bluuebunny/crossref_metadata_2025 huggingface dataset:
1079The need for information among cancer patients and their caregivers in Colombia
Authors: Pedraza Ana , Barrera-Suárez Erika , Pérez Luis , Soto Jesica , Arias María A. , Patiño Andrés , Chaparro Henry M. , Perales RN Vera J. , Rubiano Juan A. , Pinzón-Rondon Ángela M. , Cifuentes Claudia L. , Ruíz-Sternberg Ángela M. , Le PhuongThao D. , Taylor Carolyn
Published: September 2021

Background

Cancer is a worldwide concern and a public health issue. Physical symptoms and psychological effects of cancer place a significant burden on the quality of life of cancer patients. Several studies have demonstrated the positive benefits of tailored therapeutic education for cancer patients and their caregivers. Colombian population has important disparities in cultural and educational backgrounds and health care access in cancer patients. The aim of this study is to identify the informational needs of cancer patients and caregivers in Colombia.

Methods

We performed a descriptive qualitative study among cancer patients and caregivers at the Hospital Universitario Mayor-Mederi. Between August and November 2019 we conducted 7-focus group discussions with a total of 47-participants to understand the informational needs of the participants in the context of their own oncology diagnosis, treatment and rehabilitation in the Colombian health-system. The focus group discussion were transcribed verbatim and analyzed using content-analyses technique, identifying the emerging categories by saturation.

Results

The most salient themes of informational needs identified were: causes of the disease; continuous information tailored to treatment; treatment goals; adverse effects of treatment; warning signs; self-learning of the disease; nutritional and physical activity recommendations; alternative therapies.

Conclusions

This study provides specific types of information that can be incorporated into existing health promotional campaigns in order to address the informational needs of cancer patients and their caregivers.

Key messages

Incorporation specific types of information according to local necessities in cancer care can potentially alleviate the stress and burden among cancer patients and their caregivers
1409Legal abortion in the context of the COVID-19: a literature review focusing on Latin America
Authors: Pilecco Flávia B.
Published: September 2021

Background

The COVID-19 pandemic changed the functioning of several health services. This work aimed to understand how different countries, especially Latin Americans, dealt with legal abortion ones.

Methods

Narrative review on abortion and COVID-19 from January 1st, 2020 to March 10th, 2021. Databases searched included MEDLINE (through LitCOVID), Global Index Medicus, Virtual Health Library, and Journal Storage, complemented by gray literature.

Results

Of the 668 documents found, 111 were duplicated. After thematic screening, 75 were included. The vast majority reinforced the importance of abortion as a reproductive right and the maintenance of abortion services during the pandemic as essentials. Medical protocols without prior testing and supported by telemedicine were proposed to respect the distance measures. The pandemic amplified existing problems and restricted access to sexual and reproductive health services, such as legal abortion. This impact may be even stronger in low- and middle-income countries, especially in Latin America, where access to legal abortion is usually restricted. However, empirical peer-reviewed studies in this region are still scarce.

Conclusions

Latin American countries must place reproductive rights as a priority on their agendas and adapt legislation to accommodate alternative models of abortion care, or else they are at risk of increasing rates of unsafe abortions and maternal mortality, especially among the most vulnerable women.

Key messages

Maintaining legal abortion services during the pandemic is essential, at the risk of increasing maternal mortality, especially in contexts where access to these services is already restricted, such as in Latin America.
738Health Status and Quality of Life of Indigenous Elderly Population of Bangladesh
Authors: Rahman Farah Naz , Rahman AKM Fazlur , Khan Hafiz T.A
Published: September 2021

Background

Indigenous people, although constitute 1.8% of the country’s population, are one of the most deprived communities of Bangladesh in all sectors. This study was conducted to explore the health status and quality of life of indigenous elderly of Bangladesh as there is scarcity of knowledge regarding this.

Methods

A mixed-method approach was deployed on October,2019 in Sylhet-division of Bangladesh. A cross-sectional survey was conducted among 400 indigenous elderlies from 8 tea-gardens and ten in-depth-interviews were conducted with health-service providers of tea-garden health-facilities.

Results

Of the indigenous elderly-respondents, majority (79.5%) were suffering from any kind of chronic diseases. Visual difficulty was found predominant (74%) among the chronic conditions, followed by locomotion difficulty (49%) and gastrointestinal problem (41%). Extreme age, being male, living alone and low family income were significantly associated with suffering from chronic conditions. Furthermore, having chronic condition and extreme-age was found to be significantly associated with low quality of life. Health-service providers identified lack of logistical support in health-facilities, economic crisis and lack of awareness as the causes of poor health-status and health-seeking behavior of the indigenous elderly.

Conclusions

Indigenous older men in extreme old age are more vulnerable to adverse health conditions and poor quality of life. Health literacy and health seeking behaviour is poor among indigenous older adults generally and there is a huge gap in the health services and social supports available to them.

Key messages

Indigenous, Older population, Bangladesh.
515Association between hysterectomy and risk of thyroid cancer
Authors: Rahman Sabbir , Pandeya Nirmala , Neale Rachel , McLeod Donald , Jordan Susan
Published: September 2021

Background

Hysterectomy (surgical removal of the uterus) has been consistently associated with increased thyroid cancer risk. While there may be a biologic explanation, increased ascertainment (over-diagnosis) because of greater healthcare use by women having this procedure might also contribute to the observed increased risk. We explored this association considering indications for hysterectomy, age at hysterectomy, and the potential for the association to be mediated by increased contact with health professionals or increased thyroid function testing.

Methods

We recruited 730 women diagnosed with thyroid cancer and 785 age-matched population controls. We estimated odds ratios (OR) using logistic regression to assess the associations and used causal mediation analysis to investigate potential mediation.

Results

Prior hysterectomy was associated with an increased thyroid cancer risk (OR = 1.55, 95% CI: 1.14-2.12). When stratified by indication for hysterectomy, the increased risk was apparent only among those who had undergone hysterectomy for bleeding disorders (OR = 1.79, 95% CI: 1.26-2.56). Additionally, the association varied by age at hysterectomy (<55 years, OR = 1.68, 95% CI: 1.22-2.31 versus ≥ 55 years, OR = 0.87, 95% CI: 0.42-1.81). Around 30% of the association was mediated by more frequent use of healthcare services.

Conclusions

Hysterectomy for bleeding disorders was associated with an increased risk of thyroid cancer among women and a moderate proportion of this appeared due to frequent medical contact.

Key messages

The way in which women use health services probably explains at least some of the association between hysterectomy and risk of thyroid cancer.
610Official statistics on health outcomes and risk factors for small geographic areas
Authors: Rayson Ian
Published: September 2021

Background

The 2017-18 National Health Survey (NHS) is an Australia-wide detailed health survey conducted by the Australian Bureau of Statistics (ABS). Although the survey enables reliable National and State official health statistics, the sample size is too small to produce reliable data for smaller population areas. To produce such data the ABS applies an innovative Small Area Estimation (SAE) approach, combining the survey data and several population data sources.

Methods

We predict prevalence of each health outcome variable by fitting a logistic mixed model. The modelled NHS data are enhanced by data from the ABS 2016 Census, Estimated Resident Population, and several administrative sources including Medical and Pharmaceutical transactions.

Models are selected using a bespoke stepwise selection process; where the predictor variables have a strong association with the health outcome, whilst also ensuring that the estimated rates maintain consistency with published national data for that health outcome.

Results

Health statistics were produced for over 25 health outcomes and risk factors for 1134 Population Health Areas (PHAs) across Australia. The data show significant variation in rates between areas that are not evident in National and State level data. For example, the prevalence of adult current smokers in PHAs ranged from 4.4% to 34.6%, compared to 15.1% nationally.

Conclusions

The ABS SAE approach is an innovative method that enables production of reliable official health statistics, meeting a known data gap of local level health data.

Key messages

The ABS SAE approach delivers reliable official local health statistics, meeting an important data need not met using survey data alone.
817Official small area health statistics using the stratified reweighting method
Authors: Rayson Ian , Buttsworth Sean
Published: September 2021

Background

The Australian Bureau of Statistics (ABS) presently produces health data for small population groups using a Generalised Linear Mixed Model (GLMM) method. Although this method is highly effective at producing reliable local level health data, it takes several months to compile data once it’s collected. The Stratified Reweighting Method (SRM) was investigated as an innovative efficient method for producing local level health data.

Methods

The SRM harnesses information from both health survey and Census data. A cluster analysis of 12 Census data items creates 13 area groups with similar population demographics. A replicated survey data set is then created where each small area is bolstered by the other small areas within its area group. The survey weights from this dataset are adjusted to match Census data of each small area across several demographic variables. A final survey weight adjustment ensures consistency of the small area predictions with national survey estimates.

Results

Health statistics were produced for over 20 health outcomes in the latest ABS National Health Survey; and the ABS Survey of Disability, Ageing and Carers. It was found that, compared to the GLMM method: the models had lower, but still acceptable quality; the errors of prevalence estimates were similar magnitude; and the data compilation time was reduced to within two weeks.

Conclusions

The SRM is an efficient approach for producing acceptable quality official local health statistics.

Key messages

The SRM is an innovative and efficient weight-based method using health survey and population Census data to produce official local health statistics.
1116Spatial diffusion of the 2015-2016 Zika, dengue, and chikungunya epidemics in Rio de Janeiro, Brazil
Authors: Dalvi Ana Paula Razal , Braga Jose
Published: September 2021

Background

Text: Different countries, especially Brazil, that have faced recurrent dengue epidemics for decades and chikungunya epidemics since 2014, have had to restructure their health services to combat a triple epidemic of arboviruses - Zika, dengue, and Chikungunya - transmitted by the same vector, mainly Aedes aegypti, in 2015-2016. Several efforts have been made to better understand these three arboviruses. The knowledge of the patterns of spatial diffusion of diseases during an epidemic can contribute to the planning of surveillance actions and control of these diseases. This study aimed to identify spatial diffusion processes of these viruses in the context of the triple epidemic in 2015-2016 in Rio de Janeiro, Brazil.

Methods

Text: Two study designs were used: cross-sectional and ecological. Zika, dengue, and chikungunya cases notified to the national notificable disease surveillance system of the Ministry of Health of Brazil in 2015 and 2016 were used. The residential addresses of the cases were geocoded. Sequential Kernel maps, nearest-neighbor ratios calculated cumulatively over time, Moran global autocorrelation correlograms, and local autocorrelation changes over time were used to identify spatial diffusion patterns.

Results

Text: Our findings suggest an expansion diffusion pattern for the 2015-2016 triple epidemic of Zika, dengue and chikungunya in the city of Rio de Janeiro, Brazil, as well as the sites most affected by the diseases.

Conclusions

Text: The spatial diffusion pattern of expansion was suggested by the results of the spatial analysis used.

Key messages

Text: These findings can be considered for more effective control measures and for new studies on the dynamics of these three arboviruses.
1441Indirect effects of COVID-19 in Australia during 2020
Authors: Reynolds Anna , Moon Lynelle , Gourley Michelle
Published: September 2021

Focus of Presentation

COVID-19 is a major health threat that has led to substantial disruption to almost all parts of society worldwide. We brought together available data to assess the impact of the first 12 months of COVID-19 in Australia, examining initial data on the indirect effects of the pandemic on Australian’s health and welfare.

Findings

During 2020, Australia recorded lower than expected total mortality, in contrast to many other countries where excess mortality (higher than expected deaths) was observed. Age-standardised death rates for influenza and pneumonia, and chronic lower respiratory infections during both waves of COVID-19 cases were lower than in previous years. The initial impacts of the epidemic in Australia appear to have increased levels of psychological distress. However, the number of deaths by suicide in NSW, Victoria and Queensland have remained at similar levels to previous years. Important health behaviours, such as physical activity and alcohol consumption, worsened for some people but improved for others. The travel restrictions appear to have caused a reduction in injuries due to falls and road traffic accidents, particularly during the first lockdown in March-April 2020.

Conclusions/Implications

Public health measures introduced to control the spread of COVID-19 in Australia had both positive and negative health effects. The impact of these effects will need to be monitored over time.

Key messages

The indirect effects of COVID-19 in Australia are wide-ranging and include impacts on mental health, health behaviours and deaths from other diseases.
1466Vitamin D status before, during and after treatment and ovarian cancer survival
Authors: Ross Tanya , Webb Penny , Neale Rachel
Published: September 2021

Background

Previous work found higher serum 25-hydroxyvitamin D (25(OH)D) [circulating form of vitamin D] concentrations at diagnosis were associated with longer survival in patients with ovarian cancer (OvCa). There was no evidence for an association with 25(OH)D after primary treatment, but power was limited. Our aim was to reassess this association in a larger sample, including measures collected during treatment and using techniques to deseasonalise 25(OH)D.

Methods

Participants were diagnosed between 2002-2006 and 2012-2015 from the Australian Ovarian Cancer Study (AOCS) and the Ovarian Cancer, Prognosis and Lifestyle (OPAL) study, respectively. 25(OH)D concentrations were available for 676 at diagnosis (AOCS), 805 during treatment (AOCS:208; OPAL:597) and 861 after completion of primary treatment and before recurrence (AOCS:342; OPAL:519); 1006 AOCS samples were included in the previous analysis. Sociodemographic, diet and lifestyle data came from questionnaires self-completed at recruitment, and clinical/survival data from medical records, supplemented with National Death Index linkage. We will use Cox regression and non-parametric models to examine associations with survival.

Results

Median 25(OH)D concentrations were lowest during treatment, intermediate at diagnosis and highest after treatment (AOCS 51, 64, and 71 nmol/L, respectively). 5-year survival was 50% in AOCS and 59% in OPAL. Updated survival results will be presented.

Conclusions

If the association is confirmed in this updated analysis, then increasing vitamin D concentrations may provide a way to improve survival following OvCa.

Key messages

Higher circulating vitamin D concentrations may improve survival in OvCa.
1067Annual changes in job strain and risk of coronary heart disease in Denmark
Authors: Sørensen Jeppe Karl , Framke Elisabeth , Madsen Ida E.H. , Rugulies Reiner
Published: September 2021

Background

We examined the association between annual changes in job strain and incident coronary heart disease (CHD) in a population-based cohort study in Denmark.

Methods

We studied all workers residing in Denmark in 2000, aged 30-59 years with no prevalent CHD (N = 1,660,150). Using a job exposure matrix (JEM) with annual updates, we assessed changes in job strain from 2000-2009. Incident CHD was identified in hospital and death registers from 2001 to 2010. Using Cox regression, we calculated hazard ratios (HR) and 95% confidence intervals (CI) for the association between annual changes in job strain and incident CHD.

Results

During 16.1 million person-years (mean time of follow-up: 9.7 years), we identified 24,159 CHD cases (15.0 per 10,000 person-years). Compared to persistent no job strain, persistent job strain (HR 1.07, 95% CI 1.03–1.10), onset of job strain (HR 1.20, 95% CI 1.12–1.29) and removal of job strain (HR 1.20, 95% CI 1.12–1.28) were associated with higher CHD incidence.

Conclusions

Persistent and onset of job strain was associated with a higher risk of CHD. Removal of job strain was also associated with a higher risk, which might be due to health selection. Our results suggest that job strain contributes to risk of CHD in the Danish workforce.

Key messages

Implementing JEM in a population-based cohort of more than 1.6 million workers enabled us to demonstrate associations between annual changes in job strain and risk of incident CHD.
197Assessment of Depression, Anxiety and Fatigue in relation to diet quality in Multiple Sclerosis
Authors: Saul Alice , Taylor Bruce , Simpson Steve , Oddy Wendy , van der Mei Ingrid
Published: September 2021

Background

Many people with multiple sclerosis (MS) modify their dietary intake, but there is low evidence that this influences MS disease activity or progression. We examined whether indices of diet quality (Dietary Quality Tracker and Australian Recommended Food Score) were associated with depression, anxiety and fatigue using a prospective cohort.

Methods

The Auslong Study participants were followed annually for 10 years (n = 223 with MS at 10 years). Depression & anxiety (Hospital Anxiety & Depression Scale, HADS) and fatigue (Fatigue Severity Scale) were assessed at the 5th and 10th-year reviews. Dietary intake in the preceding 12 months using the Cancer Council Victoria Food Frequency Questionnaire was assessed at the baseline, 5th and 10th year reviews.

Results

Overall diet quality at the 5th-year review was not associated with a change in depression, anxiety or fatigue in the subsequent 5 years. However, a higher intake of protein, grain and discretionary foods at the 5th-year review using the Dietary Quality Tracker were associated with an increase in HADS depression score over the subsequent 5 years (e.g. highest vs lowest quartile protein: β=2.14,95%CI=0.91,3.37,p<0.001). Also, a higher legume intake at the 5th-year review was associated with a decrease in HADS anxiety score over the subsequent 5 years( e.g. highest vs lowest quartile: β=-1.92,95%CI=-3.32,-0.53,p=0.01).

Conclusion

Overall diet quality was not associated with a subsequent change in depression, anxiety or fatigue over 5-years but some specific food groups were associated with depression and anxiety. Replication is required before testing these findings with diet intervention programs in people with MS.

Key messages

Overall diet quality was not associated with 5-year change in depression, anxiety and fatigue in people with MS. However, some individual food groups were associated with a change in depression and anxiety.
523Use of beta blockers and death from breast cancer in New Zealand breast cancer patients
Authors: Scott Oliver , TinTin Sandar , Cavadino Alana , Elwood Mark
Published: September 2021

Background

Beta blockers (BB), used for a range of cardiovascular indications, have been associated with improved, worsened, and unchanged breast cancer outcomes in previous studies. This study examines the association between the use of BBs and death from breast cancer in a large, representative sample of New Zealand women.

Methods

Women diagnosed with a first primary breast cancer between 2007 and 2016 were identified from four population-based regional NZ breast cancer registries and linked to pharmaceutical data, hospital discharges, and death records. The median follow up time was 4.51 years. Cox proportional hazard models were used to assess the hazard of breast cancer specific death (BCD) associated with post-diagnostic BB use.

Results

Of the 14,976 women included in analysis, 21% used a BB after diagnosis. Although not significant, beta blocker use increased the risk of BCD (adjusted hazard ratio: 1.08; 95% CI: 0.93-1.26). The increased risk was seen only in those with at least one cardiac condition, and was also reduced by lagging the exposure, suggesting effects of BB use close to the end of life. The increased risk was also confined to short term use (0-3 months). BB use for more than 1 year was associated with a decreased risk of BCD, and the risk steadily decreased to HR 0.53 (95% CI: 0.33-0.85) for use for 3+ years.

Conclusions

Any increased risk associated with BB use is likely to be due to a combination of confounding by indication and short-term use. Long-term BB use may confer some protection for BCD.

Key messages

The effect of beta blockers is difficult to separate from the indications for the drug. While there was no significant overall effect, there was a suggestion that beta blockers may be protective for breast cancer death with long-term exposure.
1523Early political actions on education and healthcare sectors against COVID-19 in five Latin American countries
Authors: Gómez Arley , Segura Omar , Villamizar Licet , Rivera Diana , Niño Levinson , Bejarano Diego
Published: September 2021

Background

The first Latin-American COVID-19 case was reported in Brazil on February 26, 2020; since then, all regional governments tried to set-up sanitary measures to avoid COVID19 and lower mortality rates among susceptible population. Main goal here is to describe early political decisions and actions on education and healthcare against COVID-19 in five regional countries.

Methods

Qualitative study based upon intersectoral policy content analysis of bills, plans, and ministry-level documents issued in Argentina, Chile, Brazil, Colombia and Ecuador during February – April 2020; political actions and social reactions as depicted in broad news agencies (CNN, DW) were considered also. Analysis was categorized by three document levels (government, corporate, news), two dimensions (education, healthcare), five measures (quarantine, curfews, social distancing; hands washout, face mask). PDF/DOC/DOCX files were downloaded from their respective webpages, compiled in Google Drive, and analyzed to obtain both emergent categories and compacted texts for integration in a narrative way.

Results

Emerging categories included political/legal context, rationale, choice of approach against COVID-19, timeline, recurring concepts. Healthcare and education reflected citizens’ perception, states’ strength, and reactive/proactive congressional or ministerial responses. Lack of preventive measures - laboratory tests, low to none contacts’ follow-up, insufficient vaccines/biological products development, and failure in long-term education or science programs triggered a negative cascade effect.

Conclusions

Depending on each country, there was either compromise on social science to bolster executive management or negation, political polarization, and corruption/corruption of state structures; these issues are complex demanding long-term inter/transdisciplinary approaches solutions against a new pandemic in the future.

Key messages

Social and political structures and organization have had direct incidence in national response to COVID-19 pandemic.

In Latin America, long term research in both health and education is required facing a future new pandemic.
884Data sharing willingness and attitudes
Authors: Seidler Anna Lene , Tan Aidan , Hunter Kylie E , Barba Angie , Askie Lisa
Published: September 2021

Background

Row-by-row individual participant data (IPD) from a set of similar studies allows meta-analyses with exposure, confounder and outcome standardisation, and additional analyses at little extra cost. The ICMJE recently declared data sharing an ethical obligation. Consequently, registries have introduced mandatory data sharing statements. Our aims were to analyse data sharing willingness, and identify barriers and facilitators to data sharing.

Methods

We included all trials registered on the Australian New Zealand Clinical Trials Registry (ANZCTR) in 2019. We analysed data sharing statements from registry records, and conducted an in-depth survey. Associations between willingness to share data and trial characteristics (e.g. trial purpose, funding) were analysed.

Results

Of the 1,517 included trials, 23% planned to share IPD upon completion. Investigators were less willing to share IPD for industry-funded trials (OR = 0.50,95%CI=0.34-0.70), but there was no difference by sample size or health condition. The main reasons for not sharing IPD were concerns about participant privacy (22%), ethics approval limitations (19%) and lack of understanding for the need of IPD (17%). Among the 281 survey respondents, 78% supported data sharing, but only 40% intended to share their data. Major barriers included concerns about time/resources (96%) and insufficient academic recognition (91%).

Conclusions

There is insufficient willingness to share data, particularly among industry funders. Addressing the identified barriers can improve this.

Key messages

Data sharing enables the use of new methodologies, such as improved meta-analysis. Low willingness to share data jeopardises the use of these new methodologies and needs to be addressed.
919Step-by-step guidance on prospective meta-analyses
Authors: Seidler Anna Lene , Hunter Kylie , Cheyne Saskia , Berlin Jesse , Ghersi Davina , Askie Lisa
Published: September 2021

Focus of Presentation

In a prospective meta-analysis (PMA), studies are included before their results are known. This can reduce risk of publication bias and selective outcome reporting, and enables researchers to harmonise their research efforts. Despite rising numbers, there is little guidance on how to conduct PMA. We, the Cochrane PMA Methods Group, developed step-by-step guidance based on a scoping review, and expert opinions and experiences. Each step is illustrated with a recent case study.

Findings

We describe seven steps for conducting PMA. After developing a protocol (Steps 1), a systematic search for eligible planned/ongoing studies should be conducted, including a search of registries, medical databases and contacting stakeholders (Step 2-3). These studies are then invited to form a collaboration (Step 4), ideally including a steering and data analysis committee. Next, important study features such as common core outcomes and confounders are agreed upon (Step 5). This reduces heterogeneity and increases the number of available outcomes for meta-analysis. Certainty of evidence is assessed by adapting tools such as GRADE (Step 6). Results should be reported using adapted versions of reporting tools such as PRISMA (Step 7).

Conclusions/Implications

PMA reduce many problems of traditional retrospective systematic reviews and meta-analysis. Updated guidance and recent technical advances will help increase their numbers further.

Key messages

PMA are ‘next generation systematic reviews’ that allow for greatly improved use of data, whilst reducing bias and research waste. This step-by-step guidance will enable more researchers to conduct successful PMA.
178Depression but not physical activity mediates the fatigue-mental quality of life relationship in multiple sclerosis
Authors: Fidao Alexander , De Livera Alysha , Weiland Tracey , Jelinek George , Neate Sandra , Nag Nupur , Simpson-Yap Steve
Published: September 2021

Background

Fatigue is among the most prevalent symptoms of multiple sclerosis (MS), and significantly detrimental to mental quality of life. We examined the role of depression and physical activity as mediators in the fatigue-QoL relationship in MS.

Methods

Using an international study cohort measuring a wide range of lifestyle and clinical factors, determinants of fatigue (Fatigue Severity Scale) and mental quality of life (MSQoL-54; QoL) were assessed in 2,104 participants using log-binomial and linear regression, respectively. Structural equation modelling (SEM) was used to assess the mediating role of depression and physical activity between fatigue and mental QoL.

Results

The median mental QoL score in the sample was 73.8/100. The mean fatigue score was 40.5/63, with 65.6% having clinically significant fatigue. In SEM analyses evaluating depression as a mediator of the fatigue-QoL relationship, mental QoL was 14.17-points lower in those with clinically significant fatigue, of which the indirect effect via depression accounted for over 30.8% (p < 0.001). This mediation effect was most pronounced for the Role Limitations from Emotional Issues (44.9%, p < 0.001) and Emotional Wellbeing (41.6%, p < 0.001) subdomains. Evaluating physical activity as a mediator of the fatigue-QoL relationship, mental QoL was 11.03-points lower in those with clinically significant fatigue, of which the indirect effect via physical activity accounted for only 1.0% (p = 0.001).

Conclusions

This study provides evidence that depression accounts for a majority of the fatigue-mental QoL relationship, while physical activity only plays a small role. While replication and longitudinal studies are required for validation, our findings may inform the development of treatments for reducing the impacts of fatigue and improving QoL in people with MS.

Key messages

Fatigue’s negative impact on emotional quality of life in multiple sclerosis is not a function of reduced ambulation but instead its impact on depression. Reducing depression may thus markedly improve quality of life in this population.
100Identification of a latitude gradient in the prevalence of Primary Biliary Cholangitis in Australia
Authors: French Janine , Simpson-Yap Steve , Ng Justin , Angus Peter , van der Mei Ingrid , Gow Paul
Published: September 2021

Background

Primary biliary cholangitis (PBC) is an autoimmune destructive condition of the gall bladder, with environmental factors like sun exposure implicated in its aetiology, similar to multiple sclerosis. PBC prevalence varies significantly and appears to have a positive latitudinal gradient. To determine whether there was a latitudinal gradient of PBC prevalence in Australia using two methods of prevalence estimation: private pathology anti-mitochondrial antibody (AMA) results, the primary diagnostic test for PBC, and ursodeoxycholic acid (UDCA) prescriptions, the sole pharmacological treatment for PBC.

Methods

We investigated the latitudinal variation in PBC prevalence across the states and territories of Australia (latitudinal range 18.0° to 42.7°S) using pathology-based (private pathology AMA results search (three of the major private pathology companies in Australia which cover 77% of all private pathology testing) and PBC-specific prescription databases (prescriptions for UDCA).

Results

Pathology-based PBC prevalence was significantly increased with latitude, such that the postcodes in the highest quintile of latitude (encompassing the south coastal areas of the Australian mainland and insular Tasmania (latitude range -37.75 to -42.72)) had 1.83-times higher frequencies than those in the lowest quintile (encompassing tropical and southern Queensland (latitude range -18.02 to -27.59). Analogous results were seen for state-based UDCA prescriptions, being 2.31-times higher in Tasmania than Queensland.

Conclusions

We have found for the first time that the prevalence of PBC significantly varies with latitude in Australia. While the most immediate mediating factors underlying this association would be ultraviolet radiation and vitamin D levels, studies to substantiate this mechanism are needed.

Key messages

In line with some other autoimmune conditions, PBC shows a significant positive latitudinal gradient, with nearly 2-times higher prevalence in the southernmost state than the northernmost.
101Pre-onset sun exposure significantly associated with risk of primary biliary cirrhosis
Authors: French Janine , Simpson-Yap Steve , Ng Justin , Angus Peter , van der Mei Ingrid , Gow Paul
Published: September 2021

Background

Primary biliary cholangitis (PBC) is an autoimmune destructive condition of the gall bladder, with environmental factors like sun exposure implicated in its aetiology, similar to multiple sclerosis. Using a case-control study design, we assessed sun exposure across the life course prior to PBC diagnosis between PBC cases and age/sex-matched healthy controls.

Methods

Cases with definite/probable PBC were recruited, these having been identified from a PBC prevalence study. Age/sex matched controls were recruited from the electoral roll or at the Austin Hospital. Pre-onset sun exposure behaviours were queried at baseline by questionnaire and life calendar, this combined with ambient UVR data to estimate total UVR load. Relationships with case status were assessed using conditional logistic regression.

Results

200 cases and 200 age/sex-matched controls were recruited. 91% of the cases were female and the mean age was 63.6 years. Increasing sun exposure was associated with significantly lower odds of being a case, robust to adjustment for birthplace, education and smoking, the strongest associations seen for summer exposure in 6-10yo (OR = 0.39), 11-16yo (OR = 0.44), and 16-20yo (OR = 0.47). Similar results were seen for ambient UVR.

Conclusions

Higher pre-onset sun exposure and UVR load were associated with a decreased risk of primary biliary cholangitis. This is the first study that has examined the environmental risk factors of sun exposure and UV radiation with regard to PBC.

Key messages

In line with the observation of a significant latitudinal gradient in PBC prevalence, this work shows that pre-onset sun exposure is significantly lower among PBC cases compared to matched controls, suggesting sun exposure has an aetiological relationship with PBC risk.
909Testing ‘hardening hypotheses’ in 30 Global Adult Tobacco Survey countries: an ecological study
Authors: Sreeramareddy Chandrashekhar , Aye Saint His
Published: September 2021

Background

Evidence from high-income countries suggests “softening” but not “hardening” occurs when smoking prevalence decreases; however, evidence is lacking from developing countries.

Methods

We constructed heaviness of smoking index (HIS) based on cigarettes smoked per day (CPD) and time-to-first-cigarette (TTFC) and a score of 4-6 was high nicotine dependence; Hardcore smokers (HCS) are daily smokers who smoked within 30 minutes after waking up, smoke ≥10 cigarettes per day, have not made any quit attempts in 12 months, and have no intention to quit at all or during next 12 months; light smokers (<10 CPD or occasional smokers). We plotted two-way linear prediction graphs using country-level data and estimated Spearmańs rank-correlation coefficient. On pooled data multi-level binary logistic regression analyses for HCS, high dependence and light smoker.

Results

Among men and women range (lowest vs. highest) of rates varied between countries and were lower among women. Daily smoking prevalence was moderately and positively correlated with hard-core smoking (Rsp=0.473), and high dependence (Rsp=0.384) but negatively correlated with light smoking (Rsp=-0.677). HCS and high dependence were associated with socio-economic factors but effect sizes were higher for women. Among GDP and tobacco control score showed protective effect for HCS and high dependence but increased risk for light smoking.

Conclusions

Positive relationship of daily smoking with HCS and high dependence and its negative relationship with light smoking is contrary to “hardening hypothesis”.

Key messages

Hardening may not happen in developing countries as well.
456Mode of delivery and urinary incontinence in middle age: longitudinal analysis of the SWAN cohort
Authors: Stephenson Nikki , DR Brenner , Metcalfe Amy
Published: September 2021

Background

Urinary Incontinence (UI) is the involuntary loss of urine. Multiparity increases risk of UI, but this risk differs by mode of delivery. This study evaluated the association of mode of delivery (vaginal/cesarean) and prevalence of urge, stress, and mixed UI in middle age.

Methods

Using longitudinal data (baseline through visit ten collected annually) from the SWAN (Study of Women Across the Nation) cohort, the association between mode of delivery and UI subtypes was examined. We employed conditional mixed-effect logistic regression modelling, adjusting for baseline age, race, parity, smoking, diabetes, marital status, income, and body mass index. Menopausal status, hormone-replacement therapy use, and hysterectomy status were considered as time-varying and subject-specific covariates. A composite variable of mode of delivery was created to account for total pregnancies per participant, and women who experienced only vaginal (n = 2110) or caesarean (n = 379) deliveries were included.

Results

For women delivering vaginally vs cesarean, the baseline mean age (years) was 46.0(95%CI:45.9-46.1) and 45.6(95%CI:45.3-45.9), and proportion of perimenopausal women was 46.7%(95%CI:44.6-48.9) and 41.6%(95%CI:36.8-46.7). Women who deliver vaginally vs cesarean had an odds ratio (95% confidence interval) of 0.93(0.61-1.41), 1.46(1.04-2.05), and 1.58(1.21-2.05) for urge, stress, and mixed UI respectively.

Conclusions

The present study found vaginal deliveries increased odds of stress and mixed UI in middle age, but not urge UI.

Key Messages

Women have the most contact with health-care systems right after delivery; this is the optimal timing for increased awareness of UI in middle age and provision of interventions, including pelvic floor therapy, for women delivering vaginally.
1384Factors related to neck and shoulder pain during the COVID-19 pandemic in Japan
Authors: Tanaka Sayo , Ohde Sachiko , Katanoda Kota , Abe Sarah Krull , Tabuchi Takahiro
Published: September 2021

Background

Shoulder stiffness is a common health issue in Japan. During the COVID-19 pandemic, people were forced to stay home which possibly escalated the development of shoulder stiffness. We aimed to assess associations of lifestyle changes and newly developed neck and shoulder pain (NSP) during the pandemic.

Methods

A cross-sectional study was conducted, analyzing the data from the Japan COVID-19 and Society Internet Survey (JACSIS), an internet survey conducted from August to September 2020. Data included sociodemographic, lifestyle and health measures related to NSP during the pandemic. Multivariable logistic regression models were fitted to calculate adjusted odds ratio (AOR) with 95% confidence interval (CI) for newly developed NSP with adjustment for lifestyle, physiological and psychosocial changes.

Results

After exclusion of participants with existing pain, 25,482 participants (12,673 male, 12,809 female) aged 15-79 years were included in the analysis. Of these, 4.1% reported newly developed NSP. Weight gain and long sedentary time were strongly associated with the NSP (AOR (95%CI): 2.4 (2.0-2.8) and 1.81 (1.4-2.3)). Stratified analyses of 1,751 students and 4,211 teleworkers showed significant associations (AOR (95%CI): 2.1 (1.4-2.8) and 2.5 (1.9-3.2)) compared to non-workers and non-teleworkers, respectively.

Conclusions

Students and teleworkers became prone to NSP during the pandemic. However, factors which were associated to pain did not differ during the pandemic compared with the previous studies.

Key messages

Preventive measures for NSP should be taken in students and teleworkers.
1482Comparative epidemiology analysis of major depressive disorder with DSM-5 and DSM-IV criteria in high-income countries
Authors: Thakur Shilpa , Tadwalkar Swarali
Published: September 2021

Background

Depression is a major contributor to the overall global burden of disease and one of the leading causes of disability worldwide. In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) there were a few changes in the inclusion criteria but there is a limited literature to quantify this change.

Methods

We conducted a literature review using PubMed and Clarivate’s Cortellis database from 1/1/2008 to 7/4/2020, to identify the country-specific total prevalence of MDD according to the DSM-5 and DSM-IV in nine high-income countries. In countries lacking published prevalence estimates according to DSM-5 criteria, we derived DSM-5 prevalence estimates by multiplying the country-specific DSM-IV data with the ratio of DSM-5 to DSM-IV prevalence in countries with comparable risk factors and healthcare access.

Results

Changes in the criteria between the DSM-IV and DSM-5, resulted in a substantial increase (30%) in the MDD patient counts across the countries under study ranging from 0.1 million patients in New Zealand to 5.8 million in United States.

Conclusions

Total prevalent cases of MDD increased after the introduction of DSM-5 criteria because of the changes in the inclusion criteria. Elimination of bereavement as the exclusion criteria was one of the key changes which resulted in more patients becoming eligible for the diagnosis and treatment of MDD.

Key messages

This analysis provides a comparative insight into the effect of change in the DSM-IV to DSM-5 diagnostic criteria on the MDD patient counts which is not reported frequently in the published literature.
540A simulation to evaluate HTLV-1 screening for pregnant women in prevention of adult T-cell leukemia
Authors: Tomoya Takiguchi , Nishino Yoshikazu , Fukui Keisuke , Koriyama Chihaya , Itabashi Kazuo
Published: September 2021

Background

In Japan, the nation-wide screening program of pregnant women for HTLV-1 infection was launched in 2010 to prevent mother-to-child transmission. It is difficult to assess the effect of the screening program on adult T-cell leukemia (ATL) prevention by observational study because ATL develops after long-term (about 50 years) latency in HTLV-1 carriers. Thus, we assessed the effect of the screening using computer simulation.

Methods

We constructed our model that simulates lifetime history of the children born to HTLV-1 carrier mothers. Lifetime risks of ATL among the children in unscreened group and screened group were estimated employing Monte Carlo simulation. We developed three scenarios for the risk estimation of ATL in screened groups, each making different assumptions for the choice of feeding methods (formula feeding, short-term breast-feeding, and long-term breast-feeding).

Results

Our simulation revealed that lifetime risk of ATL among the children born to HTLV-1 carrier mothers was 1.19 % in unscreened group and 0.21 to 0.27 % in screened groups.

Conclusions

In Japan, it is estimated that there were 1,363 pregnant women with HTLV-1 infection in 2016 (Sekizawa 2018). From this figure, the estimated annual number of ATL patients prevented by the screening is 12.6 to 13.5.

Key message

HTLV-1 screening in pregnant women for one year is estimated to reduce the number of ATL among their children by about 13 in Japan.
306Association between polypharmacy and mortality in the community-dwelling older population: a data linkage study
Authors: Van der Heyden Johan , Berete Finaba , Devleesschauwer Brecht , De Ridder Karin , Bruyère Olivier , Renard Françoise , Charafeddine Rana
Published: September 2021

Background

Literature findings on the association between polypharmacy and mortality in older people are not consistent. Appropriate tools, making use of linkages, are helpful to investigate this further.

Methods

Data of participants of the Belgian Health Interview Survey 2013 aged ≥ 65 years (n = 1950) were linked with billing data and 5 year’s mortality follow-up information. Polypharmacy was defined as concomitant use of ≥ 5 medicines in the past 24 hours or ≥ 5 recent prescriptions of reimbursed medicines. The impact of polypharmacy on mortality was assessed through mortality rate ratios (MRR) from a Poisson regression model adjusting for gender, age, multimorbidity, functional limitations and health care use, and including interactions.

Results

The prevalence of polypharmacy was 38,3%. Age and disability status were effect modifiers in the association between polypharmacy and mortality. Whereas polypharmacy was significantly associated with mortality among people aged 65-79 years (MRR 2.52; 95% CI 1.67-3.80), this was not so for the 80 + (MRR 1.46; 95% CI 0.93-2.29). Polypharmacy was a mortality predictor among people with no/moderate functional limitations (MRR 2,29; 95% CI 1.61-3.25), but not for those with severe functional limitations (MRR 1,22; 95% CI 0.67-2.34).

Conclusions

By linking health interview survey, billing and mortality data further insights can be gained on the association between polypharmacy and mortality.

Key messages

A critical evaluation of polypharmacy in older people below 80 years and in people without severe functional limitations may reduce mortality in these population groups.
211Real-World Data Assessment Plan for a Heat-Not-Burn Tobacco Product: Proof of Concept
Authors: van der Plas Angela , Hankins Matthew , Heremans Annie
Published: September 2021

Focus of Presentation

Real-world data (RWD) is readily available in Japan through multiple sources. Considering the crucial need to substantiate the beneficial effects of switching from cigarette smoking to heat-not-burn (HNB) products, both at the individual and population levels, the use of RWD seems a viable option.

For instance, ecological studies using RWD have assessed the impact of population-level interventions such as smoking bans and their effects on smoking-related diseases and their endpoints

As a proof of concept, ecological analyses were performed to assess the rates of chronic obstructive pulmonary disease (COPD) exacerbations and acute Ischemic Heart Disease (IHD) hospitalizations before and after the introduction of and HNB product in the Japanese market.

Findings

Hospital admissions associated with ICD codes for COPD and IHD from 2008 to 2019—5 years before and 4 years after the introduction of the target HNB product in the Japanese market—were retrieved from the MDV database. Referrals were below those predicted from pre-launch trends.

Conclusions

The use of RWD in assessment of HNB products is viable for ecological studies with the well-known caveats. Their use in exposure-specific studies will become feasible once the systematic collection of exposure to tobacco products and use history is guaranteed. This will greatly increase the range and robustness of the evidence base.

Key messages

The use of RWD is a practical way of assessing the impact of HNB products in the population as a whole.