bluuebunny/crossref_metadata_2025 huggingface dataset:
300Association between rs2231142 of ABCG2 and gout, hyperuricemia and uric acid: Systematic review and meta-analysis
Authors: Lukkunaprasit Thitiya , Rattanasiri Sasivimol , Turongkaravee Saowalak , Ingsathit Atiporn , Attia John , Thakkinstian Ammarin
Published: September 2021

Background

Genome-wide association studies showed that rs2231142 (C421A) of ABCG2 gene has strong effects on gout and uric acid (UA). However, replication studies showed conflicting results. We aimed to pool effects of rs2231142 on gout, hyperuricemia, and UA across studies.

Methods

Studies were located from MEDLINE and Scopus until 17th June 2018. Data extractions were performed by two independent reviewers. Hardy-Weinberg equilibrium was checked. Genotype effects were pooled by ethnicity using mixed-effect logistic model for gout and hyperuricemia and multivariate meta-analysis for UA. Publication bias was assessed using funnel plots and Egger’s tests.

Results

Thirty studies were eligible; 21, 5, and 8 studies assessed association between rs2231142 and gout, hyperuricemia, and UA, respectively. Carrying AA and CA genotypes were 3.2 (2.4, 4.4) and 1.6 (1.5, 1.8) higher odds to develop gout in Caucasians. Likewise, in Asians, the ORs for corresponding genotypes were 4.5 (4.1, 5.0) and 2.1 (2.0, 2.3) for gout; 2.3 (1.8, 2.8) and 1.6 (1.4, 1.8) for hyperuricemia. Mean differences of UA in Caucasians carrying AA and CA were 50.4 (32.7, 68.2) and 19.5 (14.2, 24.7) µmol/l compared with those carrying CC genotype while in Asians, they were 18.4 (8.7, 28.1) and 11.5 (4.1, 18.9) µmol/l, respectively. Additive gene effects were suggested.

Conclusions

Significant effects of rs2231142 on gout, hyperuricemia, and elevated UA were confirmed. Our findings should be useful in personalized risk scores for prediction of gout and diseases related to high UA.

Key messages

rs2231142 increased the risk of gout and UA in Asians and Caucasians
1373Severe acute respiratory infection with high mortality rate in Sana'a city, 2018-2019 Yemen
Authors: Mahsoon Manal , Ghaleb Yasser , Al-dubaiee Riham , Amad Mohamed Al
Published: September 2021

Background

The burden of influenza and severe acute respiratory infection (SARI) in conflict countries such as Yemen is exacerbated due to limited resources and the collapse of the health system. The aims are to describe epidemiology of SARI, determine influenza detection and case fatality rates among SARI patients.

Methods

We used a descriptive analytical study design. All SARI patients who meet WHO case definition during 2018-2019 from Sana'a city were included. Nasopharyngeal samples were examined by polymerase chain reaction. A soft copy of data that collected by surveillance staff was obtained from the National Influenza Control Program (NICP). Case fatality rate and detection rate were calculated and P value < 0.05 used for statistical significant.

Results

1447 SARI patients were reported: 73% males, 54% aged 15- < 50 years. Comorbidity was among 27% (387) of them: (57% cardio-vascular diseases and 50% diabetes). Samples of 934 (64%) SARI patients were tested and influenza viruses were detected in 141 (15%) patients (13% type A and 2% type B). Higher influenza viruses were detected in winter months (November – February) (17% vs 9%, P < 0.001). Overall SARI fatality rate was 19% (276), significantly higher among patients with comorbidity (26% vs 16%, P < 0.001) confirmed influenza (30% Vs 15%, P value < 0.001) and not receiving antiviral (51% vs 17%, P < 0.001) than relevant groups.

Conclusions

SARI patients in Yemen had a high case-fatality rate particularly SARI patients with confirmed influenza. Introduce influenza vaccination for the risk group should be considered.

Key messages

Influenza and SARI cases are high in Yemen and progress to death.
1209Physical activity and sitting time across postpartum life stages: A cross-sectional analysis
Authors: Makama Maureen , Lim Siew , Skouteris Helen , Harrison Cheryce L. , Joham Anju E. , Mishra Gita D. , Teede Helena , Brown Wendy , Martin Julie C. , Moran Lisa J.
Published: September 2021

Background

Physical activity (PA) is beneficial for psychological wellbeing and weight management but is generally low in postpartum women. This study aimed to investigate how PA and sitting time (ST) varied with time since last childbirth.

Methods

Data from survey 5 (N = 5219) of the 1973-8 birth cohort (31 – 36 years) of the Australian Longitudinal Study on Women’s Health were used to assess association of time since last childbirth (0–6, 7–12 and >12 months) with PA and ST using multiple linear regression.

Results

In adjusted model, PA was lower at 0–6 (-238.5METmin/day; 95%CI -319.6, -157.4) and 7–12 (-81.2METmin/day; 95%CI -157.0, -5.5) than >12 months postpartum. ST was longer at 0–6 (0.65hours/day; 95%CI 0.39, 0.91), but not different at 7–12 than at > 12 months postpartum. Overall, higher BMI and being pregnant were inversely associated, while being single, higher stress levels and better self-rated health were positively associated with PA. Conversely, better self-rated health, having more children and breastfeeding were inversely associated, while higher BMI, income and stress levels were positively associated with ST.

Conclusion

In the first 6 months, women are less physically active and sit longer than beyond the first postpartum year. This may be due to the high demands of infant feeding/care in early postpartum suggesting a need for additional support to safely resume PA e.g. walking and reduce sitting time.

Key message

The first 6 months postpartum is characterized by lower PA and longer ST which may contribute to obesity and chronic diseases.
341The birth of an electronic chronic disease registry bank in Nigeria
Authors: Makinde Olusesan , Mgbachi Ifeanyi , Salau Adeyemi
Published: September 2021

Background

Nigeria is rapidly undergoing epidemiological transition resulting in a double burden of infectious and chronic diseases. Efforts have been concentrated on addressing infectious diseases, neglecting chronic diseases. However, the benefit of targeted chronic disease investigation cannot be overemphasized.

Methods

We conducted a literature search to identify ongoing chronic disease registry efforts in Nigeria. We then contacted the researchers and obtained additional information on the projects including information on the process for data management and number of contributing institutions.

Results

We found several single institutional efforts but were able to identify five efforts that were cross institutional and promising. These were the Cancer, Paediatric Cardiology, Adult Cardiology, Nephrology and Cardiac Surgery registries. Of the five, the cancer registry was well established with an electronic system and several publications from this registry. Next was the cardiac surgery registry with an online repository. Others did not have proper electronic archives and were often made of single institution efforts.

Conclusions

To address the data management need, we built a bank of chronic disease registries https://disreg.org/ and established partnerships with research teams. The bank is designed with multiple levels of access control. Additional registries can be plugged into the bank with ease. It provides a warehouse for chronic disease researchers to archive their data in Nigeria and potentially beyond.

Key messages

The bank will enrich the data available for investigating risk factors of chronic diseases pertinent in our environment.
1544Baseline predictors of attrition in a randomised controlled trial of treatments for people with recurrent binge eating episodes associated to overweight or obesity
Authors: Mannan Haider , Hay Phillipa
Published: September 2021

Purpose

Understanding the high rate of treatment attrition in trials of people with eating disorders is important as it can compromise the quality of the trials. In clinical practice, it may also contribute to illness chronicity, relapse, and costs. Thus, we investigated factors associated with treatment attrition to a new manualised psychotherapy HAPIFED compared to CBT-E, for individuals with Bulimia Nervosa or Binge Eating Disorder comorbid with overweight or obesity.

Methods

In total, 98 participants were recruited with 50 randomised to HAPIFED and 48 to the control intervention CBT-E, all administered in groups of up to 10 participants. An investigator external to the site conducted the random allocation, which was concealed from the statistician involved in the analysis, and known only to the therapists until the finalization of the 12-month follow-up after the end of active treatment. Three scenarios in the timeline treatment of a total of 30 sessions were assessed: 33% or 60% or 75% of presence. Logistic regression analysis was performed to find the correlates of attrition.

Results

None of the six variables - frequency of binge eating episodes, purging, eating disorder symptom severity, weight, illness duration and mental health-related quality of life - significantly predicted attrition at 33%, but longer illness duration predicted lower treatment attrition at both 60% and 75% presence of the interventions. Also for 75% presence, lower body weight predicted lower treatment attrition.

Conclusions

Lower attrition due to late treatment completion was associated with longer binge eating illness length and a lower body weight. More research is needed to recognize factors that may interfere with engagement in treatments aiming to avoid early dropout.

Keywords

binge eating disorder, bulimia nervosa, cognitive therapy, obesity, patient dropout

Trial registration

US National Institutes of Health clinical trial registration number NCT02464345, date of registration 1 June 2015.
1145Obesity-related changes in metabolomic profiles in youth
Authors: Mansell Toby , Sabin Matthew , McCallum Zoe , Juonala Markus , Burgner David , Saner Christoph
Published: September 2021

Background

Obesity during childhood and adolescence is linked to subclinical atherosclerosis, metabolic dysfunction and later cardiovascular disease. Adults with obesity have metabolomic profiles that predict cardiovascular disease and mortality. Analogous data from children with obesity are sparse. Here, we aimed to investigate i) the relationship between the severity of obesity (determined by the percentage above the 95th BMI-centile (%>95th BMI-centile)) and metabolomic profiles, ii) the effect of changes in the severity of obesity on the metabolomic profile and iii) the relationship between obesity-related metabolites and subclinical atherosclerosis outcomes.

Methods

Participants from the Childhood Overweight Biorepository of Australia (COBRA) cohort had %>95th BMI-centile and NMR metabolomic profile (Nightingale, Finland) from fasted blood analysed at two time-points (mean interval of 5.5 years). At the follow-up visit, subclinical atherosclerosis phenotypes (carotid elasticity, carotid intima-media thickness, and pulse-wave velocity) were assessed.

Results

There were 98 participants who attended both visit 1 (mean %>95th BMI-centile 134.6±19.0) and visit 2 (mean %>95th BMI-centile 130.7±26.2). Higher absolute, and increasing severity, of obesity between visits were associated with increased phenylalanine, tyrosine, GlycA (a marker of chronic inflammation), and pyruvate, in both sexes (estimated increases of 0.14-0.18 standard deviations per 10% BMI-centile at visit 2, and 0.15-0.25 per 10% increase in BMI-centile between visits). There was modest evidence for a relationship between lower alanine and higher carotid elasticity.

Conclusions

In children with obesity, the overall severity of obesity and changes in obesity severity were associated with a metabolomic pattern that in adults is predictive of cardiovascular disease. In children, these metabolites were not related subclinical atherosclerosis; these relationships may become manifest with increasing age.

Key messages

There is evidence for an early effect of severe obesity on metabolomic profiles in childhood and adolescence.
1241Alcohol and hypertensive disorders of pregnancy: a negative control analysis
Authors: Martin Flo , Fraser Abigail , Zuccolo Luisa
Published: September 2021

Background

Alcohol increases blood pressure, yet estimates of its association with pre-eclampsia range from positive to negative. Here we estimated the association of maternal drinking during pregnancy with preeclampsia and gestational hypertension, separately and jointly as hypertensive disorders of pregnancy (HDP). We also used partner’s alcohol intake as a negative control exposure to strengthen causal inference.

Methods

We used data on self-reported alcohol intake in the Avon Longitudinal Study of Parents And Children (ALSPAC, N∼9,000). HDP was ascertained from obstetric notes. Multivariable multinomial regression models were adjusted for confounders and mutually-adjusted for partner’s or maternal alcohol. Sensitivity analyses assessed the robustness of results to assumptions of no selection bias, no reporting bias, and no residual confounding (e.g. comparing estimates for beer and wine separately, which have different socioeconomic patterning).

Results

In mutually-adjusted analyses, maternal and partner’s drinking were associated with decreased HDP odds (OR(95% CI): 0.86(0.77–0.96) and 0.82(0.70-0.97)) respectively. In contrast, the negative control design confirmed the expected associations for maternal but not partner’s smoking (figure), demonstrating the validity of this approach. Multiple sensitivity analyses did not alter results. Estimates were more extreme for increasing levels of wine compared to increasing levels of beer drinking.

Conclusions

Our extensive negative control and sensitivity analyses point at confounding mechanisms shared between mothers and partners as the most plausible explanation for the alcohol-HDP association.

Key messages

It is unlikely that alcohol intake in pregnancy reduces the risk of HDP.
288What proportion of patients with chronic noncancer pain are prescribed an opioid medicine?
Authors: Mathieson Stephanie , Wertheimer Graeme , Maher Christopher G , Lin Christine , McLachlan Andrew J , Buchbinder Rachelle , Pearson Sallie-Anne , Underwood Martin
Published: September 2021

Background

Guidelines now discourage opioid analgesics for chronic non-cancer pain because the benefits frequently do not outweigh the harms. This review determined the proportion of patients with chronic non-cancer pain who are prescribed an opioid, the types prescribed, and factors associated with prescribing.

Methods

Database searches were conducted from inception to 29th October 2018 without restrictions. We included observational studies of adults with chronic non-cancer pain measuring opioid prescribing. Opioids were categorised as weak (e.g. codeine) or strong (e.g. oxycodone). Risk of bias assessed study quality. Results were pooled using a random-effects model. Meta-regression investigated study-level factors associated with prescribing. The overall evidence quality was assessed using GRADE criteria.

Results

Of the 42 studies (5,059,098 participants) included, majority (n = 28) from the United States of America. Eleven studies were at low risk of bias. The pooled estimate of the proportion of patients with chronic non-cancer pain prescribed opioids was 30.7% (95%CI 28.7% to 32.7%, 42 studies, moderate-quality evidence). Strong opioids were more frequently prescribed than weak (18.4% (95%CI 16.0% to 21.0%, n = 15 studies, low-quality evidence), versus 8.5% (95%CI 7.2% to 9.9%, n = 15 studies, low-quality evidence)). Meta-regression determined opioid prescribing was associated with year of sampling (more prescribing in recent years) (p = 0.014) and not geographic region (p = 0.056).

Conclusions

Opioid prescribing for patients with chronic non-cancer pain is common and has increased over time.

Key message

Opioid prescribing for patients with chronic non-cancer pain and has increased over time. This review is the first systematic review to synthesized such data.
1267Prevalence and HLA-B27 Positivity Rate among Patients with Ankylosing Spondylitis/Non-Radiographic Axial Spondyloarthritis in Japan
Authors: Matsubara Yuri , Nakamura Yosikazu , Tomita Tetsuya
Published: September 2021

Background

Ankylosing spondylitis (AS) causes severe chronic inflammation of the spine and sacroiliac joints, leading to severe physical dysfunctions. Non-radiographic axial spondyloarthritis (nr-ax SpA) is a newly categorized disease in SpA that shows SpA without definite radiographic findings in sacroiliac joint. Although human leukocyte antigen (HLA) positivity is related to these diseases, little is known about the prevalence of these diseases and HLA-B27 positivity in Japan.

Methods

A nationwide survey was conducted from January to December 2017. 2221/8456 facilities (26.3%) were selected randomly as a target sample, comprising all three departments: orthopedics, pediatrics, and rheumatology. We estimated the number of these patients by using response and extraction rate, and calculated the HLA-B27 positivity rate.

Results

We estimated the prevalence of AS and nr-ax SpA as 2.6/100,000 (0.0026%) and 0.6/100,000 (0.0006%), respectively. HLA-B27 test was performed in 60% of patients with AS, of which 55.5% being HLA-B27 positive; however, they were less likely to receive HLA-B27 test if their estimated age of onset was over 50 years.

Conclusions

The prevalence in AS and nr-ax SpA and their HLA-B27 positivity rate in Japan were lower compared to other countries. Further studies will be required to reveal the association between HLA-B27 and the clinical features.

Key messages

The prevalence of AS and nr-ax SpA in Japan are estimated to be 2.6/100,000 (0.0026%) and 0.6/100,000 (0.0006%), respectively, and are lower than those in other countries. In addition, HLA-B27 positivity rate was lower.
1382Adjustment for the Siblings of Children with Autism Spectrum Disorder during COVID-19
Authors: Matsubara Yuri , Fossi Alexander , Townsend Sabra , Ross Wendy
Published: September 2021

Background

During the COVID-19 pandemic, children with autism spectrum disorders (ASD) and neurotypical siblings of children with ASD and their parents and caregivers have been required to change their daily schedule. In this study, we focused on siblings of children with ASD to reveal their adjustment to their daily life. In addition, we examined their caregivers’ stress.

Methods

An online Qualtrics survey was given to caregivers of children with ASD on February, 2021 at Thomas Jefferson University in the United States. First, we assessed the severity of children with ASD. In addition, we examined how their neurotypical siblings adjusted to their daily life using the validated Strength and Difficulties Questionnaire (SDQ). Moreover, we analyzed caregivers’ stress and their socioeconomic status.

Results

Fifteen caregivers responded to the survey. 42% of children with ASD had behavioral issues beforehand, 80% of which showed worse behaviors during this pandemic. Siblings of children with ASD showed higher scores of difficulties in adapting to new routines during COVID-19. Some caregivers lost their jobs and caregivers of those with behavioral issues reported stress levels that were 4.4 points higher on the scale.

Conclusions

Siblings of children with ASD and their caregivers are facing difficulties in their daily life during this pandemic. Appropriate support systems for children with ASD, their siblings, and their parents and caregivers may help them with their better adjustment.

Key messages

Siblings of children with ASD show difficulties in adjusting, and their caregivers feel more stress during COVID-19 pandemic.
879Sleep Duration and all-cause and cause-specific mortality in people with diabetes
Authors: Melaku Yohannes Adama , Appleton Sarah , Reynolds Amy , Gills Tiffany , Adams Robert
Published: September 2021

Background

Evidence shows that habitual short and long sleep is associated with higher mortality risk in the general population. However, studies on the association between sleep duration and mortality in people with diabetes are scarce.

Methods

Data from the National Health Interview Survey (NHIS) of the United States (US) between 2004 and 2014 (N = 32,766) were used. Self-reported habitual sleep duration for those with self-reported doctor diagnosed diabetes was categorized as ≤ 6 hr (short sleep), 7-8 hr (adequate sleep), and ≥9 hr (long sleep). Mortality status and cause of death data were retrieved from the US National Death Index and linked. We used adjusted Cox proportional models to examine the association between sleep duration and mortality risk. Dose-response relationships were quantified. Sensitivity analysis was performed excluding cardiovascular and cancer cases.

Results

In the median follow-up time of 4.6 years (171,375.2 person-years), 5312 all-cause, 1129 cardiovascular, 1148 cancer and 494 diabetes deaths were recorded. Whereas short sleep duration (adjusted hazard ratio (aHR)=1.04; 95% confidence interval (CI): 0.97, 1.11) in diabetic patients was not associated with all-cause mortality, long sleep duration was positively (aHR=1.43; 95% CI: 1.30, 1.57) associated with increased mortality risk. A similar trend of association was found with cause-specific mortality and the dose-response analysis identified a “J” shape association. Similar results were found upon sensitivity analysis.

Conclusions

Long but not short sleep duration is associated with all-cause and cause-specific mortality in diabetic patients.

Key messages

Sleep should be part of behavioural intervention to prevent premature mortality in those with diabetics.
67Maternal Exposure to PM2.5 from a Coal Mine Fire is Associated with Gestational Diabetes Mellitus
Authors: Melody Shannon , Wills Karen , Ford Jane , Venn Alison , Johnston Fay
Published: September 2021

Background

In 2014, the Hazelwood coal mine fire was an unprecedented six-week severe smoke event in the Latrobe Valley, southeastern Australia. We aimed to determine whether maternal exposure to fine particulate matter (PM2.5) attributable to coal mine fire smoke was associated with gestational diabetes mellitus (GDM), hypertensive disorders of pregnancy and abnormal placentation.

Methods

We defined a cohort of all births >20 weeks in the Latrobe Valley from 1 March 2012 - 31 Dec 2015 utilising administrative perinatal data. Average and peak PM2.5 was assigned to residential address at delivery using a chemical transport model. Maternal, meteorological and temporal variables were included in final log-binomial regression models.

Results

3,612 singleton pregnancies were included; 766 were exposed to the smoke event. Average maternal PM2.5 exposure was 4.4 µg/m3 (IQR 2.1). Average peak PM2.5 exposure was 44.9 µg/m3 (IQR 35.0). An interquartile range increase in average and peak PM2.5 was associated with a 7% and 16% increased likelihood of GDM respectively (Average PM2.5 95%CI 1.03, 1.10; <0.0001; Peak PM2.5 95%CI 1.09, 1.22; <0.0001). No association for hypertensive disorders or abnormal placentation was observed.

Conclusions

This is the first study to examine obstetric complications relating to a discrete smoke event. These findings may guide the public health response to future similar events.

Key messages

Exposure to a smoke event was associated with an increased risk of GDM.

The public health implications may be substantial with a changing climate.
855Multiple Imputation in the Context of Case-Cohort Studies: Simulation and Case Study
Authors: Middleton Melissa , Moreno-Betancur Margarita , Carlin John , Lee Katherine J
Published: September 2021

Background

Multiple imputation (MI) is commonly used to address missing data in epidemiological studies, but valid use requires compatibility between the imputation and analysis models. Case-cohort studies use unequal sampling probabilities for cases and controls which are often accounted for during analyses through inverse probability weighting (IPW). It is unclear how to apply MI for missing covariates while achieving compatibility in this setting.

Methods

A simulation study was conducted with missingness in two covariates, motivated by a case-cohort investigation within the Barwon Infant Study. MI methods considered involved including interactions between the outcome (as a proxy for weights) and analysis variables, stratification by weights, and ignoring weights, within the context of an IPW analysis. Factors such as the target estimand, proportion of incomplete observations, missing data mechanism and subcohort selection probabilities were varied to assess performance of MI methods.

Results

There was similar performance in terms of bias and efficiency across the MI methods, with expected improvements compared to IPW applied to the complete cases. Precision tended to decrease as the subcohort selection probability decreased. Similar results were observed irrespective of the proportion of incomplete cases.

Conclusions

Our results suggest that it makes little difference how weights are incorporated in the MI model in the analysis of case-cohort studies, potentially due to only two weight classes in this setting.

Key messages

If and how the weights are incorporated in the imputation model may have little impact in the analysis of case-cohort studies with incomplete covariates
337Systematic social observation tool for auditing the physical, built and social health-related urban neighboourhood environment
Authors: Middleton Nicos , Kleopa Daphne , Panayiotou Andrie , Kouta Christiana , Nicolaou Christiana , Kaifa Stalo
Published: September 2021

Background

Several generic or feature-specific neighborhood audit tools have been developed. While inter/intra-observer reliability if commonly assessed, validity is not always considered.

Methods

A two-phase mixed-methods process was used to develop the Cyprus Neighborhood Observational Tool for urban environments (CyNOTes). Phase I: draft based on literature review, culturally adapted and content validated in focus groups with community professionals and social media ethnographic study of citizens’ experience and feasibility tested across 15 neighbourhoods. Phase II: variability in features across 45 neighbourhoods along the social disadvantage continuum and associations with census area indicators, citizens’ perceptions and health-related quality of life were assessed.

Results

Content validity was supported by residents’ and professionals’ descriptions of neighbourhood problems, giving rise to a 17-domain, 151-item inventory, 126 from the literature and 25 arising via Nominal Group Technique consensus and content analysis of social media posts. With good inter- and intra-observer agreement, neighborhoods with lower educational attainment scored lower in over half domains. Social gradient and clustering of adverse features observed while in neighbourhoods with adverse features residents reported lower physical and mental health-related quality of life. The social gradient was not always reflected in the perception survey. With the exception of social aspects, residents did not rate the built and physical environment favorably. “Influence and sense of control” was rated lowest while “Citizens’ voice” emerged in the inductive content analysis of residents’ lived experience.

Conclusions

A culturally relevant audit tool of the health-related neighborhood microenvironment was developed by assessing its content, concurrent, criterion and predictive validity.

Key messages

There is need for valid audit tools, independent of residents’ perceptions, for supplementary profiling of the health-related neighbourhood microenvironment

Neighborhoods audits can trigger and widen conversation among local research community and policy-makers about health and place.
221Association of physical activity bout length and changing intensity with mortality in UK Biobank
Authors: Millard Louise , Tilling Kate , Gaunt Tom , Carslake David , Lawlor Deborah
Published: September 2021

Background

Spending more time active (and less time sedentary) is associated with many health benefits but it is unclear whether these associations differ depending on whether time spent sedentary or in moderate-vigorous physical activity (MVPA) is accumulated in long or short bouts. We used a novel analytical approach to examine whether length of sedentary and MVPA bouts associates with all-cause mortality.

Methods

We used data on 79,507 participants from UK Biobank. We derived the total time participants spent in activity categories (sleep, sedentary, light activity and MVPA) and in sedentary and MVPA bouts of short (1-15 minutes), medium (16-40 minutes) and long (41+ minutes) duration, on average per day. We used Cox proportion hazards regression to estimate the association of spending 10 minutes more average daily time in one activity or bout length category, coupled with spending 10 minutes less time in another, with all-cause mortality.

Results

Those spending more time in MVPA had lower mortality risk, irrespective of whether this replaced time spent sleeping, sedentary or in light activity. We found little evidence to suggest that mortality risk differed depending on the length of sedentary or MVPA bouts.

Conclusions

We uniquely show that higher total MVPA improves health irrespective of whether it is obtained from several short bouts or fewer longer bouts, supporting recent policy changes in some countries.

Key messages

Our results suggest that time spent in MVPA associates with lower mortality risk irrespective of whether it is obtained from several short bouts or fewer longer bouts.
149Interaction of socioeconomic status on the association between guardians’ sense of coherence and children’s caries
Authors: Mizuta Akiko , Aida Jun , Nakamura Mieko , Ojima Toshiyuki
Published: September 2021

Background

Untreated caries is the most prevalent disease in the world. A sense of coherence (SOC) contributes to oral health. However, little is known about the association between guardians' SOC and children’s oral health. We aimed to clarify the association between guardians’ SOC and their children’s caries based on socioeconomic status in Japan.

Methods

This study’s subjects were Japanese public junior high schoolers, aged 12-15, and their guardians. We administered a questionnaire survey among guardians in 2016 to assess their SOC and family environment. With their students’ consent, public junior high schools shared the results of the dental examinations. Multivariate logistic regression was conducted to clarify the association between guardians’ SOC and their children’s untreated decayed permanent teeth. We also conducted a stratified analysis according to a relative poverty line. Furthermore, we included interaction term of annual equivalent incomes, educational attainment with guardians’ SOC in analysis.

Results

We observed a significant inverse association between children’s untreated decay and their guardians’ SOC (OR 0.93). Equivalent annual income had a significant marginal association with decayed teeth (OR 0.14). The association of SOC was stronger in the low economic group (OR 0.64). In the high economic group, educational attainment was significantly associated with decayed teeth (OR 0.50).

Conclusions

Guardians with higher SOC were associated with children having fewer caries. Guardians’ SOC is a preventive factor for children’s caries, especially among children with low economic status.

Key messages

This result suggests that guardians’ SOC is one of the psychosocial determinant of children’s oral health.
1129Uncontrolled hypertension among patients with comorbidities; a systematic review and meta-analysis
Authors: Mohamed Shukri
Published: September 2021

Background

We did a systematic review and meta-analysis to estimate the prevalence of uncontrolled hypertension among patients with comorbidities in sub-Saharan African countries.

Methods

We searched MEDLINE via OVID, Embase, and Web of Science as well as Grey literature for studies published between January 2000 to June 15th, 2019 without setting or language restriction. Eleven comorbidities were considered for this review. Methodological quality of eligible studies was assessed, and random-effect models meta-analysis was conducted to estimate the pooled prevalence of uncontrolled hypertension among patients with comorbid conditions. Heterogeneity (I²) was assessed via the χ² test on Cochran’s Q statistic. This review is published in Systematic Reviews and registered in PROSPERO number CRD42019108218.

Results

We screened 7365 records of which 509 studies were included for full-text review. Following full text review, only 19 articles were included for meta-analyses. Ten articles were among diabetic patients, five articles among HIV patients, two were among stroke patents while chronic kidney disease and atrial fibrillation had one article each. The pooled prevalence of uncontrolled hypertension among patients with diabetes was 65·3% (95% prediction interval 69·5–96·1; I² 99·8%),

Conclusions

The prevalence of uncontrolled hypertension among patients with comorbidities is high in SSA.

Key messages

These findings strongly support an urgent need for comprehensive studies that report on the hypertensive treatment state and blood pressure control state of study participants with comorbidities.
314Data-adaptive methods for high-dimensional mediation analysis: Application to a randomised trial of tuberculosis vaccination
Authors: Moreno-Betancur Margarita , Messina Nicole L , Gardiner Kaya , Curtis Nigel , Vansteelandt Stijn
Published: September 2021

Focus of Presentation

Statistical methods for causal mediation analysis are useful for understanding the pathways by which a certain treatment or exposure impacts health outcomes. Existing methods necessitate modelling of the distribution of the mediators, which quickly becomes infeasible when mediators are high-dimensional (e.g., biomarkers). We propose novel data-adaptive methods for estimating the indirect effect of a randomised treatment that acts via a pathway represented by a high-dimensional set of measurements. This work was motivated by the Melbourne Infant Study: BCG for Allergy and Infection Reduction (MIS BAIR), a randomised controlled trial investigating the effect of neonatal tuberculosis vaccination on clinical allergy and infection outcomes, and its mechanisms of action.

Findings

The proposed methods are doubly robust, which allows us to achieve (uniformly) valid statistical inference, even when machine learning algorithms are used for the two required models. We illustrate these in the context of the MIS BAIR study, investigating the mediating role of immune pathways represented by a high-dimensional vector of cytokine responses under various stimulants. We confirm adequate performance of the proposed methods in an extensive simulation study.

Conclusions/Implications

The proposed methods provide a feasible and flexible analytic strategy for examining high-dimensional mediators in randomised controlled trials.

Key messages

Data-adaptive methods for mediation analysis are desirable in the context of high-dimensional mediators, such as biomarkers. We propose novel doubly robust methods, which enable valid statistical inference when using machine learning algorithms for estimation.
1383Interaction of cognitive decline and walking ability to influence wandering behavior: a cohort study
Authors: Murata Shunsuke , Takegami Misa , Ogata Soshiro , Ono Rei , Nakaoku Yuriko , Hagihara Akihito , Nishimura Kunihiro
Published: September 2021

Background

Wandering behavior is one of the most troublesome behavioral disturbances in dementia. Though cognitive decline leads to wandering behavior, its effects may vary across walking ability. The purpose of this study was to investigate the joint effect of cognitive decline and walking ability on wandering behavior.

Methods

This retrospective cohort study in community analyzed 3920 elderly adults with dementia. The association of cognitive function and walking ability with an incidence of wandering behavior during a 5-year follow-up period were examined using a generalized linear model, and relative excess risk due to interaction was calculated.

Results

Compared to ‘walk independently’, adjusted risk ratios (95% confidence intervals) for ‘walk with help’ and ‘unable to walk’ were 0.51 (0.42, 0.63) and 0.21 (0.16, 0.28), respectively (P for trend < 0.001). Compared to mild cognitive decline, adjusted risk ratios (95% confidence intervals) for moderate and severe cognitive decline were 1.44 (1.17, 1.77) and 1.73 (1.36, 2.18), respectively (P for trend < 0.001). Additionally, some joint effects of cognitive decline and walking ability decline were lower than the sum of its individual effects (relative excess risk due to interaction (95% confidence interval), moderate cognitive decline × ‘walk with help’: -0.45 (-0.98, -0.01); severe cognitive decline × ‘unable to walk’: -0.95 (-1.71, -0.37)).

Conclusions

Effects of cognitive decline and walking ability on incidence of wandering behavior were observed, and the effects varied depending on their combination.

Key messages

Our results help clinicians to predict and manage wandering behavior.
1134Seroprevalence and Risk Factors of Coxiella burnetti infection in the general population of Senegal
Authors: Djomo Patrick Nguipdop , Diop Sylvie Nyafouna , Dieye Ndeye Licka , Wotodjo Amélé-Nyedzie , Kim Min , Ba Elhadji , Guitian Javier , Mangtani Punam
Published: September 2021

Background

Coxiella burnetti, the causal agent of Q-fever, contributes to aetiologies of fevers of unknown origin (FUO) in West Africa. We compared its seroprevalence between Dakar, the largest urban centre in Senegal, and Niakhar, a rural area, and investigated the association to contacts with livestock and dairy products consumption.

Methods

Large cross-sectional surveys; households randomly selected using a two-stage cluster sampling. Within households, 1-2 participants were randomly selected using a Kish grid. A small blood sample was collected to detect phase 1 and 2 Coxiella burnetti IgG using ELISA, and a questionnaire was administered. Random effect logistic regression models were used to measure the association with risk factors.

Results

Overall, 2102 participants recruited in Dakar and 1156 in Niakhar. The prevalence of C. burnetti was high in both settings, but higher in rural Niakhar (37%) than urban Dakar (30%), even after adjusting for age, sex and socio-economic status (difference=7%; 95%CI [1.1% to 13%]; p = 0.02). In Dakar, ownership of sheep was associated with greater risk (OR = 1.26; 95%CI[1.00-1.59]; p = 0.048). Livestock contact was associated with higher risk in rural areas, but not in urban areas (helping cattle’s parturition (OR = 2.10; 95%CI [1.38-3.22]; p < 0.01 and abortion (OR = 1.95; 95%CI[1.18-3.23]; p = 0.009). There was no association between dairy products’ consumption and Q-fever in both settings.

Conclusions

The high seroprevalence in urban and rural settings suggest that Q-fever should be seriously considered by clinicians when investigating fevers in both settings. The observed association with livestock contact is consistent with the lack of use of personal protection equipment.

Key messages

Clinicians should consider Q-fever among differential diagnosis when investigating non-specific fevers in West Africa.
383Pneumococcal conjugate vaccine is effective against hypoxic pneumonia in Laos, Mongolia and Papua New Guinea
Authors: Nguyen Cattram , Weaver Rupert , Blyth Christopher , Mollendorf Claire von , Britton Kate , Chan Jocelyn , Dance David A B , Ford Rebecca , Lai Jana Y R , Mungun Tuya , Newton Paul , Mulholland Edward Kim , Pomat William , Vilivong Keoudomphone , Xeuatvongsa Anonh , Russell Fiona M
Published: September 2021

Background

We describe a novel approach to determine PCV13 effectiveness (VE) against hypoxic pneumonia in children admitted with pneumonia in Lao People’s Democratic Republic (Laos), Mongolia and Papua New Guinea (PNG).

Methods

A 3-5 year prospective hospital-based observational study of children < =59 months admitted with pneumonia was undertaken. Pneumonia was defined using the 2013 WHO definition. Hypoxia was defined as an oxygen saturation <90% in room air or requiring oxygen supplementation during hospitalisation. PCV13 status was determined by written record. VE was calculated using logistic regression comparing the odds of hypoxia between vaccinated and under-vaccinated pneumonia cases. To handle potential confounding, a propensity score (PS) analysis using inverse probability of treatment weighting (IPW) was used. In Laos, multiple imputation (MI) analysis was undertaken for missing data.

Results

The VE against hypoxic pneumonia were: in Laos, unadjusted 23% (95% CI: -9, 46%; p = 0·14), IPW adjusted 37% (6, 57%; p = 0.02), MI and IPW adjusted 35% (7, 55%; p = 0.02); in Mongolia, unadjusted 33% (26, 40%; p < 0.001), IPW adjusted 33% (16, 47%; p < 0.001); and in PNG, unadjusted 6% (-15, 24%; p = 0.53), IPW adjusted 36% (17, 51%; p = 0.001).

Conclusions

Our novel approach shows that PCV13 is effective against hypoxic pneumonia. PCV13 will contribute to reducing child mortality.

Key messages

We describe a novel, single hospital-based approach for determining VE that can be applied to other similar settings. This is one of the first studies showing PCV13 to be effective against hypoxic pneumonia in children in Asia.
1330Is Prognosis Worse for People with Multiple Versus Single Primary Melanoma?
Authors: Ni Yuan , Cust Anne E , Lo Serigne
Published: September 2021

Background

Patients with a primary melanoma may develop more than one in their lifetime. It is unclear whether mortality is worse after diagnosis of multiple primary melanoma (MPM) compared with single primary melanoma (SPM).

Methods

We analysed data from a population-based cohort of 3,869 patients diagnosed with primary in situ or invasive cutaneous melanoma in New South Wales, Australia in 2006-07 and followed up until 2018 (median 11.9 years) using linked mortality and cancer registry data. We compared overall mortality and melanoma-specific mortality for patients with SPM versus MPM, adjusting for other clinico-pathological prognostic indicators, using Cox proportional hazard models. The primary analysis was based on pathological features from the thickest tumour for MPM patients, however sensitivity analyses were performed using the first and last primary melanoma.

Results

The cohort consisted of 3,869 patients (2,929 SPM and 940 MPM) and 5,504 melanoma lesions (including 2,575 lesions from MPM patients). The primary multivariable analysis showed MPM was associated with lower mortality from all causes and melanoma compared with SPM with a hazard ratio of 0.62 (95% CI: 0.54-0.71, p < 0.001) and 0.37 (95% CI: 0.32-0.43, p < 0.001) respectively. These findings were also supported by the sensitivity analyses.

Conclusions

The diagnosis of MPM does not worsen mortality compared to a SPM, in fact it was associated with improved survival. This finding might be related to skin examination behaviours, biological or clinical factors.

Key messages

MPM patients have a better prognosis than SPM patients.
116Dementia risk in individuals with lifetime major trauma and post-traumatic stress disorder (PTSD) symptoms
Authors: Nilaweera Dinuli
Published: September 2021

Background

Increasing evidence suggests that stress may be a risk factor for dementia, however further investigation is required particularly in community-dwelling individuals. This study investigated whether lifetime major trauma with and without re-experiencing of PTSD symptoms is associated with dementia risk.

Methods

Participants were 1,700 community-dwelling men and women enrolled in the ESPRIT study of later-life neuropsychiatric disorders. Lifetime major trauma and PTSD were assessed using Watson’s PTSD Inventory. Cognitive function was measured using tests of global cognition, visual memory, verbal fluency, psychomotor speed and executive function. Fourteen-year incident dementia was diagnosed according to DSM-IV criteria. The association between lifetime trauma and cognition, as well as incident dementia was determined by multivariate logistic regression and Cox-proportional hazards regression, respectively.

Results

An unexpected, yet consistent finding was the association between lifetime major trauma without re-experiencing symptoms, and better baseline cognition (global OR: 0.67 [95% CI: 0.52-0.87], executive function OR: 0.69 [95% CI: 0.51-0.93]). Furthermore, lifetime trauma without re-experiencing symptoms was associated with a decreased risk of dementia (HR: 0.63, 95% CI: 0.44-0.91), particularly for females (HR: 0.49, 95% CI: 0.29-0.80).

Conclusions

Lifetime major trauma without re-experiencing symptoms may be protective for later-life cognitive function and could reduce dementia risk, especially in females. The mechanisms and moderating factors underlying these association requires further investigation.

Key messages

This study presents novel findings, and suggests that in some instances, experiencing traumatic events may be beneficial in later-life health.
460Social inequalities in second-hand smoking among Japanese adults: A repeated cross-sectional study
Authors: Noguchi Taiji , Kakizaki Masako , Wakabayashi Ryozo , Nakagawa Hiroko , Nishiyama Takeshi , Watanabe Miki , Hosono Akihiro , Shibata Kiyoshi , Ichikawa Mari , Kamishima Hiroyuki , Watanabe Hiroto , Ema Kanae , Nagaya Kenji , Yamada Tamaki , Suzuki Sadao
Published: September 2021

Background

We aimed to examine the association between educational history and second-hand smoke (SHS) exposure in Japanese adults.

Methods

We conducted a repeated cross-sectional study using data from the 2007-2011 baseline and the 2013-2016 follow-up survey in a Japanese suburban area. Overall, 5,562 male and 5,381 female non-smokers participated in the study, which evaluated the SHS exposure and educational history of the participants through self-reported questionnaires. We performed a multilevel ordered logistic regression analysis with survey year as the first level and the individual as the second level, SHS exposure as the dependent variable, educational history as the explanatory variable, and age, smoking history, marital status as covariates, stratified by gender and working status.

Results

The prevalence of SHS exposure was 45.4% in males and 41.9% in females in the 2007-2011 survey, and 31.6% in males and 28.7% in females in the 2013-2016 survey. Multilevel analysis indicated that less educational history was associated with higher SHS exposure in both genders (among males, the odds ratio compared with ≥13 years was 1.75 for 10-12 years and 1.64 for ≤9 years; among females, it was 1.79 for 10-12 years and 2.43 for ≤9 years). Stratified analysis by working status showed that for females, education-based inequalities in SHS exposure more strongly impacted for workers than non-workers (p for interaction <0.001).

Conclusions

Education-based inequalities in SHS exposure exist in Japan and might be severe among female workers.

Key messages

Measures against SHS in Japan should be promoted to reduce social and gender inequalities.