bluuebunny/crossref_metadata_2025 huggingface dataset:
1244Associations of endothelial function, arterial elasticity, and arterial stiffness with adiponectin and skeletal muscle mass
Authors: Agbaje Andrew O. , Barker Alan R. , Tuomainen Tomi-Pekka
Published: September 2021

Background

A temporal association where better arterial function and structure predicts adiponectin level and skeletal muscle mass during childhood remains uninvestigated.

Methods

We studied 5566 children and adolescents (51% girls) aged 9-11 years from the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort, Bristol, UK. Brachial artery endothelial function was determined using flow-mediated dilation (FMD), expressed as the percentage change in diameter from baseline after reactive hyperemia; arterial elasticity as distensibility coefficient (DC) expressed in mean percentage change in cross-sectional area relative to blood pressure (BP); and arterial stiffness by carotid to radial pulse wave velocity (crPWV). Skeletal muscle mass and total fat mass were assessed by dual-energy Xray absorptiometry. We conducted multivariable linear regressions with Sidak correction and adjusted for age, sex, total fat mass, cardiorespiratory fitness, pubertal status, brachial artery diameter, systolic BP, low-density lipoprotein cholesterol, mother’s social-economic class, and time (years) between the measurement of predictors and outcomes.

Results

FMD (β [95% CI]) = (0.027 [0.007 to 0.047]; P = 0.009) and DC (0.229 [0.088 to 0.369]; P = 0.001) were directly associated with skeletal muscle mass. FMD had a borderline inverse association with adiponectin (-0.004 [-0.008 to < 0.0001]; P = 0.056). crPWV was unrelated to adiponectin and skeletal muscle mass, while DC was not associated with adiponectin.

Conclusions

Better endothelial function and arterial elasticity were associated with higher skeletal muscle mass while arterial stiffness was unrelated to adiponectin and lean mass.

Key message

Healthy arterial function and structure may enhance muscle growth in children.
150Trends and factors associated with complementary feeding practices in Ethiopia from 2005 to 2016
Authors: Ahmed Kedir Yimam
Published: September 2021

Background

Introducing appropriate complementary feeding at sixth months of age is crucial for the optimal growth and development of an infant. The aim of this study is to investigate the trends and determinants of complementary feeding practices in Ethiopia from 2005 to 2016.

Methods

The study was conducted using the Ethiopia Demographic and Health Survey (EDHS) data for 2005 (N = 2520), 2011 (N = 2850), and 2016 (N = 2864). Multivariate logistic regression was used to examine the association between socioeconomic, demographic, health service and community-level factors and (i) the introduction of complementary foods, (ii) minimum dietary diversity (MDD), (iii) minimum meal frequency (MMF) and (iv) minimum acceptable diet (MAD).

Results

The proportion of mothers who met MDD increased from 6.3% to 13.5% and MAD increased from 4.1% to 7.1% from 2005 to 2016. Improvements in the introduction of complementary foods (from 50.3% to 59.5%), and MMF (from 41.3% to 43.6%) were not statistically significant. Maternal education and occupation were associated with the introduction of complementary foods, MDD, MMF and MAD. Higher partner education and frequent antenatal visits were associated with MDD and MAD. Children whose mothers listened to the radio had higher odds of MDD, MMF, and MAD.

Conclusions

Interventions aiming to improve complementary feeding practices in Ethiopia should also target mothers with low education, antenatal service usage and media exposure

Key messages

The study showed that there were improvements in the proportion MDD and MAD.
835Neighbourhoods and mental health in early childhood: what does the evidence tell us?
Authors: Alderton Amanda , Villanueva Karen , O'Connor Meredith , Boulangé Claire , Badland Hannah
Published: September 2021

Background

Mental health inequities can emerge early in life and are shaped by the daily conditions and environments where children develop, including neighbourhoods. Synthesizing evidence around neighbourhoods, disadvantage, and early childhood mental health can advance understandings of neighbourhood features (e.g. housing, parks) associated with (1) optimal mental health and (2) narrowing inequities.

Methods

We systematically searched and critically reviewed the international quantitative literature investigating associations between the neighbourhood built environment and young children’s (0-8 years) mental health, including positive aspects (‘competence’) and difficulties.

Results

Eight of the 14 included studies examined nature or public open space (parks); seven found some association between greater access to neighbourhood nature or parks and better mental health. Significant gaps included few studies investigating: (1) social infrastructure (e.g. services, childcare), (2) competence, (3) the extent to which the neighbourhood built environment closed the gap (versus benefiting children generally), and (4) pathways between neighbourhoods, disadvantage, and mental health.

Conclusions

Emerging evidence suggests that features of the neighbourhood are associated with young children’s mental health. Future research should unpack the neighbourhood’s role in narrowing inequities in early childhood. Availability of population linked geospatial and child development data in Australia offers opportunities to address these gaps and is prioritized as the next step in this research program.

Key messages

The neighbourhood built environment holds potential for promoting young children’s mental health. Future research should examine its potential to reduce inequities during early childhood.
1356Translating urban health research in Bangkok: partnership framework for building capacity in monitoring liveability
Authors: Alderton Amanda , Nitvimol Kornsupha , Higgs Carl , Butterworth Iain , Correia Joana , Davern Melanie , Badland Hannah
Published: September 2021

Focus of Presentation

This poster outlines a partnership framework for developing a web-based liveability indicators monitoring system for Bangkok, Thailand, as a mechanism for translating urban health research into urban planning and policy. We reflect on our partnership with the Bangkok Metropolitan Administration, including its critical success factors and framing around the Sustainable Development Goals, and provide an overview of the capacity building program supporting the use of the indicators in practice.

Findings

In total, 65 indicators were calculated for Bangkok and housed in a web-based urban liveability portal. A series of capacity building activities, including face-to-face meetings, webinars and online presentations, supported the use of these indicators in monitoring liveability. Numerous critical success factors were identified, such as having a bilingual liaison as well as two working groups within the Bangkok Metropolitan Administration.

Conclusions/Implications

This partnership provides a framework for other cities seeking to translate urban health research and progress the Sustainable Development Goals through building capacity in monitoring liveability. Future international partnerships should seek to engage partners through a mix of face-to-face and online activities and develop project governance structures (e.g. bilingual project liaison) that enable the prioritisation of local knowledge.

Key messages

This partnership provides a framework for translating urban health research into urban planning and policy, with relevance for other cities globally. It resulted in the mapping of 65 liveability indicators across Bangkok.
1364Predicting obesity and smoking using medication data: a machine-learning approach
Authors: Ali Sitwat
Published: September 2021

Background

Administrative health datasets are widely used in public health research but often lack information about common confounders. We aimed to develop and validate machine learning (ML)-based models using medication data from Australia’s Pharmaceutical Benefits Scheme (PBS) database to predict obesity and smoking.

Methods

We used data from the D-Health Trial (N = 18,000) and the QSkin Study (N = 43,794). Smoking history, and height and weight were self-reported at study entry. Linkage to the PBS dataset captured 5 years of medication data after cohort entry. We used age, sex, and medication use, classified using Anatomical Therapeutic Classification codes, as potential predictors of smoking and obesity. We trained gradient-boosted machine learning models using data for the first 80% of participants enrolled; models were validated using the remaining 20%. We assessed model performance overall and by sex and age, and compared models generated using 3 and 5 years of PBS data.

Results

Based on the validation dataset using 3 years of PBS data, the area under the receiver operating characteristic curve (AUC) was 0.70 (95% confidence interval (CI) 0.68 – 0.71) for predicting obesity and 0.71 (95% CI 0.70 – 0.72) for predicting smoking. Models performed better in women than in men. Using 5 years of PBS data resulted in marginal improvement.

Conclusions

Medication data in combination with age and sex can be used to predict obesity and smoking. These models may be of value to researchers using data collected for administrative purposes.
1315Influence of comorbidity on mortality in patients with Rheumatoid Arthritis 1980-2015: A longitudinal population-based study
Authors: Almutairi Khalid , Nossent Johannes , Preen David , Keen Helen , Inderjeeth Charles
Published: September 2021

Background

To describe temporal changes in mortality rates for patients with Rheumatoid arthritis (RA) in relation to comorbidity accrual from 1980-2015 in Western Australia (WA).

Methods

Using population-level linked data from WA health administrative datasets (hospital morbidity, emergency department and death data) we followed 17,125 RA patients (ICD-10-AM M05.00–M06.99, ICD-9-CM 714) from 1980- 2015. Comorbidity was ascertained using the Charlson Comorbidity Index (CCI). Mortality rate ratios (MRR) were calculated per decade between the RA cohort and the WA general population by direct age standardisation method,

Results

During 356,069 patient-years, a total of 8955 (52%) deaths occurred in the RA cohort. The highest prevalence of comorbidity (688.6 per 1000 separations) was in the period 1991-2000 following a 1.3% average annual increase since 1980. In-hospital mortality rate was highest (26.7 deaths per 1000 separations) in the same period. After 2001, both RA comorbidity and mortality rates decreased annually by -0.5% and -4.8%, respectively, with annual changes of -4.4% to -2% and from 2011-2015, respectively. The overall mortality rate in RA patients after age adjustment was 2.5-times (95%CI: 2.52-2.65) higher than the general population between 1980-2015 and 1.5-times (95%CI: 1.39-1.81) for 2011-2015.

Conclusions

The annual comorbidity prevalence and mortality rates in WA have decreased significantly since 2001 reflecting improvements in the management of RA and comorbidity.

Key messages

The mortality rate in Rheumatoid Arthritis patients in Western Australia remains 1.5-times higher than their community.
607Longitudinal weight gain and lifestyle factors in women with and without polycystic ovary syndrome
Authors: Awoke Mamaru Ayenew , Earnest Arul , Joham Anju , Hodge Allison , Brown Wendy , Teede Helena , Moran Lisa
Published: September 2021

Background

Women with polycystic ovary syndrome (PCOS) have a higher prevalence of overweight/obesity and greater weight gain than women without PCOS. The association of lifestyle factors with weight change in PCOS is not known.

Methods

We used data from the 1973-78 birth cohort of the Australian Longitudinal Study on Women’s Health collected from seven surveys over 19 years (N = 14127 survey 1). Linear mixed-effects models were used to examine associations between diet, physical activity, and sitting time with weight change, after adjustment for socio-demographics, psychological factors, and health care utilisation.

Results

Women with PCOS gained more weight annually (0·26 kg/year, 95% CI 0·13, 0·39; P < 0·0001) and over 19 years (4·75 kg; 95% CI 3·17, 6·34; P < 0·0001) than women without PCOS (adjusted analyses). For all women, there were positive associations between weight gain and energy intake, sitting time, and stress; inverse associations with fibre intake and physical activity; and no associations with diet quality, glycemic index, healthcare utilization, depression, or anxiety. There were interactions between lifestyle factors (energy intake P = 0·006, glycemic index P = 0·007, sitting time P = 0·029, and physical activity P = 0·022), PCOS status and time (age) such that weight gain varied between women with and without PCOS according to these factors.

Conclusions

Women with PCOS had a higher rate of weight gain than women without PCOS. This was most marked in those with indicators of unhealthy lifestyles. Increased stress, energy intake and sitting time and lower physical activity contributed to weight gain in women with and without PCOS.

Key messages

The findings reinforce the importance of early and ongoing lifestyle intervention and the potential use of specific lifestyle factors for weight gain prevention and management in PCOS.
250Different perspectives of survival outcomes for Australian cancer patients
Authors: Baade Peter , Kou Kou , Dasgupta Paramita , Cramb Susanna , Yu Xue Qin
Published: September 2021

Background

While relative survival is commonly used to describe cancer prognosis, its interpretation remains confusing. Alternative measures provide additional insights into the survival experience of Australian cancer patients.

Methods

Population-based cohort of over 2 million Australians diagnosed with 19 types of primary invasive cancer from 1982 to 2014 with mortality follow-up to 31 December 2015. Flexible parametric survival models were used to estimate loss of life expectancy, avoidable cancer deaths, crude survival, probability of cure and survival of uncured population for cancers diagnosed in Australia.

Results

There has been an overall decrease in the loss of life expectancy caused by a cancer diagnosis. Australians diagnosed in 2014 will gain an extra 432,588 life years due to the improvement in relative survival since 1982. Similarly, 29% (females) and 40% (males) of expected cancer deaths among the 2005-2014 cohort will be avoided compared to the 1985-1994 cohort. While the 10- year crude probability of cancer deaths decreased over time, patterns varied by cancer type. The crude probability of competing deaths increased with age. Between 1982 and 2009, the cure proportion increased significantly for all cancers.

Conclusion

Alternative measures of survival may help communicate the reducing impact that a cancer diagnosis has on average life expectancy.

Key messages

The growing number of Australian cancer survivors can pose emerging challenges to these patients, their caregivers, medical professionals and health-care systems in accessing or providing evidence-based survivorship and psychosocial care after a cancer diagnosis.
172A research-policy partnership for the achieving the Sustainable Development Goals in Bangkok
Authors: Badland Hannah , Alderton Amanda , Higgs Carl , Davern Melanie , Butterworth Iain , Correia Joana , Nitvimol Kornsupha
Published: September 2021

Focus of presentation

Through the UN’s Sustainable Development Goals (SDGs), there is a major commitment from cities to prioritise health and wellbeing, reduce poverty, support environmental resilience, and increase liveability. Existing tools for tracking progress towards liveable, equitable cities have been developed primarily for high-income country contexts. This project is a collaboration led by RMIT University (Australia), partnering with the Bangkok Metropolitan Administration (BMA) (Thailand), the UN Global Compact - Cities Programme, and the Victorian Department of Health and Human Services (Australia). It aims to provide a proof-of-concept spatial indicators system using open access and local spatial data to monitor progress towards the SDGs in Bangkok.

Findings

Approximately 50 spatial indicators aligned to the SDGs have been generated for Bangkok. These are available in a range of formats, including a bi-lingual online-portal, and static and interactive maps. The BMA have identified three Bangkok districts for deeper interrogation, and on-going workshops shape the capacity building activities.

Conclusions/Implications

This partnership has enhanced understandings of liveability within the SDG framework including: i) providing indicators for monitoring liveability in a low-to-middle income city context; ii) developing an international liveability network and deeper understanding of challenges; and iii) creating opportunities for capacity building and reciprocal learning.

Key messages

There has been little ‘liveability’ guidance for cities in low- or middle-income country contexts. This project contributes to the global SDG agenda to enhance health and wellbeing through the built environment in diverse contexts.
1034All-cause mortality in Australia: impact of social isolation and living alone
Authors: Barr Margo , Kabir Alamgir , Harris-Roxas Ben , Comino Elizabeth , Jackson Tony , Crozier Ann-Marie , Goodger Brendan , Finch Julie , Harris Mark
Published: September 2021

Background

The prevalence of social isolation (SI), living alone (LA) and loneliness among older people in Australia is 17%, 25% and 19% respectively. In a meta-analysis of 70 prospective studies undertaken by Holt-Lunstad et al (2015)1 they found, after controlling for covariates, a 29% increased all-cause mortality for SI, 32% for LA, and 26% for loneliness. But how accurate is this evidence for Australia considering that the meta-analysis only included three Australian studies; all only reporting on LA, and only one reported a significant effect of LA on total mortality.

Methods

We conducted a record linkage study in NSW using the Social Economic and Environmental Factors sub-study questionnaire data (n = 60,399) from the 45 and Up Study (n = 267,153) and death registrations (Centre for Health Record Linkage). Overall, 20% were SI and 18% were LA. Univariate and multivariable generalised linear models were used to estimate crude and adjusted 7-year all-cause mortality rate ratios (MRR).

Results

Crude MRR were 28% higher for SI and 98% higher for LA. When adjusted by age and sex they were still significantly higher (28% and 23% respectively). However, when controlled for covariates, SI was 9% higher [AdjRR(95%CI):1.09(1.01-1.18)] and LA had no effect on mortality [AdjRR(95%CI):1.05(0.94-1.18)].

Conclusions

As was the case for the Australian studies used in the meta-analysis we found no association between LA and all-cause mortality. We did however find a small significant effect for SI.

Key messages

Applying the overall meta-analysis results to Australia overestimates the effect of SI and LA on increased all-cause mortality.
1268Occupational risk factors for declined kidney function among field and non-field sugarcane workers in Peru
Authors: Bazalar-Palacios Janina , Zafra-Tanaka Jessica , Bazo-Alvarez Juan Carlos
Published: September 2021

Background

Compare the estimated glomerular filtration rate (eGFR) between field and non-field working in the sugar industry, exploring occupational factors associated with eGFR levels.

Methods

Cross-sectional study performed with workers of a sugar company in San Jacinto, Peru. We compared both groups regarding their eGFR<90 (ml/min/1.73m2) estimated from serum creatinine using the CKD-EPI prediction equation. We analyzed heat stress, vigorous activities and dehydration as risk factors associated with eGFR. We fitted Poisson regression models with robust variance to estimate the prevalence ratio (PR) of eGFR<90 between field and non-field and the association to risk factors.

Results

We analyzed the data from 137 men, aged 42.3 years (SD = 11.3) on average. Field (57/137, 41.6%) were exposed to higher occupational heat stress (median +0.1 °C), drank 0.7 litres more fluids, and developed more vigorous activities than non-field. The eGFR<90 was more prevalent in field (31.6%) than in non-field (23.6%). After adjusting for occupational factors, the PR between field and non-field was 1.40 (95% CI:0.83-2.37). Occupational heat stress (PR:2.11; 95% CI:1.06-4.22) and age (PR:1.04; 95% CI:1.01-1.08) were associated with a deteriorated renal function (eGFR<90).

Conclusions

Field had a more deteriorated kidney function compared to non-field. Strenuous work in high-temperature environments and age contribute to reducing the kidney function of field. Occupational interventions focused on these factors can help to reduce the incidence of Chronic Kidney Disease of an undetermined cause among Peruvian fields.

Key messages

Occupational health; Sugarcane work; CKDu.
931Work productivity trajectories in a representative sample of Australians living with multiple sclerosis- group-based modelling
Authors: Bessing Barnabas , Hussain Mohammad A. , Blizzard Leigh , Claflin Suzi B. , Taylor Bruce V. , Mei Assoc Ingrid van der
Published: September 2021

Background

Studies have documented loss of work capacity and work productivity loss in multiple sclerosis (MS). Little is known about the longitudinal trajectories of work productivity in MS.

Objectives

To explore trajectories of work productivity in people living with multiple sclerosis (PwMS) and examine the baseline factors linked with assignment to the trajectories group.

Methods

Study participants were from the Australian MS Longitudinal Study (AMSLS) from 2015 to 2018 who were employed with ≥2 datapoints (n = 1205). We used group-based trajectory modelling to identify unique work productivity trajectories in PwMS. Multinomial logistic regression was used to assess associations with the work productivity trajectories.

Results

We identified three distinct trajectories of work productivity: ‘moderately worsened’ (16.7%) with a mean work productivity of 47.6% in 2015, ‘mildly worsened’ (50.1%) with a mean work productivity of 86.3% in 2015 and ‘normal’ (33.2%) with a mean work productivity of 99.7% in 2015. On multivariable analysis, the relative probability of being in moderately or mildly worsened work productivity trajectory were higher for baseline factors such as higher education level, longer disease duration, higher disability score, and high MS symptom severity. For example, the relative probability of being in ‘moderately worsened’ rather than ‘normal’ work productivity trajectory increased by 94% (RRR:1.94 ; 95% confidence interval:1.68 - 2.25) for each unit increase in ‘fatigue and cognitive symptoms’ cluster.

Conclusion

Education level, disability and MS symptom severity increased the probability of following low work productivity trajectory.

Key messages

Work productivity interventions should target MS symptom severity and disability reduction.
1062Effectiveness of recruitment and retention strategies in a population based prospective LoCARPoN AIIMS cohort study
Authors: Bhasin Renu , Prasad Kameshwar , Dwivedi Sadanand , Kant Shashi , Vibha Deepti , Verma Vivek
Published: September 2021

Background

In Indian population, recruitment and retention of elderly population for any study is challenging due to different demographic variations and ageing effects. In LoCARPoN (Longitudinal Cognition and Aging Research in the Population of National Capital Region) Cohort study which is first study in India to identify the risk factors for stroke or major cognitive disorders among elderly different multiple strategies were adopted for recruitment and retention of healthy participants aged 50 years and above .

Methods

The study was conducted in urban population in Delhi, India. The strategies adopted for recruitment and retention of participants for 3 years including follow up is done by following multiple principles viz, participants centric, resource management, system functionality, approachable facilities and other reinforcement tactics.

Results

Among 18294 households, 9817 households were found to be eligible to participate in the study. Out of that 7383 houses were approachable others refused (2434) at first stage. By following the strategies which incorporates participants’ satisfaction, efficient system functionality and reliable information a total of 12250 eligible participants in 7383 houses were contacted, out of them 8858 (72.3%) were consented to visit medical sites . Out of he Consented individuals 7505 (61.3 %) visited medical site.

Conclusions

The multiple strategies used were very effective for recruitment and retention of cohort participants

Key messages

Multiple strategies concerning study participants needs flexible and approachable techniques helps in recruitment and retention in any longitudinal cohort studies.
961Absolute cardiovascular disease risk scores and medication use in rural India
Authors: Birhanu Mulugeta Molla , Evans Roger G , Zengin Ayse , Riddell Michaela A , Kalyanram Kartik , Kartik Kamakshi , Suresh Oduru , Thomas Nihal , Srikanth Velandai K , Thrift Amanda G
Published: September 2021

Background

Low-to-middle-income countries (LMICs) have limited resources to tackle the burden of cardiovascular disease (CVD). Most screening guidelines recommend the use of absolute risk scoring to determine treatment, but there is uncertainty among policy makers and clinicians about which risk algorithm to choose. We aimed to compare laboratory-based absolute CVD risk algorithms in a LMIC setting.

Methods

The study was conducted in the Rishi Valley, Andhra Pradesh, India. Over 8,000 participants were surveyed between 2012-2015. The 10-year absolute risk was computed and compared using the Framingham, WHO, and Australian absolute risk CVD algorithms.

Results

In participants aged 35-74 years, 151 (3%) had prior CVD. In all algorithms, absolute CVD risk increased with age and was greater in men than women. Using the WHO algorithm 4% were characterized as high-risk while >29% were at high-risk using the Australian risk tool. Agreement of risk classification among men ranged from a high of 84% (Spearman’s rho (rs) =0.92) between Australian and Framingham algorithms to 43% (rs=0.6) between the Australian and WHO risk scores. Among the high-risk population, only 15% were on lipid-lowering or antihypertensive therapy.

Conclusions

The Framingham and Australian risk scores enable some discrimination between high- and low-risk groups. However, the WHO algorithm underestimates these high-risk groups. Even though one third of the participants were at high-risk, most of them were not receiving recommended treatment.

Key messages

Lab-based CVD risk assessment tools have the potential in identifying high-risk populations in LMICs but the WHO risk scoring tool should be used with caution.
1374International representation of authors, editors and research in neurology journals
Authors: Bojanic Teodora , Tan Aidan
Published: September 2021

Background

Published research informs international healthcare, yet only a few studies have assessed the representation of authors, editors, and research from developing countries in biomedical journals.

Methods

We reviewed all research articles published in five high-ranking peer-reviewed neurology journals (The Lancet Neurology, Acta Neuropathologica, Nature Reviews Neurology, Brain and Annals of Neurology) in 2010 and 2019 to determine the extent of contributions of authors, editors and research from developing countries, and the degree of international research collaboration between developed and developing countries.

Results

First authorship was attributed to authors from developing countries in only 2% (11/729) of research articles in 2010 and 3% (19/647) of research articles in 2019. All 144 editorial board members in 2019 were from developed countries. International research collaboration between developing and developed countries accounted for only 4% (30/729) of all research articles in 2010 and 6% (40/647) of all research articles in 2019.

Conclusions

Representation of authors, editors and research from developing countries is rare in high-ranking peer-reviewed neurology journals, and this has not improved over the past decade. Supporting high quality and contextually appropriate biomedical research now is necessary for developing countries to meet the rising healthcare needs of their populations in the future.

Key messages

Published research should reflect the diversity of global health. There is an urgent need for strategies to support high quality and contextually appropriate biomedical research in developing countries.
345Occupational heat stress and economic burden: evidence to support development of workplace heat management policies
Authors: Borg Matthew , Bi Peng , Xiang Jianjun , Anikeeva Olga
Published: September 2021

Background

The adverse effects of heat on workers’ health and work productivity are well documented. However, the resultant economic consequences and productivity loss are less understood. This review aims to summarize the retrospective and potential future economic burden of workplace heat exposure in the context of climate change.

Methods

Literature was searched from database inception to October 2020 using Embase, PubMed, and Scopus. Articles were limited to original human studies investigating costs from occupational heat stress in English.

Results

Twenty studies met the criteria. Eighteen studies estimated costs from heat-induced labor productivity loss. Predicted global costs from lost worktime, in US$, were 280 billion in 1995, 311 billion in 2010 (≈0.5% of GDP), 2.5 trillion in 2030 (>1% of GDP) and up to 4.0% of GDP by 2100, with additional expenses after considering reduced work efficiency. Three studies estimated heat-related healthcare expenses from occupational injuries with averaged annual costs (US$) exceeding 1 million in Spain, 1 million in Guangzhou, China and 250,000 in Adelaide, Australia. Low- and middle-income countries and countries with warmer climates had greater losses as a proportion of GDP. Greater costs per worker were observed in outdoor industries, amongst males, and workers aged 25 to 44 years.

Conclusions

The estimated global economic burden of occupational heat stress is substantial. Climate change adaptation and mitigation strategies should be implemented to likely minimize future costs. Further research exploring the relationship between occupational heat stress and related expenses from lost productivity, decreased work efficiency and healthcare, and costs stratified by demographic factors, is warranted.

Key messages

The estimated retrospective and future economic burden from occupational heat stress is large. Responding to climate change is crucial to minimize this burden. Analyzing heat-attributable occupational costs may guide the development of workplace heat management policies and practices as part of global warming strategies.
533The psychosocial profiles of children aged 11-12 years who have self-harmed: A prospective cohort study
Authors: Borschmann Rohan , Mundy Lisa , Canterford Louise , Moreno-Betancur Margarita , Moran Paul , Allen Nicholas , Viner Russell , Degenhardt Louisa , Kosola Silja , Fedyszyn Izabela , Patton George
Published: September 2021

Background

Self-harm in very young people can be a clinically ominous event. While most studies to date have focused on self-harm during the teenage years, fewer studies have examined children aged 12 years or under. We aimed to estimate the incidence and correlates of recent self-harm in a population-based, non-treatment-seeking sample of primary school-aged children.

Methods

1059 children from 43 primary schools in Melbourne, Australia were interviewed at the age of 8 years (Wave 1), and followed up annually until the age of 11 years (Waves 2-4). Interviews covered a range of physical and mental health, social, educational and family domains, including (at Wave 4) self-harm during the previous 12 months.

Results

At Wave 4 (mean age: 11.9 years), a total of 28 children (3%; 18 girls [3%], 10 boys [2%]) reported self-harming during the previous 12 months. When compared with children who reported no self-harm, they were more likely to report depression, anxiety, poor emotional control, frequent bullying victimisation (including online bullying), truancy, recent alcohol consumption, and antisocial behaviour during Waves 1-3. They were also more likely to report having few friends.

Conclusions

Self-harm was reported by a proportion of community-dwelling children aged 11-12 years. As these children were more likely to report a range of other adverse behaviours, experiences and health conditions, clinicians should consider the possibility of prior self-harm when assessing children presenting with such behaviours and issues.

Key messages

The focus of intervention efforts aimed at preventing and reducing adolescent self-harm should extend to primary school-aged children, with a focus on mental health and peer relationships during the pubertal transition.
1283Licit and Illicit substances use among Brazilian youth population: a cross-sectional, nationwide study
Authors: Brito Emerson , Bessel Marina , Kops Natália , Souza Flávia Moreno , Wendland Eliana
Published: September 2021

Background

Psychoactive substances are increasing within the young population enhancing exposure to sexual risks, violence and mortality by preventable causes. Moreover, the use of these substances at this stage of life can be a predictor of abuse in adult live. Thus, this study aims to examine the patterns of drugs use in Brazilian young adults.

Methods

A cross sectional study was performed in all Brazilian capitals between September-2016 to December-2017. 8581 participants aged 16 to 25 years answered a structured interview with socio and behavioral questions. The sample was weighted in each capital by age range and sex.

Results

Alcohol (71.6%), cannabis (27.4%), and cocaine (9.9%) were the most common addictive substances experienced once in life in the sample. The regular use in the past 12 months was reported in 40.5%, 12.5% and 2.5%, respectively. Significant differences were observed between men and women in regular use of alcohol (48.7% and 32.5%, p<.001), cannabis (18.8% and 6.3%, p<.001) and cocaine (3.8% and 1.4%, p<.001). Also observed high drug consumption regarding to low education level, upper class population and who had partner presence. Additionally, participants who had previous homosexual relationship had high rates of regular alcohol (65.9%) and cannabis use (22.6%).

Conclusions

Brazilian youth showed high rates of psychoactive substances use mainly alcohol and cannabis. Thus, knowledge about the patterns of alcohol and drugs use in this population is important to direct actions and prevent associated risks.

Key message

High rates of alcohol and cannabis use are reported in Brazilian youth population.
997Childhood pneumonia in the Eastern Highlands Province, Papua New Guinea: clinical predictors of severe disease
Authors: Britton Kathryn , Pomat William , Ford Rebecca , Sapura Joycelyn , Kave John , Nivio Birunu , Lehmann Clinical Deborah , Chan Jocelyn , Russell Fiona , Blyth Clinical Christopher
Published: September 2021

Background

Pneumonia is the leading cause of death in young children globally and is prevalent in the highlands of Papua New Guinea (PNG). We investigated clinical predictors of severe pneumonia to inform local treatment guidelines in this resource-limited setting.

Methods

Between 2013 and 2020, prospective studies were undertaken enrolling children <5 years presenting with pneumonia to health-care facilities in Goroka Town, Eastern Highlands Province. Physical examination findings and blood cultures were collected. Logistic regression analyses were performed to determine predictors of hypoxaemia (oxygen saturation <90% on presentation), bacteraemia and death.

Results

There were 2067 cases of pneumonia, hypoxaemia was detected in 36.1%. Bacteraemia was identified in 47/1943 (2.4%) blood cultures. Of 1444 children followed up, 18 (1.2%) died. Central cyanosis (odds ratio 3.82, 95% CI 2.55-5.71) and reduced breath sounds (2.77, 2.17-3.53) independently predicted hypoxaemia; altered consciousness (21.44, 3.91-117.48), bronchial breathing (10.49, 2.01-54.63) and apnoea (2.54, 1.26-5.14) independently predicted bacteraemia; and altered consciousness (20.95, 2.32-189.00), reduced skin turgor (14.43 (4.79-43.49) and central cyanosis (5.96, 2.13-16.66) independently predicted death.

Conclusions

In children with pneumonia in the PNG highlands, those with central cyanosis, apnoea, bronchial breathing, altered consciousness or reduced skin turgor are at greatest risk of severe outcomes. Ongoing training of health care workers is essential to ensure these signs are recognised and appropriate management promptly instituted.

Key messages

Prompt recognition of signs of severity is likely to lead to better outcomes for children in PNG with pneumonia. These findings will inform future modifications to local treatment guidelines.
1428Factors leading to institutionalization among the oldest old. Longitudinal findings from the AgeCoDe-AgeQualiDe study
Authors: Buczak-Stec Elzbieta , Hajek André , Wagner Michael , Scherer Martin , Maier Wolfgang , Riedel-Heller Steffi G. , König Hans-Helmut
Published: September 2021

Background

Due to the strong association between old age and the need for long-term care, the number of individuals in need for care is projected to increase noticeably. The aim of this study is to examine determinants of institutionalization nursing home admission among the oldest old longitudinally.

Methods

Longitudinal data were gathered from a multicenter prospective cohort study (“Study on Needs, health service use, costs and health-related quality of life in a large sample of oldest-old primary care patients (85+)”; AgeQualiDe). At baseline (2014), complete measures were available for 684 individuals. The average age was 88.9ys (85-100), 68% were female. Sociodemographic and health-related variables (e.g., depressive symptoms, functioning) were included in the regression model. Institutionalization was defined as a date of admission to a nursing home. Competing risk survival analysis was performed using death as a competing event (Fine and Gray model).

Results

During the follow-up of the study, altogether 104 individuals were institutionalized, 81 died. Based on the estimated subhazard ratios, the risk of institutionalization increased with functional decline sHR=0.62, 95% CI [0.56-0.69] in total sample. Moreover, cognitive decline was associated with an increased risk of institutionalization only in men (sHR=1.73, 95%CI [1.05-2.87]).

Conclusions

Our findings stress the importance of functional decline (for both sexes) and cognitive decline (only for men) for institutionalization among the oldest old.

Key messages

Preventing or at least postponing functional decline might help to delay as far as possible institutionalization.
187Racial discrimination, life stress and allostatic load in Aboriginal and Torres Strait Islander adults
Authors: Cave Leah , Cooper Matthew N. , Zubrick Stephen R. , Shepherd Carrington C.J.
Published: September 2021

Background

Increased allostatic load is linked with racial discrimination exposure, providing a mechanism for the biological embedding of racism as a psychosocial stressor. We undertook an examination of how racial discrimination interacts with socioecological, environmental and health conditions to affect multisystem dysregulation in a First Nations population.

Methods

We conducted latent class analysis (LCA) using indicators of life stress, socioeconomic background and physical and mental health from a nationally representative sample of Australian Aboriginal adults (N = 2 056). We used LCA with distal outcomes to estimate the effect of the latent class variable on our derived allostatic load index and conducted a stratified analysis to test whether allostatic load varied based on exposure to racial discrimination across latent classes.

Results

Our socioecological, environmental and health measures informed a four-class structure; ‘Low risk’ (30.8%), ‘Challenged but healthy’ (27.8%), ‘Mental health risk’ (24.0%) and ‘Multiple challenges’ (17.4%). Mean allostatic load was highest in ‘Multiple challenges’ compared to all other classes, both in those exposed (4.5; 95% CI: 3.9, 5.0) and not exposed (3.9; 95% CI: 3.7, 4.2) to racial discrimination. Allostatic load was significantly higher for those with exposure to racial discrimination in the ‘Multiple challenges’ class (t = 1.74, p=.04) and significantly lower in the ‘Mental health risk’ class (t=-1.67, p=.05).

Conclusions

Racial discrimination may not always modify physiological vulnerability to disease. Social and economic contexts must be considered when addressing the impact of racism, with a focus on individuals and sub-populations experiencing co-occurring life challenges.

Key messages

Racial discrimination can increase physiological dysregulation in Aboriginal and Torres Strait Islander adults with a profile of psychosocial stress and adverse health.
710Do exercise facilities moderate the effect of socioeconomic inequities in Body Mass Index?
Authors: Tejedor Luis Cereijo , Tosio Pedro Gullón , Cerrato David Valadés , Badland Hannah , Tejero Manuel Franco
Published: September 2021

Background

The influence of area-level socioeconomic status (SES) on Body Mass Index (BMI) and adiposity is well known. There is an unequal distribution of exercise facilities (EF), which is dependent on area-level SES. However, is unclear whether EF intervenes on the relationship between SES and BMI.

Methods

BMI data were obtained from baseline of the Heart Healthy Hoods Cohort. Overall, 1,258 (40-75 years old) residents of Madrid, Spain were recruited between 2017 and 2019. Area-level SES was calculated for each census section based on 7 indicators in 4 domains: education, welfare, employment and living conditions. Availability of EF was defined as the count of EF in a 1,000m street network buffer around participants’ census sections of residence. A five-step mediation analysis was carried out to quantify the effect of EF availability. Analysis of each specific path was carried out with multilevel regression model, adjusted by sex and population density.

Results

Increases in SES were associated with decreases in BMI (β=-0.723, IC95% -1.003; -0.444). Alike, increases on availability of EF were associated with decreases on BMI (β=-0.09, IC95% -0.132; -0.048). Multilevel regression confirmed availability of EF was a significant moderator between SES and BMI (β=-0.566, IC95% -0.959; -0.173). Thus, the indirect effect of EF on the association between SES on diabetes was -0.258.

Conclusions

Availability of exercise facilities moderate socioeconomic inequities in BMI.

Key messages

Increasing the availability of EF in disadvantaged areas may have the potential to moderate inequities related to body size.
882Relationship of Urban Sprawl with Overweight and Obesity: Roles of Physically-Active and Sedentary Travel Behaviours
Authors: Chandrabose Manoj , Owen Neville , Hadgraft Nyssa , Sugiyama Takemi
Published: September 2021

Background

Urban sprawl – low-density neighbourhood developments at the city’s periphery – is related to risk of overweight/obesity. Our mediation analysis examined the extent to which this relationship may be explained by physically-active and sedentary travel behaviours.

Methods

We analysed data from 2,465 metropolitan residents in the 2011-12 wave of the Australian Diabetes, Obesity and Lifestyle Study. Urban sprawl measure was geographic information system derived residential proximity to the major city centre. Self-reported weekly frequency of walking for transport (WT) and car driving duration (car use) were used as measures of physically-active and sedentary travel behaviours. Risk of overweight/obesity was calculated using objectively-measured body mass index (> 25 kg/m2). Multi-level regression models and joint-significance mediation tests were used.

Results

Residing near the city centre was associated with higher levels of WT and lower levels of car use. For instance, compared to those living within 10km from the city centre, those living over 30km away had 57% lower WT frequency (p<0.001) and 1.4 hours/week more car use (p=0.002). In turn, lower levels of WT and higher levels car use were associated with elevated overweight/obesity risk.

Conclusions

These analyses suggest that travel behaviors can be potential mediators in relationships of urban sprawl with overweight/obesity. Future studies are warranted to assess causality of these relationships.

Key messages

Urban planning policies need to consider these impacts of the expansion of urban sprawl and promote inner-city high-density development by encouraging more physically-active travel and less time spent sitting in cars to reduce the population burden of overweight/obesity.
1411Alcohol and tobacco use and risk of multiple myeloma: a case-control study
Authors: Cheah Simon , Milne Roger , Harrison Simon , English Dallas , Giles Graham
Published: September 2021

Background

Although responsible for significant mortality and morbidity, our knowledge of modifiable causes of multiple myeloma (MM) remains limited. This analysis of an Australian population-based case-control family study investigated associations between smoking and alcohol consumption and MM risk.

Methods

Incident cases (n = 789) of MM were recruited mainly via cancer registries in Victoria and NSW. The controls included in the analysis (n = 1,113) were either family members of cases (n = 696) or recruited as part of a similarly designed case-control family study of renal cancer (n = 417). Unconditional multivariable logistic regression was used to estimate ORs, 95% CIs and p-values for associations between alcohol- and tobacco-related exposures and risk of MM.

Results

Heavy drinkers of alcohol had lower MM risk compared with non-drinkers (OR = 0.68, 95% CI = 0.50 – 0.93), and there was an inverse dose-response relationship for alcohol intake (OR per 10g ethanol per day = 0.92, 95% CI: 0.86 – 0.99); there was no evidence of interaction with sex (p = 0.27). There was no evidence of association between smoking-related exposures and MM risk.

Conclusions

These findings extend the knowledge of MM risk factor epidemiology. Further research into the causality of the association of alcohol with MM risk and potential underlying mechanisms is recommended.

Key messages

We found alcohol consumption to be inversely associated with risk of multiple myeloma.