bluuebunny/crossref_metadata_2025 huggingface dataset:
1459Socioeconomic position influence on the early-life individual exposome in the Italian NINFEA birth cohort
Authors: Pizzi Costanza , Moccia Chiara , Moirano Giovenale , d'Errico Antonio , Maule Milena , Fossati Serena , Lioret Sandrine , Calas Lucinda , Richiardi Lorenzo
Published: September 2021

Background

Early exposure to unhealthy lifestyles and environmental risk factors is known to affect health throughout the life-course. There is also evidence that the exposure patterns are influenced by the socioeconomic position (SEP).

Methods

We use the data of the Turin participants of the Italian NINFEA birth cohort (n∼2500) to study how family SEP drives the early life exposome. SEP at birth is measured through the EHII (Equivalized Household Income Indicator), while the exposome includes urban environment, diet and lifestyle exposures measured during infancy. We use standard regression models to evaluate the effect of EHII on each exposome variable accounting for multiple comparison and potential confounders (Drivers-Exposome Wide Association Study – DExWAS) and the hierarchical clustering on the principal components approach to identify groups with similar exposure pattern.

Results

The DExWAS show that low EHII is associated with lower consumption of fruit and vegetables, lower levels of NO2, building and facilities densities, traffic, walkability and connectivity index, higher land-use diversity index, and higher exposure to pets. The hierarchical cluster analysis identifies three groups, with subjects belonging to the cluster characterized by higher level of urban environment risk factors and a healthier diet having a higher mean EHII.

Conclusions

These SEP-early life exposome analyses will be replicated in several European birth cohorts participating in the H2020 ATHLETE and LifeCycle projects.

Key messages

In the Italian city of Turin children from low SEP family are exposed to higher levels of environmental risk factors and unhealthy lifestyles during infancy.
1225Symptoms of depression and anxiety in Dutch adults during and before the COVID-19 pandemic
Authors: Qi Yuwei , Lepe Alexander , Almansa Josué , Ots Patricia , de Kroon Marlou L.A. , de Winter Andrea F. , Cok Vrooman J. , Reijneveld Sijmen A. , Brouwer Sandra
Published: September 2021

Background

The COVID-19 pandemic may impact mental health outcomes differentially based on an inidivdual’s capital, i.e. resources used to maintain and enhance health. This study examined changes in depression and anxiety symptoms before and during the pandemic, and assessed their association with different elements of capital.

Methods

Data from 65,854 individuals (Mage=50.4, SDage=12.0) from the Lifelines COVID-19 cohort were used. Baseline mental health symptoms were on average measured 4.7 (SD = 1.1) years before the first COVID-19 measurement wave (T1), and subsequent waves were (bi)weekly (March 30 — August 05, 2020). Mental health symptom trajectories were estimated using a two-part Latent Class Growth Analysis (cutoff=2 symptoms), and class membership was predicted by several elements of economic (education, income, and occupation) and person capital (neuroticism).

Results

Most individuals were unlikely to report □2 symptoms of depression (80.6%) and anxiety (75.9%), but small stable-high classes for both conditions were identified (1.6% and 6.7%, respectively). Compared to T0, T1 showed increases in the mean number of symptoms (Mdep_t0=4.1 vs Mdep_t1=4.7, Manx_t0=4.2 vs Manx_t1=4.3) and probability of reporting symptoms (Probdep_t0=0.65 vs Probdep_t1=0.96, Probanx_t0=0.70 vs Probanx_t1=0.92). Lower income (ORdep=1.10; 95%CI:1.05-1.16; ORanx=1.05; 95%CI:1.02-1.07) and higher neuroticism (ORdep=1.10; 95%CI:1.09-1.11; ORanx=1.08; 95%CI:1.08-1.09) increased the odds of being in both stable-high classes. Low education increased the odds of being in the stable-high depression class (ORdep=1.46; 95%CI:1.07-1.99), and higher occupation increased the odds of being in the stable-high anxiety class (ORanx=1.06; 95%CI:1.03-1.09).

Conclusion

Overall, a minority of individuals, who generally possessed less capital, reported an increase in symptoms of depression or anxiety.

Key message

Inidividuals with less capital, i.e. resources, generally experienced more symptoms of depression and anxiety, which stresses the importance of devoting more resources to improve their mental health.

Keywords

Longitudinal studies, Social epidemiology/determinants, Mental health
735Dynamics and Determinants of Birth Spacing in India
Authors: Sahu Priyanka , Pandey C.M. , Mishra Shambhavi
Published: September 2021

Background

Birth spacing is an important determinant of the high fertility populations and has a strong bearing on maternal and infant health. The birth interval is composed of three major components namely postpartum amenorrhoea (PPA), waiting time to conception and gestation. To manage the high fertility in India, the present study is aimed to investigate the differential pattern of duration of birth interval components with respect to various socio demographic, child mortality, family planning services etc.

Methods

The data for this analysis was taken from National Family Health Survey 2015-16 (NFHS-4), provides information on population, health and nutrition for India and each State / Union territory. It gathered information from 601,509 households from overall India.

Results

Cox’ regression explores infant mortality, lactation, use of contraceptive devices, son preference and religion are found significant (P < 0.01) factors on the dynamics of birth interval components After adjustment of the effects of other explanatory variables, duration of breast feeding (P < 0.01), infant mortality (P < 0.01) and family income (P < 0.05) are found to have their significant impacts on the variation of PPA whereas death of previous child in infancy (P < 0.01), sex of previous child (P < 0.05), lactation (P < 0.01), education of mother (P < 0.05), and use of effective contraceptives have are found to be significant factors influencing the duration of waiting time to conception.

Conclusions

Among the determinants, infant mortality, lactation and religion have significant impacts on both duration variables in the Cox’s stepwise regression models.

Key messages

To control the growth of population, birth spacing must be maintained.
716A study of clinical and trichoscopic evaluation of diffuse hair loss in adult females
Authors: Sahu Priyanka , Pandey C.M. , Bhatia Shibani
Published: September 2021

Background

Hair fall is a major concern to the patient leading to angst, psychological distress and decrease in quality of life style, more so in female. The aim of the study is to evaluate diffuse hair loss (DHL) in adult females & find the underlying causes.

Methods

This was an observational, prospective time bound hospital-based study including clinical and trichoscopic evaluation of DHL in women. 222 adult women who had DHL of 4 or more weeks were studied. Detailed history was taken and clinical examination was performed. Laboratory investigations like Hb, Iron Profile, Thyroid Panel was also noted. Trichogram, trichoscopy was performed for perfect visualization of hairs.

Results

Among the subjects, 95 women were diagnosed as having female pattern hair loss (FPHL), 89 as telogen effluvium, 24 as chronic telogen effluvium (CTE) while 14 had FPHL and TE both. Mean age of females was 33.92 ± 5.46 years. Majority, 145 (65.3%) of the patients were in the age group of 31-40 years. Stress (18%) and PCOD (15%) were the most common precipitating factors. Majority (75.3 %) females with TE have positive hair pull test. Brown peripilar sign (PPS) and white PPS was present in 15.8% and 8.1% women respectively.

Conclusions

The common causes for DHL are FPHL, TE, CTE and FPHL with TE.

Key messages

Along with definitive treatment, understanding of the cause of hair loss by the patient goes a long way in appropriate beneficial lifestyle modification and holistic management.
626Epidemiology of facial injuries in the context of fatal family violence in the Victorian population
Authors: Sarkar Reena , Ozanne-Smith Joan , Bassed Richard
Published: September 2021

Background

The oral cavity is reported to be a key focus of physical injury in family violence (FV). Our purpose is to explore the potential opportunity for dentists to assist in the prevention of serious injuries in FV. This paper aims to describe the patterns of orofacial injuries in FV homicides.

Methods

All FV homicides in Victoria, Australia January 2006-December 2018, were identified amongst closed cases of assaults screened for eligible victim-offender relationships. Epidemiologic trends in FV in the Victorian population over the 12-year period were determined. Sociodemographic, interpersonal, incident and injury characteristics including ICD-10 coding were studied and compared across facial and non-facial injury FV subgroups.

Results

There was a non-significant downward trend in FV homicide over the period. Of 170 adult cases, 150 were included for facial injury analysis. Of these, 117 (78%) showed orofacial injuries in the 12-year period. Two-step cluster analysis revealed blunt force and threat to breathing injury mechanisms to be significantly associated with facial FV and sharp force with nonfacial FV. Among the additional 26 child homicides, descriptive analysis elucidated patterns in 20 cases eligible for facial injury analysis. Coding limitations were found for the FV homicide cases.

Conclusions

This population study reports significant involvement of the orofacial region in the FV homicide population during the 12-year study period, potentially informing dental practice and the related policy framework in Victoria and internationally.

Key messages

The significant involvement of the orofacial region in FV homicides may inform optimal intervention outcomes in FV in Victoria.
1196Trajectories of disability throughout adolescence and labour force status as a young adult
Authors: Shields Marissa , King Tania , Dimov Stefanie , Kavanagh Anne , Spittal Matthew
Published: September 2021

Background

Young people with disabilities have poorer labour force outcomes than their peers without disabilities. Existing studies typically assess disability at one time point, obscuring potential variation in the experience of disability over time. This study aimed to identify trajectories of disability during childhood/adolescence and assess associations between trajectory membership and labour force status in young adulthood.

Methods

Group-based trajectory modeling was applied to disability status information from Waves 2-7 (age 4/5 to 16/17 years) of the Longitudinal Study of Australian Children; labour force participation (employed, unemployed, not in the labour force (NILF)) was measured at Wave 8 (18/19 years). Two logistic regression models assessed the relationship between trajectory group membership and labour force participation, adjusted for confounders.

Results

Four trajectory groups were identified: low (75.5% of cohort), low increasing (9.7%), high decreasing (10.9%), and consistently high (3.9%) prevalence of disability. Compared to individuals in the low trajectory (reference group), individuals in the consistently high trajectory had increased odds of being NILF at age 18/19 years (AOR 3.48, 95%CI 2.14, 5.68). Individuals in the low increasing trajectory had increased odds of unemployment at age 18/19 years compared to the reference group (AOR 2.93, 95%CI 1.91-4.48).

Conclusions

Results suggest that early experiences of disability among young Australians may differentially impact future labour force outcomes.

Key messages

Additional supports to prepare young people for the labour force should focus on individuals with consistently high or increasing prevalence of disability trajectories.
800A census approach to monitoring child development - informing policy and practice beyond survey samples
Authors: Sincovich Alanna , Brinkman Sally
Published: September 2021

Background

The Sustainable Development Agenda calls for population monitoring of children’s development. A census approach, as implemented in Pacific Island Countries (PICs), offers advantages beyond nationally representative survey samples in informing local policy and practice.

Methods

A census approach was employed in Kiribati, Samoa, Tonga, and Tuvalu to collect information from caregivers and teachers on the development of every child aged 3-5 years. Funded by the Global Partnership for Education through the Pacific Early Age Readiness and Learning Program, data were collected from 2013-17 using the early Human Capability Index (eHCI), a population measure of holistic child development.

Results

Locally, whole-of-country data collection in Kiribati (n = 8339), Samoa (n = 12191), Tonga (n = 6214), and Tuvalu (n = 549) enabled empowerment and mobilisation of communities to support children’s development through use of their own data. Nationally, a census approach provided reliable information on the magnitude of inequality within and across populations, understanding of development amongst sub-populations and minority groups, and the interplay between geographic and socioeconomic position and children’s development, together, highlighting what was working well and where extra supports were needed.

Conclusions

In PICs, information collected through implementation of the eHCI national census was able to inform a progressive universalist approach to policy and service delivery, including provision of the right mix of universal and targeted services needed to support populations.

Key messages

A census approach to monitoring child development can inform policy and practice in ways not otherwise possible via survey sampling, particularly in contexts where population estimates and weighting are not available/accurate.
1047Epidemiology of different Cancers in Rural Jodhpur (India)
Authors: Singh Garima , Raghav Pankaja
Published: September 2021

Background

Cancer is the second leading cause of death in India accounting for nearly 9.6 million deaths in 2018. Crude annual incidence rate of all cancers together in Rajasthan has increased from 1990 to 2016 from 58.8 to 72.6 per lakh population. Few studies done are based on hospitals and pathology centres, but the data is limited. Community based study is required to know the true burden and trend of cancer prevalent in the region.

Methods

A sampling frame was prepared from all the blocks in rural Jodhpur, one block was selected by simple random sampling. Then another sampling frame was prepared by enlisting the villages in the selected block, one third villages were selected by simple random sampling.

Results

Based on interim analysis, 25 villages have been surveyed till date, with the population of 57,856. We found 91 (0.16%) cancer patients, out of which burden of Oral cancer (19,20.87%) was highest followed by Breast cancer (17,19.31%), Laryngeal cancer (10,10.98%), Primary brain tumours (6,6.59%) respectively. Other cancers were Oesophageal cancer (5) Colorectal cancer (5) Cervical cancer (4) Leukemia (4) Bone tumours (4) Stomach cancer (4) Intestinal cancer (3) Pharyngeal cancer (3) Urinary bladder cancer (1) Thyroid cancer (1) Uterus cancer (1) Lung cancer (1) Renal cell carcinoma (1) Hepatocellular carcinoma (1) and Skin Cancer (1).Tobacco and Opium consumption were found to be associated with Oral and Laryngeal cancer.

Conclusions

According to the World Cancer Report 2020, Lung cancer is the leading cause of mortality followed by Breast cancer Colorectal cancer, Prostate cancer, Stomach cancer and Cervical cancer which is different from the pattern of Western India.

Key messages

This study highlights the common cancers and the need to have a public health approach to identify or create awareness for quick treatment.
357Infant pacifier sanitization and risk of food allergy: the Barwon Infant Study
Authors: Soriano Victoria , Koplin Jennifer , Forrester Mike , Peters Rachel , O'Hely Martin , Dharmage Shyamali , Wright Rosemary , Ranganathan Sarath , Burgner David , Thompson Kristie , Dwyer Terence , Vuillermin Peter , Ponsonby Anne-Louise
Published: September 2021

Background

Environmental microbial exposure and human gut microbiota play a role in development of the immune system and susceptibility to food allergy. Pacifier use has been inconsistently associated with allergy, but the association between sanitization and food allergy is unknown. We investigated the association between infant pacifier use, with a consideration of sanitization, and food allergy at age 1 in the Barwon Infant Study (BIS).

Methods

Questionnaire data were collected prospectively from pregnant mothers from the Barwon region of south-east Australia at baseline and at infant ages 1, 6, and 12 months. Pacifier sanitization was defined as the joint exposure of a pacifier and cleaning methods (antiseptic, mouth, tap water, boiling). Challenge-proven food allergy was determined at age 1.

Results

Any pacifier use at 6 months was associated with food allergy (aOR, 1.94; 95% CI, 1.04-3.61), but not at other ages. This overall association was driven by the joint exposure pacifier-antiseptic use (aOR, 5.90; 95% CI, 2.18-15.97) compared to no pacifier use. Among pacifier users, pacifier-antiseptic was still associated with food allergy (aOR, 3.88; 95% CI, 1.55-9.72) when compared to pacifier-no antiseptic use. Further, increased use of pacifier-antiseptic at 0, 1 or 2 interviews over the first 6 months was associated with higher food allergy risk (ptrend=0.005).

Conclusions

Joint exposure to antiseptics and pacifiers at 6 months increased the odds of food allergy, showing a trend with increased use over time.

Key messages

This is the first report of pacifiers used with antiseptic being positively associated with challenge-proven food allergy.
811Teaching “syndemic theory” in a High School class: a Problem Based Learning approach
Authors: Souza Israel
Published: September 2021

Focus of Presentation

The main focus of this work is a Problem Based Learning approach in a High School class after read an abstract “The Global Syndemic of Obesity, Undernutrition, and Climate Change: The Lancet Commission report”. The main students concerns is about ultra-processed products because they are not healthy, and their ecological footprints. So, the students had a question: how to search for this phenomena around the our school?

Findings

The classroom was split in two groups (A and B). The group A proposed a research about food wastage and group B proposed an opinion survey about ultra-processed food consumption and health self-perception. Both groups conduct either research around the school, in Paracambi city (Rio de Janeiro, Brazil). The group A found a huge food wastage despite a number of homeless in the city. The group B reached 22 interviews with individuals aged between 18 and 83 years. They found that all age groups reported consumption of ultra-processed foods and that younger people reported their health self-perception isn’t good.

Conclusions/Implications

Finaly, students presents their work at academic school session, and showed their notes about how the research stimulate themselves to study and understanding some phenomena like a relationship about obesity, undernutrition and climate change as syndemic, or synergy of epidemics.

Key messages

Problem Based Learning can be a stimulate strategy to teaching and learning about epidemiology topics
774The appropriateness of the Effort-Reward Imbalance ratio for investigating musculoskeletal symptoms
Authors: Stanhope Jessica , Weinstein Philip
Published: September 2021

Background

Effort-reward imbalance (ERI), an indicator of occupational stress, can provide valuable insights into musculoskeletal symptom (MSS) outcomes for workers. The ERI ratio is typically used in analysis, rather than the effort and reward variables individually, or the reward sub-scales (promotion opportunities, job security and esteem). The appropriateness of this approach has not been investigated. We were interested in the association between the ERI ratio and its components (e.g. effort, promotion opportunities), and MSS outcomes (the presence of any MSSs, and a range of consequences) in professional musicians.

Methods

Employed, professional musicians completed a questionnaire that included the short version of the Effort-Reward Imbalance questionnaire, and questions regarding their MSSs. Regressions were performed to determine the association between the ERI ratio and other ERI components, and MSS outcomes.

Results

The ERI ratio was associated with a number of MSS outcomes, including chronic MSSs and MSSs that impaired playing, however this relationship appeared to be driven by increased perceived effort, not by reward.

Conclusions

Our findings highlight the need to investigate the individual ERI components (e.g. subscales), rather than just the ERI ratio, when investigating the association between occupational stress and MSS outcomes. By doing so, more targeted recommendations can be made, which for musicians include reducing their perceived effort to lower their MSS burden.

Key messages

Studies investigating the association between occupational stress and MSS outcomes should investigate the individual components and subscales of the ERI model.
1454Renal disease in Aboriginal children and young adults (ARDAC): evolution to a data linkage study
Authors: Stephens Jacqueline , Sinka Victoria , Kerr Marianne , Dickson Michelle , Teixeira-Pinto Armando , Wong Germaine , Howell Martin , Alexander Stephen , Tong Allison , Craig Jonathan
Published: September 2021

Focus of Presentation

The ‘Antecedents of Renal Disease in Aboriginal Children and Young Adults’ (ARDAC) Study was the first large population-based longitudinal cohort study seeking to identify the early emergence and trajectory of kidney disease among Aboriginal and non-Aboriginal children. Since 2002, 3758 young people (2155 Aboriginal and 1603 non-Aboriginal) from across New South Wales, Australia, were enrolled, with clinical data collected every two years. However, the confluence of a maturing cohort, local issues (bushfires), and the COVID19 pandemic made follow-up screenings a challenge. As such, in 2021, ARDAC evolved into a data linkage to evaluate the cohort’s healthcare utilization and kidney health trajectory.

Findings

The ARDAC dataset contains 340 variables, which have been linked to a further 878 variables from state and federal government agency administrative datasets. Data incorporated in the linkage includes perinatal, pharmaceutical, hospital admissions, literacy, kidney health, kidney transplant, and death data. Preliminary findings from this unique and important linkage will be the focus of this presentation.

Conclusions/Implications

The breadth and scope of this data linkage makes it the largest on the kidney health of First Nations Peoples internationally. Analysis will provide a detailed understanding of the healthcare usage of this population and identify critical gender-specific timepoints and risk factors to inform the development of co-designed, community-driven strategies for future action.

Key messages

With governance provided by a strong Investigator-Advisory Group nexus, with extensive representation from Aboriginal and Torres Strait Islander researchers, patients, and community leaders, ARDAC is an exemplar of Aboriginal community-led research.
1Development of persuasive message to encourage help-seeking for depression
Authors: Suka Machi , Yamauchi Takashi , Yanagisawa Hiroyuki
Published: September 2021

Background

Delayed initial treatment contact for mental disorders is an important public health problem. The objective of this study was to develop persuasive messages to encourage help-seeking for depression.

Methods

Firstly, we conducted a questionnaire survey among Japanese adults to understand the reasons why people avoid seeking professional help for depression (BMC Public Health 2016). Secondly, we created 6 depression help-seeking messages with 3 frames× 2 formats and assessed their effectiveness in eliciting help-seeking intentions for depression (BMJ Open 2018). Thirdly, we redesigned the loss-framed formatted message to make it more visually appealing and made a trial of repeated message exposure with the aim of sustaining the messaging effect over time.

Results

Less than 40 % of survey participants reported a positive help-seeking intention for depression. The neutral-, loss-, and gain-framed messages were selected so as to be matched against the top 3 reasons for having no help-seeking intention, respectively. The loss-framed formatted message functioned better than the others; help-seeking intentions increased from 36% to 47% after the message exposure. Repeated message exposure increased the message retention rate (once 26% vs. twice 48% at 2-week follow-up) which enhanced the elicitation of help-seeking intentions.

Conclusions

The depression help-seeking message can elicit the intent to do so among people who otherwise lack this.

Key messages

The Step approach to Message Design and Testing is useful for developing public health messages and materials.

Acknowledge: This work was supported by JSPS KAKENHI Grant Number JP25460815, JP16K09147 and the Uehara Memorial Foundation Research Grant.
1285Distinctive variations in accident and suicide mortality rates among Japanese elderly in 2020
Authors: Takahashi Mihoko , Kamei Midori , Uemura Makiko
Published: September 2021

Background

In April 2020, the Japanese government requested that people stay home except when unavoidable for their livelihood, as a COVID-19 emergency measure. Especially, elderly people refrained from going out. We investigated mortality rates from external causes in 2020 among Japanese elderly people.

Methods

The monthly mortality rates from accidents (V01-X59), traffic accidents (V01-V99) and suicides (X60-X84) among elderly from 2015 to November 2020 were analyzed. Ordinary monthly expected values and reference ranges (RR: 95% range) were calculated by cause and sex and compared with the observed values.

Results

All accidents: Abnormal increases (beyond the RR) occurred in August for both sexes.

Traffic accidents: Extreme decreases (below the RR) occurred in at least 3 months from March to October for each sex.

Suicides: Extreme decreases occurred in at least 2 months from February to May for each sex. Abnormal increases occurred in November for males, and in September to November for females.

Conclusions

Extreme decreases in traffic accident mortalities can be explained by people staying home. Abnormal increases in accident mortalities in summer might be explained by the heat. The increases might also be related to wearing face masks. Suicide results suggest that females are especially vulnerable to the social environment created by the preventive measures against COVID-19.

Key messages

COVID-19 measures might have affected the physical, mental, and social well-being of elderly people.

Acknowledgements

This study was supported by Mitsui Sumitomo Insurance Welfare Foundation.
455Association of interpregnancy interval and preterm births: what does a sibling-matched study indicate?
Authors: Tessema Gizachew , Marinovich M Luke , Håberg Siri E , Gissler Mika , Mayo Jonathan A , Nassar Natasha , Ball Stephen , Betrán Ana Pilar , Gebremedhin Amanuel T , de Klark Nick , Magnus Maria C , Marston Cicely , Regan Annette K , Shaw Gary M , Padula Amy M , Pereira Gavin
Published: September 2021

Background

Most evidence for interpregnancy interval (IPI) and adverse birth outcomes come from between-women (unmatched) studies that are prone to incomplete control for confounders that vary between women. Comparing pregnancies to the same women (sibling-matched) can address this issue.

Methods

We conducted an international longitudinal study of births from Australia, Finland, Norway, and United States (California) covering over three decades (1980-2017). We included 5,523,914 births to 3,849,737 women, and within each country, we first investigated the associations between IPI and preterm birth (PTB), spontaneous PTB using logistic regression (unmatched analyses). Second, we used conditional logistic regression comparing IPIs in the same women (sibling-matched analyses), with 2,908,907 births to 1,234,730 women having at least two IPIs. Random effects meta-analysis was used to calculate pooled effect estimates.

Results

Compared to an IPI of 18-23 months, there was insufficient evidence of association between IPI <6 months and overall PTB (adjusted odds ratio (aOR)=1.08, 95%CI 0.99-1.18) but increased odds of spontaneous PTB (aOR=1.38, 95%CI 1.21-1.57). We observed elevated odds of both birth outcomes associated with IPI ≥60 months. In comparison, between-women analyses showed elevated odds of adverse birth outcomes for <12 month and >24 month IPIs.

Conclusions

We found consistently elevated odds of PTB following long IPIs. IPI shorter than 6 months were associated with elevated risk of spontaneous PTB, but there was insufficient evidence for increased risk of overall PTB.

Key message

Current recommendations of waiting at least 24 months to conceive after a previous pregnancy, may be unnecessarily long in high-income countries.
322Incidence, and mortality associated with primary postpartum haemorrhage following hospital births in northwest Ethiopia
Authors: Tiruneh Bewket Tadesse , McLelland Gayle , Plummer Virginia
Published: September 2021

Background

Primary postpartum haemorrhage remains the primary cause of maternal mortality, in low-resource countries such as Ethiopia. National datasets about the incidence of primary postpartum haemorrhage are often limited, incomplete or unavailable. This study was designed to determine the incidence, mortality, and factors associated with primary postpartum haemorrhage following in-hospital births.

Methods

This was a cross-sectional study design, an audit of 1060 maternity care logbooks of discharged women. The data were abstracted December to May 2018/2019 using systematic random sampling. The tool used was the Facility Based Maternal Death Abstraction Form. Data were entered, cleaned then analysed using SPSS version 25. Bivariate logistic regression was fitted. Adjusted odds ratio with 95% confidence interval was used to determine the statistical significance.

Results

The incidence of primary postpartum haemorrhage was nearly 9.0% (95% CI: 6.91, 10.73). Of these, there was 7% maternal mortality. Unique to women in Ethiopia health facility referrals of women in labour (AOR: 2.13; 95% CI: 1.19, 3.80), birth attended by final year medical students (AOR: 3.59; 95% CI: 1.89, 6.84), women who were discharged as early as six hours following birth (AOR: 3.50; 95% CI: 1.24, 9.91) were associated with primary postpartum haemorrhage (p < 0.05).

Conclusions

The reported incidence of primary postpartum haemorrhage was relatively low, however, the associated deaths of women found was comparatively high.

Key messages

The increased maternal mortality appears to be directly related to the three delays model.
1473Early life immune modulatory exposures and allergy risk in Japanese children
Authors: Urayama Kevin , Furusawa Yoshimi , Hoshino Eri , Ohde Sachiko , Onishi Kazunari , Takahashi Osamu , Fukui Tsuguya
Published: September 2021

Background

Incidence of allergies among children is increasing and is an important public health issue. We examined whether early life immune modulating exposures and surrogate measures are associated with a reduced risk of allergic diseases among Japanese children.

Methods

We analyzed data from the Health Diary Study comprising a nationally representative cross-sectional sample of children/adolescents aged 1 to 17 years in Japan. Data were collected on early life factors and diagnosed allergic diseases using a self-administered questionnaire. Multivariable logistic regression was conducted evaluating the effects of delivery method, breastfeeding, infections in infancy, older siblings, and daycare on the risk of any allergy and specific types.

Results

Among 744 children included (mean age=9.5 years; 52% males), 41% experienced an allergic condition. Infection in infancy was associated with an increased risk of asthma (OR = 1.77, 95% CI: 1.09-2.85) especially related to bronchitis and ear infection, and showed a dose-response effect with increasing number of infections (p=0.04). Having older sibling(s) modified the effect of infections on asthma risk (p-interaction=0.11). Reduction in risk of allergic rhinitis was suggestive related to exclusive breastfeeding and having two or more siblings.

Conclusions

Evidence is unclear regarding a protective role of early life immune modulatory exposures in allergy risk in Japanese children. In contrast, infectious episodes in infancy may increase the risk of asthma.

Key messages

While multiple mechanisms may be at play, infections in infancy may increase the risk of asthma which supports protection against infectious transmissions.
773Triple elimination of mother-to-child transmission of HIV, syphilis and hepatitis B in the Pacific Islands
Authors: Van Gemert Caroline , Hellard Margaret , Howell Jess , O'Connor Michelle , Cowie Ben , Allard Nicole , Homer Caroline , Brink Anne , Chan Po-Lin , Kaldor John , Hockin Jane
Published: September 2021

Background

Without intervention, HIV, hepatitis B virus and syphilis can be transmitted from mother-to-child during pregnancy, birth and breastfeeding and these can cause adverse pregnancy and longer-term outcomes. The 22 Pacific Island countries and territories (PICTs) have among the highest global prevalence of syphilis and hepatitis B. Mother-to-child transmission remains a concern, particularly hepatitis B. Global and regional elimination targets have been set to eliminate mother-to-child transmission (EMTCT) however progress of PICTs towards meeting targets is unknown.

Methods

Data from 2000-2019 relating to EMTCT epidemiological, process and impact targets were extracted from peer reviewed literature, online data repositories and grey literature.

Results

27 peer reviewed reports, data from online data repositories for 19 countries and twelve national demographic and/or health reports were collated. Existing online databases report data for only small number of EMTCT indicators and there are few peer-reviewed studies that report EMTCT coverage estimates for PICTs. Availability of data varied between countries and available data suggests that few countries are meeting EMTCT indicator targets.

Conclusions

Based on the current trach trajectory, PICTs will not reach triple elimination by 2030. Both interventions to improve EMTCT activity coverage and strengthened surveillance, monitoring and evaluation systems are required.

Key messages

Mother-to-child transmission of HIV, hepatitis B and syphilis is a major concern in the Pacific and increased efforts are required, including strengthened monitoring and evaluation systems.
520Helicobacter pylori infection in parents and their children
Authors:   Watanabe,   Helicobacter pylori infection in parents and their children Teruo Nagaya1, Helicobacter pylori infection in parents and their children Hiroko Nakagawa-Senda,   Helicobacter pylori infection in parents and their children Satoyo Hosono,   Helicobacter pylori infection in parents and their children Kyoko Ban,   Helicobacter pylori infection in parents and their children Tamaki Yamada,   Helicobacter pylori infection in parents and their children Sadao Suzuki
Published: September 2021

Background

Helicobacter pylori (H.pylori) may be commonly transmitted among family members, especially from parents to their children. Therefore, we investigated the prevalence of H.pylori infection in parents and their children.

Method

The subjects (n = 607) were selected from participants of the Japan Multi-Institutional Collaborative Cohort Study in Okazaki, Japan, which was conducted from November 2018 to March 2019, and their families. Of the 607 subjects, 126 subjects (32 men=fathers, 94 women=mothers) participated in this study with at least one of their children (126 children in total). We defined ‘H.pylori infection+’ as 1) H.pylori antibody titer≥3U/mL or 2) pepsinogen I ≤ 70ng/mL with the ratio of pepsinogen I/II≤3.0 or 3) past eradication of H.pylori or 4) past history of gastric cancer. The prevalence of ‘H.pylori infection+’ was compared with between mothers and fathers who has infected children. Finally, the 94 mothers were divided into two groups according to their birth-year (1936-1963 and 1964-1973), and we compared the prevalence of ‘H.pylori infection+’ in mothers and their children by group.

Result

The prevalence of ‘H.pylori infection+’ in mothers and fathers was 44 (46.8%) and 9 (28.1%), respectively. 13 (29.5%) of the 44 infected mothers had at least one infected child, but the infected fathers did not have infected children. The prevalence of ‘H.pylori infection+’ in 50 mothers born in 1936-1963 was 28 (56.0%), and 9 (32.1%) of the 28 infected mothers had at least one infected child. The prevalence of ‘H.pylori infection+’ in 44 mothers born in 1964-1973 was 16 (36.4%), and 4 (25.0%) of the 16 infected mothers had at least one infected child.

Conclusion

In family members, H.pylori may be transmitted mainly from mothers, rather than from fathers, to their children.

Key messages

Among Japanese, the prevalence of H.pylori infection will decrease with decline of the infection in women.
502Modelling Chlamydia trachomatis and Mycoplasma genitalium transmission in men who have sex with men
Authors: Xu Xianglong , Fairley Christopher K , Zhang Lei
Published: September 2021

Background

Chlamydia trachomatis (CT) and Mycoplasma genitalium (MG) are two common sexually transmitted infections in men who have sex with men that are assumed to be transmitted only by oral and anal sex. However, this assumption has not been tested in mathematical models before.

Methods

To test a variety of potential transmission routes against the known proportion of infections at the oropharynx, mouth and anus, we established 20 compartmental models involving different sexual practices. We tested transmission by a) only anal sex and oral sex; b) adding rimming and kissing to anal and oral sex, and c) adding sequential sexual practices (e.g. oral sex followed by oral-anal sex (rimming) or vice versa.

Results

We could not replicate the proportion of anatomical sites infected with CT using anal or oral sex alone or by adding riming and kissing. However, if we included sequential sexual practices, then we were able to replicate the prevalence of CT at each site including infection at more than one site. In contrast, we were able to replicate infection for MG at the three sites using transmission routes that involved only anal sex and oral sex without the need for adding any other routes of transmission.

Conclusions

Our model indicates that more complicated transmission routes are required to explain the observed prevalence of infection with CT, but that for MG transmission involving only anal and oral sex is sufficient.

Key messages

Unlike CT, MG transmission does not require more complicated transmission routes.
279GWAS of heart rate in 87,759 Chinese subjects highlighted its genetic correlations with cardiometabolic traits
Authors: Yang Songchun , Yu Canqing , Guo Yu , Bian Zheng , Walters Robin G. , Millwood Iona Y. , Yang Ling , Chen Yiping , Du Huaidong , Chen Junshi , Chen Zhengming , Li Dalin , Lv Jun , Li Liming
Published: September 2021

Background

Resting heart rate (RHR) has been associated with risks of mortality and multiple chronic diseases. Previous studies, predominantly conducted in Europeans, have reported 91 independent variants associated with RHR and its genetic correlations with several cardiometabolic traits. Studies from East Asians are lacking.

Methods

We performed a GWAS for RHR in 87,701 participants aged 30-79 years from China Kadoorie Biobank (CKB). A linear mixed model was used under an additive model. Replication was conducted in 37,251 Chinese participants from CKB and UK Biobank. We conducted LD score regression to quantify genetic correlations across RHR and 11 cardiometabolic traits.

Results

Only 50 previously reported variants were replicated in CKB (=0.025). We identified ten novel loci associated with RHR (P<5 × 10-8), of which 50 candidate genes were prioritized. RHR showed significant genetic correlations with diastolic blood pressure (rg=0.258, P=5.71 × 10−10), mean arterial pressure (rg=0.225, P=3.08 × 10−8), systolic blood pressure (rg=0.170, P=4.92 × 10−5), plasma glucose (rg=0.197, P=0.003), total cholesterol (rg=0.287, P=0.012), and high-density lipoprotein (rg=0.246, P=0.030).

Conclusions

We identified ten novel loci associated with RHR in a large Asian cohort. The identified genetic correlations of RHR with blood pressure, glucose, and lipids indicate previously reported association of RHR with risk of all-cause death might be mediated via its correlations with cardiometabolic traits.

Key messages
177Physical functional limitations and psychological distress in people with and without colorectal cancer
Authors: Zhang Yuehan
Published: September 2021

Background

This study aims to quantify physical disability and psychological distress in people with and without colorectal cancer (CRC).

Methods

Questionnaire data (2006-2009) from 267,153 Australian general population members aged ≥45 years participating in the 45 and Up Study (n = 213,231 following exclusions) were linked to cancer registry and hospital admission data, to ascertain CRC status. Modified Poisson regression estimated adjusted prevalence ratios (PRs) for physical disability and psychological distress in participants with versus without CRC.

Results

Compared with participants without CRC (n = 210,836), CRC survivors (n = 2,395) had significantly higher disability prevalence (11.9% versus 19.5%, respectively): PR = 1.11 (95%CI=1.03-1.20); and a similar prevalence of distress (23.1% versus 20.2%): PR = 1.03 (0.94-1.20). Adverse outcomes were associated with certain clinical characteristics. Compared to participants without CRC, CRC survivors diagnosed 5-<10 and ≥10 years, with regional spread and without recent cancer treatment had similar outcomes; survivors with metastatic CRC and recent treatment had 30-60% higher prevalence of disability and distress. Compared to participants with neither CRC nor disability, PRs for distress were 4.71 (4.22-5.26) for those with disability and CRC and 4.22 (4.13-4.31) for those with disability without CRC.

Conclusions

Physical disability is elevated in CRC survivors. Psychological distress is elevated 4- to 5-fold with disability, regardless of CRC diagnosis, with lesser increases around diagnosis and treatment.

Key message

CRC survivors with less advanced disease and who have not been recently diagnosed or treated have physical disability and psychological distress comparable to the general population. Survivors with disability are at particularly high risk of distress.
586Effects of maternal circulating amino acids on offspring birthweight: a Mendelian randomisation analysis
Authors: Zhao Jian , Freathy Rachel , Evans David , Warrington Nicole , Langenberg Claudia , Stewart Isobel , Lotta Luca , Pietzner Maik , Borges Maria Carolina , Lawlor Deborah
Published: September 2021

Background

It is suggested amino acids are critical for fetal growth, but analyses assessing causality are lacking. Mendelian randomisation (MR) can be used to examine causal effects under instrumental variable (IV) assumptions.

Methods

We conducted a two-sample MR study utilizing summary data from genome-wide association studies (GWAS) of amino acids (sample 1, n = 86,507) and of offspring birthweight (sample 2, combined UK Biobank and Early Growth Genetics Consortium, n = 406,063). Seventy-five independent single nucleotide polymorphisms (SNPs) robustly associated with 18 amino acids (p < 4.9 × 10-10) were used as genetic instruments. Wald ratio and inverse variance weighted methods were used in MR main analysis. Sensitivity analyses were performed to explore IV assumption violations. To explore whether there was consistency between SNP-amino acid associations in pregnancy and in the GWAS, the latter were compared to associations in the Born in Bradford cohort.

Results

There was evidence of positive causal effects of maternal alanine (51.9 g birthweight increase per SD increase in amino acid level, 95% CI: 24.2, 79.5), glutamine (51.3 g, 95% CI: 33.5, 69.0), glycine (10.4 g, 95% CI: 1.3, 19.6) and serine (27.1 g, 95% CI: 11.2, 43.0) on birthweight and inverse causal effects of maternal isoleucine (-109.7 g, 95% CI: -194.6, -24.9) and histidine (-41.1 g, 95% CI: -78.5, -3.7) on birthweight. Sensitivity analyses to explore reverse causality and bias due to horizontal pleiotropy supported our findings.

Conclusions

Some maternal circulating amino acids have causal effects on birthweight.

Key messages

MR can be extended to probe effects of maternal nutrition on offspring development.
932Using marginal structural models to account for selection bias in the analysis of legacy effect
Authors: Zhu Lin , Hayen Andrew , Bell Katy
Published: September 2021

Background

Analyses of legacy effects are mainly based on post-trial follow-up study after initial randomized controlled trials (RCT). However, the differential event rates between arms may cause a violation of randomization balance and induce selection bias in the post-trial analysis. We conducted a simulation to illustrate the bias and explore if marginal structural model (MSM) can address it.

Methods

Our simulation combined an RCT and an extended follow-up study. The scenarios investigated include different settings of direct treatment effect, legacy effect and underlying event rate. To fit the MSM, we used the inverse probability weighting method. The performance of MSM was compared to the standard model with and without adjustment of baseline covariate.

Results

Post-trial analysis without making adjustment resulted in biased estimates, and the bias increased with the underlying event rate and treatment effect. Both MSM and standard baseline covariate adjustment equally corrected for the bias if no patients took treatment after the trial. We are currently undertaking analysis for scenarios where some people continue treatment post-trial, and there is treatment confounder feedback; these results will be presented at the Congress.

Conclusions

Estimation of legacy effects using post-trial data without adjusting for differential survival between randomised treatment arms results in biased estimates. Although both standard covariate adjustment and MSM correct the bias if no patients take treatment in the post-trial period, MSM is expected to be the best method in the more realistic scenario where some patients continue to take treatment, and there is treatment confounder feedback.

Key messages

Post-trial analysis without making adjustment results in biased estimation of legacy effect. Marginal structural models may be used to address the selection bias.