021

Background

To determine the global prevalence of rheumatoid arthritis (RA) based on published studies and reveal factors which influence the RA prevalence estimates.

Methods

Four electronic databases- ProQuest Central, MEDLINE, Web of Science, and EMBASE were searched for publications from 1980 and 2019, reporting prevalence estimates of RA. A random-effect meta-analysis model was used to produce the pooled prevalence estimates. The potential sources of between-study heterogeneity were identified using sensitivity analysis, sub-group and meta-regression analyses.

Results

A total of 67 studies consisting of 212,335,171 patients were included in the meta-analysis. The global prevalence of RA was estimated 0.46% (95% CI: 0.39-0.54; I2=99.9%) with a 95% prediction interval (0.06–1.27). The point-prevalence of RA was 0.45% (95% CI: 0.38- 0.53%), while the pooled period-prevalence was 0.46% (0.36% and 0.57%). The highest RA pooled prevalence was estimated at 0.69% (95% CI: 0.47–0.95) derived from linked data sources studies. Based on subgroup analyses, the pooled prevalence of RA was influenced by geographical location, the risk bias of studies, period-prevalence method and urban population setting over the stratified periods.

Conclusion

The global prevalence of RA was 460 per 100,000 population from 1980–2018, with a 95% prediction interval (0.06– 1.27%). RA prevalence estimates were influenced by geographical location, the risk bias assessment of studies, period-prevalence method and urban population setting over time.

Key messages

The global prevalence of RA was 460 per 100,000 population from 1980–2018, with a 95% prediction interval (0.06– 1.27%).
1494Content Analysis and Predicting Survey Refusal: What Are Respondents’ Concerns about Face-to-face Mental Health Survey?
Authors: Altwaijri Yasmin
Published: September 2021

Background

Previous studies suggest that refusals form the largest proportion of nonresponse for household surveys. As face-to-face household health surveys are uncommon in several countries, it might be advantageous for prospective surveys to preemptively tackle respondents’ refusal to survey participation.

Methods

Using contact history data from the Saudi National Mental Health Survey, we examined the relationship between social environmental factors, respondent characteristics, survey request concerns recorded by interviewers, and respondents’ propensity to refuse to participate in the survey. Content analysis and logistic regressions were conducted.

Results

Our findings suggest that urbanicity, region, socioeconomic status, age, and gender are associated with refusal. Patriarchal gatekeepers and specific survey-related concerns are more likely to lead to temporary refusals compared to final refusals.

Conclusions

These results have implications for survey researchers employing similar recruitment and data collection methods, for example in tailoring refusal conversion strategies for interviewers to address concerns expressed by Saudi and/or culturally similar respondents.

Key messages

Results might benefit studies considering similar methods and investigating sensitive issues, improve response rates, and combat the declining trend that potentially jeopardizes the quality of survey data collected.
513Ophthalmic disease and older adults’ sedentary and physically-active behaviors: Findings from the NEIGE study
Authors: Amagasa Shiho , Inoue Shigeru , Murayama Hiroshi , Fujiwara Takeo , Kikuchi Hiroyuki , Fukushima Noritoshi , Machida Masaki , Chastin Sebastien , Owen Neville , Shobugawa Yugo
Published: September 2021

Background

Physical inactivity can be associated adversely with markers of eye health, but little is known about how ophthalmic disease (OD) may be related to sedentary behaviour (SB) and different intensities of physical activity in older adults. We compared device-assessed time spent in SB, light-intensity PA (LPA), and moderate-to-vigorous physical activity (MVPA) between older adults with and without OD.

Methods

A randomly-recruited sample of 512 community-dwelling older adults (47% male; aged 65–84 years) in Japan wore a valid tri-axial accelerometer for seven consecutive days in 2017. Prevalence of OD was assessed by medical interview. Times spent in SB, LPA, and MVPA were compared between those with and without OD by compositional multivariate analysis of covariance, adjusting for potential confounders (gender, age, residential area, living arrangement, working, body mass index, self-rated health, and cognitive function).

Results

Overall, percent times spent in SB, LPA, and MVPA during waking hours were 51.0, 44.6, and 4.4, respectively; and, 167 (36.5%) had OD. Activity patterns differed significantly between those with and without OD: in those with OD, the proportion of time spent in MVPA relative to other behaviours was lower, and the proportion of time spent in SB relative to other behaviours was higher.

Conclusions

Older adults with OD were found to be less physically active than those without.

Key messages

While these cross-sectional findings need to be confirmed by evidence from prospective studies, the reciprocal influences of OD and inactivity in older adults should be addressed as scientific, clinical and public health considerations.
1058Association between loneliness and residential green space: a longitudinal study of Australian adults
Authors: Astell-burt Thomas , Feng Xiaoqi
Published: September 2021

Background

Loneliness, a condition associated with premature death, is estimated to affect 1 in 4 Australian adults. Evidence to inform public policy responses is needed. The UK’s loneliness strategy suggested more green space is part of the solution, based on cross-sectional evidence.

Methods

Association between incident loneliness over five years with respect to residential green space exposure within 1600m, 800m and 400m was assessed using multilevel models adjusting for potential socioeconomic and demographic confounders. The sample was restricted to adults living in major cities in Australia who did not report feeling lonely at baseline.

Results

Incidence of loneliness was 12% (820/6017) in a sample with a mean age of 44 (range 15-93), 53% female. Adjusting for age and gender, lower odds of incident loneliness were reported in areas with 10% higher green space provision within 1600m (OR = 0.90, 95%CI 0.83-0.96) and within 800m (0.93, 0.88-0.99), but not within 400m. Adjustment for income, education, couple status, ancestry and children attenuated association with green space within 800m, but association with green space within 1600m remained (0.90, 0.85-0.97). This association also remained after adjustment for neighbourhood disadvantage and personality traits and was stronger for people living on their own.

Conclusions

The odds of incident loneliness appear lower among adults with more green space within 1600m

Key messages

Strategies to increase green space provision within 1600m in cities may support prevention of loneliness in adults and especially those living on their own.
600Homelessness in Hamilton, New Zealand: debt as a tipping point?
Authors:   Polly Atatoa Carr, Whitehead Jesse , McMinn Carole
Published: September 2021

Background

The People’s Project (TPP) in Hamilton, NZ takes a Housing First approach to eliminate homelessness. A recent research collaboration provides epidemiological evidence regarding: the people served through TPP; their service engagement; pathways into homelessness; and lost opportunities for early intervention.

Methods

Data has been collected from a total of 755 TPP participants, including those from client registrations (July 2015-March 2017; n = 695) and a ‘pathways into homelessness’ questionnaire implemented in 2019. All participants were asked questions regarding their experiences of debt, levels of debt and the specific agencies and debtors involved.

Results

Common pathways into homelessness included individual factors (e.g. substance dependencies, family breakdown), structural factors (lack of suitable and accessible housing, deinstitutionalisation, service failures), and poverty exacerbated by debt. Of this cohort, 62% described current debt, and $2.8million (NZD) of debt was estimated (average of $10000 per person). Debts to government agencies were common and significant, including to Work and Income NZ, student loans, court costs and Housing NZ.

Conclusions

Financial difficulty, and particularly debt, is an important tipping point into homelessness. High levels of debt exclude people from permanent housing and challenge policies and practices aiming to end homelessness. Furthermore, debt to government agencies - required to invest in homelessness prevention and support - is a systems and policy failure.

Key messages

Financial difficulties, specifically debt, and systems failures are important tipping points for vulnerable populations into homelessness

Debts owed to government agencies by the homeless population provide an opportunity to reorient the system to support homelessness prevention.
599RCT of Harti Hauora Tamariki: a holistic family-centred programme for child health and equity
Authors:   Polly Atatoa Carr, Scott Nina , Jones Amy , Masters-Awatere Bridgette , Sandiford Peter
Published: September 2021

Background

In Aotearoa NZ, preventable paediatric admissions and readmissions with diseases of poverty are common, particularly for Māori (Indigenous) children. In response, the Harti Hauora Tamariki (HHT) was developed. This is a multilevel programme of: culturally safe engagement; comprehensive high-quality screening; standardised evidence-based protocols for addressing need(s) and navigation. Methodological innovations are required for a RCT of HHT effectiveness within the context of whānau (family) wellbeing.

Methods

Approximately 980 children admitted to paediatrics at Waikato Hospital were randomised (with whānau) to HHT or usual care. Measures of effectiveness include: level of unmet need identified; impact of HHT on meeting needs; qualitative assessment of HHT support for health outcomes and whānau satisfaction with care. The primary quantitative endpoint is relative readmission risk.

Results

Qualitative case studies demonstrate the importance of engagement and the high-trust environment of HHT enabling whānau to reveal needs. Needs are common. Many needs identified (such as food insecurity, lack of resources) are not recognised through standard hospital care. HHT adaptations were required. Quantitative outcome analyses are underway.

Conclusions

The whole health system has responsibility and ability to improve whānau health promotion, prevention, and wellbeing support. HHT provides a model for action. RCT assessment of HHT needed to be whānau-centred and flexible to match programme evolution and provide evidence for effectiveness.

Key messages

A family-centred holistic screening programme, with culturally-safe engagement, improves inpatient care and enhances determinants of health.

Indigenous leadership and commitment to Indigenous wellbeing and equity facilitates effective programme improvement, within an adaptable RCT framework.
1345Uptake of Intermittent Preventive Treatment for malaria during pregnancy with Sulphadoxine-Pyrimethamine in Malawi
Authors: Azizi Steven
Published: September 2021

Background

This study aimed to estimate the proportion of and identify factors associated with uptake of ≥ 3 doses of Intermittent preventive treatment of malaria during pregnancy with sulphadoxine-pyrimethamine (IPTp-SP) among pregnant women in Malawi after adoption of the 2012 updated WHO IPTp-SP policy.

Methods

The 2015–16 Malawi Demographic and Health Survey dataset was re-analysed. Only 1069 women were included in the analysis from 1219 women who had live births, born after July 2015. Logistic regression was used in data analysis considering complex survey sample design.

Results

Of the 1069 women, 447 (42%) received ≥3 doses (optimal) of IPTp-SP, while 47% managed to attend ≥4 antenatal care (ANC) clinics. Only 52% received optimal SP doses among those who made ≥4 ANC visits. The number of ANC visits was associated with the optimal uptake of SP. Women who attended ANC three times only and those who visited ANC at most twice were less likely to receive optimal doses than those who managed to attend ANC ≥4 times during pregnancy (AOR = 0.71, 95% CI 0.49–1.02) and (AOR = 0.12, 95% CI 0.06–0.21) respectively.

Conclusions

There is low uptake of optimal SP doses in Malawi. This seems to be associated with the number of ANC visits. However, there is limited effectiveness of increased number of ANC visits on the uptake of optimal SP doses.

Key messages

Increased number of ANC visits is not enough to increase uptake of optimal doses of IPTp-SP. There is need for continued and varied efforts.
638Reporting of gestational diabetes and chronic conditions of pregnancy: validation of routinely collected hospital data
Authors: Baldwin Heather , Torvaldsen Siranda , Rickard Kristen , Nippita Tanya , Patterson Jillian
Published: September 2021

Background

Gestational diabetes, hypertension, thyroid conditions and morbid obesity in pregnancy are associated with increased risks of adverse outcomes. Hospital data are important for research on these conditions, however, up-to-date validation of reporting is needed to understand the extent to which the data reflect the clinical situation.

Methods

Women giving birth to singleton infants in two tertiary hospitals in New South Wales, Australia, between 2011 and 2015 were included. Obstetric data, from the ObstetriX system, was used as the gold standard to which linked hospital data, from the Electronic Medical Record, were compared.

Results

There were 35,928 births included. Gestational and pre-existing diabetes had high sensitivity (83.6% and 88.2%) and positive predictive values (PPV, 92.7% and 86.0%). Pre-eclampsia and eclampsia, gestational hypertension and any hypertension had good sensitivity (80.0%, 80.1%, 81.5%), but moderate PPVs (59.7%, 65.6%, 70.4%), while for chronic hypertension sensitivity (53.5%) and PPV (53.2%) were lower. Obesity and thyroid conditions showed low sensitivity (9.8%, 12.9%; PPV 65.6%, 82.3%). Specificity and NPV were high for all conditions.

Conclusions

We found reliable reporting of gestational diabetes, pre-existing diabetes and all types hypertension, except for chronic hypertension which was moderately well reported. Thyroid conditions and morbid obesity were very poorly reported.

Key messages

Diabetes appears well reported in the hospital data, and sensitivity for hypertension may be improved by using a grouped category. Hospital data on thyroid conditions and obesity should be used with caution.
713Domestic violence and self-poisoning in Sri Lanka
Authors: Bandara Piumee , Page Andrew , Senarathna Lalith , Kidger Judi , Feder Gene , Gunnell David , Rajapakse Thilini , Knipe Duleeka
Published: September 2021

Background

There is increasing evidence that domestic violence is an important risk factor for suicidal behaviour. The level of risk of domestic violence (DV) and its contribution to the overall burden of suicidal behaviour has not been quantified in South Asia, where 37% of suicide deaths globally occur. We examined the association between DV and self-poisoning in Sri Lanka through a large case-control study.

Methods

Multivariable logistic regression models were conducted on 298 self-poisoning cases and 500 hospital controls to estimate the association between domestic violence and self-poisoning, and population attributable fractions (PAF) were estimated. Sensitivity analyses were conducted using 455 population-based controls.

Results

DV exposure within the previous 12 months was strongly associated with self-poisoning for women (adjusted OR [AOR] 4·08, 95%CI 1·60-4·78) and men (AOR 2·52, 95%CI 1·51-4·21), compared to no abuse. Physical violence showed the highest risk among women, whereas among men, emotional abuse showed the highest risk (AOR 2·75, 95%CI 1·57-4·82). PAF% for exposure to at least one type of DV was 38% (95%CI 32-43) in women and 22% (95 CI 14-29) in men.

Conclusions

DV was strongly associated with suicidal behaviour for men and women. Almost 40% of female self-poisoning cases and a fifth of male cases may be reduced if domestic violence is addressed.

Key messages

The significant contribution of DV to the overall burden of self-poisoning suggests preventative and curative interventions to address domestic violence may yield significant gains in reducing suicidal behaviour in Sri Lanka, and other similar settings.
1528Prospective Vs Retrospective Cohort Studies: Is a Consensus Needed?
Authors: Bashir Maryam Mohammed , Maskari Fatma Al , Ahmed Luai , Al-Rifai Rami H.
Published: September 2021

Focus of Presentation

There is a confusion among epidemiologists, especially early-career epidemiologists, on the different definitions and use of prospective and retrospective cohort studies. There is a need for consensus by the expert community on this methodological dilemma.

Findings

Different Epidemiology experts define prospective and retrospective cohort studies differently. Most textbooks define prospective cohort study as one conducted when all the subjects are outcome-free while in retrospective cohort study, at least some of them have developed the outcomes, then researchers go back in time to study exposures. However, some experts define both study types based on the time of development of the research hypothesis or question in relation to data collection.

Some experts consider retrospective studies to be only from records. Meanwhile, some consider any follow up study to be prospective even if historical data is used.

These disparities in definitions lead to confusion among young epidemiologists. Some experts state that there is no need to differentiate between the two studies, however, we are aware of the possible bias and confounding that could occur from retrospective studies.

Conclusions/Implications

It has become essential for the expert community to address this methodological dilemma and to reach consensus on it. This could serve as a guide for young epidemiologists and ensure the uniformity of research worldwide.

Key messages

There are disparities in definitions and use of prospective and retrospective cohort studies. Hence, the expert community, especially the International Association of Epidemiology, should address this dilemma and reach a consensus to form standard guidelines.
797Understanding bias in recruitment through population-based cancer registries
Authors: Bergin Rebecca , White Vicki , English Dallas , Milne Roger
Published: September 2021

Focus of Presentation

Participant recruitment through registries can provide population-based samples, but there are methodological challenges. We examine challenges and solutions in two studies recruiting participants through the Victorian Cancer Registry. Cross-sectional surveys of patients with colorectal, lung or ovarian cancer conducted in 2013-14 (study 1) and repeated in an ongoing study (study 2). The registry managed fast-track recruitment of eligible patients ( > =40yrs, confirmed diagnosis, approached within 6-months of diagnosis)

Findings

In study 1, registry rules for confirmed diagnosis required surgical histopathology. For cancers primarily treated non-surgically (e.g. lung), selection bias was common. In study 2, confirmation rules were extended to include biopsies with subsequent hospital notification.

The registry does not receive imaging notifications and pathology labs/hospital reports can be delayed (>60days). Study eligibility criteria meant cases with advanced disease, common in lung cancer, or without a confirmed diagnosis within the study timeframe were excluded. However, colorectal and ovarian cases in study 1 were largely representative of the eligible population.

In study 2, a different fast-track recruitment approach meant a longer time from diagnosis to response compared to study 1 (median 7 vs 5 months). Recruitment procedures are being improved through engagement between researchers and registry.

Conclusions/Implications

Local registry-based rules for recruitment and available data, study eligibility criteria and cancer type (particularly cancers without histopathological confirmation), may introduce bias. Researchers need to work closely with registry colleagues to understand and optimise recruitment.

Key messages

Registry-based recruitment can be biased. Early and ongoing communication between researchers and registry is strongly recommended.