bluuebunny/crossref_metadata_2025 huggingface dataset:
1023The uses and abuses of regression models: a new approach to teaching regression analysis
Authors: Carlin John , Moreno-Betancur Margarita
Published: September 2021

Focus of Presentation

Multivariable regression models are widely used in epidemiological data analysis. Traditional teaching often focusses on technical aspects with insufficient attention paid to the purposes for which regression methods are used.

Findings

We have addressed these issues in a new short course that provides an introduction to regression analysis in the context of learning about causal inference, beginning from the standpoint that the majority of research questions in epidemiology are causal in nature. This approach leads naturally to using regression models in two different ways, firstly for direct estimation of a causal effect, under an assumption of constancy of the effect across strata of confounders, and secondly for prediction of outcomes, as a necessary step in the estimation of causal effects via g-computation.

Conclusions/Implications

Approaching the teaching of regression methods within a causal inference framework helps to dispel confusion created by traditional statistical approaches that imply the existence of “true models” and encourage the building of models in a way that is unclear about the purpose for which they will be used, for example seeking to identify “risk factors” in an exploratory manner.

Key messages

The teaching and practice of regression methods in epidemiology can be enhanced by emphasising the key differences between three distinct analytic purposes: description, prediction, causal. Regression models may play a role in all three but the way in which models are developed and interpreted differs between them.
145Educational inequalities in primary prevention statin use in UK Biobank
Authors: Carter Alice , Gill Dipender , Morris Richard , Smith George Davey , Taylor Amy , Davies Neil , Howe Laura
Published: September 2021

Background

Socioeconomic inequalities in cardiovascular disease are well documented, but the association of socioeconomic position with treatment for cardiovascular disease prevention is unclear.

Methods

Using data from a large prospective cohort study, UK Biobank, we calculated QRISK3 cardiovascular risk scores for 472 097 eligible participants with complete data on self-reported educational attainment and statin use (55% female; mean age, 56).

We used logistic regression to explore the association between i) QRISK3 score and ii) educational attainment on self-report statin use. We then stratified the association between QRISK3 score, and statin use by educational attainment to test for interactions.

Results

For an equivalent QRISK3 score, more educated individuals were more likely to report taking statins. In women with 7 years of schooling, a one unit increase in QRISK3 score was associated with a 7% higher odds of statin use (odds ratio (OR) 1.07, 95% CI 1.07, 1.07). In women with 20 years of schooling, a one unit increase in QRISK3 score was associated with an 14% higher odds of statin use (OR 1.14, 95% CI 1.14, 1.15). Comparable ORs in men were 1.04 (95% CI 1.04, 1.05) for 7 years of schooling and 1.08 (95% CI 1.08, 1.08) for 20 years of schooling.

Conclusions

Individuals with less education are less likely to access statins conditional on cardiovascular risk factors.

Key messages

Inequalities in access to cardiovascular preventive medication are likely contributing to cardiovascular inequalities.
571Effect of a computer network-based feedback program on antibiotic prescription rates of primary care physicians
Authors: Chang Yue
Published: September 2021

Background

Antibiotic overuse is one of the major prescription problems in rural China and a major risk factor for antibiotic resistance. Low antibiotic prescription rates can effectively reduce the risk of antibiotic resistance.

Methods

A cluster randomized crossover open controlled trial was conducted in 31 hospitals. These hospitals were randomly allocated to two groups to receive the intervention for three months followed by no intervention for three months in a random sequence. The feedback intervention information, which displayed the physicians’ antibiotic prescription rates and ranking, was updated every 10 days. The primary outcome was the 10-day antibiotic prescription rate of the physicians.

Results

There were 82 physicians in group 1 (intervention first followed by control) and 81 in group 2 (control first followed by intervention). Baseline comparison showed no significant difference in antibiotic prescription rate between the two groups (30.8% vs 35.2%, P-value = 0.07). At the crossover point, the relative reduction in antibiotic prescription rate was significantly higher among physicians in the intervention group than in the control group (33.1% vs 20.3%, P-value < 0.001). After a further 3 months, the rate of decline in antibiotic prescriptions was also significantly greater in the intervention group compared to the control group (14.2% vs 4.6%, P-value < 0.001).

Conclusions

A computer network-based feedback intervention can significantly reduce the antibiotic prescription rates of primary care outpatient physicians.

Key messages

The feedback intervention continuously affected their prescription behavior for up to six months.
656Risk factors for lung cancer in never-smokers in Australia
Authors: Cheng Elvin , Weber Marianne , Steinberg Julia , Canfell Karen , Yu Xue Qin
Published: September 2021

Background

Lung cancer in never-smokers (LCINS), if considered as a distinct type, would rank as Australia’s eighth most deadly cancer. We investigated several demographic, lifestyle and health-related risk factors for LCINS in Australia.

Methods

Using the longitudinal 45 and Up Study cohort with 267,153 New South Wales (NSW) residents aged ≥45 years at recruitment (2006-2009), we quantified the relationship of 20 potential risk factors with LCINS. Self-reported never-smoking participants who were cancer-free at baseline were followed for incident lung cancer (LC), and adjusted hazard ratios (HR) and 95% confidence intervals (CI) were estimated using Cox regression. The NSW Cancer, Lifestyle and Evaluation of Risk (CLEAR) Study, a case-control study including 10,781 NSW residents aged ≥18 years, was also used to examine 16 potential risk factors for LCINS. Adjusted odds ratios (OR) and 95% CI for LC were estimated using logistic regression.

Results

In the 45 and Up Study, there were 226 LC cases among 132,354 cancer-free never-smokers with a median follow-up of 5.41 years. In the CLEAR Study, there were 58 LCINS cases and 1316 cancer-free never-smoking controls. After adjusting for potential confounders, analyses of both datasets showed that Asian-born participants had a higher risk of LCINS than those born elsewhere: cohort HR = 2.83 (95% CI: 1.64-4.89) and case-control OR = 3.78 (95% CI: 1.19-12.05).

Conclusions

Our findings support the growing evidence that never-smokers born in Asia are at higher risk of developing LC than those born elsewhere.

Key messages

Region of birth could be considered when assessing potential LC risk among never-smokers.
1069Reflection from working with multi-disciplinary teams on practice of teaching epidemiology
Authors: Chih HuiJun , Firth Ann
Published: September 2021

Focus of Presentation

Health research teams has increasingly worked together as multi-disciplinary teams. Sponsorships and/or fellowships may provide teaching academics the opportunity to collaborate with multi-disciplinary teams on real-life research and enhance their teaching practice. This presentation will focus on sharing reflection of a teaching academic working with multi-disciplinary teams, and the experience on influencing the academic’s practice of teaching epidemiology.

Findings

The opportunity to work with multi-disciplinary clinicians has been enriching. In addition to building networks, it has helped to build confidence of the academic in clarifying unit learning outcomes, developing well-aligned curricula and designing authentic activities that scaffold threshold concepts effectively to assist students achieve the unit learning outcomes. The confidence of students on the teaching academic is also enhanced as they gain quantitative research skills on real-life examples, which would be useful for the future workforce.

Conclusions/Implications

The opportunity for academic who teach epidemiology to work with multi-disciplinary research teams can bring along positive outcomes. It not only enhances research outputs of both parties, teaching capability of the academic, but also the confidence of our future workforce in the area of epidemiology.

Key messages

Teaching academics need opportunities to work with the industry in order to effectively bridge the teaching-research nexus in both directions, and create win-win-win situations for the academics, the students and the industry collaborators.
176Associated factor for abnormal cervical citology in women with HIV at a hospital in Peru
Authors: Chincha Omayra , Samalvides Magister Frine
Published: September 2021

Background

Women living with HIV (WLWH) are at higher risk of abnormal cervical lesions. The aim of this study was to determine the risk factors associated with abnormal cytology in WLWH

Methods

A case-control study was performed, all WLWH >18 years were enrolled at Cayetano Heredia Hospital during 2012-2015. A case and control were defined as a WLWH with abnormal pap smear and with normal pap smear, respectively. Factors associated with the increased risk of abnormal pap smear in WLWH were assessed using logistic regression modeling

Results

We assessed 141 cases and 227 controls. Alcohol consumption was diagnosed in 30.5% (43/141) of the case group and 18.1% (41/227) of the control group. In the case group, 75.2% (106/141) were on antiretroviral treatment (ART) while 85.1% (193/227) in the control group were in ART. Additionally, 37% of cases (40/106) and the 23.1 % of controls (40/173) had virologic failure. The multivariate model showed that alcohol consumption (OR 1.77, IC95% 1.06-2.95), be in virologic failure (OR 2.41, IC95% 1.55-3.74) and were on ART (OR 0.07, IC95% 0.02-0.23) were associated with abnormal cytology

Conclusions

Alcohol consumption and virologic failure are significant risk factors associated with abnormal cytology. ART was found to be a protective factor. Screening for these factors in WLWH, should be considered for promoting the prevention with pap smear.

Key message

We have to have consider periodic screening with pap smear for cervical cancer in this population as mandatory
91Is rainfall associated with paediatric acute gastroenteritis in an affluent setting? A 21-Year Retrospective Investigation
Authors: Chong Ka Chun , Chan Emily , Lee TC , Kwok KL , Lau SYF , Wang P , Lam HCY , Goggins W , Mohammad K , Leung SY , Chan PKS
Published: September 2021

Background

Although many literatures demonstrated heavy rainfall was associated with an increased risk of acute gastroenteritis via contaminated food and water, we hypothesized there is no association between rainfall and paediatric acute gastroenteritis in a setting with high-standard food and water hygiene.

Methods

Intestinal infection-related hospital admissions data during 1998-2018 for children under 5 years of age in Hong Kong were collected. Meteorological data were collected from the Hong Kong Observatory. A distributed lag nonlinear model was employed to examine the associations between meteorological factors and the risk of hospital admissions due to acute gastroenteritis.

Results

Rainfall did not exhibit a statistically significant association with the risk of paediatric admission due to acute gastroenteritis but low temperature, low and high relative humidity did. The risk was 6.3% higher (95% confidence interval: 0.3% to 12.6%) when temperature was at 15.1oC (i.e. the 5th percentile). The adjusted relative risk was statistically significantly higher when relative humidity was ≤73.0% or ≥ 84.0%.

Conclusions

Text: We suggest rainfall playing a minor role in disease transmission via contaminated food and water in affluent societies like Hong Kong. Instead, we speculate low temperature and humidity extremes have greater impact on transmission through increased stability and infectivity of enteric viruses.

Key messages

Weather plays a minor role in food and water contamination in affluent societies.

Low temperature and humidity extremes might improve survival of enteric viruses.
1007Vitamin B6 intake, its active form pyridoxal 5’-phosphate, and markers of B6 activity and catabolism
Authors: Clasen Joanna , Heath Alicia K , Van Puyvelde Heleen , Huybrechts Inge , Johansson Mattias , Ferrari Pietro , Park Jin Young , Brennan Paul , Riboli Elio , Muller David C
Published: September 2021

Background

Several biological pathways implicated in cancer risk rely on vitamin B6, which can be measured in its active form pyridoxal 5’-phosphate (PLP). Functional markers of B6 enzymatic activity have been proposed, including the homocysteine:cysteine ratio (Hcy:Cys, a marker of transsulfuration), 3-hydroxykynurenine ratio (HKr, a marker of tryptophan catabolism), and the 4-pyridoxic acid ratio (PAr, a marker of B6 catabolism). We investigated the extent to which these markers are associated with B6 intake.

Methods

Data from 4,750 participants in the European Prospective Investigation into Cancer and Nutrition (EPIC) study were included. We estimated the expected percentage change in each of the markers (PLP, Hcy:Cys, HKr, and PAr) for a doubling in B6 intake using log-linear Bayesian hierarchical regression models with log-transformed intake and biomarker data.

Results

The percent change (posterior mean [95% Credible Interval (CrI)]) for a doubling of B6 intake was 61.0 [51.2, 71.8] for PLP, -12.7 [-15.2, -9.9] for Hcy:Cys, -12.9 [-15.7, -9.9] for HKr, and 1.3 [-3.5, 6.2] for PAr.

Conclusions

B6 intake is most strongly associated with PLP, but is also associated with functional markers of transsulfuration and tryptophan catabolism, in the direction of increased activity in these pathways. There is no evidence of a linear association between vitamin B6 intake and catabolism.

Key messages

Our results show differing sensitivity of PLP, markers of tryptophan catabolism and transsulfuration, and vitamin B6 catabolism to B6 intake.
616BMI and SBP impact on survival of dialytic patients: multivariate joint model approach
Authors: Colugnati Fernando , Fernandes Natalia , Franco Marcia
Published: September 2021

Background

Studies on impact of routine clinical parameters on mortality of patients on peritoneal dialysis (PD), especially among elderly, are inconsistent. Although association between body mass index (BMI) and systolic blood pressure (SBP) is well known, their joint role on PD patient evolution is not clear. We aimed to model the joint impact of BMI and SBP trajectories on a cohort of incident elderly PD patients.

Methods

Prospective multicenter cohort study with 674 patients. Repeated measurements were modeled by random effects multivariate linear model. For the time-to-event outcome, used Cox proportional hazards model with log-Gaussian frailty. Stochastic dependence is captured by allowing random effects of the linear model to be correlated with the frailty term of the survival model, allowing for different clinical interpretations. All sub-models were adjusted for age in years.

Results

Isolated current values effects of increased BMI and BPS showed both as protective factors (1% and 2% risk reduction, respectively, for each unitary increase). When jointly modeled BMI changed its effect to 5% risk reduction while BPS remained the same, showing great impacts on survival depending on the combination of trajectories.

Conclusions

Clinical parameters association and its impact on survival is complex, and estimation of isolated effects may provide biased survival curves leading to unrealistic prognosis. A multivariate joint modeling can be seen as a valuable tool for clinical protocols on patient evolution.

Key message

Modern clinical epidemiology must foster use of modern statistics
1087Ethnic inequalities in reproductive health in Latin America
Authors: Costa Janaina Calu , Gatica-Dominguez Giovanna , Victora Cesar , Barros Aluisio
Published: September 2021

Background

African descendants continue to be affected by discrimination in the Americas. We assessed ethnic inequalities in sexual/reproductive health (SRH) in Latin American countries.

Methods

Using data from national surveys we analyzed SRH in nine countries. Absolute differences in coverage for Afro women and the country-specific reference group (usually full or mixed European ancestry) were estimated for contraception with modern methods (CPmo), family planning needs satisfied with modern methods (FPSmo), 4+ antenatal care visits (ANC4), and antenatal care start in the first trimester (ANC1st). The slope index of inequality (SII) was used to assess wealth-based inequalities.

Results

Afrodescendants represented from 2.4% of the sample (Costa Rica) to 56.4% (Brazil) and SRH coverage was lower for Afros compared to the reference. Average difference was of 4 percent points (pp) for CPmo and 6pp for FPSmo, and respectively 7pp and 11pp in the poorest group. The lower average difference (0.64) was found for ANC4, however Colombia had a gap of 7pp. For ANC1st, ethnic differences were >5pp in Brazil, Colombia, Ecuador and Suriname. Suriname had systematically lower coverage among Afros. In Honduras Afros presented similar/higher coverage than the reference. Positive SII revealed coverage concentrated in the richest group for all indicators, however the wealth-based inequalities were much greater among Afros, especially for ANC1st (mean SII = 23pp).

Conclusion

Lower coverage for Afro women is pervasive and worse for the poorest ones.

Key messages

Such evidence can help overcome ethnic long-term disadvantage in the Americas.
1457Aboriginal and/or Torres Strait Islander deaths by suicide in Australia
Authors: Cutler Tessa , Pirkis Jane , Eades Sandra , Gibberd Alison , Gubhaju Lina
Published: September 2021

Background

The fifth leading cause of death for Aboriginal people in Australia is suicide. These deaths are preventable, and their impact is significant for family and the wider community. This work aims to increase understanding of suicide deaths among Aboriginal people by describing these deaths by a range of factors, and identifying similarities and differences between Aboriginal and non-Aboriginal deaths by suicide.

Methods

Suicide deaths in Australia from 2001 to 2019 will be identified from the National Coronial Information System database. Demographic factors, details of the deaths and geographic factors will be described, and comparisons will be made between Aboriginal and non-Aboriginal deaths by suicide. Overall suicide rates by Aboriginal status and age- and sex-standardised rates per 100,000 person-years will be calculated using mid-year estimated resident population and death counts stratified by year, age, sex, and Aboriginal status from the Australian Bureau of Statistics.

Results

The analysis for this work is currently underway and will be finalised prior to the conference.

Conclusions

The results of this research will provide information about sub-groups of the Aboriginal population and areas of Australia with heightened and reduced risks and rates of suicide. The findings will be interpreted with guidance from the Aboriginal Advisory Committee involved in this work. Findings will be shared with service providers, policymakers, communities, and researchers to enable improved targeting of interventions.

Key messages

Better understanding of Aboriginal deaths by suicide is critical to inform and improve the much-needed targeting of services and interventions.
1223Handling missing data for causal effect estimation in cohort studies using Targeted Maximum Likelihood Estimation
Authors: Dashti Ghazaleh , Lee Katherine J. , Simpson Julie A. , White Ian R. , Carlin John B. , Moreno-Betancur Margarita
Published: September 2021

Background

Causal inference from cohort studies is central to epidemiological research. Targeted Maximum Likelihood Estimation (TMLE) is an appealing doubly robust method for causal effect estimation, but it is unclear how missing data should be handled when it is used in conjunction with machine learning approaches for the exposure and outcome models. This is problematic because missing data are ubiquitous and can result in biased estimates and loss of precision if handled inappropriately.

Methods

Based on a motivating example from the Victorian Adolescent Health Cohort Study, we conducted a simulation study to evaluate the performance of available approaches for handling missing data when using TMLE with machine learning. These included complete-case analysis; an extended TMLE approach incorporating an outcome missingness probability model; the missing indicator approach for missing covariate data (MCMI); and multiple imputation (MI) using standard parametric approaches or machine learning algorithms. We considered 11 missingness mechanisms typical in cohort studies, and a simple and a complex setting, in which exposure and outcome generation models included two-way and higher-order interactions.

Results

MI using regression with no interactions and MI with random forest yielded estimates with the highest bias. MI with regression including two-way interactions was the best performing method overall. Of the non-MI approaches, MCMI performed the worst

Conclusions

When using TMLE with machine learning to estimate the average causal effect, avoiding standard MI with no interactions and MCMI is recommended.

Key messages

We provide novel guidance for handling missing data for causal effect estimation using TMLE.
1539Australia’s worsening mental health – what’s next?
Authors: Dawadi Shrinkhala , Shawyer Frances , Teede Helena , Meadows Graham , Enticott Joanne
Published: September 2021

Background

The population prevalence of mental illness over time, and by sociodemographic subgroups, are important benchmark data. Examining reliable population level data can highlight groups with greater mental-illness related symptom burden and inform policy and strategy.

Methods

Secondary analysis of Australian National Health Surveys (n = 78,204) from 2001-02 to 2017-18. Trends in the prevalence of very high scores on the Kessler-10 (K10), a measure of psychological distress capturing symptoms of affective and anxiety disorders, were examined by time, age, gender, and socioeconomic status. Data were standardised to the 2001 Australian census population on the strata of sex and age.

Results

In 2017-18, the rate of probable mental illness was estimated at 5.1%, a 1.5% increase (representing an additional 367,000 Australians) since 2007. In 2017-18, the subgroups with the highest rates were women aged 18-24 (8.01%, 95% CI = 5.9%-10.2%), and the poorest fifth of Australians (8.02%, 95% CI = 7.0%-9.0%). Women aged 55-64 demonstrated the greatest increase in rates (2001: 3.5%, 95% CI = 2.5%-4.6%; 2017: 7.2%, 95% CI = 5.9%-8.5%; z = 4.10, p ≤ 0.001).

Conclusions

Despite efforts to improve population mental health, rates of probable mental illness in Australia have increased since 2007. Findings will be discussed in conjunction to extant social and health policies, and potential gaps in the delivery of gold-standard mental health care.

Key messages

The rate of probable mental illness in Australia seem to be increasing, especially in women aged 55-64, and those from low-SES backgrounds.
1097Inequalities in full vaccination coverage by maternal education and wealth quintiles in South Asian countries
Authors: Dharel Dinesh , Paudel Yuba Raj , Bhattarai Asmita , Subedi Rajkumar , Acharya Kiran
Published: September 2021

Background

Estimated one in four children is not fully immunized in South Asia. This study aimed to compare full vaccination coverage in the region and its inequalities by maternal education and household wealth quintile.

Methods

We used data from the most recent Demographic and Health Survey (DHS) from Nepal, India, Pakistan, Bangladesh, Afghanistan, and the Maldives. Children aged 12-23 months were included. We defined full vaccination as receiving at least six antigen: Bacille Calmette Guerin, Diptheria, Pertussis, Tetanus, Polio, and Measles. We measured absolute inequalities using the slope index of inequality (SII), and relative inequalities using the relative index of inequality (RII) both for maternal education and household wealth quintiles.

Results

The full vaccination coverage ranged from 46% in Afghanistan to 84% in Bangladesh. Pakistan had the largest inequalities in coverage by maternal education (SII: -50.0, RII: 0.4) and household wealth quintile (SII: -47.1, RII: 0.5). The SII by wealth quintiles was smaller (-8.4) in Nepal compared to Bangladesh, India, Pakistan, and Afghanistan, but it was larger (-30.5) by maternal education compared to Bangladesh and India, although smaller than Pakistan and Afghanistan. The RII followed a similar trend.

Conclusions

All South Asian countries studied had full vaccination coverage under 85%. Both absolute and relative inequalities were larger by maternal education compared to wealth quintile in four of the six countries.

Key messages

Larger inequalities by maternal education compared to wealth-based inequalities in most South Asian countries indicate the critical role of maternal education to improve child health outcomes.
461Alcohol use and anti-retroviral adherence among people living with HIV in ART centre of Nepal
Authors: Dhungana Upendra , Pahari Durga Prasad , Poudyal Amod Kumar
Published: September 2021

Background

Alcohol use is known to have higher prevalence among HIV infected individuals. Hazardous use of alcohol in many studies is negatively associated with the adherence to antiretroviral therapy. Use of alcohol and ART adherence among PLHIV is inadequately explored in Nepalese context. This study aimed at identifying the level of alcohol use and its relationship with adherence to ART among PLHIV.

Methods

A total of 205 PLHIV of age 18 years or more were randomly selected at a national ART centre of Nepal. Self-reported adherence questionnaire was used to get the level of adherence, Alcohol Use Disorder Identification Test (AUDIT) with five questions was adopted for screening the hazardous alcohol use. Those who took more than 95% of the prescribed doses were considered as adherent.

Results

About 86% of the respondents were adherent to ART in four days recall. About one third of the respondents were alcohol user and 40% of them had hazardous use of alcohol. Those having hazardous use of alcohol were four times (AOR=4.60, 95% CI 1.27,16.62) more likely to be non-adherent as compared to those who had not hazardous use of alcohol. Multivariate analyses adjusted ethnicity, Knowledge on dangers of non-adherence, subjective feeling of own health, use of memory aid, IDU background, treatment substitution and depression category.

Conclusion

Hazardous use of alcohol was independently associated with non-adherence with the ART.

Key message

Screening at the start of the treatment and intervention targeting alcohol use may improve HIV outcomes in individuals with hazardous alcohol use.
1263Exploring postgraduate epidemiology competencies in the Australian context
Authors: DiSipio Tracey , Finnane Anna , Protani Melinda , Hall Lisa
Published: September 2021

Background

In response to emerging challenges faced by epidemiologists, it is timely to ensure that university teaching aligns with the competencies required in professional practice. Therefore, the field requires a regular evaluation of the educational competencies being covered. The aim of this research was to seek consensus from both students and experts on postgraduate epidemiology competencies relevant to the Australian context.

Methods

A two-round online survey using a modified Delphi method was used to establish expert consensus on postgraduate epidemiology competencies. Focus groups were also conducted with recent graduates who completed a postgraduate epidemiology course to assess their viewpoints on learning experiences and employability.

Results

In total, 41 experts participated in the first Delphi round. A total of 19/40 factors (general epidemiologic methods/concepts) reached consensus in the first round for importance (high/most important by > 70% of participants). Seventeen factors also reached consensus in terms of feasibility (usually/always/very feasible by > 70% of participants). Further results from the second Delphi round focusing on advanced analysis skills, applied fields and professional/transferrable skills will be available for presentation at the Conference. One main theme emerging from the graduate focus groups was the substantial value gained in undertaking a dissertation, acknowledging its benefit for applying research skills and for networking opportunities.

Conclusions

Competencies for postgraduate epidemiology students require periodic review to safeguard a workforce that can meet emerging challenges.

Key messages

To ensure that high quality epidemiological research and practice continues we need consensus on the set of essential skills required of graduating students.
504Patterns of physical activity and sedentary time: Changes and tracking from early childhood
Authors: Downing Katherine , Hinkley Trina , Timperio Anna , Salmon Jo , Carver Alison , Cliff Dylan , Okely Anthony , Hesketh Kylie
Published: September 2021

Background

Little is known about how activity patterns change throughout childhood. This study examined changes and tracking of total volume and bouts of physical activity (PA) and sedentary time (SED) from early to late childhood.

Methods

Volume and bouts of SED and light-, moderate- and vigorous-intensity PA (LPA, MPA and VPA) were assessed by accelerometry at 3-5y (n = 758), 6-8y (n = 473) and 9-11y (n = 478). Mixed models examined changes and generalized estimating equations assessed tracking (β < 0.3=weak, 0.3-0.6=moderate, >0.6=strong), stratified by sex and controlling for baseline age and time between measurements.

Results

Patterns of SED increased and LPA decreased for both sexes. Total volume of MPA decreased for girls, but time in ≥ 1-min bouts increased for both sexes. Total volume of VPA increased for both sexes, with time spent in ≥ 1-min bouts increasing for boys. All volume and bout variables tracked moderately for boys, except SED bouts ≥15-min, LPA bouts ≥5-min and MPA bouts ≥1-min which tracked weakly. For girls, total SED and bouts ≥1-min tracked strongly, while total volume of LPA, MPA and VPA, ≥5- and ≥10-min SED bouts, and ≥1-min LPA and MPA bouts tracked moderately.

Conclusions

Activity patterns changed from early to late childhood, with total volumes and short bouts of PA and SED tracking more strongly than longer bouts. Although MVPA increased slightly, total volume and bouts of SED increased considerably more and, of concern, replaced LPA.

Key messages

Interventions are needed to ensure that young children establish and maintain healthy PA and SED levels from a young age.
1309Breastfeeding and weight retention in women with Gestational Diabetes Mellitus (GDM): LINDA-Brasil Cohort
Authors: Drehmer Michele , Cherubini Kadhija , Vigo Alvaro , Schmidt Maria Inês
Published: September 2021

Background

Breastfeeding seems to be inversely related to postpartum weight retention (PPWR), but this relationship is unclear in women with GDM. We aimed to describe the association between breastfeeding and PPWR at 1 year postpartum in women with GDM.

Methods

Multicentre cohort study of 524 women with GDM enrolled in prenatal clinics of the Brazilian National Health System and followed by telephone up to one year postpartum. Socio-demographics and pre-gestational weight were obtained during recruitment. Breastfeeding and post-partum maternal weight through telephone calls. PPWR was defined as 1-year postpartum weight minus pre-pregnancy weight and categorized as above and below the 80th sample percentile of retention. Breastfeeding was categorized as duration greater or less than 6 months. Adjusted Poisson regression was performed to assess relative risks (RR).

Results

Most women were 30 to 39 years old (50.6%), multiparous (71.0%), 39.5% completed high school, 60.1% were non-white (60.1%). Mean pre-gestational BMI was 30.42 (± 6.7) kg/m² and the mean weight gain during pregnancy was 9.5 (± 7.1) kg. After adjustments for previous variables, breastfeeding for 6 months or more reduced by 35% (RR 0.65; 95% CI 0.47; 0.90, p < 0.01) the incidence of 1-year PPWR up to 80th percentile (≥7Kg) compared to breastfeeding less than 6 months.

Conclusions

Breastfeeding up to 6 months might be encouraged in women with GDM to help preventing higher levels of 1-year PPWR.

Key messages

Breastfeeding up to 6 months was associated with less PPWR at 1 year after delivery in women with GDM.
1311Postpartum weight retention and pregnancy weight gain in women with Gestational Diabetes Mellitus (GDM)
Authors: Drehmer Michele , Silveira Leticia , Bracco Paula , Schmidt Maria Inês
Published: September 2021

Background

Since GDM is important risk factor for type 2 diabetes and maternal obesity can potentiate this outcome, the study sought to describe gestational weight gain and one-year postpartum weight retention (PPWR) in women with GDM.

Methods

Multicentre cohort study of 598 women with GDM enrolled in prenatal clinics of the Brazilian National Health System and followed by telephone up to 1-year postpartum. Socioeconomic and nutritional data were evaluated in recruitment. Gestational weight gain (GWG) and pre-pregnancy BMI were classified according to Institute of Medicine, 2009. PPWR was the difference between weights 1-year postpartum and pre-pregnancy. Chi-square test compared proportions of PPWR, pre-gestational BMI and GWG.

Results

Women had mean age 31.2 ± 6.1 years. Mean pre-pregnancy BMI was 30.3 ± 6.5 kg/m², GWG was 9.6 ± 7.3 kg and PPWR was 0.8 ± 6.8. Pre-pregnancy BMI over 25 kg/m² was found in 78%, excessive GWG in 37.6% and PPWR 1-year in 47.7%. PPWR ≥ 5kg was found in 27.6% and was higher in excessive GWG (p < 0.001). Women with excessive GWG, 55.2% had PPWR ≥ 5kg. For all categories of pre-pregnancy BMI, there was higher proportion of PPWR ≥ 5kg in those who had excessive GWG.

Conclusions

Almost half of women who had GDM presented weight retention in 1-year postpartum. We found more PPWR in who had excessive pregnancy weight gain.

Key messages

PPWR is common in women with GDM and there is higher proportion of PPWR ≥ 5kg in women with excessive GWG in all pre-pregnancy BMI categories.
857Data harmonisation of Australian and New Zealand ambulance service datasets
Authors: Eastwood Kathryn , Johnson Alison , Jones Angela , Cameron Peter , Teede Helena
Published: September 2021

Background

Australia has eight state-based ambulance services and New Zealand (NZ) has two. Significant variation between their datasets compromises cross-border research opportunities and translation of research to improve patient care. Ambulance data harmonisation has occurred in the United States and United Kingdom however, to-date no data harmonisation has occurred in Australia. This study aims to compare ambulance service variables in Australia and NZ to identify opportunities and barriers for harmonisation.

Method

Available 2019 variables were mapped to each other and several international standardized terminology systems to identify variations and similarities in variable names and definitions, and harmonisation opportunities.

Results

Four Australian ambulance services used one electronic patient care record (ePCR) system, three used other ePCR systems, one used paper-based records and both NZ services used one ePCR system. Only the NZ services had mapped their variables to two international standardised terminology systems.

Barriers to harmonisation included the variables collected, the variable definitions and the variable naming convention. The core variables available for mapping varied and numbered from 27-69. Differences included similar variable names having different definitions, variables that should have different definitions having the same, and naming convention for similar/same variables differing between services.

Conclusions

Ambulance service data harmonisation in Australia and NZ is possible and presents significant opportunities for improvement in patient outcomes and performance audit. It would facilitate quality, large-scale, high-impact collaborative national and international research.

Key Message

There is an opportunity for Australian and NZ ambulance services to harmonise their data to conduct large scale international research.
1217The prevalence of post-traumatic stress disorder in Syrian refugees increased after long-distance migration
Authors: Eiset Andreas Halgreen , Aoun Michaelangelo P. , Stougaard Monica , Gottlieb Annemarie Graa , Haddad Ramzi S. , Frydenberg Morten , Naja Wadih J.
Published: September 2021

Background

Refugees are forced migrants but there is a large variation in the distance that refugees cover. Previous studies suggest an inverse association between long-distance migration and self-reported health in the general population but there is a knowledge gap in the health effects of migration in refugee populations. Here, we estimate the association between long-distance migration and post-traumatic stress disorder (PTSD), a severe mental health disorder associated with deteriorating mental and somatic health.

Methods

Included were 712 adult Syrian refugees and asylum seekers newly arrived in Lebanon and Denmark. PTSD was assessed using the Harvard Trauma Questionnaire, confounding was handled by propensity score-weighting with covariates age, sex, socioeconomic status, trauma experience, and WHO-5-score after multiply imputing missing data, and the 95-percentile confidence interval (CI) was computed by bootstrapping.

Results

The prevalence of PTSD was high in both Lebanon (55%) and Denmark (60%). After adjusting for biases the prevalence difference increased to 9 percentage point (95-percentile CI: [-1; 19] percentage point). All sensitivity analysis produced estimates of the same magnitude and direction, except when grossly violating the assumption of multiple imputation which halved the magnitude of the association.

Conclusions

Long-distance migration was associated with an estimated 87 additional cases of PTSD for every 1000 Syrian refugees. This is a first step in examining the effects of migration in refugee health.

Key messages

Long-distance migration was positively associated with prevalence of post-traumatic stress disorder in Syrian refugees.
444Frailty status and all-cause mortality in the community-dwelling individuals: An umbrella review
Authors: Ekram A R M Saifuddin , Ryan Joanne , Britt Carlene , Espinoza Sara , Woods Robyn
Published: September 2021

Background

Frailty is increasingly recognised for its association with adverse health outcomes, including mortality. However, various measures are used to assess frailty, and the strength of association could vary depending on the specific definition used. This umbrella review aims to map which frailty scale can best predict the relationship between frailty and all-cause mortality among community-dwelling older people.

Methods

A protocol was registered at PROSPERO, and it was conducted following the PRISMA statement. MEDLINE, Embase, PubMed, Cochrane Database of Systematic Reviews, Joanna Briggs Institute (JBI) EBP database, and Web of Science database was searched. Methodological quality was assessed using the JBI critical appraisal checklist and online AMSTAR-2 critical appraisal checklist. For eligible studies, essential information was extracted and synthesized qualitatively.

Results

Five systematic reviews were included, with a total of 434,115 participants. Three systematic reviews focused on single frailty scales; one evaluated Fried's physical frailty phenotype and its modifications; another focused on the deficit accumulation frailty index. The third evaluated the FRAIL (Fatigue, Resistance, Ambulation, Illness, and Loss of weight) scale. The two other systematic reviews determined the association between frailty and mortality using different frailty scales. All of the systematic reviews found that frailty was significantly associated with all-cause mortality.

Conclusion

This umbrella review demonstrates that frailty is a significant predictor of all-cause mortality, irrespective of the specific frailty scale.

Key messages

Frailty is associated with an increased risk of all-cause mortality in community-dwelling individuals signifying the importance of assessment in the primary healthcare setting.
1247Low-calorie sweeteners consumption: a population-based study from Campinas, Brazil
Authors: Grilo Mariana Fagundes , Duran Ana Clara
Published: September 2021

Background

The addition of low-calorie sweeteners (LCS) has been increasingly used by industry but their metabolic effects are controversial. Objectives: to estimate the consumption of foods and beverages with LCS among adolescents, adults and the elderly and to verify which food categories most contribute to this consumption.

Methods

Cross-sectional study. We used data from the Campinas Health Survey (ISACamp 2014-15) and the Food Consumption and Nutritional Status Survey (ISACamp-Nutri 2015-16) of 2570 individuals from 10 years old. We estimated the prevalence of LCS consumption and described the food categories that most contributed to this consumption. Using regression analysis, we verified which population groups had the highest consumption of products with LCS.

Results

More than 40% of adolescents, adults and the elderly consumed at least one product with LCS, mainly coming from sweetened beverages, tabletop sweeteners, and yogurt and other dairy beverages. The consumption of LCS was evenly found across adolescents and elderly from all socioeconomic strata, and whether elderly participants presented overweight and/or diabetes. Among adults, greater prevalence of foods and beverages with LCS consumption was found in those with higher education but did not vary by the presence of overweight and/or diabetes.

Conclusions

We found similar consumption of foods and beverages with LCS in most socioeconomic strata, and in participants with and without overweight or diabetes.

Key messages

The results can contribute to the development of public policies on clearer information of LCS addition in food labels.
902Effect modification by homeownership in the relationship between household income and child oral health
Authors: Alfonzo Ludmila Fleitas , Bentley Rebecca , Singh Ankur
Published: September 2021

Background

Poor oral health among children is socially patterned and poorly understood. To optimise interventions aimed at reducing the persistent socioeconomic gap in health, we need to understand its shaping mechanisms. We examined if homeownership modifies the widely recognised association between household income and child oral health.

Methods

Data were analysed on 3,344 children from the Longitudinal Study of Australian Children. Multivariable regression models tested associations between tertiles of household income and dental decay and tooth loss. Effect modification by homeownership was tested on both additive and multiplicative scales. Models were adjusted for demographic variables, area of residence and family characteristics.

Results

For dental decay and tooth loss, children in households in the lower tertiles of income had worse oral health than children in the highest. Additive interaction was weakly supported in our models. The relative effect of income on oral health was greater for homeowners than renters for dental decay (medium household income 0.65 (95%CI: 0.44; 0.98) and low household income 0.82 (95%CI: 0.58; 1.15)) and tooth loss (medium household income 0.25 (95%CI: 0.09; 0.68) and low household income 0.41 (95%CI: 0.17; 0.97)).

Conclusions

Low-income children have poorer oral health outcomes. Although children of homeowners have better oral health than children of renters, income inequality is higher among the homeowner’s group. Current rent assistance programs for low-income families in Australia may minimise income-related inequalities on a relative scale.

Key messages

Our findings shed light on the potential of equalising policies in reducing income-related oral health inequalities.
1421Effects of the Colombian armed conflict on reproductive, maternal and child health
Authors: Garcés-palacio Isabel , Salazar-Barrientos Mary , Bedoya Edison Bedoya , Langer Ana
Published: September 2021

Background

Colombia has been affected by internal armed conflict for 70 years. About 7.3 million people have been internally displaced and nearly 50% of them were women. In conflict-afflicted areas, pregnant women and newborns have higher rates of adverse health outcomes.

Methods

Secondary analysis of public databases. We examined sixteen indicators from the Countdown to 2030 initiative, for which data from Colombia were available and reliable between 1998 and 2016. We also constructed a variable (victimization rate) to measure the intensity of the conflict for each municipality/year and grouped them into quintiles. We compared relative differences and confidence intervals using the Rothman and Greenland method.

Results

Across time, most indicators improved in all municipalities. However, four indicators were significantly different between municipalities with high versus low victimization rates. The maternal mortality ratio was higher in the municipalities with higher victimization rates in the periods 1998-2004, 2005-2011 and 2012-2016. The percentages of caesarean births and women who received four or more antenatal care visits were lower in settings with highest levels of victimization (1998-2000,) while the fertility rate among women 15-19 years old was higher in those municipalities between 2012 and 2016.

Conclusions

In Colombia, several maternal and child health indicators have improved during the years of the conflict; however, municipalities most affected by the armed conflict had poorer reproductive and maternal health outcomes.

Key messages

Maternal and reproductive health were negatively affected by protracted armed conflict in Colombia.
1201Vitamin D and family history of hypertension in relation to hypertension status among college students
Authors: Cuffee Yendelela , Wang Ming , Geyer Nathaniel , Akuley Susanne , Saxena Sangeeta , Jones Lenette , Wilson Robin Taylor
Published: September 2021

Background

Whereas hypertension and vitamin D concentrations have heritable components, these factors have not been investigated concurrently among young adults. The objective of this study is to investigate hypertension risk among young adults with respect to family history of hypertension, adjusting for vitamin D status.

Methods

Resting blood pressure was measured in 398 college students aged 18-35 and classified according to the 2017 American Heart Association criteria. Plasma vitamin D metabolite (25(OH)D3; 24,25(OH)2D3; 1,25(OH)2D3) concentrations were determined using liquid chromatography tandem mass spectrometry (LC-MS/MS). Stepwise logistic regression was used to select covariates.

Results

Nearly 40 percent of young adults were classified with elevated blood pressure or hypertension. Compared with no parental history, the adjusted odds ratio (AOR) for hypertension was elevated among participants with two parents having hypertension (AOR=4.5, 95% CI: 1.70-11.76), adjusting for sex, body mass index, physical activity, and plasma 25(OH)D3. Results for systolic hypertension were similar but more extreme (two parents AOR=7.1, 95% CI: 2.82, 17.66), although dihydroxy metabolites (1,25(OH)2D3 and 24,25(OH)2D3) were significant. Approximately five percent (4.8%) of those with hypertension reported knowledge of their hypertensive status.

Conclusions

The findings suggested a strong influence of dual parental history of hypertension on hypertensive status among young healthy adults. The overall prevalence and the combined lack of self-awareness of hypertensive status among relatively well-educated healthy young adults emphasizes the need for targeted primary and secondary prevention efforts.

Key messages

Hypertension was prevalent in nearly one-third of the sample and underscores the need for targeted prevention for young adults.